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Associations Between Tooth Loss, With or Without Dental Prostheses, and Malnutrition Risk in Older Adults: A Systematic Review

Zelig, Rena DCN, RDN, CDE, CSG; Touger-Decker, Riva PhD, RDN, CDN, FADA; Chung, Mei PhD, MPH; Byham-Gray, Laura PhD, RD

doi: 10.1097/TIN.0000000000000077
Current Research for Practitioners

A systematic review was conducted to investigate the associations between missing teeth, teeth replaced with dental prostheses, and malnutrition risk, as determined by the Mini Nutritional Assessment (MNA), among community-dwelling older adults. A comprehensive search strategy was designed to identify studies published between 2000 and 2014 that met inclusion criteria. Searches were conducted in Medline, CINAHL, and Cochrane Libraries. Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines were followed and risk-of-bias analyses were performed. Study data were abstracted and synthesized in narrative and summary tables. Of the 8 studies that met inclusion criteria, 5 found significant associations between MNA score and tooth loss. Those with fewer teeth/limited occlusion had lower MNA scores, hence were at greater risk for malnutrition than those with a greater number of teeth and/or more occluding teeth pairs. Provision of dentures to older adults was associated with significant increases in MNA scores. The studies reviewed support associations between tooth loss, replacement with prostheses, and malnutrition risk; individuals with more missing teeth and limited occlusion were at increased risk of malnutrition. Additional high-quality research seems warranted to substantiate a causal relationship between dental and nutritional status. Inadequate oral health and poor nutritional status are associated with increased mortality risk in older adults. Efforts to optimize oral health and nutritional status of older adults are needed.

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Department of Nutritional Sciences, Rutgers School of Health Related Professions, Newark, New Jersey (Drs Zelig, Touger-Decker, and Byham-Gray); and Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts (Dr Chung).

Correspondence: Rena Zelig, DCN, RDN, CDE, CSG, Department of Nutritional Sciences, Rutgers School of Health Related Professions, 65 Bergen St, Ste 157, Newark, NJ 07107 (

The author would like to acknowledge and thank Dr Diane Rigassio-Radler and Dr Theresa Marshall for their initial external review of this article and constructive feedback. The authors would also like to acknowledge and thank Marie Saimbert, Rutger's University Librarian, for her assistance.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The authors have disclosed that they have no significant relationships with, or financial interests in, any commercial companies pertaining to this article.

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