effects of aging edentulous patient

7/16/2019 Effects of Aging Edentulous Patient

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EFFECTS OF AGING ON

EDENTULOUS PATIENT

Presentation by:Maliha Tahir


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THE AGING POPULATION

In the population of western countries 10% of populationis older than 65 years.

Women continue to outnumber men by nearly 2:1because they live longer , the average life expectancy ofwoman is 80 years , while man is only expected to live 73years !!

Everyone by age 75 is burdened to some extent by atleast one chronic disorder that could limit their access todental care or influence their response to dentaltreatment.


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Biomechanics of the

Edentulous State

Support mechanism for natural dentition.

Support mechanism for complete denture.

Changes in Morphological face height and the TMJ.

Esthetic, Behavioural and Adaptive responses.


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Support Mechanism For Natural

Dentition

The principal functions of the

periodontium are support andpositional adjustment of teeth together

with secondary and dependent

function ofsensoryperception.


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Periodontium As A Supporting

Element

Soft tissue=PDL

Highly organized and

oriented.

Highly vascularized. Highly innervated( touch,

pain &pressure).

Contain elastic fibers.

Approximately uniformthickness.

Hard tissue=bone+cementum

Cementum hard to resorb.

Bone well vascularized.

Normally they receivetensile loads.

Provide excellent medium

for PDL attachment


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Support mechanism for

complete denture

Alveolar mucosa:

Uneven thickness.

Uneven attachment &resiliency.

Less vasularization &innervations.

Diminished proprioceptive nerve

endings.

Reduced elasticity.


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Masticatory support and masticatory loads:

Total surface area: 22.96 cm2 edentulous maxilla

12.25 cm2 edentulous mandible

45 cm2 PDL

Tolerance and adaptability: reduced by systemic and

metabolic disease.

Masticatory loads: 44Ib(20 kg) natural teeth

13 to 16 Ib(6 to 8kg) complete denture.


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The residual ridges:

Consists of denture-bearing mucosa, the submucosa and

periosteum, and the underlying bone.

Following teeth loss, the alveolar ridge is subjected toongoing resorption.


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Denture movement -- resiliency of mucosa & instability of

complete denture can cause tissue damage

Factors affecting retention:

Maximal extension of denture base

Maximal intimate contact of denture base & its basal seat

Muscular factors (actions of buccinator, orbicularis oris,

and the extrinsic and intrinsic muscles of the tongue) with

appropriate impression techniques.


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Viscoelastic Behavior Of The

Alveolar Mucosa

Oral mucosa is displaced under

load about 10 times more than

the periodontium. Mucosa has less elasticity than

PDL.

A slower recovery rate to

sustained loads.


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Occlusion

Primary components:

- Dentition.

- Neuromuscular system.

- Craniofacial structures.

These are disturbed by the substitution of a complete

denture for the teeth/periodontium.


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DEVELOPMENT AND ADAPTATION OF THE

OCCLUSION

Developing dentition

Healthy adult dentition

Deteriorating adult dentition

The edentulous state

1- extensive sensory input

2-development of motor skills&

neuromuscular learning.

3- dental , alveolar, craniofacial adaptability

1-dental adaptation (wear, drift, extrusion)2-bone adaptation is reparative.

3-learned protective reflexes.

1-partial edentulism.

2-periodontal disease.

3-diminished dental reflex adaptation.

1-residual ridge reduction..

2-compromised reflex.

3-increase in parafunctional movements.


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Changes In Morphological Face

Height And TMJ

Premature reduction occurs with attrition/abrasion of teeth.

Reduction is more conspicuous in edentulous & complete

denture wearers.

Most of edentulous patients experienced a spectrumvariation as a result of mutilated dentition.

In the course of such periods, pathological and/or adaptive

structural alterations may take place.

Continued loading beyond adaptive capability of thearticular tissues may lead to osteoarthritis.

TMJ could undergo degenerative joint disease, however

other investigators consider it as a process rather than

disease entity.


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Esthetic, Behavioral & Adaptive

Responses

Esthetic changes: Deepening of the nasolabial sulcus.

Loss of labioincisal angle. Narrowing the lip.

Increase in columella philtral angle.

Prognathic appearance.

Decrease in horizontal labial angle.


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Adaptive & psychological responses: Complete denture requires adaptation of learning, muscular skill &

motivation

Patients ability & willingness to accept & learn to use dentures.

Also Habituation gradual diminution of responses to continued or

repeated stimuli.

In old ageMemory & Storage is difficult, so adaptation to complete

denture becomes difficult (as progressive atrophy of elements in

cerebral cortex & consequent loss in facility of coordination occurs)

So Dentists role is to MOTIVATE the patients & make understand

their NEEDS has proven to be of greatest clinical value


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The Impact Of Age On The

Edentulous Mouth

Mucosa Bone Saliva


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MUCOSA

Becomes thin, easilyabraded, and frequentlyreacts unfavorably to thepressure of dentures.

Stomatitis and other mildinflammation are the mucosallesions encountered mostfrequently in older edentulousmouths, especially of oldermen who wear dentures,smoke tobaccos and drinkalcohol excessively.

High risk of oral cancer in

such patients.


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BONE

Lessefficient

osteoblast

Decreaseestrogen

Decreasecalcium

absorption


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Increase in porosity i.e. osteoporosis

Types of osteoporosis

- Type 1 (post menopausal)- Type 2 (senile or idiopathic)

Treatment of osteoporosis

- Bisphosphonates, estrogen


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Decreases in quantity and changes inquality

Lack of lubrication or viscous or soapysaliva decreases the retention of

dentures and increases frictional traumato the thin mucosa

Causes of change in saliva:

1. Xerostomic medication

2. Xerostomia

3. Sjogren syndrome4. Stress

5. Depression

6. Tobacco use

7. Alcohol abuse


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JAW MOVEMENTS IN OLD AGE

Decrease inactivity of brain

Poor motorcoordination &weak muscles

Short chewingstrokes &prolonged

chewing time


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Pain on swallowing due to

- osteophytes

- spurs growing on the upper spine

adjacent to the pharynx.


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Taste and Smell

Senstation of taste and smell are frequently confused

because the sensory mechanisms are closely related

and dependant.

Olfactory cells damage with age.

Decreased sensitivity to taste seen more commonly in

ALZHEIMER.

Associated cranial nerves VI, IX, X can be disturbed and

damaged by tumors and viruses.


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Nutrition And Diet

As one ages people become less active sincemuscle activity is limited canonic requirementis lower

It is time for more protein and fewercarbohydrates

There is risk of malnutrition because of varietyof factors ranging from socioeconomic statusto over consumption of drugs

Obesity can result from excessive intake ofreturned carbohydrate

Patients who are successfully using denturesare suddenly find that dentures are no longercomfortable because of the supporting tissuechange with the weight loss.

Angular cheilitis and stomatitis caused bymalnutrition.


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Aging Skin And Teeth

Skin: Skin becomes thin, wrinkled and

dried.

Upper lip shows decreasedconcavity, pouting and flat

philtrum, drooping of upper lip.

Naso-labial groove deepens,

which produce a sagging look to

the middle third of the face.

Atrophy at subcutaneous endbuccal pads of fat hollows thecheeks


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Teeth: Altered chroma and value

Abraded enamel

Brownish appearance of dentition


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Summary

Need of complete denture will increase in coming centuries.

Poor healing in old age i.e. trauma of ill fitting dentures heals slowly.

Prosthodontics requires good diagnosis of systemic and localproblems.

New dentures are not accepted easily by older patients so try modify

the older one .

Patients identity should be embedded.


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Life at any age does not have pleasant

surprises and rewards so adaptationshould be the hallmark of successful aging.


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effects of aging edentulous patient

Documents

aging populationin

cm2 edentulous maxilla12

denture movement

masticatory support

masticatory loads

hard tissue

receivetensile loads

bone cementum cementum