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The relationship between oral health and nutrition in older people
Abstract
The oral health of older people is changing with reducing numbers of people relying on complete dentures for function, and retaining some natural teeth. Despite this there are substantial numbers of older people whose ability to chew foods is compromised by their oral health status, either because they have few or no natural teeth. This alteration results in individuals selecting a diet that they can chew in comfort. Such diets are low in fruits and vegetables intake with associated reduction in both non-starch polysaccharide and micronutrient intakes. There is also a trend for reduced dietary intake overall. Salivary flow and function may have an impact in relation to the ability to chew and swallow. Whilst there are few differences in salivary function in fit healthy unmedicated subjects, disease resulting in reduced salivary flow and particularly polypharmacy, with xerostomia as a side effect, are likely to have a role in older people. This paper explores the relationships between oral health status and food's choice and discusses the potential consequences for the individual of such dietary change.
... Food accessibility, preparation and consumption challenges, coupled with health status, age-related changes, environment, social support, income and nutrition knowledge can contribute to insufficient dietary fibre intake in an ageing population (21,22) . For example, oral health can be impacted by age often resulting in modulated food preferences favouring easy-to-chew foods; this may impact diet quality and variety as well as contribute to lower dietary fibre intake in an ageing population (23)(24)(25)(26)(27)(28) . Accordingly, food structure is a key consideration in ensuring age-appropriate foods (29) . ...
... For example, oral health can decline with age (such as teeth loss, chewing problems and lower bite force); thereby, negatively impacting dietary fibre intake (e.g. modulating food preferences and cooking preparation) within an ageing population (23)(24)(25)(26)(27)(28) . Such findings were evident in our older adult cohort where Dietary fibre consumption in an ageing population 5 individuals with poor chewing ability and without their own natural teeth tended to consume less dietary fibre. ...
... Such findings were evident in our older adult cohort where Dietary fibre consumption in an ageing population 5 individuals with poor chewing ability and without their own natural teeth tended to consume less dietary fibre. This suggests older adults with oral health impairments food preferences and diet quality are also influenced implying tailored advice with relevant substitutions would be helpful for this population (23,46,47) . Therefore, developing targeted strategies to meet older adults' needs (including understanding relevant changes in oral processing behaviours with increasing age) would be suggested to overcome associated barriers and subsequently help reduce the widespread deficit in dietary fibre intake. ...
The UK population is living longer; therefore, promoting healthy ageing via positive nutrition could have widespread public health implications. Moreover, dietary fibre intake is associated with health benefits; however, intake is below UK recommendations (30 g/d). Utilising national dietary survey data can provide up-to-date information on a large representative cohort of UK older adults, so that tailored solutions can be developed in the future. This study used cross-sectional data from the National Diet and Nutrition Survey (years 2008–2009 to 2018–2019) for older adults’ (n 1863; 65–96 years) dietary fibre intake (three-to-four-day food diaries), top ten dietary fibre-rich foods, associated factors (demographics, dietary/lifestyle habits) and various health outcomes (anthropometric, blood and urine). Mean dietary fibre intake was 18·3 g/d (range: 2·9–55·1 g/d); therefore, below the UK dietary recommendations, with compliance at 5·7 %. In addition, there were five significant associations (P < 0·05) related to lower dietary fibre intake such as increasing age group, without own natural teeth, impaired chewing ability, lower education leaving age and poor general health. Older adults’ key foods containing dietary fibre were mainly based on convenience such as baked beans, bread and potatoes. Positively, higher dietary fibre consumption was significantly associated (P = 0·007) with reduced diastolic blood pressure. In summary, the benefits of dietary fibre consumption were identified in terms of health outcomes and oral health were key modulators of intake. Future work should focus on a life course approach and the role of food reformulation to help increase dietary fibre intake.
... As mentioned above, malnutrition is an important mediator between oral frailty and fall risk. There is abundant evidence that poor oral function causes malnutrition and sarcopenia [41][42][43]. Older people sometimes have difficulties not only in eating hard food due to the loss of natural teeth or improper prosthesis but also in swallowing because of insufficient saliva production [42]. An increase in the frequency and time of mastication and a decrease in the sense of taste decrease their appetite itself [42,44]. ...
... There is abundant evidence that poor oral function causes malnutrition and sarcopenia [41][42][43]. Older people sometimes have difficulties not only in eating hard food due to the loss of natural teeth or improper prosthesis but also in swallowing because of insufficient saliva production [42]. An increase in the frequency and time of mastication and a decrease in the sense of taste decrease their appetite itself [42,44]. ...
... Older people sometimes have difficulties not only in eating hard food due to the loss of natural teeth or improper prosthesis but also in swallowing because of insufficient saliva production [42]. An increase in the frequency and time of mastication and a decrease in the sense of taste decrease their appetite itself [42,44]. Consequently, they often suffer from the deficiency of nutrients, especially in macronutrients, which are essential for anabolism and maintaining muscle strength [43]. ...
Background: Identifying older adults with a high risk of falling and providing them with appropriate intervention are vital measures for preventing fall incidents. Scholars report that oral frailty, a decline in oral function, is related to physical function; thus, it bears a potential association with fall risks. This study aimed to investigate the relationship between fall incidents and the status of physical and oral frailty among a sample of residents in Osaka Prefecture. Subjects and Methods: This study targeted community-dwelling people aged 50 years and older who responded to an annual questionnaire survey using a health app for 2 consecutive years, namely, 2020 and 2021. This study analyzed responses from 7591 (62 ± 7 years) participants and determined the status of their oral frailty and comprehensive and physical frailty using the Kihon Checklist. Results: In the 2020 and 2021 surveys, 17% and 19% of the participants exhibited oral frailty and experienced a fall in the previous year, respectively. Logistic regression analysis demonstrated that oral frailty (adjusted odds ratio: 1.553) and physical frailty as well as low levels of awareness of frailty were significant explanatory variables of the occurrence of fall incidents during the subsequent year. Conclusions: Future studies are required to elucidate the mechanisms by which oral frailty induces fall incidents.
... Further, evidence suggests that nutritional status is influenced by oral health factors [7]. A well-established literature exists on the relationship between oral health and nutritional outcome [8]. Ageing adults face multiple issues with oral health due to the loss of natural teeth, which significantly impacts their diet pattern as they prefer food that is comfortable to chew, along with reduced intake of vegetables and fruits, which leads to nutritional disturbances [8][9][10][11]. ...
... A well-established literature exists on the relationship between oral health and nutritional outcome [8]. Ageing adults face multiple issues with oral health due to the loss of natural teeth, which significantly impacts their diet pattern as they prefer food that is comfortable to chew, along with reduced intake of vegetables and fruits, which leads to nutritional disturbances [8][9][10][11]. A review study suggested that tooth loss during ageing inhibits individuals from consuming fruits and vegetables, leading to nutritional imbalance [10]. Further, a study discussed the importance of enhancing oral health among older adults to reduce the risk of nutritional deficiencies [12]. ...
... A well-established literature exists on the relationship between oral health and nutritional outcome [8]. A review study suggested that tooth loss during ageing inhibits individuals from consuming fruits and vegetables, leading to nutritional imbalance [10]. ...
Background
In this study, we attempted to generate insights into the determinants of nutritional status among older adults in India by exploring the role of factors including oral health, food insecurity, socioeconomic, demographic and health-related variables. The study also examined the moderating role of tooth loss with the association between chewing ability and nutritional status.
Methods
The data was obtained from Longitudinal Ageing Study India (LASI) – Wave 1 (2017-18). The sample consisted of 27,411 older adults (Male = 13, 232; Female = 14, 179) aged 60 years and above. In addition to descriptive and bivariate analysis, we employed multinominal logistic regression analysis.
Result
There was a significant association between the ability to chew solid food and tooth loss in the nutritional status of older adults. It was further revealed that tooth loss acted as a moderator (aRRR = 1.50, 95 % CI: 1.08–2.08) between the chewing ability and the risk of being underweight. The weight loss due to food insecurity increased the relative risk ratio of being underweight (aRRR = 1.58, 95 % CI: 1.25–2.00). Further evidence showed that self-rated health (SRH), Instrumental Activities of Daily Living (IADL), morbidity status and socioeconomic factors had a significant role in determining the nutritional status among older adults.
Conclusion
Chewing ability, tooth loss, and food insecurity determine nutritional status among older adults. It is suggested to care for oral and general physical health as these factors increase the risk of nutritional deficits. Also, policy measures should be strengthened to address the specific health and food security needs of older adults from vulnerable socioeconomic circumstances.
... Indeed, it is today well recognizable that tooth loss and severe tooth loss affect Oral Health-Related Quality of Life (OHRQoL), overall QoL, well-being, successful/comfortable aging, and longevity [1,2]. All of these factors are thought to be closely associated with the quality of the diet [3]. Further, it is well established that socioeconomic status affects diet and, consequently, QoL and OHRQoL, especially in older people (ρ low intake of certain types of foods, nutrients, and minerals). ...
... Indeed, almost two decades ago, Joshipura et al. [11,12] tackled this nutritional state link and found that the average intake of dietary fiber, vegetables, and fruits decreased with the loss of teeth, noting that in parallel, the consumption of calories and saturated fat increased. Similar findings have been reported by other authors and studies [3,4,13,14]. Therefore, it can be stated herein that the impact on QoL and OHRQoL of disease as well as oral and dental rehabilitation (Figure 1) and its termed (short vs. long) consequences should be taken into consideration when assessing the overall health status and evaluating the clinical outcomes of therapeutics. ...
Tooth loss can cause functional impairment, in terms of chewing/mastication ability and choice of foods/diet, leading to malnutrition, which might ultimately impact general health and well-being. No studies on homocysteine (Hcy), an inflammatory sulfur-containing amino acid biomarker, levels, and tooth loss (or number of remaining teeth), are present. This study opted to obtain data from the available National Health and Nutrition Examination Survey III (NHANES III) and perform statistical analysis to investigate the association between tooth loss and tHcy (plasma/serum levels), with a focus on the elderly population. Acquired data for 1568 individuals aged 65 years or older were then tabulated, to detail. Age, gender, cholesterol, income, education, exercise, creatinine, systolic blood pressure, body mass index, and dental state were each found to be independently associated with tHcy. In a multiple regression model, only age (ρ < 0.0001), education (ρ < 0.0001), creatinine (ρ < 0.0001), and dental state (ρ < 0.003) were significantly associated with tHcy, explaining 22% of the variation detected in log-[tHcy]. Plasma Hcy levels in patients are associated with dental status and can be notably affected with oro-dental health, socioeconomic status, and access to therapeutic interventions. Considering these findings, tHcy level monitoring (to diagnose vitamin B6, B9/folate/folic acid or B12 deficiency) as well as nutritional counseling and vitamin supplementation (rechecked post-8 weeks) should be considered and incorporated into the diagnostic and treatment plan for the edentate/edentulous elders, especially if other cardiovascular or inflammatory risk factors are present. In the context of osteogenesis and oral health, research exploring the relationship between elevated Hcy levels and alveolar bone, and tooth loss can provide valuable insights into the underlying mechanisms of bone metabolism and dental health. Understanding how Hcy levels impact bone density, bone remodeling processes, and periodontal health can potentially lead to the design, innovation, development, and translation of novel therapeutic approaches and preventive strategies for osteoporosis, periodontal disease, as well as tooth loss.
... The higher the score, the more diverse the food intake. We defined a score less than 7 as low DDS and a score greater than or equal to 7 as high DDS [25]. ...
... The weakening of chewing and swallowing ability by tooth loss may unconsciously change the food intake preferences of older adults by reducing the type and amount of food they consume. For example, they may prefer soft and easy-to-chew food [40] and may avoid fiber-rich food such as fruits, vegetables, and nuts [25,40,41]. The reduction in food variety and the high-fat, low-fiber nature of food intake has a direct effect on the physical and mental health of older adults. ...
Diet is a modifiable factor in healthy population aging. Additionally, oral health and diet are important factors affecting depressive symptoms. To assess the mediating role of dietary diversity (DD) in oral health and depressive symptoms in older adults, we selected 8442 participants aged ≥ 65 years from the 2018 Chinese Longitudinal Health Longevity Survey (CLHLS) for a cross-sectional study. Depressive symptoms were determined based on scores on the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). Dietary diversity scores (DDS) were established based on the frequency of intake of food groups. Oral health was measured by denture use and toothbrushing frequency. Stepwise multiple linear regression and PROCESS macros were used for mediated effects analysis and testing. The sample had a positive detection rate of 44.1% for depressive symptoms, 40.8% for denture use, and 41.9% for once-a-day toothbrushing. Denture use (ρ = −0.077, p < 0.01) and toothbrushing frequency (ρ = −0.115, p < 0.01) were negative predictors of depressive symptoms in older adults. DD significantly mediated the association between denture use (indirect effect −0.047; 95%CI: −0.068–0.028; p < 0.001), toothbrushing frequency (indirect effect −0.041; 95%CI: −0.054–0.030; p < 0.001), and depressive symptoms. Denture use and toothbrushing frequency not only directly reduce the risk of depressive symptoms in older adults, but also indirectly affect depressive symptoms through DD.
... [3] The masticatory ability of the elderly is compromised by their oral health status, because of few or no natural teeth. [4] The loss of natural teeth can affect mastication due to bone resorption, temporomandibular dysfunction, muscular hypotonicity and can alter the mandibular rest position and dental occlusion. [5] The mandibular position has an influence on the body posture, which is associated closely with body equilibrium. ...
... They were instructed to chew for 3 min (average of 120 chewing strokes considered, as high interclass correlation coefficient of 0.83) [11] on both sides of the mouth. Using a five-point color scale, the operator collected the chewing gum and assigned it a score (1)(2)(3)(4)(5) for the degree of color change [ Figures 6 and 7]. A higher score indicated better masticatory ability. ...
Aim:
Mastication is an important consideration for patients seeking prosthodontic treatment. Individuals with mastication problems have increased risk of systemic diseases which can negatively affect a person's postural balance control, which in turn increases the risk of falls. This study aims to correlate masticatory efficiency and dynamic postural balance in complete denture patients at 3 and 6 months after denture insertion.
Settings and design:
In vivo - observational study.
Materials and methods:
Fifty edentulous healthy patients were rehabilitated with conventional complete dentures. The dynamic postural balance was evaluated using the timed up-and-go test. The masticatory efficiency was evaluated using a color-changing chewing-gum and a color scale. The values for both were recorded 3 and 6 months after denture insertion.
Statistical analysis used:
Spearman's correlation.
Results:
The correlation between the values of dynamic postural balance and the values of masticatory efficiency was negative (values are inversely proportional) at 3 months (-0.379) and at 6 months (-0.246).
Conclusions:
This study showed that there is a correlation between dynamic postural balance and masticatory efficiency. Prosthodontic rehabilitation of edentulous patients is important for improving postural balance by generating adequate postural reflex through mandibular stability for the prevention of falls in the elderly population and improving masticatory efficiency.
... Adequate nutrition, including a diet rich in fruits and vegetables, relies heavily on efficient chewing function. It has been noted that patients with compromised chewing often avoid fibrous and crunchy food, reflecting a relationship between diet quality and oral function [25]. This aligns with findings that limited food diversity and reduced intake of key nutrients such as β-carotene and omega-3 acids, along with reduced prosthesis adaptation, may hinder nutrition. ...
Background: Head and neck cancers (HNCs) and their surgical treatment can result in significant functional deficits including impaired masticatory function, dysphagia and dysgeusia, among others. These contribute to nutritional deficits weakening immune responses, increased post-surgical infections and complications. Aim: This study assesses the impact of removable prosthetic restorations on nutritional habits in edentulous patients who have undergone surgery for head and neck cancer. Materials and methods: This study included 44 post-surgical oncology patients and 20 healthy edentulous patients who served as controls. All patients received removable acrylic complete prostheses. Controls received maxillary and mandibular complete prostheses and HNC patients received post-resection complete maxillary and mandibular prostheses. Nutritional intake was assessed through a 24 h dietary recall and the Food Frequency Questionnaire administered before prosthetic treatment and 6 weeks and 3, 6 and 12 months after the provision of removable prosthetic restorations. Results: This study found that both patient groups maintained consistent meal frequency, with the study group exhibiting stable food intake over time. The intake of various food items fluctuated post prosthesis delivery in both groups, with an initial decline followed by partial recovery. Statistically significant differences were observed in food preferences; however, diet variations between and within the groups were not statistically significant. Conclusions: This study found that the use of removable prosthetic restoration in surgically managed edentulous head and neck cancer patients and edentulous controls showed no significant differences apart from certain food preferences and diet variations. A prolonged adaptation period was observed highlighting the need to include clinical dietitians to support the patients.
... As people age, their food choices are often dictated by their ability to masticate and maintain oral function [14][15][16]. When people lose weight, frequent intake of high calorie foods are often high in fat and high in sugar, such as high calories replacement meals [17]. ...
Introduction
People living in nursing or residential homes are at an increased risk of having or developing oral and dental diseases. This is due to contributing factors such as comorbidities and polypharmacy coupled with poor manual dexterity and lack of disease prevention and access to care. These risk factors combined with frequent and high sugar consumption increases risk of developing dental decay. Care home residents are a diverse population from different backgrounds. Little is known about decision making around nutrition in care settings and nutritional practices of older people in care homes, including the choices and challenges. The purpose of this study was therefore, to understand care home landscape and resident experiences.
Materials and methods
Semi-structured interviews were conducted with participants including residents, care home managers, carers and kitchen staff. Interviews were held face-to-face, recorded and transcribed and the findings were analysed using a thematic approach.
Results
A total of 17 participants across 4 care homes in one outer London borough took part in this study, with findings relating to both nutrition and oral health. Resident food preferences were collected upon admission into the home, including information on the incoming resident’s lifestyle, routine and choices. Staff tried to maintain these where possible and accommodate to resident choices when possible. Opportunities for wider food choice was dependent on the residents’ ability and willingness to request alternatives, their financial freedom to purchase their own foods, mobility to access food outside of the care home setting and food bought in by family and friends. This was compounded by residents being prescribed high calorie, high sugar meal supplemented for weight management. Participants reported that the structured routine revolved around meals and activities. Most care staff reported that an alternative healthy option was offered at mealtimes, but this was not the case in all homes. Care staff faced challenges managing weight of residents who had appetite loss and tried to accommodate and make provisions for those with these experiences and were aware of how to raise concerns. There was variation in mandatory training expectations, with no integration of oral health and nutrition.
Discussion
The findings provided valuable insight into the disparities between and within homes and highlights the challenges in this complex group with regards to nutritional choices. It is vital that a range of food options are in place to protect residents’ rights to choose what they wish to eat, whilst offering healthy options and all care staff are educated on offering balanced, nutritious meal and snack options. By offering a range of foods, the healthier choice can be the easier choice.
... However, food choices can be modified by the built environment choice architecture or by the provision of information leading to trade-offs between different food values (price, taste, healthiness, sustainability…) [52][53][54][55]. In elderly, biological changes such as changes in oral health [56] impose a redefinition of nutritional needs. Familiarity as well as loss of food autonomy may lead to a delegation of foodchoice decision making [57]. ...
Purpose
To present the outcomes of the EGEA Conference on the state of knowledge regarding the contribution of diets rich in fruit and vegetables (FV) to human and planetary health, commonly included in the One Health concept.
Methods
The 9th edition of EGEA Conference (20–22 September 2023, Barcelona) provided a transversal and multidisciplinary perspective on the contribution of FV to One Health, in particular to the health of individuals, society and the planet. Nearly 150 international scientists and stakeholders discussed the current state of knowledge. These proceedings are based both on a literature review and the scientific studies presented by the speakers.
Results
Scientific evidence confirms the role of FV in preventing cardiovascular diseases and type 2 diabetes; more evidence is needed on the effects and mechanisms of FV in cancer prevention. FV production and consumption helps ensure territorial cohesion and provides a denser, nutrient-rich diet with less environmental impact (except water use) than other food groups, but use of synthetic pesticides in FV production remains a challenge that could be addressed with agro-ecological solutions. Various factors influence consumer choice and behaviour towards FV consumption across the lifespan, with specific periods being more conducive to change. New research is emerging on the role of FV consumption in regulating gut microbiota and on both mental and brain health; the potential role of FV production and supply in tackling biodiversity loss and climate change; and better monitoring of FV consumption.
Conclusion
Sufficient evidence confirms the contribution of diet rich in FV to One Health, with some emerging research on this topic. Concerted actions are required towards an increased consumption of FV and a more diversified and environmentally neutral FV production.
... Accordingly, occlusal support in the molars is considered a crucial factor in oral health. Furthermore, decreased chewing ability due to loss of molar occlusions has been shown to influence the choice of food [21]. Therefore, the loss of molars may lead to undernutrition due to a decrease in nutrient intake from the diet. ...
Background/Objectives: Undernutrition increases the mortality risk in older persons requiring long-term care; further, it is associated with oral functions such as swallowing and chewing. Moreover, occlusion affects oral function and is crucially involved in nutritional intake. The present study aimed to examine the association between the number of molar occlusions and undernutrition according to body mass index (BMI) in older persons requiring long-term care. Methods: Japanese older persons requiring long-term care were categorized based on BMI (<20 kg/m² vs. 20 kg/m²). We examined the association between undernutrition and the number of molar occlusions (one in each of the left and right premolars and molars, for a total of four). Results: Among 893 included participants, 440 (49.3%) had BMI < 20 kg/m² and 453 (50.7%) had BMI > 20 kg/m². Binomial logistic regression analysis revealed that BMI < 20 kg/m² was significantly associated with increased number of molar occlusions (odds ratio: 0.52–0.70, 95% CI: 0.28–1.00). This indicated that a decrease in the number of molar occlusions was associated with malnutrition as determined through BMI in older persons requiring long-term care and residing in long-term care insurance facilities in Japan. Conclusions: Our findings suggest that maintaining occlusal support may help maintain nutritional status in older persons requiring long-term care.
... Therefore, the limited availability of senior-friendly diets (SFDs) containing fruits or vegetables could lead to deficiencies in vitamins, minerals, and fiber, raising new concerns. 4 Additionally, SFDs currently containing fruit are all in purée form, which lacks the visual appeal of consuming whole fruit. Applying reformation techniques to create products that resemble the original fruit shape could provide greater visual satisfaction, making the development of products shaped like actual fruit an emerging objective. ...
... Particular attention needs to be paid to older people, as they are vulnerable when it comes to unhealthy lifestyles, and in particular with regard to food (Purdam et al., 2019). They are also more exposed than others to physical problems, such as poor oral health, as well as loneliness and isolation, which can lead to the consumption of unhealthy food products in a poor food environment (Pilgrim et al., 2015;Walls and Steele, 2004). ...
The disappearance of food shops in small towns and villages is a common feature in many European areas. The food habits of rural inhabitants are affected by the limitations on their food supply, posing a challenge to how they organise their daily eating. Although this represents a major problem for the quality of life in rural areas, food access problems have been understudied in Europe. This paper presents some research notes to encourage the study of the effects of the shortfall in food businesses in depopulated rural areas of Europe as a guide for research on this phenomenon. The paper reviews the international literature, drawing attention to the theoretical problems and methodological limitations involved in this type of study. A series of recommendations are given with the aim of enabling future research to record the food situation of the inhabitants of impoverished and depopulated territories with greater precision and depth.
... The oral and overall health status deteriorates with age and sickness [12,13], leading to an increase in the number of difficult-to-chew food clumps over time, and ultimately changing dietary preferences and eating habits [12,14]. The older adults tend to choose foods that are soft and easy to chew, while avoiding foods that are hard textures and rich in fiber [14,15], which increases the intake of fat, other carbohydrates, and processed foods, and reduces the consumption of raw fruits, vegetables, nuts, and meat [15][16][17]. Consistently making unbalanced food choices can lead to an unhealthy diet that is high in carbohydrates and calories but low in protein, minerals, and fiber [17], which may even cause malnutrition in older adults and increase their risk of developing certain diseases, becoming feeble, or even dying [9]. Therefore, there is a relationship between oral health, function, and malnutrition in the older adults. ...
Background
Malnutrition is related to impaired oral health and function that causes poor dietary intake, declining the general health of older adults. The role of dietary intake in the association between oral function and nutritional status of Chinese older adults (aged 75 and above) was examined in this cross-sectional study.
Methods
Through the randomized cluster sampling method, 267 older adults living in rural areas of Qingdao, Shandong (aged 81.4 ± 4.3, 75–94 years) were chosen as the primary research participants. A Mini Nutritional Assessment - Short Form was used to determine nutritional status, and Food Frequency Questionnaire and 24-hour Food Intake Recall were used to assess dietary intake. The oral function was evaluated by analyzing the teeth, oral problems, bite force, tongue pressure, lip sealing pressure, chewing function questionnaire, whole saliva flow rate, 10-Item Eating Assessment Tool, and water swallow test.
Results
Based on the MNA-SF score, it was divided into a well-nourished group and a malnutrition group, with the malnutrition group comprising 40.6% of participants. The participants in the malnutrition group showed a higher rate of xerostomia, lower bite force, tongue pressure, and lip sealing pressure, and higher Chewing Function Questionnaire and 10-Item Eating Assessment Tool scores. Furthermore, their plant fat, iron, cereals and potatoes, vegetables, fruits, and seafood intake were relatively low. The regression model indicated that exercise frequency, stroke, chewing and swallowing function, intake of vegetables and fruits were risk factors for nutritional status of older adults.
Conclusion
Malnutrition was relatively common among the Chinese older adults aged 75 and above, and it was significantly correlated with exercise frequency, stroke, chewing and swallowing function, and intake of vegetables and fruits. Therefore, nutrition management should be carried out under the understanding and guidance of the oral function and dietary intake of the older adults.
... For instance, diets high in sugars and carbohydrates have been consistently linked to an increased risk of dental caries [6][7][8][9], periodontal diseases [10][11][12][13], and oral cancers [14,15]. Conversely, the state of oral health can significantly impact an individual's ability to maintain a nutritious diet [16], affecting aspects such as mastication, taste perception, and nutritional intake. Oral health issues such as periodontal diseases, edentulism, or poorly fitting dental prosthetics can hinder proper mastication, making it difficult to chew and digest certain foods. ...
The complex connection between oral health and dietary habits is fundamental to holistic well-being. Oral
health is closely linked to dietary choices, both as a reflection and a factor in overall health. This
bibliometric analysis investigates clinical trials published in the PubMed database spanning six decades to
understand the landscape of research on the impact of diet on oral health. The analysis reveals a fluctuating
yet generally increasing trend over the decades, with significant growth periods interspersed with occasional
declines, culminating in a recent slight decrease in research output. With strong collaborative networks,
Devizio and Proskin emerge as primary contributors. The University of Sydney has published the maximum
number of clinical trials. Thematic clusters highlight diverse research facets, including physiological
measurements, socio-economic influences, and biochemical aspects. The evolution in research priorities
from experimental studies to longitudinal evaluations underscores the interdisciplinary nature of the field.
The analysis of country-wise research output revealed that the United States, Germany, and Australia lead in
scientific research output, with notable contributions to the global landscape. While larger countries like
China and India are represented, their frequencies are relatively lower, suggesting potential areas for further
exploration. Collaboration patterns vary between countries, influencing the global impact of their scientific
output. Despite the limitations inherent in database selection, this study integrates bibliometric and
thematic analyses to offer comprehensive insights into research trends and priorities.
... The link between chewing ability and food choices has been established through several national surveys of large numbers relating loss of all or some teeth to adverse food choices. 41 Such (wrong) food choices place patients at risk of increasing morbidity, and so it would seem logical that improving masticatory ability by replacing missing teeth would also remove those risks of morbidity. Unfortunately, this is not necessarily the case, and merely improving mastication by providing prostheses does not guarantee an improvement in food choices and therefore overall nutrition. ...
For many decades the literature has regularly reported that there is a discrepancy between what is taught in dental school and what is practised, especially in the field of removable partial dentures. Not only that, but for more than 60 years reports from around the world have shown that, usually, the majority of clinicians abdicate their responsibility to design a removable partial denture (RPD) and instead leave this to the dental technician, who has no knowledge of the clinical condition of the patient and works only from a cast. Most patients around the world who require RPDs to improve aesthetics and chewing can only afford a removable prosthesis simply because the majority are poor. But RPDs can improve these aspects and contribute to an improved quality of life. The purpose of this series of articles is to derive the basic, evidence-informed principles of partial denture design and to suggest a simplified explanation and application of those principles in the hope that clinicians will increasingly take responsibility for the design of partial dentures. Part 1 summarises studies revealing what can only be described as the malpractice of abdication of responsibility for design by clinicians, and then explain the evidence-informed basic principles of design; Part 2 will look at the biomechanical basis of those principles in terms of support; Part 3 will do the same for the biomechanical basis of retention; Part 4 will provide a simple seven-step approach to design, applied to an example of an acrylic resin-based and a metal framework-based denture for the same partially edentulous arch; and Part 5 will provide examples of designs for RPDs that have been successfully worn by patients, for each of the Kennedy Classifications of partially dentate arches. Much of this is referenced from an electronic book on the Fundamental of removable partial dentures.
... Conventional dentures are not an ideal treatment for mandibular edentulism. (1,2,3) When considering contemporary treatment of the edentulous patient, endosseous dental implants can offer an alternative treatment to complete denture therapy. (4) Among the advantages of mandibular implants are the improvements in mandibular function, the prevention or reversal of alveolar bone loss, and the measurable improvement in self-reported satisfaction with treatment. ...
... 46 This impairment ultimately impacts the ability of chewing, biting & swallowing, thus culminating in diet modification. [47][48] These facts demonstrate that tooth mortality, negatively impacts physical domain of OHRQOL. 49 ...
... Chewing ability is a general term that refers to the ability to put food into the mouth and bite, chew, and swallow it [3]. Functional limitations can in turn affect dietary choices and nutritional intake and therefore have consequences for general health [4]. In addition, functional limitations may go along with disinterest in eating with others due to discomfort [2]. ...
Background Oral well-being is an important component of general well-being and quality of life, as it is greatly influenced by the ability to chew and speak, and thus by central factors of social interaction. Because quality of life and participation are important factors for health in older age, the aim of this article was to examine the chewing ability, including associated factors, for the older population in Germany on the basis of a nationally representative sample.
Methods Database is the German Health Update (GEDA 2019/2020-EHIS), a population based cross-sectional survey of the Robert Koch Institute. In the telephone interview, participants aged 55 years and older were asked: “Do you have difficulty biting and chewing on hard foods such as a firm apple? Would you say ‘no difficulty’, ‘some difficulty’, ‘a lot of difficulty’ or ‘cannot do at all/ unable to do’?” Prevalences and multivariate prevalence ratios (PR) were calculated with 95% confidence intervals (95% CI) from log-Poisson regressions. Sociodemographic, health-, behavioral- and care-related characteristics were investigated as associated factors.
Results The analyses were based on data from 12,944 participants (7,079 women, 5,865 men). The proportion of people with reduced chewing ability was 20.0%; 14.5% had minor difficulty, 5.5% had major difficulty. There were no differences between women and men. The most important associated factors for reduced chewing ability were old age (PR 1.8, 95% CI 1.5–2.1), low socioeconomic status (PR 2.0, 95% CI 1.7–2.5), limitations to usual activities due to health problems (PR 1.9, 1.6–2.2), depressive symptoms (PR 1.7, 1.5–2.1), daily smoking (PR 1.6, 95% CI 1.3–1.8), low dental utilization (PR 1.6, 95% CI 1.4–1.9), and perceived unmet needs for dental care (PR 1.7, 95% CI 1.5–2.1).
Conclusions One fifth of adults from 55 years of age reported reduced chewing ability. Thus, this is a very common functional limitation in older age. Reduced chewing ability was associated with almost all investigated characteristics. Therefore, its prevention requires a holistic view in the living environment and health care context of older people. Given that chewing ability influences quality of life and social participation, maintaining or improving chewing ability is important for healthy aging.
... Another longitudinal study by Noriko Takeuchi et al. has shown that lower articulatory oral motor skill is a risk factor for the future development of physical frailty [27]. The mechanism of the correlation between the two has also attracted much attention, with some scholars suggesting that it may be related to a variety of different mechanisms of aging [34], in ammation[28], In addition, the role of a variety of in uencing factors, such as nutrition [35], mood[36], social activities [37], etc., in the correlation between the two has not yet been con rmed. Anyhow, the present study ndings are consistent with those of these previous studies, providing additional evidence for the relationship between oral and physical frailty. ...
Methods
This cross-sectional study was conducted in urban communities in Beijing from March 2022 to June 2023. We chose the Frailty Phenotype (FP) to assess physical frailty and Oral Frailty Index-8 to assess oral frailty. The analysis of factors affecting oral frailty was analyzed by multi-factorial logistic stepwise regression.
Results
427 participants (147 women; mean age 81.81 ± 9.54 years) were enrolled in this study, 169 (39.58%) were non-oral frailty and 258(60.42%) were oral frailty. Visit a dental clinic less than annually (75.0%) and tooth loss(70.2%) are the most prevalent subdomains in oral frailty adults. After adjusting covariates, logistic regression analysis revealed that frailty phenotype (OR: 1.433, 95% CI: 1.150–1.785,p = 0.001)was associated with oral frailty. In the subdomains of physical frailty, exhaustion( OR = 2.363, 95% CI:1.302–4.289, p = 0.005 ) and slow gait speed (OR = 1.752, 95% CI:1.076–2.853, p = 0.024 ) were associated with oral frailty .
Conclusion
People with physical frailty should be more concerned about oral health issues, exhaustion and slow gait speed can be the sensitive indicators of oral frailty.
... La caries dental, y en particular las RCLs en personas mayores, son uno de los principales factores de riesgo que explican la pérdida dentaria (10)(11)(12) . Perder dientes se ha relacionado con un impacto en la salud sistémica, probablemente debido a que la falta de función bucal condiciona una disminución en la ingesta de nutrientes de calidad y cambios en la selección de los alimentos, afectando el peso, generando dolor y comprometiendo la calidad de vida (13)(14)(15)(16)(17)(18)(19)(20) . Con el aumento de la edad, el sentido del gusto también disminuye, lo que, junto a la disminución en la capacidad masticatoria, puede dar lugar a un menor consumo de frutas y verduras y a un aumento en el consumo de carbohidratos simples, fácilmente masticables, pero potencialmente cariogénicos (21) y con bajo aporte nutricional. ...
Current demographic and epidemiological changes will condition increased caries
prevalence and incidence, specifically root caries lesions (RCLs) in the elderly. There
will be a need, therefore, for therapeutic approaches with greater coverage and
effectiveness. This article summarizes, in Spanish, the current available evidence
leading to clinical recommendations for preventive, non-invasive, micro or minimally
invasive and invasive interventions for the management of dental caries in older people, with special emphasis on RCLs. This publication is based on a consensus workshop, followed by an e-Delphi consensus process, conducted by a panel of experts nominated by the European Organization for Caries Research (ORCA), the European Federation of Conservative Dentistry (EFCD) and the German Federation of Conservative Dentistry (DGZ). The purpose of this article is to present the main conclusions reached in the ORCA/EFCD/DGZ consensus to allow a better dissemination of knowledge and the application of these concepts in clinical practice, guiding the correct decision-making for the disease management and the RCLs in the elderly.
... La caries dental, y en particular las RCLs en personas mayores, son uno de los principales factores de riesgo que explican la pérdida dentaria (10)(11)(12) . Perder dientes se ha relacionado con un impacto en la salud sistémica, probablemente debido a que la falta de función bucal condiciona una disminución en la ingesta de nutrientes de calidad y cambios en la selección de los alimentos, afectando el peso, generando dolor y comprometiendo la calidad de vida (13)(14)(15)(16)(17)(18)(19)(20) . Con el aumento de la edad, el sentido del gusto también disminuye, lo que, junto a la disminución en la capacidad masticatoria, puede dar lugar a un menor consumo de frutas y verduras y a un aumento en el consumo de carbohidratos simples, fácilmente masticables, pero potencialmente cariogénicos (21) y con bajo aporte nutricional. ...
Current demographic and epidemiological changes will condition increased caries prevalence and incidence, specifically root caries lesions (RCLs) in the elderly. There will be a need, therefore, for therapeutic approaches with greater coverage and effectiveness. This article summarizes, in Spanish, the current available evidence leading to clinical recommendations for preventive, non-invasive, micro or minimally invasive and invasive interventions for the management of dental caries in older people, with special emphasis on RCLs. This publication is based on a consensus workshop, followed by an e-Delphi consensus process, conducted by a panel of experts nominated by the European Organization for Caries Research (ORCA), the European Federation of Conservative Dentistry (EFCD) and the German Federation of Conservative Dentistry (DGZ). The purpose of this article is to present the main conclusions reached in the ORCA/EFCD/DGZ consensus to allow a better dissemination of knowledge and the application of these concepts in clinical practice, guiding the correct decision-making for the disease management and the RCLs in the elderly.
... If missing teeth are not replaced, a modification of masticatory mechanical function may occur and removable prosthetic rehabilitation is unable to fully restore the masticatory performance to that of a dentate patient, (especially when eating fibrous or hard food) regardless of the congruity of the prosthesis itself. Thus, literature [8][9][10] investigated the association between oral rehabilitation and nutrients intake, and when the masticatory effectiveness of these patients resulted impaired by an improper or missing rehabilitation, it was considered associated with macro and micronutrients deficiency in their diet. However, these articles don't cover completely all the literature describing this association. ...
Objective. When investigating nutrients intake in ageing patients, a compromised dental status leading to impaired masticatory performance has been considered associated with nutrients deficiency. The aim of the study was to investigate the association between oral rehabilitation and nutrients intake in independent elderly. Methods. PubMed, Web of Science, Cochrane Library e Tripdatabase were searched for eligible studies published between 1991 and 2020. The search comprised articles written in English, selected using the key words “denture” OR “mastication” AND “nutrition” OR “elderly”. Samples of patients with age not inferior to 65 years and with independent life conditions were considered. Results. Among 1362 studies found searching the databases, 10 articles referred to 4 randomized controlled trials and 8 observational studies fulfilled the inclusion criteria. The overall results of the observational studies suggested that a proper oral rehabilitation provides the elderly with a higher nutrients intake. Three RCT comparing different prosthetic treatments found no difference in the nutrients intake between the two study groups. One RCT compared the effect of nutritional advice vs standard advice on dentures’ maintenance: at 6 months the intervention group showed a higher intake of plant protein and a higher MNASF score, while the control group showed a higher intake of animal protein and vitamin B12. Conclusions. Congruous prosthetic rehabilitations alone can’t assure adequate nutrients intake in the elderly, but the influence of other factors is suggested: nutritional counseling seems an important factor to improve nutrients intake and it’s recommended to be associated with the prosthetic rehabilitation.
... Clinical research on masticatory performance suggests that the number of teeth greatly influences chewing capabilities and bolus formation, with fewer than 20 teeth and/or fewer than eight functional tooth units (premolars and molars that can occlude) compromising ease of chewing and swallowing. This is often accompanied by alterations in food preference and undernutrition in later life (Hildebrandt et al 1995;Miura et al 1998;Sheiham et al 1999;Sheiham and Steele 2001;Sahyoun et al 2003;Walls and Steele 2004;Adiatman et al 2013;Zaitsu et al 2022). The contiguous abscess affecting the sockets of the right maxillary molars probably would have been painful, and possibly caused inflammation of the right cheek. ...
... The first plausible mechanism is a nutritional pathway including food intake and food selection. Having fewer or no teeth could possibly result in decreased intake of fruits and vegetables and less consumption of micronutrients and proteins and an increased intake of carbohydrates due to the inability to chew, leading to the deterioration of general health [33]. Given that this is cross-sectional data, it is also possible that poor diet is the underlying cause of both MCC and tooth loss. ...
Objectives:
To examine the relationship between tooth loss and co-occurrence of multiple chronic conditions (MCC) among American adults at working age.
Materials and methods:
Data was from the Behavioural Risk Factor Surveillance System 2018, a cross-sectional telephone-based, nationally representative survey of American adults. We included participants aged 25-64 years. The survey included sociodemographic data, reported diagnosis of chronic conditions, the number of missing teeth and health behaviours. An aggregate variable of chronic conditions was created which included heart attack, angina, stroke, cancer, chronic pulmonary disease, diabetes, asthma, arthritis, depression, and kidney diseases. The association between the number of missing teeth and the aggregate of chronic conditions was assessed adjusting for confounders.
Results:
The analysis included 202,809 participants. The mean number of MCC was 0.86 (95% Confidence Interval 'CI':0.85,0.87). Tooth loss was significantly associated with MCC with rate ratio 1.18 (95% CI:1.15,1.21), 1.53 (95% CI:1.48,1.59) and 1.62 (95% CI:1.55,1.69) for those reporting losing 1-5 teeth, 6 or more but not all, and all teeth, respectively after adjusting for demographic, socioeconomic, and behavioural factors.
Conclusion:
Tooth loss could be an early marker for the co-occurrence of multiple chronic conditions among adults of working age. The association could be attributed to common risk factors for oral and general health.
... Chewing ability affects food choices in older adults, as shown by studies suggesting a significant relationship between chewing ability and nutrient intake. 32 In our study, individuals with chewing difficulty had significantly lower protein intake than those without chewing difficulty, which is consistent with the result of a previous study. 33 Considering that appropriate protein intake is essential for the prevention and treatment of sarcopenia, 25,34 this may at least partially explain why the participants with chewing difficulty had lower grip strength than those without. ...
Purpose
Frailty is closely associated with biological age, concurrent medical conditions, morbidity, and decreased survival. Poor oral health is common in older individuals and is associated with frailty. Considering its potential importance, a study on the association between oral health and frailty is meaningful. Therefore, we aimed to analyze the association between major oral health factors and frailty using nationally representative samples of older adults.
Patients and Methods
This cross-sectional study included 3018 older adults (age ≥ 65 years) from the seventh Korea National Health and Nutrition Examination Survey. Oral examination results, laboratory data, handgrip strength, life style factors derived from questionnaires, and food intake survey results were analyzed. This study used the deficit accumulation model among the main operational definitions of frailty. We constructed a frailty index based on 36 items and classified participants as non-frail, pre-frail, or frail. Oral health factors included chewing difficulty, number of teeth, periodontal disease, and number of carious teeth. Logistic regression analysis was performed to determine significant factors.
Results
A total of 1222 (40.5%), 1014 (33.6%), and 782 (25.9%) individuals were classified as non-frail, pre-frail, and frail, respectively. Chewing difficulty was associated with increased risk of frailty after adjusting for age, sex, socioeconomic factors, and comorbidities (odds ratio 2.68, 95% confidence interval 2.08–3.44). Periodontal disease was positively associated with chewing difficulty (odds ratio 1.29, 95% confidence interval 1.07–1.56), and chewing difficulty decreased as the number of teeth increased (odds ratio 0.97, 95% confidence interval 0.96–0.99).
Conclusion
Chewing difficulty was significantly associated with frailty in the older population. Considering the negative effect of chewing difficulty on frailty, more attention should be focused on oral health.
... Smoking also has this same effect, and preliminary studies have shown that long-term smoking is significantly associated with hyposalivation [8]. Profound and complex interactions exist between nutrition and oral health [9], however, to our knowledge, no existing studies have considered the relationship between diet in older people and the sensation of dry mouth, although Machowicz et al. [10] associated adherence to a Mediterranean diet with a lower probability of suffering from primary Sjögren's Syndrome. ...
Background
This study investigated the association between xerostomia and health risk behaviours, general and oral health and quality of life.
Methods
A cross-sectional study involving 800 adults over 65 years of age residing in Spain using a computer-assisted telephone questionnaire. The severity of xerostomia was assessed through the Xerostomia Inventory (XI). Both univariate and adjusted multinomial logistic regression were used to determine the risk (OR) of xerostomia.
Results
The sample comprised of 492 females (61.5%) and 308 males, with a mean age of 73.7 ± 5.8 years. Some, 30.7% had xerostomia: 25.6% mild, 4.8% moderate and 0.3% severe, the majority being female (34.8% vs 24%; p = 0.003). The mean XI was 24.6 ± 6.3 (95% CI 19.2–24.8) for those with poor health, whereas it was 17.4 ± 6.3 (95%CI 16.1–18.6) in those reporting very good health (p < 0.001). This difference was also observed in terms of oral health, with the XI mean recorded as 14.7 ± 10.7 for very poor oral health and 6.4 ± 5.4 for those with very good health (p = 0.002). Logistic regression showed that the highest OR for xerostomia was observed among adults with poor general health (2.81; 95%CI 1.8–4.3; p < 0.001) and for adjusted model the OR was still significant (2.18; 95%CI 1.4–3.4; p = 0.001). Those who needed help with household chores had 2.16 higher OR (95%CI 1.4–3.4; p = 0.001) and 1.69 (95%CI 1.1–2.7; p = 0.03) in the adjusted model. Females had a higher risk of suffering from xerostomia than males.
Conclusion
The strong association between xerostomia and the general and oral health status of older adults justifies the need for early assessment and regular follow-up.
... Similarly, dental caries, periodontal diseases and periapical infections can also act as infectious foci for local oral tissues. If left untreated, these conditions can elicit a systemic inflammatory response [25] and therefore may affect athletes' physical fitness, performance, and wellbeing [26][27][28]. ...
Frequent consumption of sports and energy drinks among athletes is of concern due to its detrimental impact on oral health. The present study aimed to assess sports and energy drink consumption, oral health status and impacts on daily activities and sports performance among elite athletes from Pakistan. Data regarding socio-demographic characteristics, sports and energy drink consumption, oral health and hygiene practices, self-reported oral health and psychosocial and performance impact was assessed using a self-administered, structured questionnaire followed by clinical oral examination by a single, experienced dentist. A total of 104 athletes, a majority of whom were male (80.8%), participated in the study. Around two third of the participants reported consumption of sports and energy drinks, energy gels or bars at least once a week, the commonest being Sting. Despite good oral hygiene practices, the athletes generally had poor oral health with high prevalence of dental caries (63.5%), gingivitis (46.1%), irreversible periodontitis (26.9%) and erosive tooth wear (21.2%). More than a quarter (28.8%) of the athletes rated their oral health as fair—very poor. Four in five athletes (80%) also experienced at least one oral problem with negative impacts on daily activities (64.4%) and participation training and sports performance (36.5%). Regression analyses revealed a significant association between periodontal disease and impact on both daily activities and sports performance. To our knowledge, this is the first study reporting that high-prevalence sports and energy drink consumption and oral problems among elite athletes from Pakistan has a negative impact on daily activities and sports performance. These findings may have important implications for oral health education programs, and the need to create awareness among the athletes regarding the use of sports and energy drinks, as well as regular oral health screening of athletes to minimize the impact on performance.
... Similarly, dental caries, periodontal diseases and periapical infections can also act as infectious foci for local oral tissues. If left untreated, these conditions can elicit a systemic inflammatory response [25] and therefore may affect athletes' physical fitness, performance, and wellbeing [26][27][28]. ...
Frequent consumption of sports and energy drinks among athletes is of concern due to its detrimental impact on oral health. The present study aimed to assess sports and energy drink consumption, oral health status and impacts on daily activities and sports performance among elite athletes from Pakistan. Data regarding socio-demographic characteristics, sports and energy drink consumption, oral health and hygiene practices, self-reported oral health and psychosocial and performance impact was assessed using a self-administered, structured questionnaire followed by clinical oral examination by a single, experienced dentist. A total of 104 athletes, a majority of whom were male (80.8%), participated in the study. Around two third of the participants reported consumption of sports and energy drinks, energy gels or bars at least once a week, the commonest being Sting. Despite good oral hygiene practices, the athletes generally had poor oral health with high prevalence of dental caries (63.5%), gingivitis (46.1%), irreversible periodontitis (26.9%) and erosive tooth wear (21.2%). More than a quarter (28.8%) of the athletes rated their oral health as fair—very poor. Four in five athletes (80%) also experienced at least one oral problem with negative impacts on daily activities (64.4%) and participation training and sports performance (36.5%). Regression analyses revealed a significant association between periodontal disease and impact on both daily activities and sports performance. To our knowledge, this is the first study reporting that high-prevalence sports and energy drink consumption and oral problems among elite athletes from Pakistan has a negative impact on daily activities and sports performance. These findings may have important implications for oral health education programs, and the need to create awareness among the athletes regarding the use of sports and energy drinks, as well as regular oral health screening of athletes to minimize the impact on performance.
... Among these factors, the frequency of snacking was negatively correlated with PD prevalence. A previous study suggested that elderly people with snacking habits have better nutritional status, which may explain this phenomenon [45,46]. In regard to the serving location, PD prevalence was lower when a commercial location was frequently used. ...
This study, as part of a study on the dietary lives of elderly people, investigates the association between plant food (fruit + non-starchy vegetable) intake and the prevention of periodontal disease among elderly people aged over 65 years. A total of 4514 subjects over 65 years of age participated in a dental survey, health behavior interview, and 24 h dietary recall test for the Korea National Health and Nutrition Examination Survey (KNHANES). Subjects with energy intake of less than 500 kcal or more than 5000 kcal were excluded. The results showed that plant food intake was inversely associated with the prevalence of periodontal disease in the elderly Korean population. The prevalence of periodontal disease decreased with increasing plant food consumption. Compared with those in tertile 1 (T1), subjects in tertile 3 (T3) showed a decrease in periodontal disease of about 26.7% (OR = 0.733). In conclusion, the consumption of plant food lowers the risk of periodontal disease, suggesting that it should be encouraged among elderly Koreans.
Diet is one of the most important aetiological factors in dental caries. This chapter describes the relationship between sugar consumption and dental caries through history. Cariogenicity of food items and diet, as well as factors that influence the cariogenicity, is reviewed. The interplay of diet with other preventive measures also receives attention. Prevention through diet with natural sugar alcohol, xylitol and beneficial bacteria (probiotics) is discussed. Finally, diet counselling for caries prevention for specific age groups is summarised, and dietary suggestions with health benefits are reported.
Introduction: Language disorder among children with autism spectrum disorder increased risk for development of
dental complications for poor oral hygiene maintain because children are unable to express their emotions, thought and
ideas through language according situation and context. If we focus how to maintain oral hygiene by the help of dentist
at early stage and intervene in their daily routine with speech language therapy, we can reduce dental complications
and burden of the family and state.
Objective: The aim of this study is to describe the language disorders increased risk for development of dental
Complications among Children with Autism Spectrum Disorder, through neurolinguistic approach.
Methods: This is a cross-sectional descriptivestudy, with a neurolinguistic approach. It was conducted during theperiod
from February 2021 to February 2022 at the Department of Psychiatry Z.H.Sikder Women’s Medical College and
Hospital patient attending with the diagnosis of autism spectrum disorder with language disorders present with the
dental complications.
Results: The duration of study was one year. Participation rate 50. The mean age of the respondents was 6.89 ± 1.54
years, ranging from 4 to 12 years,50 children enrolled, the majority (64%) were 4-7 years old, and the remainder (36%)
were 8-12 years old . (72%) were male and 28% female. 68% of children expressive language disorders (child unable
to express thought, ideas according to the rules of Phonetics and Phonology); 64%of children wereunabletounderstand
any speech of others according to social context (Reception / Perception disorder); due to receptive and expressive
language disorder 80% of children could not deliver language according to social situation and context (pragmatic
disorder/sociolinguistic disorder). 86% had disorders in the development of meta-linguistic competence; 76% had
semiotic disorder
Conclusion: Dental complications among autism spectrum disorder with language disorder is poorly addressed in
Bangladesh .In this perspective the dentist must be give importance to meet the special needs of the children with autism
spectrum disorder during their dental management strategies and build a inter-professional collaborations among
dentist , speech language specialist and psychiatrist to reduce the barrier and burden on the family for provision of
effective dental care for a better quality of life . This work makes a pioneering neurolinguistic approach in Bangladesh
further large-scale studies are needed to better visualize the extent of the problem.
The mouth is a vital aspect of daily life, contributing to survival through eating and fostering social interaction via communication. Despite its crucial role, the consequences of oral diseases on activities of daily living and overall quality of life are often overlooked. Recent research has uncovered a significant link between oral diseases and frailty, prompting assertions of a causal connection. Although oral diseases precede frailty by a considerable time span, understanding the underlying mechanisms is essential. Diet, a key component of healthy living, is notably affected by oral diseases, potentially leading to enduring changes with repercussions in later years. The intricate interrelationships among oral diseases pose challenges for managing older patients clinically. This chapter provides a thorough examination of the complex interplay between oral diseases and their potential repercussions on the overall health and frailty of older adults.
Aim
Efforts to combat frailty and preserve good health in older adults have highlighted oral frailty as an early indicator of overall frailty. Individuals showing oral frailty are at an elevated risk of insufficient nutritional intake compared with those without oral frailty; however, underlying mechanisms remain poorly explored. In this cross‐sectional study, we aimed to examine the link between oral frailty and undernutrition, especially regarding poor appetite and low dietary diversity.
Methods
The analysis included 2727 late‐stage older adults (mean age 79.9 ± 4.3 years) who underwent dental checkups in a prefecture in Japan from 2016 to 2020. The examination involved a questionnaire survey (covering basic information, frailty screening index, appetite index: Simplified Nutritional Appetite Questionnaire; and dietary variety: Dietary Variety Score) and a measurement survey (including intraoral confirmation, oral diadochokinesis and masticatory efficiency test). Individuals with three or more indications of poor oral function, identified through oral function assessment, were defined as showing oral frailty. Binomial logistic regression and path analyses examined associations among oral frailty, Simplified Nutritional Appetite Questionnaire and Dietary Variety Score.
Results
Among those analyzed, 1208 (44.3%) participants were categorized into the oral frailty group. Binomial logistic regression analysis showed that Simplified Nutritional Appetite Questionnaire (odds ratio for oral frailty per 1‐point increase 0.88, 95% confidence interval 0.84–0.93) and Dietary Variety Score (odds ratio 0.95, 95% confidence interval 0.92–0.98) were significantly associated with oral frailty. The path analysis showed individual associations between each examined factor.
Conclusions
Oral frailty was associated with decreased appetite and dietary variety in late‐stage older adults. Geriatr Gerontol Int 2024; 24: 626–633 .
Objectives
SENIOR (uSing rolE‐substitutioN In care homes to improve oRal health) is a randomised controlled trial designed to determine whether role substitution could improve oral health for this population. A parallel process evaluation was undertaken to understand context. This paper reports on the first phase of the process evaluation.
Background
The oral health and quality‐of‐life of older adults residing in care homes is poorer than those in the community. Oral health care provision is often unavailable and a concern and challenge for managers. The use of Dental Therapists and Dental Nurses rather than dentists could potentially meet these needs.
Materials and Methods
Semi‐structured interviews were conducted with 21 key stakeholders who either worked or had experience of dependent care settings. Questions were theoretically informed by the: Promoting Action on Research Implementation in Health Services (PAHRIS) framework. The focus was on contextual factors that could influence adoption in practice and the pathway‐to‐impact. Interviews were fully transcribed and analysed thematically.
Results
Three themes (receptive context, culture, and leadership) and 11 codes were generated. Data show the complexity of the setting and contextual factors that may work as barriers and facilitators to intervention delivery. Managers are aware of the issues regarding oral health and seek to provide best care, but face many challenges including staff turnover, time pressures, competing needs, access to services, and financial constraints. Dental professionals recognise the need for improvement and view role substitution as a viable alternative to current practice.
Conclusion
Although role substitution could potentially meet the needs of this population, an in‐depth understanding of contextual factors appeared important in understanding intervention delivery and implementation.
Background
It is important to detect oral health problems early among patients admitted to pediatric intensive care units to establish the diagnosis and consequently allow nurses to plan appropriate oral care practices.
Objectives
The study aimed to assess the oral health status of patients admitted to pediatric intensive care units.
Methods
This descriptive cross-sectional study was conducted from June to September 2021 in the pediatric intensive care units of 3 hospitals. A total of 88 children were included in the study. An intraoral assessment was performed using a tongue depressor and a flashlight, and data were collected using a patient information form and the Oral Assessment Guide (OAG).
Results
The mean OAG score was 8.45 ± 2.876 points. A significant difference was found in the OAG score between the patients 60 months or younger and those 61 months or older ( P < .05). The OAG score was significantly associated with the use of diuretics ( P < .05) and the frequency of oral care ( P < .05). A negative relationship was found between the OAG score and the Glasgow Coma Scale score ( P < .05).
Conclusions
The oral health status of the patients worsened as their age increased, and their state of consciousness decreased. Oral care was more frequently applied to the patients who received artificial respiration. The study provides evidence-based data regarding the early detection of the factors threatening oral health and the necessary precautions.
Tam protezler günümüzde hala sıklıkla kullanılan hareketli protezlerdendir. Hareketli tam protezlerin üretimi için geleneksel yaklaşımın bazı dezavantajları bulunmaktadır. Çok sayıda klinik ve laboratuvar aşamasının bulunması, zaman alıcı olması ve yoğun emek sarf edilmesinin gerekmesi bunlardan birkaçıdır. Ayrıca tüm bu klinik ve laboratuvar aşamalarının manuel olarak gerçekleştirildiği göz önüne alınırsa hazırlanan protezlerde optimal kaliteyi sağlamak oldukça zordur. Tam protezlerde kaide materyali olarak en çok tercih edilen akrilik rezin, polimetil metaakrilattır. Bu rezinin kolay onarımı ve maliyetinin düşük olması gibi avantajları olmasına rağmen polimerizasyon büzülmesine bağlı olarak ortaya çıkan boyutsal değişimi ise en büyük dezavantajıdır. Bu deformasyonlardan kaçınmak için birçok muflalama tekniği geliştirilmiş olsa da istenilen düzeyde bir başarı sağlanamamış olması araştırmacıları başka teknik arayışlarına yönlendirmiş ve bu yüzden tam protezlerin yapımında daha fazla tekniğin optimizasyonunun klinik pratiğe fayda sağlayacağı düşünülmüştür. Dijital diş hekimliğindeki güncel gelişmeler tam protez tedavi yöntemlerini ve üretimlerini etkilemeye başlamıştır. Modern teknolojinin tam protezlerin üretimine olan entegrasyonuyla fabrikasyon prosedürlerinde farklılıklar ortaya çıkmıştır. Dijital iş akışı için yayınlarda önerilen adımlar oldukça çeşitlilik göstermektedir. Yeni teknolojiler hem hekimler hem de teknisyenler için özel bilgi ve beceriler gerektirirken, vasıflı el işçiliğine olan ihtiyacı ise azaltmıştır. Bu derlemenin amacı tam protezlerin geleneksel ve dijital tekniklerle üretimi ile ilgili mevcut literatürü pekiştirmek, klinik ve laboratuvar aşamalarının mevcut dijital iş akışlarını özetlemek, dijital alternatiflerin aşamalarını açıklamak ve bunların avantajlarını ve sınırlamalarını tartışmaktır.
Aim
Neglected oral health is a major issue, especially in women of developing countries, leading to early loss of teeth which may further lead to malnutrition, degradation of overall health, and increased chances of osteoporosis. Thus, the aim of this study was to assess the effect of food supplement on masticatory performance, nutritional status, electromyography (EMG) (masseter and temporalis), and bone mineral density (BMD) among women rehabilitated with complete denture.
Settings and Design
Hospital based randomized controlled trial.
Materials and Methods
A randomized controlled trial with 106 women of 45–65 years rehabilitated with complete denture (56 received food supplement and 50 did not receive food supplement) and 52 healthy control was conducted. The outcomes were assessed at baseline and 3 and 6 months of follow up (after complete denture fabrication). Outcomes were measured via masticatory performance, nutritional status (hemoglobin, serum calcium, albumin, and Vitamin D level), EMG of masseter and temporalis muscles, and BMD.
Statistical Analysis Used
Friedman’s analysis of variance test was used as a nonparametric test, and the Statistical Package for the Social Sciences version 21.0 at a significance level of 0.05 was used for statistical analysis.
Results
A statistically significant change was observed during follow up for the group with food supplement for BMD, EMG, and masticatory performance. When biochemical parameters were assessed during follow up, no statistically significant change was observed for both groups (with and without food supplement), except for serum calcium level in group which received food supplement.
Conclusion
It was found that the magnitude of effect was remarkably meager in food supplement group which could be perhaps due to less time given for follow up period. Longer duration of trials would yield better results.
Aims
The aim of this study was to assess the impact of prosthodontic rehabilitation on glycemic and lipid control in functionally and completely edentulous patients with diabetes.
Setting and Design
An in vivo study conducted with the intention of studying the potential link between edentulism and impaired masticatory efficiency with the nutritional status in diabetic patients.
Materials and Methods
A total of 20 diabetic patients based on the inclusion criteria were selected. They were rehabilitated using a removable prosthesis, and observations were made across three parameters – glycosylated hemoglobin (HbA1C), serum cholesterol (S col), and serum protein (SP) at three stages – baseline, 3 months, and 6 months posttreatment. This was done to gauge the impact of the prosthetic rehabilitation on their health due to an increased masticatory efficiency potentially causing changes in dietary patterns.
Statistical Analysis Used
•Inter group comparison (>2 groups) was done using one way ANOVA followed by pair wise comparison using post hoc test. •Intra group comparison was done using repeated measures ANOVA (for>2 observations) followed by post Hoc test. For all the statistical tests, P < 0.05 was considered to be statistically significant, keeping α error at 5% and β error ati20%, thus giving a power to the study as 80%.
Results
Hba1c at the baseline had a mean value of 8.04%, which reduced to 7.87% at the 3-month stage and 7.38% at the 6-month stage. S col at the baseline had a mean of 151.6 mg/dL; at the 3-month follow-up, it was 166.5 mg/dL, and at the 6-month follow-up, it was 173.95 mg/dL. SP had a mean baseline value of 6.38 mg/dL, which progressed to 6.67 mg/dL at the 3-month stage and 6.97 at the 6-month stage.
Conclusion
Within the limitations of this study, it can be concluded that after 6 months of prosthetic rehabilitation in edentulous/functionally edentulous patients:
There was a reduction in HbA1c (8.04%-7.38%); however, it was found to be statistically insignificant at that stage
There was an increase in S col (151.6 mg/dL–173.95 mg/dL); it was found to be statistically significant
There was an increase in SP (6.38 mg/dL–6.97 mg/dL); however, it was found to be statistically insignificant at that stage.
Objectives:
To pilot an exploration of older adults' future preferences using discrete choice experiments to understand who should provide dental examinations and treatment, where these services should be provided, and participants' willingness to pay and willingness to travel.
Background:
The proportion of older adults in the general population is increasing and is recognised as a pressing public health challenge.
Materials and methods:
Older people aged 65 years and over were recruited into this study from the UK, Switzerland and Greece. Drawing on earlier stakeholder engagement, a set of choice experiments are developed to explore the future preferences of older people for dental examinations and dental treatment, as they anticipated losing their independence. These were presented to the participants using a range of platforms, because of the COVID pandemic. Data were analysed in STATA using a random-effects logit model.
Results:
Two hundred and forty-six participants (median age 70 years) completed the pilot study. There was a strong preference across all countries for a dentist to undertake a dental examination (Greece: β = 0.944, Switzerland: β = 0.260, UK β = 0.791), rather than a medical doctor (Greece: β = -0.556, Switzerland: β = -0.4690, UK: β = -0.468). Participants in Switzerland and the UK preferred these examinations to be undertaken in a dental practice (Switzerland: β = 0.220, UK: β = 0.580) while participants in Greece preferred the dental examination to be undertaken in their homes (β = 1.172). Greek participants preferred dental treatment to be undertaken by a specialist (β = 0.365) in their home (β = 0.862), while participants from the UK and Switzerland preferred to avoid any dental treatment at home (Switzerland: β = -0.387; UK: β = -0.444). Willingness to pay analyses highlighted that participants in Switzerland and the UK were willing to pay more to ensure the continuity of future service provision at a family dental practice (Switzerland: β = 0.454, UK: β = 0.695).
Conclusion:
Discrete choice experiments are valuable for exploring older people's preferences for dental service provision in different countries. Future larger studies should be conducted to further explore the potential of this approach, given the pressing need to design services that are fit for purpose for older people. Continuity of dental service provision is considered as important by most older people, as they anticipate losing their dependence.
El objetivo de este trabajo es recopilar información sobre las enfermedades y afecciones orales y como estas afectan el estado nutricional de los adultos mayores. Se ha demostrado que existe una correlación directa entre la salud bucal y el grado nutricional de los adultos mayores. Alteraciones de la salud oral como las lesiones cariosas y la enfermedad periodontal producen pérdidas prematuras de órganos dentarios y dolor dental, lo que dificulta el proceso masticatorio. Además, en adultos mayores es común el desarrollo xerostomía (disminución en la cantidad y calidad de la saliva) ya sea por atrofia de las glándulas salivales o como efecto secundario de diversos medicamentos para el tratamiento de enfermedades crónicas. Esto en su conjunto produce alteraciones en la dieta, disminución en la ingesta alimenticia y de la eficacia metabólica, lo que se traduce en cuadros de desnutrición de los adultos mayores. Palabras clave: Salud bucal, Desnutrición, Adulto Mayor, Proceso Masticatorio, Saliva.
This eighth edition of Dr Reichel's formative text remains the go-to guide for practicing physicians and allied health staff confronted with the unique problems of an increasing elderly population. Fully updated and revised, it provides a practical guide for all health specialists, emphasizing the clinical management of the elderly patient with simple to complex problems. Featuring four new chapters and the incorporation of geriatric emergency medicine into chapters. The book begins with a general approach to the management of older adults, followed by a review of common geriatric syndromes, and proceeding to an organ-based review of care. The final section addresses principles of care, including care in special situations, psychosocial aspects of our aging society, and organization of care. Particular emphasis is placed on cost-effective, patient-centered care, including a discussion of the Choosing Wisely campaign. A must-read for all practitioners seeking practical and relevant information in a comprehensive format.
Sensorial perceptions change as people age and biometrics analysis can be used to explore the unconscious consumer
responses. Investigation was conducted of effects of consumer age (younger, 22–52 years; older, 60–76 years) on facial expression response (FER) during consumption of beef patties with varying firmness (soft, medium, hard) and taste (±plum sauce). Video images were collected and FERs analysed using FaceReader™. Younger people exhibited higher intensity for happy/sad/scared and lower intensity for neutral/disgusted, relative to older people. Interactions between age and texture/sauce showed little FER variation in older people, whereas younger people showed considerable FER variation. Younger people, but not older people, had lowest intensity
of happy FER and highest intensity of angry FER for the hard patty. Sauce addition resulted in higher intensity of
happy/contempt in younger consumers, but not older consumers. FER collected using FaceReader™ was successfully used to differentiate between the unconscious responses of younger and older consumers.
Embedded 3D printing is an emerging method of immobilizing scaffolds fabricated with semi-solid foods into solidifying gel matrices. In this study, we present some pioneering examples of textured bespoke gel forms with rich protein loading for potential use as texture-controlled foods for the elderly. Printability enhancement for fabrication of the defined scaffold structures of abalone proteins was achieved through incorporation of gelatinized starch at various concentrations (0, 1, 3, 5, and 7%). Moreover, the effects of starch addition on the rheological properties and microstructure of the abalone protein paste was investigated. Upon increasing the amount of added starch, it was confirmed that the storage modulus (G′) of the abalone paste and uniformity of the microstructure increased. Starch incorporation of 3% showed the most desirable print resolution for fabricating a defined scaffold structure. About 20–80% of the infill ratio of the scaffold was 3D printed with abalone paste containing 3% starch and embedded with a gelatin solution. The decreased infill densities of the abalone scaffolds showed greater hardness values (37.0 ± 0.4 to 63.6 ± 1.3 kN/m²) because of the increased portion of gel in the same volume of the product. Our results thus demonstrate that modifying the infill ratio of 3D printing with embedding technology could modulate the texture of 3D printed food products.
The aim of this study was to examine salivary flow rate and its association with the use of medication in a representative sample of 76-, 81-, and 86-year-old subjects, totaling 368.
In this study, 23% (n = 80) of the subjects were unmedicated. From one to three daily medications were used by 47% (n = 168) and more than four medications by 30% (n = 104). The most commonly used medications were nitrates, digitalis or anti-arrhythmic drugs (47.7%), analgesics and antipyretics (32.6%), and diuretics (29.5%). The mean number used daily was significantly higher in 86-year-olds than in the two younger age groups (p < 0.01). No significant differences in this respect were found between genders.
Among the unmedicated subjects, 76-year-olds had significantly higher stimulated salivary flow rates than did the 81-year-olds (p < 0.05). Unmedicated women showed significantly lower unstimulated (p < 0.01) and stimulated flow rates than did men (p < 0.05).
Stimulated salivary flow rate was also significantly higher in the 76-year-old medicated subjects than in the medicated 86-year-old subjects (p < 0.05). No statistically significant differences were found in unstimulated salivary flow rates among the three age groups. Medicated women showed significantly lower unstimulated salivary flow rates than men (p < 0.001), although the difference in stimulated saliva flow was not significant. A statistically significant difference in unstimulated and stimulated salivary flow rates was found between unmedicated persons and those who took from four to six, or more than seven, prescribed medications daily.
51 healthy dentate subjects aged between 20 and 60 years were evaluated with regard to their masticatory efficiency using a sieving test. A subjective evaluation of difficulty in chewing different kinds of food was also obtained by means of a questionnaire. The occlusal and restorative status were assessed using specific indices. The masticatory efficiency was shown to be lower with increasing age 20-39 years, mean = 39.8 and 40-60 years, mean = 27.1, respectively (p < 0.05). Males had a statistically significantly higher masticatory efficiency index than females. Multiple regression analysis showed that age, sex, the number of occluding teeth and the orthodontic treatment need index can predict half the variance in masticatory efficiency. It is concluded that it is more appropriate to describe masticatory efficiency with an average value for different age groups.
The authors collected dietary intake data about the food and nutrient intake of 49,501 male health professionals. Edentulous participants consumed fewer vegetables, less fiber and carotene, and more cholesterol, saturated fat and calories than participants with 25 or more teeth. These factors could increase the risks of cancer and cardiovascular disease. Mean differences in intake ranged from 2 to 13 percent, independent of age, smoking, exercise and profession. Longitudinal analyses suggest that tooth loss may lead to detrimental changes in diet.
The authors examined nutrient intake in relation to the number of teeth, denture type and masticatory function among 638 men in the U.S. Department of Veterans Affairs Dental Longitudinal Study. They found that calorie-adjusted nutrient intakes decreased with progressively impaired dentition status, independently of age, smoking status and alcohol use. Intakes of fiber and most vitamins and minerals were inversely correlated with masticatory function. The findings suggest that prevention of tooth loss and prosthodontic replacement of missing teeth could improve diets of older adults.
To evaluate the relationship between oral health status and nutritional deficiency.
Cross-sectional clinical study.
324 institutionalized frail older adults (mean age 85).
Structured oral examination including an evaluation of mucosa, periodontal state, caries prevalence and denture quality. The nutritional status was assessed using serum albumin concentration and the body mass index. Physical dependence was assessed using the Barthel index. To identify oral health disorders associated with markers of malnutrition we performed the Pearson chi2 test separately for edentulous and dentate patients. Subjects with at least one of the identified oral disorders were classified as having compromised oral functional status.
About two-thirds of the subjects were functionally dependent and half had either a body mass index <21 kg/m2 or serum albumin <33 g/l. Among the edentulous, wearing dentures with defective bases or not wearing dentures at all were the factors most associated with malnutrition. In dentate subjects, corresponding identifiers were the number of occluding pairs of teeth (five or fewer, either natural or prosthetic), the number of retained roots (four or more), and the presence of mobile teeth. According to these criteria, 31% of the subjects had a compromised oral functional status. This was more frequently found in dependent subjects (37%) than semi-dependent subjects (18%; odds ratio, 2.6; 95% confidence interval, 1.4-4.8). Those with compromised oral functional status had a significantly lower body mass index and serum albumin concentration.
Specific detrimental oral conditions are associated with nutritional deficiency in very old people.
The 1998 Adult Dental Health Survey, published this year, showed that the number of people without teeth should fall over the next three decades, to only 4% of the UK population. Patterns of tooth loss and retention are also changing. This article, the first of a series on the interpretation of the Adult Dental Health Survey, discusses the implications of these trends for dentistry.
Overall diet quality indices, such as the Healthy Eating Index (HEI), are preferred for epidemiological studies, yet studies in dentistry have focused on isolated dietary components. This study investigated the influence of socio-demographic and masticatory variables (masticatory performance, bite force, number of posterior functional tooth units, TMJ disorder, and dentition status) on overall diet quality in a community-based sample (n = 731). Cross-sectional data were derived from clinical examinations, bite force recordings, masticatory performance measurements, and two 24-hour dietary recalls. Females, European-Americans, and older subjects had better HEI scores than males, Mexican-Americans, and younger subjects, respectively. Income, education, and the masticatory variables were not related to diet quality. Analyses according to dentition status (good dentition, compromised dentition, partial denture, and complete dentures) showed no inter-group differences for HEI except for the age groups. The results suggest that the chewing-related factors evaluated in this sample are not predictors of overall diet quality across the socio-demographic groups.
OBJECTIVE: To evaluate the relationship between oral health status and nutritional deficiency. DESIGN: Cross-sectional clinical study. SUBJECTS: 324 institutionalized frail older adults (mean age 85). MEASUREMENTS: Structured oral examination including an evaluation of mucosa, periodontal state, caries prevalence and denture quality. The nutritional status was assessed using serum albumin concentration and the body mass index. Physical dependence was assessed using the Barthel index. To identify oral health disorders associated with markers of malnutrition we performed the Pearson chi2 test separately for edentulous and dentate patients. Subjects with at least one of the identified oral disorders were classified as having compromised oral functional status. RESULTS: About two-thirds of the subjects were functionally dependent and half had either a body mass index < 21 kg/m2 or serum albumin < 33 g/l. Among the edentulous, wearing dentures with defective bases or not wearing dentures at all were the factors most associated with malnutrition. In dentate subjects, corresponding identifiers were the number of occluding pairs of teeth (five or fewer, either natural or prosthetic), the number of retained roots (four or more), and the presence of mobile teeth. According to these criteria, 31% of the subjects had a compromised oral functional status. This was more frequently found in dependent subjects (37%) than semi-dependent subjects (18%; odds ratio, 2.6; 95% confidence interval, 1.4-4.8). Those with compromised oral functional status had a significantly lower body mass index and serum albumin concentration. {CONCLUSION}: Specific detrimental oral conditions are associated with nutritional deficiency in very old people.
Commissioned by the Ministry of Agriculture, Fisheries and Food, the Department of Health and carried out by Social and Community Planning Research and MRC Dunn Nutrition Unit, the dental hospitals of the Universities of Newcastle and Birmingham and the Department of Epidemiology of the University of London, this research forms part of the National Diet and Nutrition Survey. Set up in 1992 the surveys cover representative groups of the population and examine the diet of the over-65s in terms of actual dietary intake, habits, energy and nutrient intakes, physical measurements. Regional and socio-economic comparisons are made.
The TNM system is used to describe and classify cancer stages and progression based on the assessment of three components: T The extent of the primary tumour
N The absence or presence and extent of regional lymph node metastasis
M The absence or presence of distant metastasis.
TNM classification for the above site is described under the following headings: Rules for classification with the procedures for assessing T, N, and M categories; additional methods may be used when they enhance the accuracy of appraisal before treatment
Anatomical sites and subsites where appropriate
Definition of the regional lymph nodes
TNM Clinical classification
pTNM Pathological classification
G Histopathological grading
Stage grouping
Summary
Food plays a significant and essential role in the survival of all people. There has been a suggestion that there is a strong association between changes in dental status such as loss of teeth and denture wearing and low intake of essential nutrients. This paper explores the relationship between diet and nutrition and a change from (A) an old complete denture to an implant-sup ported denture, from (6) the dentate status to an immediate complete denture, and from (C) an old complete denture to a functionally corrected new complete denture. A summary of the findings is that loss of teeth influences masticatory efficiency and function and that a replacement prosthesis may improve function but does not significantly change dietary intake.
This review describes an approach to examining the interaction of aging and systemic disease on a key aspect of oral physiology, salivation. The approach requires several steps: defining general health, and a specific physiological function, at different ages; defining a disease of interest and the influence of the disease on the specific physiological function; and determining if the disease can affect performance of the physiological function with increased age.
Dry mouth (xerostomia) is a common complaint which occurs in about 25% of the elderly. Drugs play a principal role in its etiology. This REFERENCE GUIDE is designed to help the practitioner identify the medicaments which may cause this condition. Moreover, it offers suggestions for the treatment of drug-induced dry mouth.
Masticatory efficiency, the subjective experience of masticatory performance, and dietary intake were evaluated in 19 subjects who were treated with a removable partial denture in the lower jaw. The subjects were tested on three occasions: before treatment, with the dentures when free from symptoms, and about 4 months after the dentures were inserted. Masticatory efficiency and the subjective experience of masticatory performance increased significantly after the subjects were provided with the dentures, but no changes were found in the dietary intake.
The masticatory efficiency of subjects with all natural teeth, with complete upper and partial lower dentures, and with complete dentures was measured. Two different methods were used. The results showed significant differences among the groups irrespective of the method used. The subjects with dentures compensated for decreasing masticatory efficiency by using more strokes when chewing until swallowing. Great interindividual differences were found within groups with similar dental states. There was no or weak correlation between the two methods. A value from one method corresponded to a large range of values in the other method and vice versa.
A reduced consumption of hard-textured fibrous foods may promote the development of digestive disturbances in more susceptible elderly people who wear prostheses having deficient masticatory function. The purpose of this study was to evaluate the effects of a program combining denture relining and dietary counselling on the masticatory performance, fibre intake, and prevalence of digestive symptoms in elderly women with low chewing efficiency. This program was provided to 55 women between 55 and 74 years of age. Chewing ability was assessed quantitatively with the Swallowing Threshold Test Index (STTI), and qualitatively according to the participants' experience in chewing five specific foods. Nutritional data were collected using a food frequency questionnaire. The mean value of the STTI was significantly increased at three weeks and at six to nine months after completion of relining by 37 and 31 per cent, respectively. Subjects included one more food in their diet at the end of the six- to nine-month period only. Fibre intake from vegetables was significantly increased by 18 per cent, while colonic and gastrointestinal symptoms were both reduced. Prosthetic relining increased the masticatory performance of elderly women, but not to a functional level. In addition, dietary counselling stimulated subjects to eat foods that had previously been avoided. These observations suggest that the improvement of chewing efficiency, combined with dietary counselling, could reduce the presence of digestive symptoms.
Particle sizes obtained with progressive chewing cycles were quantified by use of an optical scanning device and compared with the sieving method. The aim of this study was to validate the optical method by comparison with sieving using a natural test food, almond. Masticatory efficiency was assessed in six dentate subjects. The almonds were chewed for 1, 4, 8, 16 and 32 chewing strokes. Each experiment was replicated. The chewed material was sieved through a 1 mm aperture sieve on a Büchner funnel and dried after washing with water and 100% alcohol. The dried particles were weighed and scanned by an optical scanning device for number and size. The same samples were sieved and weighed with a conventional sieve method. The results of both methods were described by particle size distributions based on the volume of particles. The results derived from the optical scanning and sieving showed similarity. It can be concluded that the optical method is simple to use, faster than sieving and needs little skill in the use of equipment. The comparison of the results validates both methods.
The effects of ageing and dental state on the cross-sectional area and density of two jaw muscles, the masseter and medial pterygoid, were investigated using computed tomography. The study involved 84 male and 70 female subjects between the ages of 20 and 90 years. The cross-sectional area of both muscles showed a significant reduction with age; values for female subjects being found in the lower range of the distribution. When consideration was given to the presence or absence of a natural dentition, the cross-sectional area of both muscles in edentulous subjects showed a greater decrease throughout the age range studied. There was a significant decrease in the density of the muscles with increasing age. Previously, this has been interpreted to indicate a progressive increase in fat and fibrous tissue. Subject gender and the absence of teeth appeared to have little effect on this parameter. Changes in the cross-sectional area and density of these muscles would appear to be consistent with a general age related change of muscle tissue in the body as a whole and may specifically indicate a reduction in the masticatory forces which can be or are being utilised by ageing patients, many of whom have no remaining natural dentition.
The effect of four modifications to improve the fit and maxillomandibular relationships of poorly fitting dentures and the insertion of new dentures on masticatory performance was assessed in 21 denture wearers. A 2-week adaptation period was allowed for each of the four modifications and 3 weeks and 12 weeks of adaptation for new dentures. The preferred side masticatory performances were not appreciably affected by either the modifications to improve the fit of the original dentures or the new dentures. In most instances there was a slight decline in performance. Three denture modifications caused significant declines in the carrot-swallowing threshold performances and the new dentures in the peanut-swallowing threshold performance. In other words, the denture wearers had a greater percentage of coarse particles in their bolus ready for ingestion when they chewed with altered or new dentures compared with original dentures. However, they chewed faster and applied fewer chewing strokes with their modified and new dentures. A steady but gradual improvement in the mean performance score with carrots was noted with time after the insertion of new dentures. Dentists and patients need to understand that adaptation to new or modified old dentures may be a long, drawn-out process for some patients.
To analyse the state of dentition and related aspects and to study their influence on the dietary intake of nutrients.
In the second cross-sectional measurement of SENECA's follow-up study, 12 research towns in 10 European countries and one town in Connecticut (USA) participated, involving 1424 elderly men and women born between 1913 and 1918. Dentition-related data were obtained from a general questionnaire; nutritional data were collected using a standardized modified dietary history.
A large variation in the dental state existed among the towns. Women were more often edentulous and had fewer teeth. Self-reported chewing difficulties varied enormously. Most complaints were found in: women, edentulous subjects without dentures and in the towns in Spain, Portugal and Poland. More dentate women reported having visited their dentist. In the edentulous groups, differences between towns were small; for the dentate groups the percentage of dental visits varied from 0 in Coimbra (Portugal) to 96 in Mansfield (Connecticut/USA). For the edentulous subjects without any prosthetic supply, intakes of carbohydrate and vitamin B6 were significantly reduced. Also intakes of vitamin B1, vitamin C, dietary fibre, calcium and iron tended to be lower in this group. Town-dentition interactions existed for most nutrients.
Substantial differences existed between towns in the influence of dentition on dietary intake.
The number of teeth in the dentition was compared with the number and types of dental functional units (opposing tooth pairs) to correlate the number of functional units with complaints about chewing and swallowing in the elderly.
Complaints of oral pharyngeal function and food avoidance practices were compared with the number and types of functional units. A convenience sample of 602 elderly subjects (468 men, 134 women, mean age 70 years) were interviewed and examined dentally.
Functional unit measures, which included functional arrangement of the teeth and the number and type of teeth present, were found to be more discriminatory and descriptive of masticatory potential than the more number of teeth. Elderly persons (> or = 60 years of age) with reduced numbers of functional units tended to report difficulty chewing, avoidance of stringy foods (including meat), crunchy foods (including vegetables), and dry solid foods (including breads), and difficulty in swallowing. Removable prostheses did not appear to prevent these consequences and, at least in this elderly population, did not appear to be equivalent to natural teeth in terms of masticatory potential.
It is possible that compromised dental function results in the swallowing of poorly chewed food, food avoidance patterns, dietary inadequacies, and systemic changes favoring illness, reduced vigor, debilitation, and shortened life expectancy. Emphasis should be placed on maintaining natural teeth whenever possible.
Xerostomia (dry mouth) is an uncomfortable and potentially harmful oral symptom which is usually caused by a decrease in the secretion rate of saliva (salivary gland hypofunction, or SGH). It is more prevalent in the elderly population, primarily due to their increased use of drugs and their susceptibility to disease. Many drugs and drug classes have been linked to xerostomia; the xerogenic effect increases when many drugs are taken concurrently. This Reference Guide to Drugs and Dry Mouth is designed to allow the reader to rapidly identify those pharmacologic agents which have the capacity to induce xerostomia and SGH. Xerogenic drugs can be found in 42 drug categories and 56 sub-categories. A guide to the management of drug-induced SGH and xerostomia is also provided.
Convincing evidence is lacking to demonstrate the functional superiority of mandibular implant-supported overdentures over conventional dentures.
This randomized clinical trial was conducted to compare masticatory functional effectiveness of mandibular implant-supported overdentures and conventional dentures in diabetic denture wearers with clinically acceptable metabolic control.
A total of 102 edentulous diabetic patients, treated with or without insulin, were randomized to receive a new maxillary and either a mandibular conventional denture or an implant-supported overdenture. Treatment was completed in 89 patients, 37 with conventional dentures and 52 with Hader bar-clip attachment overdentures supported by two IMZ implants. Besides data from medical and dental histories, oromaxillofacial examinations, and questionnaires, masticatory tests were performed by patients before and at 6 and 24 months after treatment completion. Although 78 patients (28 in the conventional, 50 in the overdenture group) performed tests at 6 months after treatment, 68 (25 in the conventional, 43 in the overdenture) had performance data for both entry and 6-month posttreatment intervals.
The two treatment groups were highly comparable in terms of general characteristics, quality of original dentures, tissue support, and past denture experience. No significant differences were found between patients treated for diabetes with or without insulin. All four masticatory performance scores with original dentures were higher in the conventional denture group than the overdenture group. The posttreatment performance scores for the two treatment groups became similar because of the higher gains in the overdenture group. Patients with low initial performance scores showed greater posttreatment gains with both conventional dentures and overdentures.
The implant-supported overdenture showed no significant advantage over the conventional denture for improving the ability to comminute food in this group of diabetic patients with higher than average initial functional levels observed for other groups of denture wearers in previous studies.
To evaluate, in an elderly population, whether poor oral status might be a contributing factor to the development of undernutrition and might be associated with less eating pleasure, more subjective eating difficulty and increased mashed food consumption.
An oral examination and an evaluation of masticatory capacity were performed on 120 institutionalized elderly subjects. The nutritional assessment included serum albumin concentration, the Mini Nutritional Assessment and a questionnaire on eating habits.
Edentulous subjects without dentures or with only one complete denture had significantly lower MNA scores than edentulous subjects with two complete dentures (p < 0.05). Edentulous subjects with two complete dentures more frequently reported taking pleasure from eating (p = 0.05), and had less frequent difficulties with hard foods (p = 0.01) than edentulous subjects without dentures or with only one complete denture. Mashed food consumption (p < 0.01) was also reported more frequently in edentulous subjects without dentures or with only one complete denture. Subjects with two complete dentures had similar or better MNA scores as dentate subjects with relatively few remaining teeth (10.4 +/- 7.8 teeth). About half of the subjects (53%) could not perform the masticatory test. These subjects had lower MNA scores (p = 0.001) and a larger proportion ate mashed food (p < 0.001) compared to those who were able to perform the test.
Poor oral status (edentulous without dentures or with only one complete denture) increased difficulty in eating hard foods, increased mashed food consumption and decreased eating pleasure. It seemed also to put institutionalized subjects at higher risk of undernutrition.
The combined influence of age-associated factors such as general health, degree of dependency, diminished odor perception, and poor oral health on the risk for malnutrition was explored.
A total of 81 persons living in retirement homes took part in the study (mean age 83.4 years, SD = 6.6, range 61-98). The Mini-Nutritional Assessment (MNA) was used to evaluate the risk of malnutrition. Odor perception was measured by the detection threshold for isoamylacetate. The number of drugs taken by each person was counted. General health status was determined by the Medical Outcome Study (MOS) scores. Oral examinations were carried out to count the number of natural teeth and type of dentures.
On average, women had slightly, but significantly, lower MNA scores than men (respectively, 23.4, SD = 2.8; and 24.6, SD = 2.6; p = .048). The correlations between age and MNA score and between odor perception and MNA score were not significant. Significant correlations were found between age and number of natural teeth (r = -.26, p = .001) and between MNA score and number of natural teeth (r = .27, p = .001). The mean MNA score of complete denture wearers (22.8, SD = 2.9) was significantly lower than that of partial denture wearers (25.8, SD = 2.9; p = .0005). The total MOS and MNA scores were not correlated, but a significant correlation was found with the subscales mental functioning (r = .29, p = .003), social functioning (r = . 19, p = .045), and perceived health (r = .19, p = .047). No relation was found between the activities of daily living (ADL) and MNA scores. A significant negative correlation was observed between number of drugs taken and the MNA score (r = -.34, p = .001). When participants without risk of malnutrition (MNA > or = 24) were compared with those at risk (MNA = 17-23.5), again, the number of drugs taken was significantly different (on average, respectively, 4.5, SD = 2.9; and 7.0, SD = 2.6; p < .0005). Using multiple regression to test the separate effects of the different independent variables, the number of drugs taken showed a significant negative regression coefficient (beta = -.31, p = .008), as did the mental health score (beta = .27, p =.02), giving a total R2 = .32. The other parameters did not contribute significantly.
Among the elderly in retirement homes, the health state (as measured by the MOS subscale mental health and by the medication use) appears to be the most clinically relevant parameter to explain the risk for malnutrition. Loss of natural teeth and perceived health are less independently contributing, whereas no contribution derives from decline of odor perception, degree of dependency, and age itself.
Dental health status may influence nutrition. The objective of this part of the National Diet and Nutrition Survey was to assess if there is a relationship between dental status in people 65 years and older and intake of certain nutrients and any link between dental status and blood-derived values of key nutrients. Random national samples of independently living subjects and those living in institutions had dental examinations, interviews, four-day food diaries, and blood and urine analyzed. In the sample living independently, intakes of most nutrients were lower in edentate than dentate subjects. Intake of non-starch polysaccharides, protein, calcium, non-heme iron, niacin, and vitamin C was significantly lower in edentate subjects. People with 21 or more teeth consumed more of most nutrients, particularly of non-starch polysaccharide. This relationship in intake was not apparent in the hematological analysis. Plasma ascorbate and plasma retinol were the only analytes significantly associated with dental status.
The objective was to assess the prevalence, in a British population aged 65 years and older, of oral health related impacts and the effects they had on the quality of daily life and in particular on eating.
753 free living and 202 institutionalised subjects aged 65 years and over, participating in the oral health survey of the British National Diet and Nutrition Survey (NDNS), had a dental examination and interview. Data on the impact of dental and oral disorders on the activities of daily living based upon the modified Oral Impacts on Daily Performance (OIDP) indicator were collected.
17% of the free living edentate participants reported that their mouth affected their pattern of daily living on a regular basis. Oral impacts levels were lowest in dentate subjects with the greatest number of teeth. For the dentate, the most common oral impacts were on eating and speaking. Impacts relating to emotional stability, sleeping, relaxing, carrying out physical activity and social contact were very infrequent, but were severe when they did occur. Among those with an impact on eating, 25% said it was severe and 42% had the impact nearly every day or in a spell of 3 or more months. Oral impacts were more prevalent among the institution sample, particularly the dentate. The impacts were associated with the inability or difficulty to eat a range of 16 common foods.
This survey has shown that the oral status of older people fairly frequently affects the quality of life of older people, and in particular, the ability to eat several common types of foods.
Previous studies in complete denture wearers evaluated the relationship between diet and measures of chewing, yet only isolated nutrient intake was considered. This limited information makes the assessment of overall diet quality and the planning of interventions difficult.
This study investigated the relationship of complete denture quality to masticatory performance, perceived ability to chew, and diet quality as measured by the Healthy Eating Index (HEI), an overall diet quality index.
The study population comprised 54 complete denture wearers. Data were obtained from clinical examinations, masticatory performance measurements, and 2 non-consecutive 24-hour dietary recalls. (Masticatory performance data were not collected for 9 subjects because of time constraints, patient fatigue, or patient refusal. Statistical analysis showed no significant effect of their absence on the reported findings.) Based on a composite rating scale, subjects were divided into 3 denture quality groups described as good, medium, and poor. The outcome variables were the HEI and its components, plus selected nutrient and non-nutrient intake. Explanatory variables were quality of complete dentures, masticatory performance, and reported chewing ability. Data were analyzed with Kruskal-Wallis tests, Mann-Whitney U-tests, and Fisher exact tests. Because a large number of dietary components were examined, results were considered significant at alpha=.01.
Masticatory performance and perceived ability to chew were unrelated to diet quality. The good quality denture group had significantly better masticatory performance than the medium and poor quality groups, but the median HEI scores and dietary intakes were not significantly different among these 3 groups. Milk, vegetable, fruit, and grain intake scores were mainly responsible for the low overall HEI scores.
In the population evaluated, complete denture quality, food comminution capacity, and perceived chewing ability were not related to diet quality. The majority of subjects had deficient diets regardless of the technical quality of their dentures.
It is unclear whether mandibular implant overdentures improve the nutritional state of edentulous patients better than conventional dentures. In a randomized clinical trial, we tested for post-treatment differences in nutritional status between patients with mandibular two-implant retained overdentures and those with conventional complete dentures. Edentulous subjects (ages 65-75 yrs) received two-implant mandibular overdentures (IOD, n = 30) or conventional dentures (CD, n = 30). Measures of nutritional state were gathered before and 6 mos after treatment. Significant improvements in anthropometric parameters were detected in the IOD but not in the CD group, for percent body fat (p = 0.011) and skin-fold thickness at the biceps, subscapularis, and abdomen (p < 0.05), with significant decreases in waist circumference (p < 0.0001) and waist-hip ratio (p = 0.001). Significant increases were seen in concentrations of serum albumin (p = 0.015), hemoglobin (p = 0.01), and B12 (p = 0.01). No significant between-group differences were found. These results suggest that low-cost IOD treatment may improve the nutritional state of edentulous people.
Dental status and its relationship to diet and nutritional status have been little explored. In this study of a representative sample of the US civilian, non-institutionalized population (NHANES III), we predicted that the intake of nutritious foods, dietary fiber, and levels of biochemical analytes would be lower, even after adjusting for potential social and behavioral factors, among those who were edentulous and wore complete dentures than for those who had all their natural teeth. Multivariate analyses indicated that intake of carrots and tossed salads among denture-wearers was, respectively, 2.1 and 1.5 times less than for the fully dentate (p < 0.0001), and dietary fiber intake was 1.2 times less (p < 0.05). Serum levels of beta carotene (9.8 microg/dL), folate (4.7 ng/dL), and vitamin C (0.87 mg/dL) were also lower among denture-wearers (p < 0.05). Intakes of some nutrient-rich foods and beta carotene, folate, and vitamin C serum levels were significantly lower in denture-wearers.
A loss of acinar cells occurs with aging, while salivary production remains age-stable in healthy adults. It is hypothesized that a secretory reserve exists to preserve function despite a loss of acinar cells in normal aging. The purpose of this double-blind, placebo-controlled, crossover study was to determine age-related differences in salivary response to an anti-sialogogue (glycopyrrolate). Thirty-six healthy subjects (18 young--20-38 yrs; 18 older--60-77 yrs) received 4.0 microg/kg i.v. glycopyrrolate. Parotid and submandibular/sublingual saliva samples and xerostomia questionnaire responses were collected. Variables calculated for each subject were: times to initial and maximum suppression and xerostomic complaint; time to recovery; and durations of suppression and complaint. Salivary function was more adversely affected in older persons. There were no consistent age-associated questionnaire response differences. These findings suggest that salivary gland output is more adversely affected by an anti-sialogogue in healthy older vs. younger adults, supporting the secretory reserve hypothesis of salivary function.
National Diet and Nutrition Survey: people aged 65 years and over Report of the Oral Health Survey Total tooth loss in the United Kingdom in 1998 and implications for the future
- J G Steele
- A Sheiham
- W Marcenes
- A W G Walls
- London
- J G Steele
- E Treasure
- N B Pitts
- J Morris
- G Bradnock
Steele, J.G., Sheiham, A., Marcenes, W., Walls, A.W.G., 1998. National Diet and Nutrition Survey: people aged 65 years and over, vol. 2. Report of the Oral Health Survey, Stationary Office, London. Steele, J.G., Treasure, E., Pitts, N.B., Morris, J., Bradnock, G., 2000. Total tooth loss in the United Kingdom in 1998 and implications for the future. Br. Dent. J. 189 (11), 598–603.
Adult Dental Health Survey Oral Health in the United Kingdom
- M Kelly
- J Steele
- N Nuttall
- G Bradnock
- J Morris
- J Nunn
- C Pine
- N Pitts
- E Treasure
- D White
Kelly, M., Steele, J., Nuttall, N., Bradnock, G., Morris, J., Nunn, J., Pine, C., Pitts, N., Treasure, E., White, D., 2000. Adult Dental Health Survey Oral Health in the United Kingdom. The Stationery Office, London.
Relationship between oral health and nutrition in very old people (see comments)
- Mojon