Teeth, Dentures and Eating Well in Later Life

How teeth and nutrition are linked

• Chewing efficiency falls with missing or painful teeth, so people swallow larger chunks or avoid tough foods.
• Food choices narrow: fresh fruit, raw vegetables, nuts, meat, whole grains and crisp foods are dropped, lowering fibre, protein, iron and vitamins.
• Eating slows or tires, so smaller amounts are eaten.
• Pain, mouth ulcers or denture sores reduce appetite.
• Dry mouth makes chewing and swallowing hard, and raises decay risk.
• Gum disease and infection cause bad breath, pain and, through chronic inflammation, are linked with diabetes control and heart disease.
• Poor oral hygiene raises the risk of pneumonia in frail people; see oral care for frail older adults and denture hygiene.
• Weight loss and malnutrition can follow; see malnutrition in older adults: signs and prevention and loss of appetite in older adults: causes and practical fixes.

Studies show that older adults with fewer functioning teeth or poorly fitting dentures tend to have lower intakes of key nutrients and a higher risk of undernutrition.

Common dental problems in later life

• Tooth loss, partial or complete.
• Tooth decay, often at the necks of teeth where gums have receded, and around old fillings.
• Gum disease: red, swollen, bleeding gums, loose teeth, bad breath.
• Worn, cracked or broken teeth.
• Dry mouth, from medicines (for blood pressure, depression, allergy, bladder, pain), diabetes, mouth breathing or oxygen therapy.
• Oral thrush (white patches, soreness), particularly under dentures, with inhaled steroids or diabetes.
• Denture problems: poor fit, sores, loose or broken dentures, denture stomatitis.
• Mouth ulcers and persistent sores, including signs of mouth cancer in tobacco, pan, gutkha or alcohol users.
• Dental abscess: swelling, pain, fever.

What the dentist can do

Regular check-ups, ideally every six to twelve months, even for people with dentures, allow early treatment and cost less than emergency care.

• Examination and cleaning (scaling) to remove tartar and treat gum disease.
• Fillings, root canal treatment, crowns to save teeth.
• Extraction of unsalvageable teeth.
• Dentures: complete or partial removable dentures, adjusted or relined for fit; implant-supported dentures or bridges in suitable cases, though cost and surgical suitability matter.
• Treatment of ulcers, thrush and sore spots, and checks for lesions.
• Fluoride treatments and high-fluoride toothpaste for people at high risk of decay.
• Advice on dry mouth, diet and cleaning aids.
• Home or domiciliary visits for those who cannot travel; some hospitals and charities offer these; ask the local dental college or hospital.
• Coordination with the doctor for people with diabetes, heart disease, bleeding risk or other conditions; tell the dentist about all medicines, including blood thinners, and about bisphosphonates for osteoporosis, which affect jaw surgery.

Costs vary widely; government dental colleges and hospitals, charitable clinics and senior citizen schemes may help; see government schemes for senior citizens and health insurance for senior citizens in India.

Living well with dentures

Give new dentures weeks to settle: start with soft foods cut small, chew slowly on both sides and return to the dentist for adjustments rather than going without. Gums shrink after tooth loss, so review the fit every year or two and when weight changes; a thin layer of adhesive may help briefly but should not replace a good fit. Remove, rinse and clean dentures daily, leave them out at night and keep them labelled; see oral care for frail older adults and denture hygiene. Take care with hot food, since dentures reduce the sense of heat, and ask why if a parent has dentures but will not wear them.

Eating well with chewing difficulty

### Principles

• Do not just accept a soft, bland diet of rice, tea and bread. Aim for foods that are soft, moist, nutritious and tasty.
• Protein first: soft proteins at every meal; see how much protein do older adults need and high-protein Indian meals for seniors.
• Moisture helps: add gravy, dal, curd, ghee, soup or sauces so that food forms a soft bolus.
• Cook longer and smaller: pressure cook, steam or stew until tender; chop, grate, mash or mince.
• Keep texture variety appropriate to ability; do not puree if the person can manage soft pieces.
• Eat slowly, small bites, sitting upright; if swallowing is also difficult, seek an assessment; see swallowing problems (dysphagia) in older adults and soft and pureed diets.

### Indian ideas

Breakfast: soft idli soaked in sambar, upma or poha with vegetables cooked soft, dalia or oats porridge with milk, ragi malt, soft dosa with chutney, besan or moong chilla (thick, soft), scrambled egg or egg bhurji, paneer bhurji, curd with mashed banana, bread soaked in milk.

Lunch and dinner: khichdi with ghee and vegetables, curd rice, dal chawal, well-cooked dals, rajma or chole mashed, vegetable stew, kofta in gravy, mashed vegetable sabzi (pumpkin, lauki, carrot, potato, beans cooked soft), soft chapatis soaked in dal or curry, minced chicken, fish or keema in thick gravy, soft fish curry with bones removed, tofu or paneer curry, vegetable pulao cooked soft, soft roti with ghee.

Snacks: banana, ripe papaya, stewed or grated apple and pear, ripe mango, melon, avocado, curd, lassi, milkshakes with nut powder, kheer, custard, halwa, soaked and ground nuts and dry fruits (almonds soaked and peeled), nut butter, soft laddoos, egg, soups, buttermilk.

Avoid or modify tough items: hard raw vegetables and salads (grate or cook), raw apples and guavas (grate or stew), whole nuts, chana and popcorn, tough meat, chewy rotis (make them softer with more water or ghee or soak in curry), crispy fried snacks, sticky sweets and toffee, bones and fish with many small bones.

### Keep nutrition high

• Fortify: add milk powder, ghee, paneer, nut powders, besan, sattu or egg to porridges, dals and soups; see loss of appetite in older adults: causes and practical fixes.
• Fibre: use cooked vegetables, soaked dalia, oats, ragi, cooked fruit and psyllium if needed, with fluids; see constipation in older adults: fibre, fluids and movement and psyllium husk: how to take it and who should be careful.
• Fruit and vegetables: soft-cooked, mashed, juiced with pulp (limiting sugar), blended into soups.
• Supplements: protein powder, sip feeds and a multivitamin if the dietician advises; see protein powder for older adults: who needs it and how to choose, nutrition supplements and sip feeds: when food is not enough and multivitamins for older adults: helpful or wasteful?.
• Calcium and vitamin D: keep up dairy, ragi and sesame, as softened; see calcium and vitamin D after 60: doses, food and sun.
• Weigh regularly; see weighing scales and unplanned weight loss in older adults.
• Adapted cutlery such as easy-grip spoons can help people with weak hands; see easy-grip cutlery guide.

Dry mouth

Sip water through the day and with meals, moisten food with gravy, curd or ghee, try sugar-free gum or lozenges if safe, use saliva substitutes as advised, avoid alcohol-based mouthwashes and tobacco, and ask the doctor to review medicines that dry the mouth (do not stop them yourself); see hydration for older adults: how much and how to remember.

Diabetes, heart and blood thinners

Gum disease and diabetes affect each other, so keep sugar controlled; see eating for diabetes after 60. Tell the dentist about blood thinners, heart valve problems and bisphosphonates, and do not stop any medicine without medical advice.

Cleaning teeth when the person cannot manage

Brush twice a day with a soft brush and fluoride toothpaste, using an electric or easy-grip brush if hands are weak; see oral care for frail older adults and denture hygiene. Reduce sugary snacks and sweet tea between meals.

Tobacco, pan and mouth cancer

Chewing tobacco, pan, supari, gutkha and smoking, alone or with alcohol, are major causes of oral cancer in India. Quitting, with medical support, matters at any age. See a dentist or doctor for any ulcer, white or red patch, lump, numbness or bleeding that lasts more than two to three weeks.

Red flags

Seek urgent help (call 112) for a swollen face or neck with fever, difficulty swallowing or breathing, or spreading swelling from a tooth.

See a dentist or doctor promptly for: severe tooth or jaw pain, a mouth ulcer or patch that does not heal, bleeding gums with loose teeth, painful or ill-fitting dentures, refusal to eat because of mouth pain, or unplanned weight loss.

When to ask a professional

Ask a dentist for a full mouth check, treatment, and a review of dentures. Ask a dietician for soft, nutritious menus suited to the person's tastes and conditions. Ask a speech and language therapist about swallowing. Ask the doctor about dry mouth, weight loss and medicines. Seek urgent help for facial swelling, breathing trouble or choking; call 112 if severe.