Nutrition care of the denture patient/ orthodontic seminars

NUTRITION CARE OF THE
DENTURE PATIENT
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

INTRODUCTION
Since the turn of the century, there is considerable increase
in the number of elderly patients. Life expectancy has
increased from the age of 45 in 1900 to the age of 72 for
men and 77 for women in the 1980s. This shift is due in
part to improved dietary practices and better over all health.
But it is observed that nearly half of older individuals have
clinically identifiable nutritional problems. Nutritional risk
increases with advancing age. Therefore a large number of
denture patients can be expected to have nutritional deficits.
The nutritional status of the elderly is adversely affected by
low income, loneliness, and poor cooking facilities. Lack of
knowledge and interest in desirable food choices also
contributes to the poor nutritional status of elderly.

Dental and medical infirmities that interfere with
chewing, digestion, or metabolism can also contribute
to a poor nutritional status.
Certain nutrition related maladies for example diabetes,
obesity, cardiovascular disease, osteoporosis and cancer
– require special dietary regimens.
Proper nutrition is essential to the health and comfort of
oral tissues, and healthy tissues enhance the possibility
of successful prosthodontic treatment of the elderly.
A proper nutritional assessment and suitable dietary
advice is often a more appropriate way to cope with
malnutrition than merely instituting prosthetic therapy.

DEFINITIONS
Nutrition
• Nutrition can be defined as the sum of the processes by
which an individual takes in and utilizes food. (FDI
working group – Dr. M. Midda, Prof. K.G. Konig).
• Nutrition may be defined as the sum total of the
process by which the living organism receives and utilizes
the food materials necessary for growth, maintenance of
life, enhancing metabolic process, repair and replacement of
worn out tissues and energy supply. (Z.S.C Okoye)
Nutritional status
• Nutritional status is defined by Christakis as the “health
condition of an individual as influenced by his intake and
utilization of nutrients determined from the correlation of
information from physical, biochemical, clinical and dietary
studies (Nizel, Papas).www.indiandentalacademy.com

Food
Food can be defined as an edible substance made up of a
variety of nutrients that nourish the body. (Nizel and
Papas).
Food may be defined as any liquid or solid substance
which when ingested serves one or more of the following
functions.
• Provides energy,
• Supplies materials for growth, maintenance of body
functions and sustenance of life and metabolic processes,
reproduction, or for repair and replacement of worn out
tissues.
• Supplies materials necessary for the regulation of energy
production or the processes of growth maintenance,
reproduction, or repair. (Z.S.C Okoye)

Diet
• Diet can be defined as the types and amounts of
food eaten daily by an individual (FDI).
• The some total of the foods or mixtures of
foods which an individual consumes each day is
referred to as his diet. (Z.S.C Okoye)
Malnutrition
• Malnutrition is a generic term given to the patho-
physiological consequences of ingestion of
inadequate, excessive or unbalanced amounts of
essential nutrients (Primary malnutrition), as well as
the impaired utilization of these nutrients brought
about by factors such as disease (Secondary
malnutrition). (FDI).www.indiandentalacademy.com

• 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)
• As stated by GPT – 7
• Geriatrics
• The branch of medicine that treats all
problems peculiar to the aging patients, including
the clinical problems of senescence and senility.
• Dental geriatrics
• The branch of dental care involving problems
peculiar to advanced age and aging or Dentistry for
the aged patient. www.indiandentalacademy.com

Gerodontics
The treatment of dental problem in aged or aging
persons, also spelled Geriodontics.
Gerodontology
The study of the dentition and dental problems in
aged or aging persons.
Metabolism
The sum of all the physical and chemical processes
by which living organized substance is produced
and maintained (anabolism) and also the
transformation by which energy is made available
for the uses of the organism (catabolism).www.indiandentalacademy.com

Factors contributing to nutritional problems in
the elderly
• Physiologic changes associated with aging.
• Psychosocial aspects
• Drugs
• Economic factors
• Changes in oral conditions

1. Physiologic changes associated with aging
The elderly are often at high risk for developing a
nutritional deficiency due to the physiologic
changes accompanying aging. Knowledge of the
effects of the aging processes on nutritional status,
nutrient requirements of the elderly, and the factors
affecting dietary intake will help the prosthodontist
provide meaningful guidance to the elderly patient
in achieving improved oral health.

There is gradual loss of function associated with aging in
most organs and tissues of the body. These changes occur
slowly and are influenced by genetics, socioeconomic
status, illness, life events, accessibility of health care, and
the environment. There is a general loss of cells and lower
energy levels of the remaining cells during aging. This is
associated with a diminished reserve capacity. That is, in
the absence of disease, the organ will function
appropriately, but its ability to respond to stress will
decrease with time. There is a wide variability in the rates
at which these changes take place, not only between
individuals, but within individuals. Changes might occur
more rapidly in one organ system and more slowly in
others; for example physical changes might occur at a more
rapid rate then mental changes in some individuals.www.indiandentalacademy.com

Body composition
Advancing age, with or without illness, results in significant
changes in body composition. As age advances, there is a
steady decrease in lean body mass (muscle mass) of about
6.3 per cent for each decade of life. This loss in lean tissue,
however, is accompanied by an increase in body fat and
decrease in total body water. This appears to imply that
skeletal muscles are a major contributor to the age
associated loss in lean body mass. Because protein tissue is
the most physiologically active tissue, its decrease results in
a lowered basal metabolic rate. Between the ages of 20 and
90, BMR declines by 20%. If this is not accompanied by a
reduction in caloric intake or increase in activity levels,
slow weight gain will occur.

Bone density also declines with age. During growth
and development, bone formation exceeds
resorption. After peak bone age is achieved, usually
between 30 and 40 years of age, bone loss begins to
occur, as bone resorption exceeds bone formation.
Progressive bone loss begins in women at about 35
– 45 years of age and in men at about 40 – 45 years
of age. Women tend to have less bone density than
do men.

Metabolic alterations
Varying but progressive decrements occur in indices
of physiologic function such as cellular enzymes,
nerve conduction & velocity, resting cardiac output,
renal blood flow, maximum work rate, and
maximum oxygen uptake. Nutrient uptake by cells
appears to decline with age, suggesting that older
organisms may require higher plasma levels of
nutrients in order to maintain optimal tissue
concentrations.

Gastrointestinal functioning
The physiologic changes in the gastrointestinal tract
that occur with aging include decreased peristalsis,
decreased hydrochloric acid secretion, and altered
oesophageal motility. There is also reduction in the
levels of some digestive enzymes including salivary
amylase, pancreatic amylase, lipase, trypsin, and
pepsin. The overall capacity for absorption, as
determined by xylose absorption, has been shown to
decrease after the age of 70; and the intestinal
mucosal surface area available for absorption also
has been shown to be significantly reduced. It is
suggested that the degree of malabsorption differs
for various nutrients with age.

Sensory changes
It is assumed that olfaction and taste generally
decrease with age. In addition to smell and possibly
taste, visual and hearing acuity declines with age.
These changes can indirectly affect nutrient intake
through altered food purchasing and preparation
behaviors. Inability to read labels, recipes, prices or
light the gas stove can lead to an inadequate dietary
intake. Loss of hearing can result in a self-imposed
restriction on social activities such as eating out or
asking questions in grocery stores.

Psychosocial factors
Exton Smith has categorized malnutrition in the
elderly according to various primary and
secondary causes.
Primary causes
• Ignorance of balanced diet.
• Inadequate income
• Social isolation
• Physical disability
• Mental disorders

Secondary causes
• Alcoholism
• Increased use of drugs
• Edentulism
Because eating is very much a social activity, loneliness
can contribute to malnutrition. Loss of a spouse or friend
can result in the loss of an eating companion for the
elderly individual who might be eating alone or preparing
his own meals for the first time in his life. Individuals
who have family or friends living in close proximity are
more likely to have their needs met (social, economic or
physical) than are those living in relative isolation. It has
been observed that anemia and low leukocyte ascorbic
acid levels are more common in single men living alone,
than their age matched counterparts living with relatives.

Mental disorders in the older patient can result in confusion,
irritability, acute depression, or in extreme situations true
dementia. These persons can forget to eat even if food is
available and are particularly at risk for protein or caloric
malnutrition.
Alcoholism undermines the nutritional status by providing
“empty” calories derived from alcohol and interferes with
nutrient absorption.
Drugs
Older people are the chief users of drugs. Although the
elderly account for 11% of the population, they are taking
25% of the prescribed and over the counter drugs. Many of
these drugs interfere with digestion, absorption, utilization
or excretion of essential nutrients. Additionally, some drugs
profoundly affect appetite, decrease salivary flow and affect
taste and smell acuity.www.indiandentalacademy.com

Economic factors
Economic factors are a major force in determining the
variety and nutritional adequacy of the diet. Surveys
suggest a relationship between income and nutritional
adequacy. Vitamin C, in particular, is a nutrient that has
been shown to be influenced by income. Additionally,
other factors that can affect nutritional intake are also
influenced by income, such as transportation, housing and
facilities for food storage and preparation.
Modified diets
It is estimated that 18 – 43% of elderly individuals are
following special diets restricting their intake of sodium, fat,
cholesterol, calories or carbohydrates because of chronic
disease. Although this could have a positive effect on
nutritional status if foods are selected wisely, but there also
could be adverse effects.www.indiandentalacademy.com

Changes in oral status of the elderly
1. Alteration in gustation and olfaction
Gustation (taste perception) is mediated through the
papillae, taste buds and free nerve endings that are found
primarily in the tongue but also over the hard and soft
palates and in the pharynx. In general, the number of these
structures appears to decrease with age.
The tongue perceives four modalities of taste – salt, sweet,
sour, and bitter. The tongue is more sensitive to salt and
sweet, where as the palate is more sensitive to sour and
bitter.
Olfaction is the act of perceiving odours. In contrast with
gustation, olfaction can be stimulated by extremely low
chemical concentrations.www.indiandentalacademy.com

In the process of aging, taste perception diminishes
– the perception for salt at an early age, and for
sweet a little later. This is as a result of hyper
keratinization of the epithelium that may occlude the
taste bud ducts. Vitamin A deficiency may be
associated with it. The receptors for the bitter taste
in the circumvallated papillae of the tongue seem to
survive aging process.
Denture wearers, do exhibit a significant decrease in
their ability to decipher differences in sweetness of
certain foods, along with hardness and texture. This
decrease in the sensory aspect of the food can result
in a decrease in food consumption because tasteless,
odorless food most likely will not be eaten.

Salivary function
Xerostomia is a condition of dry mouth as a result of
diminished salivary flow commonly found in the
elderly. It is not a direct consequence of the aging
process but may result from one or more factors
affecting salivary secretion.
Emotions (especially fear or anxiety), neuroses,
organic brain disorders, and drug therapy all can
cause xerostomia. Some of the commonly
prescribed groups of drugs that produce xerostomia
are antihypertensives, anticonvulsants,
antidepressants, tranquilizers and anti Parkinson
drugs. www.indiandentalacademy.com

In addition salivary gland function may be diminished by
obstruction of the duct with a salivary stone, therapeutic
radiation for head and neck cancer, infection such as
mumps, sjogrens syndrome, lupus erythematosus, biliary
cirrhosis, polymyositis, or dermatomyositis or sarcoid and
autoimmune hemolytic anemia.
Since saliva lubricates the oral mucosa, the lack of saliva
creates a dry and often painful mucosa. Without significant
salivary flow, food debris will remain in the mouth, where it
is fermented by dental plaque bacteria to organic acids that
initiate the dental caries process. A major function of
saliva, which contains calcium phosphates, is to buffer the
acids and to re-mineralize the eroded enamel surface.

In addition, lack of saliva can affect the nutritional
status in a number of ways;
• It hinders the chewing of food because it prevents
the formation of a bolus.
• It makes the mouth sore and chewing painful.
• It makes swallowing difficult due to the loss of
saliva’s lubricating effect.
• It can cause changes in taste perception that
decreases adequate food intake.

Oral mucosal changes
The mucous membranes of the lips, the buccal and palatal
tissues and the floor of the mouth change with age. The
patient’s chief complaints are a burning sensation, pain
and dryness of the mouth, as well as cracks in the lips.
Chewing and swallowing become difficult, and taste is
altered. The epithelial membrane is thin and friable and
easily injured. It heals slowly because of impaired
circulation. If the salivary deficiency is pronounced, the
oral mucosa may be dry, atrophic, and sometimes
inflamed, but more often it is pale and translucent.

When flow of saliva is disturbed, food may have a
metallic or salty taste, and sensitivity to bitter and
sour foods can increase, where as a reduced
sensitivity to sweet tastes can generate an unhealthy
craving for sugar. These changes potentially have
an impact on food choices. In the denture patient it
can affect adaptation of the prosthesis and may lead
to the development of denture related problems.

Muscle function and oral movements
People chew more slowly as they get older. Age
may impair the central processing of nerve
impulses, impede the activity of striated muscle
fibers, and retard the ability to make decisions. In
addition there may be a reduction in the number of
functional motor units along with a decrease in the
cross sectional area of the masseter and medial
pterygoid muscles. Consequently, older people tend
to have poor motor co-ordination and weak muscles.
Muscle tone can decrease by as much as 20% to
25% in old age, which probably explains the shorter
chewing strokes and prolonged chewing time.www.indiandentalacademy.com

Temporomandibular joint pain
As a result of masticating very firm foods over
many years or as a result of bruxism, attrition of the
incisal and occlusal surfaces takes place. The
resulting teeth have shortened anatomical crowns,
exposed dentin, and wide, flattened chewing
surfaces. This type of tooth wear can produce
overclosure of the jaws and affect the relations of
the mandibular condyle to the glenoid fossa. With
age, the glenoid fossa can become shallower and the
head of the condyle, flatter. Thus it is possible for
the meniscus or articular disc between the condyle
and fossa, to be perforated or damaged by this
change in temporomandibular relationships, causing
pain and limitation of range of movements of thewww.indiandentalacademy.com

Another common cause of over closure or loss of
vertical dimension is partial or complete edentulism
without prosthetic replacement. It is also possible
that degenerative changes, such as osteoarthritis
(seen in other joints of the body), can affect the
temporomandibular joint and can also produce the
articular disc changes that creates the clicking of the
jaw and discomfort in the ear. There may even be
limitation to the opening of the mouth, which may
permit only a small sized bolus of food.

Edentulism
Edentulism increases with age. It is generally
agreed that one third to one half of elders over the
age of 65 are edentulous in both maxillary and
mandibular arches. Lack of dentition does not
necessarily mean dietary intake will be
compromised but considering that teeth serve as the
primary means of mastication as well as has an
impact on socialization and communication. Loss of
teeth will alter selection of food, often adversely.
Frequently, individuals with poor dentition consume
soft, easily chewed foods that are low in fiber and
have a low nutrient density.www.indiandentalacademy.com

Alveolar bone loss
The alveolar bone participates in the maintenance of
body calcium balance just as the rest of skeletal
bone does. Thus calcium is constantly being
deposited or resorbed from the alveolar bone to
maintain calcium homeostasis in the body. Alveolar
bone density, like skeletal mass declines with
advancing age. The rate at which this occurs is
affected by oral hygiene, (intestinal absorption of
calcium) nutrition, genes, hormones, bone density at
maturity, exercise and sunlight exposure.

In persons with osteoporosis the rate of alveolar
bone loss is increased. It has been demonstrated
that calcium supplementation can slow down the
rate of bone loss including alveolar bone.
The relationship of systemic bone loss to jaw bone
loss is unclear. Bone loss is accelerated and bone
height is diminished when teeth are lost. A greater
degree is observed in women than in men.
Resorption is much greater in the mandible than in
the maxilla.

Energy needs of the Body
The overall energy needs of the body are
calculated to be the sum of three factors
• Basal metabolism
• Energy for physical activity,
• A small amount of additional energy expended
during digestion and absorption of carbohydrates,
proteins, and fats in the gastrointestinal tract,
called the specific dynamic action, or SDA of
food.
Thus the energy requirement = basal metabolism +
physical activity + SDA.www.indiandentalacademy.com

Basal metabolism and Basal Metabolic Rate
The basal metabolic rate (BMR) is defined as the
number of kilocalories expended by the organism
per square meter of body surface per hour
(kcal/m2/hour). It is determined by body size, age,
sex, and secretions of endocrine glands.
Physical activity
Muscular activity affects both energy expenditure
and heat production. Energy expenditure increases
with muscular activity.

Environmental temperature
Environmental temperature is an important factor in
heat production. When the body is exposed to a low
environmental temperature, it automatically
produces more heat to maintain normal body
temperature.
Specific Dynamic Action (SDA) of Food
Specific dynamic action (SDA) is the term used to
describe the expenditure of calories during the
digestion and absorption of food.

Classification of foods
By origin
a. Plant food
– Cereals, legumes, fruits, vegetables, sugars, oils.
Animal products
– Meat, fish, milk, dairy products, eggs, poultry products.
By chemical composition
a) Macronutrients
– Proteins
– Fats
– Carbohydrates
b) Micronutrients
– Vitamins
– Minerals
By predominant function
– Body building foods (Proteins)
– Energy giving foods (Carbohydrates, fats)
– Protective foods (Minerals, vitamins)www.indiandentalacademy.com

Recommended dietary allowances (RDA, s)
The recommended dietary allowances (RDA, s) are
standards commonly agreed upon for assessing and
planning to meet nutrient needs at various ages.
RDA for the elderly currently are based on
extrapolations from the nutrient and calories needs
of adults up to the age of 50. RDA includes two age
groupings for energy allowances – persons aged 51
to 75 and those aged 76 or older. But the RDA for
vitamins and minerals includes only one age
grouping – those aged 51 and older.

Nutrient Effect of metabolism
Calcium Increases peak bone mass, decreases rate of bone loss in
postmenopausal women
Vitamin D Increases intestinal absorption of calcium, decreases bone
resorption
Phosphorus High intake may increase calcium urinary losses
Sodium High intake may increase urinary calcium losses if calcium
intake is low
Fluoride Stimulates osteoblasts, increases trabecular bone mass, new
bone may be poorly mineralized
Alcohol High intake accelerates menopause, toxic effects on
osteoblasts.
Caffeine High intake increases calcium urinary losses
Protein Urinary calcium losses rise as protein intakes increase, if
calcium intake is low. Therefore they should have increased
calcium along with high protein.
Effects of dietary factors in bone metabolism

Effect of nutritional deficiencies on oral health in
elderly patients
A nutritional deficiency is thought to be an
expression of metabolic malfunction caused by
lower than desirable intake and use of essential
interacting nutrients from the daily diet.

Cheliosis
Cheilosis (cheilitis or angular stomatitis) is the
inflammation of the entire upper and lower lip
surfaces. It involves cracks at the corners of the
mouth, inflammation and infection at the junction of
the upper and lower lips and the adjoining skin
characteristically. It may be a sign of deficiency of
one or more of the following nutrients; riboflavin,
niacin, pyridoxine, folic acid, vitamin B12, protein
and iron
Non-nutritional etiologic factors like over closure of
the jaws must also be considered. Therapeutic doses
of vitamin B complex and vitamin C as well as
balanced, varied adequate diet.www.indiandentalacademy.com

Painful burning tongue
A painful burning tongue is often encountered in
nutritional anemias associated with deficiencies of
vitamin B12, folic acid or iron.
Vitamin B12 deficiency (pernicious anemia), is
characterized by a triad of symptoms.
• generalized weakness
• sore painful tongue
• numbness or tingling of extremities.

There is gradual atrophy of the papillae resulting in a
smooth or bald, tongue. Treatment is intramuscular
administration of vitamin B12. Folic acid deficiency causes
megaloblastic anemia, which is characterized by
glossodynia, glossitis, Stomatitis, diarrhea and general
weakness. Treatment is to supplement the diet with 5-15
mg. of folacin tablets daily until reticulocytes in the blood
increase, then this improvement is maintained with doses of
2-5 mg. daily.
Iron deficiency anemia is manifested as glossitis and
fissures at the corner of the mouth. Papillae of the tongue
are atrophied giving the tongue a smooth, shiny red
appearance. Nutritional management consists of ingesting
iron – rich or enriched foods, such as liver, eggs and cereals,
as well as iron supplements (1gm and ferrous sulfate in four
divided doses daily)

Inflammation of oral mucosa
A patient with an acute vitamin B complex
deficiency, as seen in alcoholism, will develop a
markedly red and flamed oral mucosa. The
epithelial layer very often becomes detached from
the underlying tissues, leaving raw red readily
infected patches.
Pallor of oral mucosa is seen in patients with
anemias. There may be apthae with fiery red border.
This condition may be improved by a good diet and
vitamin supplementation.

Xerostomia
Xerostomia is a clinical manifestation of salivary gland
dysfunction. There are several causes of dry mouth; the use
of medications, therapeutic radiation to the head and neck,
diabetes, depression, alcoholism, pernicious anemia,
menopause, vitamin A or vitamin B complex deficiency,
and autoimmune diseases such a sjogren’s syndrome.
Aging as the sole cause of decreased salivary flow is
unproven. The most common cause of dry mouth is drugs
used to manage chronic diseases.
The management of xerostomia depends on the cause of the
condition. If a drug is suspected to be the cause, consulting
with the patient’s physician may result in an alternate drug
being prescribed or modification of the doses schedule.

Saliva substitutes are available, but regrettably have not
proven to be acceptable to many patients and furthermore
are expensive. Milk has been proposed as a saliva
substitute. Because dry mouth may result in inadequate
nutritional intake, the use of milk not only serves as saliva
substitute but is an excellent source of nutrients.
Sialogogues (agents that stimulate salivary flow) such as
sugar free gum, lozenges, or sugar free candies containing
citric acid may be recommended. Sorbitol or xylitol
sweetened products will decrease the risk of candidiasis
developing in susceptible adults. Additional
recommendations include beverages that may produce
more saliva such as water with a slice of lemon lemonade,
or limeade. Carrying a sport bottle when leaving home
will allow for frequent sips of water. Sucking ice chips
will increase comfort and provide lubrication; sauces,
gravies, and dressing will moisten foods and make them
easier to swallow. www.indiandentalacademy.com

Osteoporosis
Osteoporosis results from the loss of bone,
especially the spongy spicules of bone which
support the weight bearing parts of the skeleton.
Osteoporosis is common in the aging person
especially in the postmenopausal woman in whom
the estrogenic blood level has dropped
precipitously. In elderly men as well as women
osteoporosis is caused by a variety of factors.
• Lack of calcium intake
• Lack of calcium absorption
• Lactase deficiency
• Low estrogen www.indiandentalacademy.com

Management: Effective treatment for established
osteoporosis is difficult once bone mass has fallen
below the fracture threshold, so emphasis is placed
on preventing osteoporosis in high-risk subjects.
Physical exercise, ensuring an adequate calcium
intake (1500mg. Daily and avoiding cigarette
smoking and alcohol abuse are encouraged.
Hormone replacement therapy (HRT) should be
considered in women with low bone mass following
menopause. It is the most effective means of
preventing bone loss in women at this stage. But
because of the possible side effects of estrogen
therapy, such treatment cannot be recommended
solely to prevent residual ridge resorption in elderly
women

If bone loss is not too severe treatment of
established symptomatic osteoporosis can be
undertaken with antiresorptive drug therapy
(calcium supplements, HRT, biphosphonate or
calcitonin) and in selected very severe cases with
recurrent symptomatic spinal fractures, bone
stimulating drug therapy with anabolic steroids and /
or fluoride can be attempted.

Diet, nutrition, and drug interactions
The elderly account for 40% of acute hospital bed
days and 15% of psychiatric disturbances. They
have a 20% chance of being admitted to nursing
care facilities. Four percent of persons aged 65 to
74 years and 20% of those 75 years or older have
organic brain impairment.
On an average the elderly take 13 prescriptions per
year, three times as much as the population under
age 65. Of the ambulatory 85% and of
institutionalized almost 95% receive drugs; 25% of
all the elderly are dependent on prescription drugs
for activities of daily living.www.indiandentalacademy.com

The most common medications are analgesics and
cardiovascular and psychotropic medications, especially
those with sedative and hypnotic effects.
More than 50% of elderly patients in skilled nursing care
facilities are given psychotropic medications (those that
affect mental activity). Persons who take these medications
also use more prescription drugs of other kinds and tend to
consult physicians about medications more often than older
persons who do not take them. With age there is an altered
sensitivity of psychotropic medications that can lead to
central nervous system toxicity if the medication level is not
adjusted. The body’s ability to absorb, bind, metabolize,
and accept drugs changes with age. It is generally
recommended to start with half the normal adult dose and
slowly increase it to a therapeutic level. With the numerous
medications given to the elderly, care should be taken to
avoid adverse drug interactions and drug nutrient
interactions.

Medications can interact if one changes the
metabolism of other through enzyme induction, by
altering binding to plasma proteins receptor sites,
and by delaying or enhancing excretion. These
interactions are dose-dependent and vary from
individual to individual.
A number of drugs affect the body’s use of
nutrients, appetite and food intake nutrient
absorption or metabolism or both
Also, requirements of persons who receive certain
drugs over long periods are different from those
who have not taken these drugs before. The purpose
of this section is to inform the clinician how to
minimize drug-induced malnutrition in geriatric
patients.

Food Recommended for the Elderly
The five 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.
These are
1. Vegetable Fruit Group Four servings of vegetables
and fruits, subdivided into three categories
– Two servings of good sources of vitamin C, such as citrus fruits,
salad greens, and raw cabbage
– One serving of a good source of provitamin A, such as deep
green and yellow vegetables or fruits
– One serving of potatoes and other vegetables and fruits
Bread – Cereal Group Four servings of enriched bread,
cereals, and flour products

Milk - Cheese group Two servings of milk and
milk based foods, such as cheese (but not butter)
Meat, Poultry, Fish and Beans Group Two
servings of meats, fish poultry, eggs, dried beans
and peas, and nuts
Fats, Sugar and 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.

In 1992, the U.S. Department of Agriculture
developed the Food Guide Pyramid. This replaces
the former basic four model of milk, fruits and
vegetables, and grains. The pyramid now contains
six categories:
– Bread, cereal, rice, and pasta.
– Vegetables.
– Fruits.
– Milk, yogurt, cheese.
– Meat, poultry, fish, dry beans, eggs, and nuts.
– Fats, oils and sweets.

Dietary Counseling of Prosthodontic Patients
One expectation of patients seeking new dentures is
that they will be able to eat a greater variety of
foods. Such patients often are receptive to
suggestions aimed at improving the quality of their
diets. Nutrition screening begins at the first
appointment so that counseling and follow up can
occur during the course of treatment.

Risk factors for malnutrition in denture patients:
• Unplanned weight gain or loss of >10 lb in the last 6
months
• Undergoing chemotherapy or radiation therapy
• Poor dentition or ill-fitting prosthesis
• Oral lesions – glossitis, cheliosis, or burning tongue
• Severely resorbed mandible
• Alcohol or drug abuse
• Eating less than 2 meals/day

• Providing nutrition care for the denture patient
entails the following steps.
• Obtaining a nutrition history and an accurate record
of food intake over a 3-, 4- or 5-day period.
• Evaluating the diet
• Teaching about the components of a diet that will
support the oral mucosa as well as bone health and
total body health
• Guidance in the establishment of goals to improve
the diet.
• Follow up

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 vegetable daily
• Select fish, poultry, lean meat, or diet peas and
beans every day.
• 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.www.indiandentalacademy.com

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