CHAPTER 11 | Etiology of Poor Oral Health 165 Dentures, implants, and bridges serve to replace
missing teeth. However, their functional ability varies based on many factors, including type, location, fit, age, and device condition and frequency of wear. Dentures and bridges may be fixed or removable and may replace all (complete dentures) or some (partial dentures) of the teeth in one or both dental arches. After an adult tooth is lost, the bone in the jaw may be reabsorbed. How well a denture fits is related to how much bone remains.18
Older adults with removable
dentures have approximately 20% of the chewing ability of their counterparts with natural dentition,19 and they have a greater risk of malnutrition than those with natural teeth or fixed dentures.20
dentition.42 Replacement of missing teeth with partial
dentures has been shown to be protective against malnutrition risk,43-47
the same functional ability as natural teeth.47,48
but they do not always provide It may
be difficult for older adults to adjust to new dentures and change their eating behaviors and experiences.25 Although tooth loss remains the most prevalent challenge in oral health as it relates to nutritional status, more older adults are retaining an increased number of natural teeth throughout their life span, owing to improvements in oral care and access to oral health professionals.4
However, with increased Individ-
uals who wear fixed or implant-supported dentures have improved masticatory ability, better diet quality and quantity, and improved eating-related quality of life compared with those who wear conventional removable dentures.20-25
In addition, having ill-fitting
dentures or removing dentures for eating is associated with poorer diet quality and food avoidance.15,26-28 Chewing difficulty can lead to a decline in over-
all quality and quantity of oral intake or replace- ment of difficult-to-chew foods (eg, meats and raw fruits and vegetables) with softer foods and more carbohydrate-rich foods.29
Such foods may be more
calorically dense or nutrient poor, which could lead to changes in body weight and overall nutritional status.17,30,31
Research has demonstrated that individ-
uals with tooth loss and poor masticatory ability are notably more likely to experience unplanned weight loss,32
underweight,30,31,33-37 or overweight or obesity17,30,33,34,38-40
unplanned weight gain,29 compared with
those with more teeth and better occlusion, placing them at higher risk of malnutrition. In a systematic review of the associations between tooth loss and malnutrition risk, researchers found that older adults who were at risk of malnutrition or malnourished had substantially fewer teeth, fewer pairs of teeth, and fewer functional teeth units compared with individuals with normal nutritional status.41
When assessing associations between tooth
replacement and malnutrition risk, another systematic review showed that individuals with complete den- tures were less likely to be at risk of malnutrition vs those who were completely edentulous, but they had a higher risk of malnutrition than those with natural
Oral Health Challenges Beyond Tooth Loss
Oral health challenges extend beyond tooth loss and are affected by other systemic physiological condi- tions, cognitive and functional decline, sensory and neurological changes, and other social disparities and barriers to oral care access.2,9,10,52
Insurance cover-
age and dental care access are substantial barriers to routine oral health care for older adults, given that Medicare does not include dental coverage. These challenges can affect a person’s ability to prepare and consume foods and fluids, thus affecting their overall nutritional status and increasing malnutrition risk. Optimal oral health depends primarily on good
oral hygiene. Oral hygiene requires both functional and cognitive components that can decline with age, increasing susceptibility to oral diseases, including oral infections, soft tissue disorders, and periodontal disease, and tooth loss.53 With the increasing incidence of malnutrition and
chronic disease in older adults, oral manifestations of select nutrient deficiencies and chronic diseases, such as diabetes or osteoporosis, may affect oral health and oral mucosa integrity.54
Furthermore, xerostomia, a
common side effect of hundreds of medications, may occur secondary to the type and number of medica- tions used by older adults. Xerostomia may also occur
tooth retention comes an increased risk of caries, periodontal disease, and tooth loss.49-51
Good oral
care and improved oral health, combined with education and interventions to improve nutritional status, are warranted for older adults with and at risk of tooth loss.2,51
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