Assessment of Nutritional and Psychosocial Status of Elderly Patients Wearing Removable Dental Prosthetics.

Introduction: Tooth loss is an age-related problem. As age advances, people's ability to maintain their teeth is affected due to their reduced physical capacity and income. After fitting dentures, resuming a healthy diet can help alleviate a variety of discomforts, both psychological and physiological. The present study was conducted to evaluate the nutritional and psychological status of elderly patients with removable dentures. Materials and
Methods: A longitudinal study was conducted among 502 elderly participants to assess their nutritional status and psychological impact on elderly people who recently underwent denture placement. The data regarding nutritional status and its psychological impact due to tooth loss were collected from participants, and after 3 months of adaptability, postdenture data were collected. The survey was conducted in five parts, including initial demographic analysis, nutritional status, and psychological impact before and after denture wearing.
Results: > Most participants noticed a substantial increase in food consumption after wearing dentures to 59.76%. About 39.64% of the participants were reported to be skipping their meals regularly before wearing the denture. There was a significant increase in participants' ability to eat hard food, which accounts to be by 66.53%. There was an improvement in confidence in their smile by 32.87% of the participants after wearing dentures compared with their previous state. Only 34.66% of participants were worried about wearing dentures in public.
Conclusion: Removable dentures in senior persons had a substantial impact on nutritional balance. The study also claims that wearing a complete denture improves edentulous people's psychological well-being and quality of life. Copyright:

INTRODUCTION

The greatest wealth is health, as it defines the quality of life.[1] Diet and nutrition should be considered an integral part of the oral health assessment and management of the elderly.[2] A large segment of the elderly more than one-third of those over 65 years are edentulous.[3] Tooth loss is an age-related problem and as age advances, people's ability to maintain their teeth is affected due to their reduced physical capacity and income.[4] In a review article published in 2002, Emami et al. stated good evidence that edentulism is linked to poor food and nutrition.[5] According to Albert Yurkstas, certain meals in the diet must be chewed before they may be comfortably consumed.[6] Frequently, elderly individuals with extensive tooth loss preferentially consume soft, easier-to-chew foods, which have a low-nutrient density.[7] A previous study has reported that people with self-perceived good-fitting dentures had diets that were not different from participants with 18 or more teeth, indicating that successful dental treatment may improve dietary selection.[8] In patients with complete tooth loss, prosthetic therapy not only restores the teeth but also installs confidence in them.[9] After fitting dentures, resuming a healthy diet can help alleviate various discomforts, both psychological and physiological.[10] Hence, the present study was conducted to evaluate the nutritional and psychological status of elderly patients with removable dentures.

MATERIALS AND METHODS

A longitudinal study was conducted to assess the nutritional status and its psychological impact on elderly people that underwent denture placement recently. Among a convenient sample of 625 chosen individuals, a total of 123 participants, later on, opted out. As a result, the unresponsiveness rate is 19.68%. Hence, a convenient final sample of 502 individuals (290 males and 212 females) underwent the study. Informed consent was obtained from all the patients. The study included only first-time denture wearers in the age group of 45–70 years with no gender discrimination. Those suffering from systemic diseases and those who did not give consent were excluded. In addition, sociodemographic data (age, gender, economic status, and occupation) was noted. The questionnaire was distributed among 38 dental clinics across Saudi Arabia.

The data regarding nutritional status and its psychological impact due to tooth loss was collected from participants when they visited the dental clinics for the denture. Moreover, after 3 months of adaptability, postdenture data were collected via telephonic interviews. The survey was conducted infive parts, including initial demographic analysis, nutritional status, and psychological impact before and after denture wearing. The study was conducted between July 2020 and July 2021. The respondents were given complete discretion to decline the study if not interested. The responders' identities were kept anonymous.

Evaluation of nutritional status

In the form of yes or no questions, participants were assessed on nutritional status before and after wearing dentures. Questions were based on their frequency of meals, ability to eat hard foods, meat, any diseases regarding reduced food consumption, and their satisfaction with their nutritional status.

Evaluation of psychological status

This was also conducted in the form of yes or no questions. Participants were assessed on psychological status before and after wearing dentures. Questions were based on their confidence with a smile, their satisfaction while in public.

Statistical analysis

The information was coded, entered, and analyzed utilizing SPSS 23.0 version (IBM Corp., Armonk, NY, USA). An independent biostatistician analyzed the data. Descriptive statistics in terms of frequencies and percentages were used, to sum up, the demographic variables (age, gender, marital status, occupation, economic status, and apatite).

RESULTS

Among 502 patients enrolled in this study, 57.7% were male, and 42.2% were female. The majority of the patients are between 60 and 70 years and are married, unemployed, and from a middle-class background with a good appetite.

Nutritional status

There are many viewpoints on the impact of dentures on eating habits. Most of the participants noticed a substantial increase in food consumption after wearing dentures to 59.76%. About 39.64% of the participants were reported to be skipping their meals regularly before wearing the denture. There was a significant increase in participants' ability to eat hard food, which accounts to be by 66.53%. There was also a noticeable improvement inability to eat meat by 16.41%. About 75.8% of the participants were unaware if they had any diseases with regard to reduced food consumption. Only 11.3% of the participants were satisfied with their weight and nutrition before wearing the dentures. Only 30.27% of participants further reported having a gagging reflex even after an adaptability period of 3 months. Furthermore, the nutritional satisfaction of the patients went from 11.3% to 51.79% after wearing the dentures [Tables 1 and 2].

Table 1

Nutritional status before using dentures

Items	Yes, n (%)	No, n (%)	Don’t know, n (%)
1. Skipping meals regularly	199 (39.64)	285 (56.77)	18 (3.5)
2. Ability to eat hard food	59 (11.75)	439 (87.4)	4 (0.7)
3. Ability to eat meat	247 (54.5)	226 (45.01)	2 (0.3)
4. Diseases as a result of reduced food consumption	47 (9.3)	74 (14.7)	381 (75.8)
5. Satisfaction with weight and nutrition	57 (11.3)	147 (29.2)	298 (59.3)

Table 2

Nutritional status after wearing dentures

Items	Yes, n (%)	No, n (%)	Don’t know, n (%)
1. Increase in food consumption	300 (59.76)	174 (34.66)	28 (5.57)
2. Ability to eat hard food	393 (78.28)	109 (21.71)	0
3. Ability to eat meat	356 (70.91)	146 (29.08)	0
4. Feeling of a gagging reflex	152 (30.27)	338 (67.33)	12 (2.39)
5. Improvement in nutrition	260 (51.79)	155 (30.87)	87 (17.33)

Psychological status

About 72.70% of the participants reported having improved their self-confidence after wearing dentures. There was an improvement in confidence in their smile by 32.87% of the participants after wearing dentures compared with their previous state. Only 34.66% of participants were worried about wearing dentures in public. About 50.59% of the participants later preferred implant-supported dentures over removable dentures. Almost 71.9% of the participants were unaware of denture cleansers and their usage. About 91.83% of the participants were unable to follow-up with their dentists during the current pandemic [Tables 3 and 4].

Table 3

Psychological effect before using dentures

Items	Yes, n (%)	No, n (%)	Don’t know, n (%)
1. Confidence with smile	244 (48.6)	250 (49.8)	8 (1.5)
2. Nervousness while speaking in public	99 (19.72)	386 (76.89)	17 (3.38)
3. Worriedness about other people judging regarding tooth loss in public	323 (64.34)	179 (35.65)	0
4. Difficulties in pronunciation certain syllables	435 (86.65)	67 (13.34)	0
5. Consideration of the usage of dentures in future	402 (80.07)	88 (17.5)	12 (2.39)

Table 4

Psychological status after wearing dentures

Items	Yes, n (%)	No, n (%)	Don’t know, n (%)
1. Improvement in self confidence	365 (72.70)	130 (25.89)	7 (1.39)
2. Comfortness while eating in public	289 (57.56)	213 (42.43)	0
3. Worriedness about other people’s judgement regarding denture in public	174 (34.66)	268 (53.38)	60 (11.95)
4. Satisfaction with smile	409 (81.47)	25 (4.98)	68 (13.54)
5. Preferring implant supported denture over removable denture	254 (50.59)	210 (41.83)	38 (7.56)
6. Ability to consult dentist during COVID-19 pandemic	461 (91.83)	41 (8.1)	0
7. Awareness on denture cleansers	141 (28.08)	361 (71.9)	0

DISCUSSION

The loss of teeth is one of the most common disabilities among the elderly, impacting their mastication, causing psychological problems, and dietary intake and nutritional balance.[1112] According to a study by Ahmed there is a decrease in food intake by elderly edentulous people due to poor chewing ability.[13] This is in accordance with our study that showed 39.64% of the participants were skipping their meals regularly. In a study conducted by Singh et al., more than 50% of the denture wearers were able to eat hard foods, which is similar to our study findings of 66.53%.[14]

According to a study conducted by UK National Diet and Nutrition Survey 2008–2014, 4.3% of denture wearers only suffered from some difficulties to eating meat which is lesser in comparison with our study that shows only 29.08%, later on, suffered difficulty to eating meat after wearing the denture.[15] Even after a 3-month adaptability period, 30.27% of our study participants reported having a gagging reflex. Studies show that this could be due to denture-related mucosal irritation in the mouth during chewing, which could cause the dentures to lose their adaptability and stability, resulting in gagging.[16] According to the findings of our study, the majority of participants' self-confidence and functional status improved as a result of wearing complete dentures because tooth loss had a bigger impact on self-esteem and social life, as well as a greater apprehension about disclosing tooth loss and a higher risk of depression.[17] Similarly, research demonstrates that edentulous patients desire aesthetically pleasing dentures and a smile that are as close to their dentate state as possible.[18] This fact can be appreciated in our study that shows 32.87% of improvement in smile satisfaction after wearing dentures. Based on our study, 71.9% of the participants were unaware of denture cleansers and their usage, which is in support with the study that shows that Participants' intended degree of usage of denture cleaners was low overall, and especially among those with low levels of education, which is to be expected. It has also been discovered that the majority of denture wearers do not give their dentures the attention they deserve when it comes to sanitation and hygiene.[19] Studies show that patients have limited their visits to the dentist to only extreme emergency procedures due to their fear of COVID-19 spreading.[20] Our study shows that 91.83% of the participants were unable to keep a follow-up with their dentists during the current pandemic foods that require chewing ability are often under-consumed by older adults. Those with dentures or fewer functional teeth may also be more likely to avoid foods like meat that require a lot of chewing.[21] People malnourished have fewer protein levels in their bodies, and body cell mass is also often less. When the proteolytic mechanisms are activated, protein synthesis slows down. A decrease in the activities of mitochondrial complexes also leads to less muscle activity and impaired free energy change.[22] Perceived oral health-related quality of life (OHRQoL) impairment is thought to be an additional indicator of a higher risk of malnutrition.

CONCLUSION

A doctor's greatest reward is a patient who smiles. According to the current study, the use of removable dentures in senior persons has a substantial impact on nutritional balance, and there is an urgent need to focus on obtaining acceptable dietary goals. The study also claims that wearing a complete denture improves edentulous people's psychological well-being and quality of life.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.