Chapter 9 Consequences of Poor Oral Health

may report better chewing ability without dentures and may be resistant to getting dentures or may use them only for cosmetic appearances, they should be encour- aged to try new dentures or other dental prosthesis such as implants. Most often edentulous individuals require a mechanically altered diet, although in some cases the mandibular bone hardens and some may be able to tol- erate a regular textured diet. When possible, edentulous older adults should be encouraged to use their knife and fork as their teeth to cut up foods into smaller pieces, moisten difficult-to-chew foods with sauces and gravies, prepare chopped salads of raw or cooked veg- etables, and cut up fruits into small pieces. Soft, whole- grain cereals and breads should be encouraged as tolerated (15). For older adults who cannot tolerate foods that have been cut into small pieces, the use of pureed foods is always an option. Mechanically altered diets such as pureed meals enable older adults to meet their nutritional needs.

SUMMARY

It has been said that “there is no shortcut to longevity; it is the work of a lifetime of habits” (author unknown). This statement is quite true regarding oral health and nutrition habits. Functional changes in the oral cavity of older adults are not typically due to a short-term problem or acute episode. They are more likely the result of many years of gradual reduction in functional dentition due to oral and systemic disease. Consequently, eating habits cannot be changed overnight. It is incumbent on the RDN to conduct a nutrition-focused physical exam of the oral cavity and to determine history; a consultation with or a referral to a dental professional can be made to assess the degree of oral function of the older adult and to tailor diet modifications accordingly. Diet modification is, in fact, an iterative process, with needs changing as oral func- tion changes. The guidelines provided for assessment and management should be customized to meet the cli- ent’s individual needs.

REFERENCES 1. Touger-Decker R, Mobley C; Academy of Nutrition and Dietetics. Position of the Academy of Nutrition and Dietetics: oral health and nutrition. J Acad Nutr Diet. 2013;113(5):693-701.

2. US Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000.

3. Petersen PE, Yamamoto T. Improving the oral health of older people: the approach of the WHO global health programme. Community Dent Oral Epidemiol. 2005;33(2):81-100.

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4. Sheiham A, Steele J. Does the condition of the mouth and teeth affect the ability to eat certain foods, nutrient and dietary intake and nutritional status amongst older peo- ple? Public Health Nutr. 2001;4(3):797-803.

5. Mallonee LFH, Boyd LD, Stegeman C; Academy of Nutrition and Dietetics. Practice paper of the Academy of Nutrition and Dietetics: oral health and nutrition. J Acad Nutr Diet. 2014;114(6):958.

6. El-Solh AA. Association between pneumonia and oral care in nursing home residents. Lung. 2011;189(3):173- 180.

7. Pace CC, McCullough GH. The association between oral microorganisms and aspiration pneumonia in the institutionalized elderly: review and recommendations. Dysphagia. 2010;25(4):307-322.

8. The WHO Fact Sheet. April 2012. Oral health. www. who.int/mediacentre/factsheets/fs318/en. Accessed March 23, 2015.

9. Sheiham A, Steele JG, Marcenes W, Tsakos G, Finch S, Walls AWG. Prevalence of impacts of dental and oral disorders and their effects on eating among older peo- ple; a national survey in Great Britain. Community Dent Oral Epidemiol. 2001;29:195-203.

10. Emami E, Freitas de Souza R, Kabawat M, Feine JS. The impact of edentulism on oral and general health. Int J Dent. 2013;2013:7.

11. Centers for Disease Control and Prevention. New series of reports to monitor health of older americans. January 26, 2010. www.cdc.gov/nchs/pressroom/01facts/old- erame.htm#DEATH%20AMONG%20THE%20 ELDERLY. Accessed December 29, 2015.

12. Mojon P, Budtz-Jorgensen E, Rapin CH. Relationship between oral health and nutrition in very old people. Age Ageing. 1999;28(5):463-468. www.ncbi.nlm.nih .gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed &dopt=Citation&list_uids=10529041. Accessed December 29, 2015.

13. Ritchie CS, Joshipura K, Hung HC, Douglass CW. Nutrition as a mediator in the relation between oral and systemic disease: associations between specific meas- ures of adult oral health and nutrition outcomes. Crit Rev Oral Biol Med. 2002;13(3):291-300. http://cro. sagepub.com/content/13/3/291.long. Accessed Decem- ber 29, 2015.

14. Weyant RJ, Newman A, Kritchewvsky SB. Periodontal disease and weight loss in older adults. Am Geriatr Soc. 2004;52:547-553.

15. Gati D, Vieira AR. Elderly at greater risk for root car- ies: a look at the multifactorial risks with emphasis on genetics susceptibility. Int J Dent. 2011;2011:6.

16. Touger-Decker R. Nutrition and oral health in older adults. Top Clin Nutr. 2005;20(3):211-218.

17. Johnson V, Chalmers J. Evidence-Based Practice Guideline: Oral Hygiene Care for Functionally Dependent and Cognitively Impaired Older Adults. Iowa City, IA: University of Iowa College of Nursing, John A. Hartford Foundation Center of Geriatric Nurs- ing Excellence; July 2011:61.