ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title A New Prosthesis Alone May Not Improve a Patient's Nutritional Status
Clinical Question Does an adult edentulous patient’s nutritional status change upon receiving a new prosthesis, when compared to no prosthesis?
Clinical Bottom Line It is unclear if an adult edentulous patient’s nutritional status will improve with prosthesis. Several studies indicate that edentulous patients have decreased nutritional intake and quality, while others indicate that there is no change.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 12090466Ritchie/2002Adult patients who received prosthesis.Meta-Analysis
Key resultsAccording to Ritchie, the studies “provide unclear results- dentures appear to improve dietary quality somewhat but do not really compensate for loss of teeth.” 12 cross sectional studies and 1 randomized trial (N = 10,354) were evaluated for evidence related to “prostheses and their impact on dietary intake.” The different studies were split in that some offered evidence that there was dietary intake improvement with prosthesis and some said there was no change from the treatment.
#2) 18568230Muller/2008Adult patients who were edentulous > 10 yrs and wore conventional dentures regularly.Randomized Controlled Trial
Key resultsAccording to Muller, “no significant differences were observed in the nutritional status between patients who had been rehabilitated with either conventional dentures or implant supported overdentures 1 year previously.” N = 53, no significance in dietary intake (p>0.05). The conventional dentures when compared with implant supported overdentures showed that mean calories (p =0.34), protein (p=0.67), and vitamin A (p=0.37) were not significantly different amongst treatment groups.
#3) 21951464Awad/2012Adult patients who were >65 yo, edentulous 5+ yrs.Randomized Controlled Trial
Key resultsAccording to Awad, “although patients who received implant overdentures had significant improvement in ability to chew and food habits, clinically important differences in blood nutrients and health parameters were not observed.” Serum folate, B12, B6, and albumin levels changes not clinically significant (p < 0.0035).
Evidence Search ("prostheses and implants"[MeSH Terms] OR ("prostheses"[All Fields] AND "implants"[All Fields]) OR "prostheses and implants"[All Fields] OR ("prosthetic"[All Fields] AND "devices"[All Fields]) OR "prosthetic devices"[All Fields]) AND ("diet"[MeSH Terms] OR "diet"[All Fields] OR "dietary"[All Fields]) AND intake[All Fields]
Comments on
The Evidence
Validity: The meta analysis (Ritchie) evaluated 12 cross sectional studies and 1 randomized trial selected using an “oral-nutrition pathway relationship” including search items such as dietary and nutrient intake, body weight, body mass index, and blood nutrient levels. These were MeSH searched In a MEDLINE database. A sample size >30 was specified, and English only articles were chosen. Review articles were excluded from their search. The RCT (Muller) took edentulous patients between 35-65yo who had been edentulous for 10+ yrs. Patients were selected randomly after being interviewed by phone. The RCT (Awad) took patients >65yo who had been edentulous >5yrs and had adequate bone for implant supported prosthesis. Patients with contraindications to implants were excluded from the study. No conflicts of interest, funded by Canadian Institutes of Health Research and Straumman Canada Ltd. Perspective: Prosthesis alone may not adequately improve the dietary intake of a patient. Other methods such as nutritional counseling may increase the chances of improving the dietary intake of these patients.
Applicability A patient's nutritional status will not likely improve by fabrication of a new prosthesis alone. Nutritional counseling and adequate follow up may be other services that a healthcare provider may utilize to improve the patient's overall well being.
Specialty/Discipline (General Dentistry) (Prosthodontics)
Keywords Edentulous, complete denture, denture, implants, nutrition, diet, nutritional status
ID# 2671
Date of submission: 03/27/2014spacer
E-mail majdalani@livemail.uthscsa.edu
Author Charles Majdalani
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Georgiana S. Gross, MPH
Faculty mentor/Co-author e-mail GROSSG@uthscsa.edu
Basic Science Rationale
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