Effect of dietary counselling with prosthetic restoration on fruit and vegetable intake in partially dentate patients: A prospective study

Effect of dentures and dietary advice on protein intake in older Thai adults with missing posterior occluding teeth

OBJECTIVE

To compare the effectiveness of dentures with dietary advice and dentures alone on protein intake in older Thai adults.

BACKGROUND

Dentures combined with nutritional advice may improve protein intake in older adults with posterior tooth loss. However, evidence is limited, especially in developing countries.

METHODS

A randomised-control trial including 69 older adults with less than four pairs of posterior occluding teeth was conducted for 3 months. The experimental group received dentures and dietary advice based on the Health Belief Model (HBM); the control group received dentures alone. Three-day dietary records were collected and protein intake was assessed using INMUCAL-NUTRIENTS V.4.0 software at baseline, 1 month, and 3 months after the intervention. Data were analysed using a t-test, Mann-Whitney U test, chi-square test, and repeated-measure ANOVA.

RESULTS

Both groups reported significantly increased protein intake (control group = 0.4, 0.5, 0.6 g kg BW-1  d-1 , intervention = 0.4, 0.6, 0.7 g kg BW-1  d-1 , at baseline, 1 month and 3 months, respectively). However, participants in the experimental group had significantly higher total protein (36.3 vs. 39.8 g/d, P = .032) and animal protein intake (18.9 vs. 23.2 g/day, P = .020) than those in the control group at 3 months after the intervention; plant protein intake was similar (10.9 vs. 11.5 g/day, P = .923). In addition, the HBM scores of the experimental group were higher than those of the control group after the intervention (P < .001).

CONCLUSION

Dentures combined with dietary advice significantly increased the total and animal protein intake of older people with posterior tooth loss more than dentures alone. To maintain optimal protein intake, dental practitioners should incorporate dietary advice when providing dental prostheses to older adults with posterior tooth loss.

Development of patient-centric eating advice for complete denture wearers

BACKGROUND

Edentulous people eat less healthily, and wearing dentures impairs eating function and enjoyment.

OBJECTIVE

To apply a sequential approach to integrate scientific evidence, and patient and professional experience to co-develop intervention to support better eating with dentures.

METHODS

Focus groups, two with purposive samples of patients and two with dental professionals, explored experiences and opinions about advice on eating with complete dentures. Findings were distilled with evidence from the literature to underpinned concepts for eating interventions. User engagement informed prioritisation of ideas and led to the development of a leaflet on eating with dentures.

RESULTS

Patients receive no advice on what they can realistically expect when eating with dentures, and professionals lacked confidence to provide eating advice. Patients did not think dentists a credible provider of eating advice, feeling peer support more appropriate and offering numerous strategies for eating with dentures. Concepts for eating intervention included a patient leaflet, Web-based eating interventions, patient support blogs, waiting room videos and improved nutrition training for dental professionals. User feedback informed prioritisation of ideas, leading to the development of a leaflet on eating with dentures. Justified by the data, the leaflet focused on patient-generated tips for overcoming the functional limitations of eating with dentures, and unobtrusive healthier eating advice. Face validity with users confirmed acceptability.

CONCLUSION

A systematic and rigorous integration of scientific evidence, expert experience and patient input has developed a patient-centric, evidence-based approach to a patent leaflet on eating with dentures that, based on initial face validity, is likely to be well received.

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.

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.

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.

Responsiveness of methods to evaluate objective masticatory function in removable partial denture treatments

PURPOSE

The aim of this study was to examine the responsiveness of chewing tests after removable partial denture (RPD) treatment in this prospective cohort study.

METHODS

Pre- and post-RPD treatment, objective masticatory function was evaluated in 248 patients via chewing tests involving peanuts, a gummy jelly, and a color-changeable gum. A statistical comparison was performed between the pre- and post-treatment scores, and the standardized response mean (SRM) was determined as the treatment effect size (ES).

RESULTS

After RPD treatment, the median particle size in the sieving method using peanuts significantly decreased, and the glucose concentration in the gummy jelly method significantly increased (P < 0.001). The ESs of the sieving and gummy jelly methods were larger (|SRM| = 0.3-0.4) than that of the gum method (|SRM| = 0.1). In the subgroup analysis, the sieving and gummy jelly methods resulted in a broader effective range (|SRM| ≥ 0.3) than the gum method. In patients without pre-treatment dentures, the ES was medium in the sieving method (|SRM| = 0.6) and weak in the gummy jelly and gum methods (|SRM| = 0.3-0.4). The pre-treatment level of masticatory function was significantly correlated with ES (ρ = 0.93, P < 0.001).

CONCLUSIONS

These results suggest that the sieving and gummy jelly methods are more responsive than the gum method for RPD treatment and that the pre-treatment scores affect the responsiveness.

Responsiveness of methods to evaluate chewing ability after removable partial denture treatments

BACKGROUND

The ability of an instrument to detect a clinically important change in patient-reported outcomes following prosthetic treatment is critical for its use in clinical practice and research settings.

OBJECTIVES

This study aimed to examine the responsiveness of instruments in evaluating patient perception of chewing ability after removable partial denture (RPD) treatment in a prospective cohort.

METHODS

A single 100-mm visual analogue scale (VAS), 20-item food intake questionnaire (FIQ) and 6-point chewing difficulty scale (CDS) were administered to 248 partially edentulous patients to evaluate chewing ability pre- and post-RPD treatment. We conducted a statistical comparison between the pre- and post-treatment scores and determined the effect size (r) of RPD treatment for the instruments.

RESULTS

A significant improvement in chewing ability after RPD treatment was identified by VAS and CDS (P < .05), but not by FIQ (P = .16), which identified an improvement after controlling for sex, age, the number of missing teeth and presence/absence of existing removable dentures. The effect size was medium for VAS (r = .54), weak for CDS (r = .14-.17) and absent for FIQ (r = -.09). The increase in r was significantly associated with impaired chewing ability before treatment (ρ = -0.87, P < .001).

CONCLUSIONS

These results suggest that the 100-mm VAS, followed by CDS, is the most responsive instrument to detect an improvement in chewing ability after RPD treatment. Pre-treatment impairment of chewing ability was associated with better responsiveness of the instruments.