Tooth Loss May Indicate Malnutrition

Compared to the general population, older adults with only 10 to 19 teeth are more likely to be at risk for impaired oral health and malnutrition, which may adversely affect quality of life. These findings position dental clinics as ideal settings to perform nutritional screenings to help identify patients who may be at risk for malnutrition, according to Rutgers University researchers.

Published in the Journal of Aging Research and Clinical Practice, the study, “Dentition and Malnutrition Risk in Community-dwelling Older Adults,” builds off past research exploring the associations between missing teeth and nutritional status. In phase 1 of the most recent mixed-methods study, researchers analyzed the health records of 107 community-dwelling older adults treated from 2015 to 2016 at the Rutgers School of Dental Medicine clinic in New Jersey. The results showed more than 25% of patients had, or were at risk of, malnutrition—in addition, patients with 10 to 19 teeth were more likely to be at risk for malnutrition compared to those with 20 or more teeth.

Malnourished patients were classified as having higher rates of weight loss. They also ate less, and more frequently reported dementia and/or depression and severe illnesses than those with a normal nutritional status, according to the study. “These findings are a call to action—we need our teeth to consume an adequate diet, and we need an adequate diet to maintain oral and systemic health,” says Rena Zelig, DCN, RDN, CDE, CSG, an assistant professor and director of the Master of Science in Clinical Nutrition Program in the Department of Clinical and Preventive Nutrition Sciences at Rutgers University School of Health Professions.

Patients in the study had an average of 17 teeth, which is below the national average of 19 teeth in individuals age 65 and older in the United States. Given the prevalence of tooth loss, physicians and other health care professionals should consider the detrimental effects tooth loss has on a person’s ability to consume an adequate diet, and make timely referrals to dental providers.

In the dental office, clinicians can do their part to help identify patients who are at risk for, or are experiencing, malnutrition by performing nutritional status screening. A nutritional assessment provides a deeper look into a patient’s food intake, history of weight loss or gain, and medical and medication histories. In turn, this will help dental teams identity patient-centered interventions.

Evaluating medical records and patient interviews provide insight to any factors that might limit older adults access to (or ability to prepare) nutritional meals; these could include finances, cognitive function, mobility, and transportation challenges. Once identified, clinicians can refer patients to primary care physicians, registered dietitians, or community assistance programs, such as Meals on Wheels.

“Given the synergistic relationship between diet, nutrition, and the integrity of the oral cavity in health and disease, these findings have interprofessional implications for dental and dietetic professionals, as well as other health care providers,” says Zelig.

These findings beg more questions and further investigation. The upcoming qualitative phase of the study will focus on adaptive and maladaptive behaviors reported by older adults with impaired dentition (patients with less than 20 teeth, with no denture replacement). The results will be published in 2019.

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