Age changes in periodontium /certified fixed orthodontic courses by Indian dental academy

INDIAN DENTAL ACADEMY
Leader in continuing Dental Education

www.indiandentalacademy.com

DEFINITION
• Aging is slowing of natural function, a disintegration of
the balanced control and organization that
characterize the young adults (Little C.c. 1947)
• Aging of an organ is defined as post maturational
deteriorative changes that with time, lead to an
increased vulnerability to challenges, there by
decreasing the functional ability of the organ.

AGE CHANGES

External
Hair - Brittle, Less abundant, gray
Skin - Dehydration, decreased elasticity,
thermo sensitive
Eyes - Diminished vision, enopthalmos
Nose - Diminished sense of smell
Secretary glands - Diminished epithelial activity


Internal
Renal - Decreased renal blood flow
Leading to water retention
Difficulty in removing waste products
Vascular - Rise in systolic blood pressure
GIT - Constipation and gas accumulation due to
hypotonic musculature
Gonads - Decrease estrogen and androgen secretion
Liver - Decrease hepatic function
Pancreas - Decrease function (diabetes)


Alternations in oral motor functions
Lip posture - Drooling, angular chelosis
Muscles of mastication - Efficiency of mastication
Tongue - Speech, dysphagia, traumatic
bite injury
Swallowing - Dysphagia
Taste - Loss of sensation


Periodontal changes associated with aging
Gingiva
• Thinning and decreased keratinization of gingival
epithelium.
• Increase in the width of the attached gingiva, with
constant location of the mucogingival junction
throughout the life
• More dense and coarse connective tissue
• Increase (or) no change in mitotic index of gingival
epithelium
• Reduced (or) no change in stippling

Periodontal Ligament
• Greater no of elastic fibers
• Decrease in vascularity
• Decrease in mitotic activity
• Decrease in fibroplasia
• Decrease in number of collagen fibers
• Width of periodontal ligament increased or
decreased

Alveolar bone
• Changes occurring in alveolar bone are similar to remainder
of skeletal system
• Increased osteoporosis
• Decreased vascularity
• Bone resorption increased (or) decreased
• Greater irregularity in the surfaces of alveolar bone facing
periodontal ligament
• Healing rate of bone in extraction sockets appears to be
unaffected
• Recent observations with bone graft preparations from
donars more than 50 yrs old possess less osteogenic potential
than younger donars.

CEMENTUM
• Greater irregularity in the surface facing periodontal
ligament.
• Continuous increased in amount of cementum
ORAL MUCOUS MEMBRANE
• Thinning of the oral epithelium or no change
• Increased keratinization of lip and cheek mucosa- it
may be related to smoking
• Atrophy of connective tissue with loss of elasticity
• Increased in number of mast cells

SALIVARY GLANDS
• There is no reduction in potential of salivary gland
function
TOOTH –PERIODONTIUM RELATIONSHIPS
• Loss of tooth substance – Attrition
• Degree of attrition is influenced by
• Musculature
• Consistency of food
• Tooth hardness
• Occupational factors
• Habits like bruxism
• Continuous tooth eruption
• www.indiandentalacademy.com
Gingival recession

• By reducing the clinical crown length, attrition appears to
preserve the balance between the tooth and its bony support.

INTERACTIONS BETWEEN PERIODONTAL DISEASES,
MEDICAL DISEASES AND IMMUNITY IN THE ELDERLY:

• Host immunity is the key factor in evaluating the interplay
between dental if medical diseases.
• Age having much less effect in altering the host response.


PERIODONTAL DISEASE AND ASPIRATION PNEUMONIA
• Aspiration pneumonia caused by infection of anaerobic
organism usually occurs in patient with periodontal disease.
• Aspiration pneumonia results when oro pharyngeal secretions,
food, gastric contents are aspirated into the lungs and causes
infection
• Commonly seen in elderly patients.
• Salivary duct as a medium of delivery of organism from the oral
cavity into the lungs.
• P.gingivals, pseudomonas A.eruginaso capnocytophaga species
fusobacterium nucleatum are commonly isolated species.


PERIODONTAL DISEASE AND HEART DISEASE:
Relationship between the periodontal diseases and heart disease.

Study done by Inference

Loesche et al Individuals with the most
medical problems -
highest rates of dental
diseases
A patient without teeth was
1.84 times > coronary heart
disease
2.4 times > peripheral vascular
disease
1.57 times> history of stroke

ROLE OF POOR ORAL HYGIENE
Poor oral hygiene
↓
periodontal disease
↓
Elevated level of WBC
↓ Predispose
Cardiovascular disease

• Supra gingival plaque – give rise to caries in
presence of sucrose
• Sub gingival plaque provoke inflammatory
response, giving rise to periodontal disease

ROLE OF SUPRAGINGIVAL PLAQUE IN HOST DISEASE

Most of the gram positive facultative species
↓
Survive high PO2
(if they penetrate oral epithelium)
↓
Not scavanged by phagocytes
↓
Gain access to periodontal circulation
↓
Symptomatic bacteremia


ROLE OF SUBGINGIVAL PLAQUE

Subgingival plaque flora
↓
Increased access to flora (compared to supra gingival plaque)
↓
VIA ulcerated epithelial lining of the pocket
↓
Underlying connective tissue
Antimicrobial potential Cellular debris
In the tissues ↓ Enter
↓ Systemic circulation
Destroyed ↓ cause
Alterations in serum components
Of clotting mechanisms
↓ Such as
Elevated levels of fibrinogen
↓ Predict
Risk of future coronary heart disease

AGING AND SUBGINGIVAL MICROBIOLOGY
• Holm pederson et al (1975) - Gingival recession was
more frequent in the older individual.

Gingival recession
↓
Altered Hard tissue morphology
↓
Provides a large dentine surface for plaque accumulation
↓
Higher plaque index in the older individuals
↓
Developmental of gingivitis


COMPOSITION OF SUBGINGIVAL MICROBIOTA
Rodenburg et al (1990) Actinobacillus actinomycetum
slots et al comitance ↓ with age
Savitt of Kent (1991) Porphyromonas
gingivalis – ↑ with age & blacks

PERI IMPLANT MICROBIOTA

- Microbiota in the oral cavity before implantation determines
the composition of the newly established microbiota on
implants
- Bacteria colonizing implants originate from the adjacent soft
tissues
- Ecological considerations affecting the periodontal microbiota
with age may be significant for the peri implant microbiota


TREATMENT PLANNING IN ELDERLY

Oral hygiene instruction
• Establish daily routine of brushing
• Fluoride dentifrices
• Instruments can be adapted as
– Handles can be customized
– Electrical (or) interproximal brushes


PERIODONTAL TREATMENT PLANNING IN
OLDER INDIVIDUALS
- Goal of periodontal treatment is preserve function and
prevent the progression of inflammatory disease
- Factors must be considered in treatment planning
Patients
- Medical and health status
- Medications
- Life style behaviors
- Ability to perform oral hygiene procedures
- Ability to tolerate treatment
- Amount of remaining periodontal support, tooth type
Operator side
- Decrease the length of surgical time
- Maintain open communication
- Minimize trauma
- Recalculatewww.indiandentalacademy.com
medication dosages
- Schedule morning appointment

-Non surgical approach – first treatment of choice
-Surgical approach – depends on nature and extent of
disease
-Palliative supportive periodontal care – patients who are
not comply with treatment, have poor oral hygiene,
medically or mentally compromised, functionally impaired.
ROOT CARIES
Root caries – slow progress, rare pulp involvement, painless
To arrest caries – single topical fluoride and daily use of
fluoride tooth paste
In high incidence – Daily brushing with fluoride tooth paste
of caries or 0.4% fluoride gel
APF rinse followed by 1.64% stannous
fluoride rinse once weekly

XEROSTOMIA
Fluoride rinses and dentifrices
Reduced consumption of alcohol, tobacco, spicy
and acidic foods
Frequent water in take
Artificial salivary substitutes
Burning mouth
Salivary substitutes
Diphenhydramine, koalin, lidocaine mouth wash


Age changes in periodontium /certified fixed orthodontic courses by Indian dental academy

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