Changes in the nutritional statuses of edentulous elderly patients after new denture fabrication with and without providing simple dietary advice

Influence of prosthodontic rehabilitation and dietary advice on glycaemic control, nutritional status and oral health-related quality of life of older adults with type 2 diabetes

OBJECTIVES

This prospective clinical study aimed to determine the influence of oral prosthodontic rehabilitation with partial removable dentures and simplified dietary advice on glycaemic control, nutritional status and oral health-related quality of life (OHRQoL) of older adults with type 2 diabetes.

BACKGROUND

Individuals with tooth loss who did not wear complete or partial dentures are more likely to be at nutritional risk, suggesting that using dental prostheses would benefit the re-establishment of an adequate nutritional status and potentially improve quality of life. Nutritional therapy is essential for diabetes prevention, treatment and management, favouring glycaemic control. The literature provides little evidence on the contribution of partial removable dentures to improving diabetes control, nutritional profile and satisfaction in older adults, especially those with type 2 diabetes.

MATERIALS AND METHODS

Older individuals diagnosed with type 2 diabetes mellitus, aged 60 years or older and needing oral rehabilitation with partial removable dentures were eligible for this prospective study. The primary outcome measure was glycaemic control, measured by glycated haemoglobin (HbA1c) levels. The Oral Health Impact Profile (OHIP-14) questionnaire and the Mini Nutritional Assessment short-form (MNA-SF) represented secondary outcome measures. These measures were assessed at baseline and 12 months of follow-up after prosthesis delivery, combined with simple dietary advice in pamphlet form. The data were analysed using the Wilcoxon matched-pairs test.

RESULTS

Forty-four patients who met the inclusion criteria and required treatment with removable partial dentures were selected for this study, which was carried out for a year. During this period, seven participants declined to participate because they moved to another city. Hence, a final sample of 37 participants (16 men and 21 women, average age of 65.8 years, ranging from 60 to 83 years) were included in the study. No laboratory parameter (HbA1c levels) changed significantly during the investigation. The number of older adults at risk of malnutrition was significantly lower at 12 months than at baseline. Furthermore, nutritional status significantly improved 12 months after prosthodontic treatment combined with dietary advice, and the effect sizes were large. OHRQoL significantly improved after prosthodontic therapy combined with dietary advice.

CONCLUSIONS

Prosthodontic treatment with partial dentures associated with simple dietary advice did not influence glycaemic control but improved the nutritional status and OHRQoL of older adults with type 2 diabetes.

Relationship between tooth loss and progression of frailty: Findings from the English longitudinal study of aging

OBJECTIVE

The objective of the present study was to investigate the relationship between indicators of oral health status (number of teeth; denture use) and the progression of frailty amongst adults in England.

METHODS

The subjects were participants of the English Longitudinal Study of Aging [ELSA] aged 50 years and older. We used panel data from three waves of the study (Waves 7-9). Indicators of oral health comprised the number of teeth (≥20; 10-19; 1-9; 0) and combination of removable denture usage and the number of teeth. Frailty was assessed by the 32-item Frailty Index (FI). Covariates were age, sex, education, marital status, smoking, alcohol, and physical activity. The longitudinal relationship between oral health indicators and change in FI were investigated using linear mixed-effect models considering frailty as a time-varying variable.

RESULTS

Among the 7,557 participants, compared to those people with 20 or more teeth, change in frailty over time was significantly higher among those with less than 20 teeth: 10-19 teeth (β: 0.249, 95 %CI: 0.116 to 0.382), and 1-9 teeth (β: 0.238, 95 %CI: 0.053 to 0.423) and being edentate (β: 0.286, 95 %CI: 0.106 to 0.465) when adjusting for co-variates. The rise in frailty over time was significantly higher among those with fewer teeth (<20 teeth), including those using dentures.

CONCLUSIONS AND IMPLICATIONS

This longitudinal analysis suggests that tooth loss is associated with accelerated progression of frailty and utilizing dentures did not reduce the trend in frailty. Thus, maintaining a functional natural dentition is important in healthy ageing.

Factors influencing the selection of oral healthcare providers in multidisciplinary Nutrition Support Team for malnourished inpatients: A cross-sectional study

BACKGROUND

Oral health management involving dental professionals in a multidisciplinary Nutritional Support Team (NST) is effective collaborative care. However, the indicators for the triage of oral health management requirements and selection of oral healthcare providers remain unclear.

OBJECTIVE

This cross-sectional study included inpatients with malnutrition and aimed to investigate the factors associated with determining the need for oral health management involving dental professionals and selecting primary oral healthcare providers when needed.

METHODS

Participants included 255 inpatients (154 males and 101 females, mean age 69.7 ± 14.4 years) aged ≥20 years who underwent oral assessment by the NST between April 2016 and July 2019. Participants were assigned to the following groups: good oral health group, oral health management by nurses under the supervision of dental professionals group, and oral health management by dental professionals group. The comprehensive oral health status was investigated using the Oral Health Assessment Tool (OHAT). The total OHAT score ranges from 0 to 16, with a higher score indicating a poorer oral environment.

RESULTS

The total OHAT score had a significant correlation with the need for oral health management by dental professionals. Inpatients with denture problems required oral health management from dental professionals. The optimal cutoff value of the total OHAT score for determining the need for oral health management was four.

CONCLUSION

The need for oral health management by dental professionals increased with worsening oral health status, especially denture problems. The OHAT score could be used to triage inpatients who require oral health management collaborated with dental professionals.

Behavioral model-guided nutritional counseling could improve the dietary practice and nutritional status of elders in Ethiopia: a quasi-experimental study

BACKGROUND

Physiological, pathological, and socioeconomic changes occurring in older people negatively influence food intake, utilization, nutritional status, and health. These problems are deeply rooted in low socio-economic settings and could partly be addressed through systematic behavioral change approaches. Hence, this study was to evaluate the effect of behavioral model-guided nutritional counseling on the dietary intake and nutritional status of elders.

METHODS

A one-armed pre- and post-test quasi-experimental design was conducted on 293 community-dwelling older adults aged above 60 years from January to May 2022. A health education tool was developed and validated using health beliefs and the theory of behavioral change. The sessions were delivered by trained nurses through home-to-home visits every week lasting 45-60 min for up to two months. Data on nutritional knowledge, dietary intake, and body weight were captured using standardized questionnaires and measurements. The primary outcome was captured using the validated mini-nutritional assessment (MNA) tool and classified accordingly. The data was analyzed using Stata software, where it is presented in tables, graphs, and summary statistics. A paired t-test and the p-value were used to identify statistically significant effects of the intervention.

RESULTS

A total of 263 elders were involved in the experiment, and modeled nutritional counseling significantly improved the knowledge score from 7.58 (± 1.05) to 11.6 (± 1.37) (P < 0.001) at the pre- and post-intervention periods. A significant improvement has been shown in the consumption of dairy products, fruits, and animal-source foods and, importantly, in the mean dietary diversity score (p < 0.001). As a result, the burden of malnutrition was significantly lower in the post-intervention period (9.6%: 7.9-11.3) compared to baseline (12.5%: 11.4-13.8). There is a significant increase in the mini-nutrition assessment score (MD = 0.30; p = 0.007). The mean body weight and the body mass index did not change significantly after the intervention (p > 0.05).

CONCLUSION

Targeted behavioral model-guided nutritional counseling could help promote perception, diversify dietary consumption, and reduce the risk of undernutrition among elders. Particular attention to older people with the use of participant-centered nutritional behavioral change interventions coupled with livelihood support could help reduce undernutrition among older people.

TRIAL REGISTRATION

Clinical Trial Registration-URL: www.

CLINICALTRIALS

gov , identifier number: NCT04746664, first released 10/02/2021.

The effect of prosthetic rehabilitation with or without dietary advice on nutritional status in elderly patients: a systematic review

BACKGROUND

Elderly people frequently report tooth loss, affecting their nutritional status. There is a gap in the scientific evidence about the influence of prosthodontic rehabilitation on nutritional status.

OBJECTIVE

To investigate the influence of prosthodontic rehabilitation combinates or not with dietary advice on nutritional status in elderly patients.

METHODS

A systematic literature search was conducted in three electronic databases to identify randomized clinical trials that evaluated the effect of prosthetic rehabilitation on nutritional status in subjects aged 60 years or older, with a follow-up of at least 1 month after prosthesis rehabilitation.

RESULTS

Of the 1517 articles identified in the initial search, 12 were selected for the final review. No significant difference between the types of prosthesis were found regarding the chewing by the elderly population. Although patients who received prosthetic treatment had significant improvement in chewing ability, a consistent pattern of improvement in nutritional status was not observed when they did not receive dietary advice. In addition, the association between the condition of the dentition, the masticatory performance and nutritional change of elderly patients has been found. Studies that evaluated simultaneous complete denture treatment and simple dietary advice showed an improvement of nutrient intake in elderly patients.

CONCLUSIONS

Isolated prosthetic rehabilitation may not have the effect of exerting a change in nutritional status of edentulous elderly patients. In general, simultaneous dietary consulting and prosthetic treatment in combination may improve dietary habits, since masticatory capacity and efficiency are not the only factors that influence the nutritional status of a patient.

Eating Advice for People Who Wear Dentures: A Scoping Review

Objective: A scoping review of available advice to address eating problems experienced by people who wear dentures was conducted in accordance with the PRISMA statement. The objective was to identify and map type, volume, and content of the available eating advice. Methods: Medline, CINAHL, and grey literature databases and Google were searched. Relevant content pertaining to study type, peer-review vs. grey literature, country of origin, advice content, and methods to evaluate effectiveness was mapped. Results: Of the 4591 records identified from peer-reviewed literature, 56 full papers underwent duplicate screening, resulting in 26 papers (from Germany (n = 1), Europe (n = 1), India (n = 2), Japan (n = 7), UK (n = 6), USA (n = 6), or other (n = 3)) being included in the review. These yielded 18 different items of relevant eating advice. Of the 258 screened websites, 63 were included, yielding 30 different items of eating advice. The most-cited advice was to eat soft food and avoid hard and sticky food, cut food into bite-sized pieces, and chew on both sides of the mouth and chew slowly and thoroughly. The identified advice was not supported by reference to peer-reviewed evidence. Advice included some conflicting messages and some advice was non-compliant with authoritative nutritional advice (e.g., avoid red meat, take a vitamin supplement). Conclusion: There is support for providing eating advice at the time of denture provision. A broad range of advice based on clinical experience to support people who wear dentures to overcome the functional limitations exists. However, the efficacy of this advice in improving diet and eating experience has not been tested.

Regular Oral Health Management Improved Oral Function of Outpatients with Oral Hypofunction in Dental Hospital: A Longitudinal Study

This longitudinal study aimed to clarify the impact of regular oral health management for oral hypofunction on the oral function of older dental outpatients. The 68 participants enrolled in this study were older dental outpatients (mean age 78.5 ± 8.1 years). According to the number of declined oral examinations after the first exam, participants were assigned to the oral hypofunction group (Hypo group, ≥3), receiving regular oral health management with a leaflet at the dental clinic, or the pre-oral hypofunction group (Pre-hypo group, ≤2), which served as a control. At the second oral examination, after approximately 6 months to 1 year, the Hypo group showed significant improvement in the tongue-lip motor function (Oral diadochokinesis, ODK) /pa/, /ta/, and masticatory function, while the Pre-hypo group showed significant worsening in oral hygiene and oral wetness. Temporal changes in ODK /pa/, /ta/, and the number of declined examination items were significantly different between the groups. Multiple analysis revealed that the number of improved oral examination items were associated with presence of regular oral health management after adjusting for age, sex, number of visits, measuring period, and dental treatment. Regular comprehensive oral health management for oral hypofunction improves and maintains oral function among older dental outpatients.

Dietary advice with or without oral nutritional supplements for disease-related malnutrition in adults

BACKGROUND

Disease-related malnutrition has been reported in 10% to 55% of people in hospital and the community and is associated with significant health and social-care costs. Dietary advice (DA) encouraging consumption of energy- and nutrient-rich foods rather than oral nutritional supplements (ONS) may be an initial treatment.

OBJECTIVES

To examine evidence that DA with/without ONS in adults with disease-related malnutrition improves survival, weight, anthropometry and quality of life (QoL).

SEARCH METHODS

We identified relevant publications from comprehensive electronic database searches and handsearching. Last search: 01 March 2021.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of DA with/without ONS in adults with disease-related malnutrition in any healthcare setting compared with no advice, ONS or DA alone.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed study eligibility, risk of bias, extracted data and graded evidence.

MAIN RESULTS

We included 94, mostly parallel, RCTs (102 comparisons; 10,284 adults) across many conditions possibly explaining the high heterogeneity.  Participants were mostly older people in hospital, residential care and the community, with limited reporting on their sex. Studies lasted from one month to 6.5 years.  DA versus no advice - 24 RCTs (3523 participants) Most outcomes had low-certainty evidence. There may be little or no effect on mortality after three months, RR 0.87 (95% confidence interval (CI) 0.26 to 2.96), or at later time points. We had no three-month data, but advice may make little or no difference to hospitalisations, or days in hospital after four to six months and up to 12 months. A similar effect was seen for complications at up to three months, MD 0.00 (95% CI -0.32 to 0.32) and between four and six months. Advice may improve weight after three months, MD 0.97 kg (95% CI 0.06 to 1.87) continuing at four to six months and up to 12 months; and may result in a greater gain in fat-free mass (FFM) after 12 months, but not earlier. It may also improve global QoL at up to three months, MD 3.30 (95% CI 1.47 to 5.13), but not later. DA versus ONS - 12 RCTs (852 participants) All outcomes had low-certainty evidence. There may be little or no effect on mortality after three months, RR 0.66 (95% CI 0.34 to 1.26), or at later time points. Either intervention may make little or no difference to hospitalisations at three months, RR 0.36 (95% CI 0.04 to 3.24), but ONS may reduce hospitalisations up to six months. There was little or no difference between groups in weight change at three months, MD -0.14 kg (95% CI -2.01 to 1.74), or between four to six months. Advice (one study) may lead to better global QoL scores but only after 12 months. No study reported days in hospital, complications or FFM. DA versus DA plus ONS - 22 RCTs (1286 participants) Most outcomes had low-certainty evidence. There may be little or no effect on mortality after three months, RR 0.92 (95% CI 0.47 to 1.80) or at later time points. At three months advice may lead to fewer hospitalisations, RR 1.70 (95% CI 1.04 to 2.77), but not at up to six months. There may be little or no effect on length of hospital stay at up to three months, MD -1.07 (95% CI -4.10 to 1.97). At three months DA plus ONS may lead to fewer complications, RR 0.75 (95% CI o.56 to 0.99); greater weight gain, MD 1.15 kg (95% CI 0.42 to 1.87); and better global QoL scores, MD 0.33 (95% CI 0.09 to 0.57), but this was not seen at other time points. There was no effect on FFM at three months. DA plus ONS if required versus no advice or ONS - 31 RCTs (3308 participants) Evidence was moderate- to low-certainty. There may be little or no effect on mortality at three months, RR 0.82 (95% CI 0.58 to 1.16) or at later time points. Similarly, little or no effect on hospitalisations at three months, RR 0.83 (95% CI 0.59 to 1.15), at four to six months and up to 12 months; on days in hospital at three months, MD -0.12 (95% CI -2.48 to 2.25) or for complications at any time point. At three months, advice plus ONS probably improve weight, MD 1.25 kg (95% CI 0.73 to 1.76) and may improve FFM, 0.82 (95% CI 0.35 to 1.29), but these effects were not seen later. There may be little or no effect of either intervention on global QoL scores at three months, but advice plus ONS may improve scores at up to 12 months. DA plus ONS versus no advice or ONS - 13 RCTs (1315 participants) Evidence was low- to very low-certainty. There may be little or no effect on mortality after three months, RR 0.91 (95% CI 0.55 to 1.52) or at later time points. No study reported hospitalisations and there may be little or no effect on days in hospital after three months, MD -1.81 (95% CI -3.65 to 0.04) or six months. Advice plus ONS may lead to fewer complications up to three months, MD 0.42 (95% CI 0.20 to 0.89) (one study). Interventions may make little or no difference to weight at three months, MD 1.08 kg (95% CI -0.17 to 2.33); however, advice plus ONS may improve weight at four to six months and up to 12 months. Interventions may make little or no difference in FFM or global QoL scores at any time point.

AUTHORS' CONCLUSIONS

We found no evidence of an effect of any intervention on mortality. There may be weight gain with DA and with DA plus ONS in the short term, but the benefits of DA when compared with ONS are uncertain. The size and direction of effect and the length of intervention and follow-up required for benefits to emerge were inconsistent for all other outcomes.  There were too few data for many outcomes to allow meaningful conclusions. Studies focusing on both patient-centred and healthcare outcomes are needed to address the questions in this review.

The association of oral function with dietary intake and nutritional status among older adults: Latest evidence from epidemiological studies

Inadequate and poor quality of diet and malnutrition are common and associated with adverse health outcomes, including morbidity and mortality, among older persons. This review aimed to establish the latest evidence from studies investigating the association between oral function and nutrition among older adults. An electronic search of MEDLINE using PubMed for literature published in English between March 2018 and March 2021 was conducted, and 27 papers were identified. The selected studies comprised 23 observational studies (17 cross-sectional and 6 longitudinal studies) and 4 interventional studies. Most of the observational studies demonstrated the following associations in older adults: older adults with poor oral function are likely to have poorer dietary intake and poorer nutritional status, and malnourished older adults are likely to have poorer oral function. The results of the intervention studies demonstrated that the combination of prosthodontic treatment and dietary counseling is more effective for improving dietary intake and nutritional status in older persons with tooth loss than the prosthodontic treatment alone. Our review confirmed that a relationship exists between oral function and nutrition and revealed the need for additional high-quality studies investigating comprehensive oral function, rather than a single aspect of oral function, with regard to nutritional status.

Impact of oral health guidance on the tongue-lip motor function of outpatients at a dental hospital

Objective

To clarify the effect of oral health guidance on tongue‐lip motor function in the outpatients visiting the Showa University Dental Hospital (Tokyo, Japan).

Background

The management of the oral function of older people visiting a dental hospital is important. Previous studies have revealed that tongue‐lip motor function is easy to improve. However, the impact of oral health guidance on tongue‐lip motor function in the outpatients of dental hospital requires further elucidation.

Materials and Methods

The participants (n = 35) included patients who were diagnosed with low tongue‐lip motor function on evaluation by oral diadochokinesis (ODK) at the outpatient clinic. They underwent a second examination approximately 6‐12 months later. Their demographic characteristics were recorded. Oral health guidance was provided through an educational leaflet on oral hypofunction when the participants visited the clinic. It included content on tongue twisters, voice training and a range of movement and muscle training of the tongue and lip.

Results

Following oral health guidance on tongue‐lip motor function, the ODK values changed from 5.6 at the first examination to 6.0 at the second for /pa/, from 5.6 to 5.8 for /ta/ and from 5.2 to 5.4 for /ka/. This improvement was not significantly associated with age, sex, measurement period or number of visits.

Conclusion

The findings of this longitudinal study suggested that oral health guidance using an oral hypofunction educational leaflet may be effective in improving the tongue‐lip motor function of outpatients who had low tongue‐lip motor function, regardless of the measurement period or the number of visits to the dental hospital.

Oral health status and its association with nutritional support in malnourished patients hospitalised in acute care

OBJECTIVES

This cross-sectional study aimed to examine the oral health of malnourished acute-care hospital inpatients, who were the subjects of a nutritional support team (NST). We also aimed to elucidate the systemic and nutritional factors associated with the oral health of those patients.

BACKGROUND

Interventions by NST are essential for inpatient nutrition management and require the active participation of dental professionals. However, information is limited regarding the state of oral health among acute-stage malnourished inpatients.

MATERIALS AND METHODS

We enrolled 255 hospitalised patients (101 women, mean age: 69.7 ± 14.4 years) who were referred to an NST for nutrition management between April 2016 and July 2019. The main outcome was the Oral Health Assessment Tool (OHAT) scores. Moreover, we assessed participants' demographic characteristics, nutritional status, number of natural and functional teeth, posterior occlusal support, denture use, Dysphagia Severity Scale, whether oral health management was needed, and the methods of nutrition intake.

RESULTS

Several participants presented with a deteriorated oral health. Consequently, oral health management was often regarded necessary in these patients. Approximately half were fed by parenteral or tube feeding. Multiple regression analysis revealed the OHAT score has a positive association with age (P = .008), and a negative association with body mass index (P = .009) and the method of nutrition intake (P = .028).

CONCLUSION

Malnourished inpatients at an acute care hospital who were subject to an NST had a deteriorated oral health status. Additionally, poor oral health was associated with poor nutritional status and nutrition intake methods.

Effects of denture wearing on coordinated features of jaw and neck muscle activities during chewing in partially edentulous elderly patients

PURPOSE

This study was performed to examine how denture wearing improves jaw and neck muscle coordination during chewing in partially edentulous elderly patients.

METHODS

Sixteen patients classified as Eichner's index B2 or B3 and 16 young dentate subjects were enrolled. Jaw and neck muscle activities during chewing were recorded using electromyography with and without denture wearing, then analyzed using intermuscular Electromyography (EMG)-EMG transfer and EMG-EMG coherence function analyses to clarify quantitative, temporal, and functional coordination of jaw and neck muscle activities while chewing. Occlusal force and masticatory scores were also determined.

RESULTS

Denture wearing increased the power values for jaw closing muscle activities, and improved occlusal area and force, and masticatory score. Gain values for jaw closing and opening muscle activities were decreased in those wearing dentures compared to those not wearing dentures. Denture wearing resulted in equivalent gain values for jaw closing and opening muscle activities as compared to the young subjects. Coherence values for chewing and non-chewing side neck muscle activities were increased as compared to not denture wearing.

CONCLUSIONS

The suitability of denture wearing can be evaluated from the viewpoint of gain as a quantitative parameter showing coordination between jaw closing and opening muscle activities. Such evaluation can be performed from the viewpoint of coherence as a parameter of functional coordination between jaw and neck muscle activities during chewing in partially edentulous elderly patients. The gain parameter in regard to jaw muscle activities may be compensated to a state equivalent to that seen in young subjects by wearing an appropriate denture.

The relationship between masticatory performance and intakes of foods and nutrients in Japanese male workers: A cross-sectional study

BACKGROUND

Although many studies have been conducted on the relationship between masticatory performance and nutrient ingestion in the elderly, few large-scale studies have been carried out using relatively young individuals.

OBJECTIVES

The objective of this study was to clarify the association between the masticatory performance evaluated by the gummy-jelly test, not by visual examination, and nutrient ingestion state based on the brief self-administered diet history questionnaire (BDHQ).

METHODS

This was a cross-sectional survey of 540 male workers. Somatometry, blood pressure measurement, blood test and medical interview were performed as a periodic health check-up. In the dental check-up, an oral examination, gummy-jelly test (glucosensor) and survey of ingested food and nutrients using BDHQ were performed. The participants were classified into two groups with low and normal values of masticatory performance. Participants with a score on the gummy-jelly test below 150 mg/dL or 150 mg/dL or higher were included in the low and normal groups, respectively.

RESULTS

Two hundred and forty-eight participants (45.8%) had low masticatory performance, and 292 (53.2%) had normal masticatory performance. The intakes of some minerals and vitamins, such as calcium, vitamin D, vitamin B₂ , small fish with bones and non-oily fish, were significantly lower in the low masticatory group than in the normal group. In contrast, the intake of sugar for coffee and tea and that of chicken were significantly higher in the low masticatory group than in the normal group.

CONCLUSION

This study suggested that low masticatory performance can affect nutrient intake, which may cause non-communicable diseases.