NUTRITION FOR THE DENTURE PATIENT*

DETROIT DENTAL CLINIC CLUB, COMPLETE DENTURE SECTION*’

Detroit, Mich.

P ERFECT HEALTH is a prize that has been the goal of mankind throughout all
ages. It must be understood that there can be no separation between good
‘bodily health and good dental health. A diseased body often produces a diseased
.mouth ; in turn, a diseased mouth may often lead to a diseased body.
While the great majority of people have a heritage of good health, many
destroy this priceless possession by failure to properly care for their bodies. Much
of this neglect is due to a lack of knowledge 6f the best way to care for this corn-
plicated and wonderful machine.
The process of “feeding” the body is not simple. Involved are chemical, physi-
cal, and even mental reactions, many of which are still a mystery to scientists.
Some funda.mental facts, however, are now well established and easily understood.
There is no “cure-all,” but this article offers sound and simple advice which,
if followed, promises the largest possible measure of health which can be obtained
through proper dietaky measures.
The words “diet” and “nutrition” are often confused, Diet refers to foods
eaten. Nutrition refers to the digestion of food elements and the building and
repairing of body tissues by these digested food elements, which are distributed
throughout the body by the blood.
A good diet is a basic necessity. The tissues cannot live on food that is funda-
mentally wrong. A person may “starve” his body even though he puts what he
considers good food in sufficient quantity into his stomach. There also must be
present the proper vitamins and minerals and then the body must be capable of
using these materials and foods properly.
The purposes of this article are (1) to establish a proper diet, one that will
provide the needed fuel and body building elements for the human machine, (2) to
suggest, when necessary, additional vitamins and minerals, and (3) to emphasize
the importance of proper exercise, relaxation, rest, and, when necessary, medical
assistance, to be certain the body is functioning in such a manner that these
nutritional elements may be utilized to the best advantage in maintaining or re-
storing health.

*Revised from a booklet originally prepared by the members of the Complete Denture
Section of the Detroit Dental Clinic Club with Dr. Chester Perry as Director, copyright 1956,
and revised 1957.
**The members of the Complete Denture Section of the Detroit Dental Clinic. Club are
Drs. W. St. Clair Anderson, Stephen G. Applegate, Wesley I. Follls, Earl A. Gelhaar, Henry .I.
Herpel, B. F. Goodman, Joseph J. Jablonski, Charles H. Jamieson, Paul Kowalchuck, P. C.
Lowery, A. A. Nelson, Chester Perry, E. M. Ribits, A. J. Richards, Sr., A, J. Richards, Jr.,
W. S. Stash%‘, Victor H. Sears, Russell W. Tenth, H. C. Vorys, A. M. Yeager, and Horton D.
Kimball, Director, 1958-1960.
53
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54 DETROIT DENTAL. CLINIC CLUB Jan.-Feb., 19.60

NUTRITION FOR THE PATIENT

Unless teeth have been lost as a result of an accident’or removed to improve

appearance, it is probable that a major reason for their loss and for the fact
that one must wear an artificial dental restorative appliance, such as a fixed partial
denture, jacket crown, partial or complete denture, was faulty nutrition. This may
appear to be a new concept. Dental nutritional research has demonstrated, how-
ever, the direct relationship between the present high consumption of refined
sugars, sweets, starches, and soft drinks and the production of tooth decay. In
other words, as people eat and drink more of these foods, their teeth decay more
rapidly. Faulty nutrition also may have been responsible, in part, if the teeth
were lost because of periodontal conditions. Adequate diet and proper nutrition
are extremely important in the building and maintenance of healthy teeth, gums, ’
and supporting jaw bone.
The subject of nutrition is complex and one about which more is constantly
being discovered. Much of what has been written about nutrition provides excellent
and educational reading; on the other hand, there has been much written on the
subject which is predicated upon half-truths. While it is difficult to disprove some
of these half-truths, one is wise to accept the suggestions of recognized nutritional
authorities.
.Nutritional authorities agree that food substances may be classified into the
following components : (1) proteins, (2) carbohydrates, (3) fats, (4) vitamins,
and (5) minerals. A detailed discussion of these food groups would merely serve
to confuse those who are unfamiliar with the field of nutrition. Therefore, only
a short discussion of the food groups and their sources will be presented.

PROTEINS .

Proteins are necessary for building, repairing, and maintaining body tissue,
as well as supplying energy. Meat, fish, poultry, dairy products, and eggs are the
best sources of animal protein, ‘especially when not overcooked. Peas and beans
are among the best sources of vegetable proteins. Among the meats, steaks and
chops are hard to chew, but liver and sweetbreads are easier to chew. Ground and
chopped meats and many kinds of fish are easy to eat. One can get much of the
goodness of meats from soups, broths, and gravies.
Milk and cheese are good protein foods. Cream cheese and well-aged cheddar
and Swiss style are preferable to the. cheese spreads.
Protein is a “must” for denture wearers. The average patient will have more
comfortable gums and the dentures will continue to fit longer if the amount of
carbohydrates in the diet is reduced and proteins are increased.
CARBOHYDRATES

Carbohydrates include the sugars and starches and are obtained mainly from
plants. They are primarily a source of energy. In our American diet, many of the
carbohydrates are in refined form, as in sugar, white bread, flour, and refined
cereals. These refined carbohydrates are the “empty calories” an’d contain little or
none of the essentials required for building and maintaining a healthy body and
mouth.
Volume 10 NuTBITXON F6lc THE DENTURE: PATIENT 5.5
Number I

Most of the carbohydrates, especially the cooked cereals, are among the
easiest foods to eat. That is why there is real danger that too much of them will
be eaten. They are called the “energy foods,” because many of them supply little
except energy ; but fats and proteins also supply energy! One could eat little or
no carbohydrates, as the Eskimos do, and still have plenty of pep and energy.
Refined sugar is a carbohydrate “energy food.” Clever advertising has made
some people think of sugar as almost a necessity. The fact is that most people
use too much refined sugar and they would be better off with little or none at all.

FATS

The primary function of fats is to produce heat and energy. Only secondarily
do they build and repair tissue. Chief sources of fats are fat meats, lard, vegetable
oils, butter, cream, egg, yolk, and nuts. Fats are an essential part of the diet. They
contain vitamins and other nutrients but, in general, should be used sparingly.

VITAMINS

These are chemical substances which promote growth and assist in the mainten-
:ance of healthy body tissues. There are times when the body may be unable to
provide a sufficient amount of the vitamins and, as a dietary essential, they must
be obtained from outside sources.
One who eats the proper variety of food is relatively sure of getting the re-
quired assortment of vitamins needed. Denture patients, however, frequently are
on a deficiency diet and may need additional vitamins.
Vitanziri A.-Vitamin A is essential for normal vision. A marked deficiency
may produce what is often called “night blindness.” It also helps to keep the skin
and the linings of the mouth, nose, and inner organs in healthy condition and
thus aids in making them more resistant to infection.
Good sources of vitamin A are egg yolks, butter, whole milk, cream, and
fish liver oils. The body can also produce vitamin A from yellow, leafy green, and
some red vegetables.
I/itumi:n D.-Vitamin D is essential because it works with minerals (calcium in
particular) to form straight, strong bones and sound teeth. It is often spoken of as
the “sunshine vitamin,” because the rays of the sun change certain substances
in the skin into vitamin D.
Foods such as egg, yolk, butter, cream, and irradiated whole milk contain
vitamin D. Fish liver oils are the richest natural sources known.
It is advisable to supplement the diet with some vitamin D preparation, espec-
ially in the winter when it is difficult to be out in the sun. A physician or dentist
should be consulted about the prescribed amount.
Vitamin B Complex.-Thiamine, or B,, riboflavin, or B,, and niacin are
the best known and best understood members of the vitamin B family. Folic acid
and vitamin B,, are also very important members of the vitamin B group, They
are necessary for a healthy state of the blood.
When. thiamine (B,), riboflavin (Ba), and niacin are seriously deficient in
the diet, malnutrition or diseases such as beriberi and pellagra occur. Much more
 J. Pros. Den.
56 DETROIT DENTAL CLINIC CLUB
Jan.-Feb., 1960

common are the partially deficient or borderline cases, in which may develop burn-
ing of the tongue or cracking at the corners of the mouth. In other instances, the
nervous person, the individual who tires easily, the chronic grouch, or the person
with vague complaints may possibly be showing the effects of foods which provide
too little of these important members of the vitamin B complex. Foods deficient
in these vitamins are the refined carbohydrates (sugars, starches, and cereals)
to which reference has already been made. This should again emphasize the im-
portance of restricting these foods from the diet.
Good natural sources of thiamine, riboflavin, and niacin are the whole grain
cereals and whole grain breads. Leafy green vegetables also contain some of
the group. Milk is a good source of the vitamin B group, especially riboflavin.
Meats are also good sources, and liver is especially rich in vitamin Bi2, as well
as in vitamin A.
Vitamin C.-A profound deficiency of vitamin C causes scurvy. Less marked
deficiencies of this vitamin may manifest themselves, however, by a tendency to
bruise easily and by tender gums which bleed easily. Many people get too little
vitamin C to be in their best state of health. All of the citrus fruits are excellent
sources of vitamin C. Other good sources include tomatoes, fresh strawberries,
cantaloupe, and raw green foods, such as cabbage, green pepper, and lettuce.
Potatoes contain some vitamin C.

MINERALS

Certain minerals are essential nutritional needs. These include calcium, phos-
phorous, iodine, potassium, sodium, magnesium, and iron, Other “trace minerals”
are known to be important to human life. These include copper, cobalt, manganese,
and zinc. Of this group, only minute quantities are required in the diet.

APPLICATION

The essential requirements of the daily diet have been described. The problem
of how, to apply them remains. In other words, how does one go about obtain-
ing in the daily diet the proper amount of all the materials needed for correct
nutrition?
One of the simplest and most practical nutritional systems to follow is the
“basic seven.” This plan was developed by leading nutritionists (Table I). If
used daily as the basis of the normal diet, it will insure an adequate amount of
every essential nutrient.
In general, the “basic seven” provides an excellent scheme for a daily plan
of eating. If, however, there is gall bladder, stomach, or other intestinal trouble,
or other organic illness, a physician should be consulted for dietary advice. The
following foods are recommended :
Well-cooked cereals : oatmeal, corn meal, and creamed wheat. (These should
he eaten only in moderate quantities.)
Stewed fruits : peaches, apples, prunes, and apricots.
Fresh fruits : crushed apples, pears, bananas, tomatoes, avocados, and oranges.
Volume 10 NUTRITION FOR THE DENTURE PATIENT 57
Number 1

Soups : rice spaghetti, vegetable, and all creamed soups.

Cooked vegetables : peas, potatoes, spinach, carrots, squash, beets, asparagus
tips, turnips, rutabaga, and Brussels sprouts.
Uncooked vegetables: finely cut lettuce, parsley, water cress, and cauliflower.
Fish : boiled, broiled, or baked.
Eggs : poached, boiled, or scrambled.
Ground meats : beef, lamb, and liver.
Cheese : cottage, cream, Swiss, and cheddar.
Desserts : custards, ice cream, tapioca, and rice puddings.
Beverages : sweet milk, skimmed milk, buttermilk, malted milk, eggnog, orange
juice, beef juice, pineapple juice, tomato juice, all vegetable juices.
If at any time the gums are tender, almost any kind of food can be prepared
i,n such a way that it will need little or no chewing.
The healthy digestive system changes all foods into more liquid substance,
E#Othey can be absorbed and used by the body. Making foods liquid before eating
relieves the digestive system of part of its work. This is one reason why a weakened
patient is temporarily given a liquid diet. For those who go on a liquid diet,
there is one word of warning. The human digestive tract needs a certain amount
of “bulk” or solid substance. This does not mean that the solid part must be in

TABLE I
--
BASIC SEVEN FOOD GROUPS APPROXIMATE DAILY MEASURE CHIEF NUTRIENTS SUPPLIED
_____ _- ___--

1. Leafy green or yellow One or more servings Vitamin A chiefly; also, B,, C,
vegetables calcium, and iron
2. Citrus fruit or juice One-half cup juice or two Vitamin C
whole fruits
3. Potatoes, other vegetables, Two or more servings Calories! minerals, and
and fruits vitamins
4. Milk and milk products Children-l qt. milk Proteins, calcium (this group is
(fluid, evaporated, and Pregnant women-l qt. milk the best source), and vita-
dried milk, cheese, and Other adults-l pt. milk mins A, BQ,and D
ice cream)
5. Meat, poultry, fish, dried One or more servings; one Proteins, iron, and vitamins
peas, beans, and eggs daily preferably (at least 4 Bt and B,
per week)
6. Bread, cereals, and flour Two servings Calories, iron, vitamin BI, and
(natural whole grain, proteins. (These arevegetable
preferably, or enriched) proteins and are not so readily
available as in Group 5)
7. Butter or fortified margarine Tye;i;fy appetite and energy ,Calories and vitamin A

Although grain, cereal, and vegetable proteins are ‘!incomplete,” their availability is greatly
increased when consumed with animal proteins. For example, milk on cereal greatly increases
the availability of the protein in the cereal.
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58 DETROIT DENTAL CLINIC CLUB Jan.-Feb., 1960

chunks. The solids may be suspended in a liquid as extremely small particles-so

small that they cannot be seen. These small particles, nevertheless, can furnish
the necessary bulk. There seems to be a great difference in the amount of bulk
needed by individuals.
The above suggestions should be disregarded if they are not in accordance with
the physician’s orders.

DIGESTION

If it were not for the pleasure of smelling and tasting, all foods might be
gulped down without chewing if it were not for one factor-mixing the foods
with mouth secretions is part of Nature’s scheme of digestion. All foods should
be well mixed around in the mouth and tasted. In that sense, even liquids should
be “chewed.” None of the nerves of taste are covered by dentures, so one can still
taste all of the flavors. The sensation of taste telegraphs ahead’ to the rest of the
system to get ready for what is on the way. This stimulates the flow of digestive
juices in the stomach and other organs even before the food is swallowed.
After the meal is over, there is little one can do about digestion except rest
and stay happy while Nature does its work. Tranquility is said to be the best aid
to digestion.

WHY DO WE COOK FOODS?

Cooking is a necessity for some of our foods. If eaten in the raw state, they
would not be well digested or could even cause indigestion. Cooking softens foods,
making them easier to chew. Of the varidus methods of cooking, roasting or baking
is preferable. Fried foods are. less readily digested, while, in general, broited, baked,
and boiled foods are more easily digested.
It is wise not to overcook anything and to, include in the diet a goodly propor-
tion of fresh, unprocessed, and uncooked foods. Meats should be cooked as little
as possible and at a low temperature, with the exception of pork, which must be
well cooked. Fruits and vegetables should be fresh and properly ripened. Cooking
should be done by the waterless method and at a low temperature.
All water used in cooking meats and vegetables should be saved and used
in soups and gravies, since this water residue contains valuable vitamins and
minerals.
Perishable canned foods, after opening, or frozen foods, after thawing, should
not be kept for any length of time but should be cooked and eaten as soon as possible
to obtain maximum food value.

FOR THOSE WHO HAVE ALREADY LOST THEIR TEETH

Although the teeth have been lost, it is -most important that the tissues and
bones which support the denture be kept healthy. What one eats from now on is
going to determine, to a large extent, how healthy these tissues will be . A person
without natural teeth can be just as well nourished as one with them. In fact, if he
follows the few simple suggestions in this article, he will probably be better fed than
at any other time in his whole life,
gtml~ ;o
1 NUTRITION FOR THE DENTURE PATIENT 59

The removal of teeth and the wearing of dentures may force one to alter his
eating habits. Therefore, the necessity for change from solid and fibrous to semi-
solid and softer foods becomes desirable. Fortunately, semisolid or even liquid foods
can supply all the essential elements necessary for good nutrition, and as the indi-
vidual becomes more proficient in the use of his new teeth, he often can change back
gradually to solid and even fibrous foods.
It is true that some persons can eat anything and everything with their den-
tures. However, some have little feeling in their gums and may injure them without
knowing it. Sooner or later the gums may shrink if the load is too great, the bone
may dissolve away, and the dentures may become loose. So, go easy on the gums!
Do not attempt to chew any but the softest foods until the tissues or gums have be-
come sufficiently accustomed to the pressure of dentures.
Bread is difficult to chew with dentures. Melba toast or crisp crackers will be
found less difficult. Avoid sticky foods. Thorough chewing can be wzore readily ac-
coutzplished ;.f the food is taken in slnall portions and masticating is done slowly.
L4void all foods that require vuigorous chewing. Solid foods can be eaten when the
mouth is in condition to properly masticate them.
For the denture wearer, the matter of food is more complicated than merely
finding things easy to chew. A proper diet should consist of tissue-building foods
rich in protein, minerals, and vitamins essential for healing and. repair of the dental
ridges. It should also include the energy foods and calories required for daily
activities.
By proper nutrition, it is often possible to slow down or even prevent the tissue
Ichanges under dentures which contribute to tenderness, soreness, and lack of fit.

CONCLUSION

Appearance of natural or artificial teeth is, to a great extent, dependent upon

the physical well-being of the individual. Beauty is not only skin deep, but bone
deep.
Health depends upon the quantity and quality of food eaten, as well as on the
proper chewing of it. The daily exercise of mastication, when muscular forces are
properly directed, is a dominant factor in the preservation of facial contours.
The functions of swallowing and massaging the neck are extremely important
in improving blood circulation of the head, throat, and sinuses. These exercises re-
duce excess tissue and create and maintain a healthier appearance about the mouth
and throat areas. Healthy tissue is radiant and improves the appearance of either
natural or artificial teeth.
Daily exercise and care of neck muscles is important, especially to women den-
ture patients. When the neck muscles are properly toned, the skin is taut and
smooth, with less superfluous tissue and fewer wrinkles. Skin dryness can be bene-
fited by nightly massage with a good face cream. Careful cosmetic attention also
assists denture esthetics.
In the study of foods, one should note the superiority, in most cases, of natural
foods grown in enriched soil, ripened, properly preserved, and prepared for the pa-
tient’s consumption with a minimum loss of vitamin content. Do not forget the fact
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60 DETROIT DENTAL CLINIC CLUB Jan.-F&., 1960

that heat and certain other factors destroy vitamins in foods. However, many den-
ture patients cannot masticate enough food to supply themselves with a sufficient
amount of all the vitamins they need. Thus, it is often necessary to supplement the
diet with additional vitamins and trace minerals. Certain foods, vitamins, and min-
erals help build healthy tissues.
This article is concerned with nutrition and general health in relation to den-
tistry. The information contained in it, when conscientiously applied, will add to
dental comfort and general well-being.
873 LAKEWWD BLVD.
DETROIT 15, MICH.