Effect of Dental Status on Changes in Mastication in Patients with Obesity following Bariatric Surgery

Anne Espérance Godlewski,Anne Espérance Godlewski,Anne Espérance Godlewski,Arnaud Basdevant,Arnaud Basdevant,Arnaud Basdevant,Arnaud Basdevant,Emmanuel Nicolas,Sébastien Czernichow,Sébastien Czernichow,Sébastien Czernichow,Catherine C Chaussain,Cécile A Ciangura,Cécile A Ciangura,Cécile A Ciangura,Martine Hennequin,Martine Hennequin,Martine Hennequin,Jean Luc Veyrune,Jean Luc Veyrune,Jean Luc Veyrune

doi:10.1371/journal.pone.0022324

Abstract

BackgroundPatients scheduled for bariatric surgery (BS) are encouraged to chew slowly in order to optimise the digestion process. The influence of dental status on patients' ability to comply with advice on chewing behaviour is poorly documented. This study aims to compare modifications of chewing function before and after BS in three groups of obese patients differing in dental status.Method and FindingsA cohort of 46 obese women provided three groups: FD group: fully dentate (7–10 functional dental units [FU]); PD group: partially dentate (4–6 FU) without partial dentures; DW group: partial and complete denture wearers. Chewing time (CT), number of chewing cycles (CC), and chewing frequency (CF) were measured before and after surgery during mastication of standardised samples of raw carrot, peanuts, banana, apple and jelly. The median particle-size distribution (D50) of the pre-swallowed bolus was also evaluated for peanut and carrot. Before surgery, the PD and DW groups exhibited greater mean CCs and CTs than the FD group (SNK p<0.05) and produced a bolus with higher granulometry (SNK, p<0.05) than the FD group. After surgery, CT and CC increased for all groups and for all foods, but not statistically significant for jelly. The resulting changes in bolus granulometry observed depended on both food and dental status. The granulometry of carrot bolus remained as fine or as coarse in FD and DW groups respectively as it was before surgery while it was significantly decreased in the PD group (Student's test, p<0.001).ConclusionsAfter bariatric surgery, all the obese patients, regardless of dental status modified their chewing kinematics. The effects of this chewing behaviour on bolus granulometry depended on dental status and type of food. Further studies are needed to understand better the impact of dental status on feeding behaviour and nutrition in patients with obesity.

Highlights

Bariatric surgery (BS) is the only consistently-effective long-term treatment for morbid obesity [1]
After bariatric surgery, all the obese patients, regardless of dental status modified their chewing kinematics. The effects of this chewing behaviour on bolus granulometry depended on dental status and type of food
The present study aims to address this point by comparing chewing parameters and the granulometry of the pre-swallowed bolus before and after gastric bypass surgery in patients with morbid obesity scheduled for bariatric surgery and differing in dental status

Summary

Introduction

Bariatric surgery (BS) is the only consistently-effective long-term treatment for morbid obesity [1]. International guidelines generally suggest that patient criteria for elective surgery for BS should firstly, include the control of feeding behaviour in order to eat less and more slowly and, secondly, a functional dental status providing good chewing function [6]. This set of conditions was assumed to reduce the prevalence of physiological complications of BS, such as vomiting, diarrhoea, pain or dumping syndrome. This study aims to compare modifications of chewing function before and after BS in three groups of obese patients differing in dental status

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Conclusion