Ernährung und orale Gesundheit im Alter

Zusammenfassung

Die Wechselwirkung zwischen Mundgesundheit und allgemeinem Gesundheitszustand zeigt sich im Alter besonders deutlich. Ein schlechter Zahnstatus reduziert die Kaufähigkeit und hat Auswirkungen auf die Ernährung. Zahlreiche Studien konnten einen Zusammenhang zwischen reduziertem Zahnstatus und verminderter Ernährungsqualität speziell in Bezug auf Gemüse und Früchte zeigen. Unklar bleibt aber, ob es sich um einen kausalen Zusammenhang handelt. Ebenso konnten die meisten Studien nicht zeigen, dass sich die Essgewohnheiten oder der Ernährungszustand durch prothetische Maßnahmen alleine verbessern lassen. Die tägliche Nahrungsaufnahme ist stärker geprägt von Gewohnheiten als der Kaufähigkeit. Durch Kombination von Ernährungsberatung mit zahnmedizinischer Rehabilitation könnte die Ernährungsqualität optimiert werden.

Geriatrische Patienten leiden oft unter Mundtrockenheit und sind zahnmedizinisch unterversorgt. Sie haben ein Risiko für Malnutrition und es besteht ein unabhängiger Zusammenhang zwischen Mundgesundheit und Malnutrition. Da Malnutrition ein komplexes und multifaktoriell bedingtes Problem ist, lässt es sich nicht einseitig durch zahnmedizinische oder ernährungstherapeutische Interventionen angehen.

Mundgesundheit wurde oft isoliert vom ganzen Körper oder der allgemeinen Gesundheit betrachtet. Senioren und Gesundheitsfachpersonen müssen sensibilisiert werden bezüglich der Wechselwirkung und die präventiven Maßnahmen kennen. Bei geriatrischen Patienten müssen Probleme früh erkannt werden und für eine angemessene Therapie braucht es eine ganzheitliche Betrachtung und multiprofessionelle Zusammenarbeit.

Abstract

The interrelationship between oral health and general health is particularly pronounced among the elderly. Poor dentition compromises chewing ability and affects nutritional intake. Research has shown that edentulousness is associated with a low dietary quality, especially low fruit and vegetable intake. However, whether this is a direct causal effect remains unclear. Furthermore, the majority of studies did not find that prosthetic interventions alone improve diet quality or nutritional status. The diet is stronger influenced by habits than chewing abilities. The combination of nutrition counseling with dental rehabilitation might improve the quality of the diet.

Geriatric patients often suffer from dry mouth and are dentally underserved. They are vulnerable for malnutrition and there is an independent association between oral health status and malnutrition. However, as malnutrition is a complex and multi-factorial problem, there is no isolated solution by dental medicine or nutrition therapy alone.

Oral health has often been seen in isolation from the rest of the body or from general health. Health professionals and the elderly need to be sensibilized for the interrelationship between oral health and be aware of the preventive actions. In geriatric patients the problem should be identified early, and an integrated approach and interprofessional collaboration is required for adequate therapy.

Schlüsselwörter

Mundgesundheit - Mundtrockenheit - Zahnstatus - Malnutrition - Ernährungsqualität

Keywords

oral health - xerostomia - dental status - malnutrition - diet quality

• Literatur

• 1 Weber T. Memorix Zahnmedizin. Stuttgart: Thieme; 2010
• 2 Buchalla W. Zusammensetzung und Funktion eines oft unterschätzten Helfers. Zm online 2013; 8
• 3 Villa A, Connell CL, Abati S. Diagnosis and management of xerostomia and hyposalivation. Ther Clin Risk Manag 2015; 11: 45-51
• 4 Osailan S, Pramanik R, Shirodaria S et al. Investigating the relationship between hyposalivation and mucosal wetness. Oral Dis 2011; 17: 109-114
• 5 Fischer D, Ship JA. Effect of age on variability of parotid salivary gland flow rates over time. Age Ageing 1999; 28: 557-561
• 6 Thomson W, Van Der Putten G, De Baat C et al. Shortening the xerostomia inventory. Oral Surg Oral Med Oral Path Oral Rad Endodont 2011; 112: 322-327
• 7 Thomson W, Williams S. Further testing of the xerostomia inventory. Oral Surg Oral Med Oral Path Oral Rad Endodont 2000; 89: 46-50
• 8 Selwitz R, Ismail A, Pitts N. Dental caries. Lancet 2007; 369: 51-59
• 9 Muller F, Nitschke I. Mundgesundheit, Zahnstatus und Ernährung im Alter. Z Gerontol Geriatr 2005; 38: 334-341
• 10 Naka O, Anastassiadou V, Pissiotis A. Association between functional tooth units and chewing ability in older adults: a systematic review. Gerodontology 2014; 31: 166-177
• 11 Gotfredsen K, Walls AW. What dentition assures oral function?. Clin Oral Implants Res 2007; 18 (Suppl. 03) 34-45
• 12 Zitzmann NU, Staehelin K, Walls AW et al. Changes in oral health over a 10-yr period in Switzerland. Eur J Oral Sci 2008; 116: 52-59
• 13 Eurobarometer. Oral health. Special Eurobarometer 330/Wave 72.3. TNS Opinion & Social; 2009
• 14 Weitkamp JFJ. Vierte Deutsche Mundgesundheitsstudie (DMS IV) Kurzfassung. 2006
• 15 Katsoulis J, Huber S, Mericske-Stern R. Gerodontologischer konsiliardienst bei stationären Geriatriepatienten: Allgemeinmedizinischer Zustand (I). Schweiz Monatsschr Zahnmed 2009; 119: 12-18
• 16 Katsoulis J, Huber S, Zumsteg P et al. Gerodontologischer Konsiliardienst bei stationären Geriatriepatienten: zahnmedizinischer Befund und zahnärztliche Massnahmen (II). Schweiz Monatsschr Zahnmed 2009; 119: 688-694
• 17 Takata Y, Ansai T, Awano S et al. Relationship of physical fitness to chewing in an 80-year-old population. Oral Dis 2004; 10: 44-49
• 18 Okada K, Enoki H, Izawa S et al. Association between masticatory performance and anthropometric measurements and nutritional status in the elderly. Geriatr Gerontol Int 2010; 10: 56-63
• 19 Norman K. Messung der Muskelkraft als ernährungsmedizinische Zielgrösse. Aktuel Ernahrungsmed 2009; 34: 263-268
• 20 Abizanda P, Navarro JL, Garcia-Tomas MI et al. Validity and usefulness of hand-held dynamometry for measuring muscle strength in community-dwelling older persons. Arch Gerontol Geriatr 2012; 54: 21-27
• 21 Brand C, Bridenbaugh SA, Perkovac M et al. The effect of tooth loss on gait stability of community-dwelling older adults. Gerodontology 2014; 32: 296-301
• 22 Listl S. Oral health conditions and cognitive functioning in middle and later adulthood. BMC Oral Health 2014; 14: 70
• 23 Papas AS, Joshi A, Palmer CA et al. Relationship of diet to root caries. Am J Clin Nutr 1995; 61: 423S-429S
• 24 Touger-Decker R, van Loveren C. Sugars and dental caries. Am J Clin Nutr 2003; 78: 881S-892S
• 25 Ship JA, Fischer DJ. The relationship between dehydration and parotid salivary gland function in young and older healthy adults. J Gerontol A Biol Sci Med Sci 1997; 52: M310-319
• 26 Gazzani G, Daglia M, Papetti A. Food components with anticaries activity. Curr Opin Biotechnol 2012; 23: 153-159
• 27 Kashket S, DePaola DP. Cheese consumption and the development and progression of dental caries. Nutr Rev 2002; 60: 97-103
• 28 Hannig C, Sorg J, Spitzmuller B et al. Polyphenolic beverages reduce initial bacterial adherence to enamel in situ. J Dent 2009; 37: 560-566
• 29 Iwasaki M, Manz MC, Taylor GW et al. Relations of serum ascorbic acid and alpha-tocopherol to periodontal disease. J Dent Res 2012; 91: 167-172
• 30 Staudte HSB. Oraler Diskomfort von Parodontispatienten bei der Nahrungsaufnahme. ZWR 2010; 119: 1-2
• 31 Hirschmann JV, Raugi GJ. Adult scurvy. J Am Acad Dermatol 1999; 41: 895-910
• 32 Doll S, Ricou B. Severe vitamin C deficiency in a critically ill adult: a case report. Eur J Clin Nutr 2013; 67: 881-882
• 33 Andres E, Vidal-Alaball J, Federici L et al. Clinical aspects of cobalamin deficiency in elderly patients. Epidemiology, causes, clinical manifestations, and treatment with special focus on oral cobalamin therapy. Eur J Intern Med 2007; 18: 456-462
• 34 Belbraouet S, Biaudet H, Tebi A et al. Serum zinc and copper status in hospitalized vs. healthy elderly subjects. J Am Coll Nutr 2007; 26: 650-654
• 35 Aliani M, Udenigwe CC, Girgih AT et al. Zinc deficiency and taste perception in the elderly. Crit Rev Food Sci Nutr 2013; 53: 245-250
• 36 Moynihan P, Cappelli D, Mobley C. Oral consequences of compromised nutritional well-being. In: Tougher-Decker R, Mobley C, Epstein J, eds Nutritional and Oral Medicine. New York: Springer; 2014: 111-127
• 37 Krall Kaye E. Osteoporosis. In: Touger-Decker R, Mobley C, Epstein J, eds. Nutrition and Oral Medicine. New York: Springer; 2014: 299-312
• 38 Zhan Y, Samietz S, Holtfreter B et al. Prospective study of serum 25-hydroxy vitamin D and tooth loss. J Dent Res 2014; 93: 639-644
• 39 Ostberg A-L, Bengtsson C, Lissner L et al. Oral health and obesity indicators. BMC Oral Health 2012; 12: 50
• 40 Asai K, Yamori M, Yamazaki T et al. Tooth loss and atherosclerosis: the Nagahama study. J Dent Res 2015; 94: 52S-58S
• 41 Rosenquist K, Wennerberg J, Schildt E-B et al. Oral status, oral infections and some lifestyle factors as risk factors for oral and oropharyngeal squamous cell carcinoma. A population-based case-control study in southern Sweden. Acta Otolaryngol 2005; 125: 1327-1336
• 42 Daly RM, Elsner RJ, Allen PF et al. Associations between self-reported dental status and diet. J Oral Rehabil 2003; 30: 964-970
• 43 Quandt SA, Chen H, Bell RA et al. Food avoidance and food modification practices of older rural adults: association with oral health status and implications for service provision. Gerontologist 2010; 50: 100-111
• 44 Sahyoun NR, Lin CL, Krall E. Nutritional status of the older adult is associated with dentition status. J Am Diet Assoc 2003; 103: 61-66
• 45 Savoca MR, Arcury TA, Leng X et al. Severe tooth loss in older adults as a key indicator of compromised dietary quality. Public Health Nutr 2010; 13: 466-474
• 46 Brennan DS, Singh KA, Liu P et al. Fruit and vegetable consumption among older adults by tooth loss and socio-economic status. Aust Dent J 2010; 55: 143-149
• 47 Tsakos G, Herrick K, Sheiham A et al. Edentulism and fruit and vegetable intake in low-income adults. J Dent Res 2010; 89: 462-467
• 48 Ervin RB, Dye BA. Number of natural and prosthetic teeth impact nutrient intakes of older adults in the United States. Gerodontology 2012; 29: e693-702
• 49 Nowjack-Raymer RE, Sheiham A. Numbers of natural teeth, diet, and nutritional status in US adults. J Dent Res 2007; 86: 1171-1175
• 50 Sheiham A, Steele JG, Marcenes W et al. The relationship among dental status, nutrient intake, and nutritional status in older people. J Dent Res 2001; 80: 408-413
• 51 Savoca M, Arcury T, Leng X et al. Food avoidance and food modification practices due to oral health problems linked to the dietary quality of older adults. J Am Geriatr Soc 2010; 58: 1225-1232
• 52 Loef M, Walach H. The combined effects of healthy lifestyle behaviors on all cause mortality: a systematic review and meta-analysis. Prev Med 2012; 55: 163-170
• 53 Zhu Y, Hollis JH. Tooth loss and its association with dietary intake and diet quality in American adults. J Dent 2014; 42: 1428-1435
• 54 Sahyoun NR, Krall E. Low dietary quality among older adults with self-perceived ill-fitting dentures. J Am Diet Assoc 2003; 103: 1494-1499
• 55 Bradbury J, Thomason JM, Jepson NJ et al. Perceived chewing ability and intake of fruit and vegetables. J Dent Res 2008; 87: 720-725
• 56 Shinkai RS, Hatch JP, Rugh JD et al. Dietary intake in edentulous subjects with good and poor quality complete dentures. J Prosthet Dent 2002; 87: 490-498
• 57 Millwood J, Heath MR. Food choice by older people: the use of semi-structured interviews with open and closed questions. Gerodontology 2000; 17: 25-32
• 58 Hamdan NM, Gray-Donald K, Awad MA et al. Do implant overdentures improve dietary intake? A randomized clinical trial. J Dent Res 2013; 92: 146S-153S
• 59 Moynihan PJ, Butler TJ, Thomason JM et al. Nutrient intake in partially dentate patients: the effect of prosthetic rehabilitation. J Dent 2000; 28: 557-563
• 60 Wostmann B, Michel K, Brinkert B et al. Influence of denture improvement on the nutritional status and quality of life of geriatric patients. J Dent 2008; 36: 816-821
• 61 Morais JA, Heydecke G, Pawliuk J et al. The effects of mandibular two-implant overdentures on nutrition in elderly edentulous individuals. J Dent Res 2003; 82: 53-58
• 62 McKenna G, Allen PF, Flynn A et al. Impact of tooth replacement strategies on the nutritional status of partially-dentate elders. Gerodontology 2012; 29: e883-890
• 63 Allen PF. Association between diet, social resources and oral health related quality of life in edentulous patients. J Oral Rehabil 2005; 32: 623-628
• 64 Tada A, Miura H. Systematic review of the association of mastication with food and nutrient intake in the independent elderly. Arch Gerontol Geriatr 2014; 59: 497-505
• 65 Savoca MR, Arcury TA, Leng X et al. Impact of denture usage patterns on dietary quality and food avoidance among older adults. J Nutr Gerontol Geriatr 2011; 30: 86-102
• 66 Thomason JM, Heydecke G, Feine JS et al. How do patients perceive the benefit of reconstructive dentistry with regard to oral health-related quality of life and patient satisfaction? A systematic review. Clin Oral Implants Res 2007; 18 (Suppl. 03) 168-188
• 67 Bradbury J, Thomason JM, Jepson NJ et al. Nutrition counseling increases fruit and vegetable intake in the edentulous. J Dent Res 2006; 85: 463-468
• 68 Volkert D, Bauer JM, Frühwald T et al. Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Zusammenarbeit mit der GESKES, der AKE und der DGG. Klinische Ernährung in der Geriatrie. Aktuel Ernahrungsmed 2013; 38: e1-48
• 69 Van Lancker A, Verhaeghe S, Van Hecke A et al. The association between malnutrition and oral health status in elderly in long-term care facilities: a systematic review. Int J Nurs Stud 2012; 49: 1568-1581
• 70 Dion N, Cotart JL, Rabilloud M. Correction of nutrition test errors for more accurate quantification of the link between dental health and malnutrition. Nutrition 2007; 23: 301-307
• 71 Saarela RK, Lindroos E, Soini H et al. Dentition, nutritional status and adequacy of dietary intake among older residents in assisted living facilities. Gerodontology 2014; DOI: 10.1111/ger.12144.
• 72 Lamy M, Mojon P, Kalykakis G et al. Oral status and nutrition in the institutionalized elderly. J Dent 1999; 27: 443-448
• 73 Enwonwu CO. Interface of malnutrition and periodontal diseases. Am J Clin Nutr 1995; 61: 430S-436S
• 74 Tosello A, Foti B, Sedarat C et al. Oral functional characteristics and gastrointestinal pathology: an epidemiological approach. J Oral Rehabil 2001; 28: 668-672
• 75 Poisson P, Laffond T, Campos S et al. Relationships between oral health, dysphagia and undernutrition in hospitalised elderly patients. Gerodontology 2014; DOI: 10.1111/ger.12123.
• 76 Pace C, McCullough G. The Association Between Oral Microorgansims and Aspiration Pneumonia in the Institutionalized Elderly: Review and Recommendations. Dysphagia 2010; 25: 307-322
• 77 Coleman P. Resistive behaviors of elderly nursing home residents during oral care. Geriatric Nursing 2005; 26: 349-350
• 78 Catteau C, Piaton S, Nicolas E et al. Assessment of the oral health knowledge of healthcare providers in geriatric nursing homes: additional training needs required. Gerodontology 2013; DOI: 10.1111/ger.12094.
• 79 Wright L, Cotter D, Hickson M et al. Comparison of energy and protein intakes of older people consuming a texture modified diet with a normal hospital diet. J Hum Nutr Diet 2005; 18: 213-219
• 80 Urushiyama T, Akutsu S, Miyazaki J et al. Change from a hard to soft diet alters the expression of insulin-like growth factors, their receptors, and binding proteins in association with atrophy in adult mouse masseter muscle. Cell Tissue Res 2004; 315: 97-105
• 81 Volkert D, Sieber C. Malnutrition in geriatrics. Aktuelle Ernahrungsmedizin 2011; 36: 175-190
• 82 Dwyer J. Screening older Americans’ nutritional heath. Current practices and future possibilities. Washington, DC: 1991
• 83 Beck AM, Damkjaer K, Beyer N. Multifaceted nutritional intervention among nursing-home residents has a positive influence on nutrition and function. Nutrition 2008; 24: 1073-1080
• 84 Quandt S, Savoca M, Leng X et al. Dry mouth and dietary quality in older adults in North Carolina. J Am Geriatr Soc 2011; 59: 439-445
• 85 Liu B, Dion MR, Jurasic MM et al. Xerostomia and salivary hypofunction in vulnerable elders: prevalence and etiology. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114: 52-60
• 86 Nayak LWA, Fedele S, Martin-Granizo R et al. The burden of xerostomia in independent community-dwelling older adults: Results from the Saliwell project. Oral Biosci Med 2004; 1: 283-289
• 87 Syrjala AM, Pussinen PI, Komulainen K et al. Salivary flow rate and risk of malnutrition – a study among dentate, community-dwelling older people. Gerodontology 2013; 30: 270-275
• 88 Dormenval V, Budtz-Jorgensen E, Mojon P et al. Associations between malnutrition, poor general health and oral dryness in hospitalized elderly patients. Age Ageing 1998; 27: 123-128
• 89 Van Eijk JVCJ, Beijnen JH, Tulner LR. Prevalence of xerostomia and its relationship with underlying disease, medication and nutrition: A descriptive observational study. J Am Ger Soc 2013; 61: 1836-1937
• 90 Bischoff S. Flüssigkeitsversorgung von Senioren – Eine kritische Bestandsaufnahme aktuellen Wissens und etablierter Empfehlungen (Teil 1). Aktuel Ernahrungsmed 2012; 37: 81-90
• 91 Baumgartner W, Schimmel M, Müller F. Zur Mundgesundheit und zahnärztlichen Betreuung pflegebedürftiger Betagter. Swiss Dent J 2015; 125: 459-496
• 92 Moynihan P, Thomason M, Walls A et al. Researching the impact of oral health on diet and nutritional status: Methodological issues. J Dent 2009; 37: 237-249