Geroscience: Aging and Oral Health Research.

Research in aging has significantly advanced; scientists are now able to identify interventions that slow the biologic aging processes (i.e., the "hallmarks of aging"), thus delaying the onset and progression of multiple diseases, including oral conditions. Presentations given during the 3-part session "Geroscience: Aging and Oral Health Research," held during the 2023 American Association for Dental, Oral, and Craniofacial Research meeting, are summarized in this publication. Speakers' topics spanned the translational research spectrum. Session 1 provided an overview of the geroscience and health span (disease-free and functional health throughout life) concepts. The common molecular mechanisms between oral cancer and aging were discussed, and research was presented that showed periodontal microflora as a potential factor in Alzheimer's disease progression. Session 2 focused on behavioral and social science aspects of aging and their oral health significance. The keynote provided evidence that loneliness and isolation can have major health effects. These social conditions, along with poor oral health, tooth loss, and cognitive decline, could potentially affect healthy eating ability and systemic health in older adults. Research could help elucidate the directions and pathways connecting these seemingly disparate conditions. Session 3 focused on the delivery of oral care in different settings and the many barriers to access care faced by older adults. Research is needed to identify and implement effective technology and strategies to improve access to dental care, including new delivery and financing mechanisms, workforce models, interprofessional provider education and practice, and use of big data from medical-dental integration of electronic health records. Research to improve the "oral health span," reduce oral health disparities, and increase health equity must be tackled at all levels from biologic pathways to social determinants of health and health policies.

Associations between Dentition Status and Nutritional Status in Community-Dwelling Older Adults.

BACKGROUND/OBJECTIVE: Older adults are at higher risk of malnutrition. The aim of this study was to explore associations between nutritional status and dentition status among older adults seeking care in a dental clinic. METHODS: This was a cross-sectional study of data from older adults (65-89 y) who received care at a northeastern US urban dental school clinic between June 2015 and June 2020 (N = 305). Clinical and demographic data were obtained from the electronic health record; nutritional status was determined using the Self-Mini Nutritional Assessment (Self-MNA), and odontograms and digital radiography were used to determine dental data. Adjusted multivariable models were used to explore associations between variables. RESULTS: The sample was 53.8% female with a median age of 72.0 y. The median Self-MNA score was 13, reflective of normal nutritional status; 29.5% were at risk of or had malnutrition. Median numbers of teeth and posterior and anterior occluding pairs of teeth (POP, AOP) were 18.0, 2.0, and 5.0, respectively. Those with normal nutritional status had significantly more teeth, POPs, and AOPs than those at risk of or with malnutrition (P = 0.015, P = 0.015, and P = 0.039, respectively). Every additional unit increase in the number of natural or restored teeth or POP was associated with significantly lower odds of being at risk of or with malnutrition (3% and 13%, respectively). Having functional dentition was associated with 46% lower odds of being at risk of or with malnutrition. CONCLUSION: This study demonstrated that older adults who had more teeth, better occlusion, and functional dentition were more likely to be of normal nutritional status than those who had less teeth, had poorer occlusion, and lacked functional dentition. Further research with larger, more diverse samples and varied measures of dentition are needed to better understand the associations between nutritional status and dentition status. KNOWLEDGE TRANSFER STATEMENT: The findings from this study suggest that older adults with fewer teeth and therefore less efficient occlusion are at higher risk for malnutrition than those with more teeth and better occlusion. Health care professionals should include screening for dentition and malnutrition as part of their routine practice to identify patients who may have tooth loss and be at risk of malnutrition and refer them accordingly for interventions to optimize oral health and nutritional status.

Tooth Loss and Nutritional Status in Older Adults: A Systematic Review and Meta-analysis.

BACKGROUND/OBJECTIVE: Older adults are at risk for tooth loss and compromised nutritional status. Our objective was to conduct a systematic review and meta-analysis to answer the following question: Among adults aged ≥60 y living in developed countries, what are the associations between tooth loss and nutritional status as assessed by a validated nutrition screening or assessment tool? METHODS: PRISMA guidelines were followed. PubMed, Scopus, CINAHL, Web of Science, and MEDLINE were searched for studies published in English between 2009 and 2019 that met inclusion criteria. Data extracted included study and participant characteristics, dentition, and nutritional status. Risk of bias was assessed with a modified Newcastle-Ottawa Scale. Random effects meta-analysis was used. RESULTS: Of the 588 unduplicated articles identified, 78 were reviewed in full text, and 7 met inclusion criteria. Six studies were combined for a meta-analysis, which revealed that individuals who were completely edentulous or who lacked functional dentition had a 21% increased likelihood of being at risk of malnutrition or being malnourished, as compared with those who were dentulous or had functionally adequate dentition (risk ratio, 1.21; 95% CI, 1.11 to 1.32; I2 = 70%). Whether the article statistically adjusted for medical history explained most of the heterogeneity in the pooled effect. CONCLUSIONS AND IMPLICATIONS: Findings suggest that older adults with tooth loss are at greater risk of malnutrition than those with functionally adequate dentition. Use of validated tools to assess risk of malnutrition in older adults with tooth loss is important to promote early intervention and referral to optimize nutrition and oral health status. Findings were limited by heterogeneity, risk of bias, and overall quality of the studies reviewed. Cohort studies that adjust for known confounders and use consistent approaches to assess tooth loss and nutritional status are needed. KNOWLEDGE TRANSFER STATEMENT: The results of this study suggest that older adults with tooth loss are at greater risk of malnutrition than those with functionally adequate dentition. Screening of this population for malnutrition by health care professionals, including dentists and dietitians, may result in corresponding referrals to optimize nutrition and oral health status. Further research is needed with consistent approaches to assess tooth loss and nutritional status.

The Eating Experience: Adaptive and Maladaptive Strategies of Older Adults with Tooth Loss.

OBJECTIVE: To explore the eating experience and eating-related quality of life (ERQOL) of community-dwelling older adults with tooth loss. METHOD: Nineteen older adults from the clinics of a northeast US dental school who met inclusion criteria (>65 y old, <20 teeth, and no dentures) composed the sample. For this mixed methods study, demographic characteristics, number and location of teeth, Mini Nutritional Assessment-Short Form score, and anthropometrics data were collected; semistructured interviews were conducted to collect in-depth information about the eating experience and ERQOL. Thematic analysis was completed with NVivo 12 software (QSR International). RESULTS: Participants' mean age was 71.3 y (SD = 5.2); 52.6% (n = 10) were women; 63.2% (n = 12) were Black or African American. The mean Mini Nutritional Assessment-Short Form score of 12.1 was reflective of normal nutrition status; 31.6% (n = 6) of patients were at risk for malnutrition or were malnourished. Fifteen percent (n = 3) were fully edentulous; 84.2% (n = 16) had 1 to 19 teeth (mean = 10.8, SD = 6.5). The 2 overarching themes identified were adaptive and maladaptive behavioral responses to tooth loss. Adaptive strategies included modification in food preparation and cooking methods, food texture selection, meal timing, and approaches to chewing. Maladaptive behaviors included food avoidance and limiting eating and smiling in front of others. Psychosocial factors, including finances, limited food choices and ERQOL, whereas the support of family and friends enhanced ERQOL according to participants. CONCLUSION: Older adults with tooth loss exhibit both adaptive and maladaptive behaviors that affect their eating experience, dietary intake, and ERQOL. While many expressed positive adaptive coping strategies, they also described maladaptive behaviors, including avoidance of healthy foods and limiting eating during social interactions, which may affect their nutritional status and overall health and well-being. Further research is needed to explore how duration and severity of tooth loss influence these behaviors and risk of malnutrition. Interprofessional approaches are needed to support positive adaptation and coping with tooth loss. KNOWLEDGE TRANSFER STATEMENT: The results of this study can be used by health professionals treating patients with tooth loss in an effort to improve their eating experience and eating-related quality of life. The findings provide data to support further studies and the need for evidence-based guidelines and educational materials to meet the unique needs of older adults with tooth loss.

Oro-facial pain and nutrition: a forgotten relationship?

Oro-facial pain (OFP) is known to exert profound impacts on quality of life including functionally and psychosocially mediated changes in dietary intake and thereby nutrition. This commentary explores the evidence base available on chronic oro-facial pain, diet and nutrition and discusses current dietary guidance for individuals with chronic OFP; potential impact of chronic OFP on eating and nutritional status; impact of nutritional status on pathophysiology of chronic OFP; and potential role of nutrition in the management of chronic OFP.

Nutrition education in health professions programs: a survey of dental, physician assistant, nurse practitioner, and nurse midwifery programs.

OBJECTIVE: This study determined the perceived needs and curriculum recommendations for nutrition education, and expected competencies in nutrition of graduates, of predoctoral dental, physician assistant, nurse practitioner, and midwifery programs. SUBJECTS: Surveys were mailed to all dental schools (n = 54) and physician assistant (n = 95), nurse practitioner (n = 150), and certified nurse midwifery programs (n = 42) in the United States. Surveys were addressed to the program directors of physician assistant, nurse practitioner, and certified nurse midwifery programs and the associate or assistant dean of academic affairs of dental schools. DESIGN: A 4-page survey was designed and pilot-tested. The survey included questions on respondents perceptions of and recommendations for their programs in nutrition education and expected nutrition competence level of their graduates. A reminder postcard was mailed 2 weeks after the initial mailing to nonrespondents; a second survey was mailed to nonrespondents 1 month after the postcard mailing. STATISTICAL ANALYSES: Data were analyzed using JMP-IN software. Frequencies, and chi 2 analyses, Wilcoxon rank sum test, Pearson chi 2 test. RESULTS: The overall response rate was 80.7% (n = 276). Perceived needs for competence in nutrition varied by respondents. Most of the physician assistant nurse midwifery, and nurse practitioner program directors had similar perceptions of graduates' competence in nutrition. Dental school academic administrators differed significantly from the program directors about the perceived need for knowing how to counsel on a modified diet and how and when to refer to a registered dietitian. Time was the most important factor that would enhance provision of nutrition education in the programs. Computer-based programs were the most frequently requested education tool to enhance nutrition education. APPLICATIONS/CONCLUSIONS: The disciplines agreed that graduates of dental schools and physician assistant, nurse practitioner, and nurse midwifery programs need some level of competence in nutrition relative to their discipline. Registered dietitians involved in health professions education can play an active role in developing practice-based, time-sensitive, and flexible strategies for nutrition education of these health professions groups.

Role of registered dietitians in dysphagia screening.

OBJECTIVE: To examine the ability of registered dietitians to identify patients at risk for dysphagia and make appropriate diet/feeding recommendations in comparison with the speech-language pathologist, and to determine screening criteria for the registered dietitian to use for prediction of dysphagia risk. DESIGN: The dietitian and speech-language pathologist performed dysphagia screening on subjects independently through questioning and/or mealtime observation to identify signs and symptoms of dysphagia. Presence of dysphagia risk and diet/feeding recommendations were determined and results from the dietitian and speech-language pathologist were compared. SUBJECTS/SETTING: Thirty-four patients admitted during a 2-month period to a neuroscience unit at an urban teaching hospital were analyzed prospectively. STATISTICAL ANALYSES PERFORMED: kappa Statistics were used to assess agreement between the dietitian and speech-language pathologist. A kappa level of less than 0.4 indicated weak agreement, 0.4 to 0.7 indicated moderate agreement, and greater than 0.7 indicated strong agreement. Logistic regression methods were used to evaluate screening criteria as potential predictors of dysphagia risk. RESULTS: Moderate agreement (0.61) was found between the dietitian and speech-language pathologist in determination of dysphagia risk. The dietitian predicted the ability of the patient to consume an oral diet with strong agreement with the speech-language pathologist (1.0); various diet consistencies with moderate agreement (0.61); and the need for liquid restrictions with strong agreement (1.0). The most significant screening variables for prediction of dysphagia risk (P < .05) were age (P = .018), history of dysphagia (P = .042), difficulty swallowing solids (P = .0007), observed facial weakness (P < .0001), and a change in voice quality (P = .0007). Self-reported screening variables significantly related to dysphagia risk included drooling of liquids (P = .0009) and solids (P = .0080), facial weakness (P = .0006), change in voice quality (P = .0010), and prolonged eating time (P = .0157). APPLICATIONS/CONCLUSIONS: Dietitians can effectively identify patients with dysphagia. Screening for dysphagia can be implemented as part of standard nutrition assessments and may aid in decreasing dysphagia-related complications.

Personal and professional beliefs and practices regarding herbal medicine among the full time faculty of the newark-based schools of the university of medicine and dentistry of new jersey.

Background: The use of alternative and herbal medicine is increasing among the general population in the United States. The use of herbal medicine by health care professionals has not been documented. Health care professionals tend to base personal and professional practices on scientific research and facts. This population interacts with the public and with health care students. Therefore, personal and professional practices will impact these audiences. Methods: A survey was distributed to all faculty members of the University of Medicine and Dentistry of New Jersey via interoffice mail. A total of 904 surveys were sent. Statistical analyses included descriptive analysis of personal and professional practice regarding herbal medicine and chi(2) analysis of the relationship between personal and professional practices regarding herbal medicine. Significance was set at alpha <.05. Results: The overall response rate was 51%. Approximately one-third (29.6%, n = 134) of the population reported personal use of herbal medicine, 22.1% (n = 42) of the population who provide patient care recommend herbal medicine, 9.4% (n = 36) of those involved in teaching include herbal medicine in coursework, and 1.1% of the population were involved in research on herbs. Respondents who use herbal medicine were more likely to recommend herbs to patients (p <.0001); likewise, users of herbal medicine were more likely to teach students about herbal medicine (p =.001). Conclusions: The results support the hypothesis that personal beliefs and practices do impact professional practices within the clinical and academic settings of the university.

Oral manifestations of nutrient deficiencies.

There is a synergistic relationship between nutrition, oral health, and disease. Nutrient deficiency may result in oral symptomatology. Oral conditions and systemic diseases associated with oral manifestations may lead to nutrient deficiencies as a consequence of compromised mastication and swallowing, pain, or discomfort. Health professionals must recognize the manifestations of these deficiencies, consider their causes and provide early treatment to prevent further compromise in nutrition status and to promote optimal nutrition, oral and overall health.

Nutritional considerations in rheumatoid arthritis.

Rheumatoid arthritis is a chronic, systemic, inflammatory disorder of unknown etiology. The severity of the disease process adversely affects nutritional status. Articular changes, such as small joint deformities and temporomandibular joint syndrome, alter the ability to self-feed. The inflammatory process may increase metabolic rate. Ingestion, digestion, absorption, and excretion may be compromised by secondary manifestations of the disease. Comprehensive nutrition assessment incorporates evaluation of disease and treatment-specific factors, along with the usual assessment parameters. Abnormal values for certain assessment parameters do not necessarily reflect nutritional status. Treatment methods, including medications, may have an impact on nutritional status, assessment tools, and self-feeding. Nutrition management goals focus on identification and implementation of feeding strategies. Evaluation of the ability to feed oneself includes consideration of functional status, secondary manifestations, and medical treatment. Multiple feeding modalities may be required. Oral supplements, tube feedings, and parenteral nutrition may be employed to meet the nutrition needs of the individual with rheumatoid arthritis.