Model development of mandibular two-implant retained overdentures plus nutritional empowerment in elderly with dentures (NEED)

Background: In Thailand according to age pyramid of 2550, older people above 65 years in men and women are about 4.0 million and 4.4 million respectively. A few studies have reported deficiencies of isolated nutrients in denture wearers, but there is no consistent pattern There are 1038 elderly edentulous people residing in Pathumthani Province and wearing Conventional Dentures. Objective: To explore the effective of IOD plus NEED programme by making comprehensive comparison of the efficacies among three intervention groups and control group in Thai elderly edentulous people in Prachatipat hospital, Pathumthani province, in the aspect of satistisfaction, OHRQoL, nutritional improvement and costeffectiveness. Study design: A Randomized Clinical Trail. Intervention: IOD plus NEED in intervention group I, IOD only in intervention group II, CD plus NEED in intervention group III, CD only in control group. Main Outcome Measure: Oral health related quality of health (OHIP-21), Satisfaction (VAS score), Chewing, biting and swallowing scores, Nutritional improvement (MNA, BMI, blood parameters), cost-effectiveness. Data analysis: To compare demography among the groups was analyzed by ANOVA. To test intervention effects (before-after test) within group by Paired T-test. To compare intervention effects among groups will be analyzed by repeated measured one-way ANOVA. The level of significance is set at p < 0.05. Results: All general characteristics were not statistically significant difference among the four groups (p>0.05). Pretest, mean of scores of OHIP, QMF, satisfaction for maxilla, BMI, body fat percentage (skin fold thickness), lean body mass, Plasma cobalamin, serum and erythrocyte folate, and Hb (g/L) among the four groups were not significant different. Post 6 mos, mean scores for OHIP, QMF, satisfaction for maxilla and mandibular, MNA, BMI, sub-scapular and abdominal skin fold thickness, HC, and Hb were statistically significance higher than pretest in IODNEED group (p<0.05). In IOD group, mean scores for OHIP, QMF, satisfaction for maxilla and mandibular, MNA, BMI, sub-scapular and abdominal skin fold thickness, HC, and Hb were statistically significance higher than pretest. In CDNEED group mean scores for OHIP, QMF, satisfaction for maxilla and mandibular, MNA, BMI, LBM, Hip Circumference, serum albumin, Serum and erythrocyte folate, and RBC were statistically significance higher than pretest (p<0.05). In CD group, only OHIP, QMF, satisfaction for maxilla and mandibular were significant higher. Comparison between IODNEED and IOD, there had significant higher mean score in serum albumin, serum Fe, and RBC, and significant lower mean score in body fat percent (skin fold thickness). whereas, comparison between IODNEED and CDNEED, there had significant higher mean score in OHIP, QMF, VASMD, serum albumin, serum and erythrocyte folate, serum Fe, and RBC. Comparison between IODNEED and CD, there had significant higher mean score in OHIP, QMF, VASMD, VASMX, serum albumin, plasma B¹², serum and erythrocyte folate, serum Fe, and RBC. (p<0.001) Discussion and conclusion: The NEED the participatory education on nutritional empowerment in elderly people with dentures program was effective in terms of oral health related quality of life, satisfaction, nutritional status, BMI, body fat percentage (skin fold thickness), and blood parameters. we can concluded that IODNEED program had more effective in improvement of oral health related quality of life, mastication function, satisfaction for mandibular, nutritional status, BMI, body fat percentage (skin fold thickness), and blood parameters. Moreover, positive correlation of cost and effective was found between IODNEED group and IOD group, and CDNEED group and CD group. From those, it can be concluded that NEED had not only improvement in mean scores of studied parameters but also effective by cost. Regular participatory nutritional empowerment and isometric exercise should be provided in conjunction with mandibular two implant-retained overdentures in elderly edentulous persons.