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INDIANAPOLIS, US: Although prosthodontic treatment is the primary means of helping either completely or partially edentulous patients, nutritional counselling too might be warranted for patients who have received dentures, according to a recent retrospective longitudinal study by Regenstrief Institute in Indianapolis and the Indiana University School of Dentistry.
The study linked laboratory values of nutritional biomarkers with dental records. The laboratory tests included complete blood count, basic metabolic profile, and lipid and thyroid panel tests. The research team compared the nutritional state of 3,519 study subjects who had received removable partial or complete conventional or implant- or abutment-retained dentures with the nutritional state of 6,962 members of a control group who had not received or required prosthodontic intervention. In addition to age and sex, the authors considered other factors available in the electronic records, including race, treatment history, and insurance status. The study used records spanning from 1 January 2010 to 31 December 2018 of patients who had been treated at Indiana University School of Dentistry clinics, and nutritional markers over the course of two years were compared.
Noticeable findings included significant decreases in serum albumin, creatinine and blood urea nitrogen (BUN) in completely edentulous patients after they had received their dentures and an increased estimated glomerular filtration rate (eGFR) in the same group. Those who had dentures also had decreased serum albumin, protein and serum calcium compared with controls. For partially edentulous patients, there was a decrease in thyroid-stimulating hormone, BUN and total cholesterol. Records for patients who were edentulous in either the maxillary or mandibular arch indicated decreased BUN and eGFR as well.
The authors suggested that lowered levels of serum albumin in denture wearers could have a connection to older patients having problems with chewing and swallowing and in patients who already struggle with chronic inflammation and malnutrition. Generally, serum albumin and prealbumin decrease only in patients who experience severe malnutrition, and the study authors recommended further studies to explore the connection between albumin levels and prosthodontic intervention.
Senior author Dr Thankam Thyvalikakath, a research scientist at Regenstrief Institute and director of the dental informatics core at the Indiana University School of Dentistry, shared her perspective in a press release. She said: “Dentures are a significant change for a person. They do not provide the same chewing efficiency, which may alter eating habits. Dentists need to be aware of this and provide advice or a referral for nutrition counselling. These patients need support during the transition and possible continued monitoring.”
The study authors concluded that serological testing could help with monitoring the health and nutritional state of denture wearers and that patients should be offered nutritional counselling when receiving their prosthodontic treatment.
Although serum albumin, calcium, protein and creatinine decreased in denture wearers, the mean values of haematological markers remained within normal ranges, excluding triglyceride, low-density lipoprotein and total cholesterol. Weight and body mass index were above the normal range. The study authors noted that the latter values indicated overweight patients in both the control and study groups and were consistent with the local population in Indiana.
The risk of undernutrition is not a new consideration, but the use of electronic records enabled a much more feasible approach to evaluating the health and progress of a larger selection of patients.
The study, titled “Nutritional assessment of denture wearers using matched electronic dental-health record data”, was published online in the Journal of Prosthodontics on 23 March 2022, ahead of inclusion in an issue.
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