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Review Article
Nutrition for geriatric denture patients
Kranti Ashoknath Bandodkar, Meena Aras
Department of Prosthodontics, Goa Dental College and Hospital, Bambolim, Goa, India
For correspondence
Kranti A. Bandodkar, H. No. 346/A, Cavorim, Chandor, Salcete, Goa - 403714, India. E-mail: shreyacolvenkar@gmail.com
Perfect health is a prize that has been the goal of mankind throughout all ages. Nutrition provides substrates
essential for expression of genetic heritage. It follows therefore, that nutrition might influence the occurrence and
severity of degenerative diseases that are associated with aging. Nutritional problems may result from changes
associated with aging process itself, from disease or other medical conditions, from interactions with medications,
or from all of these. This review summarizes articles that describe the changes in diet associated with aging.
Key words: Nutrition, geriatrics, complete denture, nutritional analysis
INTRODUCTION AGING FACTORS THAT AFFECT NUTRITIONAL
[2-20]
STATUS
Proper nutrition is essential to the health and com
fort of oral tissues and healthy tissues enhance the Physiological factors
possibility of successful prosthodontic treatment in With a decline in lean body mass in the elderly,
the elderly. caloric needs decrease and risk of falling increases.
In patients with partial or complete tooth loss, pros Vitamin D deficiency in turn, is a major cause of
thetic therapy may be important to maintain or re metabolic bone disease in the elderly.
store masticatory function. However, many other fac Declines in gastric acidity often occur with age
tors also are essential for the nutritional status of older and can cause malabsorption of foodbound vita
adults. Thus, many agerelated medical problems and min B12.
diseases have nutritional aspects and the patient’s Many nutrient deficiencies common in the elderly,
socioeconomic status and dietary habits have a pro including zinc and vitamin B6, seem to result in
found influence on their dietary selection. The dental decreased or modified immune responses.
team must be aware of these potential detrimental ef Dehydration, caused by declines in kidney func
fects of dental treatment and provide counteractive tion and total body water metabolism, is a major
dietary guidance. Problems vary with the patient and concern in the older population.
the dental condition, so suggestions must be tailored Overt deficiency of several vitamins is associated
to meet the patient’s specific needs. This article de with neurological and/or behavioral impairment
scribes associations between oral health and nutri B1 (thiamin), B2, niacin, B6 [pyridoxine], B12, fo
tional status among geriatric denture patients liate, pantothenic acid, vitamin C and vitamin E).
[1]
NUTRITIONAL OBJECTIVES Psychosocial factors
A host of lifesituational factors increase nutritional
1. To establish a balanced diet which is consistent risk in elders.
with the physical, social, psychological and eco Elders, particularly at risk, include those living
nomic background of the patient. alone, the physically handicapped with insuffi
2. To provide temporary dietary supportive treatment, cient care, the isolated, those with chronic disease
directed towards specific goals such as carries and/or restrictive diets, reduced economic status
control, postoperative healing, or soft tissue condi and the oldest old.
tioning.
3. To interpret factors peculiar to the denture age group Functional factors
of patients, which may relate to or complicate Functional disabilities such as arthritis, stroke,
nutritional therapy. vision, or hearing impairment, can affect nutritional
22 The Journal of Indian Prosthodontic Society | March 2006 | Vol 6 | Issue 1
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Bandodkar, et al.: Nutrition for geriatric denture patients
status indirectly. oldest old Iowans sampled.[5]
Pharmacological factors Effects of dentures on taste and swallowing
Most elders take several prescription and overthe A full upper denture can have an impact on taste
counter medications daily. and swallowing ability.
Prescription drugs are the primary cause of anor The hard palate contains taste buds, so taste sen
exia, nausea, vomiting, gastrointestinal disturbances, sitivity may be reduced when an upper denture
xerostomia, taste loss and interference with nutri covers the hard palate. As a result, swallowing
ent absorption and utilization. These conditions can be poorly coordinated and dentures can be
can lead to nutrient deficiencies, weight loss and come a major contributing factor to death from
ultimate malnutrition. choking.
ORAL FACTORS THAT AFFECT DIET AND Effects of dentures on chewing ability
[2-9]
NUTRITIONAL STATUS As adults age, they tend to use more strokes and
chew longer, to prepare food for swallowing.
Xerostomia Masticatory efficiency in complete denture wearers
Xerostomia affects almost one in five older adults. is approximately 80% lower than in people with
Xerostomia is associated with difficulties in chew intact natural dentition.
ing and swallowing, all of which can adversely
affect food selection and contribute to poor nutri Effect of dentures on food choices, diet quality
tional status. and general health
The use of drugs with hypo salivary side effects The effect of dentures on nutritional status varies
[6]
may have deleterious influence on denture bearing greatly among individuals.
[2]
tissues. 1. Some people compensate for decline in mastica
Deficient masticatory performance leads to consump tory ability by choosing processed or cooked
tion of more drugs, than those with superior per foods rather than fresh food and by chewing
[3]
formance. longer before swallowing.
2. Others may eliminate entire food groups from
Sense of taste and smell their diets.
Agerelated changes in taste and smell may alter Dentate adults tend to eat more fruits and veg
food choice and decrease diet quality in some people. etables than fulldenture wearers.[7]
Factors contributing to this reported decreased Replacing illfitting dentures with new ones does
function may include health disorders, medications, not necessarily result in significant improvements
[6]
oral hygiene, denture use and smoking. in dietary intake.
Sense of smell decreases markedly with age, much Similarly, exchanging optimal complete dentures
more rapidly then the sense of taste. Diminished for implantsupported dentures, has not resulted
[2]
taste is the result of aging. in significant improvement in food selection or
Sensory changes may diminish the appeal of some nutrient intake.[7]
foods (e.g., sensitivity to the bitterness of crucifer
ous vegetables), limiting their consumption and Nutrient needs of the elderly
potential health benefits function. The oral aspects of aging as related to nutritional
deficiencies, have been reviewed in dental literature,
Oral infectious conditions wherein many of the degenerative changes seen in the
[8-14]
Periodontal disease also increases with age and oral cavity may be due to essential nutrients.
may be exacerbated by nutritional deficiencies.
Energy
Dentate status Energy needs decline with age due to a decrease in
Poor oral health leads to impaired masticatory basal metabolism and decreased physical activity.
function. Whether MF plays a role in food selec Crosssectional surveys show that the average energy
tion is still matter of debate, but impaired mastica consumption of 6574 year old women is about
tory function leads to inadequate food choice and 1300 kilocalories (Kcal) and 1800 Kcal for men of
[4]
therefore alter nutrition intake. the same age.
The presence of natural teeth and well fitting den Deficiency causes dull, dry, sparse easily plucked
tures were associated with higher and more varied hair, parotid gland enlargement, muscle wast
nutrition intakes and greater dietary quality, in the ing, pallor, pale atrophic tongue, spoon nails and
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Bandodkar, et al.: Nutrition for geriatric denture patients
pale conjunctiva. gram of difference in dietary fiber intake between
the dentate and edentulous, could lead to approxi
[16]
Calories mately 2% increased risk of myocardial infarction.
Caloric requirements decrease with advancing age,
owing to reduced energy expenditures and a de Water
[10]
crease in basal metabolic rate. Elderly are particularly susceptible to negative water
The mean RDA is 1600 Kcal for women and 2400 balance, usually caused by excessive water loss
[17]
Kcal for men. through damaged kidney.
Inadequate intake of fluid by the elderly will lead
Protein to rapid dehydration and associated problems such
As the patients become older, the amount of pro as hypotension, elevated body temperature and
[13]
tein required increases. dryness of the mucosa, decreased urine output and
Protein depletion of body stores in the elderly, is mental confusion.
seen primarily as a decrease of the skeletal muscle Under normal conditions, fluid intake should be at
[12]
mass. Proteins is a must for denture wearers. least 30 ml per kg body weight per day.
The RDA for proteins, for persons aged 51 and
over, is 0.8g protein/kg body weight per day. (56 Vitamin A
gms for males and 46 gms for females, or 9 and The RDA for vitamin A is 8001000 micrograms
10% respectively, of the recommended calorie in RE.
take). However, because of the general decline in Vitamin A in food occurs in two forms: retinal, or
energy intake, as age increases, the recommenda active Vitamin A in animal foods (liver, milk and
tion is that the elderly should satisfy 12% or more milk products and betacarotene or provitamin A,
of their energy intake with proteinrich foods. found in deep green and yellow fruits and veg
The best sources of proteins for the elderly diet are etables (apricots, carrots, spinach).
dairy products, poultry, meats and fish in the boiled Deficiency causes Bitot’s spots (eyes), conjunctival
and not dried form. Nuts, grains, legumes and and corneal xerosis (dryness), xerosis of skin, fol
vegetables contain protein, which if eaten in the licular hyperkeratosis, decreased salivary flow,
proper combination, is of the same quality as ani dryness and keratosis of oral mucosa and decreased
mal sources of protein. taste acuity.
Deficiency of proteins causes edema. Long standing deficiency may cause hyperplasia
[11]
of the gums, as well as generalized gingivitis.
Carbohydrates
The elderly consume a large proportion of their VITAMIN B COMPLEX
calories as carbohydrates, possibly at the expense
of protein, because of their low cost, ability to be Thiamine
stored without refrigeration and ease of prepara Evidence of thiamine deficiency occurs most often
tion. in the poor, institutionalized and alcoholic seg
The recommended range of intake is 50 to 60 per ment of the elderly population.
cent of total calories. The RDA has been set at 0.5 per 1000 calories, or
Food sources include grains and cereals, vegetables, at least 1 mg daily.
fruits and dairy products. Food sources include meats (especially pork and
chicken), peas, whole grains, fortified grains, cere
Fiber als and yeast.
An important component of complex carbohydrates Deficiency causes beriberi.
is fiber, which promotes bowel function, may re
duce serum cholesterol and is thought to prevent Vitamin B6 deficiency (pyridoxine)
diverticular disease. Ranges from 50 to 90% of the elderly affected, which
Fiber in the form of bran is frequently added to dry may be an important cause of the increased preva
cereals and breads, but vegetable fiber is more ef lence of the carpal tunnel syndrome (an inflamed
[14]
fective and less expensive. tendon attached to the wrist bone.) in the elderly.
Reduced selection of foods rich in fiber that are The RDA is 1.21.4 mg.
hard to chew, could provoke gastrointestinal dis Deficiency causes nasolabial seborrhea, glossitis.
turbances in some edentulous elderly, with defi
cient masticatory performance.[15] Vitamin B12 (riboflavin)
A study conducted on the impact of edentulousness The RDA is 3.0 microgram.
on nutrition and food intake, inferred that even 1 Is found in kidney, heart, milk, eggs, liver and
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Bandodkar, et al.: Nutrition for geriatric denture patients
green leafy vegetables. which may be related to negative balance of cal
Deficiency causes nasolabial seborrhea, fissuring cium, which contributes to development of os
and redness of eyelid corners and mouth magenta teoporosis.[13]
[11]
colored tongue and genital dermatosis.
Iron
Vitamin C A recent review concluded that the prevalence of
The RDA is about 60 microgram. iron deficiency, is relatively rare among the healthy
Food sources include citrus fruits, tomatoes, pota elderly. When anemia is found in an older person,
toes and leafy vegetables. blood loss should be suspected.
Deficiency causes spongy, bleeding gums, petechiae, The RDA for iron is 10 mg.
[13]
delayed healing tissues, painful joints. Good food sources include meat, fish, poultry, whole
grains, fortified breads and cereals, leafy green
Vitamin D vegetables, dried beans and peas.
The elderly are frequently deficient in Vitamin D Deficiency causes burning tongue, dry mouth,
[11]
because of lack of sun exposure and an inability to anemia’s and angular cheilosis.
synthesize Vitamin D in skin and convert it in the
kidney. Vitamin D is found in fish liver oils. Zinc
The RDA is 5 microgram. Zinc utilization declines with advancing age, be
Deficiency causes bowlegs, beading of ribs. cause intestinal absorption decreases after the age
of 65 years.
Vitamin E The RDA is 15 mg.
Vitamin E deficiency in the elderly does not seem Good sources of zinc are animal products, whole
to be a problem. Total plasma vitamin E levels grains and dried beans.
increase with age. Deficiency causes decreased taste acuity, mental
The RDA is 810 mg alphaTE. lethargy and slow wound healing.
MINERALS MODIFIED FOOD PYRAMID DIAGRAM
A study conducted by J. Crystal Braxter illustrated A new food pyramid has been designed for people
deficiencies in magnesium, fluoride, folic acid, zinc and aged 70 years and above, to reflect the unique needs
[18] [9]
calcium, in the geriatric population. of older people [Figure 1].
[9]
Folic acid Assessing nutritional status
Economically deprived urban blacks and institu
tionalized elderly are at the most risk of foliate Triphasic nutritional analysis
deficiency. Phase 1
RDA is 500 microgram. The first phase should be used to screen all patients
Good food sources of folic acid include leafy green and consists of obtaining information from a medical
vegetables, oranges, liver, legumes and yeast. social history, screening for clinical signs of deficiency,
Deficiency causes megaloblastic anemia, mouth conducting selected anthropometrical measurements
ulcers, glossodynia, glossitis, stomatitis. and assessing the adequacy of dietary intake.
Calcium Qualitative dietary assessment
· The recommended daily allowance of calcium is The purpose of the dietary assessment is to deter
800 mg/day. mine what an individual is eating now, what he or
Because calcium absorption is decreased in the she has eaten in the past and recent changes in the
elderly (lack of hydrochloric acid in the stomach), diet. A questionnaire has been developed to identify
the calcium must be acidulated before digestion. older individuals with nutritional problems (Vogt et
Lactase deficiency resulting in lactose intolerance al, 1995) [Tables 1 and 2]. This questionnaire may be
is also common in elderly persons. This is another administered by health care professionals and applied
reason for modifying the milk for elderly persons.[19] in both inpatient and outpatient settings.
Food sources of calcium include milk and milk If potential nutritional problems are detected, based
products, dried beans and peas, canned Salmon, on any of these parameters, the nutritional evaluation
leafy green vegetables and tofu. should progress to Phase II. However, if at the conclu
Elderly patients with complete dentures often ex sion of Phase I, enough information is available to
perience a rapid and excessive ridge resorption, ensure a rational basis for therapy, the nutritional
The Journal of Indian Prosthodontic Society | March 2006 | Vol 6 | Issue 1 25
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