Malnutrition & Dentition

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Philip Silver looks at dentition and malnutrition

Although we can produce enough food to feed everyone, over 800 million people around the world still do not have enough to eat. Climate-induced disasters, economic crises and armed conflict continue to cause high hunger rates and food insecurity and over 113 million people experience acute hunger [1] as well as one in three suffering from some form of malnutrition [2].

Living in one of the wealthiest nations in the world, you may be forgiven for thinking that this is not a problem in the UK, but unfortunately it is a real issue. It has been estimated that around three million people in the UK are malnourished and many more are at risk of malnourishment [3].

Defined as a deficiency of nutrients such as energy, protein, vitamins and minerals, malnutrition can cause adverse effects on body composition, function and clinical outcomes [4]. Furthermore, it often goes unrecognised and consequently untreated even though it can have a considerable impact on health and well-being. And sadly, prevalence figures are expected to rise as our population ages [5].

Malnutrition can affect anyone; it is caused by having an inadequate diet or a problem absorbing nutrients from food. It can occur for many reasons, but factors such as living alone, being on a low income, living in poor conditions, being dependant on drugs or alcohol or having a long-term health condition all increase susceptibility.3

Certain diseases and medical conditions can also increase the risk of malnutrition as their effects may suppress the appetite, impair the usual process of eating or digestion, prevent the body from absorbing nutrients from food or increase its demand for energy. Other conditions can restrict normal movement, dexterity or mental capacity, which may compromise a person’s ability to look after themselves properly or communicate their needs adequately. Equally, certain treatments or types of medication can cause side effects that can also contribute to malnutrition [6].

Lack of nutrients can affect the entire body, it can weaken the immune system, reduce the ability to fight infection, impair wound healing and increase vulnerability to illness. It can cause tiredness, lack of energy, low mood and muscle weakness, resulting in reduced physical performance and even inactivity. In children, malnutrition can cause poor growth, development and concentration.

Studies also indicate that undernutrition in infancy can increase the risks of developing chronic diseases such as cardiovascular disease and diabetes in adulthood [7,8]. , Malnutrition is also a widespread problem in adults over the age of 65 [9]. Older adults experience more of the difficulties that compromise the ability to shop, cook and eat a nutritious diet but another of the major factors that links older people with malnutrition is dentition, as pain, loose teeth and denture problems can prevent them from eating well [10]. 

As one would expect, impaired dental status influences food selection and the intake of important nutrients. For example, research suggests that edentulous individuals tend to eat fewer fruits and vegetables and less fibre, calcium, iron, vitamins and polyunsaturated fat, but more cholesterol, saturated fat, and calories [11].

A recent study revealed that having no remaining natural teeth while wearing dentures increases the risk of reduced nutrient intake. However, having natural teeth to support a prosthesis may result in nutrient intakes corresponding to those with only natural teeth and no prosthesis [12].

Nevertheless, poorly fitting dentures can cause discomfort and reduced mastication ability which can lead to changes in the types of foods eaten and consequently, the consumption of nutrients [13].

Additionally, when metals are used to support removable partial dentures (RPDs), patients may experience taste disturbances which can ruin the enjoyment of some foods and potentially suppress the appetite, influence food selection and impact nutritional intake.

Research shows that 1 in 10 people over the age of 65 are malnourished or at risk of malnutrition.9 Public awareness of this often-hidden condition is low and it can occur gradually and easily go unnoticed.

For this reason, all healthcare professionals are encouraged to look out for the signs of malnutrition in order to deliver the level of patient care required to avoid complex health repercussions and any detrimental effects to well-being and quality of life. Dental professionals can support patients by helping them to preserve their natural teeth and, by using advanced technology and materials to enable full dental function to be maintained.

Author:


Philip Silver is the UK Country Manager at Solvay Dental 360™ and a regular contributor to Dental Review. He says: “Fortunately, with the advancements in digital technology and dental materials, clinicians are now able to offer patients accurate and precisely-fitting removable partial dentures (RPDs), which can help to prevent the risks of poor diet and nutritional insufficiencies.

“For example, a high-performance polymer called Ultaire® AKP has been custom-developed by Solvay Dental 360® specifically for the fabrication of RPDs, which is biocompatible and completely metal-free. This material offers superior strength, fit and retention and patients are able to enjoy good function and aesthetics with a lightweight, comfortable feel.”

References:

1] Food Security Information Network (FSIN). 2019 Global Report on Food Crises. http://www.fsinplatform.org/sites/default/files/resources/files/GRFC_2019-Full_Report.pdf

2] World Food Programme. Zero hunger. https://www1.wfp.org/zero-hunger

3] NHS Inform. Malnutrition. https://www.nhsinform.scot/illnesses-and-conditions/nutritional/malnutrition [Accessed 2nd July 2019]

4] National Institute for Health and Clinical Excellence (NICE). Clinical Guideline 32.Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition, February 2006. Click HERE [Accessed 2nd July 2019]

5] Botherton A. et al. on behalf of the BAPEN Quality Group. Malnutrition Matters. Meeting Quality Standards in Nutritional Care. A toolkit for commissioners and providers in England. https://www.bapen.org.uk/pdfs/bapen_pubs/mm-toolkit-exec-summary.pdf [Accessed 2nd July 2019]

6] NHS. Malnutrition. Causes. https://www.nhs.uk/conditions/malnutrition/causes/
[Accessed 2nd July 2019]

7] Barker D.J. et al. Fetal nutrition and cardiovascular disease in adult life. Lancet 1993 Apr 10;341(8850):938-41. https://www.ncbi.nlm.nih.gov/pubmed/8096277 [Accessed 2nd July 2019]

8] Martins V.J.B. et al. Long lasting effects of undernutrition. Int J Environ Res Public Health. 2011 Jun; 8(6): 1817–1846. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3137999/#b100-ijerph-08-01817 [Accessed 2nd July 2019]

9] Age UK. The Malnutrition Task Force. State of the Nation. Older people and nutrition in the UK today. Click HERE 

10] Public Health England. The British Association for the Study of Community Dentistry. What is known about the oral health of older people living in England and Wales. A review of oral health surveys of older people. December 2015. Click HERE  [Accessed 2nd July 2019]

11] Palacios C. et al. Nutrition and oral health: A two-way relationship. In: Handbook of Clinical Nutrition and Aging. Oct 2014 pp 81-98. https://link.springer.com/chapter/10.1007/978-1-4939-1929-1_5 [Accessed 2nd July 2019]

12] Watson S. et al. The impact of dental status on perceived ability to eat certain foods and nutrient intakes in older adults: cross-sectional analysis of the UK National Diet and Nutrition Survey 2008–2014. International Journal of Behavioural Nutrition and Physical Activity. 2019 16:43. https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-019-0803-8 [Accessed 2nd July 2019]

13] Cafaro M. et al. The impact of dentures on the nutritional health of the elderly. The Journal of Aging Research and Clinical Practice. http://www.jarcp.com/872-the-impact-of-dentures-on-the-nutritional-health-of-the-elderly.html [Accessed 2nd July 2019]

Photos by Paulo Silva and Hanna Morris on Unsplash