The fight against malnutrition in older adults: new aproaches in dentistry

A minimal oral treatment aiming a clean and comfortable mouth could be very helpful in malnutrition control of dependent elderly persons. In such a case, it is necessary and generally it is enough to perform dental scaling and/or extractions with anxiolytic premedication (oral or rectal diazepam). Most of times, such minimal dental care can be performed at bedside, avoiding patient's stress and displacement to a dental surgery. The nursing staff can reassure the residents and their families on the absence of dentures, because saliva would be even more important than teeth. Actually, there is a tight relation between oral health, saliva, drugs, food texture and nutritional state of person. The notion of saliva includes two important criteria: 1) saliva-bacteria in the saliva, 2) fluid saliva-oral biofilm covering mucous membranes. All factors which change saliva secretion or inhibit oral bacteria community may lead to malnutrition. Several studies performed in hospital geriatric wards and in retirement homes allowed us to identify the following iatrogenic causes for malnutrition: 1) inappropriate preservation of teeth or dentures which may lead to oral reservoir (Candida albicans yeast-hyphal transition, antibiotic resistance genes transfer); 2) excessive uses of antiseptic mouthwashes for oral hygiene (leading to oral biofilm inhibition which is a cause of xerostomia); 3) drugs crushed in food (alteration of food taste and alteration of the oral biofilm); 4) exclusive recourse to a soft or mixed texture of food (alternative solutions exist, such as texture-adapted protein rich cookies). All these iatrogenic practices raise the possibility of formation of thick microbial communities in the mouth. This would explain why, despite attentive oral care, most of nurses and nurse's aides feel that in retirement homes the oral hygiene of the many residents is insufficient.