1. BY
MONICA SHEETHAL

2. GINGIVAL EPITHELIUM
 Thinning of epithelium
 Increased epithelial permeability to pathogens
 Decreased resistance to functional trauma

3.  Altered cell density
 Migration of junctional epithelium apically causing gingival
recession
 Decreased cellular component →decreased cellular reserves and
protein synthesis→affects oral epithelium→tissue becomes thin
with decreased keratinization

5.  Coarser and denser gingival connective tissue
 Qualitative and quantitative changes to collagen include;
increased rate of conversion of soluble to insoluble
collagen.
increased mechanical strength
increased denaturing temperature
 These results indicate increased collagen stabilization caused by
the changes in the macromolecular conformation

6.  Decreased number of fibroblasts
 Decreased organic matrix production
 Decreased epithelial cell rests
 Decreased number of collagen fibers
↓
reduction or loss in tissue elasticity

7.  Cells of PDL have reduced mitotic activity
 Changes in the width of PDL
 Decreased functional status of the teeth
 Decreased vascularity
↓
decreased mucopolysaccharide production

8.  Increase in cemental width
 Increase may be 5 to 10 times with increasing age
 Increase in width is greater apically and lingually

9.  Reduction of bone mass
 More irregular periodontal surface of bone
 Less regular insertion of collagen fibers
 Increased bone resorption

10.  Decrease in vascularity occurs
 Although age is a risk factor for the reduction of the bone
mass in osteoporosis,it is not causative and therefore
distinguished from physiologic aging process
 Success of osseointegrated dental implant ,which relay on
intact bone healing is less.

11.  Dentogingival plaque accumulation increases with increase in
age
with Increase in hard tissue surface area resulting
from gingival recession
the surface charecterstics of the exposed root
surfaceas a substrate for plaque formation

12.  For sub gingival plaque ,increased number of entric rods and
pseudomonads in older adults
 Periodontal pathogens specifically including an increased role for
PORHYROMONAS GINGIVALIS,and decreased role for
ACTINOBACILLUS ACTINOMYCETEMCOMITANS

13.  Age has been recognized as having much less effect in
altering the host response
 Difference between younger and older individuals can be
demonstrated for T and B cells,cytokines,and natural
killer cells,but not polymorphonuclear cells and
macrophages activity

14. NUTRIENT
INCREASED FUNCTION
DECREASED FUNCTION
VITAMIN A
BACTERIAL ADHESION
SALIVARY
ANTIMICROBIAL
PROPERITIES,IMMUNOG
LOBULIN AND
LYMPHOCYTES
PRODUCTION
VITAMIN E
------------------------------
ANTIBODY
SYNTHESIS,RESPONSE
OF
LYMPHOCYTES,PHAGOC
YTIC ACTION
VITAMIN C
------------------------------
PHAGOCYTIC ACTION
OF NEUTROPHILS AND
MACROPHAGES,ANTIBO
DY RESPONSE
ZINC
-------------------------------
ANTIBODY

15. RIBOFLAVIN,VIT
B6,PANTHOTENIC ACID
--------------------------------
FOLIC ACID AND
VITAMIN B 12
--------------------------------
IRON
--------------------------------
ANTIBODY
SYNTHESIS,CYTOTXIC TCELL
TOXICITY,LYMPHOCYTE
RESPONSE
CYTOTOXIC T CELL
TOXICITY,LYMPHOCYTE
PRODUCTION,PHAGOCY
TIC FUNCTION OF
NEUTROPHILS
LYMPHOCYTIC
PROLIFERATION,NEUTR
OPHIL CYTOTOXIC
ACTIVITY,ANTIBODY
RESPONSE

16.  Older individual demonstrate more inflammation
 Long standing exposure include
chronic mechanical trauma from tooth brushing
iotrogenic damage from unfavourable restorations
or repeated scalings and root planing
plaque associated periodontitis,
 Age is not a true risk factor but a background or associated factor
for periodontitis

17.  Gingival recession
 Reduced overjet manifesting as an increase in the edge-to-
edge contact of the anterior teeth
 Functional changes-reduced masticatory efficency
 Attrition is compensatory change that acts as a stabilizer
between loss of bony support and excessive leveraging from
occlusal forces imposed on the teeth

19.  Although effectiveness of mastication may remain efficiency
is reduced because→
◊ missing teeth
◊ loose teeth
◊ poorly fitting prostheses
◊ non compliance of the patient,who may
refuse to wear prosthetic appliance

20.  Reduced bony mass and support
 Increased bone resorption

22.  Evidence is limited on whether the risk factors for
periodontal disease differs with age.
 Factors to consider-General health status,immune
status,diabetes,nutrition,smoking,genetics,medictions,ment
al health status,salivary flow,functional deficits
 For both younger and older persons,the most important
factors determining a successful outcome of periodontal
treatment are plaque control and frequency of professional
care.

23.  Advanced age doesnot decrease plaque control;however,older
adults may have difficulty performing adequate oral hygine
because of;
◊compromised health
◊ altered mental status
◊medications,
◊ altered mobility and dexterity
 Older adults may change tooth brush habitsbecause of
disabilities such as hemiplegia secondary to CVA,visual
difficulties,dementia and arthritis

24.  ORAL EPITHELIUM
● Asscess a decrease in intracellular water
content,amount of subcutaneous fat,elsticity and vascularity
of tissues,muscle tone
●Asscess for thin,waxy appearance of tissue
●Asscess for hyperkerotosis of keratin areas

25.  TONGUE
● Asscess for defoliation of papillae,fissures and varicosities
●Asscess for alteration of taste
●Asscess clinical complaints of the following
▫smooth,gloossy and painful tongue[vit b12
deficiency]
▫ geographic tongue[erythema migrans]
▫ Oral infections[eg;candidiasis]

26.  SALIVA
●Asscess for xerostomia that produces a decrease in the
following:
▫antimicrobial activity
▫ buffering capacity
▫ transport of taste sensors
▫ lubrication of the oral cavity
▫ digestive function
Note any signs of xerostomia,including the following intraoral
dryness,burning sensation,altered tongue
surface,dysphagia,chelosis,alteration in taste,difficulty with
speech,root caries.

28.  IMMUNE SYSTEM
●Asscess for pronounced inflammatory responses of the
gingiva to infection