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Part II Nutrition Assessment, Consequences, and Implications DIET MANAGEMENT GUIDELINES

FOR COMPROMISED ORAL HEALTH Abnormal findings of the nutrition-focused oral screen should be referred to the individual’s dentist for evalu- ation. Consultation with dental professionals in inter- preting oral-nutrition assessment findings and planning in the long-term care setting is also necessary in order to provide for comprehensive care. Table 9.1 (see page 138) provides the RDN with management techniques to consider based on the oral physical exam findings.

Strategies for Managing Xerostomia Eating strategies for older adults with xerostomia include using moist, temperate foods and limiting salty or dry foods, such as chips, pretzels, salted nuts and crackers, as they increase dryness in the oral cavity. Frozen grapes and other fruits with high water content are good snacks because they moisten the oral cavity as they melt. Regular dental checkups should be encouraged because individuals with xerostomia are at increased risk of dental caries. Individuals with xero- stomia should be cautioned to avoid sucking on sugared hard candies or lozenges or chewing sugared gum because these foods add to their already increased risk of tooth decay. Juices, sodas, and other sugared beverages should be limited to mealtimes only. A water bottle should be the constant companion for an individ- ual with dry mouth. Sugar-free lozenges, mints, and gum, particularly those sweetened with xylitol, are an excellent alternative. As a five- carbon sugar that is not hydrolyzed by salivary amylase, xylitol does not con- tribute to tooth decay, and, unlike some of the other sugar alcohols, it may even have some anticariogenic benefits. In instances of xerostomia, when the individu- al’s ability to consume a typical diet is altered, the RDN should consult with the dental professional regarding salivary stimulants (47).

Eating with Dentures

Denture placement does not ensure adequacy of intake. Diet issues to consider in older adults with dentures include biting and chewing ability, which may affect food group choices. Guidelines for eating with dentures are listed in Box 9.5. It is important to note that these guidelines should be interpreted for individuals depend- ing on (1) their systemic health; (2) the functional ability of their oral cavity and surrounding tissues, muscles, and nerves; and (3) whether they are receiving a mandibular (lower) or a maxillary (upper) denture, or both.

Simply stating “resume normal diet” does not work in this instance because individuals may have not consumed a “normal” diet for many months or years,

BOX 9.5 Guidelines for Eating with Partial or Full Dentures

General tips: ●

● ● Cut food into smaller pieces.

Bite at the corners of the mouth, not using only the front teeth.

Distribute the food evenly on both sides in order to keep pressure on the dentures equal

● Chew slowly and thoroughly.

During the first week after denture insertion: ●

Start slowly; progress gradually. ●

Eating with denture(s) may be uncomfortable, but continue to practice eating with them in your mouth.

●

Begin with a liquid to pureed diet (eg, soups, cereals, yogurts, eggs, applesauce/canned or mashed fruits, and mashed cooked vegetables).

●

Advance to pastas, mashed potatoes, legumes, cut and moistened meats/poultry/fish, or stewed or slow-cooked meats.

● ●

Slice/cut fruits and vegetables into very thin slices.

Exercise caution with hot liquids and foods (temperatures will be difficult to judge, as dentures insulate).

●

After the initial week(s), progress to whole foods, fresh fruits, and vegetables, rice, and seeds.

Tips to keep your mouth clean and healthy with your partial denture(s): ●

Rinse the mouth frequently to help remove food particles.

● Brush teeth after each meal.

depending on the duration and extent of their edentu- lism. Older adults should be encouraged to try biting at the corners of their mouth with a full denture because it may reduce the potential of breaking the “seal” between the denture and the gingiva (gum). Nuts, rice, and seeds, as well as other foods that may initially dis- integrate into small pieces in the mouth, should be avoided at first because these may be hard to maneuver with the new dentures. White bread and other soft, chewy breads and rolls may also be difficult to chew and swallow initially. The consumption of raw fruits and vegetables can be compromised as well.

Strategies for Eating with Edentulism Edentulism may alter the individual’s ability to eat. Although some older adults with complete edentulism