DIET AND NUTRITION IN COMPLETELY EDENTULOUS PATIENTS.pptx

Definitions
Nutritional objectives
Factors that affect nutritional status
Classification of nutrients
Calcium and bone health
Food groups
Balanced diet and food guide pyramid
Calorific value of common Indian foods
Nutritional guidelines for prosthodontic patient
Nutrition and geriatrics
Dietary management when teeth are extracted
Diet recommended for new denture wearers
Nutrition for maxillofacial prosthetic patients

1. Diet And Nutrition Factors For Completely Edentulous Patients PRESENTED BY: Dr. Ch.Praveena (BDS), PG student, Department of Prosthodontics and Crown & Bridge Including Implantology , Sibar Institute of Dental Sciences, Guntur

2. PREVIOUSLY ASKED QUESTIONS Nutritional factors in completely edentulous patient. -NTRUHS, 2004 & 2011 (7 Marks). Role of nutrition in management of elderly patients. -NTRUHS , 2000 & 2008 (10 Marks). Discuss ‘Nutrition’ for elderly patients who need prosthodontic services. -NTRUHS ,1999 (25 Marks) 2003 (10 Marks). 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 3

3. CONTENTS Introduction Definitions Nutritional objectives Factors that affect nutritional status Classification of nutrients Calcium and bone health Food groups Balanced diet and food guide pyramid 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 4

4. CONTENTS Calorific value of common I ndian foods Nutritional guidelines for prosthodontic patient Nutrition and geriatrics Dietary management when teeth are extracted Diet recommended for new denture wearers Nutrition for maxillofacial prosthetic patients Conclusion 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 5

5. INTRODUCTION Most dentures are mechanically & esthetically satisfying but the systemic factors that greatly influence their success are ignored. A complete denture prosthesis depends ultimately upon the health and integrity of the denture-bearing tissues for successful function and comfort to the patient. Denture failures are not only due to imperfect design but also to poorly nourished tissues. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 6

6. Tissues of the oral cavity are often the first to be affected by nutritional disturbances. Tissue vitality in large measure dependent upon the availability & use of nutrients . I t is advisable to inquire the nutritional status & when necessary adjust the nutritional status of our complete denture patients . 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 7 INTRODUCTION

7. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 8 DEFINITIONS

8. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 9 The science of food , the nutrients and other substances there in, their actions, interactions & balance in relation to health & disease and processes by which the organism ingests, digests, absorbs, transports, utilizes and excretes food substances. -Council of food & nutrition of the American medical association. Sum of processes by which an individual takes in & utilizes food. - FDI. Study of the materials that nourish an organism and of the manner in which the separate components are used for maintenance , repair, growth and reproduction. –Stedman’s Medical dictionary,21 st edition. DEFINITIONS NUTRITION

9. NUTRITIONAL OBJECTIVES To establish balanced diet which is consistent with the physical , social , psychological and economic background of the patient. To provide temporary dietary supportive treatment, directed towards specific goals such as caries control , postoperative healing , or soft tissue conditioning. To interpret factors , peculiar to the denture age group of patients ,which may relate to or complicate nutritional therapy. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 10

10. FACTORS THAT AFFECT NUTRITIONAL STATUS 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 11

11. AGING FACTORS THAT AFFECT NUTRITIONAL STATUS PHYSIOLOGICAL FACTORS Decline in lean body mass Vitamin D deficiency Declines in the gastric acidity Nutrient deficiencies Dehydration Impairment in function of intestinal tract secondary to illness , disease or medications 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 12

12. AGING FACTORS THAT AFFECT NUTRITIONAL STATUS Decreased immune response Decline in cognitive function 2.PSYCHOSOCIAL FACTORS Loneliness- major contributing factor to malnutrition Reduced economic status 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 13

13. AGING FACTORS THAT AFFECT NUTRITIONAL STATUS 3.FUNCTIONAL FACTORS Physically handicapped. Arthritis. Vision & hearing impairment. Decreased motor skills. 4.PHARMACOLOGICAL FACTORS: MEDICATIONS & ALCOHOL Prescription drugs. Alcohol intake-deceases appetite. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 14

14. ORAL FACTORS THAT AFFECT DIET AND NUTRITIONAL STATUS 1.Xerostomia Difficulties in chewing & swallowing. Drugs with hypo salivary side effects. Deficient masticatory performance. 2.Sense of taste & smell Altered food choice & decreased diet quality. Sensory changes may diminish the appeal of some foods, limiting their consumption & potential health benefits function. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 15

15. ORAL FACTORS THAT AFFECT DIET AND NUTRITIONAL STATUS 3.Oral infectious condition Impaired masticatory function-inadequate food choice-altered nutrition intake. 4.Effects of dentures on taste & swallowing Full upper denture have impact on taste & swallowing. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 16

16. ORAL FACTORS THAT AFFECT DIET AND NUTRITIONAL STATUS 5.Effects of dentures on chewing ability Masticatory efficiency in complete denture wearers is approximately 80% lower than in people with intact natural dentition. 6.Effects of dentures on food choices , diet quality & general health Some people compensate for decline in masticatory ability by choosing processed or cooked foods rather than fresh food . Others may eliminate entire food groups from their diet. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 17

17. CLASSIFICATION OF NUTRIENTS 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 18

18. PROTEINS Functions: -Body building. -Repair & maintenance of body tissues. -Maintenance of osmotic pressure. -Synthesis of antibodies , plasma proteins , h emoglobin, enzymes hormones & coagulation factors. Protein requirement: 1 g/kg body wt 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 19

19. PROTEIN Doubling the protein intake results in a threefold increase in calcium utilization. Assessment of protein nutrition status: -Arm muscle circumference -Creatinine-height index -Serum albumin & transferrin -Total body nitrogen 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 20

20. FOOD SOURCES Animal sources: Plant sources: 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 21

21. FATS 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 22 Concentrated sources of energy Classified as Simple lipids e.g. triglycerides Compound lipids e.g. phospholipids Derived lipids e.g. cholesterol Functions: -High energy foods (9 kcal/ gm ). -Vehicles for fat soluble vitamins. -Insulation against cold.

22. FATS Fats & diseases: - Obesity, Phrynoderma - Coronary heart disease Food sources: 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 23

23. CARBOHYDRATES Major component of food. Three main sources – starch , sugar, cellulose Geriatric patients require fewer calories. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 24

24. DIETARY FIBRE They are complex polysaccharides. The main action of dietary fiber is in the colon. Functions: Prevents constipation. Reduces the effects of toxins and carcinogens. Stimulates growth of beneficial micro flora in the large intestine. Sources : Cereals & millets , gums , fenugreek, fruits & vegetables 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 25

25. WATER INTAKE 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 26 Water is probably the most important and essential nutrient in the diet of man . Water deficiency and dehydration are more prevalent in older than younger persons due to diarrhea , febrile state and renal disease. This may be enhanced by the decrease in extracellular water that begins from eight decade of life. Furthermore , the sensation of thirst diminishes in very old. So adequate water intake should be there in elderly people.

26. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 27 IMPORTANCE OF WATER

27. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 28 VITAMINS IMPORTANCE GENERAL MANIFESTATIONS ORAL MANIFESTATIONS RDA FOOD SOURCES VITAMIN A Cellular differentiation, growth, vision Night blindness, xeropthalmia , Bitot spots, keratomalacia Xerostomia , enamel hypoplasia, delayed tooth eruption 750 mcg VITAMIN D Ca & P metabolism Rickets, osteomalacia , pigeon chest Delayed teeth eruption, wide pre-dentin zone 2.5 -5 mcg VITAMIN E Anti oxidant Decreased male fertility, Encephalomalacia --- 10 mcg VITAMIN K Helps in blood coagulation Prolonged clotting time Spontaneous gingival bleeding( prothrombin <20%) 45 mcg FAT SOLUBLE VITAMINS

28. WATER SOLUBLE VITAMINS 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 29 VITAMINS IMPORTANCE GENERAL MANIFESTATIONS ORAL MANIFESTATIONS RDA FOOD SOURCES VITAMIN C Synthesis of FH4, collagen & immunoglobulins Defective collagen synthesis, woody legs, scurvy Scurvy buds, enamel & dentin defects 40 mcg VIT B1 Thiamine Carbohydrate metabolism Dry & wet beri-beri , cerebral encephalopathy --- 0.5 mg/ 1000 c VIT B2 Riboflavin Participates in various redox reactions Nasolabial seborrhea, vascularization of cornea , scrotal dermatitis Glossitis ,magenta colored tongue, cheilosis 0.6 mg/ 1000 kcal VIT B3 Niacin Involved in redox reactions dependent on NADP & NAD PELLAGRA (dermatitis, diarrhoea & dementia) Bald tongue of sandwich, Raw beefy tongue , profuse salivation. 0.6 mg/ 1000 kcal

29. WATER SOLUBLE VITAMINS 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 30 VITAMINS IMPORTANCE GENERAL MANIFESTATIONS ORAL MANIFESTATIONS RDA FOOD SOURCES VIT B5 Pantothenic acid Serves as carrier of activated acetyl groups Burning feet syndrome ---- VIT B6 Pyridoxine Required by enzymes of RBC Peripheral neuropathy ---- 2mg VIT B7 Biotin Participates in carboxylation reaction Deficiency uncommon ---- VIT B12 Erythrocyte maturation factor Pernicious anemia, Degeneration of myelin sheath Beefy red tongue, Hunter’s glossitis 1 mcg

30. ORAL MANIFESTATIONS OF VITAMIN DEFICIENCES 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 31 Hunter’s glossitis Magenta tongue Scurvy Bald tongue

31. MINERALS 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 32 MINERAL IMPORTANCE GENERAL / ORAL MANIFESTATIONS RDA FOOD SOURCES CALCIUM Bone & tooth formation, blood clotting Bone density & hypoplasia 1000 mg PHOSPHOROUS Bone & tooth formation Rare 600-1000 mg IRON Hemoglobin formation Anemia, glossitis & cheilitis 0.9-2.8 mg ZINC Wound healing Delayed wound healing 15 mg FLUORINE Bone & tooth formation Caries susceptibility, mottled enamel COPPER Antioxidant Anemia SELENIUM Antioxidant Predisposition to cardiac disease CHROMIUM Glucose metabolism 50-200 mg

32. CALCIUM AND BONE HEALTH Bone loss is a normal process of aging that effects maxilla and mandible , as well as spine and long bones. Skeletal sites where trabecular bone ( the alveolar bone , vertebrae) is more prominent than cortical bone are affected first. Several factors are thought to contribute to age related bone loss that leads to osteoporosis. Low calcium intake throughout life is a contributor to osteoporosis. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 33

33. CALCIUM AND BONE HEALTH Osteopenia affects women earlier than men. Alveolar tissue bone loss precedes loss of mineral from the vertebrae and long bones. As age advances , calcium is absorbed less effectively. Patients with dentures who have excessive ridge resorption report low calcium intake. Atwood termed reduction of residual ridge is a manifestation of osteoporosis. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 34

34. CALCIUM AND BONE HEALTH There is a cycle of calcitonin & parathyroid hormone secretion throughout the day that maintains normal serum concentration and skeletal integrity. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 35

35. FOOD GROUPS All the nutrients necessary for optimal health in the desirable amounts can be obtained by eating a variety of foods in adequate amounts from the five food groups. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 36

36. 1)VEGETABLES & FRUITS Four servings of vegetables and fruits, subdivided into three categories. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 37

37. 2 servings of good sources of vitamin C, such as citrus fruits, salad greens, and raw cabbage 1 serving of a good source of provitamin A, such as deep green and yellow vegetables or fruits 1 serving of potatoes & other vegetables & fruits 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 38

38. 2)BREAD , CEREAL GROUP Four servings of enriched bread, cereals, and flour products. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 39

39. 3)MILK, CHEESE GROUP Two servings of milk and milk based foods, such as cheese. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 40

40. 4)MEAT, POULTRY,FISH & BEANS GROUPS Two servings of meats, fish poultry, eggs, dried beans and peas, and nuts. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 41

41. 5)FATS, SUGAR & ALCOHOL GROUP Additional miscellaneous foods, including fats and oils, sugar and alcohol; the only serving recommendation is for about 2 to 4 tablespoons of polyunsaturated fats, which supply essential fatty acids . 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 42

42. BALANCED DIET “ A balanced diet is that which supplies all the essential nutrients in adequate amounts and in biologically available forms. ” - Z.S.C.Okoye “A diet containing all essential (macro & micro) nutrients in optimum quantities and in appropriate proportions that meet the requirements.” -NIN, Hyderadad , 2011. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 43

43. BALANCED DIET PRINCIPLES In constructing balanced diet , the following principles should be borne in mind: D aily requirement of protein should be met 10-15 % of daily energy intake. b)Fat , which should be limited to 15-30% of daily energy intake. c)Carbohydrate rich in dietary fiber should constitute the remaining food energy. d)Requirements of micronutrients should be met. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 44

44. FOOD GUIDE PYRAMID, U.S. Department of Agriculture,1992 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 45

45. MODIFIED FOOD GUIDE PYRAMID FOR ADULTS 70+ YEARS- Tufts University 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 46

46. ACCORDING TO ICMR ,BALANCED DIET FOR AN ELDERLY PERSON PER DAY 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 47 FOOD STUFFS MALES QUANTITY/gm FEMALES QUANTITY/gm Cereals 520 440 Pulses 50 45 Vegetables 70 40 Green leafy vegetables 40 100 Roots & tubers 60 50 Fruits 200 200 Milk & milk products 200 150 Sugars 35 20 Fats & oils 45 25

47. Calorific value of Common Indian foods -Given by NIN ,Hyderabad. FOOD PREPARATION QUANTITY PER SERVING CALORIES (Kcal) Rice 1 cup 170 Upma 1 cup 270 Idli 2 Nos 150 Dosa 1 No 125 Plain Dhal ½ cup 100 Boiled egg 1 No 90 Fish Fried 2 big pieces 190 Mutton & chicken curries ¾ cup 260 & 240 resp Tea (2 tsp sugar +50 ml toned milk) 1 cup 75 Coffee (2 tsp sugar + 100 ml milk ) 1 cup 110 Vada 2 Nos 140 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 48

48. NUTRITION GUIDELINES FOR PROSTHODONTIC PATIENT Eat a variety of foods. Build diet around complex carbohydrates , fruits , vegetables , whole grains and cereals. Eat at least 5 servings of fruits and vegetables daily. Select fish, poultry, lean meat, or diet peas and beans everyday. Obtain adequate calcium. Limit intake of bakery products high in fat & sugar samples. Limit intake of bakery products high in sodium & fat. Consume 8 glasses of water daily. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 49

49. NUTRITION AND GERIATRICS In this age group prosthetic failures are more often the result of tissue deficiencies than technical failures. Burket discusses the effects of senescence on the teeth & jaws as well as on the oral mucosa, tongue & salivary glands. Besides loosing their adaptability & tolerance to irritants these tissues loose their repair potentialities. The changes in these tissues resulting from senescence , may alter considerably the treatment of geriatric patient. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 50

50. NUTRITION AND GERIATRICS Importance of protein As patient becomes older, the amount of protein required per kg of body increases(1.4g/kg body wt ). Body functions are quickly distracted from their normal activity when good quality proteins are omitted from the diet. Protein deficiency results in lower antibody production , decrease in muscle volume. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 51

51. NUTRITION AND GERIATRICS Importance of vitamins Vitamins contribute to nervous stability & effective resistance to bacterial infection. Vitamins A , B complex, C & D intake should be increased. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 52

52. NUTRITION AND GERIATRICS Importance of minerals Change in gastric acidity- hypochlorhydria -reduced absorption of calcium & vitamin C-OSTEOPOROSIS. Calcium loss contributes to bone fragility. Rapid & excessive ridge resorption due to negative balance of calcium. Calcium level may be improved by increased intake of milk & milk products plus a vitamin D supplement of 400-1000 units a day. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 53

53. NUTRITION AND GERIATRICS Carbohydrate tendency & obesity Because of reduced muscular activity & metabolic rate geriatric patients require fewer calories. Limitation of their budgets & often inadequate masticatory apparatus. Soft diet that is high in carbohydrates & low in proteins is usually taken. This high caloric value produces obesity. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 54

54. NUTRITION AND GERIATRICS Impaired liver function Decreased utilization of protein & B complex vitamins. These changes produce a picture of pellagra . Post menopausal women Abnormal taste & burning sensation of the oral cavity. Low estrogen levels & vitamin B complex deficiencies. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 55

55. NUTRITION AND GERIATRICS Dehydration in the elderly Water balance is critical in preventing tissue dehydration. Xerostomia –major cause of denture discomfort & failure. All secretions-sweat , sebaceous, HCl decreases. Xerophthalmia -diminished secretion of tears. Treatment Hydrophilic (water bound) foods. Soups-bound water-effectively absorbed. Vegetable soups-easily prepared & relatively inexpensive. Vegetable fibers are strongly hydrophilic & bind water until it reaches the large intestine. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 56

56. DIETARY MANAGEMENT WHEN TEETH ARE EXTRACTED Patients who are candidate for implant or immediate dentures may require several tooth extraction. The patient who is well nourished experience rapid tissue healing and will be at low risk after surgery. If the patient appears poorly nourished , surgery should be delayed until the individual health improves. The smoker and drinker should be advised to abstain or limit their habits for a few weeks before and 1 month after surgery. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 57

57. DIETARY MANAGEMENT WHEN TEETH ARE EXTRACTED Malnourished patients should be instructed to consume high-calorie , high- protein foods before surgery. After any surgical process proteins, vitamin A, C, folic acid, pyridoxine, vitamin B 12, iron and zinc must be available to body cells for the support of phagocytic cells , cell mediated immunity and collagen synthesis. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 58

58. DIETARY MANAGEMENT WHEN TEETH ARE EXTRACTED A liquid diet was chosen which contained 225 calories for each 10 fluid ounces which supplied approximately 19 gms of proteins 26 gms of carbohydrates 5 gms of fat Essential vitamins & minerals. This beginning of diet a week or two prior to surgery gives the intestinal tract additional time to adjust to necessary changes. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 59

59. DIET RECOMMENDED FOR NEW DENTURE WEARERS 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 60

60. NUTRITION FOR MAXILLOFACIAL PROSTHETIC PATIENTS An approach that involves simple nutritional principles preceding the surgery, continuing postoperatively & proceeding life long will translate into improved prosthodontic prognosis. Pre-operative phase T he assessment of nutritional status is designed to evaluate the balance of 3 aspects of nutrition i.e energy , protein & micronutrients & has 3 components –nutritional history - appropriate physical examination -laboratory studies 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 61

61. NUTRITION FOR MAXILLOFACIAL PROSTHETIC PATIENTS Post- operative phase: The utilization of oral cavity for feeding may be hindered by the adverse effects of chemotherapy or radiotherapy or by resection itself. Alternatives of oral feeding are: -Nasogastric intubation - T otal parenteral nutrition TPN -Gastrostomy - J ejunostomy 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 62

62. CONCLUSION Careful attention to systemic factors such as nutrition will allow dentists to provide an enhanced level of care for patients. Dietary guidance is an integral part of treatment for the denture-wearing patient. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 63

63. BIBILOGRAPHY AND REFERENCES Bolender CL, Zarb GA. Nutrition Care for Denture wearing Patient. In: Prosthodontic treatment for edentulous Patients.12 th edition:56-69. Winkler S. Nutrition and the Denture-bearing Tissues . In: Essentials of Complete Denture Prosthodontics.2 nd edition:15-21. Neville BW. Oral Manifestations of S ystemic Diseases. In :Oral & Maxillofacial Pathology.2 nd edition :713-15. Satyanarayana U. Carbohydrates, Lipids, Proteins, Vitamins & Minerals. In :Textbook of Biochemistry.3 rd edition : 9-116. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 64

64. BIBILOGRAPHY & REFERENCES Palmer CA.Gerodontic nutrition & dietary counseling for prosthodontic patients. Dent Clin N Am; 2003:47:355-371. Barone JV. Nutrition for edentulous patients. J of Prosthet Dent ;1965:15:5: 804-809 Ramsey WO .The role of nutrition in conditioning edentulous patients. J of Prosthet Dent; 1970;23:2 : 130-135 Swoope CC , Hartsook E .Nutrition analysis of prosthodontic patients . J of Prosthet Dent; 1977;38:2 : 208-215 Barone JV. Nutrition – Phase one of the edentulous patient . J of Prosthet Dent; 1978;40:2 : 122-126. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 65

65. BIBILOGRAPHY & REFERENCES Masseler M. Geriatric nutrition I :Osteoporosis . J Prosthet Dent 1979;42:252-254 Massler M. Geriatric nutrition II :Dehydration in the elderly . J of Prosthet Dent; 1979:42:5 : 489-491. Bandodkar A, Aras M . Nutrition for geriatric patients. The J of Indian Prosthodontic Society ;2006:6:1:22-28 . Madan.R,Singh SV,Tripathi A.Nutrition in maxillofacial prosthetic patients.The J of Indian Prosthodontic Society;2007:147-149. Dietary guidelines for Indians.NIN,ICMR,Hyd:2011:104-106. 13-Jul-14 Diet & nutrition factors for completely edentulous patients-65 66

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