Jerome C. Hill: Health in the media: The link between dentures and frailty

What does the media say?

‘Dentures put wearers at risk of malnutrition because they can’t chew healthy food’ screams the headline of a recent article in the Telegraph while the Daily Mail go with ‘Dentures linked to higher risk of weak joints and muscles’.

These sensational and worrying headlines are based on a cross-sectional study published in the peer-reviewed journal Geriatrics and Gerontology International, but how accurately do they reflect the findings of the study?

Looking at the evidence

The researchers from King’s College London Dental Institute aimed to investigate whether a relationship exists between number of teeth/denture use and musculoskeletal frailty, and whether nutritional intake can account for this relationship.

A sample comprising 1852 older adults was assessed by dentists and split into three groups:

Having at least 20 teeth;
Denture-wearer with fewer than 20 teeth; and
Non-denture-wearer with fewer than 20 teeth.

Participants’ handgrip strength was tested as a measure of musculoskeletal function. Decline in musculoskeletal function is a key indicator in diagnosing frailty, a distinctive medical syndrome related to the ageing process where multiple body systems lose their reserves and there is an increased vulnerability to minor stressors.

Assessments of nutritional intake were based on 24-hour dietary recall interviews conducted on two separate occasions. Researchers used the self-reported data to evaluate whether participants were meeting the US Food and Drug Administration’s recommended dietary intake of 13 different nutrients (protein, polyunsaturated fats, fibre, 8 vitamins and 2 minerals).

The researchers also took into consideration potential confounding factors, such as BMI, physical activity levels, comorbidities (e.g. cardiovascular disease and diabetes), education and smoking status.

What did the results of the study show?

The results showed an association between having fewer than 20 teeth and poor nutrient intake, regardless of denture use. Despite this, after adjusting for age and sex, the analyses also demonstrated no statistically significant difference in musculoskeletal frailty between those with at least 20 teeth and denture users with fewer than 20 teeth. On the other hand, non-denture-wearers with fewer than 20 teeth were more likely to be frail than those with at least 20 teeth (OR 1.32, 95% CI 1.04–1.68). According to the researchers’ analyses, this relationship could partly be attributed to poor nutritional intake but, for the most part, it was explained by other risk factors, such as being underweight and low levels of physical activity.

Therefore, this study does report an association between lack of teeth and both frailty and poor nutrition. However, contrary to the claims in the tabloid headlines, the findings imply that dentures could actually help to prevent frailty in individuals with fewer than 20 teeth.

Of course, the study has its limitations…

For instance, as a result of the study design, it is impossible to establish a causative relationship as dental status, nutritional intake and musculoskeletal frailty were all measured at a single point in time. Hence, we cannot be sure which occurred first. Moreover, using only two days’ worth of dietary data to quantify nutrient intake is unlikely to be representative of the participants’ longer term alimentary regimes. Also, it must be remembered that frailty is a multifactorial condition and, although the researchers did consider some possible contributing factors, there may exist other factors that influence the relationship observed in this study between dental status and frailty.

Nevertheless, it seems plausible that poor dental health and nutrition could together negatively impact musculoskeletal function, thus leading to frailty. This could have implications on clinical and public health interventions in the struggle against frailty in older people. Up to now, efforts to prevent frailty have been concentrated on education about improving nutrition, with dental interventions being largely neglected.

However, the findings of this study highlight the importance of maintaining the natural dentition for as long as possible and, as per the authors’ conclusions, the provision of dentures as measures that could stop the progress of frailty in older people.

References

Lee, S. and Sabbah, W. (2017). Association between number of teeth, use of dentures and musculoskeletal frailty among older adults. Geriatrics & Gerontology International. [online] Available at: http://onlinelibrary.wiley.com/wol1/doi/10.1111/ggi.13220/full [Accessed 18 Dec. 2017].

MailOnline (2017). Dentures linked to higher risk of weak joints and muscles: Wearers could be avoiding certain foods so miss out on vital nutrients. [online] Available at: http://www.dailymail.co.uk/health/article-5165657/Dentures-linked-higher-risk-weak-joints-muscles.html [Accessed 18 Dec. 2017].

nhs.uk. (2017). Denture wearers may have a risk of poor nutrition – but no link to frailty. [online] Available at: https://www.nhs.uk/news/older-people/denture-wearers-may-have-risk-poor-nutrition-no-link-frailty/ [Accessed 18 Dec. 2017].

The Telegraph (2017). Dentures put wearers at risk of malnutrition because they can’t chew healthy food. [online] Available at: http://www.telegraph.co.uk/science/2017/12/11/dentures-put-wearers-risk-malnutrition-cant-chew-healthy-food/ [Accessed 18 Dec. 2017].