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| Food For Thought | |
Here are some ideas to keep the mouth moist. Take frequent sips of water throughout the day. Chew sugarless gum - the chewing may produce more saliva. Suck on sugarless mints or hard sugarless candy. Breathe through your nose, not your mouth, as much as possible. Use a humidifier, particularly at night.
 email or call the office 916-364-5300. Janet Montano, RD Director of Menu Services |
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| Issue: 84 | September 21, 2010 |
Greetings!
Our guest presenter for RDNews this week is Nancy Sherrill, RDH, BS. Nancy is a dental hygienist working on a Master's degree and recently came to HMC to give a presentation on Oral Health and Nutrition For Older Adults.
Oral Health in the Older Adult
The US census estimates that by 2030 the population over the age of 65 will be 75 million. CDC reports that 18% of adults over the age of 65 have untreated tooth decay. Oral health and nutrition is a bidirectional process: poor nutritional status can cause or be caused by poor oral health. Conditions that can alter dietary intake in older adults include periodontal disease, dental decay, xerostomia (dry mouth), candidiasis, dysguesia (distortion of the sense of taste), and ill-fitting dentures.
Periodontal disease is associated with systemic conditions such as diabetes, cardiovascular disease, stroke, osteoporosis, respiratory infection, aspiration pneumonia and Alzheimer's disease. Periodontal disease increases the risk of root caries (decay), tooth mobility, and tooth loss. It decreases masticatory ability, nutrient intake and negatively affects speech. People may commonly avoid meats, bread, vegetables, and crunchy and stringy foods with subsequent decrease in nutritional status which can further exacerbate periodontal disease. Studies have shown that there is a noted connection between tooth loss and avoidance of socialization.
Older adults are at risk for decreased saliva which is necessary for lubrication for speech, eating and swallowing, tooth remineralization, restoring oral pH and providing enzymes with anti-bacterial and anti-fungal properties. Common diseases in older adults such as diabetes, depression and cardiovascular disease require medications that can cause xerostomia. Other medications such as antidepressants, antihistamines, antihypertensive, antiparkinson's, amphetamines, bronchodilators and decongestants can also cause xerostomia. Xerostomia significantly impacts oral health and nutrition, causes difficulty wearing dentures and oral prosthetics, leads to plaque accumulation at the gum line and is associated with systemic diseases and oral infection.
Oral candidiasis is common among older adults and denture wearers. Many adults (up to 64%) don't complain of any symptoms, and may have no clinical signs, but complain of a burning sensation when eating or drinking. Oral candidiasis may also be a symptom of systemic diseases like diabetes. Studies have shown that two risk factors of vitamin C and zinc deficiency may contribute to increased oral candidiasis which is associated with reduced energy intake, malnutrition, and negative effect on overall nutritional status. Older adults are vulnerable to antifungal drug resistant strains of non-albicans Candida. Risk factors for the development of oral candidiasis include xerostomia, denture irritation, chemo and radiation therapy, systemic corticosteroid use, malabsorption and malnutrition.
Dysguesia is a distortion of the sense of taste, is common in denture wearers, and is also associated with certain disorders and not just a part of aging. It affects and alters food choices and increases the risk of dental decay.
Ill-fitting dentures are often painful, causing mouth sores, and leads to problems with chewing and speech and will often alter food choices. Studies have shown that intake of several nutrients including magnesium, folic acid, fluoride, zinc and calcium remain low in people after adjusting to dentures and new denture wearers report 70-85% reduction in chewing efficiency.
Steps for improving oral health in older adults include:
- Regular dental check ups
- Note food avoidances
- Assess plaque level
- Remove dentures
- Evaluate for candidiasis, xerostomia, mouth sores
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RD Tip |
- Check the MDS and nursing admission assessment forms for dental/oral status
- Ask residents about their dental status and ability to taste
- Observe for chewing problems, complaints of dry mouth, burning/pain with eating
- Refer to social services or IDT if you feel a dental consult is warranted
- Let nursing staff know if you feel resident's dental hygiene needs attention
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| Dear Dietitian |
Contact me for more information or resources for Nancy Sherrill's presentation. Check out the article in Nutrition Today, Volume 45, Number 4, July/August, 2010 "It's More Than Just Candy". There is a wealth of good information on the relationship between nutrition and oral health. There are also 2 CEUs available for this article with completion of the post test. Contact the HMC office to get a copy of the article and CEU exam.
Judy Morgan, MBA, RD
HM Composite |
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