Nutrition is an important determinant of health particularly in older people a group that are considered to be at risk of malnutrition. Observational studies suggest that macronutrients and micronutrients, and nutritional status might be lower in those with tooth loss, loose dentures or edentulousness. Studies have suggested that nutrient status might be improved following treatment with overdenture treatment compared with conventional dentures
The aim of this review was to investigate whether overdenture treatment provides greater improvement in nutrient intake and markers of nutritional status than treatment with a conventional denture in edentulous patients.
Searches were conducted in the Medline, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) for randomised control trial (RCT), cohort study or case control study. Studies involving prosthetic treatment where the outcomes included change in intakes of macronutrients (ie, proteins, fats and carbohydrates) and/or micronutrients (eg, vitamins and calcium) and/ or indicators for nutritional status were considered.
Two reviewers independently screened the studies, with one reviewer abstracting data for checking by a second reviewer. Two reviewers independently assessed risk of bias using the Cochrane collaboration’s tool. A fixed effects meta-analysis was used to estimate the weighted mean difference (WMD) and 95% CI for change in body mass index (BMI), albumin and serum vitamin B12 between overdenture and conventional denture 6 months after treatment.
- 6 RCTs and 2 prospective cohort studies involving a total of 901 patients were included.
- Outcome measures were considered in 3 groups macro- nutrient intake, micronutrient intake and markers of nutritional status.
- Four studies reported changes in markers of nutritional status and nutrient intake after treatment with a prosthetic, regardless of type.
- 3 RCTs (322 patients) were included in a meta-analysis suggesting no significant difference in change in BMI between an overdenture and conventional denture 6 months after treatment WMD= -0.18 kg/m2 (95%CI; -0.52 to 0.16), and no significant difference in change in albumin or vitamin B12 between the two treatments.
The authors concluded: –
The narrative appraisal and meta-analysis demonstrated that, compared with conventional denture treatment, overdenture treatment did not have a greater effect on changes in BMI, albumin or vitamin B12 6 months after treatment among the older population. Considering cost effectiveness, the utility of overdenture treatment might be limited with regard to nutrition improvement.
This well conducted review has a number of limitations that are clearly identified by the authors, the limited number of small studies available, the relatively short follow up periods of the primary studies and the limited outcome available for nutrient intake or nutritional status in the included studies. It is also interesting to consider this review in relation to the of review of Gaewkhiew et at (Dental Elf – 8th Nov 2017) which looked at whether tooth loss per se had any impact on nutrition and nutritional status. They identified on a weak association although as with this current review the primary studies were only of poor quality.
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 Aug 3;6(8):e011799. doi: 10.1136/bmjopen-2016-011799. PubMed PMID: 27489156;PubMed Central PMCID: PMC4985797.
Dental Elf – 8th Nov 2017
Tooth loss: does it affect dietary intake and nutritional status?