Effects of Tooth Loss and Denture Wear on Nutritional Status of a Sample of Elderly Patients Attending the Dental Teaching Hospital in Peradeniya, Sri Lanka

Abstract

Background: The rapidly growing elderly population in Sri Lanka faces multiple challenges, including the ill effects of tooth loss. Tooth loss and denture wear could both affect the amount and variety of food intake of the elders, leading to a state of compromised health. Therefore, it is essential to identify whether both tooth loss and denture wear affect the nutritional status of the elderly. This study evaluated the associations between tooth loss, denture-wearing status, and nutritional levels among a sample of the elderly population attending the Dental Teaching Hospital in Peradeniya, Sri Lanka. Methods: An analytical cross-sectional study was carried out at the Dental Teaching Hospital in Peradeniya, Sri Lanka. Using the G*Power v3.1 statistics software, a sample size of 61 patients aged 60 years and above was determined as the minimum sample size. Data were gathered by means of a self-administered questionnaire, patients’ files, and an examination to identify height and weight for assessing body mass index (BMI). Minitab v18.0 statistical software was used for analysis of data, and a p-value < 0.05 was considered statistically significant. Results: One hundred patients were recruited for this study, and the majority (sixty-seven) were female. The majority (71%) were between the ages of 60 to 69 years. The majority (60%) were denture wearers and 8% had nine or more occluding pairs (of natural teeth), 25% had five to eight, and 67% had four or fewer occluding pairs. Fifty-two percent (52%) were of normal weight, while 40% were over-weight and 8% were underweight, respectively. No statistically significant associations were identified between BMI and the denture status or number of missing teeth (p-values > 0.05). There were no statistically significant associations between the underweight or overweight status and denture wearing or occluding pairs (p-values > 0.05). However, the frequency of grain intake and the number of occluding pairs were significantly associated with each other (p-value = 0.024). Also, the frequency of taking snacks was associated with denture wearing (p-value = 0.006). Conclusions: The nutritional status (BMI) of the elderly does not necessarily correlate with their denture-wearing status or the number of existing occluding pairs/number of missing natural teeth. There is no significant association noted between the denture-wearing status and the food avoidance (soft, hard food, fruits, and grains, except snacks). There is no significant association between the number of occluding pairs available in natural dentition and the avoidance of soft foods or snacks, except for grains. Given the limitations of this study, it can be suggested that nutritional strategies for the elderly population could be designed universally, irrespective of their dentate or denture status. However, further research with a larger cohort is needed to validate these findings.

1. Background

As per information from the World Health Organization, population aging is one of the most concerning trends in the twenty-first century [1]. Sri Lanka defines the elderly population as those who are 60 years of age and above [2]. A combination of low fertility and mortality rates, and a high rate of international migration among the youth has resulted in a significant increase in the proportion of the elderly population in Sri Lanka [2]. Currently, the Sri Lankan elderly population represents about 12.4% of the total population of the country; this population group has been projected to increase in size to about 25% by the year 2041 [3]. In addition, the Central and Western provinces of Sri Lanka consist of the majority of the aging population in the country [3].

Due to aging, older individuals face different problems associated with physical, psychological, and intellectual aspects of life, which have a negative impact on their quality of life [4]. Apart from the common non-communicable diseases, such as diabetes mellitus, hypertension, hypercholesterolemia, and chronic kidney disease, poor oral health is also a common problem faced by the elderly [5]. When considering their oral health, tooth surface loss, coronal and root caries, aging-related xerostomia, and loss of teeth due to poor periodontal conditions have become more prominent and commonly found problems among the elderly. Due to their reduced physical activity, economic dependence on children, and other co-morbidities, older people fail to maintain their oral hygiene status, along with their failure to attend regular dental visits for check-ups, which ultimately leads to eventual tooth loss [5]. Studies have highlighted that loss of teeth affects a patient’s quality of life, psychological status, self-image, social interactions, nutritional intake, and other socioeconomic aspects [6]. Due to poor oral condition, nutritional intake of the elderly is very much impaired, which could lead to them having either a malnourished or an obese status [7]. One of the major issues of the edentulous elderly is the impairment of their nutritional status. Reduced physical ability, reduced nutritional intake, and impairment of absorption of nutrients precipitate malnutrition among older individuals, which eventually leads to various other diseases. Thus, elderly people have a considerable energy requirement for situations such as recovering from multiple disease conditions. In addition, tooth loss also contributes to this problem [8]. Tooth loss causes difficulties in mastication for older individuals, leading them toward poor food choices. The selection of specific types of food, owing to their own chewing ability, results in elderly people consuming less fruit, meat, beans, grains, and oils. Instead of consuming the afore-mentioned foods, they tend to eat soft foods and satisfy their energy requirement mainly from solid fat, alcohol, and sugar [9].

In order to overcome concerns of chewing, swallowing, esthetics, and social acceptance with tooth loss, more elderly people are likely to wear dentures as a means of replacing lost natural teeth and their function [10]. A denture is an artificial substitute for missing natural teeth and adjacent tissues [11]. Although other restorative options are available for replacing missing teeth, most of the general population, including the elderly in Sri Lanka, choose the removable denture option, as it is way cheaper than other restorative treatment options (e.g., fixed prostheses) [9]. Further, fixed prostheses, unlike removable prostheses, involve high cost and can be complicated due to implants and surgical procedures [11].

Removable partial dentures and complete dentures can support partially dentate and edentulous elderly patients in diverse ways [10]. Multiple functions of dentures have been described in the literature; they include mastication, improvement of esthetics, pronunciation, improvement of patient satisfaction, and quality of life [12]

Although dentures are more beneficial for the improvement of mastication, esthetics, and swallowing, they may have several negative impacts on the nutritional status of the elderly [8]. For example, loose dentures may lead to inadequate nutritional intake due to difficulty in chewing ability and low perception of taste sensations [13]. Furthermore, the types of dentures used may determine the level of nutritional intake of denture wearers in the elderly [14]. Despite the positive functional abilities of dentures, some complete denture wearers face more difficulties with their use [15]. These difficulties include reduced pleasure in eating due to the difficulties in chewing hard foods, loss of appetite due to the full mucosal coverage or ill-fitting, interruption of meals due to food getting stuck beneath the denture base, and decreased self-confidence while eating outside due to movement of dentures; all of which minimize the choice of food and social interactions among elderly denture wearers [15]. In addition to the above-stated difficulties associated with denture wearers, poor general health, inadequate absorption and metabolic disturbances, reduced salivation, and socioeconomic factors also influence malnutrition among elderly denture wearers [11]. Collectively, all these factors bring a negative impact on both the nutritional intake, psychological wellbeing, and quality of life of the elderly [16].

In the Peradeniya residential area in Sri Lanka, no known study has been conducted to evaluate the factors related to tooth loss, nutritional status, and denture-wearing status among the elderly. Hence, there is a dearth of knowledge on this topic concerning the elderly among the Peradeniya regional population. Therefore, there is a need for an empirical study to fill this void. The findings from such a study will provide evidence-based insights for the dental care providers in the region to identify areas of improvement in oral health follow-up and maintenance among the elderly; hence, this study was conducted.

Aim and Objectives

The aim of this study was to evaluate the associations between tooth loss, denture-wearing status, and the nutritional status of an elderly population attending the Dental Teaching Hospital in Peradeniya, Sri Lanka. The objectives of this study were to assess: (i) the impact of tooth loss and denture usage on food avoidance/intake in the elderly, (ii) the impact of tooth loss and denture usage on the BMI of the elderly; and (iii) impact of the worn denture types on the daily food intake of the elderly.

2. Methods

2.1. Study Design

This was a cross-sectional analytical study.

2.2. Study Setting

The study was carried out at the Department of Prosthetic Dentistry, Dental Teaching Hospital in Peradeniya, Sri Lanka.

2.3. Study Population

This study was conducted among elderly individuals, aged 60 years and above, with a history of tooth loss and who are denture wearers attending the prosthetic clinic of the Department of Prosthetic Dentistry, Dental Teaching Hospital in Peradeniya, Sri Lanka. Older individuals attending the Department of Prosthetic Dentistry in the hospital, who cannot move on their own, who have debilitating illnesses (such as uncontrolled diabetes mellitus and heart diseases), and who cannot read and write were excluded.

2.4. Study Instrument

A data extraction sheet, a weighing scale, a measuring tape, and a pre-tested structured questionnaire were used to gather study data. The questionnaire consisted of 3 parts:

• Section A: This section obtained data on the socio-demographic characteristics of the study participants;
• Section B: This section gathered data related to the height and weight of the participants, as well as information related to their dietary habits;
• Section C: This section obtained data related to denture wear and tooth loss among the participants.

This questionnaire was available in three languages, Sinhala, English, and Tamil. The questionnaires were translated in the forward and backward directions, then pretested with 20 participants. Based on the feedback from the pre-testing, revisions are made to the translated questionnaire to improve clarity and cultural relevance. Once the pilot testing was completed, the questionnaires were finalized for use.

We collected the data using a data extraction sheet related to the number of missing teeth, location of missing teeth, type of denture worn, and duration of denture wear from the patients’ clinical records.

The digital bathroom weighing scale (Camry model EB1614H-F013 in kg, Camry, Tsuen Wan, Hong Kong) and the standard measuring tape made of flexible material (Singer 00218 tape measure 60 inch, Singer, La Vergne, TN, USA) were used to measure the participants’ weight and height, respectively, at the initial visit to the clinic. The measurements were obtained by avoiding error due to the parallax effect.

2.5. Sample Size

Assuming that there is an association of the body mass index(BMI) categories with tooth loss [17] and denture status, a sample size for a chi-squared test of association could be calculated at 2 degrees of freedom. Furthermore, a moderate effect size for the association was assumed along with a significance level of 0.05 and a power of the test of 0.80. Given the above statistical assumptions and values, the minimum required sample size was assessed using G*Power v3.1 statistics software (Psychonomic Society, Windsor, WI, USA). The minimum sample size required was 61.

2.6. Sampling

The participants were partially dentate, 60 years and above in age, some with tooth loss, and some wearing dentures. They were attending the Dental Teaching Hospital in Peradeniya. The volunteer sampling method was used.

2.7. Data Collection

The study data were gathered between March 2022 and May 2022. Demographic data, data related to dietary habits, data related to denture wearing, and tooth loss were collected through a pretested self-administered structured questionnaire.

Data related to the number of missing teeth, location of missing teeth, type of denture, and duration of denture wear were collected from patients’ clinical records using a data extraction sheet.

Height and weight measurements were performed using a standard measuring tape and digital bathroom weighing scale (as previously mentioned; please see the “Study Instrument” subsection for details of the instrument), and the BMI was calculated for each participant. Three categories of BMI were identified based on the WHO cut-off points for BMI [18].

Below are the highlighted variable types in this study:

• Independent variables
  • Socio-demographic characteristics
  • Status of denture wear
  • Dental status (data related to missing teeth, position of missing teeth)
  • Tooth loss site (whether anterior or posterior region of the arch)
• Dependent variables
  • BMI

2.8. Data Analysis

The data were analyzed using the statistical software Minitab v18.0 (Minitab LLC, State College, PA, USA). Descriptive statistics were displayed as frequencies and percentages. The chi-squared test was used to test associations between tooth loss, denture wear, food avoidance, BMI, and the daily food intake.

2.9. Ethical Considerations

Ethical clearance was obtained from the Ethical Review Committee at the Faculty of Dental Sciences, University of Peradeniya. Permission to collect data from the Dental Hospital, Peradeniya, was obtained from the Dean of the Faculty of Dental Sciences at the University of Peradeniya and the Deputy Director of the Dental Hospital, Peradeniya. Informed written consent was gained from the participants prior to data collection after an explanation of the purpose of the study. Privacy and confidentiality of the participants’ data were strictly followed. Further, no personal or sensitive data were collected throughout the study.

3. Results

3.1. Socio-Demographic Attributes

A total of 100 elderly individuals participated in the study, of which 67% (n = 67) were female. The majority of the participants were in the age category of 60–69 years. Most of the participants had ordinary level qualifications as their highest educational qualifications. Fifty-two percent (52%) of the participants were pensioners, and thirty-seven percent (37%) were unemployed. Eighty percent (80%) of the participants had a monthly family income of LKR10000 and above (

Table 1. Demographic summary of the participants.

Variable	Frequency	Percentage
Total	100	100%
Type of accommodation
Privately owned	98	98%
Public	2	2%
Age
60–69 years	71	71%
70–79 years	26	26%
>80 years	3	3%
Education Qualifications
Primary or Secondary	16	16%
Ordinary Level exam	45	45%
Advanced Level exam	35	35%
Graduate/Postgraduate	4	4%
Occupation
Unemployed	37	37%
Employed/Self-Employed	11	11%
Pensioner	52	52%
Type of Family
Extended	23	23%
Nuclear	77	77%
Family support
Yes	100	100%
No	00	0%
Monthly Family Income
LKR 5000–10,000	20	20%
LKR 10,000–25,000	42	42%
LKR 25,000 or above	38	38%

).

3.2. Types of Dentures Worn by the Participants

Out of the total sample of 100 participants, 60% (n = 60) were denture wearers, and the different types of dentures are summarized in the following chart (Figure 1).

3.3. BMI, Denture-Wearing Status, and Number of Missing Teeth

The mean ± SD (standard deviation) height of the male individuals was 1.63 ± 0.02 m (meters), and it was significantly higher than that of the female participants (1.49 ± 0.01) m (p < 0.001). The mean ± SD weight of the male participants (60.58 ± 1.5) kg (kilogram) was significantly higher than the mean weight of the female participants (54.6 ± 1.2) kg (p = 0.003) (

Table 2. The nutritional status of the sample based on body mass index.

Nutrition Status	BMI	Percentage
Underweight	<18.5	8%
Normal weight	18.5–24.9	52%
Overweight	>24.9	40%

).

As depicted in Table 2, and based on the WHO cut-offs for BMI, the majority (52%, n = 52) of the participants were within the normal weight range, whereas only a few (8%, n = 8) of them were in the underweight group [18].

3.4. Association Between BMI and Denture-Wearing Status/Number of Missing Teeth

Underweight or overweight statuses were not associated with denture wearing (p = 0.212). Further, no significant difference was identified between the mean ± SD BMI of those participants who do wear a denture (24.40 ± 0.55) and those who do not wear a denture (23.56 ± 0.60) (p = 0.308).

The mean ± SD of missing teeth in the participating males and females was 20.03 ± 1.3 and 19.61 ± 0.96, respectively. No association was noted between the BMI and the number of missing teeth among the participants (p = 0.142). Additionally, being either underweight or overweight was not associated with available occluding pairs of natural teeth or a number of missing teeth among the participants (p= 0.732).

3.5. Association Between Denture Wearing and Daily Food Intake

When considering the association between denture-wearing status and daily food intake, no associations were observed between denture-wearing status and the frequency of consumption of soft food (p = 0.343), hard food (p = 0.303), fruits (p = 0.237), and grains (p = 0.570). However, the frequency of snack intake was considerably associated with wearing dentures (p = 0.006). The frequency of snack intake in denture wearers was 68% less than the snack intake among those participants who do not wear a denture.

3.6. Association Between Number of Occluding Pairs and Daily Food Intake

The available number of occluding pairs in all the participants is categorized and summarized in

Table 3. Percentage of the available number of occluding pairs in the sample.

Number of Occluding Pairs	Percentage
Four or fewer than four	67%
5–8	25%
Nine or more than nine	8%

.

Chi-square test analysis showed that there was no significant association noted between the frequency of taking soft food (p = 0.077) and snacks (p = 0.677) with the number of occluding pairs. On the contrary, the frequency of grain intake and a number of occluding pairs were associated with each other (p = 0.024). The odds of taking grains were more significant when having a higher number of occluding pairs.

3.7. Impact of Denture Wearing on Food Avoidance

The association between the frequency of food intake and the different types of dentures worn is portrayed in Figure 2. Accordingly, the frequency of soft food intake was the highest, despite the type of denture. Also, it revealed that there was a negative impact on grains and hard food intake in denture wearers, despite the type of dentures that they used, compared to other types of food categories.

There was no significant association noted between the denture-wearing status and the food avoidance, including soft food, hard food (p = 0.303), fruits (p = 0.237), and grains (p = 0.570), except with snacks, as mentioned previously.

3.8. Number of Missing Teeth vs. Food Intake Grouped by Denture-Wearing Status

When the frequency of different types of food intake (soft food, hard food, fruits, snacks, grains) was considered, it did not show a significant relationship between the mean number of teeth available in an individual and the frequency of these food intakes (soft food, hard food, fruits, snacks, grains). But the denture wearers who rarely or never intake grain-type food had a higher mean number of missing teeth than those who consume grains sometimes (Figure 3).

4. Discussion

The maintenance of optimum nutritional status is important for the elderly in order to survive age-related health matters and to combat illnesses and associated polypharmacy. Further, the elderly are at higher risk of tooth loss and denture use. They are more prone to a higher incidence of tooth wear, periodontal diseases, and dental caries, especially root caries, which lead to loss of teeth and tooth tissues. Hence, it becomes crucial to identify the associations between tooth loss, wearing dentures, and nutritional levels of the elderly population. The understanding of such associations would help in the development of health recommendations on denture wear and the preservation of natural teeth of this highly vulnerable group. Therefore, this study was aimed at identifying the effect of tooth loss and denture wearing on nutritional status among a sample of elderly patients attending a tertiary referral dental center in Sri Lanka. In this study, the frequency of various types of food intake among the elderly, together with their status on tooth loss and denture wearing, was assessed to determine whether there was any food avoidance and to identify the associated effects on the nutritional status among them. The patients attending the Dental Teaching Hospital, Peradeniya, could be considered as a representative sample of the whole country, as it is the only teaching dental hospital that provides undergraduate and postgraduate dental clinical training for the community. Further, it is important to carry out research to identify various factors, such as tooth loss, which lead to nutritional deprivation in the elderly, as they are more prone to illnesses and frailty status, putting more burden on the health system in the country. We believe this study would add value to the existing literature on the topic.

4.1. Number of Occluding Pairs with Nutritional Intake

Maintenance of optimum weight and height is considered an essential component of the nutritional status in an individual. Therefore, BMI was considered an appropriate marker to evaluate the nutritional status of the individuals. A previous study in the country has shown that 20% of the elderly sample are underweight [9]. Further, it revealed that tooth loss is significantly associated with the status of being underweight. According to the present study, there was no association between the BMI and the number of missing teeth in individuals. It can be explained that the weight of the individuals is not associated with the number of missing teeth, but rather with changed dietary patterns and higher availability of refined foods in the current scenario. Further, a more frequent intake of grains was observed when a higher number of occluding pairs was present. Another study also confirmed that tooth loss in elderly individuals is linked to changes in their food intake [19]. A 2007 study found that the alteration in nutritional intake observed in the elderly population could be attributed to the solid connection between the dentate status and difficulties of chewing [20]. However, a systematic review and meta-analysis showed that fully edentulous individuals or individuals with less functional dentition had a 21% higher probability of being at risk of malnutrition or being malnourished, in comparison to those with natural teeth or acceptable functional dentition [19,21]. Our study confirmed the same finding as the elderly, with a higher number of occluding pairs having more frequent intake of grains—a rich source of macro- and micro-nutrients [22]. It would be favorable for the elderly to have a higher number of grains to maintain their nutritional levels and higher fiber content for a smooth digestion process, which can be considered more of a health challenge for them than for the younger population. Further, it could well be explained that the use of grains requires more occluding pairs of teeth. Additionally, the changes in nutritional intake observed in the elderly population in the study can be elucidated by the strong link between the dentatus status and chewing difficulties in this population [23]. Furthermore, a Brazilian study found that the severity of tooth loss was associated with a lower intake of vegetables, legumes, and fruits, as well as a higher use of beans, sweets, and artificial fruit juices [24].

4.2. Denture Wear and Nutritional Intake

Considering the association between denture wear and nutritional intake, the findings of our study reported that there was no association between the frequency of intake of grains, fruits, hard food, and soft food and denture-wearing status, except for snack intake. Variations are available in the literature regarding nutritional intake and denture wearing. A study carried out at a dental institute in Indonesia has shown that there was no association between denture wear and nutritional status [25]. Another study found that individuals who wore complete dentures consumed significantly less meat or fish on a daily basis. The study proposed that partial denture usage to replace missing teeth and meet the dietary requirements of the elderly is critical in maintaining their nutritional status [8]. Similarly, another study highlighted that the type and use of dentures were linked to significant differences in the quality of diet and food choices. It emphasized that adapting to the use of dentures during eating is a key factor in the dietary management of the elderly [14].

A similar study in 2013 explored the improvement of chewing ability after the insertion of the dentures among the selected sample, and the improvement was identified after a 12-month period, which was statistically significant [26]. However, the improvement from the 3rd month to the 12th month was not identified as statistically significant [26]. This could be explained as some period is required to adapt to dentures with individual diet patterns. The study further highlighted that food intake and chewing ability were improved in edentulous patients after the insertion of dentures. Moreover, a study in 2019 concluded through their research that there was a significant negative impact on eating ability after denture replacement, and they also indicated providing eating advice for such patients [16]. Results of our study explain the refined nature of food in the current scenario, which does not have a significant association between nutritional intake and denture-wearing status.

4.3. Complete Denture vs. Partial Denture Wearers

Additionally, a study conducted among the elderly population in Japan found that individuals who wore complete dentures consumed significantly less meat or fish daily compared to those who wore partial dentures. This suggests that using partial dentures to replace lost teeth is crucial for meeting the dietary requirements of the elderly and maintaining a healthy nutritional level. The study also highlights the importance of providing education to older adults who wear complete dentures [8]. The study further emphasized the need to maintain at least a few natural teeth by encouraging a preventive interventional approach for reducing dental caries and periodontal disease in the elderly [8]. Some researchers have explained that complete denture wearers often suffer from various physical, social, and psychological issues, which lead to malnutrition [10]. It is well explained by the fact that denture wear directly affects eating satisfaction, comfort when chewing, and maintaining the quality of life of elderly persons [6]. Some authors have concluded that there was a significant negative impact on eating ability after denture replacement, and they require eating advice for such patients as well [16]. In line with our recommendations, a systematic review and meta-analysis emphasized that screening elderly individuals for malnutrition by healthcare professionals could lead to appropriate referrals that enhance both nutrition and oral health. The study also called for further research with consistent methods to assess tooth loss and nutritional status [19].

Although the results are discussed in overall comparison, there can be disparities among the population, as the wear pattern/frequency and time duration of wearing dentures may vary individually in terms of adapting to partial dentures. Moreover, there can be differences in the condition of the dentures, as the patients were handled by different clinicians for different steps in management.

4.4. Strengths of the Study

The Dental Teaching Hospital in Peradeniya, Sri Lanka, is the only teaching dental hospital and institute that provides undergraduate and postgraduate dental education in the whole country. It accommodates patients from all over the nation and conducts specialized geriatric dental care. Furthermore, the study accommodated elderly patients from urban, rural, and estate backgrounds from all provinces in the country. Therefore, this study provides representative information for the country regarding food avoidance and the problems related to tooth loss and denture-wearing, and their effect on nutritional levels of the elderly. This study also provides insight into the oral health of the elderly on how public healthcare and community professionals can monitor the nutritional status of the elderly with tooth loss. It highlights the need for a preventive approach to preserve the natural teeth, as well as the necessity of ensuring periodic reviews of the edentulous elderly after denture delivery.

4.5. Limitations of the Study

The study has a few limitations. The sample size is relatively small compared to the overall elderly population in the country. Additionally, the use of a cross-sectional design, rather than a longitudinal follow-up, presents certain drawbacks. There is also the possibility of confounding bias; for example, the observed weight loss during the study may be linked to acute illnesses experienced by participants prior to the study duration. Lastly, as the study was carried out in a clinical setting, its findings are less generalizable compared to those from a community-based study.

Maintaining an optimal weight and height is regarded as a crucial aspect of an individual’s nutritional status, and BMI is commonly used as a reliable tool to assess this status. However, assessing Handgrip Strength (HGS) offers a reliable, simple, cost-effective, and easy-to-do method. Its outcomes may provide a more precise reflection of nutritional status than BMI measurements alone.

4.6. Recommendations of the Study

Periodic screening of the elderly population for malnutrition could lead to timely referrals that optimize nutrition and oral health, highlighting a preventive approach. The study also recommends further research using reliable methods to evaluate tooth loss and nutritional status, as well as to identify the relationship between patients’ reports of issues related to tooth loss and denture use, in order to maintain nutritional health.

5. Conclusions

The nutritional status (BMI) of the elderly population is not necessarily correlated with their denture-wearing status or the number of existing occluding pairs/number of missing natural teeth. There is no significant association between denture-wearing status and the avoidance of soft or hard foods, with the exception of snacks. Further, there is no significant association between the number of occluding pairs available in the natural dentition and the avoidance of soft foods or snacks. However, consumption of grains is more significant when having a higher number of occluding pairs. Given the limitations of this study, it can be suggested that nutritional strategies for the elderly population could be designed universally, irrespective of their dentate or denture status. However, further research with a larger cohort is needed to validate these findings.