11 March 2021

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Implant supported prostheses: impact on nutritional status and oral health in edentulous patients

Giulia Palandrani

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The world is ageing rapidly and according to United Nations Population Fund UNFPA, people aged 60 years and more represent 12.3% of the total population, and by 2050, this number will increase to 22%. The process of ageing increases the risk of chronic and oral diseases leading to disabilities and reducing the quality of life. The presence of oral problems can affect nutritional status and many reports suggest that poor oral health status leads to impaired masticatory function which favors improper food selection. 

A minimum of 20 teeth are required to maintain proper chewing function and good nutrition. However, this number is rarely encountered in people aged 60 years and more. The edentulous people usually have lower food intake compared to recommended levels, and studies have highlighted the significant association between poor dentures and weight loss in edentulous patients.

Therapeutic solutions for totally edentulous patients are various and differ from conventional denture to complete overdenture implant and fixed implant-supported prostheses.

The aim of the study was to assess and to compare the nutritional status and the oral health perception before and after insertion of conventional complete denture or implant-supported prostheses among edentulous patients aged 60 years and more. 

Material and methods 

Totally edentulous patients aged 60 years or more were selected from the Department of removable and fixed Prosthodontics at Saint-Joseph University of Beirut. 

The Arabic version of the Mini-Mental State Exam (MMSE) was used for quantitative cognitive functions evaluation, an assessment of cognitive domains including orientation to time and place, simple and complex attention, memory, language skills, and visual construction. MMSE global scores vary from 0 to 30, only patients presenting a score of 24 and more were included in the study. Patients with cognitive disorders were excluded from the study.

Nutritional status was assessed using the Mini-Nutritional Assessment (MNA) Index. A total score of 24.0 or more indicates normal nutritional status, a score of 17.0-23.5 indicates a risk of malnutrition and a score below 17.0 indicates the presence of malnutrition  

OHRQoL was evaluated using the Geriatric Oral Health Assessment Index (GOHAI). Scores of GOHAI vary from 12 to 60 with higher scores indicating better oral health. The Lebanese validated version was used with the following response format on a 5-points Likert scale: always 1; often  2; sometimes 3; rarely 4; never 5. 

The GOHAI and MNA were assessed at t0 (Baseline: at patient presentation), t1 (two to three weeks after treatment), t2 (three months after treatment) and t3 (six months after treatment). 

The number of functional dental units (FU) was examined at the time of patient presentation and after the new treatment. FU was defined as a pair of posterior antagonist teeth that had at least one contact area during chewing. The number of FUs was assessed with a thick articulating paper; the number of mandibular molars and premolars that had at least one mark provided the number of FUs. 

 Results

Fifty-one participants were recruited. Five participants were totally edentates without prostheses and 26 had their removable complete denture for more than 6 years. Eighteen participants presented caries or periodontal disease and required extraction of the remaining teeth. Two participants were not satisfied with their complete denture supported on implants. The majority of participants presented a number of FU less than four (60.8%). The mean age was 69.39 ± 7.164 years (Range: 60-88 years). 

All participants presented eight FU after treatment: 35 participants were treated with upper and lower dentures and 16 participants were treated with implant-supported prostheses.

GOHAI score has increased by 27%, 39% and 45.5% at 3 weeks, 3 and 6 months respectively in participants treated with conventional removable dentures ; however, it increased by 61%, 70.3% and 76% at 3 weeks, 3 and 6 months respectively in participants rehabilitated with implant-supported prostheses No significant difference was found between implant-supported fixed prostheses and implant-supported complete denture at t1, t2 and t3.

Conclusions

Two to 3 weeks after rehabilitation, the oral health perception of participants with Implant-supported prostheses was better compared to participants with conventional dentures. The presence of implants improved retention, support and prostheses stability. It greatly boosted patients' OHRQoL and offered more phonetic and masticatory efficiency and fewer complaints.

Implant-supported prostheses provide a good opportunity to improve nutritional status and oral health and quality- of-life of patients. Patients may resist to the implant treatment due to financial considerations, prolonged treatment times or fear from surgery. Consequently, it is fundamental that dentists explain clearly to their patients the dental intervention procedure and its outcome, and take into consideration their expectations to achieve the desired clinical result. 

Information:   Impact of implant-supported prostheses on nutritional status and oral health perception in edentulous patients.