nutrition c.d pt

8/3/2019 Nutrition c.d Pt

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Presented byDr shria dhaonMds 2nd year

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Nutrition : care in edentulous patient


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Terminologies

Nutrition:- the science of how the body utilizes food tomeet requirements for development, growth, repair

and maintenance..utilization of food by living organisms


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Diet:

the total oral intake of substance that furnish nourishmentand calories

Nutrients:are the constituents of food necessary to sustain the normal

functions of the body


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Nutrition in denture wearingpatient

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Enjoyment of food is regarded as an importantdeterminant of an adults quality of life

Loose teeth ,edentulism or ill fitting dentures may

preclude eating favorite foods and limit intake ofessential nutrients conversely affecting the health oforal tissues


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The National Institute on Aging has judged that inthe area of geriatrics, there is a triad, nutrition-health-aging, which cannot be separated and areparts of an integral whole.*

It is felt that malnutrition is the antecedent ofdisease.Since aging is a life process, good nutritionand health practices must be applied throughout

life.Watkin D: Logical bases for action in nutrition and aging. J AmGeriatr Soc

26(5): 193-202, 1978


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Decreased chewing ability ,fear of choking whileeating & irritation of oral mucosa under denturesmay influence food choices of denture wearer

Caf coronaryNutrition status of patient effects the health of oral

tissues and oral tissue adaptation to new denture


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Factors affecting nutritional status of theelderly

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S

Sight

Smell

Teeth

Memory

Ability to move

depression heart disease

lonliness diabetes, osteoporosis etc.

Physiological changes

Nutritional statusof elderly

Economical

changes

Psychological orsocial

changes

Medication or

disease


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Impact Of Dental Status On Food Intake99

Food choices of older adults are closely linked todental status and masticatory efficiency

Loss of teeth often leads adults to select diets that

are lower in nutrient densityWhen compared to dentate individuals edentulous

consume fewer vegetables , less fibre and caroteneand more cholesterol , saturated fat and calories


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Do prostheses affect dietary intake?

The studies to date, because of the way they wereconducted, provide unclear results. Dentures appear

to improve dietary quality somewhat but do notreally compensate for loss of teeth.

Papas et al. (1998a) evaluated the impact of fulldentures and noted lower intake of protein and 19

other nutrients. In a separate population, Papas etal. (1998b) reported that subjects who woredentures consumed more refined carbohydrates,sugar, and dietary cholesterol than their dentatecounterparts.


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Importance of Proper Nutrition1111

Enough intake of essential nutrients to maintain goodhealth..

Carbohydrates

Fat

Protein

Vitamins

Minerals

Water


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Nutritional Importance of Carbohydrates1212

Contributes to 60-70% of total caloric

requirement

Types of Carbohydrates

Simple

candy, sweets, fruit

individual glucose or fructose molecules

Complex

rice, breads, potatoes

Chains of glucose molecules


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Nutritional Importance of Proteins1313

Body building food repair n replacement of

body tissues

fundamental basis of cell structure and its function

10 -15% of total body energy is derived from protein

osmotic pressure, clotting of blood, muscle contraction

Starvationmajor supplier of energy

Types of Amino Acids

Nonessential (14) can be made by body

Essential (8) must be made by body

Sources of Protein


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Nutritional Importance of Fats1414

Provides 9Kcal/g of energy

Lipids contains 15-50% of body energy requirement

Fat is stored in adipose tissue and serve as energyreserve

Protect internal organs, regulate temp, store energy

during starvation

Forms cellular components

Essential Fatty Acids .which body cannotsynthesizefatty acids- linoleic and linolenic acid


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Functions of EFA :

Structural component of biological membrane

Participate in transport and utilization of cholestrol

Prevent fat accumulation

EFA rich food is sunflower oil,cotton seed oil,soyabean oil,meat ,pork and chicken


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deficiency-

-impairment in growth and reproduction

- BMR

- Toad skin (phrynoderma)- scaly dermatitis, hair loss,poor wound healing


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Nutritional importance of vitamins1717

Organic substances that regulate numerous anddiverse physiological processes in the body

Do not contain calories


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Nutritional importance of minerals1818

Inorganic elements found in food that are essentialto life processes

About 25 are essential

Classified as major or trace minerals

Sodium, zinc, iron, fluoride, calcium, phosphorus,magnesium, potassium


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Functions of Water1919

Comprises about 60% of body weight

Chief component of blood plasma

Aids in temperature regulation

Lubricates joints

Shock absorber in eyes, spinal cord

Active participant in many chemical reactions

Helps in excretion


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2020

Age (years) Water (ml/kg bodywt)

Infants Birth- 1 120 -100

children 0 -10 60 - 80

Adolscent 11- 18 41 - 55

Adult 19 - 51 20 -30


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Why do elderly or aging patients have

malnutrition??

Factors determine the nutritional status of the

geriatric patient :


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Factors affecting nutritional status of the elderly

Sight

Smell

taste

Teeth

Memory

Ability to move

depression heart disease

lonliness diabetes, osteoporosis etc.

ENERGY INTAKE OR EXPENDITURE DECREASES

HIGHER DEMAND FOR NUTRIENT CONTENT OF DIET

Nutritional statusof elderly

Economical

changes

Psychological orsocial

changes

Medication or

disease

Physiologic changes


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Biological concomitants of the aging process

Reduced taste and smell acuity accompanies aging

The largest study is that by Mattes et al. (1990),

who evaluated 118 patients with taste distortion andtaste loss.

They evaluated that sensory perception of taste

,texture acceptability is rated lowest in completedenture wearers

Ability to sense thirst is reduced,leadingdehydration


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Dry mouth and altered taste decrease PLEASURE ofEating.

Eating habits are those of having large amounts ofcommercially prepared convenience foods.

Such diets are rich in carbohydrates and calories butlow in proteins & vitamins.

With aging lean body mass is replaced by

fat,reducing metabolic rateEnergy needs decline due to reduced basal

metabolism and physical activities


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The onset of chronic disease leads to low physicalactivity

Bone loss is normal part of aging,trabecular bone is

affected first several factors contribute to age related bone loss,

leading to osteoporosis :genetic background

hormonal status bone density

low exersice level

inadequate nutrition


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Dehydration:

Major problem in seniors

Due to sense of thirst is reduced

Water lost by kidneys, intestine , lungs and skin is2500cc/day must be balanced

Kidney function is depressed in elderly ,due to

glomerular leakage

The filteration system of kidney works hard toexcrete toxic additives and preservatives present in

food everyday for years and years


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Kidney must eliminate these toxins if the person hasto survive ,over years kidney damage is cumulative

Dehydration can affect:

Saliva:

Impotant for mastication, food is formed intobolus ,which then swallowed and digested

When salivary flow is low it causes xerostomia ordry mouth


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Causes: physiologic

Menopause

Reduce water intake

Chronic glomerular leakage

psychological

DepressionDisease

DiabetesPernicious anemia , vitamin A and vitamin Bdeficiency

HIV infection and other auto immune diseases


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Clinical symptoms and signs seen by

prosthodontist

skin of the patient is wrinkled with loss of

turgidity is seen

Cornea of the eye is dry,

diminished tear secretion

old patient cry inside

Muscle strength is diminished and facial contourcollapse.


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Clinical symptoms and signs seen by prosthodontist

Oral mucosa is dry ,hot and fragile

Reduced salivary secretion,saliva is thick ,foamy andropey

Gloves sticks to mucosal surface

Materia alba accumulates due to lack of self cleasning

activity

Dorsum of the tongue is fissured*atrophy of filiformpapillae


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Treatment:for patient on medications or radiationtherapy

Salivary substitute should be provided for relief

which includes :Sialogogues: sugar free gums , lozenges candies

If drug is suspected to be the cause consulting with

physician drug can be alternated or dosage can bemodified

.


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In such cases, measurement of a patient's nonstimulatedsalivary flow rates before and after altering their medicationmay be useful in gauging the success of treatment.


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Pilocarpine hydrocholoride and Cevimilinehydrochloride are commonly used drugs for salivarystimulation and produce clinically significantincrease in salivary flow in xerostomic patients


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In severe xerostomic cases, saliva substitutes orsalivary stimulants may be used.To minimizepatient discomfort, soft denture liners can also beused. Often, a combination of treatments may be

required.

Saliva substitutes containing thickening agents forlonger relief and increased moistening and

lubrication of the oral surfaces have been developed.These are available as solutions, sprays or gels


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contents:

carboxymethylcellulose, electrolytes and flavoringagents eg wet mouth (ICPA Health Products Ltd),

aqwet (Cipla Ltd)Main problem is to deliver this substitute constantly

into patients mouth without affecting his normalroutine. Where all treatment modalities have proven

unsuccessful, the incorporation of artificial salivaryreservoir in dentures, has been proposed


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Dentures incorporating metal bases may exhibitimproved accuracy of fit and effective wettingcontributing to better retention Metal basedprosthesis are also easier to clean and have less

plaque accumulation.

Patients wearing implant supported denturesreport improved oral comfort and function when

compared with conventional, mucosa-supportedprosthesis.Removable prosthodontic therapy and xerostomia. Treatment considerations. JosephJ Massad, David R Cagna Dent Today June 2002 ,vol. 21, Issue 6, 80-7.


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Patient treatment for physiologic changes

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Milk is also proposed as salivary substitute ,aids inlubrication, pleasure eating , buffering action

Additional recommendation: breverages producing

more saliva-water with slice of lemon,lemonadeDiet planning

Patient is advised for bound water intake in form ofsoups as they are more effectively absorbed byintestine and carried to tissue cell by vascularsystem

Vegetable fibres are strongly hydrophilic and also

softens the feces for elderly patient


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Dentifrices:

Biotene and Oralbalance products are availableover-the-counter from Laclede, Inc. (These are

antixerostomia dentifrices that contain threesalivary enzymes, lactoperoxidase, glucose oxidaseand lysozyme, specifically formulated to activateintra-oral bacterial systems

Currently available formulations include:

Biotene Dry Mouth Toothpaste

Biotene Gentle Mouthwash


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Calcium deficiency and bone loss4242

Bone loss is normal part ofaging that effects maxilla and

mandible

Sites where trabecular bone ismore prominent like alveolar

bone ,Vertebrae ,Wrist


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Thus, increase bone loss leads to a condition calledas osteoporosis

Osteoporosis causes weak bones., bones looses

mineral calcium. They become fragile and breakeasily.

Fracture usually at hip , spine and wrist


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How can we evaluate???

Dentist is the first to detect

Trabecular bone is source of calcium used tomeet tissue calcium needs

Alveolar bone loss precedes loss of calciumfrom the vertebrae and long bones

In a Study done by , Wical & Swoope in 1974,They found that there was a positivecorrelation between LOW CALCIUM intake,

calcium phosphorus imbalance & severe ridge


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How to get enough calcium everyday??

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Treatment:

Dietary calcium intake is critical

Major source of calcium-are milk cheese ,

yogurt,green broccoli, salmon and sardines.Turnips ,calcium fortified fruit juices.


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Advice patient to drink 3 or 4 glasses of low fat milkeveryday

Eat 5- 7 oz of cheese every day

Adequate intake of Vitamin D is alsorecommended,as it ennhances calcium resorption inintestine

Daily dose of 10g is recommendedSources : fish fish liver oil, egg yolk,sunlight


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In lactate intorlant individuals-calcium supplementsare recommended

Osteoporotic individuals:

Calcium supplements includeCalcium carbonate - 40% Elemental Calcium

Calcium citrate - Absorbed BETTER by Older

women


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Protein deficiency4949

In elderly protein depletion of body source is seen asdecrease in body mass

Muscles account for 45% of body mass which drops

to 27% in old patientRecommended requirement adult-0.8-1.0 g/kg

body wt.

How will we identify it??Reduction in muscle mass is more conspicous in

muscles of mastication

There is marked decrease in muscle strength andbulk


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Treatment: for physiologic factor:

Patient is advised for mutual supplementationie.,cereals,wheat and rice along with pulses like

bengal gram ,2-3 servings of 1 cup (cooked)Other good source is meat ,fish-which can be

advised 2-3 oz

2 eggs per day


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Vitamin and mineral deficiency5151

RECOMMENDED DIETARY ALLOWANCE (RDA)

Represents quantity of nutrients advised daily

Vitamin C:

RDA for ascorbic acid is 500mg/day

Synthesize collagen ,basic structure of tendons andpdl


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How will we evaluate??

Slow healing of wounds ,after extraction

Hypermobility of teeth

Edematous oral mucosa

Tender & bleeding gingiva


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Treatment

Dietary sources includes CITRUS fruits, peppers,melons, KIWI fruit, mangos, papaya & strawberry

Advised dosage is 1 orange,1/2 grapefruit or cupfruit juice ,2-4 serving /day for 5 days


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Vitamin B complex:

Folic acid plays an important role in cell division &RBC formation inadequate intake of folate may resultin anemia

How will we evaluate???

Clinical symptoms of sour or metallic taste


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Lips: chelosis

angular stomatitis

inflammation

Tongue:

edema

magenta tongue

atrophy of filiform pappila

burning sensation


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Treatment:

Dietary sources include Oranges , Cantaloupe,Broccoli, asparagus & dried beans

Recommended 1 cup cooked dry beans 2-3 servings/day for 10 days

i l


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minerals

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Sodium

Regulates balance of body fluids

Nerve function

Acid base balance

Blood pressure

Deficiency..

Headache

Weakness, cramps

Inc fluid retention in body


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Zinc

Reqd for digestion n metabolism

Wound healing

Tissue growth

Reproduction

Deficiency leads to:

Retarded growth

Taste/smell alteration

Dec immune function


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Iron

Growth

Immune system health

Hb formation

Deficiency:

Anemia

Loss of weight

Gastric disturbances

Pallor


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Phosphorus

Formation of bones n teeth

Metabolism

Muscle activity

Acid base balance

Deficiency:

Weakness, loss of appetite

Retarded growth

Porous bone


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Minerals and vitamins are in small amount areessential to issue health

Many patients can be benefited from dietary

correction and combined with nutritionalsupplements


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It is often difficult ,based on visual inspection or aninterview ,to identify patient need of nutritional care

Patient should be carefully screened

Providing nutrition care for edentulous patiententails following steps

1. obtain nutritional history,record of food intake over3-5 days

2 .Evaluate diet,assess nutritional risk

3.Teach about components of diet ,that will supoortoral mucosa ,bone health and total body health

.Hel atient to establish oals

St


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Step 1

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St


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Step 2

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When record is obtained ,nutrient analysis is obtainedby either

on a computer with dietary analysis software

Or the reported foods can be classified into 5 basictype described on food pyramid guide


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Step 3


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Step 3

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The relationship of diet to the health of oral tissue andpatients diet evaluation is done

Start with a positive note

Explain about bone health and calcium relatonshipUse food guide pyramid as a visual tool to educate

patient

Step 4


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Step 4

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Small changes can be incorporated to patients dietwithin the patients budget

A diet precription can be made for the patient

The result of diet assessment should always recordedImportant detail:advicepatient to reduce the daily fat

intake to 20-35% of total calories

Evidence of link between dietary intake offat,cholestrol and occurrence of hyperlipidemias

Dietary counseling for Denture wearers


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Helping new denture wearers learn to chew

Diet for the first day after denture insertion : full-liquid diet

Vegetable fruit group: juices Bread cereal group: gruels cooked in milk or water

Milk group: in any form, : pasteurized milk,

Meat group:meat broths or soups


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Diet for the 2nd and 3rd day after denture insertion:pureed diet to soft diet

Bread/cereal group-cooked cereals, milk, toast andsoften bread, puffed rice

Vegetable group- juices, well cooked carrots, greenbeans, mashed potatoes, creamed vegetablesFruitgroup- well-cooked fruits (no seeds), juices

Meat group- soft boil eggs, chopped beef, ground liver,chicken or beef in sauce


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Diet for the fourth day and later: soft diet to regulardiet as tolerated

As soon as sore spots are healed, firmer foods can beeaten

Best to cut food into small pieces

Success of dentures-manage sandwiches and salads ofraw fruit and vegetables

conclusion


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conclusion

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Edentulous patients are particularly vulnerable tocompromised nutritional health , dietary guidance isan integral part of treatment of denture wearingpatient

bibliography


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bibliography

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Prosthodontic treatment for edentulous patients

zarb and Bolender;12th edi. Nutrition in clinical dentistry Nizel n Papas;3rd edi

Essential of complete denture prosthodontic

Sheldon Wrinkler;2nd edSyllabus of complete denture Chales Heartwell

Textbook of Biochemistry Satyanarayan


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THANK YOU

nutrition c.d pt

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