Geriatrics and Nutrition

1. NUTRITION IN
GERIATRICS
DR SHUBHAM PARMAR
1ST YEAR MDS
DEPARTMENT OF PROSTHODONTICS
1

2. CONTENT
• Introduction
• Definitions
• Classification
• Nutritional Objectives
• Components Of Nutrition
• Factors Contributing To The Compromised Nutritional Status In Elderly
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3. • Vitamins and its importance
• Assessment of nutritional status
• Triphasic nutritional analysis
• Balanced Diet
• Fluorine and fluorosis
• Prosthetic considerations
• Conclusion
• References
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4. INTRODUCTION
• As average life expectancy increases, greater attention is being focused on ways of
improving the health and quality of life of the aging population.
• The elderly are an especially vulnerable group because of the spectrum of
physiologic and psychosocial challenges that commonly confront them.
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5. • Adequate nutrition is vital factor in promoting the health and well being of the aged.
• There is interdependent relationship between nutrition and oral health.
• Sir William Osler referred “Mouth” as a “Mirror of nutritional status”.
• Inadequate nutrition may contribute to an accelerated physical and mental
degeneration.
• Poor oral health can be a detrimental factor to the nutritional status and health.
Disorders of the oral cavity have been reported be major contributor of poor eating
habits in elderly.
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6. DEFINITION
• Nutrition- The internal processing of foods and beverages, such as ingestion,
digestion, absorption, assimilation, distribution, and elimination (i.e.., metabolism)
• Health – A state of complete physical, mental and social well being and not merely
the absence of any disease
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7. • According to WHO, “Nutrition is the science of food and its relationship to health.”
• Gerontology
Branch of knowledge which is concerned with situations and changes inherent in
increments of time with particular reference to post maturational stages
- Gerodontological society (1959)
• Gerodontics : The treatment of dental problems of ageing persons- GPT 9
• Gerodontology : The study of the dentition and dental problems in aged or ageing
persons
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8. • Balanced diet - A balanced diet is that which supplies all the essential nutrients in
adequate amounts and biologically available forms. (Z.S.C. Okoye)
• Basal metabolic rate - It is defined as the number of kilocalories expended by the
organism per square meter of the body surface per hour.
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9. CLASSIFICATION
• According to age group
1. The young old (65-74years)
2. The middle old (75-84years)
3. The oldest old (85 & above)
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Geriatric Care in Restorative and Endodontics. Biological Considerations and treatment aspects; Priyanka Malagi

10. • According to Heartwell
1. Those who are well preserved emotionally and physically.
2. Those who are really aged and chronically ill.
3. Those who fall between these two extremes.
• According to Winkler
1. The hardy elderly
2. The senile elderly
3. In between groups
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11. • According to D.C.N.A.
Well, Elderly:-
• One or two minor
chronic medical
conditions: Independent
living
• E.g.- Osteoarthritis,
Hiatus Hernia
Frail, Elderly:-
• Co-existing minor
chronic, debilitated
medical conditions with
drugs:
• Independent living
support:
• E.G: Rheumatoid
arthritis, constipation,
ASVD, Might use cane or
walker.
Functionally dependent
elderly:
• Same as category II but
patient debilitated to the
extent that
independence is not
possible.
• Home bound or
institutionalized
• E.g.: Patients are
Confined to
wheelchairs..
Severely disabled,
medically compromised
elderly:
• Health status
deteriorated to the
degree it requires
constant maintenance,
• skilled nursing facility
• E.g.: Patient with end
stages Alzheimer’s
disease
• Patient with recent brain
stem trauma
• Patient with end stage
renal failure.
Geriatric Care in Restorative and Endodontics. Biological Considerations and treatment aspects; Priyanka Malagi
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12. NUTRITIONAL OBJECTIVES
1. To establish a balanced Diet which is consistent with the physical, social,
psychological and economic background of the patient.
2. To provide temporary dietary supportive treatment, directed towards specific goals
such as caries control, postoperative healing, or soft tissue conditioning.
3. To interpret factors peculiar to the denture age group of patients, which may relate
to or complicate nutritional therapy.
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13. REDUCED
NUTRITIONAL INTAKE
POOR GENERAL
HEALTH
LOW IMMUNITY
SYSTEM
POOR ORAL
HEALTH
COMPROMISED
CHEWING AND EATING
13

14. FACTORSCONTRIBUTINGTOTHECOMPROMISED
NUTRITIONALSTATUSINELDERLY
• Oral Status
• Physiological Changes
• Functional and sensory changes
• Psychosocial changes
• Alcohol abuse
• Pharmacological factors
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15. IMPACT OF ORAL STATUS ON FOOD INTAKE
• Change in ability to chew food
• Missing dentition is associated with decreased masticatory efficiency and
performance
• Chewing efficiency of denture wearer is 80% less than that of an adult with
complete dentition
• Greater number of chewing strokes
• Replacement of lost teeth or replacement of old loose denture results in improved
masticatory function.
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16. • Hardness of the food determines acceptability of food – reduced food choices
• Change to soft food which may have poor nutrients
• Swallowing of larger pieces of food – GI disturbance
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17. Physiologic Changes
• CHANGE IN TASTE AND SMELL
• Decreased sense of taste and smell
• Olfactory acuity decline with age
• Salt and bitter taste acuity decline with age but sweet and sour perceptions do not
• Inability to distinguish the sensory qualities of the food reduces enjoyment - reduced
intake of calories.
• Decline in taste acuity due to coverage of hard palate.
• Impaired tactile sensitivity -- Food asphyxiation.
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18. • Changes in the ability to absorb and utilise nutrients
• Progressive decline in the function of many organs and tissues lead to subsequent
changes in their ability to digest, absorb, utilise and excrete nutrients.
• 20% ↓ secretion of ptyalin, trypsin, and pepsin – ↓ absorption of Calcium and
Protein
• Atrophy of intestinal mucosa →achlorhydria → bacterial over growth
malabsorption of folic acid, iron, calcium.
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19. 19
• Changes in the ability to metabolize nutrients
• Enzyme deficiencies → ↓ metabolism.
• Lean body mass is replaced by fat → ↓ Basal Metabolic Rate.
• Chronic diseases → ↓ metabolism
• Changes in energy requirements and activity
• Chronic diseases → ↓ activity →energy requirements

20. Functional and sensory changes
• Physical disabilities – arthritis, strokes.
• Vision & hearing impairment
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21. PSYCHOSOCIALCHANGES
• Lack of financial support
• Depression
• Anxiety
• Loneliness and isolation
• Loss of appetite, lack of desire to prepare the food
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22. ALCOHOLABUSE
• May be a response to stress, unwanted changes in lifestyle, social isolation.
• Decrease appetite.
• Multiple nutrient deficiencies - thiamin , riboflavin, niacin, pyridoxine, folic acid,
vit A, zinc, magnesium.
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23. PHARMACOLOGICALFACTORS
• Drug and nutrient interactions are common because of inefficient metabolism of
drugs by elderly, which allows them to remain in the body for longer period.
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24. • Overuse of medication may cause – altered food intake or nutrient digestion,
absorption, and utilisation.
• Mineral oils in laxatives – bind and prevent absorption of fat soluble vitamins and
fatty acids.
• Antacids – prevent absorption of folic acid and iron
• Coumarin – inhibit vitamin K synthesis.
• Loss of appetite, anorexia, nausea, vomiting, gastric disturbances, xerostomia, lack
of taste.
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25. • Arbitrary self supplementation –
• High doses of nutrients(10 times RDA) can be toxic due to diminished renal tubular
secretion capacity
• Most commonly used supplements i.e.. vitamin E & C are rarely absent from the diet
• Nutrients at risk are Calcium, Zinc, Vitamin B6, Vitamin D.
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26. DRUG INDUCED XEROSTOMIA
• XEROSTOMIA is clinical manifestation of salivary gland dysfunction.
• Causes:
• Medications
• Therapeutic radiation to head & neck
• Diabetes
• Depression
• Alcoholism
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27. • Pernicious anaemia
• Menopause
• Vitamin A or B complex deficiencies
• Auto immune diseases Sjogren’s Syndrome
• Ageing – decreased rate of stimulated saliva, no effect on unstimulated saliva.
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28. • Also mouthwashes, alcohol, tobacco, caffeine aid in causing Xerostomia. 28

29. EFFECTS OF XEROSTOMIA ON NUTRITION
• Dry mucosa , decreased lubrication, poor retention of dentures
• Soreness, mucosal ulcerations – inability to use dentures
• Hampered swallowing – as saliva facilitates mastication, bolus formation
• Reduced pleasure of eating
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30. OTHERORALFACTORSAFFECTINGNUTRITIONINELDERLY
• Denture induced stomatitis.
• Acrylic allergy.
• Unhealthy oral tissues prone to trauma.
• Maladaptive dentures.
• Irritation of mucosa.
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31. COMPONENTSOFNUTRITION
• MAJOR NUTRIENTS:
1. Carbohydrates
2. Proteins
3. Fats/lipids
• MICRO NUTRIENTS:
1. Vitamins
2. Minerals
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32. PROTEINS
• Proteins means “of prime importance” , because it mediates most of the actions of
life.
• Essential for all body tissues: skin, tendons, bone matrix, cartilage, and connective
tissue.
• It also forms hormones, enzymes, antibodies and acts as a chemical messenger within
the body.
• Requirements for protein vary between 40-65 g/day depending on physical activity,
stress, and growth cycles.
32

33. • Functions:
• Body building
• Repair and maintenance of tissues
• Synthesis of antibodies, haemoglobin
enzymes.
• They provide 4kcal of energy per gram.
• RDA for protein for adults is 0.8-1
gram of protein/day/kg body weight.
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34. ORAL MANIFESTATIONS
• Bright reddening of tongue.
• Loss of papillae: erythematous and smooth dorsum of tongue
• Edema of tongue with scalloping around the lateral margins due to indentation of the
teeth.
• Bilateral angular cheliosis
• Fissuring of lip
• Loss of circumoral pigmentation
34

35. • Dry mouth
• Reduced caries activity due to lack of
substrate carbohydrate.
• Delayed eruption.
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36. FATS / LIPIDS
• Fats are solid at 20 deg C, they are called oils if they are liquid at that temperature.
• They are concentrated sources of energy.
• CLASSIFICATION:
• Simple lipids - Triglycerides
• Compound lipids - Phospholipids
• Derived lipids - Cholesterol
• Almost 99% of body fats are in the form of triglycerides.
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37. Functions:
• They provide 9 kcal of energy per gram.
• Carry flavour of food.
• Carry the fat-soluble vitamins A,D,E and K.
• Fat beneath skin provides insulation against cold.
• Fat supports viscera like heart, kidney and intestine.
• Omega-3 fats-lenolenic acid-decreases cholesterol level and cardiac risky disease baby
reducing blood pressure and preventing blood clots.
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38. Effect on oral health
• Phospholipids are a structural component of cell membrane, tooth enamel and dentin.
• Research indicates that high-fat foods tend to be inhibitory towards dental caries.
• Small quantities of nuts and cheese can be good between meal snacks for patients concerned
with dental caries.
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39. CARBOHYDRATES
• Carbohydrates provide the body’s primary source of fuel
for heat and energy. They also maintain body’s back up
store of quick energy as glycogen (animal starch).
• The 3 main sources are Starches, Sugars and Cellulose.
• The carbohydrate reserve of a human adult is about
500gms, which is rapidly exhausted when a person is
fasting.
• RDA for carbohydrates is 130g/day.
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40. • Effect on oral health
Dental caries is a local phenomenon caused by the
diet, especially the carbohydrates.
• The most important among them is Sucrose,
which is utilized by the bacteria to produce both
intra and extracellular polysaccharides.
• The type, consistency, time of intake and
frequency of the carbohydrates are major
factors in causation of dental caries.
40
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41. VITAMINS
• Vitamins and minerals form the protective foods and are also called functional foods.
• Those with RDA<100mg/day were traditionally called micronutrients.
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42. Vitamin A
• It maintains the health of specialized tissues such
as retina.
• Intake of 25000 IU or more during early
pregnancy can lead to congenital malformations.
• Hypervitaminosis leads to GI upset, pseudotumor
cerebri, skin desquamation , dry hair.
• Daily requirement - 1500 IU (500 μg)
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43. ORAL MANIFESTATIONS
• TEETH:
• -Defective formation of enamel
• -Epithelial invasion of pulpal tissue is characteristic of vitamin A def.
• -Distortion of shapes of incisors and molars.
• -Enamel hypoplasia:
• -Enamel matrix is poorly defined.
• -Increased caries susceptibility.
• -Delayed eruption.
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44. • GINGIVA
• - Hyperplastic gingival epithelium
• - In prolonged def. : shows keratinization
• Major and minor salivary glands show typical keratinizing
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45. Vitamin D
• The active form (Calcitriol) promotes bone resorption and
mineralization and intestinal calcium and phosphorus absorption.
• In preterm babies, deficiency may manifest as early as 8 weeks of
age, leading to rickets.
• Deficiency is treated with administration of 6lakhs IU of vitamin
D oral or IM.
• Hypervitaminosis leads to GI upset, hypotonia, polyuria,
polydypsia, hypercalcemia, hypercalciuria, metastatic
calcification
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46. Oral Manifestations
• Developmental abnormalities of dentin and enamel.
• Delayed eruption.
• Malalignment of teeth.
• Higher caries index.
• Enamel: may be hypoplastic, mottled, yellow
• gray in colour.
• Delayed closure of root apices.
• Osteoid is so soft that the teeth are displaced, leading to malocclusion of the teeth.
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47. Vitamin E
• Protects cell membranes and tissues from damage by oxidation.
• •Aids in the formation of red blood cells and the use of vitamin K.
• •Promotes function of a healthy circulatory system.
• •Called “Shady lady of nutrition” as more applications are yet to be known.
• •Excess may cause necrotising enterocolitis in the newborn.
• Daily requirement: 5-15 IU (5-15mg)
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48. Oral Manifestations of Vitamin E Deficiency
• Loss of pigmentation.
• Atrophic degenerative changes in enamel.
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49. Vitamin K
• Participates in oxidative phosphorylation.
• Increases concentration of prothrombin (II), proconvertin (VII), plasma
thromboplastin component (IX) and stuart-prower factor(x)
• Deficiency leads to haemorrhagic disease of new-born (HDN), gingival bleeding.
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50. Vitamin B1
• Plays important role in metabolism of carbohydrates, alcohol and
branched chain amino acids.
• •Main deficiency diseases are beriberi and Wernicke- Korsakoff
Syndrome.(WKS)
• •Anaphylaxis may occur on thiamine injection.
• Daily requirement: 0.5- 1.5mg/day (1mg/1000cal)
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51. Vitamin B2
• Has a vital role in cellular oxidation.
• •Deficiency manifests as angular stomatitis, cheilosis,
atrophic papillae on tongue, and neovascularization of
cornea.
• •In severe cases, tongue becomes glazed and smooth due to
complete atrophy of papillae.
• •Lips: red and shiny because of epithelial desquamation.
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52. Vitamin B3
• Niacin : also called “Nature’s valium” a part of NADP co-enzymes.
• •70mg protein intake provides 12mg of niacin.
• •Deficiency state is termed PELLAGRA which leads to photosensitive dermatitis,
diarrhoea and dementia.
• •Casal’s necklace and glove and stocking type dermatitis occurs in the exposed parts.
Daily requirement: 5- 15 mg
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53. Vitamin B6
• Pyridoxal, pyridoxamine and their phosphates have
B6 activity.
• •It keeps up the level of GABA, an inhibitory
neurotransmitter.
• Deficiency causes
• Neuritis, Anaemia, Convulsions
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54. • Oral manifestations:
• - Cheilosis
• - Glossitis
• - Angular stomatitis
• - Halitosis due to tooth decay
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55. Vitamin B12
• Cyanocobalamin: Called “red vitamin”
• Contains cobalt in the molecule: only vitamin that contains a
mineral.
• Present only in animal foods, fish and milk.
• Even though colonic bacteria synthesize it, but its not bio-
available.
• Absorbed from ileum under the influence of intrinsic factor
secreted from the stomach. 55

56. • Takes part in synthesis of fatty acids in myelin.
• Deficiency leads to pernicious anaemia, and subacute
combined degeneration of spinal cord.
• Additional signs are weight loss, pallor, confusion and
hypotension.
• Daily requirement: 0.5- 1.5 μg/day
56

57. Oral manifestations of Vit B12 Deficiency
• Tongue:
• Sore painful tongue, glossitis and glossodynia
• Beefy red tongue
• Small shallow ulcers with atrophy of papillae
with a loss of normal muscle tone, called as
Hunter’s glossitis.
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58. Vitamin C
• Converts proline to hydroxyproline, which is a constituent
of collagen
• Involved in collagen synthesis and teeth formation.
• Increases iron absorption.
• Acts as antioxidant due to its reducing property.
• Deficiency leads to scurvy, defective bone growth, bleeding
gums and delayed wound healing.
• Subperiosteal bleeding and calcification.
• Daily requirement: 40mg/day
58

59. Oral Manifestations of Vit C Deficiency
• Occurs chiefly in gingival and periodontal region.
• Interdental and marginal gingiva is bright red,
swollen, smooth, shiny surface producing an
appearance called, “Scurvy bud”.
• In fully developed deficiency, gingiva becomes
boggy, ulcerated and bleeds easily.
• Typical fetid breath.
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60. 60

61. 61

62. 62

63. ASSESSMENTOFNUTRITIONALSTATUS
• Nutritional screening should begin at the first appointment so that counselling and
follow up can occur during the course of treatment.
• The main objective of diet counselling for Prosthodontic patient is to correct
imbalance in nutrient intake that interfere with maintenance of oral tissue health.
63

64. • Providing nutritional care for the denture patient entails the following steps:
• Obtaining the nutritional history and accurate record of food intake over a 3-5
days period.
• Evaluating the diet.
• Teaching about the components of a diet that will support the oral mucosa as well
as bone health and total body health.
• Guidance in the establishment of goals to improve the diet.
• Follow –up.
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65. TRIPHASICNUTRITIONALANALYSIS
• PHASE 1-
• ANTHROPOMETRIC MEASUREMENTS
• QUANTITATIVE DIETARY ASSESMENT
• PHASE 2-
• SEMIQUANTITATIVE DIETARY ANALYSIS
• BIOCHEMICAL ASSESMENT
• PHASE 3
65
Deogade SC, Naitam D, Sundarkar P, Aswani K. Nutrition for Geriatric Complete Denture Wearing Patients. ACTA
Scientific Nutritional Health 2020;4(3):01-06

66. PHASE 1
• The first phase should be used to screen individual and obtaining information from a
medical standpoint.
• ANTHROPOMETRIC MEASUREMENTS
• Body Mass Index
• Triceps Skinfold
• Mid Arm Circumference
66

67. • QUANTITATIVE DIETARY ASSESMENT
• The purpose is to ascertain what the individual is eating now , what he has eaten in the
past and recent dietary changes. If potential nutritional problems are detected the
nutritional evaluation must progresses to phase 2.
• However if at the conclusion of phase 1 enough information is available to ensure a
rationale basis for therapy, the nutritional assessment may be terminated and dietary
counselling instituted.
67

68. PHASE - 2
• When the parameters indicate an existing nutritional problem then more information
needs to be accumulated.
• SEMIQUANTITATIVE DIETARY ANALYSIS:
• At the level of this analysis dietary intake is assessed at a more quantitative means .
• Nutrients in all food and beverages consumed in 3-5 days must be calculated using
computer assisted nutritional analysis program.
• BIOCHEMICAL ASSESMENT:
• Common automated blood tests are useful in providing more definitive information
regarding the nutritional status of an individual
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69. PHASE-3
• The final phase of nutritional analysis is reserved for more complex problems and
are accomplished under the guidance of a physician. The analysis in this phase
includes comprehensive nutritional and biochemical assays of blood, urine and
tissues as well as tests of metabolic and endocrine functions.
69

70. 70

71. • One which supplies all the nutrients in
the right quantity and proportion.
• Requirement of an adult sedentary male:
2400 kcal, i.e. 1 unit Of energy.
• PERCENTAGE IN DIET
• CARBOHYDRATES 55- 60%
• PROTEINS 10-15%
• FATS 30-35%
71
Balanced Diet

72. 72

73. Special Considerations In Balanced Diet
• Supplementation during pregnancy :
300 kilocalories extra
• During lactation: 600 kilocalories extra
• Exchanges for non-vegetarians:
• 50%legumes + 1egg/30g meat or fish.
• No legume, 1 egg + 30g meat or fish
• No legume, no egg, 60g meat or fish
73

74. Food Guide Pyramid
• Russell et al. in 1999
suggested Food Guide
Pyramid and the
modified Food Guide
Pyramid for adults
more than 70 years of
age.
• This was recommended
for dietary needs of
older adults.
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75. Fluoride
• Fluoride is an important preventive agent against dental
caries and more efforts are needed to ensure that the
majority of populations are exposed to optimum
fluoride concentrations in water.
• Fluoride acts to reduce dental decay.
• Exposure to fluoride alone may not eliminate caries but,
along with reduction in free sugars intake, it has a
significant effect on caries prevention.
• Research into effective means of delivering optimum
exposure to fluoride should continue.
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76. Fluoride and their role in prevention of caries
• Fluoride deposits in calcified structures such as bones and teeth when they are in
active stage of mineralization – via the systemic route when it is developing and
maturing.
• Developing tooth enamel, fluoride is deposited within the body of the crystal
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77. Mechanism of action of fluoride
• 1. Increased enamel resistance or reduction in
enamel solubility.
• 2. Increased rate of post eruptive maturation.
• 3. Remineralization of incipient lesions.
• 4. Interference with plaque micro-organisms.
• 5. Modification in tooth morphology.
77

78. Dental Fluorosis
• Tooth enamel is principally made up of hydroxyapatite (87%)
which is crystalline calcium phosphate.
• Fluorosis of enamel occurs when excess fluoride is ingested
during the years of tooth calcification essentially during the first
7 years of life.
• It is characterized by mottling of dental enamel.
• On prolonged continuation, the teeth become hard and brittle.
This is called dental fluorosis. 78

79. • Dental fluorosis in the initial stages results in the tooth
becoming coloured from yellow to brown to black.
• Depending upon the severity, it may be only discolouration of
the teeth or formation of pits in the teeth.
• Prolonged ingestion of fluoride through drinking water excess
of the daily requirement is associated with dental and skeletal
Fluorosis.
• Similarly, inadequate intake of fluoride in drinking water is
associated with dental caries.
79

80. Diet and Oral health
• Appropriate nutrition plays a major role in good dental health.
• Diet is major etiological factor for-
• 1. Dental caries
• 2. Enamel erosion
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81. • Nutritional status impacts on the
- Development of the teeth.
- The host’s resistance to many oral conditions.
- Periodontal diseases.
- Oral cancer
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82. Role of Diet in Dental Caries
82

83. Role of diet in dental development
• Vitamin A – Enamel
• Vitamin C – Dentin
• Vitamin D – Structural matrix of bones and teeth
• Calcium – Fluorapatite formation along phosphorous
and fluoride.
83

84. Effect of Diet on oral health
84

85. DIETRECOMMENDEDFORNEWDENTUREWEARER
85
Deogade SC, Naitam D, Sundarkar P, Aswani K. Nutrition for Geriatric Complete Denture Wearing Patients. ACTA Scientific
Nutritional Health 2020;4(3):01-06

86. PROSTHETIC CONSIDERATIONS
• Difficulties in prosthodontic treatment result from atrophy of the alveolar process
and can be manifested by the presence of undercuts on the denture bearing area,
especially evident in the maxilla, e.g. at highly protruding maxillary tubercles, the
difficulties in insertion of the denture can be encountered.
• On the other hand, a complete lack of tubercles, being also a result of atrophy,
does not favour denture retention.
• The presence of strongly protruding palatal torus can cause not only pain
complaints while wearing the prosthesis but also destabilization of the complete
denture.
K Romańczuk Prosthodontic rehabilitation of the elderly – a literature review Clin Exp Med Lett 2008; 49(4): 203-206
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87. • Another example of atrophy is the so called migration of frenulum attachment,
which leads to changes in the neutral zone, considerably limiting the conditions
for ideal denture fabrication.
• The difficulties in prosthodontic treatment may also arise from changes in the oral
mucosa. Dry mouth hinders prosthesis wearing, thin and flabby oral mucosa of an
atrophic nature is particularly susceptible to chafing under the prosthesis.
• Lack of the neuro-musculo-articulatory balance may also contribute to all these
problems.
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88. • Prosthodontic rehabilitation of the elderly may be additionally complicated by
disorders of proprioceptive sensibility associated with tooth loss. Loss of teeth and
occurrence of changes affect appearance of the face.
• Atrophy of the maxillary and mandibular alveolar process causes direct passing of
the maxillary external surfaces into the palatal plane, and in consequence a
decrease in the face width. Also, the size of the mandible undergoes reduction.
Due to atrophy of the mandibular body, the mandibular canal and mental foramen
move ostensibly upwards, close to the dental arch.
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89. PROSTHETIC CONSIDERATIONS
• Elderly Patients who are deficient in vitamin c should be supplemented in diet and
any invasive treatment should be avoided as deficiency causes delayed wound healing
• Elderly patients are often deficient in calcium which can be seen as increased residual
ridge resorption.
• Sufficient dietary intake of calcium should be provided in the diet to encounter this
loss.
89

90. • Early detection and prompt treatment of a vitamin B12 deficiency are essential to prevent
development of irreversible neurologic damage.
• Angular cheilitis may be caused by nutritional deficiencies vitamin B2, fungal infections, or
bacterial infections.
• There is evidence that dietary supplements of proteins and minerals increase tolerance to
dentures.
90

91. • Major reason for poor adaption for dentures in elderly people is often reduced tissue
tolerance resulting from an inadequate diet.
• Dentist should therefore be prepared to assess the nutritional quality of the diets of
prosthetic patients and to guide them towards good nutritional practices.
91

92. Review Articles
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93. Role Of Diabetes In The Prosthodontic Management Of A
Completely Edentulous Patient
• Rathee M, Jain P, Singh S, Divakar S, Chahal S, Wakure P
• International Journal of Dental Research
• Volume 3, Issue 1, 2021, Page No. 50-52
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94. • Salivary hypofunction
• Diabetes mellitus is well known to alter qualitatively and quantitatively the
parenchyma of major salivary glands leading to hypo salivation
• Patient is instructed to wet his mouth constantly during appointments salivary
substitutes can be given if condition is severe.
• Cholinergic agonist drugs such as pilocarpine can also be prescribed
• Candidal infection
• Hypo salivation is normally associated with augmentation of fungi such as Candida
albicans and other species leading to increased chance of oral infections
• Occurs due to change in pH, increased salivary glucose levels and immune
dysregulation in diabetic patients
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95. • Delayed or impaired wound healing
• It occurs in diabetes because of poor blood supply to the tissues, microvascular angiopathic
changes, reduced oxygen to the cells, reduction of collagen production, increased
collagenase activity
• Any surgical procedure planned like pre-prosthetic surgery or dental implant placement
should be performed only when normal glycemic levels are achieved
• Burning mouth syndrome
• Most diabetic patients experience altered taste sensation, burning mouth syndrome,
dysphagia etc. The cause for this is due to the variations in the salivary flow, changes in the
buffering capacity of saliva and peripheral neuropathy
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96. • Residual ridge resorption
• Decreased blood supply to the tissues because of microvascular angiopathy increase
the amount of residual ridge resorption
• Anaesthetic Consideration
• Excessive quantities of epinephrine should be avoided.
• In gingival retraction, retraction cords impregnated with epinephrine should also be
avoided.
• Epinephrine breakdowns glycogen to glucose and this results in the precipitation of
hyperglycemia.
• Alumina or zinc chloride-based retraction cords are preferred in patients with diabetes
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97. • Impression technique for prosthesis fabrication
• Mucostatic or minimal pressure impression technique or neutral zone impression technique
is recommended for impression making in such patients. These approaches will decrease
the stress on the underlying tissue to retard bone resorption.
• Liquid supported dentures
• In diabetic patients, liquid supported denture bases are good alternatives then conventional
dentures.
• Liquid supported dentures offer minimal distribution of forces and hence preservation of
residual ridge, better retention, stability and support, prevention of chronic soreness from
rigid denture bases, comfort to the patients with flexible surfaces, and improved patient
tolerance. Liquid dentures thus provide benefits of soft liners and tissue conditioners on
long term basis
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98. 26-07-2022 98

99. Management of Diabetes Mellitus Patients in Prosthodontics
• M Hussain, N Yazdanie, J Askari
• J Pak Dent Assoc 2010;19(1): 46 - 48
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100. Management Considerations: General Dental Considerations
• Arrange appointment in the morning
• Avoiding lengthy appointments
• Procedures should be done involving minimal possible trauma
• Stress free environment
• Maintenance of good oral hygiene
• In this regard application of topical agents like chlorhexidine, fluoride gel is found very
useful.
• The use of prophylactic medication to avoid postoperative infection and pain is
recommended
M Hussain, N Yazdanie, J Askari Management of Diabetes Mellitus Patients in Prosthodontics. J Pak Dent Assoc 2010;19(1): 46 - 48
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101. Prosthodontics Management Considerations
• Removable partial denture (RPD)
• Health of abutment teeth should be checked
• components of RPD must be tissue friendly
• diabetic patients are more prone to develop periodontal diseases, therefore in
certain cases splinting of periodontally compromised teeth
• If an acrylic denture is a preferred option then the design should incorporate
the principles of ‘Every Denture’ with wider self cleansing interdental spaces
and embrasures areas, uncovered marginal gingiva, point contact between
denture and natural abutment teeth
M Hussain, N Yazdanie, J Askari Management of Diabetes Mellitus Patients in Prosthodontics. J Pak Dent Assoc 2010;19(1): 46 - 48
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102. 26-07-2022 102

103. • Complete denture
• Use tissue friendly material
• Impression making will be done by mucostatic technique
• Use an occlusal scheme that has narrow bucco-lingual dimension and
shortened mesiodistal length.
• This will decrease the stress on the underlying tissue to retard bone resorption
• Concept of neutral zone can also be employed
• Denture flanges should be smooth and polished.
• There should be no working or non-working occlusal interference between
opposing teeth
M Hussain, N Yazdanie, J Askari Management of Diabetes Mellitus Patients in Prosthodontics. J Pak Dent Assoc 2010;19(1): 46 - 48
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104. • Fixed partial denture (FPD
• Finish-line of the preparation should be placed supragingival
• Provide chamfer finish-line on the facial aspect of prepared tooth as it is better than
shoulder because shoulder can concentrate stresses on weakened tooth/ teeth.
• Ante’s law should be obeyed;
• Minimal preparation like three quarter crown can be done on teeth like pre molar
• A narrow occlusal table, group function or mutually protected occlusal scheme is
better choice for periodontally compromised teeth
• Implant supported prosthesis are not advised for patients whose blood sugar level
remains uncontrollable but if conditions are favorable , then this type of prosthesis
can be planned
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105. Conclusion
• Changing our diet can have enormous impact on health- for better or worse.
• A balance diet and appropriate meal timings are important for a healthy body and
mind.
• Nutrition education is an important factor in overall improvement for society
health and prevention of all forms of malnutrition.
• Many health education programmes are initiated which include feeding to
students, vitamin and mineral supplementation.
105

106. References
• Park K. Nutrition and Health. Textbook of Preventive and Social Medicine. 24th
edition. Jabalpur: Banarasidas Bhanot publishers;2017. Pg 686
• Semba RD. The Discovery of the Vitamins. Int J Vitam Nutr Res 2012;82
(5):310-5
• Whitney E, Rolfes SR. Understanding nutrition. 15th ed. USA: Cengage Learning;
2007.
• Moynihan P, Petersen PE, Diet, nutrition and the prevention of dental diseases;
Public Health Nutr. 2004 Feb; 7(1A): 201–226
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107. • Winkler : Essentials of complete denture prosthodontics, third edition.
• Food selection ,dietary adequacy and related dental problems of patients with dental
prosthesis.(JPD 1964 VOL 32,pg 32,ELAINE HARTSOOK)
• The relationship of dietary calcium and phosphorus with residual ridge resorption:
JPD1979,42,5:489
• Gerodontic nutrition and dietary counselling for prosthodontic patients Carole A. Palmer,
EdD, RD, LDN. Dent Clin N Am 47 (2003) 355–371JORGESEN, ODONT:
Prosthodontics for elderly
• BOUCHER’S: Prosthodontic treatment for edentulous Patient
• M Hussain, N Yazdanie, J Askari Management of Diabetes Mellitus Patients in
Prosthodontics. J Pak Dent Assoc 2010;19(1): 46 - 48
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