Download - Aging oe periodontium
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
--------------------------------
ANTIBODY SYNTHESIS,CYTOTXIC T-CELL TOXICITY,LYMPHOCYTE RESPONSE
FOLIC ACID AND VITAMIN B 12
--------------------------------
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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