Comparison Of Tooth Replacement Strategies On The Nutritional
Status Of Older Patients: A Randomised Controlled Clinical Trial
Introduction
Diet
plays a key role in disease prevention in older age. Although nutritional
state is influenced by various factors, dental status can have an
important impact. Poor oral health and loss of teeth can have significant
negative effects on dietary intake and nutritional status for older
patients. Increasingly, patients are retaining some natural teeth into old
age (partially dentate). Many receive removable partial dentures to
replace all missing teeth despite their potential to increase the risk of
further dental disease. Alternative, functionally-orientated treatments
exist including the shortened dental arch (SDA). Instead of aiming to
replace all missing teeth, this provides patients with 10 pairs of teeth which
are easy to maintain whilst ensuring acceptable function and aesthetics.
The aim of this study was to compare the impact of two different tooth
replacement strategies on the nutritional status of partially dentate
older patients. The study compared conventional treatment using removable
partial dentures and functionally-orientated treatment based on the SDA.
Method
50
partially dentate patients (mean age 68.8 years) completed a randomised
controlled clinical trial. 26 patients were allocated to conventional
treatment with removable partial dentures and 24 were allocated to
functionally-orientated treatment with adhesive bridgework used to create 10 pairs
of teeth. Nutritional status was assessed at baseline and 1 month after
treatment using a range of haematological markers and the Mini Nutritional
Assessment (MNA).
Results
1
month after treatment intervention, haematological measures did not illustrate
a clear picture of improvement for either group. For the conventional
group average levels of vitamin B12 (p=0.68), albumin (p=0.20) and cholesterol
(p=0.50) all increased. For the functionally-orientated group average
levels of vitamin B12 (p=0.62), albumin (p=0.16) and vitamin D (p=0.37) all
increased. MNA scores improved for both treatment groups post
operatively. For the conventional group mean MNA score increased from 23.3
to 24.4 (p=0.03). For the functionally-orientated group mean MNA score
increased from 23.2 to 24.1 (p=0.03).
Conclusions
Haematological
markers did not demonstrate any statistically significant improvements in
nutritional status for either treatment group. However, MNA scores
improved for both conventional and functionally-orientated groups after
treatment intervention (p=0.03).