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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 274-280

The effect of complete denture rehabilitation on nutritional status of geriatric patients: A clinical study


1 Department of Prosthetic and Restorative Dentistry, Dar Al Uloom University, Riyadh, Saudi Arabia
2 Department of Prosthodontics, Subharti Dental College, Meerut, Uttar Pradesh, India

Date of Submission05-Jan-2021
Date of Decision15-Jan-2021
Date of Acceptance01-Feb-2021
Date of Web Publication26-Jul-2021

Correspondence Address:
Yash Pal Singh
Department of Prosthetic and Restorative Dentistry, Dar Al Uloom University, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jnsm.jnsm_1_21

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  Abstract 


Background: Nutrition in elderly patients has been the topic of interest in field of geriatrics. Quality of life is directly correlated with nutritional status in geriatric patients. Aim of the Study: This study was undertaken to evaluate the nutritional status when completely edentulous patients were rehabilitated with conventional complete dentures. Materials and Methods: Hundred edentulous patients, in the age group of 45–65 years, were selected, and biochemical blood analysis was done at three different time periods (0, 3, and 6 months after delivery of complete dentures) for levels of calcium, protein, phosphorus, and hemoglobin in blood. The results at three different time periods were then compared to evaluate the change in the values of these nutrients in the body. Results: Loss of teeth was associated with lower than normal values for calcium, protein, phosphorus, and hemoglobin in blood. There was a significant improvement in the blood calcium and protein levels at the end of 3 months, whereas there was no significant improvement in the blood phosphorus and hemoglobin. Conclusion: Complete denture rehabilitation has a definite positive impact on nutritional status of geriatric patients.

Keywords: Geriatrics, nutrients, quality of life


How to cite this article:
Singh YP, Saini M, Rehman SU. The effect of complete denture rehabilitation on nutritional status of geriatric patients: A clinical study. J Nat Sci Med 2021;4:274-80

How to cite this URL:
Singh YP, Saini M, Rehman SU. The effect of complete denture rehabilitation on nutritional status of geriatric patients: A clinical study. J Nat Sci Med [serial online] 2021 [cited 2021 Oct 19];4:274-80. Available from: https://www.jnsmonline.org/text.asp?2021/4/3/274/322315




  Introduction Top


Optimal nutrition in elderly patients has been held responsible as one of the important factors in determining the quality of life.[1],[2],[3] The presence of healthy dentition is required for proper mastication of food and further for digestion and assimilation of essential nutrients.

Individuals with partial or complete absence of teeth are found to have poor masticatory system that causes a deficient metabolic process essential for absorption of nutrients. Furthermore, choice in a variety of foods that can be taken to have balanced diet is also adversely affected which, in turn, affects the nutritional status.[4],[5],[6]

There are only a few studies that associate the presence of teeth in oral cavity and masticatory ability with its effect on nutritional status of elderly patients. A few of the studies were able to correlate healthy dentition with wider choices of nutritious food and better nutritional status of such individuals as compared to edentulous patients.[7],[8],[9],[10],[11]

The role of protein, calcium, and phosphorus along with hemoglobin in blood has been found very crucial for maintaining optimal health. However,their levels in blood start to drop once there is state of edentulism in patients causing limited choices of type of foods and decreased overall intake.[12],[13],[14],[15],[16] Rehabilitation of edentulous patients with conventional complete denture is expected to improve the health status and quality of life of elderly individuals.

This study was conducted to evaluate the change in the nutritional status of completely edentulous patients over a period of 3 and 6 months after acquiring complete dentures through a biochemical blood analysis for serum calcium, protein, phosphorus, and blood hemoglobin levels.


  Materials and Methods Top


One hundred completely edentulous patients in the age group of 45–65 years were selected for the study from the Dental Outpatient Department of Prosthodontics Department of Subharti Dental College, Meerut, India. Individuals who were free from any local, systemic, or debilitating disease and were not under any medication were included in the study. All the individuals were first-time denture wearers, edentulous for at least 1 year, and belonged to the low socioeconomic group.

Written informed consent was obtained from those patients who agreed to participate voluntarily, and the ethical clearance was obtained from Ethical Committee of the University with approval number 958/Ethics/2020 on 15/1/2020. Strobe Guidelines were followed while designing this Observational Study.

One hundred complete dentures were fabricated using conventional procedures.

A biochemical analysis for blood calcium, protein, and phosphorus and hematological investigation for blood hemoglobin levels were carried out at the time of insertion.

The patients were then followed up after 3 months where the same tests were carried out and finally after 6 months where the tests were again carried out. The results were compared for the difference in the levels of blood calcium, phosphorus, protein, and hemoglobin at the time of insertion, after 3 months, and finally, after 6 months in completely edentulous patients.

The VITROS Ca slide method was performed using the VITROS Ca slides and the VITROS Chemistry Products Calibrator Kit 1 on VITROS chemistry systems.

Test type and conditions:



The VITROS TP (total protein) slide method was used that is a multilayered, analytical element coated on a polyester support. The method of analysis is based on the biuret reaction which produces a violet complex when protein reacts with cupric ion in an alkaline medium.

Test type and conditions:



The VITROS PHOS slide was performed that is a multilayered, analytical element coated on a polyester support.

Test type and conditions:



Standard operating procedure was followed for estimation of hemoglobin level in blood.

The data so obtained were analyzed using paired t-test and ANOVA one-way tests.

  • ANOVA: One-way ANOVA is used to find the significant difference among the different time periods (more than 2) at a given level of significance
  • Paired t-test: It is used where the significant difference is observed between any two time periods for the same sample. TheSPSS Statistics for Windows,version 16.0(SPSS Inc.,Chicago,III., USA was used for statistically analyzing the data.



  Results Top


[Table 1] shows the mean and standard deviation of different nutrients at different time periods. The results of [Table 1] reveal that the average of blood calcium, phosphorus, protein, and hemoglobin levels was below the normal range for the participants at the time of insertion. There was a continuous increase in the blood calcium, protein, phosphorus, and hemoglobin levels after 3 months and after 6 months. [Figure 1],[Figure 2],[Figure 3],[Figure 4] display the same observation.
Table 1: Mean and standard deviation of different nutrients at different time periods

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Figure 1: Calcium level at different time intervals

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Figure 2: Phosphorus level at different time intervals

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Figure 3: Protein level at different time intervals

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Figure 4: Hemoglobin at different time intervals

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[Table 2] shows the average difference in mean and standard deviation of different nutrients at successive time points. The results of the table show that there was a continuous increase at successive time periods, i.e., from insertion to 3 months, 3–6 months, and insertion to 6 months for all four nutrients. [Figure 5],[Figure 6],[Figure 7],[Figure 8] depict the same observation.
Table 2: Mean and standard deviation of different nutrients at successive time points

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Figure 5: Calcium levels at successive time periods

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Figure 6: Phosphorus levels at successive time periods

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Figure 7: Hemoglobin levels at successive time periods

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Figure 8: Protein levels at successive time periods

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[Table 3] shows the percentage difference of different nutrients at successive time points. The results show that there was a continuous percentage increase at successive time periods, i.e., from insertion to 3 months, 3–6 months, and insertion to 6 months for all four nutrients.
Table 3: Percentage difference of different nutrients at successive time points

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[Table 4] shows that the application of one-way ANOVA F-test for calcium revealed a significant difference at different successive time points (P = 0.001), which is <0.05 (P < 0.05).
Table 4: One-way ANOVA F-test for significant difference among different time periods (calcium)

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[Table 5] shows that the application of one-way ANOVA F-test for phosphorus revealed no significant difference at different successive time points (P = 0.43), which is greater than 0.05 (P > 0.05).
Table 5: One-way ANOVA F-test for significant difference among different time periods (protein)

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[Table 6] shows that the application of one-way ANOVA F-test for protein revealed a significant difference at different successive time points (P = 0.008), which is greater than 0.05 (P < 0.008).
Table 6: One-way ANOVA F-test for significant difference among different time periods (phosphorus)

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[Table 7] shows the application of one-way ANOVA F-test for hemoglobin revealed no significant difference at different successive time points (P = 0.06), which is greater than 0.05 (P > 0.05).
Table 7: One-way ANOVA F-test for significant difference among different time periods (hemoglobin)

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[Table 8] shows that the application of paired t-test which was used to find the significant difference between baseline to 3 months, 3–6 months, and baseline to 6 months, respectively, in different types of nutrients revealed no significant difference in hemoglobin from baseline to 3 months and in phosphorus from 3 months to 6 months while all the rest nutrients significantly differed statistically between the different time intervals (P < 0.05).
Table 8: Comparison of different parameters at successive time points (paired t-test)

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  Discussion Top


Balanced diet is crucial for maintaining the nutritional status of any individual. Edentulous patients find it difficult to sustain good overall health as they struggle with limited choice of food and compromised masticatory apparatus. Understanding nutritional requirements and their effect on the quality of life in geriatric patients is essential to know for dentists.[17],[18],[19]

Factors such as decreased economic status as a result of retirement, inflation, and increased health costs along with living alone also affect the nutritional status of elderly population.[20]

Elderly individuals who are completely edentulous suffer from varied nutritional deficiencies. Protein and folate deficiency can be suspected in such persons.[17],[18] Calcium phosphorus and protein are all nutrients essential for building up bones and muscles and are markers of malnutrition.[21]

The purpose of the present study was to find out if edentulous patients were at a greater risk of deficiency of essential nutrients that include calcium, phosphorus, protein, and hemoglobin levels and whether the rehabilitation with conventional complete dentures caused an increase in the blood levels of these nutrients at the end of 3 months and 6 months.

[Table 1] represents the mean and standard deviation of different nutrients for 100 patients at baseline, 3 months, and 6 months, respectively.

At insertion, the mean and standard deviation showed a lower than normal blood level for calcium, phosphorus, protein, and hemoglobin. The foods rich in calcium, phosphorus, protein, and hemoglobin are all tough foods which are difficult to chew and are directly related to the masticatory ability. The masticatory ability of completely edentulous patients is impaired which renders them incapable to eat a variety of foods and leading to malnutrition and affects the general health.[19] The table further shows an increase in all four nutrients at the end of 3 months and also at the end of 6 months. This may be directly related to the increased masticatory efficiency and the ability to eat a variety of foods that include all these essential nutrients. [Figure 1],[Figure 2],[Figure 3],[Figure 4] depict the same observation.

Table 2 represents the average difference and standard deviation from insertion to 3 months, 3–6 months, and insertion to 6 months, respectively, in each type of nutrient in patients. The results of the table show that there was a continuous increase at successive time periods for all four nutrients. The results may again be directly related to the increased masticatory efficiency and also to the ability to eat a variety of foods and even tough foods which are rich in calcium, protein, phosphorus, and hemoglobin apart from the soft foods containing carbohydrates which are essentially rich only in glucose. [Figure 5],[Figure 6],[Figure 7],[Figure 8] depict similar observation.

Table 3 shows the average percentage improvement for each type of nutrients at successive time points for patients. There was a continuous percentage increase and improvement in all the nutrients at insertion to 3 months, 3–6 months, and insertion to 6 months.

Tables 4 and 5 display the one-way ANOVA F table. There was significant difference [P<.05] in three time periods [Insertion to 3 months,3-6 months and Insertion to 6 months] for Calcium and Protein level found in ANOVA F Test.

Results of the present study showed a significant increase in the blood calcium (P = 0.001) and protein levels (P = 0.008) at the end of 3 months from insertion and also after 6 months of insertion [Tables 5 and 6] when one-way ANOVA F-test for significant difference among different time periods was applied. The improvement of these two nutrients in blood after acquiring complete dentures can be attributed to the fact that these patients can now eat a variety of foods that include tough foods such as vegetables, meat, and cereals which are rich in both protein and calcium. Furthermore, due to better chewing efficiency food may be pulverized into smaller particles enhancing the absorption.

In [Table 6], the one-way ANOVA F table shows that no significant difference was observed among the three different time periods at 5% level of significance in phosphorus level (P > 0.05).

Phosphorus (P = 0.43) levels were not significant when one-way ANOVA F-test for significant difference among different time periods was applied.

Low serum phosphorus has also been identified as a marker of malnutrition.[22],[23] The results of the present study, however, showed no significant difference in the serum phosphorus when edentulous patients were rehabilitated with conventional complete dentures. The levels of phosphorus were expected to increase significantly after the participants were rehabilitated with complete dentures, but it was not found to be so. Foods essentially rich in phosphorus include dried fruits, meat, liver, nuts, seafood, and cereals. The participants in the present study belonged to low socioeconomic status, and the rich sources of phosphorus are all expensive foods. Thus, a possible reason that there was no significant increase in phosphorus could be the inability of these patients to afford these food items.

In [Table 7], the one-way ANOVA F table shows that no significant difference was observed among the three different time periods at 5% level of significance in hemoglobin level (P > 0.05).

The results of the present study showed no significant improvement in the blood hemoglobin level. A possible reason for this could be the pattern of absorption of iron. The absorption of dietary iron is a variable and dynamic process. The amount of iron absorbed compared to the amount ingested is typically low but may range from 5% to as much as 35% depending on circumstances and type of iron. The efficiency with which iron is absorbed varies depending on the source. In general, the best-absorbed forms of iron come from animal products. Absorption of dietary iron in iron salt form (as in most supplements) varies somewhat according to the body's need for iron and is usually between 10% and 20% of iron intake.[24]

Table 8 shows the comparison of different parameters at successive time points through the paired t-test. The results showed that there was a significant increase in all nutrients at successive time periods except for hemoglobin during the baseline to 3-month period and for phosphorus during 3–6-month period.

Another aspect that could be responsible for this is the psychological component in the elderly which is commonly found in the neglected and poor. Personality factors, especially neuroticism, have a definite relationship with denture satisfaction.[20] This explains one of the reason for not consuming variety of foods or not using complete denture at all by edentulous patient due to Psychological reasons.Due to this,levels of Phosphorus and Hemoglobin did not rise even after complete denture rehabilitation of edentulous patients.

Limitations of the study

The study was conducted on low socioeconomic status patients. This could have a bias for choice of food taken by the patients. Further studies should be done on patients with mixed socioeconomic status (including both high and low socioeconomic statuses).

Future research direction

Further studies can be done on effect of complete denture rehabilitation on status of micronutrients such as Vitamin B complex, zinc, and magnesium.


  Conclusion Top


Within the limitations of this study, the following conclusions were drawn:

  1. The blood calcium, phosphorus, protein, and hemoglobin levels were found to be below the normal range in completely edentulous patients without any prosthetic rehabilitation, suggesting that loss of teeth has a definite impact on the level of these essential nutrients in blood
  2. There was a significant improvement in the blood calcium and protein levels when rehabilitated with conventional complete dentures at the end of 3 months and at the end of 6 months postinsertion, suggesting that rehabilitation with complete dentures may lead to an increased level of blood calcium and protein
  3. There was no significant improvement in the blood phosphorus and hemoglobin levels when rehabilitated with conventional complete dentures at the end of 3 months and at the end of 6 months postinsertion, suggesting that rehabilitation with complete dentures had no effect on the blood phosphorus and hemoglobin levels in completely edentulous patients.


Financial support and sponsorship

This Project is supported by Deanship of Graduate Studies and Scientific Research at Dar Al Uloom University Riyadh. The author extends his appreciation to the Deanship of Post Graduate and Scientific Research at Dar Al Uloom University for funding this work.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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