BY MONICA SHEETHAL

AGING AND THE PERIODONTIUM

GINGIVAL EPITHELIUM

Thinning of epithelium

Increased epithelial permeability to pathogens

Decreased resistance to functional trauma

EFFECTS OF AGING ON THE PERIODONTIUM

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

Normal relationship with gingival margin

Coarser and denser gingival connective tissueQualitative and quantitative changes to collagen include;

◊ increased rate of conversion of soluble to insoluble collagen.

◊ increased mechanical strength

◊ increased denaturing temperatureThese results indicate increased collagen stabilization caused by

the changes in the macromolecular conformation

GINGIVAL CONNECTIVE TISSUE

Decreased number of fibroblasts

Decreased organic matrix production

Decreased epithelial cell rests

Decreased number of collagen fibers

↓

reduction or loss in tissue elasticity

PERIODONTAL LIGAMENT

Cells of PDL have reduced mitotic activity

Changes in the width of PDL

Decreased functional status of the teeth

Decreased vascularity

↓

decreased mucopolysaccharide production

Increase in cemental width

Increase may be 5 to 10 times with increasing age

Increase in width is greater apically and lingually

CEMENTUM

Reduction of bone mass

More irregular periodontal surface of bone

Less regular insertion of collagen fibers

Increased bone resorption

ALVEOLAR BONE

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.

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

BACTERIAL PLAQUE

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

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

IMMUNE RESPONSE

NUTRIENT INCREASED FUNCTION

DECREASED FUNCTION

VITAMIN A BACTERIAL ADHESION

SALIVARY ANTIMICROBIAL PROPERITIES,IMMUNOGLOBULIN AND LYMPHOCYTES PRODUCTION

VITAMIN E ------------------------------ ANTIBODY SYNTHESIS,RESPONSE OF LYMPHOCYTES,PHAGOCYTIC ACTION

VITAMIN C ------------------------------ PHAGOCYTIC ACTION OF NEUTROPHILS AND MACROPHAGES,ANTIBODY RESPONSE

ZINC ------------------------------- ANTIBODY RESPONSE,PHAGOCYTIC FUNCTION OF MACROPHAGES

NUTRITION EFFECTS ON IMMUNE RESPONSE

RIBOFLAVIN,VIT B6,PANTHOTENIC ACID

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ANTIBODY SYNTHESIS,CYTOTXIC T-CELL TOXICITY,LYMPHOCYTE RESPONSE

FOLIC ACID AND VITAMIN B 12

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CYTOTOXIC T CELL TOXICITY,LYMPHOCYTE PRODUCTION,PHAGOCYTIC FUNCTION OF NEUTROPHILSIRON ------------------------------

--LYMPHOCYTIC PROLIFERATION,NEUTROPHIL CYTOTOXIC ACTIVITY,ANTIBODY RESPONSE

Older individual demonstrate more inflammationLong 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

EFFECTS OF AGING ON PROGRESSION OF PERIODONTAL DISEASE

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

CLINICAL CHANGES

GINGIVAL RECESSION

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

Reduced bony mass and support

Increased bone resorption

RADIOGRAPHIC CHANGES

BONE RESORPTION

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,mental 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.

AGING AND RESPONSE TO TREATMENT OF THE PERIODONTIUM

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 dexterityOlder adults may change tooth brush

habitsbecause of disabilities such as hemiplegia secondary to CVA,visual difficulties,dementia and arthritis

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

DENTAL EXAMINATION:ASSESSMENTS FOR OLDER ADULT PATIENTS

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]

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 functionNote any signs of xerostomia,including the following

intraoral dryness,burning sensation,altered tongue surface,dysphagia,chelosis,alteration in taste,difficulty with speech,root caries.

TONGUE BLADE SCREEN FOR TESTING SALIVA

IMMUNE SYSTEM

●Asscess for pronounced inflammatory responses of the gingiva to infection

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