Edentulism and dietary health – Jonathan Fleet Nobel Biocare

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  Posted by: The Probe      11th October 2018

The relationship between oral health and dietary health is a complicated one. It is well established that carbohydrate intake leads to plaque accumulation, which negatively impacts oral health.[i]But oral health itself has a profound impact on dietary choices, which in turn has ramifications for overall health. This is especially true in edentulous individuals where mastication is impaired or even painful.

Edentulism has been associated with lower intake of fruits, vegetables and fiber, and lower levels of carotene, beta-carotene, vitamins C, E and B6, folate and potassium. Simultaneously, consumption of cholesterol, vitamin B12, as well as saturated, trans and monounsaturated fats seems to be higher than in those not suffering from tooth loss. This is likely a factor in the higher prevalence of obesity in edentulous people, which can increase the risk of cardiovascular diseases and gastrointestinal disorders.[ii][iii][iv]Even when fruits and vegetables are chosen, those suffering from edentulism are likely to overcook them to make them easier to eat. This has the consequence of reducing their nutritional value and fiber content.[v]

Edentulism can affect body mass index (BMI) in different ways, none of them for the better. People with fewer than eleven teeth have been found to be significantly more likely to be underweight than their peers. This suggests that the difficulty they face when eating results in malnutrition. Meanwhile, individuals with less than twenty-one teeth were on average three times as likely to be more obese than their peers with a more complete set of teeth (21-32).[vi]Therefore, the degree to which obesity is a cause or an effect of edentulism, has yet to be fully determined.

Some surveys report that a majority of edentulous persons feel uncomfortable eating in front of others.[vii]While mastication may be technically achievable, this concern may result in avoiding food consumption in front of others, pre-emptive swallowing, or a preference for more easily chewed food.

Dentures can improve the situation, but fixed solutions offer more substantial advantages. Patients generally report greater comfort and confidence eating with fixed implant-retained prosthetics as opposed to conventional dentures.[viii][ix]This is particularly significant in social eating situations, where dentures can cause a variety of problems when eating certain foods. This affects diet, but perhaps more importantly, patients report that it has a significant negative impact on their quality of life.[x]Morais et al.found recipients of full implant overdentures demonstrated nutritional improvements over their conventional denture-wearing counterparts. After six months, the former group had healthier fat distribution and increased levels of serum albumin, which is associated with a reduced incidence of cancer, cardiovascular disease, stroke risk and mortality.[xi]

Edentulism has been associated with a higher risk of chronic inflammatory changes of the gastric mucosa, upper gastrointestinal tract, kidney disease, pancreatic cancer and noninsulin-dependent diabetes mellitus.[xii]

The relationships between these conditions and edentulism are still debated. While dietary differences have been suggested as a possible mechanism, the changes might be better explained by other processes. For example, a change of oral flora resulting in additional carcinogens is a plausible explanation for the increased risk of pancreatic cancer.[xiii]In other instances, edentulism may be a symptom of underlying health problems, rather than a cause. These relationships can be difficult to isolate, especially given that the incidence of edentulism is higher in more disadvantaged socioeconomic groups, a status which itself has a complex relationship with various health risks.[xiv]Further research is required in this area.

Diet has a cumulative impact on a patient’s general health – the more time the patient spends eating poorly the more damage is done. Moreover, habit plays a powerful role in diet; the longer one adopts a particular diet the more difficult it becomes to change it.[xv][xvi]By reducing treatment time, the patient can return to normal oral capability sooner. With poor mastication no longer a factor, this enables the patient to choose healthier options and gives them a better chance to correct their dietary choices.

One solution that should be considered is the Trefoil™ system, which thanks to its affordability can make the benefits of a fixed, full-arch solution more viable for a broader range of patients than ever before. The Trefoil system combines the cost-efficiency of a pre-manufactured solution with a unique fixation mechanism featuring adjustable joints that enable passive fit. Under the right circumstances, this system enables the implantation of definitive teeth on the same day as surgery.

While dental implants can enable the patient to improve their diet, resuming or adopting a healthier diet ultimately depends on the individual. However, where appropriate, some education on what construes a healthy diet and the advantages of adopting one will likely be to the patient’s benefit.

 

For more information, contact Nobel Biocare on 0208 756 3300, or visit www.nobelbiocare.com

 

References
[i]Marsh P.D. Dental plaque as a biofilm and a microbial community – implications for health and disease. BMC Oral Health. 2006; 6(Suppl 1):S14.
Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2147593/Accessed March 22, 2018.
[ii]Emami E., Souza R.F., Kabawat M., Feine J.S. The impact of edentulism on oral and general health. International Journal of Dentistry. 2013; 2013:7. Available at https://www.hindawi.com/journals/ijd/2013/498305/Accessed March 22, 2018.
[iii]Hung H.C., Colditz G., Joshipura K.J. The association between tooth loss and the self-reported intake of selected CVD-related nutrients and foods among US women. Community Dentistry and Oral Epidemiology. 2005; 33(3):167-173. Available at http://www.academia.edu/25976241/The_association_between_tooth_loss_and_the_self-reported_intake_of_selected_CVD-related_nutrients_and_foods_among_US_womenAccessed March 22, 2018.
[iv]Koodaryan R. The relationship between dental status, body mass index and nutrient intake. Advances in Bioscience and Clinical Medicine.2014; 2(2):24-33. Available at http://www.journals.aiac.org.au/index.php/ABCMED/article/view/655Accessed March 22, 2018.
[v]Marcenes W., Steele J.G., Sheiham A., Walls A.W.G. The relationship between dental status, food selection, nutrient intake, nutritional status, and body mass index in older people. Cadernos de Saúde Pública. 2003; 19(3):809-815. Available at http://ref.scielo.org/zzy2gcAccessed March 22, 2018.
[vi]Marcenes W., Steele J.G., Sheiham A., Walls A.W.G. The relationship between dental status, food selection, nutrient intake, nutritional status, and body mass index in older people. Cadernos de Saúde Pública. 2003; 19(3):809-815. Available at http://ref.scielo.org/zzy2gcAccessed March 22, 2018.
[vii]Dable R.A., Nazirkar G.S., Singh S.B., Wasnik P.B. Assessment of oral health related quality of life among completely edentulous patients in Western India by using GOHAI. Journal of Clinical & Diagnostic Research.2013; 7(9): 2063-2067. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809683/Accessed March 22, 2018.
[viii]Hyland R.M., Ellis J.S., Thomason J.M., Elfeky A., Moynihan P.J. A qualitative study on patient perspectives of how conventional and implant-supported dentures affect eating. Journal of Dentistry. 2009; 37(9):718-723. Available at http://eprint.ncl.ac.uk/file_store/production/154492/449E8AE2-C5F5-4384-87B4-EA7973132B60.pdfAccessed March 29, 2018.
[ix]Neto A.F., Pereira B.M.F., Xitara R.L., Germano A.R., Ribeiro J.A.M., Mestriner W., Carreiro A.F.P. The influence of mandibular implant-retained overdentures in masticatory efficiency. Gerodontology. 2011; 29(2): e650-655. Available at https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1741-2358.2011.00539.xAccessed March 29, 2018.
[x]Hyland R.M., Ellis J.S., Thomason J.M., Elfeky A., Moynihan P.J. A qualitative study on patient perspectives of how conventional and implant-supported dentures affect eating. Journal of Dentistry. 2009; 37(9):718-723. Available at http://eprint.ncl.ac.uk/file_store/production/154492/449E8AE2-C5F5-4384-87B4-EA7973132B60.pdfAccessed March 29, 2018.
[xi]Morais J.A., Heydecke G., Pawliuk J., Lund J.P., Feine J.S. The effects of mandibular two-implant overdentures on nutrition in edentulous individuals. Journal of Dental Research. 2003; 82(1):53-58. Available at http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.493.8942&rep=rep1&type=pdfAccessed March 29, 2018.
[xii]Emami E., Souza R.F., Kabawat M., Feine J.S. The impact of edentulism on oral and general health. International Journal of Dentistry. 2013; 2013:7. Available at https://www.hindawi.com/journals/ijd/2013/498305/Accessed March 22, 2018.
[xiii]Abnet C.C., Qiao Y., Dawsey S.M., Dong Z., Taylor P.R., Mark S.D. Tooth loss is associated with increased risk of total death and death from upper gastrointestinal cancer, heart disease, and stroke in a Chinese population-based cohort. International Journal of Epidemiology. 2005; 34(2):467–474. Available at https://academic.oup.com/ije/article/34/2/467/747004Accessed March 29, 2018.
[xiv]Ritchie C.S., Joshipura K., Hung H., Douglass C.W. Nutrition as a mediator in the relation between oral and systemic disease: associations between specific measures of adult oral health and nutrition outcomes. Critical Reviews in Oral Biology & Medicine. 2002; 13(3):291-300. Available at http://journals.sagepub.com/doi/full/10.1177/154411130201300306Accessed March 22, 2018.
[xv]Jager, W. Breaking bad habits: a dynamical perspective on habit formation and change. In Hendrickx L., Jager W., and Steg L. (eds.) Understanding and Assisting Human Decision-Making, Liber Amircorum for Charles Vlek. University of Groningen. 2003. Available at https://www.researchgate.net/publication/251477649_Breaking_%27bad_habits%27_a_dynamical_perspective_on_habit_formation_and_changeAccessed March 22, 2018.
[xvi]Van’t Riet J., Sijtsema S.J., Dagevos H., De Bruijn G.J., The importance of habits in eating behaviour. An overview and recommendations for future research. Appetite. 2011; 57(3):585-596. Available at https://www.researchgate.net/publication/51546787_The_importance_of_habits_in_eating_behaviour_An_overview_and_recommendations_for_future_researchAccessed March 22, 2018.


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