DIET AND NUTRITION IN COMPLETELY EDENTULOUS PATIENTS.pptx

Diet And Nutrition
Factors For
Completely Edentulous
Patients
PRESENTED BY:
Dr. Ch.Praveena(BDS),
PG student,
Department of Prosthodontics and Crown & Bridge
Including Implantology,
Sibar Institute of Dental Sciences,
Guntur

PREVIOUSLY ASKED QUESTIONS
• Nutritional factors in completely edentulous patient.
-NTRUHS, 2004 & 2011 (7 Marks).
• Role of nutrition in management of elderly patients.
-NTRUHS , 2000 & 2008 (10 Marks).
• Discuss ‘Nutrition’ for elderly patients who need prosthodontic
services.
-NTRUHS ,1999 (25 Marks)
2003 (10 Marks).
11/11/2022
Diet & nutrition factors for completely edentulous patients-65
3

CONTENTS
Introduction
Definitions
Nutritional objectives
Factors that affect nutritional status
Classification of nutrients
Calcium and bone health
Food groups
Balanced diet and food guide pyramid
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CONTENTS
Calorific value of common Indian foods
Nutritional guidelines for prosthodontic patient
Nutrition and geriatrics
Dietary management when teeth are extracted
Diet recommended for new denture wearers
Nutrition for maxillofacial prosthetic patients
Conclusion
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INTRODUCTION
• Most dentures are mechanically & esthetically satisfying
but the systemic factors that greatly influence their
success are ignored.
• A complete denture prosthesis depends ultimately upon
the health and integrity of the denture-bearing tissues for
successful function and comfort to the patient.
• Denture failures are not only due to imperfect design but
also to poorly nourished tissues.
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• Tissues of the oral cavity are often the first to be
affected by nutritional disturbances.
• Tissue vitality in large measure dependent upon the
availability & use of nutrients . It is advisable to inquire
the nutritional status & when necessary adjust the
nutritional status of our complete denture patients .
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INTRODUCTION

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DIET
• Types & amounts of food eaten daily by an individual. -FDI
• The customary amount and kind of food and drink taken by a
person from day to day; more narrowly, a diet planned to meet
specific requirements of the individual, including or excluding
certain foods. -Stedman’s Medical dictionary,21st edition.

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•The science of food , the nutrients and other substances there in,
their actions, interactions & balance in relation to health & disease
and processes by which the organism ingests, digests, absorbs,
transports, utilizes and excretes food substances.
-Council of food & nutrition of the American medical association.
•Sum of processes by which an individual takes in & utilizes food.
-FDI.
•Study of the materials that nourish an organism and of the manner in
which the separate components are used for maintenance , repair,
growth and reproduction.
–Stedman’s Medical dictionary,21st edition.
NUTRITION

NUTRITIONAL OBJECTIVES
• To establish balanced diet which is consistent with the physical , social ,
psychological and economic background of the patient.
• To provide temporary dietary supportive treatment, directed towards
specific goals such as caries control , postoperative healing , or soft tissue
conditioning.
• To interpret factors, peculiar to the denture age group of patients ,which
may relate to or complicate nutritional therapy.
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FACTORS THAT AFFECT
NUTRITIONAL STATUS
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AGING FACTORS THAT AFFECT NUTRITIONAL
STATUS
1. PHYSIOLOGICAL FACTORS
Decline in lean body mass
Vitamin D deficiency
Declines in the gastric acidity
Nutrient deficiencies
Dehydration
Impairment in function of intestinal tract secondary to illness ,
disease or medications
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STATUS
Decreased immune response
Decline in cognitive function
2.PSYCHOSOCIAL FACTORS
Loneliness- major contributing factor to malnutrition
Reduced economic status
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STATUS
3.FUNCTIONAL FACTORS
Physically handicapped.
Arthritis.
Vision & hearing impairment.
Decreased motor skills.
4.PHARMACOLOGICAL FACTORS: MEDICATIONS & ALCOHOL
Prescription drugs.
Alcohol intake-deceases appetite.
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ORAL FACTORS THAT AFFECT DIET AND
NUTRITIONAL STATUS
1.Xerostomia
Difficulties in chewing & swallowing.
Drugs with hypo salivary side effects.
Deficient masticatory performance.
2.Sense of taste & smell
Altered food choice & decreased diet quality.
Sensory changes may diminish the appeal of some foods, limiting
their consumption & potential health benefits function.
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NUTRITIONAL STATUS
3.Oral infectious condition
Impaired masticatory function-inadequate food choice-altered
nutrition intake.
4.Effects of dentures on taste & swallowing
Full upper denture have impact on taste & swallowing.
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NUTRITIONAL STATUS
5.Effects of dentures on chewing ability
Masticatory efficiency in complete denture wearers is
approximately 80% lower than in people with intact natural
dentition.
6.Effects of dentures on food choices , diet quality & general health
Some people compensate for decline in masticatory ability by
choosing processed or cooked foods rather than fresh food .
Others may eliminate entire food groups from their diet.
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CLASSIFICATION OF NUTRIENTS
NUTRIENTS
MACRONUTIENTS
PROTEINS(7-15%) FATS (10-30%) CARBOHYDRATES
(65 -80%)
MICRONUTIENTS
VITAMINS
FAT SOLUBLE
VITAMINS
(A,D,E &K)
WATER
SOLUBLE
VITAMINS
(B & C)
MINERALS
MAJOR
MINERALS
(Ca,P,Na,K,Mg)
TRACES
ELEMENTS
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PROTEINS
Functions:
-Body building.
-Repair & maintenance of body tissues.
-Maintenance of osmotic pressure.
-Synthesis of antibodies , plasma proteins , hemoglobin, enzymes
hormones & coagulation factors.
Protein requirement: 1 g/kg body wt
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PROTEIN
Doubling the protein intake results in a threefold increase in
calcium utilization.
Assessment of protein nutrition status:
-Arm muscle circumference
-Creatinine-height index
-Serum albumin & transferrin
-Total body nitrogen
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FOOD SOURCES
 Animal
sources:
 Plant
sources:
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FATS
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• Concentrated sources of energy
• Classified as
a) Simple lipids e.g. triglycerides
b) Compound lipids e.g. phospholipids
c) Derived lipids e.g. cholesterol
Functions:
-High energy foods (9 kcal/gm).
-Vehicles for fat soluble vitamins.
-Insulation against cold.

FATS
Fats & diseases:
- Obesity, Phrynoderma
- Coronary heart disease
• Food sources:
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CARBOHYDRATES
Major component of food.
Three main sources – starch , sugar, cellulose
Geriatric patients require fewer calories.
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DIETARY FIBRE
• They are complex polysaccharides.
• The main action of dietary fiber is in the colon.
• Functions:
Prevents constipation.
Reduces the effects of toxins and carcinogens.
Stimulates growth of beneficial micro flora in the large
intestine.
• Sources : Cereals & millets , gums , fenugreek, fruits &
vegetables
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WATER INTAKE
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• Water is probably the most important and essential nutrient in the
diet of man .
• Water deficiency and dehydration are more prevalent in older
than younger persons due to diarrhea , febrile state and renal
disease.
• This may be enhanced by the decrease in extracellular water that
begins from eight decade of life.
• Furthermore , the sensation of thirst diminishes in very old.
• So adequate water intake should be there in elderly people.

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IMPORTANCE OF
WATER

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VITAMINS IMPORTANCE GENERAL MANIFESTATIONS ORAL MANIFESTATIONS RDA FOOD
SOURCES
VITAMIN
A
Cellular
differentiation,
growth, vision
Night blindness,
xeropthalmia, Bitot spots,
keratomalacia
Xerostomia, enamel
hypoplasia, delayed
tooth eruption
750 mcg
VITAMIN
D
Ca & P metabolism Rickets, osteomalacia ,
pigeon chest
Delayed teeth eruption,
wide pre-dentin zone
2.5 -5 mcg
VITAMIN
E
Antioxidant Decreased male fertility,
Encephalomalacia
--- 10 mcg
VITAMIN
K
Helps in blood
coagulation
Prolonged clotting time Spontaneous gingival
bleeding( prothrombin
<20%)
45 mcg
FAT SOLUBLE VITAMINS

WATER SOLUBLE VITAMINS
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VITAMINS IMPORTANCE GENERAL
MANIFESTATIONS
ORAL MANIFESTATIONS RDA FOOD
SOURCES
VITAMIN
C
Synthesis of FH4,
collagen &
immunoglobulins
Defective collagen
synthesis, woody legs,
scurvy
Scurvy buds, enamel &
dentin defects
40 mcg
VIT B1
Thiamine
Carbohydrate
metabolism
Dry & wet beri-beri ,
cerebral encephalopathy
--- 0.5 mg/
1000 c
VIT B2
Riboflavin
Participates in
various redox
reactions
Nasolabial seborrhea,
vascularization of cornea ,
scrotal dermatitis
Glossitis ,magenta colored
tongue, cheilosis
0.6 mg/
1000 kcal
VIT B3
Niacin
Involved in redox
reactions dependent
on NADP & NAD
PELLAGRA (dermatitis,
diarrhoea & dementia)
Bald tongue of sandwich,
Raw beefy tongue ,
profuse salivation.
0.6 mg/
1000 kcal

WATER SOLUBLE VITAMINS
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VITAMINS IMPORTANCE GENERAL MANIFESTATIONS ORAL
MANIFESTATIONS
RDA FOOD
SOURCES
VIT B5
Pantothenic
acid
Serves as carrier of
activated acetyl
groups
Burning feet syndrome ----
VIT B6
Pyridoxine
Required by
enzymes of RBC
Peripheral neuropathy ---- 2mg
VIT B7
Biotin
Participates in
carboxylation
reaction
Deficiency uncommon ----
VIT B12 Erythrocyte
maturation factor
Pernicious anemia,
Degeneration of myelin sheath
Beefy red tongue,
Hunter’s glossitis
1 mcg

ORAL MANIFESTATIONS OF VITAMIN
DEFICIENCES
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Hunter’s glossitis Magenta tongue
Scurvy
Bald tongue

MINERALS
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MINERAL IMPORTANCE GENERAL / ORAL
MANIFESTATIONS
RDA FOOD
SOURCES
CALCIUM Bone & tooth formation,
blood clotting
Bone density & hypoplasia 1000 mg
PHOSPHOROUS Bone & tooth formation Rare 600-1000 mg
IRON Hemoglobin formation Anemia, glossitis & cheilitis 0.9-2.8 mg
ZINC Wound healing Delayed wound healing 15 mg
FLUORINE Bone & tooth formation Caries susceptibility, mottled enamel
COPPER Antioxidant Anemia
SELENIUM Antioxidant Predisposition to cardiac disease
CHROMIUM Glucose metabolism 50-200 mg

CALCIUM AND BONE HEALTH
Bone loss is a normal process of aging that effects maxilla and
mandible , as well as spine and long bones.
Skeletal sites where trabecular bone ( the alveolar bone ,
vertebrae) is more prominent than cortical bone are affected
first.
Several factors are thought to contribute to age related bone loss
that leads to osteoporosis.
Low calcium intake throughout life is a contributor to
osteoporosis.
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Osteopenia affects women earlier than men.
Alveolar tissue bone loss precedes loss of mineral from the
vertebrae and long bones.
As age advances , calcium is absorbed less effectively.
Patients with dentures who have excessive ridge resorption report
low calcium intake.
Atwood termed reduction of residual ridge is a manifestation of
osteoporosis.
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There is a cycle of calcitonin & parathyroid hormone secretion
throughout the day that maintains normal serum concentration
and skeletal integrity.
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FOOD GROUPS
All the nutrients necessary for optimal health in the desirable
amounts can be obtained by eating a variety of foods in adequate
amounts from the five food groups.
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1)VEGETABLES & FRUITS
Four servings of vegetables and fruits, subdivided into three
categories.
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• 2 servings of good sources of vitamin C, such as citrus fruits,
salad greens, and raw cabbage
• 1 serving of a good source of provitamin A, such as deep green
and yellow vegetables or fruits
• 1 serving of potatoes & other vegetables & fruits
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2)BREAD , CEREAL GROUP
• Four servings of enriched bread, cereals, and flour products.
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3)MILK, CHEESE GROUP
• Two servings of milk and milk based foods, such as cheese.
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4)MEAT, POULTRY,FISH & BEANS GROUPS
• Two servings of meats, fish poultry, eggs, dried beans and peas,
and nuts.
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5)FATS, SUGAR & ALCOHOL GROUP
• Additional miscellaneous foods, including fats and oils, sugar and
alcohol; the only serving recommendation is for about 2 to 4
tablespoons of polyunsaturated fats, which supply essential fatty
acids.
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BALANCED DIET
• “A balanced diet is that which supplies all the essential
nutrients in adequate amounts and in biologically
available forms.”
-Z.S.C.Okoye
• “A diet containing all essential (macro & micro) nutrients in
optimum quantities and in appropriate proportions that meet the
requirements.”
-NIN, Hyderadad, 2011.
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BALANCED DIET PRINCIPLES
In constructing balanced diet , the following principles should be
borne in mind:
a) Daily requirement of protein should be met 10-15% of daily
energy intake.
b)Fat, which should be limited to 15-30% of daily energy intake.
c)Carbohydrate rich in dietary fiber should constitute the remaining
food energy.
d)Requirements of micronutrients should be met.
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FOOD GUIDE PYRAMID, U.S. Department of
Agriculture,1992
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MODIFIED FOOD GUIDE PYRAMID FOR ADULTS
70+ YEARS- Tufts University
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ACCORDING TO ICMR ,BALANCED DIET FOR AN
ELDERLY PERSON PER DAY
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FOOD STUFFS MALES QUANTITY/gm FEMALES QUANTITY/gm
Cereals 520 440
Pulses 50 45
Vegetables 70 40
Green leafy vegetables 40 100
Roots & tubers 60 50
Fruits 200 200
Milk & milk products 200 150
Sugars 35 20
Fats & oils 45 25

Calorific value of Common Indian foods
-Given by NIN ,Hyderabad.
FOOD PREPARATION QUANTITY PER SERVING CALORIES (Kcal)
Rice 1 cup 170
Upma 1 cup 270
Idli 2 Nos 150
Dosa 1 No 125
Plain Dhal ½ cup 100
Boiled egg 1 No 90
Fish Fried 2 big pieces 190
Mutton & chicken curries ¾ cup 260 & 240 resp
Tea (2 tsp sugar +50 ml toned milk) 1 cup 75
Coffee (2 tsp sugar+ 100 ml milk ) 1 cup 110
Vada 2 Nos 140
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NUTRITION GUIDELINES FOR PROSTHODONTIC
PATIENT
Eat a variety of foods.
Build diet around complex carbohydrates , fruits , vegetables ,
whole grains and cereals.
Eat at least 5 servings of fruits and vegetables daily.
Select fish, poultry, lean meat, or diet peas and beans everyday.
Obtain adequate calcium.
Limit intake of bakery products high in fat & sugar samples.
Limit intake of bakery products high in sodium & fat.
Consume 8 glasses of water daily.
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NUTRITION AND GERIATRICS
• In this age group prosthetic failures are more often the result of
tissue deficiencies than technical failures.
• Burket discusses the effects of senescence on the teeth & jaws as
well as on the oral mucosa, tongue & salivary glands.
• Besides loosing their adaptability & tolerance to irritants these
tissues loose their repair potentialities.
• The changes in these tissues resulting from senescence , may alter
considerably the treatment of geriatric patient.
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• Importance of protein
 As patient becomes older, the amount of protein required per
kg of body increases(1.4g/kg body wt).
Body functions are quickly distracted from their normal activity
when good quality proteins are omitted from the diet.
Protein deficiency results in lower antibody production , decrease
in muscle volume.
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• Importance of vitamins
 Vitamins contribute to nervous stability & effective resistance to
bacterial infection.
Vitamins A , B complex, C & D intake should be increased.
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• Importance of minerals
Change in gastric acidity- hypochlorhydria -reduced absorption of
calcium & vitamin C-OSTEOPOROSIS.
Calcium loss contributes to bone fragility.
Rapid & excessive ridge resorption due to negative balance of
calcium.
Calcium level may be improved by increased intake of milk & milk
products plus a vitamin D supplement of 400-1000 units a day.
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• Carbohydrate tendency & obesity
Because of reduced muscular activity & metabolic rate geriatric
patients require fewer calories.
Limitation of their budgets & often inadequate masticatory
apparatus.
Soft diet that is high in carbohydrates & low in proteins is usually
taken.
This high caloric value produces obesity.
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• Impaired liver function
Decreased utilization of protein & B complex vitamins.
These changes produce a picture of pellagra .
• Post menopausal women
Abnormal taste & burning sensation of the oral cavity.
Low estrogen levels & vitamin B complex deficiencies.
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• Dehydration in the elderly
Water balance is critical in preventing tissue dehydration.
Xerostomia –major cause of denture discomfort & failure.
All secretions-sweat , sebaceous, HCl decreases.
Xerophthalmia-diminished secretion of tears.
Treatment
Hydrophilic (water bound) foods.
Soups-bound water-effectively absorbed.
Vegetable soups-easily prepared & relatively inexpensive.
Vegetable fibers are strongly hydrophilic & bind water until it reaches
the large intestine.
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DIETARY MANAGEMENT WHEN TEETH ARE
EXTRACTED
Patients who are candidate for implant or immediate dentures
may require several tooth extraction.
The patient who is well nourished experience rapid tissue healing
and will be at low risk after surgery.
If the patient appears poorly nourished , surgery should be
delayed until the individual health improves.
The smoker and drinker should be advised to abstain or limit their
habits for a few weeks before and 1 month after surgery.
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EXTRACTED
Malnourished patients should be instructed to consume
high-calorie , high- protein foods before surgery.
After any surgical process proteins, vitamin A, C, folic acid,
pyridoxine, vitamin B 12, iron and zinc must be available to body
cells for the support of phagocytic cells , cell mediated immunity
and collagen synthesis.
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EXTRACTED
• A liquid diet was chosen which contained 225 calories for each 10
fluid ounces which supplied approximately
19 gms of proteins
26 gms of carbohydrates
5 gms of fat
Essential vitamins & minerals.
• This beginning of diet a week or two prior to surgery gives the
intestinal tract additional time to adjust to necessary changes.
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DIET RECOMMENDED FOR NEW DENTURE
WEARERS
FIRST DAY
•Juices
•Gruels cooked in milk/water
•Milk
•Egg in eggnogs, pureed meats
SECOND &
THIRD DAY
•Juices ,tender cooked fruits & vegetables
•Cooked cereals, softened breads, boiled rice
•Fluid milk, cheese
•Chopped beef, ground liver ,tender chicken
FOURTH
DAY
•Firmer foods
•Ideally cut into smaller pieces.
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NUTRITION FOR MAXILLOFACIAL PROSTHETIC
PATIENTS
• An approach that involves simple nutritional principles preceding
the surgery, continuing postoperatively & proceeding life long will
translate into improved prosthodontic prognosis.
• Pre-operative phase
The assessment of nutritional status is designed to evaluate the
balance of 3 aspects of nutrition i.e energy , protein &
micronutrients & has 3 components –nutritional history
-appropriate physical examination
-laboratory studies
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NUTRITION FOR MAXILLOFACIAL PROSTHETIC
PATIENTS
• Post- operative phase:
The utilization of oral cavity for feeding may be hindered by the
adverse effects of chemotherapy or radiotherapy or by resection
itself.
Alternatives of oral feeding are:
-Nasogastric intubation
-Total parenteral nutrition TPN
-Gastrostomy
-Jejunostomy
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CONCLUSION
Careful attention to systemic factors such as nutrition will allow
dentists to provide an enhanced level of care for patients.
Dietary guidance is an integral part of treatment for the
denture-wearing patient.
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BIBILOGRAPHY AND REFERENCES
• Bolender CL, Zarb GA. Nutrition Care for Denture wearing Patient.
In: Prosthodontic treatment for edentulous Patients.12th
edition:56-69.
• Winkler S. Nutrition and the Denture-bearing Tissues . In:
Essentials of Complete Denture Prosthodontics.2nd edition:15-21.
• Neville BW. Oral Manifestations of Systemic Diseases. In :Oral &
Maxillofacial Pathology.2nd edition :713-15.
• Satyanarayana U. Carbohydrates, Lipids, Proteins, Vitamins &
Minerals. In :Textbook of Biochemistry.3rd edition : 9-116.
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BIBILOGRAPHY & REFERENCES
• Palmer CA.Gerodontic nutrition & dietary counseling for prosthodontic
patients. Dent Clin N Am; 2003:47:355-371.
• Barone JV. Nutrition for edentulous patients. J of Prosthet
Dent;1965:15:5: 804-809
• Ramsey WO .The role of nutrition in conditioning edentulous patients. J
of Prosthet Dent;1970;23:2 : 130-135
• Swoope CC, Hartsook E .Nutrition analysis of prosthodontic patients . J
of Prosthet Dent; 1977;38:2 : 208-215
• Barone JV. Nutrition – Phase one of the edentulous patient . J of
Prosthet Dent; 1978;40:2 : 122-126.
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BIBILOGRAPHY & REFERENCES
• Masseler M. Geriatric nutrition I :Osteoporosis . J Prosthet Dent
1979;42:252-254
• Massler M. Geriatric nutrition II :Dehydration in the elderly . J of
Prosthet Dent;1979:42:5 : 489-491.
• Bandodkar A, Aras M . Nutrition for geriatric patients. The J of
Indian Prosthodontic Society ;2006:6:1:22-28.
• Madan.R,Singh SV,Tripathi A.Nutrition in maxillofacial prosthetic
patients.The J of Indian Prosthodontic Society;2007:147-149.
• Dietary guidelines for Indians.NIN,ICMR,Hyd:2011:104-106.
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