Meenakshi A et al.

: Geriatric Nutrition REVIEW ARTICLE

Geriatric Nutrition: A Prosthodontic Review

Meenakshi A1, Jill Vadodaria2
Correspondence to:
1-Prof, Dept of Prosthodontics, Tamil Nadu Govermnet Dental College, Dr. Jill Vadodaria, Post Graduate student, Tamil Nadu
TamilNadu. 2-Post Graduate student, Tamil Nadu Govermnet Dental Govermnet Dental College, Tamil Nadu.
College, Tamil Nadu. Contact Us: www.ijohmr.com

ABSTRACT
Nutritional status and masticatory function are central to the health of denture patients. Current findings suggest
changes in dietary intake & patterns among denture wearers are related to important changes in measuring of risk for
chronic disease and health outcomes. Providing a rationale for adhering to an adequate diet & giving patients guidelines
for food choices will enhance the role of the dental professional as a partner in their patient’s health.
KEYWORDS: Nutrition, Geriatrics, Elderly, Denture, Nutritional Analysis
are subjective by genetics, financial status, illness, and
ASSSAAsasasss
AINTRODUCTION availability of health care, life events and the
environment. There is in general loss of cells and poor
Enjoyment of food is regarded as an essential factor for
energy levels of the lasting cells during gradual course of
quality of life. Loose teeth, ill-fitting dentures may
aging. This is related with a reduced reserve capacity. As
prevent eating favorite foods, as well as limit the
age progresses, there is a steady decline in muscle mass
ingestion of essential nutrients. Diminished chewing
of about 6.3 percent for each decade of life. Vitamin D
ability, dread of choking while at the same time eating,
deficiency, is a major cause of metabolic bone disease in
and bothering of the oral mucosa when food particles get
the elderly. Declines in gastric acidity as well frequently
under the dentures may impact nourishment choices of
occur with age, and may involve 10% to 15% of persons
the denture wearer.1 Nearly half of older individuals have
over age 60 years6 Vitamin B12 deficiency leads to
clinically identifiable problem. The relationship between
neuropathy, megaloblastic anemia, gastrointestinal
diet and prolonged life is complex and as yet
symptoms, and cognitive impairment. Dehydration is a
inadequately explained.
major concern in the older population which is caused by
Definitions 2 declines in kidney function and total body water
Nutrition: Nutrition can be defined as the sum of the metabolism.
processes by which an individual takes in and utilizes
Psychosocial Factors: Elders at risk are mainly living
food.
solely, the physically handicapped with insufficient care,
Geriatrics:The branch of medicine that treats all
the isolated, those with chronic disease and/or restrictive
problems that is peculiar to the aging patient including
diets, and the oldest old.7 Poverty is also a major
the clinically problem of senescence and senility.
contributor to malnutrition.
Dental Geriatrics: The branch of dental care that
involves problems peculiar to advanced age and aging. Pharmacological Factors8: Drugs can affect the
Gerodontics: The treatment of dental problem in aged or absorption and utilization of some foods and nutrients,
aging persons, also spelled Gerodontics. and vice versa. Prescription drugs are the primary cause
of anorexia, nausea, vomiting, gastrointestinal
General Nutritional Status of Older Adults: Malnutrition
disturbances, xerostomia, taste loss, and interference with
is very common in older populations. The most severe
nutrient absorption and utilization. Alcoholism interferes
deficiency, protein energy malnutrition, affects 2% to 4%
with process of nutrient absorption and challenges the
of the free-living elderly.3 It is also considered is a major
nutritional status by supplying “empty” calories.
prognostic factor for mortality in the elderly.4 Inadequate
intakes of calories, folic acid, vitamin D, vitamin B6,
calcium, vitamin B12 and zinc have all been documented ORAL FACTORS THAT AFFECT
in free-living elders over age 60 years. 5
DIET AND NUTRITIONAL
FACTORS CONTRIBUTING TO STATUS
NUTRITIONAL PROBLEMS IN Xerostomia9: Xerostomia is a clinical manifestation of
THE ELDERLY salivary dysfunction. Emotions (especially fear or
anxiety), neuroses, organic brain disorders, and drug
Physiological Factors: There is progressive loss of therapy all can cause xerostomia. The comfort of wearing
function accompanying with aging in majority organs and dentures is dependent on the lubricating ability of saliva
tissues of the body. These variations occur gradually and in the mouth. If the mucosa is dry, chewing is difficult,

How to cite this article:

Meenakshi A, Vadodaria J. Geriatric Nutrition: A Prosthodontic Review. Int J Oral Health Med Res 2018;5(1):72-76.

International Journal of Oral Health and Medical Research | ISSN 2395-7387 | MAY-JUNE 2018 | VOL 5 | ISSUE 1 72
 Meenakshi A et al.: Geriatric Nutrition
denture retention is compromised and mucosa soreness or
ulceration develops. Even best fabricated denture may
fail. Saliva consists of calcium phosphates, a noteworthy
function of this saliva is to buffer the acids and to re-
mineralize the eroded enamel surface. Due to disturbed
flow of saliva food may have salty or metallic taste with
increased sensitivity to bitter and sour foods .Also,
reduced sensitivity to sweet tastes can result for craving
for sugar which will affect patient’s health. These
alterations have potential impact on food and nutritional
choices. In the complete denture patients it can distress
adaptation and retention of the prosthesis and may cause
problems like loosening of dentures. Management can be
through sialagogues which is only temporary available in
various forms like gums lozenges or candies containing
citric acid.
Changes in Oral Mucosa: With increase in age, there
are changes seen in mucous membranes of the lips,
buccal and palatal tissues and floor of the mouth. The
patient’s chief complaints are mainly burning sensation,
pain and dryness of the mouth or cracks in the lips.
Chewing and swallowing become s very difficult, and
taste is altered. The epithelial membrane is thin and
easily injured. It heals slowly because of impaired
circulation.
Tongue And The Taste Sensation10: In older
individuals, depapillation occurs, which usually begins at
the apex and lateral borders. Gradual nerve degeneration
hyperkeratinisation of the epithelium results which may
occlude taste bud ducts and pores. Tongue often appears
to be smooth and glossy or red and inflamed. The size of
the tongue probably does not vary with age. However,
tooth loss can lead to a wider tongue by virtue of
overdevelopment of tongue’s intrinsic musculature.
Glossodynia and glossopyrosis are most common
problems occuring in senescence.
Oral Infectious Conditions: With increase in age the
elderly population are more likely to be affected by root
caries. Periodontal disease are also prevalent due to
various conditions. There is resulting tooth loss due to
alveolar bone resorption.
Edentulism11: The process of edentulism increases with
age. It is concurred that one third to one half of elders
over the age of 65 are edentulous in both maxillary and
mandibular arches. Absence of dentition does not
inevitably mean dietary intake will be compromised.
However it should be kept in consideration that teeth
function as the primary means of mastication besides
having profound impact on socialization and
communication. Absence of teeth will often result in
alteration in selection of food which can intensely affect
individual’s well-being. Therefore, often these
individuals with absence of dentition or poor dentition
consumes food that are soft or low in fiber making them
easily chewable and having low nutrient density.
International Journal of Oral Health and Medical Research | ISSN 2395-7387 | MAY-JUNE 2018 | VOL 5 | ISSUE 1
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EFFECTS OF DENTURES ON
CHEWING ABILITY
The chewing ability of individuals with removable
denture we are is great reduced when compared to
individuals with natural dentition. With advance of
ageing process adults often use more strokes and chew
for longer period to assist them for swallowing.12,13 Food
Texture and hardness instead of taste and smell,
determines acceptability of a food for many patients with
dentures. Intake of hard foods is reduced the intake of
soft foods is increased.21 And while making this change
many nutrients might be lost resulting in malnutrition.
NUTRITIONAL NEEDS AND
STATUS OF ADULTS14,15,16
The nutritional research produced to date clearly
identifies the severity of dietary deficiencies.
Energy Requirement: With increase in age energy
requirement decreases in older persons by about
100kcals/decade. RDA for energy: 30kcal/kg/day. RDA
for protein: 0.8 – 1 gram/kg/day. Carbohydrates should
represent 55-60% of the total calories consumed.
Complex carbohydrates are recommended which includes
fiber content. Dietary fat 30% or less, divided equally
between saturated, polyunsaturated and monounsaturated
fats. More amount of saturated fats, cholesterol cause
several diverticular diseases and obesity so fat intake
should be kept low. (25-30%of total calories)
Carbohydrates: Carbohydrates are the major
components of the diet other than protein and fats. It is
the major and quick source of energy. It supplies 70 - 80
% of energy requirement to the body. They are the
compounds of carbon, hydrogen and oxygen. 4 Kcal of
energy is supplied by each gram of carbohydrate. By the
digestion of starch and sugar, glucose is formed and
absorbed into the blood through the walls of the intestine
and finally carried to the liver and this helps to maintain
glucose level in blood. Some carbohydrates are stored in
the form of glycogen in muscles and liver. Carbohydrates
in excess are converted to fat and are being stored. When
energy is required glycogen is broken down to glucose
which is oxidized releasing energy. Food sources
includes grains, cereals, vegetables and dairy products.
Protein: Protein depletion of body stores is seen
primarily as a decrease of skeletal muscle mass. Muscle
account for 45%of body wt. in young adults. This drops
to 27% in the very old, who clinically shows a marked
decrease in the size and strength of skeletal muscle.
Therefore person (past 50yr) must ingest- 0.8g of
protein/kg body weight. Best source of protein for the
elderly are meat and fish but these food items should be
boiled and not fried. Other sources are Nuts, legumes and
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 Meenakshi A et al.: Geriatric Nutrition
vegetables which if eaten aptly, is of the similar quality as
ani-mal sources of protein. Edema is caused by
deficiency of proteins.
Water: Elderly people are chiefly predisposed to
negative water balance, frequently resulting from
excessive water loss because of damaged kidney. [17] In
normal consideration intake of fluid should be 30 ml per
kg body weight per day.
Vitamins: Vitamins play vital role in normal metabolism
process and growth and are essential part of nutrient in
the body.
Water soluble vitamins: Vitamin C is vital component for
the collagen synthesis. It form the basic structure of
tendons and periodontal ligament and is essential for
healing of the wound. Because of half-life period of
collagen is relatively short, and must be synthesized
regularly, the prescription of 500mg per day of ascorbic
acid is frequently used during and after oral surgery.
Citrus foods, melons, mangoes, papaya, strawberries, etc.
are rich in vitamin C. Vit-B12 deficiency may lead to
problems of dementia in older adults.Vit-B12 found only
in animal products. Synthetic vit-B12 obtained from
fortified foods or vitamin supplements is better absorbed
then protein bound vitamin A. High niacin intake may
result in flushing, headaches, and itching skin. Peripheral
neuropathies may be resulted from high vit.B6
Fat Soluble Vitamins: Vitamin A present in food mainly
in two forms: retinal form, or active form. Vitamin A is
supplemented by animal foods that includes liver, milk
and milk products. Also, beta-carotene or pro-vitamin A,
obtained from deep green and yellow fruits and
vegetables like apricots, carrots or spinach. Deficiency of
Vitamin A may cause Bitot’s spots, conjunctival and
corneal xerosis, dryness of skin, follicular hyperkeratosis,
decreased salivary flow, dryness and keratosis of oral
mucosa and diminished taste sensation. Vit.E acts as an
antioxidant in cell membranes by acting as a scavenger of
free radicals, vit.E prevents oxidation of unsaturated cell
phospholipids. Dietary source includes-vegetable oils,
nuts, margarines etc. Mega doses of Vitamin D can
disturb Ca metabolism, leading to calcification of soft
tissue. Vitamin K helps in coagulation of blood & is an
antioxidant.
Minerals 1,16
Calcium18: Adequate Calcium intake throughout life is
essential for maintenance of the skeleton and is major
element in the body. An important bodily function of Ca
is formation of bone formation with other functions like
neuromuscular excitation membrane permeability blood
coagulation and others. As Ca absorption is decreased
with increasing age (lack of hydrochloric acid in the
stomach), the calcium should be acidulated before
digestion. Lactose intolerance resulting in Lactase
deficiency is also common in elderly persons. This is
another reason for modifying the milk for elderly people.
Foods rich in calcium include milk, cheese, ice cream,
broccoli, custard, whole oranges. The RDA indicates
intake of 500-600mg/d.
International Journal of Oral Health and Medical Research | ISSN 2395-7387 | MAY-JUNE 2018 | VOL 5 | ISSUE 1
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Folic Acid: Folic acid is essential for the process of cell
division and red blood cells formation. Anemia can result
from lack of folate intake. Oranges, broccoli, spinach,
and dried beans are good sources of folic acid.
Iron: Iron is essential to the oxygen carrying capacity of
the Hemoglobin of the blood. Liver, meat, fish, green
leafy vegetables are excellent source of iron. Anemia and
hypothermia are common in elderly due to its deficiency.
Magnesium: Magnesium forms a component part of the
body skeleton and also is a cofactor for more than 300
enzymes which plays a role in neuromuscular
transmission. Green vegetable and milk are good sources.
RDA is about 320mg.
Fiber: This is important component of complex
carbohydrates is promoting bowel function.
Fiber in the form of bran is frequently added to dry
cereals and breads, but vegetable fiber is more effective
and less expensive.19 Patients with deficient masticatory
function often selects food with reduced fiber contents
and easier to chew that leads to aggravating
gastrointestinal disturbances.14
Modified Food Pyramid: A new food pyramid has been
designed for people aged 70 years and above, to reflect
the unique needs of older people.1 In 1992, Food Guide
Pyramid was the U.S. Department of Agriculture
developed the Food Guide Pyramid. This replaces the
former basic four model of milk, fruits and vegetables,
and grains. The pyramid now contains six categories:
Category 1 Bread, cereal, rice, Chapatti, pasta.
Category 2 Vegetables.
Category3. Fruits.
Category4. Milk, Cheese, yogurt, .
Category5. Meat, poultry, fish, dry beans, eggs, and nuts.
Category6. Fats, oils and sweets.
My Plate21: MyPlate is the current nutrition guide
depicting a place setting with plate and glass divided into
five food groups. It is divided into four sections of
approximately 30 Percent grains, 40 percent vegetables,
10 percent fruits and 20 percent proteins, accompanied by
a smaller circle representing dairy, such as a glass of milk
or a yogurt cup.
Assessing nutritional status20: Various Methods for
assessment of nutritional status includes data collection
from these following areas, beginning with medical social
history, than clinical examination that includes both
physical signs and specific anthropometric measures.
Next step is dietary assessment, and biochemical tests.
Alteration in nutritional status can result from inadequate
consumption of a single nutrient causing simple reduction
of nutrient reserves or complex metabolic dysfunctions.
Here clinical deficiency is noted and a multilevel
sequence of procedures is further presented.
Dietary Counseling of Prosthodontic Patients: The
main concern of the prosthodontic patient is of regaining
their lost function. Patients seeking new dentures have
high expectations to be able to eat a better variety of
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 Meenakshi A et al.: Geriatric Nutrition
foods. Such patients frequently are approachable to
propositions intended at refining the quality of their diets.
Nutrition screening is initiated at the first appointment.
Thereafter, counseling and follow up can be continued
during the course of treatment.
Following steps are entailed to provide proper nutrition
guidance to the patients:
 Recording a precise nutrition history with an
accurate record of food consumption over a 3, 4 or 5
days period.
 Assessing the diet.
 Educating about the constituents of a diet that will
aid in sustenance the oral mucosa as well as bone
health and total body health
 Guidance in the establishing of goals to improve the
habitual diet.
 Follow up.
DIETARY SUGGESTIONS FOR
DENTURE WEARERS
The important aspect for denture wearers is modifying
food selection and food habits in order to achieve
nutritional goals. There are various environmental factors
influencing food selection including economic status,
entrenched food patterns, excessive unnecessary food
contemplation along with loss of independence.22 The
sense of taste that is lost when the roof of the mouth is
covered by dentures but then can be somewhat
compensated by consuming herbs and condiments in
addition to serving foods that are acceptably hot.
Consequently, training the patient to be more attentive of
the food aromas. Moreover, for enhancing food flavors
for such patients, use of onions, parsley, chives, and other
herbs can be considered. In order to obtain, supreme
taste sensation, the practice of sharply distinct flavors in
mixtures; such as sweet and sour combination, has
similarly showed to be beneficial. Food habits can be
improved with insistent and coherent nutrition education.
We do not recommend extreme changes, however if the
environmental factors are developed and with
manifestation of concern for the patient, substantial
development can be made in genuinely and beneficially
altering of food habits.
TEACHING THE PATIENT TO
MASTICATE WITH THE NEW
PROSTHESIS
Analysis of the jaw movements involved in mastication is
essential for obtaining, the skill of managing the physical
consistency of food for a new denture wearer. The
procedure of eating comprises of three steps. (1) Biting or
incising; (2) chewing, or pulverizing; and, (3)
swallowing.
Incision of food includes a tearing and grasping action by
the incisor teeth necessitating opening of the mouth wide.
International Journal of Oral Health and Medical Research | ISSN 2395-7387 | MAY-JUNE 2018 | VOL 5 | ISSUE 1
REVIEW ARTICLE
This action can cause dislodgment of the denture through
the pulling action of the over-tensed muscle.
Consequently, seal of equal and opposite force to prevent
dislodging of the denture is generated by the post dam
compressive force of the denture on the soft palate;
particularly when the leverage force through the incising
action is employed in the anterior segment of the mouth.
The chewing and pulverizing of the food by the molars
and bicuspids is easier than incising action. However, the
coordination of the many muscles of mastication that
results in the hinge and sliding movement of the
mandible throughout course of eating entails some
practice. These movements can be learned with patience
and determination given that there is absence of sore
sports or cuspal interferences generated by the dentures.
In fact, the easiest step in the eating procedure is that of
swallowing. For that reason, even though the rational
order of eating food is biting chewing and swallowing; it
is considerably easier for the new denture wearer to
master this multifaceted masticatory movements in the
converse order that is; swallowing, chewing, and biting
lastly. Therefore, food such as liquids that will involve
only swallowing, should be recommended for the first
day or two after the denture insertion. The usage of soft
foods is supported for the next few days, and a firm or
regular diet may be consumed by the end of the week.
Irrespective of consistency of the diet, it can be prepared
wide-ranging balanced with adequate nutritional supply,
as will be presented in subsequent dietary suggestions.
DIET AFTER DENTURE
INSERTION
After denture insertion on the first day, patient can select
form the foods, which are basically liquids but are
prepared according to the four basic food groups. From
the (1) vegetable fruit group: juices are consumed. (2)
Bread cereal group - gruels cooked with any milk or
water. (3) Milk group - milk may be utilized in any form
(4) Meat group - On behalf of meat for the first day eggs
will be the first choice. However, pureed meats, meat
soups, or broths may likewise be consumed.
Following, second the third post-insertion days, the
denture wearer can have soft foods that involves slightest
of chewing. Besides fruit and vegetable juices, tender
cooked fruits and vegetables with skin and seeds
removed, cooked tender carrots, prepared green beans can
be consumed from fruits and vegetables group. Also,
dried peas maybe utilized in form of thick, strained soup.
Bread-cereal group includes cooked cereals such as
cream from wheat along with softened bread or boiled
rice. Milk group consists of milk in any form. In Meat
group, chopped beef, ground liver, tender chicken or fish
in cream sauce or furthermore children’s junior food
preparations can be used. Eggs could be scrambled or
soft cooked.
By the fourth day or immediately after all the sore spots
have been cured, along with the soft diet, firmer foods
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can be started for consumption. In most cases, these
foods are supposed to be cut into small pieces prior to
eating.
As a whole it has been established that raw vegetables
and sandwiches are amongst the foods least favored by
denture wearers. In actual fact, raw vegetable needs
additional force in the course of mastication, to prepare
them for swallowing than other foods. Consequently, if
the new denture patient is capable of managing salads,
than the ultimate in denture success and patient
accomplishment ought to be recognized.
CONCLUSION
Denture wearing patients can be clearly identified as
Healthy and Unhealthy patients on the basis of the diet
they consume with an adequate content of nutrients. It is
our responsibility as Prosthodontists to motivate the
patients on the basis of their existing health with
considering all systemic illness to modify the diet for
their well-being, healthy and happy life.
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Source of Support: Nil
Conflict of Interest: Nil
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