Effects of Dental Implants and Nutrition on Elderly Edentulous Subjects: Protocol for a Factorial Randomized Clinical Trial

Shu-Jiao Qian, Beilei Liu, Junyu Shi, Xiao Zhang, Ke Deng, Jie Shen, Yang Tao, Shichong Qiao, Hong-Chang Lai, Changzheng Yuan, Maurizio S Tonetti, Shu-Jiao Qian, Beilei Liu, Junyu Shi, Xiao Zhang, Ke Deng, Jie Shen, Yang Tao, Shichong Qiao, Hong-Chang Lai, Changzheng Yuan, Maurizio S Tonetti

Abstract

Background: Loss of masticatory function consequent to tooth loss has been associated with changes in food choices and insufficient nutritional intake. To date, interventions based on dental prostheses alone did not significantly improve nutrient intake. Pilot studies have shown positive impacts of interventions combining implant-supported fixed dental prosthesis with brief dietary advice. The relative contribution and the potential synergy of the components of such interventions need to be determined as it has major public health implications for the community-dwelling aging population that continues to disproportionately suffer from tooth loss and its consequences.

Objective: To assess the effect of rehabilitation of masticatory function with fixed implant supported dentures and nutrition education in older subjects with terminal dentition (stage IV periodontitis) or full edentulism.

Methods: A 2 × 2 factorial randomized controlled trial with 16-month follow-up of eligible adults (≥60 years) with loss of masticatory function consequent to full arch edentulism or terminal dentition (n = 120) will be conducted to test whether the rehabilitation of masticatory function with fixed implant supported dentures, nutrition education and/or their combination improves intake of fresh fruits and vegetables for aging subjects. The study has been designed to detect changes in fresh fruits and fresh vegetables intake at 4 months using the 24-h dietary recall method. Changes in protein as percentage of total energy, nutritional biomarkers, plasma metabolomics, oral and gut microbiome, quality of life and masticatory function will also be assessed.

Discussion: We hypothesize that receiving rehabilitation of masticatory function with fixed implant dentures together with nutrition education is the most effective intervention for improving nutrient intake in aging community-dwelling subjects with extensive tooth loss. The results of this study will assist in designing better treatment regimens, guide medical care for individual subjects, and inform public health and policy.

Clinical trials registration: NCT05334407.

Keywords: diet; healthy aging; masticatory function and nutrition; nutrition—clinical; randomized control trial (RCT); tooth loss.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Qian, Liu, Shi, Zhang, Deng, Shen, Tao, Qiao, Lai, Yuan and Tonetti.

Figures

Figure 1
Figure 1
Study flow chart.

References

    1. Tonetti MS, Bottenberg P, Conrads G, Eickholz P, Heasman P, Huysmans MC, et al. . Dental caries and periodontal diseases in the ageing population: call to action to protect and enhance oral health and well-being as an essential component of healthy ageing - consensus report of group 4 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. J Clin Periodontol. (2017) 44(Suppl. 18):S135–44. 10.1111/jcpe.12681
    1. Sheiham A, Steele J. Does the condition of the mouth and teeth affect the ability to eat certain foods, nutrient and dietary intake and nutritional status amongst older people? Public Health Nutr. (2001) 4:797–803. 10.1079/PHN2000116
    1. Sheiham A, Steele JG, Marcenes W, Finch S, Walls AWG. The impact of oral health on stated ability to eat certain foods; Findings from the National Diet and Nutrition Survey of Older People in Great Britain. Gerodontology. (1999) 16:11–20. 10.1111/j.1741-2358.1999.00011.x
    1. Sheiham A, Steele JG, Marcenes W, Lowe C, Finch S, Bates CJ, et al. . The relationship among dental status, nutrient intake, and nutritional status in older people. J Dent Res. (2001) 80:408–13. 10.1177/00220345010800020201
    1. Bori FK, Fukuhara M, Masaki C, Ohta Y, Nakamichi I, Sakata S, et al. . The relationship between masticatory performance and intakes of foods and nutrients in Japanese male workers: a cross-sectional study. J Oral Rehabil. (2020) 47:1142–9. 10.1111/joor.13039
    1. Krall E, Hayes C, Garcia R. How dentition status and masticatory function affect nutrient intake. J Am Dent Assoc. (1998) 129:1261–9. 10.14219/jada.archive.1998.0423
    1. Zelig R, Goldstein S, Touger-Decker R, Firestone E, Parrott JS. Tooth loss and nutritional status in older adults: a systematic review and meta-analysis. JDR Clin Transl Res. (2022) 7:4–15. 10.1177/2380084420981016
    1. Felder S, Lechtenboehmer C, Bally M, Fehr R, Deiss M, Faessler L, et al. . Association of nutritional risk and adverse medical outcomes across different medical inpatient populations. Nutrition. (2015) 31:1385–93. 10.1016/j.nut.2015.06.007
    1. Agarwal E, Ferguson M, Banks M, Batterham M, Bauer J, Capra S, et al. . Malnutrition and poor food intake are associated with prolonged hospital stay, frequent readmissions, and greater in-hospital mortality: results from the Nutrition Care Day Survey 2010. Clin Nutr. (2013) 32:737–45. 10.1016/j.clnu.2012.11.021
    1. Afshin A, Sur PJ, Fay KA, Cornaby L, Ferrara G, Salama JS, et al. . Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. (2019) 393:1958–72. 10.1016/S0140-6736(19)30041-8
    1. Gennai S, Izzetti R, Pioli MC, Music L, Graziani F. Impact of rehabilitation versus edentulism on systemic health and quality of life in patients affected by periodontitis: a systematic review and meta-analysis. J Clin Periodontol. (2021) 2021:1–31. 10.1111/jcpe.13526
    1. Cousson PY, Bessadet M, Nicolas E, Veyrune JL, Lesourd B, Lassauzay C. Nutritional status, dietary intake and oral quality of life in elderly complete denture wearers. Gerodontology. (2012) 29:e685–92. 10.1111/j.1741-2358.2011.00545.x
    1. Sánchez-Ayala A, Lagravère MO, Gonçalves TM, Lucena SC, Barbosa CM. Nutritional effects of implant therapy in edentulous patients–a systematic review. Implant Dent. (2010) 19:196–207. 10.1097/ID.0b013e3181d46903
    1. Bezerra AP, Gama LT, Pereira LJ, van der Bilt A, Peyron MA, Rodrigues Garcia RCM, et al. . Do implant-supported prostheses affect bioavailability of nutrients of complete and partially edentulous patients? A systematic review with meta-analysis. Clin Nutr. (2021) 40:3235–49. 10.1016/j.clnu.2021.02.018
    1. Yamazaki T, Martiniuk AL, Irie K, Sokejima S, Lee CM. Does a mandibular overdenture improve nutrient intake and markers of nutritional status better than conventional complete denture? A systematic review and meta-analysis. BMJ Open. (2016) 6:e011799. 10.1136/bmjopen-2016-011799
    1. Gonçalves TM, Campos CH, Garcia RC. Effects of implant-based prostheses on mastication, nutritional intake, and oral health-related quality of life in partially edentulous patients: a paired clinical trial. Int J Oral Maxillofac Implants. (2015) 30:391–6. 10.11607/jomi.3770
    1. Bradbury J, Jane B, Thomason JM, Jepson NJA, Jepson NJA, Angus W, et al. . Nutrition counseling increases fruit and vegetable intake in the edentulous. J Dent Res. (2006) 85:463–68. 10.1177/154405910608500513
    1. Suzuki H, Kanazawa M, Komagamine Y, Iwaki M, Jo A, Amagai N, et al. . The effect of new complete denture fabrication and simplified dietary advice on nutrient intake and masticatory function of edentulous elderly: a randomized-controlled trial. Clin Nutr. (2018) 37:1441–7. 10.1016/j.clnu.2017.07.022
    1. Ellis JS, Elfeky AF, Moynihan PJ, Seal C, Hyland RM, Thomason M. The impact of dietary advice on edentulous adults' denture satisfaction and oral health-related quality of life 6 months after intervention. Clin Oral Implants Res. (2010) 21:386–91. 10.1111/j.1600-0501.2009.01859.x
    1. McGowan L, McCrum LA, Watson S, Cardwell C, McGuinness B, Rutherford H, et al. . The impact of oral rehabilitation coupled with healthy dietary advice on the nutritional status of adults: a systematic review and meta-analysis. Crit Rev Food Sci Nutr. (2020) 60:2127–47. 10.1080/10408398.2019.1630600
    1. Chan AW, Tetzlaff JM, Gøtzsche PC, Altman DG, Mann H, Berlin JA, et al. . SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. (2013) 346:e7586. 10.1136/bmj.e7586
    1. David Herrera MS, Kebschull M, Jepsen S, Sculean A, Berglundh T, Papapanou PN, et al. . Treatment of stage IV periodontitis –the EFP S3 level clinical practice guideline. J Clin Periodontol. (2022) 49. 10.1111/jcpe.13639
    1. Lu H, Tao D, Lo E, Li R, Wang X, Tai B, et al. . The 4th national oral health survey in the mainland of china: background and methodology. Chin J Dent Res. (2018) 21:161–5. 10.3290/j.cjdr.a41079
    1. Liu HZ, Lyu X, Liu Y, Han Z, Ye J. Validation of the Chinese version of the Short-Form Health Literacy in Dentistry (HeLD) scale. Community Dent Oral Epidemiol. (2021) 49:550–6. 10.1111/cdoe.12675
    1. Aihemaitijiang S, Ye C, Halimulati M, Huang X, Wang R, Zhang Z. Development and validation of nutrition literacy questionnaire for the chinese elderly. Nutrients. (2022) 14:1005. 10.3390/nu14051005
    1. Zhang XX, Shi JY, Gu YX, Lai HC. Long-term outcomes of early loading of straumann implant-supported fixed segmented bridgeworks in edentulous maxillae: a 10-year prospective study. Clin Implant Dent Relat Res. (2016) 18:1227–37. 10.1111/cid.12420
    1. Lai HC, Zhang ZY, Zhuang LF, Wang F, Liu X, Pu YP. Early loading of ITI implants supporting maxillary fixed full-arch prostheses. Clin Oral Implants Res. (2008) 19:1129–34. 10.1111/j.1600-0501.2008.01563.x
    1. Rosenstock IM. Historical origins of the health belief model. Health Educ Monogr. (1974) 2:328–35. 10.1177/109019817400200403
    1. Yang Y, Yang X, Zhai F, Cheng Y. Dietary Guidelines for Chinese (2016). J Acad Nutr Dietetics. (2016) 116:A37. 10.1016/j.jand.2016.06.127
    1. Gao J, Fei J-q, Jiang L-j, Yao W-q, Lin B, Guo H. Assessment of the reproducibility and validity of a simplified food-frequency questionnaire used in dietary patterns studies. Acta Nutrimenta Sin. (2011):26–30. 10.13325/j.cnki.acta.nutr.sin.2011.05.012
    1. Schimmel M, Christou P, Herrmann F, Müller F. A two-colour chewing gum test for masticatory efficiency: development of different assessment methods. J Oral Rehabil. (2007) 34:671–8. 10.1111/j.1365-2842.2007.01773.x
    1. Uy S, Deng K, Fok CTC, Fok MR, Pelekos G, Tonetti MS. Food intake, masticatory function, tooth mobility, loss of posterior support, and diminished quality of life are associated with more advanced periodontitis stage diagnosis. J Clin Periodontol. (2022) 49:240–50. 10.1111/jcpe.13588
    1. Mombelli A, van Oosten MA, Schurch E, Jr, Land NP. The microbiota associated with successful or failing osseointegrated titanium implants. Oral Microbiol Immunol. (1987) 2:145–51. 10.1111/j.1399-302X.1987.tb00298.x
    1. Slade GD. Derivation and validation of a short-form oral health impact profile. Community Dentistry Oral Epidemiol. (1997) 25:284–90. 10.1111/j.1600-0528.1997.tb00941.x
    1. Xin W-n, Ling J-q. Validation of a Chinese version of the oral health impact profile-14. Chin J Stomatol. (2006) 41:4.
    1. Wilson ID, Plumb R, Granger J, Major H, Williams R, Lenz EM. HPLC-MS-based methods for the study of metabonomics. J Chromatogr B. (2005) 817:67–76. 10.1016/j.jchromb.2004.07.045
    1. Smilowitz JT, Zivkovic AM, Wan Y, Watkins SM, Nording ML, Hammock B, et al. . Nutritional lipidomics: molecular metabolism, analytics, and diagnostics. Mol Nutr Food Res. (2013) 57:1319–35. 10.1002/mnfr.201200808
    1. Zaura E, Pappalardo VY, Buijs MJ, Volgenant CMC, Brandt BW. Optimizing the quality of clinical studies on oral microbiome: a practical guide for planning, performing, and reporting. Periodontol 2000. (2021) 85:210–36. 10.1111/prd.12359
    1. Yano Y, Hua X, Wan Y, Suman S, Zhu B, Dagnall CL, et al. . Comparison of oral microbiota collected using multiple methods and recommendations for new epidemiologic studies. mSystems. (2020) 5:e00156-20. 10.1128/mSystems.00156-20
    1. Fu BC, Randolph TW, Lim U, Monroe KR, Cheng I, Wilkens LR, et al. . Characterization of the gut microbiome in epidemiologic studies: the multiethnic cohort experience. Ann Epidemiol. (2016) 26:373–9. 10.1016/j.annepidem.2016.02.009
    1. Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, et al. . Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status. J Nutr Health Aging. (2009) 13:782–8. 10.1007/s12603-009-0214-7
    1. Li H, Jia J, Yang Z. Mini-mental state examination in elderly Chinese: a population-based normative study. J Alzheimers Dis. (2016) 53:487–96. 10.3233/JAD-160119
    1. Kan CN, Zhang L, Cheng C-Y, Wong TY, Venketasubramanian N, Chen CL-H, et al. . The informant AD8 can discriminate patients with dementia from healthy control participants in an asian older cohort. J Am Med Directors Assoc. (2019) 20:775–9. 10.1016/j.jamda.2018.11.023
    1. Radloff LS. The CES-D scale a self-report depression scale for research in the general population. Appl Psychol Measur. (1977) 1:385–401. 10.1177/014662167700100306
    1. Simon L, Giannobile WV. Is it finally time for a medicare dental benefit? N Engl J Med. (2021) 385:e80. 10.1056/NEJMp2115048
    1. Witter DJ, Cramwinckel AB, van Rossum GM, Käyser AF. Shortened dental arches and masticatory ability. J Dent. (1990) 18:185–9. 10.1016/0300-5712(90)90107-P

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren