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Medvedev listed 300 theories that have been offered in an attempt to answer this but nothing conclusive comes.
Increase in the level of production traits due to crossing is called hybrid vigor.
Dessication = dryness loss of fluid
longitudinal cracks These cracks may be developmental in origin and although their numbers do not increase with age , they become more obvious
Perikymata – external manifestations of striae of retzius …. Shallow furrows on the outer surface of enamel
Imbrication lines – faint curved lines which r roughly parallel to cej in cervical third of the tooth
Decreased pulp volume due to continued deposition of dentine.
Can also occur during pulp reactions during cavity preparations. Formed because of the distal shift of the odontoblast nuclei towards the dentinal tubules
Type1 & type 2 collagen fibres
TRUE DENTICLES: mass of calcified tissue that resemble dentine because of their tubular structure .can be free or attached
FALSE DENTICLES: localized mass of calcified material which do not exhibit dentinal tubules ..instead r deposited in concentric layers around a central nidus.
Attached gingiva The attached gingiva is continuous with the marginal gingiva. It is firm, resilient, and tightly bound to the underlying periosteum of alveolar bone.
Glycogen present in aged gingival epithelium
The expression of osteocalcin in fibroblasts from the periodontal ligament is either reduced or ceased in senescent fibroblasts This reduction may be directly related to the cell’s difficulty in progressing in the cellular cycle (G1-S) and accomplishing cell respiration .
Type 1 3 & 5 collagen fibres.
Alveolar age Changes are similar to other skeletal system
Oncocytoma - ??
Fat infilteration in parotid gland tissue
These teeth have deep fissures, larger inter proximal spaces and deeper gingival crevice, allowing a great increase in anaerobes.
IgA antibodies increase
IgG & IgM decreases
The decrease osteoblasts production are in bone less declines occurs efficient and because , there estrogen is overall reduction in calcium absorption from the GIT in old age
According to Henrikson and Wallenius (1974) between the age of 45 to 90 yrs in both males and females the density of the mandibular bone decreases from 1.9 to 1.5 but throughout this age ,the density is 8% less in women. www.indiandentalacademy.com 45. • Post menopausal women frequently develop excessive loss of mineral from bone which manifests as osteoporosis. • Osteoporosis affects collagen metabolism and bone mineralization with a decrease in bone mass. • Severe osteoporosis significantly reduces the mineral content of the jaws.
Resorption of residual ridge after removal of the teeth radically changes it’s cross sectional form . • When the teeth are first removed the ridge is broad at it’s occlusal surface but as resorption occurs the residual ridges progressively narrower and shorter
CAUSES OF AGING
THEORIES OF AGING
FACTORS AFFECTING AGING
AGE CHANGES IN ORAL TISSUES
MACROSCOPIC AGE CHANGES
-EROSION -COLOUR CHANGE
MICROSCOPIC AGE CHANGES
-AGE CHANGES IN ENAMEL
-AGE CHANGES IN DENTIN
-AGE CHANGES IN PULP
-AGE CHANGES IN CEMENTUM
-AGE CHANGES IN PDL
FUNCTIONAL AGE CHANGES
AGE CHANGES IN SALIVARY GLANDS
AGE CHANGES IN TASTE ( TONGUE)
AGE CHANGES IN PALATE
AGE CHANGES ON ORAL MOTOR PERFORMANCES
AGE CHANGES IN TMJ
• Aging is the accumulation of changes over time.
• Aging in humans is a multidimensional process.
• Like any tissue in human body, dental tissues also
undergo changes from the time of development as
the age advances
Growth is increase in size.
Development is progress towards maturity.
The stabilization of the adult stage brought about by the
growth and development
• According to Comfort (1956)
Aging is defined as biologic process that causes
increased susceptibility to disease.
• According to Athens & Papas
Defined as the sum of all morphologic & functional
alterations that occur in an organism and lead to
functional impairment which decline the ability to
• According to Carranza
Aging is defined as a process of morphological and
physiological disintegration as distinguished from infant,
childhood and adolescence which are typified by
processes of integration and coordination
According to Pederson & Loe :
Is the study of aging in all its aspects
• “ Geriatric Dentistry is the
branch of dentistry that
emphasizes dental care for
the elderly population and
focuses upon patients with
physical and/ psychological
changes or morbid
conditions/ diseases “
• Declined function of the immune system with advanced
age resulting in increased susceptibility of elderly
individuals to microbial infections
• is mainly due to the host immune response toward the
micro-organisms and their products than the organism
• In 2000, Franceschi et al. coined the term
“INFLAMMAGING” in order to refer
to a low grade pro-inflammatory status
appearing during the aging process.
CAUSES OF AGING
• Aging is the end result of various biological processes :
Genetic causes :
Where information for the initiation & maintainace of cellular
functions are encoded
Cellular causes :
Where integrity of somatic cells is maintained
Organ & Organ System Level :
Where physiologic functions are performed
Physiologic functions are controlled & assembled into complex
DNA Mutations, epimutations, base
modiﬁcations, strand breaks
RNA Base modiﬁcations, miscoding
PROTEIN Amino acid modiﬁcations, miss
incorporation, miss folding,
Carbohydrates, lipids, and
Advanced glycation end-
products (AGE), lipofuscin
THEORIES OF AGING
• MEDVEDEV Listed 300 theories that have been
offered in an attempt to answer this but nothing
• The abundance of theories indicate the multitude of
interpretations possible on aging.
1)Wear And Tear Theory
2) Mathematical Theory
3) Cellular Interaction Theory
4) Collagen Theory
5) Waste Product Theory
6) Endocrine Theory
7) Calcium Theory
8) Somatic Mutation
9) Autoimmune Theory
10)Circulatory Deficiencies Theory
WEAR AND TEAR THEORY
• Wear and tear theory
postulates that the
organism wears out with
• Each cells contains
some specific amounts
of vital substances such
as enzymes and once
these substances are
used up these are not
• This leads to death of
the cells and finally
death of organism
• Cellular interaction theory is based on the
dependence of every part of the body on every
• Eg. All the endocrine glands are dependent on
each other for proper functioning.
• Individual cells in any organ are dependent on
their neighboring cells.
• Any alteration between these will lead to aging of
Cellular interaction theory
• Collagen theory postulates that
collagen fibers form continuously at a
slow rate and the collagen is eliminated
• As there is more and more formation
of collagen fibers they lead to chocking
of the cells of tissue.
• Thus hampering the functions of tissue
and finally leads to cell death.
Waste Product theory
Metabolic waste products
are not continuously
excreted from the cells and
With the time this leads to
altered functions and
ultimately organism is
poisoned and finally
leading to its death
Aging is caused by defect in
According to Selye when
large doses of Vitamin D
and parathyroid hormone
were administered in rats, it
resulted in mineralization of
many soft tissues.
Such changes resembled the
changes seen in aged tissue.
Injury to the tissue results in
the tissue non functional
Somatic Mutation theory
Somatic cells of the body develops
As more and more cells mutate, an
appreciable number of cells eventually
Almost all the cell movements are
deleterious and eventually the organ
SOMATIC MUTATION THEORY
• Autoimmune reaction develop when
some of the cells of the body synthesize
proteins that differ immunologically
from other bodily proteins.
• These altered proteins cause anaphylactic
reaction and immune reaction in the
• Further lymphocytes from elder patient
have impaired proliferated capacity when
• Thus immune system may be
compromised in elderly
Circulatory Deficiency theory
Circulatory deficiency result
in deficient oxidation of
cells, resulting in cell death
and further replacement by
collagen with increase in
collagen deposition more
capillaries are choked off
resulting in more anoxia.
Free radical theory
Introduced by R.Gerschman,1954
• Free radical is a molecule that has one free electron…
• Free radical activity is required to produce energy,
maintain immunity, nerve transmission….
• But free radicals also attack cell membranes producing
metabolic waste products – LIPOFUSCHINS.
• Lipofuschins interfere with the ability of the cells to
repair and reproduce themselves
FREE RADICAL THEORY
The Telomerase Theory
• Monumental progress in aging research
• States that Cells undergo finite number of replications
& The chromosomes shorten a bit with each cell division
until some critical point is reached
• At that point cell become dormant & dies
• These end point are called telomere.
• Thereby aging
FACTORS AFFECTING AGING
1.MUTATIONS: Several mutations reduces life span
2. SPECIES SPECIFIC LIFE SPAN :-Each species is
characterized by its own pattern of aging & maximum life
3. HYBRID VIGOR :- Out breeding enchancement
-The effect of genetic constitution on longevity is perhaps
best exemplified where hybrid vigor is demonstrated
4. SEX :- In humans/animals, female lives longer.
5. PARENTALAGE :- Like father like son.
6. PREMATURE AGING SYNDROME :- Single gene
changes results in premature senscence in humans
e.g. progeria, cockayne’s syndrome, werner’s syndrome
1. PHYSICAL AND CHEMICAL :- Pollution, radiations,
working atmosphere etc
2. BIOLOGICAL FACTORS :- Nutrition, general health etc
3. PATHOGENS AND PARASITES :- They influence the
rate of human development low income group
4. SOCIOECONOMIC CONDITIONS :- Bad housing,
“It is defined as loss of tooth structure resulting from direct
functional forces between contacting teeth”
A)Proximal surface attrition (Proximal surface faceting)
- Caries susceptible , ↓ cleansibility ,
- Drifting Decreased arch length
• B) Occluding surface attrition (occlusal wear)
• -Loss of Vertical dimension of tooth
• Loss of Vertical dimension of face + cheek biting + lip biting
• -Overclosure of mandible during functional movements, caries
prone , TMJ problems
Abrasion is defined as loss of tooth structure resulting
from direct functional forces between the teeth and
• Loss of tooth structure
resulting from chemico-
mechanical act in the
absence of specific micro-
• Also termed Abfraction .
Excessive tensile strength at the tooth
• Enamel rods are
reduced in number
manifestations of striae
of retzius &
Levels of N2 & FLOURINE’ therefore,inorganic matrix.
Enamel near the surface become DARKER & DECAY
There is reduced PERMEABILITY & enamel becomes
AGE CHANGES IN DENTIN
• Dentin is laid down through out life..
• Dentinal age changes are – Changes in physical properties
-Vitality Of dentine
- Sclerotic Dentin
-Thickness of dentine
-Aspartic Acid Racemization
Changes In Physical Properties
• Dentine becomes dark with age
• Density & mineralization increases with age
Vitality Of Dentine
• Decreases due to decrease in odontoblastic activity
Thickness Of Dentine
• Increases with age
• Also called as Irregular Dentin/ Tertiary Dentin/
• Localised close to the irritated zone of the tooth.
• Histopathologically : dentinal tubules lesser in
number, irregular, tortuous .
• Radiologically : decreased size of pulp chambers
and root canals
• Empty tubules filled with air, where odontoblast have
• In ground sections, they entrap air ,so appear black in
transmitted light and white in reflected light.
• Decreased sensitivity in these areas.
• Probably the initial step to form sclerotic dentin
Sclerosis is the result
of occlusion of the
dentinal tubules by a
with a refractive
index similar to that
of the rest of the
Increases with age
Aspartic Acid Racemization
• Racemization is a natural process which will
eventually convert optically active compounds
into a racemic mixture.
• L-Amino acids → D-Amino acids
• The aspartic acid in human tooth enamel
shows increasing racemization with age.
• Rate constant = 8.29x10⁻⁴yr⁻ⁱ
• This rate constant suggests that in any protein
with a long in vivo lifetime, D-aspartic acid
will accumulate with age
AGE CHANGES IN THE PULP
• The age-related changes of the dental pulp are difficult to separate from
physiologic defensive changes
• Size and Morphology
• Compromised circulation and innervations
• Fat droplet deposition
• Odontoblastic vacuolization
• Reticular atrophy
• Pulpal fibrosis
• Hyaline degeneration,and
SIZE AND MORPHOLOGY
• ↓ in pulp size
• Less prominent pulp horns
• More fibrous tissue with mature collagen
• Reduction in cellular components
• Reduced ground substances
• Thinning and decreased keratinization of gingival epithelium
• Increased width of attached gingiva
• An increase in epithelium permeability to bacterial antigens
• Decrease resistance to trauma
• Reduced stippling
• Flattening of rete pegs, altered density.
• Gingival recession
AGE CHANGES IN THE
Gingival Connective Tissue
• More dense and coarse connective tissue.
• Quantitative & Qualitative changes in collagen:
*↑ in tensile strength of collagen fibrils
*↑ in thermal contraction
*↓ in extensibility
*↓in ratio of ground substance to collagen
*↓ in amount of soluble collagen
*↓ in collagen turnover
*↓ in water content
* ↑ resistance to proteolytic enzyme
• Greater number of elastic fibres
• ↓ vascularity
• ↓mitotic figures
• ↓ number of fibrous tissue
• ↑ & ↓ width of PDL space
• ↑Pocket depth
• ↓Chemotaxy, motility and proliferation rate of
periodontal ligament cells.
• Attachment of PDL fibres to cemental spikes .
• ↑ osteoporosis
• ↓ vascularity
• Alveolar socket appear jagged and uneven
• Fewer fibres attached to Bone and Cementum
• Marrow space have fatty infiltration
• Bone loss
• Increase in distance between crest of a alveolar bone and CEJ -
• Recent observations with
bone graft preparations
from donors more than
50years showed less
when compared with
younger age group.
• Rate of formation diminishes with age-
scalloped IRREGULAR SURFACE
• A thickening of cementum at the apex
may obstruct the canal
• in cemental width(5-10 times).
• in width is greater APICALLY &
• Acellular Cementum with increasing age.
• Calcified bodies called CEMENTICLES are found in PDL in
• Cemental Spikes : Due to scalloping of cementum PDL fibres
appears to be attched to the scalloped peaks.
As cementum thickens with age it envelops these
masses(CEMENTICLES) & called as EXCEMENTOSIS
• Loses elasticity and becomes atrophic
• Smooth Gingiva
• Increased keratinization of lip mucosa
• Increase in number of mast cells.
• Progressive loss of sensitivity due to fibrosis
• Flattening of rete ridges
• Less moist
• Fordyces granules increase in number.
AGE CHANGES IN ORAL
• Stratum Corneum- Decreased keratinization →Smooth mucosal
• Stratum Spinosum – Reduction Of Thickness → Frequent
• Basal Layer- Hyperactivity Of Melanocytes → Dark
• Submucosal Membrane → Reduction Of Elastic Fiber
Age Changes In Tongue
• Dorsum surface shows loss of filiform papilla
• Foliate papillae more prominent.
• Fissures increase
• Dryness of the mouth
• The ventral surface of the tongue shows the presence of
nodular varicose enlargement also known as caviar
• Loss of tastebuds with age
• The thickness of epithelium of lingual mucosa decreased with aging
• Acinar atrophy of lingual gland increased with aging, especially
quickly in females.
• The atrophy of the acinus from-
-40 years old in Blandin-nuhn gland
-30 in von Ebner gland.
• Lingual muscles Decrease in muscle fiber diameter with aging is also
AGE CHANGES IN SALIVARY
Age Changes are
- Acinar Atrophy,
- Ductal Dilatation,
- Fatty infilteration,
-Peri Acinar Callus
• Submandibular gland – 40% loss of acinar cells
• Parotid gland - 30% loss of acinar cells
• Minor labial glands - 45% loss of acinar cells
Some of the ductal and acinar cells transform into non
functional cells called ONCOCYTES. •
These cells have swollen appearance eosinophilic
granular cytoplasm and pyknotic nucleus.
Protein plugs are found more frequently in ducts of
older salivary glands. These ducts have a tendency to
• It is generally believed that salivary flow decreases
This reduction in flow is more as a consequence of
xerogenic medication taken by an older individual
rather than due to the physiologic process of aging
Change in Composition
•↑ Phosphorous and calcium content
• No change in potassium
•↓Chloride and protein
•↓Viscosity of saliva
• Mouth of full term foetus is sterile
• After birth it acquires from mother and from the
• Consists: streptococcal
Bacillus, Neisseria and Yeasts.
• Mainly Streptococcus salivarius with
ORAL MICROBIAL CHANGES
At Infancy And Early Childhood
• ↑microorganisms .
• The eruption of deciduous teeth provides a new attachment
surface and turns Streptococcus sanguis and mutans as regular
inhabitants of oral cavity.
• Anaerobes are few in number due to absence of deep gingival
• Actinomyces , Lactobacilli are found regularly
• Max increase in the microbes
• Mainly because of the varied tooth morphology
• Complex microflora
• As the teeth are lost the available sites for microbial
colonisation decreases and several species diminish.
• Edentulous persons harbour few Spirochetes or Bacteroides.
• S.sanguis & mutans disappear
• C3 specific immune factors
• Nonspecific immune factors such as
lactoferrin, lysozyme and lactoperoxidase were
higher in plaque of older age group
Changes In Oral Motor Function
SPEECH MASTICATION DEGLUTITION
• TISSUES INVOLVED ARE :-upper lip, lower
lip , jaws, tongue, floor of oral cavity, soft
Speech production is most resistant to aging but that
does not mean there are no age related changes in
• You can very well perceive differences when person of
old age speaks but these are largely related to
LARYNGEAL rather than oral events.
• The main identifying feature of older speech is an
increase in the fundamental frequencies
OTHER SPEECH CHANGES MAY OCCUR DUE TO:
• EDENTULOUS PATIENT(partial or complete)
• ILL FITTING PROSTHESIS.
MASTICATION AND DEGLUTITION
↓Biting Force (16%)
People chew slowly as they get older
Older adults are capable of fewer swallows in a 10 second period
of time than younger adults
Even healthy older persons open their mouth less wide and chew
with less power which is thought to be related to loss of
muscle bulk with age and which is worsened in edentulous
Changes In Palate
• Changes in the dimensions
• Surface pattern of the hard
• Loss of concavity
• Flat palate with the loss of
• The presence of teeth was associated with the height of
the alveolar ridge, which decreased from 7.3 +/- 4.4
mm in specimens with intact teeth to 4.7 +/- 4.1 mm in
specimens without teeth (P = 0.020).
• Less prominent Palatine rugae
• Soft palate becomes smaller in size.
Changes in Maxilla & Mandible
• Maxilla resorbs in UPWARD &
• Mandible DOWNWARD &
OUTWARD so as to become
progressively wider thereby leading
to class-III relation
Longer the maxilla is edentulous,
smaller the denture bearing area
• Incisive foramen becomes
closer to the residual ridge
Residual Ridge Resorption
Consequences of Residual Ridge Resorption
# Apparent loss of sulcus width and depth
#Displacement of muscle attachment closer to crest of the residual ridge
# Loss of vertical dimension of occlusion
# Reduction of the lower face height
#Anterior rotation of mandible
#Increase in relative prognathism
#Changes in interalveolar ridge relation
#Morphological changes in alveolar bone such as sharp ,shiny uneven
AGE CHANGES IN FORAMENS
• With the resorption of the alveolar process the mental foramen
lies at or near the level of the upper border of ramus.
• Denture wearers might face problems due to application of
pressure on the mental nerve
AGE CHANGES IN GENIAL TUBERCLES
• The genial tubercles project above the upper
border of the mandible in the symphyseal
• These sharp prominence make wearing of the
lower denture painful
AGE CHANGES IN TMJ
• With increasing age the joint tends to lose its ability
to withstand degenerative changes and shows
progressive change comparable to those seen in
• Articular disc – May show islands of cartilage and
nodules of calcification Joint space – Encroachment
of large villi of the synovial membrane into the joint
cavities after the age of 50
AGE CHANGES IN MAXILLARY SINUS
• Infants & Children – Higher Than The Nasal Floor
• Adolescence – Level With The Nasal Floor
• Adults – Lower Than The Nasal Floor
• Old Age – Level With The Nasal Floor
AGING AND FORENSICS
• The techniques used to estimate age by means of
Incremental lines of Retzius
Prenatal and postnatal line formation
Racemization of collagen in dentin
Cemental incremental lines and
Translucency of dentin.
Gustafson used six dental changes connected with aging
Apical Migration Of Periodontal Ligament,
Deposition Of Secondary Dentin,
Root Resorption And
Transparency Of The Root Dentin
• Progeroid syndromes (PS) are a group of rare
genetic disorders that mimic physiological
aging, making affected individuals appear to
be older than they are
• Jose.M: Essentials Of Oral Biology, CBS
• Nanci. A: Ten Cates Oral Histology, 8th Ed, Elsevier
• Kumar. G S : Orban’s Oral Histology & Embryology, 13th Ed ,
• Berkovitz. B K B: Oral Anatomy , Histology And
Embryology,3rd Ed, Mosby
• Gerlad Shklar ;The Affect Of Aging Upon Oral Mucosa
• Robbins General Pathology Kumar /Cotran
• Polyamines In Aging And Disease ;Aging Aug 2011 Vol 3
• Aging –Programmed Change Dcna, Geriatric Dentistry
• Effect Of Age On Periodontium U Van Der Velden J Clin
Periodont 1984; 11:281-294.
• Periodontics Grant 6th Edition Carranza’s Clinical
Periodontology 9th And 10th Edition
• Patricia Masters Helfman* And Jeffrey L. BADAT “Aspartic
Acid Racemization In Tooth Enamel From Living Humans”
• Age related changes of the dental pulp complex and their
relationship to systemic aging. (oral surgery oral medicine
oral pathology,December 1991,721- 745)
• Dorrit W.Nitzan, et al : The effect of aging on tooth
morphology : A study on impacted teeth. Oral Surg Oral Med
Oral Pathol. 61 : 54-60 : 1986.
1. Bodies seen in reduced inflammation
2. Osteodentine – a type of reparative dentine ..consists entrapped odontoblasts or fibroblasts with
fewer dentinal tubules resembling bone.
3. Compensatory curves in aging
4. Clinical crown and anatomic crown
5. Proteins expressed in rep dentine
6. Sclerotic dentine and dead tracts
7. Enzymes in bone remodelling –acid phosphatase and alk.phosphatase, pyroposphatase
8. Cell rests of malazzez degenerate???
9. Reason for formation of rep dentine
10. Y der is an increase in mast cell population
11. Y der is decrease in bone mass density
12. Y resorption is more in mandible
14. Diff between pri ,sec & rep dentine
15. Age changes r damaging or protective??
16. List age changes which r damaging
17. Age changes in pdl