PROSTHODONTICS - American College of Prosthodontists

The American College of Prosthodontistsprosthodontic estimates suggest a 38% increase in the need for prosthodontic services over thenext two to three decades (Douglass, 1990).According to the World Health Organization, optimal health and optimal oral health is theresult of the preservation or replacement of 20 teeth. States of partial or complete edentulismpatients could render an individual disabled, due to his/her inability to eat and speak effectively,two of the essential tasks of life and related to overall health when considering theconsequences of tooth loss.Having a functional masticatory system is critical for the individual to replace the body’snutrients and maintain optimal diet, nutrition, and overall health. Studies have demonstrated thatedentulous patients have a poorer diet than their dentate counterparts. In this NHANES IIIstudy, 3,794 individuals were studied, of which 36% were completely edentulous. In a follow-upstudy of 6,985 patients, the authors found that patients with less than a full complement of teethhad reduced intake of carrots, salads, and dietary fiber than did fully dentate patients, withreductions in serum levels of beta carotene, folate and vitamin C. In another investigation,denture wearers were found to be at a nutritional disadvantage, and consumed statisticallyfewer carrots and tossed salads than the fully dentate. In addition, these authors demonstratedsignificantly reduced intake of dietary fiber and foods with adequate levels of beta-carotene,folate, and vitamin C when than did dentate patients. Other studies have indicated thatedentulous patients have more difficulty chewing foods, with resultant reduced intakes ofVitamin B 6 and carbohydrates than do dentate patients.Partial edentulism, whether from caries, periodontal or pulpal disease, may alsocontribute to complications in overall patient health. Hung and colleagues (2003) examined therelationship between tooth loss and changes in consumption of various food groups, along withnutrients that are critical to overall health among 31,000 health care professionals. They foundthat subjects who lost five or more teeth had greater reductions in intake of polyunsaturated fatsand vitamin E, smaller reductions in intake of dietary cholesterol and vitamin B12 and smallerincreases in intake of dietary fiber and whole fruits than did those who were completely dentate.Such a diet change may result in a reduced likelihood of meeting the recommended dietaryallowance of important vitamins and nutrients, and thereby adversely impacting bodycomposition and nutritional status, both of which are related to overall systemic health. In adifferent study by the same research group, the authors examined the dental records of 41,407men and 58,974 women who were initially free of any cardiovascular disease. After controllingfor cardiovascular risk factors (smoking, alcohol consumption, age, body mass index, etc), theauthors found that men and women with zero to ten teeth had a statistically significant increasedrisk of coronary heart disease compared to men and women with 25-32 teeth. Interestingly, therelationship between the number of teeth and the incidence of coronary heart disease wassimilar for subjects with and without periodontal disease. The paper concludes by providingsome insight into the possible causes of the inverse relationship between number of teeth andthe risk of coronary heart disease suggesting it may be due to some combination of antecedentperiodontal disease, antecedent endodontic inflammation, dietary changes following tooth loss,and other unknown mechanisms.In a study of nutritional status of patients with and without opposing pairs of posteriorteeth or those wearing dentures, those with fewer than four pairs of opposing posterior teethwere statistically at risk for poor nutrition. A study by Slade (1996) investigated dentate andedentulous patients’ chewing capacity. He found that 58.6% of edentulous patients reporteddifficulty in chewing various food groups, compared to 6.1% of patients with fewer than ninemissing teeth; higher rates of complete edentulism were found in older, female, less-educatedAustralian-born individuals. Finally, a study of body mass index (BMI) in Great Britain suggests astrong correlation with the number of remaining teeth and the maintenance of a normal BMI,defined as