People who are above the age of 65 years are termed as geriatric persons.

1. NUTRITION IN
GERIATRIC PATIENTS
Dr. Arun Kumar Tiwari

2. CONTENTS
 Terminologies
 Energy requirements in humans
 Proper nutrition and its importance
 Nutritional importance of
 carbohydrates, lipids, proteins, vitamins, minerals, water
 Effects of nutritional deficiency
 On oral health and Periodontium
 Challenges of nutrition in the aging population
 Nutrition and osteoporosis
 Dietary counseling for Prosthodontic patient
 Conclusion
 List of references

3. INTRODUCTION
• Enjoyment of food is regarded as an important determinant of an adult’s quality of
life
• Mobile teeth, ill fitting complete dentures prosthesis or edentulism may preclude
eating favorite foods, as well as limits the intake of essential nutrients

4. INTRODUCTION
• Decreased chewing ability, fear of choking while eating and irritation of oral
mucosa when food particles get under the dentures may influence food choices of
the denture wearer
• Conversely, the nutritional status of a patient with dentures affects the health of the
oral tissues and patient’s adaption to a new prosthesis

5. INTRODUCTION
• In fact, well-designed and constructed dentures or an implant-supported prosthesis
may prove to be unsatisfactory for a patient because of poor tolerance by the
underlying tissues and bone
• Hence, denture failures can be due not only to imperfect design, but also to poorly
nourished tissues

6. TERMINOLOGIES
Nutrition:- It is the science that interprets the interaction of nutrients and other substances
in food in relation to maintenance, growth, reproduction, health and disease of an organism.
It includes food intake, absorption, assimilation, biosynthesis, catabolism and excretion.
Diet :- the total oral intake of substance that furnish nourishment and calories.
Nutrients:- are the constituents of food necessary to sustain the normal functions of the
body.
(According to WHO)

7. TERMINOLOGIES
Geriatrics :- The branch of medicine or dentistry that treats the problems peculiar to
the aging patient, including the clinical problems of senescence and senility
Gerodontics :- The treatment of dental problems of aging persons or problems
peculiar to advanced age
Gerodontology :- The study of the dentition and dental problems in aged or aging
persons
People who are above the age of 65 years are termed as geriatric persons

8. BALANCED DIET
It is defined as diet which contains a variety of food in such quantities and
proportions that the need for energy, amino acids, vitamins, minerals, fats,
carbohydrates and other nutrient is adequately met for maintaining health, vitality
and general well being and also make a small provision for extra nutrients to
withstand short duration of leanness.
(Concise Medical Physiology-Chaudhari)

9. IMPORTANCE OF PROPER NUTRITION
Essential nutrients to maintain good health are:-
• Carbohydrates
• Fat
• Protein
• Vitamins
• Minerals
• Water

10. Nutritional Importance of Carbohydrates
Contributes to 60-70% of total caloric requirement
Types of Carbohydrates
Simple
•candy, sweets, fruit
•individual glucose or fructose molecules
Complex
•rice, breads, potatoes
•Chains of glucose molecules
Non Digestible
•Pectin, gums, cellulose

11. Biologic Value of Proteins
• These support growth when given in high concentration.
• Proteins from animal sources-high EAA
• Proteins from plant sources-lower biologic value
…but can be combined

12. REQUIREMENTS OF PROTEINS IN HUMANS
• RDA average = 0.8 g/kg/day
• RDA athlete = 1.2-1.6 g/kg/day

13. NUTRITIONAL IMPORTANCE OF FATS
Provides 9cal/g of energy
• Saturated
• - Animal sources
• - Solid at room temperature
• Unsaturated (poly- or mono-)
• - Vegetable
• - Liquid at room temperature
• Provide essential fatty acids, fat soluble vitamins
• Protect internal organs, regulate temp, store energy during starvation

14. VITAMINS
• Organic substances that regulate numerous and diverse physiological processes in
the body
• Do not contain calories
• Two types:-
 Fat soluble
 Water soluble

15. WATER SOLUBLE VITAMINS
Vitamin B6 ( Pyridoxin ):- meat, fish, potato, bananas
Polyneuropathy
Biotin:- liver, egg yolk, yeast
Dermatitis, alopecia
Folate:- liver
Anaemia
VitaminB12 (Cobalamine):- animal products
pernicious anemia.
Vitamin C (Ascorbic acid):-Fresh fruits and vegetables
Scurvy

16. MINERALS
• Inorganic elements found in food that are essential to life processes
• About 25 are essential
• Classified as major or trace minerals
• Sodium, zinc, iron, fluoride, calcium, phosphorus, magnesium, potassium

17. 17
•Sodium
•Zinc
•Iron
•Fluoride
∙Regulates balance of body
fluids
∙Acid base balance
∙Blood pressure
∙Required for digestion
∙Wound healing
∙Tissue growth
∙Reproduction
∙Growth
∙Hb formation
∙Bone & tooth formation
∙Increase resistance to decay
∙Headache
∙Weakness, cramps
∙Retarded growth
∙Taste/smell alteration
∙Decreased immune function
∙Delayed wound healing
∙Slow physical /sexual maturity
∙Anemia
∙Loss of weight
∙Gastric disturbances
∙Pallor
∙Increased dental caries

18. •Calcium
•Phosphorus
•Magnesium
•Potassium
∙Development of bone & teeth
∙Clotting of blood
∙Muscle activity & nerve
function
∙Formation of bones & teeth
∙Acid base balance
∙Building bones
∙Nerve & muscle function
∙Blood clotting
∙Fluid & electrolyte balance
∙Muscle nerve function
∙Retarded growth
∙Poor tooth formation
∙Increase clotting time
∙Weakness, loss of appetite
∙Retarded growth
∙Porous bone
∙Poor tooth formation
∙Muscle twitching & tremors
∙Shaky hands
∙Muscular weakness
∙Arrhythmias

19. FUNCTIONS OF WATER
Comprises about 60% of body weight
• Chief component of blood plasma
• Aids in temperature regulation
• Lubricates joints
• Shock absorber in eyes, spinal cord and amniotic sac (during pregnancy)
• Helps in excretion
Infants
Children
Adolescents
Adults
Age (years)
Birth-1
0-10
11-18
19-51
Water (ml/kg body wt)
120-100
60-80
41-55
20-30

20. ROLE OF FLUORIDE
• Fluoride helps to maintain the hardness of bones and teeth.
• It also occurs in water, plants, seafood and animal foods.
• It reduces the number of microorganism causing decay.
• Pitted surface that are vulnerable to decay are mineralized by exposure to low
levels of fluoride.

21. POSSIBILITIES AND CHALLENGES OF NUTRITION IN
THE AGEING POPULATION

22. DEMOGRAPHICS OF NUTRITION IN OLDER ADULTS
Community
• 16% consume <1000 kcal daily
• Protein, calorie, vitamin deficiencies common
• 30% men, 40% women underweight after age 60
• Some of the elderly are malnourished, in a risk of malnutrition or obese, exercise
little, have many diseases and a lot of medication, and have a decreased function
ability

23. ENERGY INTAKE AND/ OR EXPENDITURE DECREASES
 HIGHER DEMANDS FOR THE NUTRIENT CONTENT OF THE DIET
 Sight
 Taste
 Smell
 Teeth
 Memory
 Body composition
 Ability to move
 Depression
 Loneliness
 Heart disease
 Diabetes
 Osteoporosis
NUTRITIONAL STATUS
OF THE ELDERLY
Intake vs. expenditure
FACTORS THAT INFLUENCE THE NUTRITIONAL
STATUS OF THE ELDERLY
ECONOMICAL
CHANGESPHYSIOLOGICAL
CHANGES
PSYCOLOGICAL
AND SOCIAL
CHANGES
MEDICATION
AND DISEASES

24.  Xerostomia
• Lack of salivation affects 70% of elderly
• This change creates a favorable envirornment for growth of
carogenic bacteria.
• A decrease in salivary flow can also be the result of illness
( diabetes mellitus and insipidus, nephritis, pernicious anemia)
• Administration of certain medications and other conditions,
such as menopause, x-ray irradiation and vitamin deficiencies.
Nutritionally Related Oral Problems In Elderly Patients

25. EFFECTS:-
1) The resulting dryness of the oral cavity, can lead to other symptoms. Among them are
abnormal taste sensations, burning of oral tissues and tongue.
2) The oral mucosa will become dry, smooth, and translucent.
3) A decrease in salivary flow will interfere with denture retention as well as make
mastication and deglutition difficult
TREATMENT:-
1) The use of artificial saliva and frequent mouth rinses
2) Coating the tissue surface of dentures with petrolatum, lubricating jelly, silicone fluids
can temporarily increase irritation of the underlying soft tissues.
3) Sialogues, drugs that stimulate flow of saliva, can be tried.
4) Pylocarpine hydrochloride in 5-mg doses before meals will cause flow for two to five
hours.
5) Sucking on a sour hard candy is often effective. (According to S. Winkler)

26. Severely resorbed mandible
Wical n Swoope….direct cause-and-effect between Ca intake and ridge resorption
due to alveolar osteoporosis. To estimate the amount of resorption , formula given
by Wical and swoope was used.
Dentures
• Chew 75-85% less efficiently
• Decreased intake of meat, fresh fruit, and veggies
Oral mucous membrane changes
• Burning sensation, pain, cracks in lips
• The epithelial membrane is thin and friable and easily injured
• It heals slowly because of impaired circulation.

27. Osteoporosis causes weak bones.
In this common disease, bones lose minerals
like calcium.
They become fragile and break easily.
Bone with
Osteoporosis
Normal
Bone
The “silent disease”
Often called the “silent disease”
Bone loss occurs without symptoms.

28. 28
FOOD PYRAMID FOR 70+ ADULTS
Fats, oils & sweets
USE SPARINGLY
Bread, cereal, rice & pasta
group
≥ 6 SERVINGS
Milk, yoghurt & cheese group
3 SERVINGS
Vegetable group
≥ 3 SERVINGS
Meat, poultry, fish, dry beans,
eggs, and nut group
≥ 2 SERVINGS
Calcium, vitamin D & B12
SUPPLEMENTS
F= Fibre
F F
F
F
Water
≥ 8 SERVINGS
Fruit group
≥ 2 SERVINGS

29. ORAL MANIFESTATIONS OF AGING
Loss of teeth Due primarily to degenerate of periodontal structures.
Attrition Rate is influenced by diet and masticatory habits
(bruxism).
Oral mucosa Loss of elasticity with dryness and atrophy.
Gingivae Loss of stippling. Edematous appearance. Keratinized
layer thin or absent. Tissue friable and easily injured.
Saliva Diminished function of salivary glands with relative
or absolute Xerostomia.
Tongue Atrophic glossitis, probably due to vitamin B
complex deficiency.
Lips Angular cheilosis is very common and related to
concurrent vitamin B deficiency and closed bite.

30. DIETARY COUNSELLING OF PATIENTS UNDERGOING
PROSTHODONTIC TREATMENT

31. Risk Factors For Malnutrition In Patients With Dentures
• Eating less than two meals/day
• Difficult chewing and swallowing
• Unplanned weight gain or loss of more than 10lb in the last 6 months
• Undergoing chemotherapy or radiation therapy
• Loose denture or sore spots under denture
• Oral lesions(glossitis, cheliosis or burning tongue)
• Severely resorbed mandible
• Alcohol or drug abuse

32. Alcoholism & Smoking
Decrease in food intake
Multiple nutrient deficiency Dehydration
(Vit B & C)
Thinning of oral mucosa Friable oral mucosa
Abrasion of the denture bearing mucosa
ALCOHOLISM, SMOKING & DENTURE

33. Cariogenic diet Ca++ deficiency Vitamin A & C deficiency
Caries of abutment Ridge resorption Poor periodontal health
Failure of abutment
FAILURE OF OVER DENTURE
NUTRITION AND OVER DENTURE

34. GUIDELINES FOR NUTRITON COUNSELING:-
1.Eat a variety of food- Maintain ideal weight
2.Build diet around complex carbohydrates
3.Include citrus fruit or juice containing Vitamin C everyday
4.Select fish, poultry, or dried peas and beans everyday
5.Obtain adequate Calcium e.g. milk products, curd,
cottage cheese
6.Limit intake of bakery products high in fat and
simple sugars- Simple desserts are best (custard and fruits)

35. 7. Limit intake of processed foods high in Sodium and fat-Instead of using salt use
other herbs e.g. oregano, garlic, onion.
8. Consume 6- 8 glasses of fluid daily which includes soups, coffee, tea, juices as well
as water.
9. Plan interesting meals, plan other activities around mealtimes( listen to music or
watch TV )
10. Limit the intake of alcohol thought use of an alcoholic beverages before a meal
may stimulate the appetite

36. DIETARY COUNSELING FOR DENTURE WEARERS
 Helping new denture wearers learn to chew
Diet for the first day after denture insertion:-
 full-liquid diet
Acc. to Nutritional approach to aging research-Moment

37. Diet For The 2nd And 3rd Day After Denture Insertion:-
pureed diet to soft diet
• Bread/cereal group- khichdi, cooked cereals, milk, toast and soften bread, puffed rice
• Vegetable group- juices, well cooked carrots, green beans, mashed potatoes, creamed
vegetables
• Fruit group- well-cooked fruits (no seeds), juices
• Meat group- soft boil eggs, chopped meat, non veg soups.
Dairy products- milk, curds, butter milk

38. Diet For The Fourth Day And Later:
soft diet to regular diet as tolerated
• As soon as sore spots are healed, firmer foods can be eaten
• Best to cut food into small pieces
• Success of dentures - manage sandwiches and salads of raw fruit and vegetables

39. CONCLUSION
NUTRITION is very important for Health, Fitness & positive lifestyle.
Serious deficiency in a variety of Nutrients over the long term will lead to variety of
diseases & has a negative influence on the Health as well as the soft tissues of the oral
cavity.
Nutrition is but one of the many factors which determine success or failure of prosthetic
appliances in the mouths of aging people.
The Prosthodontist should be aware, however, that a well-balanced diet of essential
nutrients is vitally essential to the general health of his patient and to the success of his
dentures.

40. REFERENCES
• Nutrition, Diet & Oral health- Rugg ,Gunn, Nunn
• Text book of biochemistry- A.C. Deb
• Text book of Physiology- Choudhury
• Nutritional approach to aging research-Moment
• Journal of Indian Prosthodontic Society 2006
• Essential of complete denture prosthodontics- Winkler
• Syllabus of complete denture- Heartwell
• Treatment for edentulous patients- Boucher

41. THANK YOU