The Right Bite

By Rebecca Stiles, RD

Rebecca is an experienced registered dietitian, freelance writer, and yoga teacher who loves to read, hike, and tend her garden.

www.rebeccastilesrd.com

Oral health may decline with age, but nutritional needs do not

Christine Wehrli, of Naperville, says that her mom has never been the best teeth brusher. Now age 93, her mom can no longer eat some of her favorite dishes. “She loves lamb chops but can’t chew meat very well anymore,” Wehrli says.

Her chewing challenges may be due to age, imperfect oral hygiene, or both. Tooth loss or decay, gum disease, chronic diseases, and ill-fitting dentures all can cause chewing issues, making eating uncomfortable or downright painful.

To make matters worse, when oral health takes a hit, nutrition tends to as well. Fibrous fruits, crunchy vegetables, and chewy meat are often the first to go. Now, like many seniors, Wehrli’s mother has to prioritize a healthy diet to match her limited chewing ability.

How poor oral health impacts nutrition

Biting, chewing, and swallowing all play a central role in consuming nutritious foods. Yet, if you’re not chewing your food well enough, your body has more trouble digesting it, says Umang Patel, DDS, owner and dentist at Romeoville Dental Center and Palos Heights Family Dental.

“This can lead to nutrient deficiencies,” he adds.

Compromised nutrition, in turn, leads to further deterioration of oral health. 

“If someone has poorly fitting dentures, or if it’s painful to eat due to tooth decay or missing teeth, they may start to limit what they eat,” says Esther Ellis, a registered dietitian nutritionist in Chicago who specializes in palliative nutrition and senior care issues. “This could mean eating less, eating less of a certain food group, or limiting their food intake to only a few foods.”

Causes of poor oral health

Our mouths change with age, regardless of how well we take care of our teeth. Some changes don’t have a major impact, while others can be problematic. 

“As we age, it’s not uncommon to have a dryer mouth due to our salivary glands not working as well,” Patel says. Additionally, he adds, “Certain medications can also cause our mouths to become dry.”

Dry mouth increases the risk for cavities and periodontal disease. Currently 26% of U.S. adults have untreated tooth decay, and 46% have signs of gum disease, according to the Centers for Disease Control and Prevention.

But dry mouth isn’t the only culprit. Poor oral health can result from many other common age-related changes. Seniors with arthritis may not be able to brush and floss thoroughly. Many chronic conditions ­­­— such as heart disease, type 2 diabetes, and chronic obstructive pulmonary disease — also increase the risk of gum disease. And a person with dementia may simply forget to take care of their teeth. 

Beyond all of the risks, dental care is expensive. Medicare doesn’t include dental healthcare, and seniors on a fixed income have a major financial barrier to dental care.

Boosting nutrition when chewing is tough

Chewing problems may be common in older adults, but they don’t have to stand in the way of good nutrition. 

While she encourages proper dental care as the first step to address chewing problems, Ellis says people may also consider modified-texture diets. This involves preparing food in a way that eases chewing and swallowing. 

“This could mean incorporating softer foods that are easier to chew or more liquid foods, plus maximizing the calories of the foods they can tolerate,” Ellis says. 

The degree of texture modification ranges from soft and easy-to-chew foods to blended and pureed options, such as smoothies and dips. Your doctor, dentist, or a registered dietitian can provide guidance on how to incorporate modified-texture foods, while a speech language pathologist usually determines the safest texture for your loved one. 

Wehrli cuts her mother’s meat into small pieces that require less chewing. She also gives her high-protein foods, such as meatloaf and yogurt, that are easier for her to eat.

“She’s always been a foodie,” Wehrli says. “She doesn’t let chewing [difficulties] stop her.”

Eating is one of the simple pleasures of life. The ability to enjoy a meal without pain protects health and improves quality of life. 

A daily dental hygiene routine and regular dental cleanings are essential to preserving oral health, too. And for those who need it, a modified texture diet can keep nutritious and tasty food on the menu.

Originally published in the Winter/Spring 2023 print issue.