Nutrition/ dental courses

NUTRITION AND DIET
FOR GERIATRIC
PATIENTS.
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

INTRODUCTION
 Diet is the total oral intake of substances
that furnish nourishment and calories to
the body.
 Nutrition is biochemistry at the cellular
level.
 “It is the science of how body utilizes
food for growth, development and
maintenance of tissues and structures”

DEFINITION
 Nutrition
“Nutrition is defined as the study of
ingestion, digestion, absorption, transport,
metabolism and excretion of the
chemicals found in food.”
 Diet :
“It is defined as the total oral intake of
substances that furnish nourishment and
calories”

 NUTRIENTS
 These are organic and inorganic
complexes contained in food.
 There are about 50 different nutrients,
which are normally supplied through the
foods.
 Each nutrient has a specific function in
the body. www.indiandentalacademy.com

 Nutrients perform the following functions
 Provide material for building, repairing or
maintaining body tissues.
 Help to regulate body processes
 Serve as a fuel to provide energy
 Body needs energy to maintain all its
functions. Energy is measured in units
called calories.

 NUTRIENTS :classified as
 1) Macronutrients :
 Proteins, fats and carbohydrates
 Contribute the main bulk of food.
 In Indian diet the total energy intake is
approximately
Proteins 7-15%
Fat 10-30%
Carbohydrate 65-80%

 2) Micronutrients
 Vitamins and minerals
 Required in small amount from a
fraction of a milligram to several grams.

 NEED FOR BALANCED DIET :
1)To delay and minimize degenerative changes
and medical problems such as diabetes,
hypertension and arteriosclerosis as well as
dental problems.
2) Prerequisite for specific therapy to have an
optimal effect.
3) Complete denture prosthesis depend, ultimately
upon the health and integrity of the denture
bearing tissues for successful function and
comfort of the patient.

DIABETIC DIET
National institute of nutrition,
Indian council of medical research, department of
diabetics
 Avoid
- Roots and tubers
- Sweets, pudding, chocolate
- Fried foods
- Dried fruits and nuts
- Sugar
- Fruits like bananas, sapotas, custard apple etc

CLASSIFICATION OF FOODS
 1. BY ORIGIN :
a) Foods of animal origin
b) Foods of vegetable origin
 2. BY CHEMICAL COMPOSITION
a) Proteins
b) Fats
c) Carbohydrates
d) Vitamins
e) Minerals

 3. BY PREDOMINANT FUNCTION
a) Body-building foods : eg : milk, meat,
poultry, fish, eggs, pulses, groundnuts etc.
b) Energy giving foods : eg : cereals, sugars,
roots and tubers, fats and oils.
c) Protective foods : eg : vegetables, fruits, milk.

 4. BY NUTRITIVE VALUE
a) Cereals and millets
b) Pulses (legumes)
c) Vegetables
d) Nuts and oil seeds
e) Fruits
f) Animal foods
g) Fats and oils
h) Sugars
i) Condiments and spices
j) Miscellaneous foods

 Also be classified as :
- Proteins
- Carbohydrates
- Fats and lipids
- Vitamins
- Minerals
- Fibers
- Water

PROTEIN
 “which is of first importance”
 Mulder in 1840 suggested this
terminology
 Considered as the food of great
importance.
 complex organic nitrogenous compound.
composed of carbon, hydrogen, oxygen,
nitrogen and sulphur in varying amounts.
also contain phosphorous and iron and
other elements.

 Constitute about 20% of body weight in
an adult.
 Made up of smaller units, called amino
acids.
 some 24 amino acids are stated to be
needed by the human body, of which 9
are called essential, because the body
cannot synthesize them and therefore,
they must be obtained from dietary
proteins.

 ESSENTIAL AMINO ACIDS
 Leucine
 Isoleucine
 Lysine
 Methionine
 Phenylalanine
 Threonine
 Valine
 Tryptophan
 Histidine

 NON-ESSENTIAL AMINO ACIDS
 Arginine
 Asparaginic acid
 Serine
 Glutamic acid
 Proline
 Glycine
 Both essential and non-essential amino
acids needed for synthesis of tissue
proteins.

 A protein is said to be “biologically
complete”
 From the nutritional stand point,
animal proteins are rated superior to
vegetable proteins because they are
“biologically complete”.
Ex : milk and egg proteins.

SOURCES
 1) ANIMAL SOURCES
o Proteins of animal origin are found in milk,
meat, eggs, cheese and fish. These proteins
contain all the EAA in adequate amounts.
o Egg proteins are considered to be the best among
food proteins because of their high biological
value and digestibility. They are used in nutrition
studies as a “reference protein”.

 2) VEGETABLE SOURCES
o found in pulses, cereals, beans, nuts, oil-
seed, cakes etc.
o poor in EAA.

 FUNCTIONS OF PROTEINS
 Building up of muscles
 Repair and maintenance of body tissues
 Maintenance of osmotic pressure
 Synthesis of certain substances like-antibodies
plasma proteins, haemoglobin, enzymes, and
hormones.

 ASSESSMENT OF PROTEIN NUTRITION
STATUS
 Best measure: serum-albumin
concentration.
 should be more than 3.5g/dl.
 A level of 3.5g/dl is considered mild
degree of malnutrition,
 A level of 3.0g/dl is considered severe
malnutrition. www.indiandentalacademy.com

PROTEIN REQUIREMENT
Indian council of medical research in
1989 recommended 1.0g protein /kg
body weight for an Indian adult.

VITAMINS
 Organic compounds, which occur in
minute quantities in natural food.
 Funk in 1911 designated a food
constituent necessary for life.
 First factor identified by him was an
amine (thiamine)
 Categorized as essential nutrients.

 Required in very small amounts.
 Micro-nutrients.
 Do not yield energy but enable the body
to use other nutrients.
 Unable to synthesize, must be provided
by food.

 DIVIDED INTO TWO GROUPS
a) Fat soluble –A, D, E and K
b) Water soluble –B group and C
 Each vitamin has a specific function
 Deficiency lead to specific deficiency disease.
Recent advances indicate that vitamins such
as A,C,E and B carotene can be able to delay
the aging process.
 Also prevent degeneration in blood vessels,
heart, joints and eye.

Functions
 normal vision.
 normal functioning of glandular and
epithelial tissues, which lines intestinal,
respiratory, urinary tract, as well as skin
and eyes.
 supports skeletal growth
 Anti-infective
 protect against some epithelial cancers-
bronchial cancers.

SOURCES
 widely distributed in animal and plant
foods
 animal foods as pre-formed vitamin-A
(retinol)
 Plant foods as pro-vitamins (carotenes)
 Animal foods are – liver, eggs, butter,
cheese, whole milk, fish and meat.
 Plant foods carrots, spinach, green leafy
vegetables, pulses.www.indiandentalacademy.com

DEFICIENCY
 causes – night blindness, conjunctival xerosis,
bitots spots, corneal xerosis and keratomalacia
– dryness with ulceration and perforation of
the cornea.
 Recommended daily allowance :
600 - 2400(mcg)

VITAMIN D (CALCIFEROL)
 E.Mc. Collum –1922
 The nutritionally important forms are
calciferol (Vit D2
) and chole-calciferol (Vit
D3
).
 when exposed to UV rays of sunlight,
cholesterol in skin is converted to vitamin
D.
 stored largely in fat
 Sources – sunlight and foods
 Foods – liver, egg yolk, butter and cheesewww.indiandentalacademy.com

FUNCTIONS AND ITS METABOLITES
 Intestine – promotes intestinal absorption of
calcium and phosphorus.
 Bone – stimulates normal mineralization,
enhances bone resorption affects collagen
maturation.
 Kidney – increases tubular reabsorption of
phosphate .
 Others – permits normal growth .

DEFICIENCY
 causes rickets and osteo-malacia
 Rickets – there is reduced calcification of
growing bones curved legs, deformed
pelvis, pigeon chest, Harrison’s sulcus
DAILY REQUIREMENTS
 Adults – 2.5mcg (100IU)
 Infants and children – 5.0mcg (200IU)

VITAMIN - E (Tocopherol)
 Discovered by H-Events and K-Bishop in
1923.
 Source – vegetable oil, cotton seed,
sunflower seed, egg yolk and butter.

VITAMIN –K
 Synthesized by the intestinal flora
 Participates in oxidative phosphorylation
 Naturally occurring
K1 – phytomenadione and K2 – mena-
quninone is of bacterial origin.
 Increases concentrations of prothrombin,
proconvertin, plasma thromboplastin,
stuwart-prower factor.

 SOURCE : fresh green vegetables,cows milk
and some fruits.
 DEFICIENCY :
 Leads to prolongation of prothrombin time
and bleeding tendency.
 HDN (haemorrhagic disease of the new born)
is due to vitamin K-deficiency.
 DAILY REQUIREMENT : 0.03mg/kg – for
adults

WATER SOLUBLE VITAMIN
 Vitamin-B-complex :
 Vitamin-B1
-Thiamine
 Vitamin-B2
-Riboflavin
 Vitamin-B6
-Pyridoxine
 Vitamin-B12
-cyanocobalamine
 Niacin
 Folic acid

THIAMINE (B1
)
 Discovered by R.R. Williams in 1936
 Essential for utilization of carbohydrates
 Sources – whole grain cereals, wheat, gram,
yeast, pulses, oilseeds and nuts. Meat, fish,
eggs and milk.

 Deficiency – Beri Beri and Wernick’s
encephalopathy.
Beri Beri occurs in three forms.
 Dry form – nerve involvement (peripheral
neuritis)
 Wet form- heart involvement (cardiac beri
beri)
 Infantile beri beri – seen in infants – 2-4
months of age

 Wernick’s encephalopathy is characterized
by opthalmoplegia, polyneuritis, ataxia
and mental deterioration.
 Requirements :
Daily requirement of thiamine is 0.5mg /
1000 k.cals of energy intake.

VITAMIN B2
– RIBOFLAVIN
 Discovered by P. Gyovzy and R. Kunn in
1933.
 fundamental role in cellular oxidation.
 Sources – milk, eggs, liver, kidney and
green leafy vegetables.Meat and fish
contain small amounts.

 Deficiency : ariboflavinosis
Lesions associated with angular stomatitis,
cheilosis, glossitis etc.
 Requirement :
Daily requirement is – 0.6mg/1000 kcal of
energy intake.

VITAMIN B6
– PYRIDOXINE
 Exists in 3 forms- pyridoxine, pyridoxal and
pyridoxamine.
 Plays an important role in metabolism of
amino acids,fats and carbohydrates.
 Sources – milk, liver, meat, egg yolk, fish,
whole grain cereals legumes and vegetables.
 Requirement : 2mg/day

VITAMIN B12
– (CYANCOBALAMINE)
 Called as “red vitamin”,Present only in animal
foods.
 It is a complex organo-metallic compound with
a cobalt atom.
 Sources – liver , kidney, meat, fish, eggs, milk
and cheese.
 Deficiency–megaloblastic anaemia
demyelinating neurological lesions in the spinal
cord.
 Requirement : adult - 1mg/daywww.indiandentalacademy.com

NIACIN
 Nicotinic acid is essential for metabolism of
carbohydrate, fat and protein,also essential for
normal functioning of skin, intestinal and
nervous system.
 Sources – liver, kidney, meat, poultry, fish,
legumes and groundnut.
 Deficiency–Pellagra, characterized by three D’s
Diarrhoea, Dermatitis, and Dementia. In
addition glossitis and stomatitis
 Requirement : 6.6mg/1000 kcal of energy

FOLATE
 Folic acid – plays a role in synthesis of nucleic
acids.
-Needed for normal development of blood cells
in marrow.
 Sources – liver, meat, dairy products, egg,
milk, fruits, cereals leafy vegetables.
 Deficiency – megaloblastic anaemia, glossitis,
cheilosis and gastrointestinal disturbances.
 Requirement : adults – 100 mcg/daywww.indiandentalacademy.com

VITAMIN-C (ASCORBIC ACID)
 Most sensitive of all vitamins to heat.
Plays an important role in tissue oxidation.
Needed for formation of collagen.
 Collagen provides a supporting matrix for blood
vessels and connective tissue and for bones and
cartilage.
It reduces ferric iron to ferrous iron, and
facilitates absorption of iron from vegetable
foods.

 Source:
fresh fruits and green leafy vegetables
 Deficiency :
Scurvy:-Swollen and bleeding gums, bleeding
into skin or joints, delayed wound healing,
anaemia and weakness.

CARBOHYDRATES
 Third major component of food
 Main source of energy, providing 4 k.cals per
gram.
 Essential for oxidation of fats for synthesis of
certain non-essential amino acids.
 Main sources of carbohydrates :
Starches
Sugar
Cellulose

 Starch : Basic human diet, found in cereals,
roots and tubers.
 Sugar : Comprise monosaccharides (Glucose,
fructose, galactose) and disaccharides (Sucrose,
lactose and maltose).
These free sugars are highly water soluble and
easily assimilated.
Free sugars along with starches constitute a key
source of energy.
 Cellulose : indigestible component of
carbohydrate with scarcely any nutritive value
Contributes to dietary fibre.

 Reserve of glycogen about 500 g.
 Stored in liver and muscles as glycogen which
is the main source of energy, providing 4 k.cals
per gram.
 Energy yielding substances
 Sense of taste and smell are less sharp among
older people, which interfere with appetite for
many foods.

 During old age,loss of teeth make it
difficult to chew food properly.
 Elderly people tend to consume more of
carbohydrate, such foods which require
minimum chewing, need minimum cooking
time and maximum storage.

FATS
 Esters of fatty acids with glycerol
 Commonly known as triglycerides. They are
sources of heat and energy.
 Solid at 200
C. Liquid at that temperature-Oils
 classified as :
Simple lipids : triglycerides
Compound lipids : phospholipids
Derived lipids : cholesterol

 Human body can synthesize triglycerides and
cholesterol endogenously.
 Most of body fat (99%) in adipose tissue in
form of triglyceride.
 In normal human, adipose tissue constitutes
between 10-15% of body weight.
 Accumulation of one kg of adipose tissue
corresponds to 7700 kcal of energy.

FATTY ACIDS
 Fats yield fatty acids and glycerol on hydrolysis
 Divided into
 Saturated fatty acids-lauric, palmitic and stearic
acid
 Unsaturated fatty acids
1) Monounsaturated fatty acids – oleic acid
2) Polyunsaturated fatty acids – linoleic acid
 Polyunsaturated fatty acids are found in
vegetable oils and saturated fatty acids in animal
fats. www.indiandentalacademy.com

ESSENTIAL FATTY ACIDS
 Are those that cannot be synthesized by
humans.
 Derived only from food.
 Most essential fatty acid is linoleic acid,
which serves as a basic for the production of
other essential fatty acids.

 Fats and oils make food palatable and help
in the absorption of fat soluble vitamin like
A, D, E and carotene.
 Excessive consumption of animal fat
increases blood cholesterol, which may be a
contributory factor for development of
coronary disease.

 Sources :
Animals fats : ghee, butter, milk, cheese, eggs and
fat of meat and fish.
Vegetable fats : ground nut, mustard, coconut etc.
 Other sources : small quantities found in
cereals, pulses,nuts and vegetables.
 Visible fat : are those separated from their
natural source. Eg : ghee from milk.
 Invisible fat : Not visible to the naked eye.
present in almost every particle of food. Eg :
cereals, pulses, nuts etc.www.indiandentalacademy.com

FUNCTIONS
 High energy foods, providing as much as 9
kcal for every gram.
 Serve as vehicle for fat-soluble vitamins.
 support viscera such as heart, kidney and
intestine,
 beneath skin provides insulation against
cold.

FATS AND DISEASE
 Obesity
 Phrenoderma :
Deficiency of essential fatty acids in the
diet is associated with rough and dry
skin-phrenoderma or toad skin.
 Coronary heart disease

 WHO expert committee on prevention of
coronary heart disease has recommended
only 20 to 30% of total dietary energy to be
provided by fats.
 At least 50% of fat intake should consist of
vegetable oils rich in essential fatty acids.

FIBERS
 A low intake of fibre commonly seen in elderly
people, especially in denture wearers
 A low intake associated with condition like
constipation, colon cancer and diabetes.
 Such conditions treated by recommending foods
high in fibres such as raw vegetables and fruits.
 If these foods are difficult to eat because of
denture problem then bran cereals, cooked
prunes or figs may be suggested.
 25-30 gm of Fibers are recommended
 Sources : green leaves, fruits, cereals, pulses
and legumes

WATER
 Deficiency and dehydration are more
prevalent in older than younger people.
 This may be partly due to a decrease in extra
cellular water
 About 60% of body weight is water.
 An intake of 6 to 8 glasses of water /day is
desirable.

MINERALS
 More than 50 chemical elements found in
human body, which are required for growth,
repair and regulation of vital body function.
 Divided into 3 major groups :
Major minerals –calcium, phosphorus, sodium
potassium and magnesium.
Minor minerals–required by body in quantities of
less than a few milligram /day. Eg : iron,
iodine, copper, zinc, cobalt, chromium,
manganese, molybdenum etc.

Trace contaminants –no known function.
Include lead, mercury, barium, boron and
aluminium.
CALCIUM
 Essential for bone and teeth formation
 99% of body calcium is present in the bone.
 Source – milk and products, oysters, crab,
fish, mutton, leafy, veg. roots,
 Requirements – 500-1000mg/day
 Normal serum calcium is 7-11mg%

 Phosphorus –closely linked to calcium
 Most of the calcium is deposited as calcium
phosphate in bone and teeth.
 Important in cellular metabolism, oxygen
transport and acid base balance.
 Source – cereals, pulses, nuts ,
 Requirement – 600-1000mg/day
 Sodium –most important constituent of body
fluids and cell.
 Maintains osmotic balance and keep cell in
proper shape.

NUTRITION AND AGING PROCESS
 Aging factors that affect nutritional status
Physiologic factors
 Declines in physical and cognitive status
 Often increase with age. For example,
decreased lean body mass, particularly muscle
mass (sarcopenia), is common.
 Muscle mass is a predictor of strength,
mobility, insulin sensitivity, and basal
metabolic rate.
 With a decline in lean body mass, caloric needs
decrease and risk of falling increases.

 Declines in gastric acidity also often occur
with age, and may affect from10% to 15% of
persons over age 60 years.
 This hypo-chlorohydria results from atrophic
gastritis and can cause mal-absorption of
food-bound vitamin B12
.
 Atrophic gastritis results in increased levels
of bacteria in the stomach and small intestine
that bind the vitamin B12
for their own use
and make it unavailable.

 Vitamin B12
deficiency result in neuropathy,
megaloblastic anemia, gastrointestinal
symptoms, and cognitive impairment.
 Vitamin D deficiency is also common in the
elderly for several reasons :
Insufficient sun exposure, decline in the skin’s
ability to synthesize vitamin D from sun
Impaired kidney or liver function needed to
activate vitamin D.
Vitamin D synthesis at age 80 years is half that
at age 20 years. www.indiandentalacademy.com

 Impairment in function of intestinal track
secondary to illness, disease, or medications
can also result in food mal-digestion and mal-
absorption.
A classic example is increase in lactase
deficiency found in older individuals.
Lactase deficiency results when villi of small
intestine secrete too little lactase enzyme to
fully digest milk sugar, lactose.
Resulting in pain, bloating, excessive gas, and
nausea

 Decrease in intestinal function also
associated with increased constipation in
older people.
Adoption of low-fiber diets in response to
chewing difficulties and dentures can
exacerbate this condition.
 Dehydration, caused by declines in kidney
function and total body water metabolism is
a major concern in older population.
Dehydration can be insidious and
unrecognised until serious side effects occur.

 Cognitive function may decline with
advancing age and range from simple
memory deficit to profound dementia.
 Psychosocial factors may play even
greater roles than physical, medical, and
dental issues in determining the health and
well-being of elders.

 Elders particularly at risk include those living
alone, Physically handicapped with
insufficient care, isolated persons with
chronic disease and restrictive diets, and the
oldest old. Poverty is also a major contributor
to mal-nutrition.
Functional factors
 Functional disabilities such as arthritis,
stroke, or vision or hearing impairment can
affect nutritional status indirectly.

XEROSTOMIA
 Affects almost one in five older adults.
 When salivary levels decline, teeth become
more susceptible to dental caries.
 Exposed root surfaces of teeth are particularly
at risk.
 Also impair complete denture retention and is
associated with increased periodontal disease,
burning or soreness of oral mucosa, and
difficulties in chewing and swallowing
All of which can adversely affect food selection
and contribute to poor nutritional status.

SENSE OF TASTE AND SMELL
 Although the olfactory system is generally
well preserved with age, age-related changes
in taste and smell may alter food choice and
decrease diet quality in some people.
 Factors contributing to this report decreased
function may include health disorders,
medications, oral hygiene, denture use, and
smoking.

Effects of dentures on taste and swallowing
 Complete upper denture can have an impact on
taste and swallowing ability.
 Hard palate contains taste buds,so taste
sensitivity may be reduced when an upper
denture covers hard palate.
 Also becomes difficult to determine location of
food in mouth when upper palate is covered.
 As a result, swallowing can be poorly
coordinated and dentures can become a major
contributing factor to deaths from choking.

Nutrition care for denture wearing patient
 All people have some basic needs of
nutritional intake for growth, development,
maintenance and metabolism.
 Enjoyment of food is an important
determinant of an adults quality of life.
 Loose teeth, edentulous ness or ill fitting
dentures may preclude eating favourite food
as well as limit intake of essential nutrients.

 Decreased chewing ability, fear of choking
while eating, and irritation of oral mucosa
when food particles get under dentures may
influence food choices of denture wearer
Conversely, affects the health of the oral
tissues and patients adaptation to the new
prosthesis.

 well designed and constructed denture or an
implant supported prosthesis may prove to be
unsatisfactory for a patient because of poor
tolerance by underlying tissues and bone.
Hence,denture failures can also be due to
poorly nourished tissues.

 Clinical symptoms of malnutrition are often
observed first in oral cavity.
Because of rapid cell turn over (3-7 days) in mouth
A regular balanced intake of essential nutrients is
required for maintenance of oral epithelium.

 Inadequate long term nutrition may result in
angular cheilitis, glossitis and slow tissue
healing.
 Nutritional status of a denture wearer is
influenced by economic hardship, social
isolation, degenerative diseases medication
regimens and dietary supplementation
practices.

IMPACT OF DENTAL STATUS OF FOOD
INTAKE
 food choices of older adults are closely linked
to dental status and masticatory efficiency.
 loss of teeth often leads adults to select soft
diet, soft foods are often lower in nutrient
density and Fiber.
 An individuals masticatory ability is mainly
determined by age, oral motor function,
adequate saliva and number of occluding pairs
of teeth in mouth.

 Masticatory function of denture wearer is
greatly inferior to person with intact
dentition.
 Denture wearer must complete a greater
number of chewing strokes to prepare food
for swallowing.

 In a study of the united states, department of
agriculture human nutrition research centre
(Boston) – Nutrition intake of those who had
one (or) two complete dentures was about
20% lower than that of dentate subjects.
 Studies in Finland showed that wearing of
dentures for several years, improved the
quality of their diet.

 Condition of an individuals denture also
influence food selection.
 When old complete dentures with poor
retention were replaced with new dentures
masticatory performance of patients improved.
 Use of Osseo integrated implants, also
increased chewing ability and variety of foods
were eaten.

 comfort of wearing dentures is dependent on
lubricating ability of saliva in mouth.
 If the oral mucosa is dry, chewing is difficult,
denture retention is compromised and mucosal
soreness (or) ulcerations develop.
 Salivary flow facilitates – mastication,
formation of food bolus and swallowing.

 Milk has been proposed as saliva substitute
 It not only aids in lubricating tissues, but also
has a buffering capacity.
 As dry mouth may result in inadequate
nutritional intake, the use of milk serves as
saliva substitute and also an excellent source
of nutrients.

NUTRITIONAL NEEDS AND STATUS OF
ELDERLY
 Nutrient needs of older persons vary
depending on health status and level of
physical activity.
 It is difficult to generalize about energy,
vitamin and mineral requirements appropriate
for all older adults.

 Depending on body metabolism, an individual
may need more (or) less of nutrients than
proposed in required daily allowances.
 Energy needs decline with age because of
decrease in basal metabolism and decreased
physical activity.
 With aging lean body mass is replaced by fat,
this leads to a decrease in metabolic rate

 Cross sectional surveys showed that average
energy consumption of 65 – 74 yrs
Men – 1800 k cal, Women – 1300 k cal.
 This is lower than adults of 51 – 65 yrs
Men 2300 k cal
Women 1900 k cal

 Complex carbohydrate should be mainstay
of elderly diet.
 Important component of complex
carbohydrate is fibre which promotes
normal bowel function, may reduce serum
cholesterol and is thought to prevent
diverticular disease,and haemorrhoids.

 Fats contribute about 33% of total calories in
an adult diet
 Protein intake of denture wearers is lower
than that of dentate adults, but is often
adequate.
 Oral symptoms of mal-nutrition are usually
due to lack of vitamin B-complex, vit C,
protein.

 Heavy smokers, alcohol abusers, or persons
with high aspirin intake have a higher daily
requirement of vitamine – C.
It plays a role in collagen synthesis (essential
for wound healing)
 Deficiency of thiamine, niacin, pyridoxine,
folate (vit-B) and ascorbic acid are
commonly seen in alcoholic’s.
 osteopenia in males, may be due to chronic
alcohol intake.

CALCIUM AND BONE HEALTH
 Bone loss is a normal part of aging that
affects maxilla and mandible, as well as spine
and long bones skeletal sites
where trabecular bone is more prominent than
cortical bone, are affected first (alveolar
bone, vertebrae,wrist, and neck of femur)

 Several factors are thought to contribute to
age related bone loss that leads to
osteoporosis :-
• Genetic back ground
• Hormonal status
• Bone density at maturity
 Disturbance in bone remodelling process
• Low exercise level
• Inadequate nutrition
• Low calcium intake through out life is a
contributor to osteoporosis.

CLIMACTERIC
 It is a period in both males and females, when
an important change in bodily function occurs.
 In females this period is termed menopause.
 Glandular functional changes have varying
effects
Generalized osteoporosis – Reduction in bone
mass with pain, deformity (or) pathologic
fracture.
Burning palate, burning tongue etc.

 Resorption of alveolar ridge is a wide spread
problem.
 A greater degree of residual ridge resorption is
seen in women than in men.
 Bone loss is accelerated in the first 6 months
after tooth extraction and resorption is greater
in the mandible than maxilla.

 Dietary calcium is critical to maintaining
body skeleton.
 Calcium intake by older adults will not
restore bone, but will improve calcium
balance and slow the rate of bone loss.
 Denture patient with excessive ridge
resorption report lower calcium intake.

VITAMIN SUPPLEMENTATION
 Based on nutrient deficiency in denture
patients, it may be reasonable to prescribe a
low- dose multivitamin diet.
 For nutrients to be present in proper ratio, to
one another a multivitamin – mineral
supplement is preferable to single –nutrient
tables.

 The use of mega dose vitamin in elderly is of
great concern
 Because with a high dose of a vitamin, it no
longer functions as a vitamin but becomes a
chemical with pharmacological activity.

1) Mega doses of vit-D, can disturb calcium
metabolism leading to calcification of soft
tissues.
2) High doses of retinol, accelerates bone
resorption increasing the risk of hip fracture.
3) Mega doses of Vit-C can induce copper
deficiency anaemia.
4) High intake of Niacin – flushing, headache,
itching skin
5) High intake of Vit B6 – peripheral
neuropathies

Dietary counselling of patients undergoing
prosthodontic treatment
 1) The main objective of diet counselling for
patients undergoing prosthodontic care is to
correct imbalances in nutrient intake, that
interfere with body and oral health.
 2) The quality of a denture wearing patients
diet can be improved with nutrition
counselling.

 3) Elderly population over 70 years of age are
more likely to have poor diets, and nutrition
risk increases with advancing age.
 4) Maintenance of oral epithelium, rapid cell
turnover in the mouth, requires a regular
balanced intake of essential nutrients.
 5) To lower the rate of alveolar ridge
resorption, increased intake of calcium and
vitamins is required.

 Dietary evaluation and counselling should be
included in prosthodontic treatment, if patient
has any of the following physical or social
conditions.
 Greater than 75 yrs of age
 Low income
 Little social contact
 Involuntary weight loss
 Daily use of multiple drugs
 Need for assistance with daily – self-care.www.indiandentalacademy.com

Risk factors for malnutrition in denture
patient
1) Unplanned weight gain or loss of > 10 lb, in
the last 6 months.
2) Undergoing chemotherapy or radiation
therapy
3) Poor dentition or ill fitting prosthesis

4) Oral lesions – glossitis, chelosis or burning
tongue
5) Severely resorbed mandible
6) Alcohol or drug abuse
7) Eating less than 2 meals / day

 Providing nutrition care for the denture –
wearing patient entails the following steps :
1) Obtain a nutrition history and an accurate
record of food intake over a 3-5 day period.
2) Evaluate the diet, asses nutritional risk

3) Teach about the components of a diet that
will support the oral mucosa, bone health
and total body health.
4) Guidance in the establishment of goals to
improve the diet
5) Follow – up.

Nutrition guide lines for prosthodontic
patient
 1) Eat a variety of diet
 2) Build diet around complex carbohydrate,
fruits, vegetables whole grams and cereals.
 3) Eat atleast 5 servings of fruit and
vegetables daily.
 4) Select fish, poultry, meat (or) dried peas
and beans every day
 5) Consume 4 servings of calcium –rich –

 6) Limit intake of bakery products high in
fat and simple sugars.
 7) Limit intake of prepared and processed
foods high in sodium and fat
 8) Consume 8 glasses of water daily, juice
or milk daily.

CONCLUSION
 success of a complete denture prosthesis is
mainly influenced by the mucosal condition
of the denture bearing areas.
 So the patient has to be well nourished and
consume a well balanced diet.
 Dietary guidance based on assessment of the
edentulous patient nutrition history and diet
should be an integral part of comprehensive
prosthodontic treatment.

Contents:
 Introduction
 The aging factors that affect nutritional status
 Oral factor that can affect diet and nutritional
status
 The impact of dental status on food intake
 Gastrointestinal functioning
 Nutritional needs and status of older adults
 Calcium and bone health

 Vitamin and herbal supplementation
 Dietary counseling of patients undergoing
prosthodontic treatment
 Risk factors for malnutrition in patients with
dentures
 Nutrition guidelines for patients undergoing
prosthodontics
 Dietary management when teeth are extracted
 Conclusion
 bibliography

Bibliography
 Gerodontic nutrition and dietary
counseling for prosthodontic patients
-Dent Clin N Am 47 [2003] 355-371
 Mayo Clinic-Diet manual-7th
edition
 Prosthodontic treatment for edentulous
patient- Boucher 12th
edition

 Essentials of complete denture
prosthodontics-Winkler s 2nd
edition.
 Text book of complete denture-
Heartwell -5th
edition
 Complete denture prosthodontics
– John J.sharry.

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