AGING AND PERIODONTIUM

Aging:

Is a slowing of natural function, a disintegration of the balanced control and organization that
characterize the young adult.

Is the process by which a person grows old, irrespective of the time required. It includes the complex
interaction of biologic, psychologic, and sociologic process over time.

Is an energy process beginning at conception that is directed by endowments and impelled by perceived
phenomenologic events, which sustain the process until the biologic mechanism ceases to function (Ebersole
and hess 1994).

The historically accepted chronologic land mark of old age is 65 years.

AGE RELATED CHANGES IN THE GINGIVA AND OTHER AREAS OF ORAL MUCOSA:

1. GINGIVA:

 Reduced or unchanged amount of splinting.

 Thinning and decrease in keratinization.

 Increased width of attached gingival.

 Increase in epithelial permeability to bacterial antigens.

 Decreased resistance to functional trauma.

 Oral epithelium becomes thinner with age.

 An increase or no change in mitotic index of gingival epithelium.

 The keratinization potential of hard palate epithelium does not change with age.

 An increased keratinization of lip and cheek mucosa.

 Atrophy of connective tissue with loss of elasticity.

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 Decrease in the number of protein bound hexoses and mucoproteins and increase in the
number of mast cells.

 The cellular component of connective tissue also decreases with age.

 Decreased oxygen consumption.

2. Gingival connective tissue:

 Coarser and denser gingival connective tissue.

 Qualitative and quantitative changes to collagen-include increase rate of conversion of soluble

3. Periodontal ligament:

 Greater number of elastic fibres.

 Decrease in vascularity.

 Decrease in mitotic activity.

 Decrease in the number of collgen fibres and mucopolysaccharides.

 Decrease number of fibroblasts and more irregular structure.

 Decrease organic matrix production and epithelial cell rests.

 Increase in arteriosclerotic changes.

 Both in increase and decrease in the width of the ligament has been described with aging.

 Unopposed tooth-hypofunction and masticatory forces decrease with age, which may
contribute to reduction in the width of the periodontal ligament.

 Increase in width may be due to the availability of fewer teeth to support the entire functional
load.

 A decrease in the width may also result from encroachment on the ligament by continuous
deposition of cementum and bone.

 A reduction in organic matrix productionand loss of acid mucoplysacharids.

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4. Alveolar bone:

 Osteoporosis.

 Decrease in vascularity.

 Decrease in metabolic rate.

 Decrease healing capacity.

 Increase in the intestinal lamellae.

 Decrease in the number of cells in the osteogenic layer of cribriform plate.

 With increasing age the periodontal surface of alveolar bone become jagged or irregular.

 Collagen fibres show a less regular insertion to the bone.

 Bone density decreases by around 20% between ages of 45 and 90.

 The peak adult bone mass is attained at 35 years, subsequently bone mass decreases with age.

5. Cementum:

 Cementum deposition appears to be continuous throught life.

 Increase in width is most marked (5-10 times) in the apical and lingual regeion of the tooth.

 A slight increase in the remodeling of cementum also occurs with age and is charectrised by
areas of resorption and apposition, which may account for increased irregularity observed on the cemental
surfaces of older teeth.

 Cementum deposition is less near cemento-enamel- junction.

 Average thickness of 95 μm at age 20 and 215 µm at age 60 has been reported at almost three
times increase.

 Cemental tears are frequently seen in specimens of aging humans.

 The total width of cementum at age 76 is three times that at age 11.

6. Effects on plaque:

Plaque increases with age, because of increases in hard tissue surface area as a result of gingival recession and
surface characteristics of the exposed root surfaces.

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 Calcium and phosphorus levels increase with age. Plaque from young patients contains more viable
microorganisms per milligram than plaque from the elderly. The number of spirochetes is reported to increase
in plaque with increase age. Conversely there is a fall in the number of streptococci.

In early stages of plaque accumulation there are significantly fewer bacteria in the elderly patient. This
phenomenon may caused by physiological changes in saliva. An increase incidence of xerostomia in the elderly
may also contribute to gross accumulation of deposits. Certain enzyme and immunological differences are
apparent in plaque from elderly patients. Levan hydrolase activity is markedly lower than in young. The
concentration of immune factors (IgA, IgM, C3, Lactoferrin, Lysozyme and Lactoperoxidase) is reported to be
higher in plaque obtained from older people.

For supra gingival plaque no real qualitative differences have been shown for plaque composition. For sub
gingival plaque there is increase in number of enteric rods and pseudomonas in older patients.

There is slight shift in the microorganisms in plaque with increase in age, they are increase role of
Porphyromonalis gingivalis and decrease in role of Actinobaccilus actinomycitocomitans.

7. Tooth-periodontal Relationships:

The most obvious change in the teeth with aging is a loss of tooth substance caused by attrition. Attrition is
defined as the physiologic wearing of a tooth as a result of tooth contact, as in mastication. The degree of
attrition is influenced by musculature, consistency of the food, tooth hardness, occupational factors, and habits
such as grinding (bruxism) and clenching.

The rate of attrition may be coordinated with other aging related changes such as continuous tooth eruption
and gingival recession.

If bone support is reduced, the clinical crown tends to become disproportionately long and exerts excessive
leverage on the bone. By reducing the clinical crown length, attrition appears to preserve the balance between
the tooth and its bony support.

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 Wear of teeth also occurs on the proximal surfaces, accompanied by mesial migration of the teeth. Proximal
wear reduces the anteroposterior length of dental arch by approximately 0.5cm by age 40years.

Abrasion is the pathologic wearing of tooth substance through some abnormal mechanical process. This
describes the condition in which tooth substance is lost by frictional effects other than those associated with
mastication. It is most marked in cervical regions of crown on buccal and labial surfaces.

8. Masticatory Efficiency:

Slight atrophy of buccal musculature has been described as the physiologic feature of aging. However,
reduction in masticatory efficiency in aged individuals is more likely to be the result of unreplaced missing
teeth, loose teeth, poorly fitting dentures.

Reduced masticatory efficiency leads to poor chewing habits and the possibility of associated digestive
disturbances. Aged persons select foods requiring less chewing effort when masticatory efficiency is impaired.
A diet high in fiber, vitamins and comparatively low in fat is beneficial for older age groups.

9. Aging and The cumulative effects of oral disease:

Changes such as gingival recession, attrition and reduction in bone height in the elderly results from
the disease and factors in the oral environment and not from physiologic aging. The experimental gingivitis
models have shown that inflammation develops more rapidly in older individuals than in children. This may
occur in part because areas of recession in older individuals may favour plaque accumulation and partly from
decreased immune response with aging.

Inflammation develops more rapidly and wound healing proceeds more slowly in old than young with the
same susceptibility to periodontal disease.

Rapidly destructive form of periodontal disease occurs in younger patients and is usually associated with
deficient leukocyte function. Elderly individuals have a slowly progressive form of the disease that does not
result from impaired leuckocyte function or host defence mechanism.

SOCIAL AND MENTAL EXAMINATION OF AGING INDIVIDUALS:

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 Elderly patients attitude toward therapy have a significant impact on the success or failure of periodontal
therapy. Freedman has described three commonly encountered behavior types.

Overdependent: demanding, urgent and repetitious

Pseudocooperative: comes on times, pays for service, is friendly and listen to instructions, but some how never
carries them out.

Perfectionist: makes unrealistic demands with veiled threats, interprets his or her own symptoms, and adjusts
own dentures, makes suggestions about the diagnosis or treatment plan, and try to eat with dentures with him
or she could not eat with natural teeth.

CONCLUSION:

Geriatric population is expanding, and their needs for periodontal services are becoming specialized. The
variety of intraoral, medical, social, mental, and physical problems encountered provide unlimited challenges to
the clinicians. If the needs of the geriatric patient are to be met, clinicians must be willing to care for each
individual with patience. The mouth must be viewed as a reflection of the systemic condition, and treatment is
approached accordingly.

Dental practioners of the 21st century should be comfortable providing comprehensive periodontal care for
aging population. Aging dental patients have particular oral and general health conditions that dentists should
be familiar with detecting, consulting, and treating.

Medical diseases and conditions that occur more often with age may require modification to periodontal
preventive tools as well as the planning and treatment phases of periodontal care.