Supervisors info:
Κοσιώνη Αναστασία, Καθηγήτρια, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Πολυχρονοπούλου Αργυρώ, Καθηγήτρια, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Χαλαζωνίτης Δημήτριος, Καθηγητής, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Summary:
Aim: The aim of this study was to explore the association between oral factors and dietary choices in Greek community-dwelling older adults, including two objectives. The first objective aimed to assess the sociomedical and oral factors affecting masticatory performance, while the second objective aimed to investigate the impact of oral factors on the adherence to the Mediterranean diet (MD).
Materials and methods: The sample included community-dwelling persons over 60 years of age visiting Open Care Community Centers for Older People in Metropolitan Athens, Greece. Oral interviews recorded demographic and sociomedical information, subjective oral complaints, and dental habits. An oral and denture examination was performed including number of natural teeth, tooth mobility, number of occluding tooth pairs, and removable dentures’ prevalence and quality, and an evaluation of the masticatory performance using a mixing ability test with two-colour chewing gum (Hue-check Gum, University of Bern) that was digitally analysed using the View Gum software program (dHAL Software, Greece). Adherence to MD was assessed using the MDI_BNC4H index (range: 0–14) and xerostomia was assessed using the validated in Greek Xerostomia Inventory. Statistical analysis included a) univariate analyses using univariate quantile regression, univariate linear regression and Kruskal-Wallis one-way analysis of variance on ranks, and b) multivariable analyses using multivariable quantile regression with backward elimination of nonsignificant predictors and multivariable linear regression modelling with backward elimination of nonsignificant predictors using as dependent variables masticatory performance and adherence to the MD respectively. The level of statistical significance was set at p≤0.05.
Results: 130 persons, 97 women and 33 men (range: 60–93 years) participated in the study with a mean age of 73.9 ± 8.5 years. The majority were either married (48.5%) or widowed (46.2%); 46.5% had received ≤6 years of education and only 41 (31.5%) more than 12. Only 12.3% were active smokers. They received 3.1 ± 2.3 different medications per day (range: 0–13), and their mean BMI score was 28.5 ± 4.7 (range: 20.3–49.9). Fifty-nine participants (45.4%) had more than 20 teeth, 30 (23.1%) had from 11 to 20 teeth and 20 (15.4%) were edentulous. Among the dentate, the mean number of teeth was 18.7±8.3 (range 1-31). The mean number of chewing contacts between natural or prosthetic teeth was 10.5±3.1 (range: 2-16), with the majority of the participants (61.5%) having more than 10 chewing contacts. Sixteen participants (14.6%) presented tooth mobility grade #2 or #3 in more than 10% of their teeth. Fifty-eight (44.6%) used various types of removable prostheses, while all edentulous persons (20) used a pair of complete dentures. Seventy-two participants (55.4%) reported that they had very good or good oral health status. A total of 111 (85.4%) reported that they had “very good” or “good” masticatory ability, 14 (10,8%) moderate masticatory ability and 5 (3,9%) a poor or very poor one. The score of adherence to the MD ranged from 3 to 9 (5.6 ± 1.4).
Univariate analyses revealed statistically significant associations (p≤0.05) between masticatory performance and age, marital status, subjective chewing ability, use of removable dentures, use of various combinations of complete dentures, pain caused by maxillary denture, number of teeth, tooth mobility, posterior chewing pairs, all chewing contacts natural or prosthetic, retention of mandibular partial dentures, and dentures’ occlusion. In addition, the parameters that were statistically significantly associated with better adherence to the MD were higher masticatory performance, smaller number of drugs per day, lower BMI and no smoking.
The multivariable quantile regression analyses revealed that fewer natural teeth (95% CI: −0.02–0.01, p<0.001), being edentulous and using a pair of complete dentures (95% CI: 0.09–0.35, p=0.001), and larger percentage of severely mobile teeth (95% CI: 0.07–0.82, p=0.020) were associated with lower masticatory performance. Lower adherence to the Mediterranean diet was significantly associated with higher BMI (95% CI: − 0.10 –0.00, p = 0.047) and lower masticatory performance (95% CI: − 2.23–0.00, p = 0.050).
Conclusions: Within the limitations of the present study in a functionally independent community dwelling urban older population, higher masticatory performance and lower BMI were independently associated with better adherence to MD. In addition, lower masticatory performance was significantly associated with fewer teeth, increased prevalence of severe tooth mobility and use of a pair of complete dentures among edentulous persons. Maintaining or improving masticatory performance by preventive interventions keeping natural dentition and managing periodontal disease may be beneficial to improve dietary quality in older adults.
Keywords:
Masticatory performance, Mediterranean diet, Older adults, Oral health, Oral factors
