nutrion in edentulous patient and calcium metabolism

NUTRITIONAL
REQUIREMENTS IN
EDENTULOUS PATIENTS &
CALCIUM METABOLISM
2
PRESENTED BY,
DR. PRAGATI AGRAWAL

CONTENTS
1. DEFINITIONS
2. INTRODUCTION
3. WHY IS NUTRITION IMPORTANT?
4. IMPACT OF DENTAL STATUS ON FOOD INTAKE
5. NUTRITIONAL NEEDS IN ELDERLY
6. ORAL SIGNS OF NUTRIENT DEFICIENCY
7. CALCIUM METABOLISM
8. OSTEOPOROSIS
9. PROSTHODONTIC CONSIDERATIONS
10. LITERATURE REVIEW
11. CONCLUSION
3
82

DEFINITIONS
 NUTRITION:-
• It can be defined as the sum of the processes by which an
individual takes in and utilizes food. (FDI)
• It may be defined as the science of foods, the nutrients and the
substances therein, their action, interaction and balance in
relation to health and diseases. (The council on Food and
Nutrition of the American Medical Association)
4
82

INTRODUCTION
 Nutrition plays an important role, as one of the primary role
of a healthy mouth is initiation of digestion.
 Various factors that can interfere with adequate nutritional
intake in edentulous patients can be:
• Economical
• Medical
• Social
• Poor oral health
5
Zarb, Hobkirk, Eckert, Jacob; Prosthodontic treatment for edentulous patients:
complete dentures and implant supported prosthesis; 13th edition82

Why is nutrition important?
1. Inadequate masticatory efficiency:-
 It has been seen that the masticatory
efficiency decreases with age, as there
is loss of teeth.
6
Sheldon Winkler; Complete denture prosthodontics, 2nd edition82

2. Success of complete denture prosthesis :-
 A complete denture prosthesis depends
ultimately upon the health and integrity of the
denture- bearing tissues for successful
function and comfort to the patient.
7

Cntd…
 For example, thin and friable epithelium covering the
edentulous ridge, thin connective tissue pad between
the underlying bone and epithelium covering and
extensively resorbed alveolar ridge may not be able to
tolerate the forces imposed upon it by the hard
unyielding acrylic base of the complete denture.
 Also, conditions like dry mouth, friable mucosa or
burning sensation of mouth may be unfavourable for
success of the complete denture treatment.
8

3. Health of the oral tissues :-
 Clinical symptoms of malnutrition often are observed first in
the oral cavity.
 Rapid cell turnover in the mouth requires a regular,
balanced intake of essential nutrients for the maintenance
of oral epithelium.
 Inadequate long term nutrition may lead to angular cheilitis,
glossitis, and slow tissue healing.
 For example, low calcium and vitamin D intake can
exacerbate the alveolar bone resorption after extraction.
9
Boucher's prosthodontic treatment for edentulous patients, 11th edition
82

IMPACT OF DENTAL STATUS ON
FOOD INTAKE
 An individual’s masticatory ability is mainly
determined by age and the number of natural
teeth in the mouth.
 It is accepted that the chewing efficiency of the
average denture wearer is about 20% of that of
an adult with complete natural dentition. Thus,
denture wearers must complete a greater
number of chewing strokes to prepare food for
swallowing.
10
82

1. Food type:-
• Generally, the intake of harder foods(raw
vegetables or fruits, fibrous meat, hard
bread, seeds, nuts, etc.) is reduced in
denture wearers.
• And, the intake of soft foods (ground beef,
breads, cereals, pastries, canned fruits
and vegetables) is increased
11
82

2. Sensory qualities:-
• When a new pair of dentures are first inserted, patients
may report of a transient decline in taste acuity.
• This might be due to overall denture base coverage of the
hard palate.
• It usually improves as the patient adapts to the denture.
12
82

xerostomia
 Dryness of mouth can lead to mucosal soreness or
ulcerations, which can further restrict the food intake in
elderly.
13
82

 Causes:-
• Medications ( antihypertensives, antidepressants, antihistamines,
antispasmodics, anticholinergics, bronchodilators and sedatives)
• Therapeutic radiation to head and neck
• Diabetes
• Depression
• Alcoholism
• Pernicious anaemia
• Menopause
• Vit A, B complex deficiency
• Autoimmune diseases ( Sjogren’s syndrome)
14
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 Management:-
• saliva substitutes(milk)
• Sialogogues ( sugar free gum, lozenges,
sugar free candies containing citric acid,
lemonade, sucking popsicles or ice chips,
etc.)
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82

16
UNHEALTHY
ORAL
TISSUES
LOW
CALORIE
INTAKE
DIABETES
ALCOHOL
ABUSE
MEDICATION
XEROSTOMIA
LOW FIBER
INTAKE
SMOKING
SOFT DIET
82

THE TRIAD
17
AGING
NUTRITION EDENTULISM
• Reduced muscle mass
• Reduced liver and kidney function
• Systemic diseases and
medications
• Increased body fat
• Reduced sense of taste, vision
and olfaction.
• 50%-60% of total intake
by carbohydrates,
preferably complex
carbohydrates
• 10%-15% by proteins
• 20%-30% by fats
• Healthy denture bearing
area
• Reduced denture failures
• Better adaptability to new
dentures
complete dentures and implant supported prosthesis; 13th edition
82

NUTRITIONAL NEEDS IN
ELDERLY
1. ENERGY
• Energy needs decline with age due to a
decrease in basal metabolism and
decreased physical activity.
• Cross-sectional surveys show that the
average energy consumption of 65-74 year
old women is about 1300 kilocalories
(Kcal) and 1800 Kcal for men of the same
age.
18
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• While for adults 51-65 years of age, it is 1900kcal for
women and 2300kcal for men.
• Due to less calorie intake, it is important to consume high
nutrient food like legumes, vegetable soups, whole grain
breads, low fat dairy foods, etc.
• Foods with high fat should be replaced with complex
carbohydrates, which also includes high fiber diet.
19
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2. FAT
 Unsaturated fats should be chosen over saturated fats.
 Also, foods containing trans-fats should be eliminated from the diet, as they
can raise the LDL-C (bad cholesterol) and lower the HDL-C (good
cholesterol).
21
unsaturatedsaturated
Cream, butter,
ghee, milk, egg
yolk, coconut oil.
Mono-unsaturated
(mustard oil, olive
oil,etc.)
Poly-unsaturated
(refined oils)
K. Chandrasekharan Nair, Purushotham Manvi, S. Srividya; A primer on complete denture prosthodontics
82

3. PROTEIN:-
• As the patients become older, the amount of
protein required increases. This is due to age –
related degenerative diseases in elderly.
• It is recommended that 12% to 14% of total
calories or 1g/kg of body weight come from
protein.
23
82

• The protein depletion of body stores is primarily due to
decrease in skeletal muscle mass.
• Thus, patients past 50 years of age should ingest 0.8g
protein/kg of weight daily (56g for males, 46g for females)
• Sources:- boiled meat and fish, pulses, soyabean,
mushroom, milk, paneer, etc.
24

3. VITAMINS:-
• Elderly patients with low calorie intake,
multiple drug consumption and GIT disorders
are at greater risk of developing
hypovitaminosis.
• For e.g.,
• PPIs- reduced absorption of vit B12,
calcium and magnesium
• Statins- reduced stored energy
• Diuretics- reduced Ca, Mg, K
• Metformin- decreased B12 and folic acid
25
Sheldon Winkler; Complete denture prosthodontics, 2nd edition
Boucher's prosthodontic treatment for edentulous patients, 11th edition82

VITAMIN A (RETINOL)
 The RDA for vitamin A is 800-1000 micrograms.
 Two forms:
• Retinal/ active Vitamin A, in animal foods (liver, milk and milk
products)
• beta-carotene/ pro-vitamin A, found in deep green and
yellow fruits and vegetables (apricots, carrots, spinach).
26
Nutrition for geriatric denture patients; The Journal of
Indian Prosthodontic Society | March 2006 | Vol 6 | Issue 1
82

 Deficiency:-
• Bitot’s spots (eyes)
• conjunctival and corneal xerosis (dryness)
• xerosis of skin
• follicular hyperkeratosis
• decreased salivary flow and decreased taste
acuity.
• dryness and keratosis of oral mucosa
• Long standing deficiency may cause
hyperplasia of the gums, as well as generalized
gingivitis.
27
Nutrition for geriatric denture patients; The Journal of Indian Prosthodontic Society |
March 2006 | Vol 6 | Issue 1
82

VITAMIN B COMPLEX
Thiamine(VIT B1)
• The RDA has been set at 0.5 per
1000 calories, or at least 1 mg
daily.
• Sources:- meats (especially pork
and chicken), peas, whole grains,
fortified grains, cereals and yeast.
• Deficiency causes beriberi.
28
82

 Riboflavin (VIT B2)
• The RDA is 3.0 microgram.
• Is found in kidney, heart, milk, eggs, liver
and green leafy vegetables.
• Deficiency causes nasolabial seborrhea,
fissuring and redness of eyelid corners and
mouth, magenta colored tongue, angular
stomatitis, cheilosis and cracks on lips.
30
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 Niacin (VIT B3)
• Sources- liver, kidney, red
meat, fish, legumes,
groundnuts, cereals and
green vegetables.
• Deficiency- pellagra
(dermatitis, diarrhoea,
dementia)
The skin is dry,
hyperpigmented, scaly and
cracked.
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Vitamin B6 (pyridoxine)
• Ranges from 50 to 90% of the elderly affected,
which may be an important cause of the
increased prevalence of the carpal tunnel
syndrome (an inflamed tendon attached to the
wrist bone.) in the elderly.
• The RDA is 1.2-1.4 mg.
• Deficiency causes nasolabial seborrhea,
glossitis.
32
82

Vitamin B12 (cyanocobalamine/ extrinsic
factor for castle)
• It helps in maturation of RBCs.
• Sources- animal food, especially liver
and meat.
• Deficiency causes megaloblastic
anemia.
33
82

Vitamin C
o It is essential for collagen synthesis which forms
the basic structure of periodontal ligament and
in wound healing.
o A prescription of 500mg/day of ascorbic acid is
used during and after oral surgeries.
o Sources: citrus fruits, peppers, melons, kiwi
fruit, mangoes, papaya, strawberries, etc.
34
Sheldon Winkler; Complete denture prosthodontics, 2nd edition
82

o The RDA is about 60 microgram.
o Deficiency causes SCURVY
• red, swollen, spongy, bleeding
gums;
• petechiae, haemorrages;
• delayed healing tissues;
• painful joints and weak bones;
• hypochromic microcytic anaemia
35
82

Vitamin D
 The elderly are frequently deficient in Vitamin D
because of lack of sun exposure and an inability
to synthesize Vitamin D in skin and convert it in
the kidney.
 Vitamin D is richly available in fish liver oils,
certain wild mushrooms.
other sources are egg yolk, butter, cheese, etc.
 The RDA is 5 microgram.
 Deficiency causes osteomalacia in adults.
37
82

VITAMIN K
 The adequate intake is 90µg/d for
women and 120µg/d for men.
 Sources :- green vegetables, grain
products, meat
 Function :- blood clotting
- bone mineralization
38
Ronni Chernoff; Geriatric nutrition: The health proffessional's handbook; 3rd edition
82

VITAMIN E
 RDA:- 15mg of α- tocopherol
39
82

VITAMIN SUPPLEMENTATION
 Today, a large number of people with high
incomes and education, and those who perceive
themselves to be in good health, use dietary
supplements.
 These are mostly self- prescribed and unrelated to
any physiological need, which may result in
toxicity to the tissues.
 Use of supplements that contain no energy or
fiber and only one-third of the essential
micronutrients may foster a false sense of security
in the prosthodontic patients.
40
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NEED FOR SUPPLEMENTATION
 Individuals who might be benefited from taking a supplement
includes persons consuming less than 1200kcal/day or those
eating an unbalanced diet that lacks fruits, vegetables, or
proteins.
 In such cases, a single multivitamin-mineral supplement is
preferable to single-nutrient tablet.
 For prosthodontic patients, a generic one-a-day tablet that
includes zinc, folacin and vitamin B6 may be recommended.
 If intake of dairy foods cannot be increased to meet daily
needs, a calcium supplement is advised as a separate tablet.
41
82

OVERDOSES OF SUPPLEMENTS
 When a high dose of vitamin is taken, it
no longer functions as a vitamin, but
becomes a chemical with
pharmacological activity.
 Adverse reactions of mega-doses of
nutrients are more likely in elderly
because they are metabolized less
efficiently and excreted more slowly.
VITAMIN D:-
• Calcification of soft tissues.
42
82

Cntd…
VITAMIN A:-
• Dry, itching skin, bone disorders, headaches,
and disturbances in blood clotting.
VITAMIN C:-
• Copper deficiency anemia
• False positive readings for glucose in urine
• Increase risk of urinary stone formation
• Rebound scurvy, if the dosage is stopped
abruptly
43
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Continued…
NIACIN:-
• Flushing, headache, itching skin
VITAMIN B6:-
• Peripheral neuropathies
ZINC:-
• Reduced copper absorption and availability
FIBER:-
• Limits absorption of calcium, zinc and iron by binding them.
44
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MINERALS
CALCIUM:-
• It is very essential in elderly individuals as,
the bones demineralize with increasing
age, called as osteoporosis.
• It should not be less than 400mg/day.
• Sources:- ragi, green leafy vegetables,
milk, sea food, etc.
45
82

IRON:-
• RDA- 30mg/day
• Deficiency leads to anaemia.
• Sources:- green vegetables, ragi, jaggery,
dates, etc.
46
82

ZINC:-
• It bolsters the immune system, promotes wound
healing and is essential for normal sense of taste and
smell.
• RDA is 8-11mg/day.
• Sources:- meat, poultry, beans, nuts, oyesters, etc.
• Care should be taken, as high concentrations of zinc
in many denture adhesives may lead to excessive
intake of zinc which can further cause copper
deficiency and profound neurological disease.
47
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WATER
 It is the most important and essential nutrient in the diet of
man.
 It is essential for all body functions:
• Cell activity
• All secretions(including saliva, perspiration for temperature
control, and all digestive juices)
• Absorption of foods
• Elimination of catabolites
48

Cntd…
 Water lost by kidneys, intestines, lungs and skin
(approx. 2500 cc/day) must be balanced everyday
by an adequate intake of water (atleast 2500cc)
from drinking water, beverages, soup, and other
foods, especially vegetables.
 If this balance is not maintained, it may lead to
chronic dehydration.
49

Continued…..
 The elderly are particulary susceptible to negative
water balance, usually caused by excessive water
loss through inefficient or damaged kidneys.
 This results in tiredness, dry and irritated eyes, skin
and oral mucosa.
 Tissue dehydration may influence the rate of ageing
also.
 The fluid intake should be atleast 1.5-2 lts/day in a
normal elderly person.
50

Effects of dehydration
 SALIVA:-
• Essential for mastication of food.
• Less water intake xerostomia
tendency to prefer soft foods
malnutrition
• Failure of dentures due to dry and
fragile mucosa.
• Accumulation of materia alba due
to lack of self-cleansing by saliva.
51

Cntd…
 SKIN:-
• Pale, dry, and wrinkled
 MUSCLE:-
• Sagging of all muscles,
diminished strength and collapsed
facial contours.
• Muscle tone is important in
assessing the prognosis of the
prosthesis.
52

Continued…
Eyes:-
 Xeropthalmia (absence of tears)
 Bitot spots at inner canthus of eye
 Dry and wrinkled cornea
Tongue:-
 Accumulation of epithelial debris on
dorsum forms coated tongue in elderly.
 In later stages it becomes smooth(bald)
and atrophic(shrivelled).
53

TREATMENT
 Acute dehydration due to severe fever and
acute diarrhoea can be treated by
intravenous or subcutaneous fluids under
hospital care.
 It is questionable whether the long term
chronic dehydration can be reversed, but it
can be decreased by ingestion of hydrophilic
(water bound) food.
 Eg. vegetable soup, vegetable fibre
54

RECOMMENDED DAILY
ALLOWANCES FOR INDIAN
ELDERLY (ICMR)
NUTRIENTS MALE FEMALE
Calories(Kcal) 1800 1400
Protein(gms) 60 50
Fat(gms) 50 40
Calcium(mg) 400 400
Iron(mg) 28 30
Vitamin
A(microgram)
2400 2400
Thiamine(mg) 1.2 0.9
Niacin(mg) 16 12
Riboflavin(mg) 1.4 1.1
Vitamin C(mg) 40 40
55
82

ORAL SIGNS OF NUTRIENT
DEFICIENCIES
NUTRIENT ORAL SYMPTOM
Protein Decreased salivary flow
Enlarged parotid glands
Vitamin B complex
(thiamine, riboflavin, niacin,
pyridoxine, folic acid, vitamin
B12)
Iron
Protein
Lips - cheilitis
-Angular stomatitis
-Angular scars
-Inflammation
Tongue- edema
- magenta tongue
- atrophy of filiform papillae
- burning sensation
- soreness
- pale, bald
Vitamin C Edematous oral mucosa
Tender, red, spongy gingiva
Spontaneous bleeding
56
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CALCIUM
 Dietary calcium intake is critical in maintaining the body
skeleton.
 It also affects the amount of alveolar ridge resorption after
the teeth extraction.
 The recommendation of 1994 National Institutes of Health
Consensus Conference on Optimal Calcium Intake was the
dietary intake of 1000mg for men of 25-65years of age and
women of 25-50 years of age.
 It was 1500mg for men over 65 years and post-menopausal
women taking no estrogen.
58
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SOURCES:-
• Dairy- milk, cheese, yoghurt, etc.
• Non dairy- broccoli, oyesters, canned salmon,
etc
DEFICIENCY:-
• Demineralization of skeleton, causing
osteoporosis and osteopenia.
• Excessive residual alveolar ridge resorption
59
82

Functions of calcium
 Genesis and maintenance of action potentials.
 Bone mineralization.
 Blood coagulation.
 Neurotransmitter release.
 Gastro-intestinal motility.
 Excitability of nerve and muscle.
60
Prof G K Pal; Textbook of medical physiology; 2nd edition
82

CALCIUM MATABOLISM
 The major hormones involved in the calcium metabolism are
• parathormone(PTH) secreted from parathyroid gland
• Calcitonin secreted from parafollicular cells of thyroid gland
• Vitamin D
 Other hormones responsible are glucocorticoids, growth factors,
insulin, etc.
 These hormones control calcium metabolism by acting on GI
tract, kidney and bones.
 The normal plasma calcium concentration is 9-11mg%.
61
82

OSTEOPOROSIS
 It is the decrease in bone mass and density.
 Usually, after the age of 40 years, bone mass
gradually decreases due to decreased bone
mineralization and increased osteoclastic activity.
This is called as involutional osteoporosis.
 In females, the process of bone resorption is
facilitated at the time of menopause due to
cessation of estrogen secretion. This is called as
postmenopausal osteoporosis.
66
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 It is commonly seen in following conditions:-
• Hyperparathyroidism
• Hyperthyroidism (thyroxine , TSH)
• Cushing’s syndrome
• Ovarian diseases causing estrogen secretion
• Cigarette smoking
• Alcoholism
• Deficiency of vitamin C ( decreased collagen synthesis)
• Inadequate dietary calcium
67
82

 Treatment:-
• Calcium or vitamin D tablets
• Estrogen therapy in severe cases
68
82

PROSTHODONTIC
CONSIDERATION
69

DIETARY COUNSELING
 Obtain a nutrition history and an accurate record of food
intake over a 3 to 5 day period or complete a food
frequency form.
 Evaluate the diet and assess nutritional risk.
 Teach about the components of a diet that will support
the oral mucosa, bone health, and total body health.
 Help the patient establish goals to improve the diet.
 Follow up on patients to support them in their efforts to
change food behaviours.
70
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RISK FACTORS FOR
MALNUTRITION IN PATIENTS
WITH DENTURES
 Eating less than 2 meals/day.
 Difficulty chewing and swallowing.
 Unplanned weight gain or loss of >10 lb in the
last 6 months.
 Undergoing chemotherapy or radiation therapy.
 Alcohol or drug abuse.
 Unable to shop for, cook for, or feed oneself.
71
82

Cntd…
 Oral lesions
 Loose denture or sore spots under denture
 Severely resorbed mandible with
consequently inability to wear lower
denture
72
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NUTRITION GUIDELINES FOR
PROSTHODONTIC PATIENTS
 Eat a variety of food.
 Build diet around complex carbohydrates(fruits, vegetables,
whole grains, and cereals)
 Eat atleast 5 servings of fruits and vegetables daily.
 Select fish, poultry, lean meat, or dried peas and beans
everyday.
 Obtain adequate calcium.
 Limit intake of bakery products high in fat and simple sugars.
 Limit intake of processed foods high in sodium and fat.
 Consume 8 glasses of water daily.
73
82

FOOD GUIDE PYRAMID FOR AN
ELDERLY INDIAN
(By National Institute Of Nutrition)
74
MALE
FEMALE
82

FOOD GROUP IN NEW DENTURE
WEARER
FOOD
GROUP
FOOD TYPE ON 1ST DAY OF
INSERTION
FOOD TYPE FROM 2ND DAY/
TILL SORE SPOTS HEAL/
PATIENT IS COMFORTABLE
TO EAT ROUTINE FOOD
Vegetable
/ fruit
group
Soup, juices Tender cook vegetables, soft
fruits
Bread-
cereal
Porridge, poha, upma Boiled rice, soft chapatti, idli
Milk group Milk, curd Milk, curd
Lentils/
meat
group
Egg white, dals and lentils in
semi-solid consistency
Dals, lentils and pulses well
cooked; liver, minced meat,
tender boiled chicken,
scrambled eggs
Fat group Used sparingly Used sparingly
75
82

76
Effect of nutrition in edentulous geriatric patients; Journal of Oral Research and Review |
Volume 10 | Issue 1 | January-June 2018
82

Nutritional adequacy of reported intake of
edentulous subjects treated with new conventional
or implant-supported mandibular dentures
 This study compared baseline food records to those records kept
semiannually for 3 years after treatment to ascertain whether nutrient
intake of edentulous patients changed after they received new implant-
supported mandibular dentures (n=41) or new conventional dentures
(n=30).
 A decline in the percent of calories from fat with a corresponding
increase in carbohydrate calories within both groups reflected a
national trend.
 A slight decrease in calories was similarly observed.
 More than 40% of patients in both groups were found to have
inadequate intakes of dietary fiber, calcium, or both, and 25% to 50%
had low intakes of vitamins A, E, D, B6 and/or magnesium.
78
82

Effects of a calcium and vitamin D supplement on
alveolar ridge resorption in immediate denture patients
Kenneth E. Wical, D.D.S., M.S.D and Peter Brussee, D.H.S.
Loma Linda University, Loma Linda, Calif.
 The purpose of this study was to test the hypothesis that a daily calcium and
vitamin D supplement would tend to reduce the rate and extent of alveolar bone
resorption following extractions of teeth.
 Total 46 patients
 Half of the subjects took three tablets daily of a supplement which provided a
total of 750 mg of calcium (calcium carbonate from oyster shell) and 375 USP
units of vitamin D, (Ergocalciferol) each day.
 Other half took the same number of tablets of a placebo preparation consisting
of lactose and methyl cellulose.
 A significant reduction in the severity of alveolar bone resorption in the
supplement group was revealed. The differences ranged from 34% less in the
maxillae to 39% less in the mandible, with an average difference of 36% less
resorption when both dental arches are considered.
79
82

Osteoporosis and reduction of residual ridge in
edentulous patients
Toshihiro Hirai, Tsutomu Ishijima, Yoshiko Hashikawa,
Toshihiko Yajima,
Higashi-Nippon-Gakuen University, School of Dentistry,
Hokkaido, Japan
Dentistry, Hokkaido, Japan The relationship between the height of the mandibular residual ridge and the
severity of osteoporosis in elderly edentulous patients was investigated.
 The residual ridge in women was lower than that of men.
 The parathyroid hormone level was high in the patients with a low residual ridge,
and the calcitonin level was low.
 This study indicates that osteoporosis strongly affects reduction of the residual
ridge in edentulous patients.
80
82

CONCLUSION
 Denture wearers may be particularly vulnerable to
both oral-systemic conditions as well as compromised
nutritional health.
 Dietary guidance should be an integral part of the
overall management of the denture- wearing patients
to maintain the health of the alveolar ridges and
various oral soft tissues.
81
82

REFERENCES
 Sheldon Winkler; Complete denture prosthodontics, 2nd edition
 Zarb, Hobkirk, Eckert, Jacob; Prosthodontic treatment for edentulous
patients: complete dentures and implant supported prosthesis;13th
edition
 Boucher's prosthodontic treatment for edentulous patients,11th
edition
 K. Chandrasekharan Nair, Purushotham Manvi, S. Srividya; A primer
on complete denture prosthodontics
 Prof G K Pal; Textbook of medical physiology; 2nd edition
 Ronni Chernoff; Geriatric nutrition: The health proffesional's
handbook; 3rd edition
82
82

CROSS REFERENCES
 Nutrition for geriatric denture patients; The Journal of Indian Prosthodontic Society |
March 2006 | Vol 6 | Issue 1.
 Nancy G. Sebring, MEd, RD, Albert D. Guckes, DDS, MSD, Shou-Hua Li, PhD, and
George R. McCarthy, DDS; Nutritional adequacy of reported intake of edentulous
subjects treated with new conventional or implant-supported mandibular dentures;
The journal of prosthetic dentistry; Volume 74.
 Gaurav Singh, Shakeba Quadri, Bhumika Kapoor, Shraddha Rathi; Effect of nutrition
in edentulous geriatric patients; Journal of Oral Research and Review | Volume 10 |
Issue 1 | January-June 2018.
 Kenneth E. Wical, D.D.S., M.S.D.,” and Peter Brussee, D.H.S.“; Effects of a calcium
and vitamin D supplement on alveolar ridge resorption in immediate denture patients;
The journal of prosthetic dentistry; January 1979; volume 41.
 Toshihiro Hirai, DDS, DDSc; Tsutomu Ishijima, DDS, DDSC;Yoshiko Hashikawa,
DDSC and Toshihiko Yajima, MS, DMSc; Osteoporosis and reduction of residual ridge
in edentulous patients; The journal of prosthetic dentistry; January 1993; volume 69.
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nutrion in edentulous patient and calcium metabolism

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