Role of vitamins and minerals in geriatric patients/ oral surgery courses

ROLE OF VITAMINS ANDROLE OF VITAMINS AND
MINERALS IN GERIATRICMINERALS IN GERIATRIC
PATIENTSPATIENTS
INDIAN DENTAL ACADEMYINDIAN DENTAL ACADEMY
Leader in continuing Dental EducationLeader in continuing Dental Education
www.indiandentalacademy.comwww.indiandentalacademy.com

CONTENTSCONTENTS
IntroductionIntroduction
DefinitionsDefinitions
Classification of foodClassification of food
Chemical composition of human bodyChemical composition of human body
RDARDA
Vitamins-Vitamins- water solublewater soluble
fat solublefat soluble
Vitamin requirements in the elderlyVitamin requirements in the elderly
Minerals-Minerals- essential macromineralsessential macrominerals
essential micromineralsessential microminerals
Mineral requirements in the elderlyMineral requirements in the elderly
Impact of dental status on food intakeImpact of dental status on food intake
Oral problems in geriatric patients related to deficient vitamins and mineralsOral problems in geriatric patients related to deficient vitamins and minerals
Nutritional needs and status of older adultsNutritional needs and status of older adults
Food pyramidFood pyramid
Review of literatureReview of literature
Summary and conclusionSummary and conclusion
ReferencesReferences

INTRODUCTIONINTRODUCTION
The nutrition of elderly people is of growingThe nutrition of elderly people is of growing
interest to many health professionals. Studiesinterest to many health professionals. Studies
concerning the effect of edentulousness andconcerning the effect of edentulousness and
complete denture prostheses functioning oncomplete denture prostheses functioning on
nutrition in elderly people have producednutrition in elderly people have produced
controversial results, nor is it clear, howcontroversial results, nor is it clear, how
chewing efficacy influences human eatingchewing efficacy influences human eating
patterns or the nutritional quality of diet.patterns or the nutritional quality of diet.
Nevertheless, elderly people are very oftenNevertheless, elderly people are very often
deficient in one or several nutrients or minerals.deficient in one or several nutrients or minerals.

Thus a decreased plasma concentration of aThus a decreased plasma concentration of a
vitamin like thiamin, riboflavin or folic acid invitamin like thiamin, riboflavin or folic acid in
elderly people may be associated with reducedelderly people may be associated with reduced
tolerance to removable complete denturetolerance to removable complete denture
prostheses. There is also evidence that dietaryprostheses. There is also evidence that dietary
supplements of proteins and minerals increasesupplements of proteins and minerals increase
tolerance to complete denture prostheses.tolerance to complete denture prostheses.
Thus, a major reason of poor adaptation ofThus, a major reason of poor adaptation of
complete denture prostheses in elderly patientscomplete denture prostheses in elderly patients
is often reduced tissue tolerance resulting fromis often reduced tissue tolerance resulting from
an inadequate diet. Dentists should thereforean inadequate diet. Dentists should therefore
be prepared to access the nutritional quality ofbe prepared to access the nutritional quality of
the diets of prosthetic patients and to guidethe diets of prosthetic patients and to guide
them towards good nutritional practices.them towards good nutritional practices.www.indiandentalacademy.comwww.indiandentalacademy.com

DEFINITIONSDEFINITIONS
VITAMINS:VITAMINS:
Vitamins are organic nutrients which are required inVitamins are organic nutrients which are required in
small quantities for a variety of biochemical functionssmall quantities for a variety of biochemical functions
and which generally cannot be synthesized by theand which generally cannot be synthesized by the
body, and must therefore be supplied by the diet.body, and must therefore be supplied by the diet.
((HARPERHARPER))
A vitamin is defined as an organic substance thatA vitamin is defined as an organic substance that
occurs in foods in small amounts and is necessary foroccurs in foods in small amounts and is necessary for
the normal metabolic functioning of the body. (NIZELthe normal metabolic functioning of the body. (NIZEL
AND PAPAS)AND PAPAS)
Vitamins are the accessory food factors or essentialVitamins are the accessory food factors or essential
compounds which are organic in nature, occurring incompounds which are organic in nature, occurring in
natural foods, synthesized in body, required in minutenatural foods, synthesized in body, required in minute
amounts for normal growth, reproduction e.t.camounts for normal growth, reproduction e.t.c. (. (A.C.A.C.
DEB.)DEB.)

MINERALS:MINERALS:
Minerals are elements required for both physiologicalMinerals are elements required for both physiological
and biochemical functions of the body and are dividedand biochemical functions of the body and are divided
arbitrarily into two groups of macrominerals andarbitrarily into two groups of macrominerals and
microminerals respectively. (HARPERmicrominerals respectively. (HARPER))
The chemical element exclusive of the commonThe chemical element exclusive of the common
elements, carbon, hydrogen, oxygen and sulphur,elements, carbon, hydrogen, oxygen and sulphur,
required for normal structure and functions of the bodyrequired for normal structure and functions of the body
are collectively called as minerals, their studyare collectively called as minerals, their study
bioinorganic chemistry, and are classified asbioinorganic chemistry, and are classified as
macrominerals and microminerals. (N.V. BHAGAVAN)macrominerals and microminerals. (N.V. BHAGAVAN)

NUTRITIONAL STATUSNUTRITIONAL STATUS::
Nutritional status is defined as the “health condition ofNutritional status is defined as the “health condition of
an individual as influenced by his intake and utilizationan individual as influenced by his intake and utilization
of nutrients determined from the correlation ofof nutrients determined from the correlation of
information from physical, biochemical, clinical andinformation from physical, biochemical, clinical and
dietary studies (NIZEL AND PAPAS).dietary studies (NIZEL AND PAPAS).
FOOD:FOOD:
Food can be defined as an edible substance made upFood can be defined as an edible substance made up
of a variety of nutrients that nourish the body. (NIZELof a variety of nutrients that nourish the body. (NIZEL
AND PAPAS).AND PAPAS).
DIET:DIET:
Diet can be defined as the types and amounts of foodDiet can be defined as the types and amounts of food
eaten daily by an individual.eaten daily by an individual.

RECOMMENDED DIETARY ALLOWANCE:RECOMMENDED DIETARY ALLOWANCE:
The RDAs are sets of values for levels of intake of the nutrientsThe RDAs are sets of values for levels of intake of the nutrients
currently considered normal.currently considered normal. ((NIZEL and PAPAS)NIZEL and PAPAS)
RDA are levels of intake of essential nutrients considered in theRDA are levels of intake of essential nutrients considered in the
judgement of the Committee on Dietary Allowances of the Foodjudgement of the Committee on Dietary Allowances of the Food
and Nutrition Board on basis of available Scientific Knowledge,and Nutrition Board on basis of available Scientific Knowledge,
to be adequate to meet the nutritional needs of practicallyto be adequate to meet the nutritional needs of practically
healthy persons.(HARPER)healthy persons.(HARPER)
MALNUTRITION:MALNUTRITION:
Malnutrition is a generic term given to the patho-physiologicalMalnutrition is a generic term given to the patho-physiological
consequences of ingestion of inadequate, excessive orconsequences of ingestion of inadequate, excessive or
unbalanced amounts of essential nutrients (Primaryunbalanced amounts of essential nutrients (Primary
malnutrition), as well as the impaired utilization of thesemalnutrition), as well as the impaired utilization of these
nutrients brought about by factors such as disease (Secondarynutrients brought about by factors such as disease (Secondary
malnutrition).malnutrition).

AS GIVEN BY HEARTWELL:AS GIVEN BY HEARTWELL:
GERONTOLOGY:GERONTOLOGY:
Is the scientific study of the process andIs the scientific study of the process and
phenomenon of aging.phenomenon of aging.
As defined by the Gerontological society inAs defined by the Gerontological society in
1959 is the branch of knowledge, which is1959 is the branch of knowledge, which is
concerned with situations and changes inherentconcerned with situations and changes inherent
in increments of time, with particular referencein increments of time, with particular reference
to post-maturational stages.to post-maturational stages.
Gerontology or gerodontics is the branch ofGerontology or gerodontics is the branch of
dentistry that deals with the oral healthdentistry that deals with the oral health
problems of older people.problems of older people.
SENILITY:SENILITY:
Is old age accompanied by infirmity.Is old age accompanied by infirmity.www.indiandentalacademy.comwww.indiandentalacademy.com

AS GIVEN IN, GPT – 8AS GIVEN IN, GPT – 8
GERIATRICS:GERIATRICS:
The branch of medicine that treats all problemsThe branch of medicine that treats all problems
peculiar to the aging patient, including the clinicalpeculiar to the aging patient, including the clinical
problems of senescence and senility.problems of senescence and senility.
DENTAL GERIATRICS:DENTAL GERIATRICS:
The branch of dental care involving problems peculiarThe branch of dental care involving problems peculiar
to advanced age and agingto advanced age and aging
Dentistry for the aged patient.Dentistry for the aged patient.
GERODONTICS:GERODONTICS:
The treatment of dental problems of aging persons,The treatment of dental problems of aging persons,
also spelled Geriodontics.also spelled Geriodontics.
GERODONTOLOGY:GERODONTOLOGY:
The study of the dentition and dental problems in agedThe study of the dentition and dental problems in aged
or aging persons.or aging persons. www.indiandentalacademy.comwww.indiandentalacademy.com

CLASSIFICATION OF FOOD:CLASSIFICATION OF FOOD:
1.1. By originBy origin
a. Plant fooda. Plant food
Cereals, legumes, fruits, vegetables, sugars, oils.Cereals, legumes, fruits, vegetables, sugars, oils.
b. Animal productsb. Animal products
Meat, fish, milk, dairy products, eggs, poultry products.Meat, fish, milk, dairy products, eggs, poultry products.
2.2. By chemical compositionBy chemical composition
a) Macronutrientsa) Macronutrients
ProteinsProteins
FatsFats
CarbohydratesCarbohydrates
b) Micronutrientsb) Micronutrients
Vitamins
Minerals
3.3. By predominant functionBy predominant function
Body building foods (Proteins)Body building foods (Proteins)
Energy giving foods (Carbohydrates, fats)Energy giving foods (Carbohydrates, fats)
Protective foods (Minerals, vitamins)Protective foods (Minerals, vitamins)www.indiandentalacademy.comwww.indiandentalacademy.com

CHEMICAL COMPOSITION OF THE HUMANCHEMICAL COMPOSITION OF THE HUMAN
BODY (IN AN INDIVIDUAL WEIGHING 65 KG,BODY (IN AN INDIVIDUAL WEIGHING 65 KG,
say)say)
PROTEIN 11 Kg 17%PROTEIN 11 Kg 17%
FAT 9 Kg 13.8%FAT 9 Kg 13.8%
CARBOHYDRATE 1 Kg 1.5%CARBOHYDRATE 1 Kg 1.5%
WATER 40 Kg 61.6%WATER 40 Kg 61.6%
MINERALS 4 Kg 6.1%MINERALS 4 Kg 6.1%
(THESE ARE THE CHIEF COMPONENTS OF THE(THESE ARE THE CHIEF COMPONENTS OF THE
HUMAN BODY.)HUMAN BODY.)www.indiandentalacademy.comwww.indiandentalacademy.com

RECOMMENDED DIETARY ALLOWANCESRECOMMENDED DIETARY ALLOWANCES
Recommended dietary allowances for the elderlyRecommended dietary allowances for the elderly
currently includes two age groupings for energycurrently includes two age groupings for energy
allowance-allowance-
Persons aged 51 – 75.Persons aged 51 – 75.
Persons aged 76 or older.Persons aged 76 or older.
But the RDA for vitamins and minerals includes onlyBut the RDA for vitamins and minerals includes only
one age grouping-one age grouping-
Those aged 51 and older.Those aged 51 and older.
It is determined on the basis of the entire range ofIt is determined on the basis of the entire range of
normal human needs.normal human needs.
(Data are yet not available for a more detailed(Data are yet not available for a more detailed
breakdown.)breakdown.)

VITAMINSVITAMINS
Humans must ingest a number of complex organicHumans must ingest a number of complex organic
molecules called VITAMINS in order to maintainmolecules called VITAMINS in order to maintain
normal health. Vitamins are generally converted in thenormal health. Vitamins are generally converted in the
body to more complex molecules called co-enzymesbody to more complex molecules called co-enzymes
that play key roles in many cellular reactions.that play key roles in many cellular reactions.
CLASSIFICATIONCLASSIFICATION
WATER SOLUBLE VITAMINS:WATER SOLUBLE VITAMINS:
Vitamins B and C.Vitamins B and C.
FAT SOLUBLE VITAMINSFAT SOLUBLE VITAMINS
Vitamins A, D, E and K.Vitamins A, D, E and K.

WATER SOLUBLE VITAMINSWATER SOLUBLE VITAMINS
VITAMIN B complexVITAMIN B complex includes a group of compounds most ofincludes a group of compounds most of
which are synthesized in the body by the microbial flora in thewhich are synthesized in the body by the microbial flora in the
gastrointestinal tract.gastrointestinal tract.
THIAMINE (VITAMIN B1)THIAMINE (VITAMIN B1)
First member of vitamin B complex.First member of vitamin B complex.
Also called anti beri-beri factor.Also called anti beri-beri factor.
SOURCES AND REQUIREMENTS:SOURCES AND REQUIREMENTS:
Is widely distributedIs widely distributed
Rich sources include- cereal grains, yeast, meat, liver, kidneyRich sources include- cereal grains, yeast, meat, liver, kidney
and heart.and heart.
Daily requirement depends upon the carbohydrate intake of theDaily requirement depends upon the carbohydrate intake of the
individual and has been defined as 0.5 mg/Kcal.individual and has been defined as 0.5 mg/Kcal.
Average adult daily requirement is 1.2 – 1.8 mg/day.Average adult daily requirement is 1.2 – 1.8 mg/day.
DEFICIENCY SYMPTOMS:DEFICIENCY SYMPTOMS:
Deficiency causesDeficiency causes beri beriberi beri which affects all tissues.which affects all tissues.www.indiandentalacademy.comwww.indiandentalacademy.com

RIBOFLAVIN (VITAMIN B2)RIBOFLAVIN (VITAMIN B2)
Also called as lactoflavin.Also called as lactoflavin.
Though it is widely distributed in nature, milk, liver and kidneyThough it is widely distributed in nature, milk, liver and kidney
are rich sources.are rich sources.
Average daily requirements is 1 -2 gms/day.Average daily requirements is 1 -2 gms/day.
Deficiency of vit B2 is not common, but is associated with theDeficiency of vit B2 is not common, but is associated with the
deficiency of iron and with Pellagra.deficiency of iron and with Pellagra.
Symptoms include, lesions of lips, cheilosis(fissures of theSymptoms include, lesions of lips, cheilosis(fissures of the
angles of the mouth), glossitis, localized dermatitis of faceangles of the mouth), glossitis, localized dermatitis of face
besides disorders of the eyes like photophobia, lacrymation,besides disorders of the eyes like photophobia, lacrymation,
burning and itching of the eyes.burning and itching of the eyes.

NIACINNIACIN
Also known asAlso known as “Pellagra Preventive Factor”.“Pellagra Preventive Factor”.
Good sources are rice polish, yeast, liver, poultry andGood sources are rice polish, yeast, liver, poultry and
green vegetables.green vegetables.
Average daily requirement is 12 – 20 mg/day.Average daily requirement is 12 – 20 mg/day.
Deficiency cause a disease calledDeficiency cause a disease called Pellagra,Pellagra, which iswhich is
characterized by dermatitis, diarrhea and dementia.characterized by dermatitis, diarrhea and dementia.
Depression, confusion and psychosis is alsoDepression, confusion and psychosis is also
observed.observed. www.indiandentalacademy.comwww.indiandentalacademy.com

DERMATITIS OF THE SKIN
CASAL’S NECKLACE
ACUTE STAGE OF PELLAGRA-ENTIRE ORAL
MUCOSA BECOMS FIERY RED AND PAINFULwww.indiandentalacademy.comwww.indiandentalacademy.com

PYRIDOXINE (B6)PYRIDOXINE (B6)
Rich sources are eggs, fish, green leafy vegetablesRich sources are eggs, fish, green leafy vegetables
and cereals.and cereals.
Besides, it is produced by the microorganisms of theBesides, it is produced by the microorganisms of the
intestinal tract of animal and man.intestinal tract of animal and man.
Daily requirement is approximately 1 – 2 mg.Daily requirement is approximately 1 – 2 mg.
Deficiency has been shown to be due to theDeficiency has been shown to be due to the
administration of antagonists such as anti tubercularadministration of antagonists such as anti tubercular
drug isonicotinhydrazide. Deficiency symptomsdrug isonicotinhydrazide. Deficiency symptoms
include cheilosis, glossitis, hypochromic anaemia andinclude cheilosis, glossitis, hypochromic anaemia and
depression in leucocyte counts.depression in leucocyte counts.www.indiandentalacademy.comwww.indiandentalacademy.com

FOLIC ACIDFOLIC ACID
Generic name is Folacin.Generic name is Folacin.
Present in all green leafy vegetables such as spinach, cabbagePresent in all green leafy vegetables such as spinach, cabbage
e.t.c., besides yeast, liver and kidney.e.t.c., besides yeast, liver and kidney.
Average daily adult requirement is 150 - 300µg.Average daily adult requirement is 150 - 300µg.
Not generally observed as it is synthesized by the intestinalNot generally observed as it is synthesized by the intestinal
flora, but deficiency may occur in pregnancy, intestinalflora, but deficiency may occur in pregnancy, intestinal
malabsorption or on antibiotics therapy.malabsorption or on antibiotics therapy.
Symptoms include, psychosis, mental retardation, anaemia andSymptoms include, psychosis, mental retardation, anaemia and
leucopenia.leucopenia.

VITAMIN B12VITAMIN B12
It is also called cyanacobalamin.It is also called cyanacobalamin.
Vitamin B12 is absorbed from the gastrointestinal tract in the presence ofVitamin B12 is absorbed from the gastrointestinal tract in the presence of
intrinsic factor (a constituent of gastric juice) and is stored in the liver.intrinsic factor (a constituent of gastric juice) and is stored in the liver.
The primary source is the synthesis by the intestinal microbial flora.The primary source is the synthesis by the intestinal microbial flora.
Besides good sources are liver, kidney, eggs, fish and milk.Besides good sources are liver, kidney, eggs, fish and milk.
Average daily requirement is 1 – 3µg.Average daily requirement is 1 – 3µg.
Not generally observed due to its widespread nature in animal tissues andNot generally observed due to its widespread nature in animal tissues and
synthesis by the microbial flora, except in geriatric cases or in strictsynthesis by the microbial flora, except in geriatric cases or in strict
vegetarians.vegetarians.
Deficiency may be seen either due to defective absorption of the vitamin inDeficiency may be seen either due to defective absorption of the vitamin in
the alimentary canal as a result of bacterial and parasitic infections or due tothe alimentary canal as a result of bacterial and parasitic infections or due to
the deficiency of intrinsic factor as inthe deficiency of intrinsic factor as in pernicious anaemia.pernicious anaemia.

VITAMIN CVITAMIN C
The most important compound with vitamin C activity isThe most important compound with vitamin C activity is L-ASCORBIC ACID.L-ASCORBIC ACID.
Majority of the animals can synthesize ascorbic acid from glucoronate, butMajority of the animals can synthesize ascorbic acid from glucoronate, but
man has to depend upon exogenous supply.man has to depend upon exogenous supply.
Dietary vitamin C is readily absorbed from the intestinal tract.Dietary vitamin C is readily absorbed from the intestinal tract.
Its absorption is reduced in intestinal infections and in achlohydria.Its absorption is reduced in intestinal infections and in achlohydria.
Widely distributed in citrus fruits, green chilies, guava and tomatoes.Widely distributed in citrus fruits, green chilies, guava and tomatoes.
Amla is the richest source of vitamin C.Amla is the richest source of vitamin C.
Since human body cannot synthesize vitamin C, its daily requirement hasSince human body cannot synthesize vitamin C, its daily requirement has
been defined as 25 – 30mg.been defined as 25 – 30mg.
Prolonged deficiency causesProlonged deficiency causes scurvy,scurvy, which is characterized by multiplewhich is characterized by multiple
haemorrhages.haemorrhages.
Early symptoms include, bleeding gums, loosening of teeth and joints pain.Early symptoms include, bleeding gums, loosening of teeth and joints pain.
In severe cases there may be epistaxis or bleeding from the GIT orIn severe cases there may be epistaxis or bleeding from the GIT orwww.indiandentalacademy.comwww.indiandentalacademy.com

This vitamin is necessary for the production of intercellularThis vitamin is necessary for the production of intercellular
cementing substances. It has a significant effect on bonecementing substances. It has a significant effect on bone
formation and repair. Osteoblasts secrete osteoid that consistsformation and repair. Osteoblasts secrete osteoid that consists
primarily of type 1 collagen. Therefore a deficiency in theprimarily of type 1 collagen. Therefore a deficiency in the
vitamin results in reduced capacity of osteoblasts to formvitamin results in reduced capacity of osteoblasts to form
collagen. Matrix formation is poor and hence wound healing iscollagen. Matrix formation is poor and hence wound healing is
also delayed. The bone formed is tender and fragile.also delayed. The bone formed is tender and fragile.
Vitamin C intake generally declines with age. An inverseVitamin C intake generally declines with age. An inverse
correlation between age and ascorbate levels in whole blood,correlation between age and ascorbate levels in whole blood,
plasma and leukocytes has been reported. Heavy smokers,plasma and leukocytes has been reported. Heavy smokers,
alcohol abusers, or persons with high aspirin intake have aalcohol abusers, or persons with high aspirin intake have a
higher daily requirement for ascorbic acid. The completehigher daily requirement for ascorbic acid. The complete
denture prostheses patient should be encouraged to consumedenture prostheses patient should be encouraged to consume
vitamin C rich food such as citrus fruits, peppers, melons, kiwivitamin C rich food such as citrus fruits, peppers, melons, kiwi
fruit, mangoes, tomatoes, papaya and strawberries daily.fruit, mangoes, tomatoes, papaya and strawberries daily.www.indiandentalacademy.comwww.indiandentalacademy.com

FAT SOLUBLE VITAMINSFAT SOLUBLE VITAMINS
VITAMIN AVITAMIN A
Good sources are animal liver oil, eggs, milk and milk products.Good sources are animal liver oil, eggs, milk and milk products.
CaroteneCarotene rich sources are papaya, carrots, sweet potato and green leafyrich sources are papaya, carrots, sweet potato and green leafy
vegetables.vegetables.
Average daily requirement for adults is 750 µg.Average daily requirement for adults is 750 µg.
DEFICIENCY DISEASES:DEFICIENCY DISEASES:
Xerophthalmia, Bilot’s spots, Keratomalacia, affects osteoblastic activity thusXerophthalmia, Bilot’s spots, Keratomalacia, affects osteoblastic activity thus
affecting growth.affecting growth.
Vitamin A deficiency is characterized by retardation of skeletal growth andVitamin A deficiency is characterized by retardation of skeletal growth and
maturation. Hypervitaminosis A results in tender painful swellings generallymaturation. Hypervitaminosis A results in tender painful swellings generally
along the course of the long bones in adults.along the course of the long bones in adults.www.indiandentalacademy.comwww.indiandentalacademy.com

VITAMIN DVITAMIN D
Vitamin DVitamin D (calciferol)(calciferol) is present in nature in several forms.is present in nature in several forms.
Common forms include ; vitamin D2 (Common forms include ; vitamin D2 (ergocalciferol,ergocalciferol, which is thewhich is the
active synthetic compound used for therapy in humans) , and,active synthetic compound used for therapy in humans) , and,
vitamin D3 (vitamin D3 (cholecalciferolcholecalciferol, which is found in animals and is, which is found in animals and is
derived from 7-dehydrocholesterol by ultraviolet irradiation inderived from 7-dehydrocholesterol by ultraviolet irradiation in
human skin).human skin).
Rich sources are milk, butter, egg yolk and fish liver oil.Rich sources are milk, butter, egg yolk and fish liver oil.
Average daily requirement is 200 I.U.Average daily requirement is 200 I.U.
Generally does not occur as it can be synthesized in the body.Generally does not occur as it can be synthesized in the body.
Deficiency in children leads to development of rickets and inDeficiency in children leads to development of rickets and in
adults leads to osteomalacia.adults leads to osteomalacia.www.indiandentalacademy.comwww.indiandentalacademy.com

Angus and coworkers isolated vitamin D in 1931 andAngus and coworkers isolated vitamin D in 1931 and
named it as calciferol. The production of vitamin D innamed it as calciferol. The production of vitamin D in
the skin is directly proportional to the exposure tothe skin is directly proportional to the exposure to
sunlight and inversely proportional to the pigmentationsunlight and inversely proportional to the pigmentation
of skin. The cholecalciferol is first transported to liver,of skin. The cholecalciferol is first transported to liver,
where hydroxylation occurs, to form 25 hydroxywhere hydroxylation occurs, to form 25 hydroxy
cholecalciferol and is the major transport form. In thecholecalciferol and is the major transport form. In the
kidney, it is further hydroxylated at the 1st positionkidney, it is further hydroxylated at the 1st position
forming 1,25-dihydroxy cholecalciferol, also calledforming 1,25-dihydroxy cholecalciferol, also called
Calcitriol, the active form of the vitamin.Calcitriol, the active form of the vitamin.

Vitamin D and Intestinal Absorption of CalciumVitamin D and Intestinal Absorption of Calcium::
Vitamin D promotes the absorption of calcium andVitamin D promotes the absorption of calcium and
phosphorus from the intestine. In the brush-border surface,phosphorus from the intestine. In the brush-border surface,
calcium is absorbed passively and this is dependent uponcalcium is absorbed passively and this is dependent upon
adequate supplies of vitamin D.adequate supplies of vitamin D.
Effect of Vitamin D in Bone:Effect of Vitamin D in Bone:
MineralisationMineralisation of the bone is increased by increasing theof the bone is increased by increasing the
activity of osteoblasts. Vitamin D stimulates osteoblasts whichactivity of osteoblasts. Vitamin D stimulates osteoblasts which
secrete alkaline phosphatase. Due to this enzyme, the localsecrete alkaline phosphatase. Due to this enzyme, the local
concentration of phosphate is increased. The ionic product ofconcentration of phosphate is increased. The ionic product of
calcium and phosphorus increases, leading to mineralisation.calcium and phosphorus increases, leading to mineralisation.
Effect of Vitamin D in Renal Tubules:Effect of Vitamin D in Renal Tubules:
Vitamin D increases the reabsorption of calcium andVitamin D increases the reabsorption of calcium and
phosphorus by renal tubules, therefore both minerals arephosphorus by renal tubules, therefore both minerals are
conserved.conserved. www.indiandentalacademy.comwww.indiandentalacademy.com

VITAMIN EVITAMIN E
Has strong anti oxidant properties.Has strong anti oxidant properties.
Rich sources are oils such as corn oil, cotton seed oil andRich sources are oils such as corn oil, cotton seed oil and
sunflower oil.sunflower oil.
Tocopherols are present in small quantities in green leafyTocopherols are present in small quantities in green leafy
vegetables, milk and milk products and egg yolk.vegetables, milk and milk products and egg yolk.
Requirement depends upon the intake of PUFA and has beenRequirement depends upon the intake of PUFA and has been
defined as nearly 0.4 mg of PUFA.defined as nearly 0.4 mg of PUFA.
On an average 5 – 10mg of vitamin E is sufficient daily.On an average 5 – 10mg of vitamin E is sufficient daily.
Sprue, creatinuria, peptic ulceration, abnormal red cellSprue, creatinuria, peptic ulceration, abnormal red cell
hemolysis and their diminished life span.hemolysis and their diminished life span.

VITAMIN KVITAMIN K
Derived from the Danish word “Koagulation” because of itsDerived from the Danish word “Koagulation” because of its
important role in blood clotting.important role in blood clotting.
Vitamin K is essential for the maintenance of normal levels ofVitamin K is essential for the maintenance of normal levels of
some blood clotting factors (viz.prothrombin, factor7, 9 and 10).some blood clotting factors (viz.prothrombin, factor7, 9 and 10).
Is found in abundance in green leafy vegetables such asIs found in abundance in green leafy vegetables such as
spinach, lettuce and cabbage.spinach, lettuce and cabbage.
Besides good sources are fish meal, liver and skeletal muscle.Besides good sources are fish meal, liver and skeletal muscle.
Requirements in adults are not well established but between 20Requirements in adults are not well established but between 20
- 100µg/day is sufficient.- 100µg/day is sufficient.
Common deficiency symptoms include cutaneous and intraCommon deficiency symptoms include cutaneous and intra
muscular haemorrhages which show bluish- red coloration inmuscular haemorrhages which show bluish- red coloration in
different parts of the body.different parts of the body.

VITAMIN REQUIREMENTS IN THE ELDERLYVITAMIN REQUIREMENTS IN THE ELDERLY
Elderly persons usually ingest foods rich inElderly persons usually ingest foods rich in vitamin Avitamin A sparingly:sparingly:
thus the intake is substantially below the RDA for vitamin A. Inthus the intake is substantially below the RDA for vitamin A. In
spite of this hypervitaminosis A may be more of a problem thanspite of this hypervitaminosis A may be more of a problem than
vitamin A deficiency because of excessive use of multivitaminvitamin A deficiency because of excessive use of multivitamin
tablet supplements by the elderly leading to an increase intablet supplements by the elderly leading to an increase in
vitamin A absorption.vitamin A absorption.
The elderly are frequently deficient inThe elderly are frequently deficient in vitamin Dvitamin D because of thebecause of the
lack of sun exposure and an inability to synthesize vitamin D inlack of sun exposure and an inability to synthesize vitamin D in
skin and convert it in the kidney.skin and convert it in the kidney.
Vitamin EVitamin E deficiency in the elderly does not seem to be adeficiency in the elderly does not seem to be a
problem. Therefore the use of megavitamin E preparations isproblem. Therefore the use of megavitamin E preparations is
not indicated. Total plasma vitamin E levels increase with age.not indicated. Total plasma vitamin E levels increase with age.

Vitamin CVitamin C intake generally declines with age. An inverseintake generally declines with age. An inverse
correlation between age and ascorbate levels in whole blood,correlation between age and ascorbate levels in whole blood,
plasma and leucocytes has been reported.plasma and leucocytes has been reported.
Vitamin B complexVitamin B complex deficiencies are seen mainly in alcoholicsdeficiencies are seen mainly in alcoholics
because they do not eat enough bread or cereals. Enrichmentbecause they do not eat enough bread or cereals. Enrichment
of bread and flour products with vitamin B complex (thiamin,of bread and flour products with vitamin B complex (thiamin,
riboflavin and niacin) by the baker or cereal manufacturer isriboflavin and niacin) by the baker or cereal manufacturer is
mandatory.mandatory.
FolacinFolacin intake is adequate for most elderly persons in spite ofintake is adequate for most elderly persons in spite of
the fact that it generally falls below the RDA of 500µg.the fact that it generally falls below the RDA of 500µg.
Vitamin B6 (pyridoxine)Vitamin B6 (pyridoxine) deficiency ranges from 50%to 90% ofdeficiency ranges from 50%to 90% of
the elderly affected, which may be an important cause of thethe elderly affected, which may be an important cause of the
increased prevalence of the carpal tunnel syndrome (anincreased prevalence of the carpal tunnel syndrome (an
inflamed tendon attached to the wrist bone) in the elderly.inflamed tendon attached to the wrist bone) in the elderly.

MINERALSMINERALS
Minerals are non organic homogeneous solidMinerals are non organic homogeneous solid
substances of the earth’s crust required forsubstances of the earth’s crust required for
both physiological and biochemical functioningboth physiological and biochemical functioning
of the body.of the body.
Minerals may be divided into to groups:Minerals may be divided into to groups:

MACROMINERALS-These are required in amountsMACROMINERALS-These are required in amounts
greater than 100 mg/dl.greater than 100 mg/dl.
Eg; Ca, P, Na, K, Cl, MgEg; Ca, P, Na, K, Cl, Mg

MICROMINERALS- These are required in amountsMICROMINERALS- These are required in amounts
less than 100 mg/dl. These are also knownless than 100 mg/dl. These are also known
as Trace elements.as Trace elements.
Eg; Cr, Co, Cu, Fe, I, Mn, Mo, Se, Si, Zn, Fl.Eg; Cr, Co, Cu, Fe, I, Mn, Mo, Se, Si, Zn, Fl.www.indiandentalacademy.comwww.indiandentalacademy.com

ESSENTIAL MACRO MINERALSESSENTIAL MACRO MINERALS
CALCIUMCALCIUM
FUNCTIONS- Constituent of bones, teeth, regulationFUNCTIONS- Constituent of bones, teeth, regulation
of nerve and muscle function.of nerve and muscle function.
SOURCES- Dairy products, beans, leafy vegetables.SOURCES- Dairy products, beans, leafy vegetables.
DEFICIENCY DISEASE- Rickets(children) andDEFICIENCY DISEASE- Rickets(children) and
osteomalacia(adults).osteomalacia(adults).
Also contributes to osteoporosis.Also contributes to osteoporosis.
TOXICITY DISEASE- Occurs with excess absorptionTOXICITY DISEASE- Occurs with excess absorption
due to hypervitaminosis D or hypercalcemia due todue to hypervitaminosis D or hypercalcemia due to
hyperparathyroidismhyperparathyroidism..www.indiandentalacademy.comwww.indiandentalacademy.com

PHOSPHORUSPHOSPHORUS
SOURCES- Phosphate food additivesSOURCES- Phosphate food additives
FUNCTIONS- Constituent of bones, teeth, ATP,FUNCTIONS- Constituent of bones, teeth, ATP,
TOXICITY DISEASE- Low serum calcium:phosphorus ratioTOXICITY DISEASE- Low serum calcium:phosphorus ratio
stimulates secondary hyperparathyroidism; may lead to bonestimulates secondary hyperparathyroidism; may lead to bone
loss.loss.
SODIUMSODIUM
SOURCES- Table salt, salt added to prepared food.SOURCES- Table salt, salt added to prepared food.
FUNCTIONS- Principal cation in extra cellular fluid, regulatesFUNCTIONS- Principal cation in extra cellular fluid, regulates
plasma volume, acid base balance, nerve and muscle function,plasma volume, acid base balance, nerve and muscle function,
TOXICITY DISEASE- HypertensionTOXICITY DISEASE- Hypertension
POTASSIUMPOTASSIUM
SOURCES- Vegetables, fruits, nutsSOURCES- Vegetables, fruits, nuts
FUNCTIONS- Principal cation in intra cellular fluid, nerve andFUNCTIONS- Principal cation in intra cellular fluid, nerve and
muscle functionmuscle function www.indiandentalacademy.comwww.indiandentalacademy.com

ESSENTIAL MICRO MINERALSESSENTIAL MICRO MINERALS
IRONIRON
SOURCES- Red meat, liver, eggs, dried beans,SOURCES- Red meat, liver, eggs, dried beans,
peas, cereals, food stored in iron cookware.peas, cereals, food stored in iron cookware.
FUNCTION- Constituent of hemoglobinFUNCTION- Constituent of hemoglobin
DEFICIENCY DISEASES- AnemiaDEFICIENCY DISEASES- Anemia

ZINCZINC
SOURCES- Animal products, whole grains, driedSOURCES- Animal products, whole grains, dried
beans.beans.
DEFICIENCY DISEASES- Growth failure, impairedDEFICIENCY DISEASES- Growth failure, impaired
wound healing, decreased taste and smell acuity,wound healing, decreased taste and smell acuity,
impaired immune functions.impaired immune functions.
FLUORIDEFLUORIDE
SOURCES- Drinking waterSOURCES- Drinking water
FUNCTION- Increases hardness of bones and teethFUNCTION- Increases hardness of bones and teeth
DEFICIENCY- Dental caries,DEFICIENCY- Dental caries,
TOXICITY- Fluorosis (dental and skeletal).TOXICITY- Fluorosis (dental and skeletal).

CHRONIC TOXICITY:SKELETALCHRONIC TOXICITY:SKELETAL
FLUOROSISFLUOROSIS
Osteosclerosis and
osteoporosis occurs.
Thickening of cortical
bone and calcification of
ligaments and tendons.
Severe pain and stiffness
in joints and spine.
Deformities of upper and
lower limbs.

MINERAL REQUIREMENTS IN THEMINERAL REQUIREMENTS IN THE
ELDERLYELDERLY
According to the 1980 edition of Recommended DietaryAccording to the 1980 edition of Recommended Dietary
Allowances, 800 mg/day ofAllowances, 800 mg/day of calciumcalcium for adults 51 years of agefor adults 51 years of age
and older is advisable.and older is advisable.
Based on newer knowledge it is recommended especially thatBased on newer knowledge it is recommended especially that
post menopausal women have a calcium intake of 1000 – 1500post menopausal women have a calcium intake of 1000 – 1500
mg/day in order for them to enjoy the benefits of good skeletalmg/day in order for them to enjoy the benefits of good skeletal
growth. The intake of 100 – 1500 mg/day is thought to be moregrowth. The intake of 100 – 1500 mg/day is thought to be more
desirable for preventing osteoporosis, currently a major causedesirable for preventing osteoporosis, currently a major cause
of hip and other bone fractures in women aged 65 years andof hip and other bone fractures in women aged 65 years and
older.older.
Vitamin DVitamin D is essential for the regulation and promotion of theis essential for the regulation and promotion of the
intestinal absorption ofintestinal absorption of calcium and phosphoruscalcium and phosphorus..

Therefore, these three nutrients must be availableTherefore, these three nutrients must be available
simultaneously in adequate amounts in order tosimultaneously in adequate amounts in order to
ensure the mineralization of the osteoid tissue.ensure the mineralization of the osteoid tissue.
Although the exact requirement of vitamin D for theAlthough the exact requirement of vitamin D for the
elderly is not known, it is definitely greater than that forelderly is not known, it is definitely greater than that for
young adults.young adults.
Bone demineralization is hastened and increased byBone demineralization is hastened and increased by
such non-nutritional factors as:such non-nutritional factors as:
-Inadequate amount of physical exercise such as-Inadequate amount of physical exercise such as
jogging, walking, swimming e.t.c.jogging, walking, swimming e.t.c.
-Immobilization of an extremity after an accident beyond-Immobilization of an extremity after an accident beyond
the necessary period of healingthe necessary period of healing
-Estrogen deficiency-Estrogen deficiency

The low dietary intake of calcium rich foods like, hardThe low dietary intake of calcium rich foods like, hard
cheeses, milk and dark green leafy vegetables, hascheeses, milk and dark green leafy vegetables, has
been shown to be one of the several factors that canbeen shown to be one of the several factors that can
contribute significantly to a greater than usual loss ofcontribute significantly to a greater than usual loss of
the alveolar ridge in edentulous patients aged 50 orthe alveolar ridge in edentulous patients aged 50 or
older, who elect to have immediate full maxillary orolder, who elect to have immediate full maxillary or
mandibular complete denture prostheses, or both. Themandibular complete denture prostheses, or both. The
rapid shrinkage of the alveolar bone creates a voidrapid shrinkage of the alveolar bone creates a void
between the complete denture prostheses and thebetween the complete denture prostheses and the
ridge that contributes to an unstable prosthesis andridge that contributes to an unstable prosthesis and
thereby loss of masticatory function and efficiency.thereby loss of masticatory function and efficiency.

This last loss can limit food choices to liquid and softThis last loss can limit food choices to liquid and soft
foods that do not provide the chewing stimulusfoods that do not provide the chewing stimulus
required for the bone mineralization necessary forrequired for the bone mineralization necessary for
maintaining alveolar bone height.maintaining alveolar bone height.
It is advisable for a prosthodontist who plans to insertIt is advisable for a prosthodontist who plans to insert
a maxillary and mandibular complete denturea maxillary and mandibular complete denture
prostheses, to prescribe a diet rich in calcium plusprostheses, to prescribe a diet rich in calcium plus
supplemental calcium carbonate tablets to be takensupplemental calcium carbonate tablets to be taken
daily for 4 weeks or more before the removal of thedaily for 4 weeks or more before the removal of the
remaining teeth and the insertion of the completeremaining teeth and the insertion of the complete
denture prostheses. Pre surgical calcium build-up maydenture prostheses. Pre surgical calcium build-up may
slow the rate of loss of alveolar ridge height, possiblyslow the rate of loss of alveolar ridge height, possibly
contributing significantly to stabilizing the prosthesiscontributing significantly to stabilizing the prosthesis
and making the patient more comfortable and tolerantand making the patient more comfortable and tolerant
of it.of it. www.indiandentalacademy.comwww.indiandentalacademy.com

In addition to calcium and vitamin D deficiencies, otherIn addition to calcium and vitamin D deficiencies, other
nutrient inadequacies may occur in older patients. Fornutrient inadequacies may occur in older patients. For
example, though iron requirements for the elderexample, though iron requirements for the elder
women are low because menstruation and growthwomen are low because menstruation and growth
phases have ceased, the exact iron requirement forphases have ceased, the exact iron requirement for
this group of people has yet not been established.this group of people has yet not been established.
SimilarlySimilarly ZincZinc utilization declines with advancing ageutilization declines with advancing age
because intestinal absorption decreases after the agebecause intestinal absorption decreases after the age
of 65 years. Thus it is conceivable that some of theof 65 years. Thus it is conceivable that some of the
clinical findings of decreased taste acuity, mentalclinical findings of decreased taste acuity, mental
lethargy and slow wound healing may be the results oflethargy and slow wound healing may be the results of
Zinc deficiency.Zinc deficiency.

IMPACT OF DENTAL STATUS ON FOOD INTAKEIMPACT OF DENTAL STATUS ON FOOD INTAKE
The food choices of older adults are closely linked to dentalThe food choices of older adults are closely linked to dental
status and masticatory efficiency. Although an intact dentition isstatus and masticatory efficiency. Although an intact dentition is
not a necessity for maintaining nutritional health, the loss ofnot a necessity for maintaining nutritional health, the loss of
teeth often leads adults to select diets that are lower in nutrientteeth often leads adults to select diets that are lower in nutrient
density.density.
Investigators in the United States and Sweden have proved thatInvestigators in the United States and Sweden have proved that
complete denture prostheses wearers have lower serum β-complete denture prostheses wearers have lower serum β-
carotene and ascorbic acid levels than dentate subjects.carotene and ascorbic acid levels than dentate subjects.
In another report by, United States Department of Agriculture’sIn another report by, United States Department of Agriculture’s
(USDA) Human Nutrition Research Center on Aging in Boston,(USDA) Human Nutrition Research Center on Aging in Boston,
it was shown that male complete denture prostheses wearersit was shown that male complete denture prostheses wearers
had poor nutrient intakes (specifically, mean intakes of calories,had poor nutrient intakes (specifically, mean intakes of calories,
proteins, vitamin A, ascorbic acid, vitamin B6 and folic acid)proteins, vitamin A, ascorbic acid, vitamin B6 and folic acid)
than female complete denture prostheses wearers. Calciumthan female complete denture prostheses wearers. Calcium
and protein intakes of female complete denture prosthesesand protein intakes of female complete denture prostheses
wearers were inferior to those of dentate women.wearers were inferior to those of dentate women.

The inability to distinguish the sensory qualities of food reducesThe inability to distinguish the sensory qualities of food reduces
a patient’s enjoyment of eating and may lead to reduced caloriea patient’s enjoyment of eating and may lead to reduced calorie
intake. Because a decrease in taste and smell acuity frequentlyintake. Because a decrease in taste and smell acuity frequently
accompanies aging, it is difficult to separate the effects of agingaccompanies aging, it is difficult to separate the effects of aging
and complete denture prostheses wearing on sensory acuity.and complete denture prostheses wearing on sensory acuity.
Texture and hardness, rather than taste and smell, determineTexture and hardness, rather than taste and smell, determine
acceptability of a food for many patients with complete dentureacceptability of a food for many patients with complete denture
prostheses.prostheses.
Generally, the intake of hard foods (raw vegetables or fruits,Generally, the intake of hard foods (raw vegetables or fruits,
fibrous meats, hard breads, seeds and nuts) is reducedfibrous meats, hard breads, seeds and nuts) is reduced
whereas the intake of soft foods (ground beef, breads, cereals,whereas the intake of soft foods (ground beef, breads, cereals,
pastries, canned fruits and vegetables) is increased. Whetherpastries, canned fruits and vegetables) is increased. Whether
these changes in food selection negatively affect nutritionalthese changes in food selection negatively affect nutritional
status depends on nutrient density of the food substituted, butstatus depends on nutrient density of the food substituted, but
soft foods are often lower in nutrient density and fiber.soft foods are often lower in nutrient density and fiber.

ORAL PROBLEMS IN GERIATRIC PATIENTSORAL PROBLEMS IN GERIATRIC PATIENTS
RELATED TO DEFICIENT VITAMINS ANDRELATED TO DEFICIENT VITAMINS AND
MINERALSMINERALS
One of the major functions of nutritional fitnessOne of the major functions of nutritional fitness
is to prevent or slow down the onset of thoseis to prevent or slow down the onset of those
degenerative or diseased conditions associateddegenerative or diseased conditions associated
with aging that occur in the mouth, such as,with aging that occur in the mouth, such as,
loss of taste, xerostomia, glossodynia,loss of taste, xerostomia, glossodynia,
glossopyrosis, oral mucous membrane disease,glossopyrosis, oral mucous membrane disease,
temporomandibular joint discomfort, periodontaltemporomandibular joint discomfort, periodontal
disease and osteoporosis of the alveolar bone.disease and osteoporosis of the alveolar bone.

1.1. ALTERATIONS IN GUSTATION AND OLFACTIONALTERATIONS IN GUSTATION AND OLFACTION
Gustation (taste perception) is mediated through the papillae,Gustation (taste perception) is mediated through the papillae,
taste buds and free nerve endings that are found primarily intaste buds and free nerve endings that are found primarily in
the tongue but also over the hard and soft palates and in thethe tongue but also over the hard and soft palates and in the
pharynx. In general, the number of these structures appears topharynx. In general, the number of these structures appears to
decrease with age.decrease with age.
The tongue perceives four modalities of taste – salt, sweet,The tongue perceives four modalities of taste – salt, sweet,
sour, and bitter. The tongue is more sensitive to salt andsour, and bitter. The tongue is more sensitive to salt and
sweet, where as the palate is more sensitive to sour and bitter.sweet, where as the palate is more sensitive to sour and bitter.
Olfaction is the act of perceiving odours. The odours of the foodOlfaction is the act of perceiving odours. The odours of the food
contribute to its palatability. The olfactory sense or the sense ofcontribute to its palatability. The olfactory sense or the sense of
smell is the special chemical sense that is activated bysmell is the special chemical sense that is activated by
stimulation of the olfactory receptors situated in the nasalstimulation of the olfactory receptors situated in the nasal
cavity. In contrast with gustation, olfaction can be stimulated bycavity. In contrast with gustation, olfaction can be stimulated by
extremely low chemical concentrations.extremely low chemical concentrations.

In the process of aging, taste perception diminishes – theIn the process of aging, taste perception diminishes – the
perception for salt at an early age, and for sweet a little later.perception for salt at an early age, and for sweet a little later.
This is as a result of hyper keratinization of the epithelium thatThis is as a result of hyper keratinization of the epithelium that
may occlude the taste bud ducts. Vitamin A deficiency may bemay occlude the taste bud ducts. Vitamin A deficiency may be
associated with such hyper keratinization. However, theassociated with such hyper keratinization. However, the
receptors for the bitter taste in the circumvallate papillae of thereceptors for the bitter taste in the circumvallate papillae of the
tongue seem to survive aging process.tongue seem to survive aging process.
Complete denture prostheses wearers, do exhibit aComplete denture prostheses wearers, do exhibit a
significant decrease in their ability to decipher differences insignificant decrease in their ability to decipher differences in
tastes of certain foods, along with hardness and texture. Thistastes of certain foods, along with hardness and texture. This
decrease in the sensory aspect of the food can result in adecrease in the sensory aspect of the food can result in a
decrease in food consumption because tasteless and odorlessdecrease in food consumption because tasteless and odorless
food is most likely not eaten.food is most likely not eaten.

2.2. XEROSTOMIA (DRY MOUTH)XEROSTOMIA (DRY MOUTH)
Xerostomia is a condition commonly found in theXerostomia is a condition commonly found in the
elderly. It is not a direct consequence of the agingelderly. It is not a direct consequence of the aging
process but may result from one or more factorsprocess but may result from one or more factors
affecting salivary secretion. This condition isaffecting salivary secretion. This condition is
characterized by dry mouth as a result of diminishedcharacterized by dry mouth as a result of diminished
salivary flow.salivary flow.
When flow of saliva is disturbed, food may haveWhen flow of saliva is disturbed, food may have
a metallic or salty taste, and sensitivity to bitter anda metallic or salty taste, and sensitivity to bitter and
sour foods can increase. These changes potentiallysour foods can increase. These changes potentially
have an impact on food choices. In the completehave an impact on food choices. In the complete
denture prostheses patient it can affect adaptation ofdenture prostheses patient it can affect adaptation of
the prosthesis and may lead to the development ofthe prosthesis and may lead to the development of
complete denture prostheses related problems.complete denture prostheses related problems.

Emotions (especially fear or anxiety), depression, useEmotions (especially fear or anxiety), depression, use
of medications, therapeutic radiation to the head andof medications, therapeutic radiation to the head and
neck, diabetes, alcoholism, pernicious anaemia,neck, diabetes, alcoholism, pernicious anaemia,
menopause, HIV infection, Sjogren’s syndrome,menopause, HIV infection, Sjogren’s syndrome,
obstruction of the salivary gland duct with a stone andobstruction of the salivary gland duct with a stone and
vitamin A or vitamin B complex deficiency, all canvitamin A or vitamin B complex deficiency, all can
cause xerostomia. Some of the commonly prescribedcause xerostomia. Some of the commonly prescribed
groups of drugs that produce xerostomia aregroups of drugs that produce xerostomia are
antihypertensives, anticonvulsants, antidepressants,antihypertensives, anticonvulsants, antidepressants,
anti histamines, anti cholinergics, sedatives and antianti histamines, anti cholinergics, sedatives and anti
Parkinsonism drugs.Parkinsonism drugs.

Since saliva lubricates the oral mucosa, theSince saliva lubricates the oral mucosa, the
lack of saliva creates a dry and often painfullack of saliva creates a dry and often painful
mucosa. Without significant salivary flow, foodmucosa. Without significant salivary flow, food
debris will remain in the mouth, where it isdebris will remain in the mouth, where it is
fermented by dental plaque bacteria to organicfermented by dental plaque bacteria to organic
acids that initiate the dental caries process. Aacids that initiate the dental caries process. A
major function of saliva, which contains calciummajor function of saliva, which contains calcium
phosphates, is to buffer the acids and to re-phosphates, is to buffer the acids and to re-
mineralize the eroded enamel surface.mineralize the eroded enamel surface.

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

MANAGEMENT:MANAGEMENT:

If a drug is suspected to be the cause, consult theIf a drug is suspected to be the cause, consult the
patient’s physician and prescribe an alternate drugpatient’s physician and prescribe an alternate drug
or modify the dosage schedule.or modify the dosage schedule.

Saliva substitutes may provide temporary relief-Saliva substitutes may provide temporary relief-
milk (aids in lubricating the tissues, increasing themilk (aids in lubricating the tissues, increasing the
pleasure of eating, has nutritional property and alsopleasure of eating, has nutritional property and also
has buffering capacity)has buffering capacity)

Sialogogues-sugar free gum, lozenges, sugar freeSialogogues-sugar free gum, lozenges, sugar free
candies containing citric acid may becandies containing citric acid may be
recommended.recommended.

Beverages that may produce more saliva-water withBeverages that may produce more saliva-water with
a slice of lemon, lemonade.a slice of lemon, lemonade.www.indiandentalacademy.comwww.indiandentalacademy.com


Chewing fibrous foods such as celery or wholeChewing fibrous foods such as celery or whole
grain breads will also increase salivary production.grain breads will also increase salivary production.

Making a conscious effort to consume at least 8Making a conscious effort to consume at least 8
glasses of water, juice or milk daily is the mostglasses of water, juice or milk daily is the most
important measure to relieve dry mouth.important measure to relieve dry mouth.

Intensive fluoride treatment over a one monthIntensive fluoride treatment over a one month
period to reduce the incidence of caries.period to reduce the incidence of caries.

Supersaturated calcium phosphate mouth rinsesSupersaturated calcium phosphate mouth rinses
are also used.are also used.

Patients are instructed proper home care, oralPatients are instructed proper home care, oral
hygiene and are given nutrition counselling so thathygiene and are given nutrition counselling so that
proper intake of vitamins and minerals is doneproper intake of vitamins and minerals is done
regularly.regularly.

3.3. GLOSSODYNIA AND GLOSSOPYROSISGLOSSODYNIA AND GLOSSOPYROSIS
(PAINFUL AND BURNING TONGUE)(PAINFUL AND BURNING TONGUE)
A painful and burning tongue is often encountered in nutritionalA painful and burning tongue is often encountered in nutritional
anaemias associated with deficiencies of vitamin B12, folic acidanaemias associated with deficiencies of vitamin B12, folic acid
or iron.or iron.
Vitamin B12 deficiency (pernicious anaemia) is seen withVitamin B12 deficiency (pernicious anaemia) is seen with
increased frequency in older people, especially in women andincreased frequency in older people, especially in women and
is characterized by a sore painful tongue and numbness oris characterized by a sore painful tongue and numbness or
tingling of the extremities. The tongue becomes dark red withtingling of the extremities. The tongue becomes dark red with
gradual atrophy of papillae exhibiting a smooth or bald surface.gradual atrophy of papillae exhibiting a smooth or bald surface.
Not uncommonly in anemic patients, the oral mucosa becomesNot uncommonly in anemic patients, the oral mucosa becomes
sensitive and intolerant to complete denture prostheses.sensitive and intolerant to complete denture prostheses.
Folic acid defficiency like vitaminB12 deficiency causesFolic acid defficiency like vitaminB12 deficiency causes
megaloblastic anaemia.megaloblastic anaemia.

Elderly patients who live on a tea-and-toast diet are primeElderly patients who live on a tea-and-toast diet are prime
candidates for iron deficiency anaemia. However, ancandidates for iron deficiency anaemia. However, an
adequately nourished older man or postmenopausal womanadequately nourished older man or postmenopausal woman
would probably not have this problem unless there iswould probably not have this problem unless there is
hemorrhage.hemorrhage.
Supplement the diet with 5 – 15 mg of folacin tablets daily untilSupplement the diet with 5 – 15 mg of folacin tablets daily until
reticulocyte count increases. This improvement is maintainedreticulocyte count increases. This improvement is maintained
with doses of 2 – 5 mg daily.with doses of 2 – 5 mg daily.
Best food sources are yeast, fresh green vegetables, liver andBest food sources are yeast, fresh green vegetables, liver and
fruits.fruits.
Ingestion of iron rich foods such as liver, eggs and cereals asIngestion of iron rich foods such as liver, eggs and cereals as
well as iron supplements like 1 gm of ferrous sulphate in 4well as iron supplements like 1 gm of ferrous sulphate in 4
divided doses.divided doses.

4.4. ORAL MUCOUS MEMBRANE PROBLEMSORAL MUCOUS MEMBRANE PROBLEMS
The mucous membranes of the lips, the buccal andThe mucous membranes of the lips, the buccal and
palatal tissues and the floor of the mouth change withpalatal tissues and the floor of the mouth change with
age. The patient’s chief complaints are a burningage. The patient’s chief complaints are a burning
sensation, pain and dryness of the mouth, as well assensation, pain and dryness of the mouth, as well as
cracks in the lips. Chewing and swallowing becomecracks in the lips. Chewing and swallowing become
difficult, and taste is altered. The epithelial membranedifficult, and taste is altered. The epithelial membrane
is thin and friable and easily injured. It heals slowlyis thin and friable and easily injured. It heals slowly
because of impaired circulation. If the salivarybecause of impaired circulation. If the salivary
deficiency is pronounced, the oral mucosa may be dry,deficiency is pronounced, the oral mucosa may be dry,
atrophic, and sometimes inflamed, but more often it isatrophic, and sometimes inflamed, but more often it is
pale and translucent.pale and translucent.

Cheilosis, inflammation of the lips caused by vitaminCheilosis, inflammation of the lips caused by vitamin
B complex deficiency is manifested by verticalB complex deficiency is manifested by vertical
fissuring of the lips. A redness along the line of closurefissuring of the lips. A redness along the line of closure
of the lips and increased inflammation can be seen.of the lips and increased inflammation can be seen.
Lesions at the angle of the mouth start out pale inLesions at the angle of the mouth start out pale in
colour, then become macerated and as a result ofcolour, then become macerated and as a result of
secondary infection, form yellow encrusted fissures.secondary infection, form yellow encrusted fissures.
Therapeutic doses of vitamin B complex and vitaminTherapeutic doses of vitamin B complex and vitamin
C.C.
A balanced varied adequate diet.A balanced varied adequate diet.

cheilitis

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

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

For temporary prevention of overclosure, anFor temporary prevention of overclosure, an
acrylic night guard can be used.acrylic night guard can be used.
Once the proper and comfortable verticalOnce the proper and comfortable vertical
dimension is achieved more definitive treatmentdimension is achieved more definitive treatment
is advocated.is advocated.
Selection of foods with medium to softSelection of foods with medium to soft
consistency (rich in vitamins and mineralsconsistency (rich in vitamins and minerals
values) in order to prevent excessive occlusalvalues) in order to prevent excessive occlusal
wear of intact dentition.wear of intact dentition.

6.6. ALVOELAR OSTEOPOROSISALVOELAR OSTEOPOROSIS
Bone loss is a normal part of aging thatBone loss is a normal part of aging that
affects the maxilla and mandible as well asaffects the maxilla and mandible as well as
the spine and long bones. Several factors arethe spine and long bones. Several factors are
thought to contribute to age related bone lossthought to contribute to age related bone loss
that leads to osteoporosis: geneticthat leads to osteoporosis: genetic
background, hormonal status, bone density atbackground, hormonal status, bone density at
maturity, a disturbance in the bonematurity, a disturbance in the bone
remodeling process, a low exercise level andremodeling process, a low exercise level and
inadequate nutrition. Low calcium intakeinadequate nutrition. Low calcium intake
throughout life is a contributor tothroughout life is a contributor to
osteoporosis.osteoporosis. www.indiandentalacademy.comwww.indiandentalacademy.com

The physiologic form of the alveolar bone isThe physiologic form of the alveolar bone is
maintained by a sensitive balance betweenmaintained by a sensitive balance between
bone formation and bone resorption, which isbone formation and bone resorption, which is
regulated mainly by local and to a lesser extentregulated mainly by local and to a lesser extent
by systemic influences. Trabecular bone in theby systemic influences. Trabecular bone in the
alveolar process is a source of calcium that canalveolar process is a source of calcium that can
be used to meet other tissue needs. Thebe used to meet other tissue needs. The
alveolar bone participates in the maintenancealveolar bone participates in the maintenance
of body calcium balance. Calcium is constantlyof body calcium balance. Calcium is constantly
being deposited and withdrawn from thebeing deposited and withdrawn from the
alveolar bone to provide for the needs of otheralveolar bone to provide for the needs of other
tissues and to maintain the calcium level of thetissues and to maintain the calcium level of the
blood.blood.

Because alveolar bone acts as aBecause alveolar bone acts as a
reservoir of mineral ions toreservoir of mineral ions to
maintain more vital functions it ismaintain more vital functions it is
susceptible to osteoporosis. Withsusceptible to osteoporosis. With
aging, bone becomes less dense.aging, bone becomes less dense.
Because of this alveolarBecause of this alveolar
susceptibility to osteoporosis somesusceptibility to osteoporosis some
investigators have suggested thatinvestigators have suggested that
internal alveolar resorption mayinternal alveolar resorption may
result from dietary calciumresult from dietary calcium
deficiency or phosphorus excess,deficiency or phosphorus excess,
or a combination of both. Increasedor a combination of both. Increased
bone density has been noted inbone density has been noted in
patients who have been given dailypatients who have been given daily
calcium supplements of 1 gm/daycalcium supplements of 1 gm/day
for a year.for a year.

Resorption of the alveolar ridge is a widespreadResorption of the alveolar ridge is a widespread
problem among complete denture prostheses wearingproblem among complete denture prostheses wearing
patients and results in unstable complete denturepatients and results in unstable complete denture
prostheses. Some remodeling of the alveolarprostheses. Some remodeling of the alveolar
processes occurs in response to occlusal forcesprocesses occurs in response to occlusal forces
associated with chewing. With the loss of teeth theassociated with chewing. With the loss of teeth the
alveolar process no longer serves its primary functionalveolar process no longer serves its primary function
of tooth support and therefore resorption isof tooth support and therefore resorption is
accelerated and bone height is diminished. A greateraccelerated and bone height is diminished. A greater
degree of residual ridge resorption is observed indegree of residual ridge resorption is observed in
women than in men. Bone loss is characterized in thewomen than in men. Bone loss is characterized in the
first 6 months after tooth extractions, and resorption isfirst 6 months after tooth extractions, and resorption is
much greater in the mandible than in the maxilla. Thismuch greater in the mandible than in the maxilla. This
loss in vertical height of bone and the changing of theloss in vertical height of bone and the changing of the
angle of the mandible is manifested as a loss in faceangle of the mandible is manifested as a loss in face
height in older people. Also, the loss of alveolar boneheight in older people. Also, the loss of alveolar bone
frequently makes it more difficult to construct afrequently makes it more difficult to construct a
mandibular complete denture prostheses that hasmandibular complete denture prostheses that has
good stability and retention.good stability and retention.www.indiandentalacademy.comwww.indiandentalacademy.com

Dietary calcium is critical to maintaining the bodyDietary calcium is critical to maintaining the body
skeleton. The most important means of preventingskeleton. The most important means of preventing
metabolic bone disease is acquiring a dense skeletonmetabolic bone disease is acquiring a dense skeleton
by the time bone maturation occurs between 30 andby the time bone maturation occurs between 30 and
35 years of age. Calcium intake of post menopausal35 years of age. Calcium intake of post menopausal
women is correlated with mandibular bone mass.women is correlated with mandibular bone mass.
Patients with complete denture prostheses who havePatients with complete denture prostheses who have
excessive ridge resorption report lower calciumexcessive ridge resorption report lower calcium
intakes. A chronically low calcium intake results in aintakes. A chronically low calcium intake results in a
negative calcium balance. For serum calcium levels tonegative calcium balance. For serum calcium levels to
be maintained calcium will be mobilized from thebe maintained calcium will be mobilized from the
bone, and this leads to demineralization of thebone, and this leads to demineralization of the
skeleton. Although a generous calcium intake by olderskeleton. Although a generous calcium intake by older
adults will not result in restoration of bone mass, it willadults will not result in restoration of bone mass, it will
improve calcium balance and slow the rate of boneimprove calcium balance and slow the rate of bone
loss.loss. www.indiandentalacademy.comwww.indiandentalacademy.com

Poor vitamin D status is an important public health problem.Poor vitamin D status is an important public health problem.
Adequate intake of vitamin D enhances calcium absorption inAdequate intake of vitamin D enhances calcium absorption in
the intestine. Low dietary intake, minimal exposure to sunlightthe intestine. Low dietary intake, minimal exposure to sunlight
and a lower rate of conversion to the active metabolite in theand a lower rate of conversion to the active metabolite in the
liver and kidney are responsible for low plasma levels of vitaminliver and kidney are responsible for low plasma levels of vitamin
D in the elderly population. To promote bone health postD in the elderly population. To promote bone health post
menopausal women and andropausal men must strive to obtainmenopausal women and andropausal men must strive to obtain
vitamin D regularly and should increase the intake withvitamin D regularly and should increase the intake with
advancing age.advancing age.
Wical and Swoope investigated the relationship between dietaryWical and Swoope investigated the relationship between dietary
combination of calcium and phosphorus and the resorption ofcombination of calcium and phosphorus and the resorption of
alveolar bone in edentulous patients. The results indicated aalveolar bone in edentulous patients. The results indicated a
direct cause and effect relationship between low calcium intakedirect cause and effect relationship between low calcium intake
or calcium – phosphorus imbalance and severe ridgeor calcium – phosphorus imbalance and severe ridge
resorption.resorption.
In a later study they reported that the ingestion of calcium andIn a later study they reported that the ingestion of calcium and
vitamin D dietary supplements reduced post extraction alveolarvitamin D dietary supplements reduced post extraction alveolar
bone resorption by 36%.bone resorption by 36%.
Administration of 750 – 1000 mg of calcium and 375 – 400 I.U.Administration of 750 – 1000 mg of calcium and 375 – 400 I.U.
of vitamin D daily to patients with a low serum calcium or highof vitamin D daily to patients with a low serum calcium or high
serum phosphorus or both.serum phosphorus or both.www.indiandentalacademy.comwww.indiandentalacademy.com

NUTRITIONAL NEEDS AND STATUS OFNUTRITIONAL NEEDS AND STATUS OF
OLDER ADULTSOLDER ADULTS
There is a great diversity in the eating habits and food intake ofThere is a great diversity in the eating habits and food intake of
older adults. Energy needs decline with age because of aolder adults. Energy needs decline with age because of a
decrease in basal metabolism and decreased physical activity.decrease in basal metabolism and decreased physical activity.
The onset of chronic diseases also usually leads to a physicalThe onset of chronic diseases also usually leads to a physical
exercise. The best means of reducing calorie intake is toexercise. The best means of reducing calorie intake is to
replace foods high in fat and sugar with complexreplace foods high in fat and sugar with complex
carbohydrates, and these should be the mainstay for the elderlycarbohydrates, and these should be the mainstay for the elderly
person’s diet. Choice of non fat dairy products, whole-grainperson’s diet. Choice of non fat dairy products, whole-grain
breads, cereals, pasta, fruits, vegetables, beans will providebreads, cereals, pasta, fruits, vegetables, beans will provide
important amounts of vitamins, minerals and fiber. Patients withimportant amounts of vitamins, minerals and fiber. Patients with
complete denture prostheses who prefer soft foods such ascomplete denture prostheses who prefer soft foods such as
pastries, cakes and cookies, should be advised of the value ofpastries, cakes and cookies, should be advised of the value of
fruits, vegetables, grains and cereals.fruits, vegetables, grains and cereals.

Vitamin deficiencies in the elder population are apt to be subVitamin deficiencies in the elder population are apt to be sub
clinical, but any body stress may result in an individual havingclinical, but any body stress may result in an individual having
detectable symptoms. Individuals who have low calorie intakes,detectable symptoms. Individuals who have low calorie intakes,
ingest multiple drugs, or have disease states that causeingest multiple drugs, or have disease states that cause
malabsorption are at higher risk for hypervitaminosis. Freemalabsorption are at higher risk for hypervitaminosis. Free
living older persons often report low dietary intakes of vitaminliving older persons often report low dietary intakes of vitamin
D, vitamin E, folic acid, calcium and magnesium. OralD, vitamin E, folic acid, calcium and magnesium. Oral
symptoms of malnutrition are usually due to the lack of thesymptoms of malnutrition are usually due to the lack of the
vitamin B complex, vitamin C, iron or protein.vitamin B complex, vitamin C, iron or protein.
With the measurements of serum metabolites of vitamin B12, aWith the measurements of serum metabolites of vitamin B12, a
high prevalence of undiagnosed vitamin B12 deficiency hashigh prevalence of undiagnosed vitamin B12 deficiency has
been noted among the elderly population. Such deficienciesbeen noted among the elderly population. Such deficiencies
may even lead to dementia in older adults.may even lead to dementia in older adults.

Folic acid plays an important role in cell division and inFolic acid plays an important role in cell division and in
red blood cell formation. Anaemia results fromred blood cell formation. Anaemia results from
deficient folate intake. Many drugs and alcohol affectdeficient folate intake. Many drugs and alcohol affect
folic acid absorption and metabolism.folic acid absorption and metabolism.
Because of its role in collagen synthesis, ascorbic acidBecause of its role in collagen synthesis, ascorbic acid
(vitamin C) is essential for wound healing. Heavy(vitamin C) is essential for wound healing. Heavy
smokers, alcohol abusers or persons with high aspirinsmokers, alcohol abusers or persons with high aspirin
intake have a higher daily requirement for ascorbicintake have a higher daily requirement for ascorbic
acid. The complete denture prostheses wearingacid. The complete denture prostheses wearing
patient should be encouraged to consume foods richpatient should be encouraged to consume foods rich
in vitamin C daily.in vitamin C daily.

Vitamin E functions as an anti oxidant in cell membranes byVitamin E functions as an anti oxidant in cell membranes by
acting as a scavenger of free radicals and preventing oxidationacting as a scavenger of free radicals and preventing oxidation
of unsaturated cell phospholipids. Therefore elderly patientsof unsaturated cell phospholipids. Therefore elderly patients
must have foods rich in vitamin E regularly.must have foods rich in vitamin E regularly.
Magnesium is a component of the body skeleton and plays anMagnesium is a component of the body skeleton and plays an
important role in neuromuscular transmission.important role in neuromuscular transmission.
Alcohol abuse seems to be a serious health problem amongAlcohol abuse seems to be a serious health problem among
some older persons. Alcoholism often remains undetected andsome older persons. Alcoholism often remains undetected and
untreated. Elderly persons tend to drink a smaller volume ofuntreated. Elderly persons tend to drink a smaller volume of
alcohol but drink more frequently. Deficiencies of thiamine,alcohol but drink more frequently. Deficiencies of thiamine,
niacin, pyridoxine, folate, (al B-complex vitamins) and ascorbicniacin, pyridoxine, folate, (al B-complex vitamins) and ascorbic
acid are commonly seen in alcoholics. Osteopenia in malesacid are commonly seen in alcoholics. Osteopenia in males
without a history of bone disease may be due to long termwithout a history of bone disease may be due to long term
alcohol intake. When efforts to resolve tissue intolerance toalcohol intake. When efforts to resolve tissue intolerance to
prosthesis are unsuccessful, the misuse of alcohol should beprosthesis are unsuccessful, the misuse of alcohol should be
considered.considered.

A detailed history of the family constellation in whichA detailed history of the family constellation in which
the patient lives, a history of the daily diet, a history ofthe patient lives, a history of the daily diet, a history of
the daily activities of the prosthetic patient arethe daily activities of the prosthetic patient are
essential to the successful management of theessential to the successful management of the
geriatric patient.geriatric patient.
TREATMENT consists of,TREATMENT consists of,
Yoghurts(curds) or cottage cheese once a dayYoghurts(curds) or cottage cheese once a day
Vegetable soup once a dayVegetable soup once a day
Referring post menopausal patient to a competentReferring post menopausal patient to a competent
physician for more complete care.physician for more complete care.
Recommended activities each and every day.Recommended activities each and every day.
Maintenance of water balance by proper intake atMaintenance of water balance by proper intake at
regular intervals.regular intervals.

VITAMIN SUPPLEMENTATION
Vitamin – mineral supplements without energyVitamin – mineral supplements without energy
or fiber and with only one third of the essentialsor fiber and with only one third of the essentials
micronutrients may foster a false sense ofmicronutrients may foster a false sense of
security in the patients undergoingsecurity in the patients undergoing
prosthodontic treatment. Older patients oftenprosthodontic treatment. Older patients often
select a supplement that does not includeselect a supplement that does not include
nutrients most likely to be missing in their diet.nutrients most likely to be missing in their diet.

For nutrients to be present in the proper ratio to oneFor nutrients to be present in the proper ratio to one
another, a multi vitamin – mineral supplement isanother, a multi vitamin – mineral supplement is
preferable to a single – nutrient tablet.preferable to a single – nutrient tablet.
On the basis of nutrient deficiencies reported inOn the basis of nutrient deficiencies reported in
complete denture prostheses wearing patients, it maycomplete denture prostheses wearing patients, it may
be reasonable to prescribe a low dose multi vitamin –be reasonable to prescribe a low dose multi vitamin –
mineral supplement for certain patients even thoughmineral supplement for certain patients even though
clinical signs of a nutrient deficiency are lacking.clinical signs of a nutrient deficiency are lacking.
For patients receiving complete denture prostheses, aFor patients receiving complete denture prostheses, a
generic one –a –day vitamin tablet that includes,generic one –a –day vitamin tablet that includes,
vitamin, folic acid and vitamin B12 may bevitamin, folic acid and vitamin B12 may be
recommended.recommended.

If intake of dairy foods cannot be increased to meetIf intake of dairy foods cannot be increased to meet
daily needs, a calcium supplement is advised.daily needs, a calcium supplement is advised.
The use of mega doses of vitamins or minerals by theThe use of mega doses of vitamins or minerals by the
elderly is a practice of great concern. When a highelderly is a practice of great concern. When a high
dose of vitamin is taken, it no longer functions as adose of vitamin is taken, it no longer functions as a
vitamin but becomes a chemical with pharmacologicalvitamin but becomes a chemical with pharmacological
activity. Adverse reactions from mega doses ofactivity. Adverse reactions from mega doses of
nutrients are more likely in the older adult becausenutrients are more likely in the older adult because
they are metabolized less efficiently and excretionthey are metabolized less efficiently and excretion
occurs more slowly. High doses of any nutrient areoccurs more slowly. High doses of any nutrient are
potentially toxic.potentially toxic.

High doses of certain vitamins may show the followingHigh doses of certain vitamins may show the following
adverse reactions:adverse reactions:
Vitamin D- disturbed calcium metabolism leading toVitamin D- disturbed calcium metabolism leading to
calcification of soft tissues.calcification of soft tissues.
Vitamin A- dry itching skin, headaches, disturbancesVitamin A- dry itching skin, headaches, disturbances
in blood clotting, accelerated bone resorption therebyin blood clotting, accelerated bone resorption thereby
increasing risk of hip bone fracture.increasing risk of hip bone fracture.
Vitamin C- induces copper deficiency anaemia, falseVitamin C- induces copper deficiency anaemia, false
positive readings for glucose in urine, increased risk ofpositive readings for glucose in urine, increased risk of
urinary stone formation in susceptible individuals.urinary stone formation in susceptible individuals.
Rebound scurvy may occur if high doses are stoppedRebound scurvy may occur if high doses are stopped
abruptly.abruptly.
Vitamin B6- peripheral neuropathies.Vitamin B6- peripheral neuropathies.
Niacin- flushing, headaches, itching skin.Niacin- flushing, headaches, itching skin.
Thus the complete denture prostheses wearing patientThus the complete denture prostheses wearing patient
must be cautioned against indiscriminate use of megamust be cautioned against indiscriminate use of mega
doses of any nutrient or fiber.doses of any nutrient or fiber.

Non- vegetarian Food Pyramid

Vegetarian Food PyramidVegetarian Food Pyramid
Vegetarian Food Pyramid

SUMMARY AND CONCLUSIONSUMMARY AND CONCLUSION
Enjoyment of food is regarded as an important determinant ofEnjoyment of food is regarded as an important determinant of
adult’s quality of life. Loose teeth, edentulism or ill-fittingadult’s quality of life. Loose teeth, edentulism or ill-fitting
complete denture prostheses may preclude eating favouritecomplete denture prostheses may preclude eating favourite
foods as well as limit intake of essential nutrients. Thefoods as well as limit intake of essential nutrients. The
nutritional status of a patient with complete denture prosthesesnutritional status of a patient with complete denture prostheses
affects the health of the oral tissues and the patient’saffects the health of the oral tissues and the patient’s
adaptation to a new prosthesis. In fact complete dentureadaptation to a new prosthesis. In fact complete denture
prostheses or implant supported prosthesis may prove to beprostheses or implant supported prosthesis may prove to be
unsatisfactory for a patient because of poor tolerance of theunsatisfactory for a patient because of poor tolerance of the
underlying tissues and bone. Hence, complete dentureunderlying tissues and bone. Hence, complete denture
prostheses failures can be due, not only to imperfect design butprostheses failures can be due, not only to imperfect design but
also to poorly nourished tissues.also to poorly nourished tissues.
Clinical symptoms of malnutrition are often observed first in theClinical symptoms of malnutrition are often observed first in the
oral cavity. Because of rapid cell turnover (every 3-37 days) inoral cavity. Because of rapid cell turnover (every 3-37 days) in
the mouth a regular balanced intake of essential nutrients isthe mouth a regular balanced intake of essential nutrients is
required for the maintenance of the oral epithelium. Inadequaterequired for the maintenance of the oral epithelium. Inadequate
long term nutrition may result in angular cheilitis, glossitis andlong term nutrition may result in angular cheilitis, glossitis and
slow tissue healing.slow tissue healing.

The amount of alveolar bone resorption that occursThe amount of alveolar bone resorption that occurs
after tooth extractions may be exacerbated by lowafter tooth extractions may be exacerbated by low
calcium and vitamin D intakes. Persons older than 70calcium and vitamin D intakes. Persons older than 70
years of age are more likely to have nutritionally pooryears of age are more likely to have nutritionally poor
diets. Dentate status can affect eating ability and thusdiets. Dentate status can affect eating ability and thus
the diet quality. Because most edentulous adults arethe diet quality. Because most edentulous adults are
of advanced age, a large number of patients withof advanced age, a large number of patients with
complete denture prostheses can be expected to havecomplete denture prostheses can be expected to have
nutritional deficits.nutritional deficits.
Dietary guidance based on the assessment of theDietary guidance based on the assessment of the
edentulous patient’s nutrition history and diet, shouldedentulous patient’s nutrition history and diet, should
be an integral part of comprehensive prosthodonticbe an integral part of comprehensive prosthodontic
treatment.treatment.

REVIEW OF LITERATUREREVIEW OF LITERATURE

In 1985, Hoffman FA discussed Micronutrient requirements ofIn 1985, Hoffman FA discussed Micronutrient requirements of
cancer patients. .Several major factors may influence thecancer patients. .Several major factors may influence the
micronutrient requirements of the patient with cancer. Thesemicronutrient requirements of the patient with cancer. These
factors include the metabolic state of the malignancy and itsfactors include the metabolic state of the malignancy and its
effects on host metabolism, the catabolic effects ofeffects on host metabolism, the catabolic effects of
antineoplastic therapy, and other physiologic stressesantineoplastic therapy, and other physiologic stresses
commonly associated with the treatment of cancer, i.e.,commonly associated with the treatment of cancer, i.e.,
surgery, fever and infection. Although the nutritional importancesurgery, fever and infection. Although the nutritional importance
of vitamins, minerals and trace elements is recognized, theof vitamins, minerals and trace elements is recognized, the
optimal daily dose that will preserve lean body mass withoutoptimal daily dose that will preserve lean body mass without
enhancing tumor growth, is not known. Recommended Dietaryenhancing tumor growth, is not known. Recommended Dietary
Allowances (RDAs), where established, are based onAllowances (RDAs), where established, are based on
populations with nonmalignant diseases. However,populations with nonmalignant diseases. However,
supplementation with vitamins, minerals, and certain tracesupplementation with vitamins, minerals, and certain trace
elements is recommended for the cancer patient who requireselements is recommended for the cancer patient who requires
prolonged parenteral support, since clinically relevant deficiencyprolonged parenteral support, since clinically relevant deficiency
states have been described. The effect of malignancy on thestates have been described. The effect of malignancy on the
metabolism of several of these micronutrients (iron, ascorbicmetabolism of several of these micronutrients (iron, ascorbic
acid, alpha tocopherol, selenium, zinc, copper) was discussed.acid, alpha tocopherol, selenium, zinc, copper) was discussed.

In 1990,Boden SD, Kaplan FS presented a review onIn 1990,Boden SD, Kaplan FS presented a review on
Calcium homeostasis.Calcium homeostasis.Precise maintenance of thePrecise maintenance of the
physiologic levels of both extracellular and intracellularphysiologic levels of both extracellular and intracellular
ionized calcium is essential to life. Calcium andionized calcium is essential to life. Calcium and
phosphate homeostasis is complex, yet three importantphosphate homeostasis is complex, yet three important
hormones are responsible for modulating most of thehormones are responsible for modulating most of the
extracellular control of these minerals. Parathyroidextracellular control of these minerals. Parathyroid
hormone acts directly on bone and kidney and indirectlyhormone acts directly on bone and kidney and indirectly
on the intestine to maintain or restore the serum calciumon the intestine to maintain or restore the serum calcium
level. The signal for increased PTH synthesis andlevel. The signal for increased PTH synthesis and
secretion is a decrease in the serum ionized calciumsecretion is a decrease in the serum ionized calcium
concentration and a decrease in serum levels ofconcentration and a decrease in serum levels of
1,25(OH)2-D. Calcitonin is produced in parafollicular1,25(OH)2-D. Calcitonin is produced in parafollicular
cells of the thyroid and inhibits bone resorption incells of the thyroid and inhibits bone resorption in
pharmacologic doses. These cells recognize the calciumpharmacologic doses. These cells recognize the calcium
signal in a different way.signal in a different way.

A diminution in serum calcium decreases calcitonin productionA diminution in serum calcium decreases calcitonin production
and release. The role of calcitonin in normal human physiology,and release. The role of calcitonin in normal human physiology,
however, remains in dispute. Finally, the biologically potenthowever, remains in dispute. Finally, the biologically potent
metabolite of vitamin D, 1,25(OH)2-D, stimulates intestinalmetabolite of vitamin D, 1,25(OH)2-D, stimulates intestinal
absorption of calcium and phosphate. It also probably plays aabsorption of calcium and phosphate. It also probably plays a
role in the orderly mineralization and resorption of bone androle in the orderly mineralization and resorption of bone and
has some influence on renal resorption of filtered calcium andhas some influence on renal resorption of filtered calcium and
phosphorus. A major stimulus to its production by proximalphosphorus. A major stimulus to its production by proximal
renal tubule cells is elevated PTH and decreased serum levelsrenal tubule cells is elevated PTH and decreased serum levels
of calcium and phosphate. The absence of PTH as well as highof calcium and phosphate. The absence of PTH as well as high
serum calcium and phosphate levels can reduce its synthesisserum calcium and phosphate levels can reduce its synthesis
and secretion. These three hormones along with otherand secretion. These three hormones along with other
mediators and messengers work in concert to maintain themediators and messengers work in concert to maintain the
normal calcium homeostasis. A disturbance at any level in thisnormal calcium homeostasis. A disturbance at any level in this
intricate regulatory network will result in a host of compensatoryintricate regulatory network will result in a host of compensatory
changes that may lead to clinical disease. A completechanges that may lead to clinical disease. A complete
understanding of these normal mechanisms is a prerequisite tounderstanding of these normal mechanisms is a prerequisite to
investigating the etiology and treatment of the variousinvestigating the etiology and treatment of the various
pathologic responses seen with many of the metabolic bonepathologic responses seen with many of the metabolic bone
disorders.disorders.

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