Older parents with few teeth: how can they get protein?

If your parents have few teeth left, the way to keep protein on the plate is to choose protein foods that are already soft, such as eggs, tofu, fish, minced pork or chicken, cooked beans and milk, and to cook tougher foods until they are soft. This is a common situation in Thailand: in the 2017 national oral health survey, 53.9% of people aged 60 to 74 had fewer than 20 teeth. The Thai Reference Daily Intake (Thai RDI) for protein is 50 g a day, counted from everything eaten. If chewing is hard or dentures are loose, a dentist can check what can be done.

How many older Thai people have few teeth or trouble chewing?

More than half of people in their 60s and early 70s have fewer than 20 teeth, according to national data.

What the national surveys found

The two dental figures come from different surveys and are not directly comparable. The oral health survey examined people aged 60 to 74 in 2017 and asked whether they had used dental services in the past year; 61.6% had not. The Health and Welfare Survey is a separate household survey that covered everyone aged 60 and over and asked about dental care in the past 12 months, reaching 7.2% who had used it in 2021. Because the surveys, years, age groups and ways of asking differ, the numbers are very different, but both show that many older Thais had not seen a dentist in the past year.

The Ministry of Public Health has set a goal for older adults to keep at least 20 natural teeth and 4 pairs of back teeth that meet, according to the authors of the oral health survey paper.

What "pairs of back teeth that meet" means

When you bite down, an upper back tooth and a lower back tooth that touch each other make one pair. Someone can still have many front teeth but few pairs at the back. In the oral health survey, people with at least 8 such pairs, or at least 27 teeth, were less likely to report difficulty chewing than those with fewer.

Limits of these numbers

Chewing difficulty in the survey was a single question with three possible answers, and the survey looked at one point in time. It describes how common these problems are, not what caused them in any one person.

Why do few teeth make it harder to eat protein foods?

Meat is one of the foods people with few teeth find hard to chew.

People leave tougher foods aside

The US National Institute on Aging (NIA) says people with problems with their teeth or dentures often avoid eating meat, fruit or vegetables, and might miss out on important nutrients. A Ramathibodi Hospital doctor writing for Rama Channel notes that people who have lost teeth cannot chew some foods, especially tough or hard ones such as meat, vegetables and fruit, and that some use their remaining teeth and gums to mash food.

Meals get skipped

In the national HART study of 2,863 Thai people aged 45 and over, followed in 2015, 2017 and 2020, wearing dentures was one of the factors linked with skipping meals. This was an observed link, not proof that dentures cause skipped meals, but it is a reason to ask how meals are going.

What to watch for at the table

Notice whether your parent pushes pieces of meat to the side of the plate, chooses only soup and rice, takes much longer to finish, or leaves fruit with a firm texture.

How much protein does an older parent need a day?

The Thai RDI for protein is 50 g a day. It is one value for the general population aged 3 and over, with no separate figure for older people, and it counts protein from everything eaten that day: rice, beans, eggs, fish, meat and milk together.

England's NHS Eatwell Guide puts beans, pulses, fish, eggs, meat and other protein foods in one group, and dairy and alternatives such as soya drinks in another. A simple check is whether a food from one of these two groups appears at each meal.

Which soft foods give protein?

Many everyday Thai foods are soft and contain protein. The table below uses figures from USDA FoodData Central, the US government food composition database. Thai recipes and portions vary, so treat these as a guide.

Foods like steamed egg, tofu, rice porridge with minced pork and steamed fish are already common in Thai homes, so the change is often about choosing them more often rather than cooking something new.

How can I cook protein foods so they are easier to chew?

Change the texture, not the food

Rama Channel suggests adjusting the texture of food so it is easier to chew and more appealing: for example, using minced pork instead of pieces, or stewing pork for longer than usual so it becomes softer. It also suggests adjusting the taste to what your parents like.

Tips for eating with dentures

The NIA suggests that people learning to eat with dentures:

• start with soft, non-sticky food
• cut food into small pieces
• chew slowly using both sides of the mouth
• avoid small crunchy foods that can get trapped under the dentures

The NIA also warns that with dentures it may be harder to feel hot food and drinks or to notice bones and other hard bits, so check the temperature and remove fish bones before serving. England's NHS says it can take a few weeks to get used to new dentures, and eating softer foods can help until your parent is comfortable with their usual diet.

Eat together when you can

Rama Channel notes that eating together with family matters for older people and can help them want to eat more. If your parent lives alone, see My parent lives alone. Are they eating enough?

When should my parent see a dentist or a doctor?

Regular dental check-ups

Rama Channel advises children, adults and older people to see a dentist every 6 to 12 months, not only when there is a problem, and to go straight away if anything in the mouth seems wrong. The NIA advises seeing a dentist if chewing is difficult, and having the fit of dentures checked. In the 2017 survey, 61.6% of people aged 60 to 74 had not seen a dentist in the previous year, so it is worth asking when your parents last went.

Signs that dentures need a dentist

The NHS says dentures can become loose as the gums and jawbone shrink or change shape with age. It advises seeing a dentist if:

• dentures click when talking
• dentures slip, or no longer fit properly
• dentures are causing pain
• dentures are worn or damaged
• the gums are very red or bleeding, or there is bad breath

When eating less needs a doctor

If your parent is eating less, their weight is going down without trying, or their clothes are getting looser, take them to a doctor as well as a dentist. For more on everyday care, see our guide to older parents' daily routine

If a doctor has advised limiting protein

If a doctor has told your parent to limit how much protein they eat each day, follow that advice. The 50 g figure in this article is a reference value for the general population.

If you are pregnant, breastfeeding, taking regular medication or have a health issue a doctor is following, speak to a doctor or pharmacist before changing your diet.

Dietary supplements are not intended to prevent, treat or cure any disease.