Dr. Kartheek.

G
Dept of Oral Pathology
Vishnu Dental College

AGING RELATED TO ORAL TISSUES

GROWTH:- Growth is increase in size. TODD
DEVELOPMENT:- Development is progress towards maturity.
TODD
MATURATION:- The stabilization of the adult stage brought
about by the growth and development.

AGING

DEFINITION:- Refers to irreversible and inevitable changes

occurs with time
It is also defined as the sum of all morphologic & functional
alterations that occur in an organism and lead to functional
impairment which decline the ability to survive stress
ATHENS &
PAPAS
GERONTOLOGY:- Is the study of aging in all its aspects
biologic, physiologic, sociologic & psychologic.

FACTORS INFLUENCING AGING

A)

GENETIC

1.

SPECIES SPECIFIC LIFE SPAN:Each species is characterized by

its own pattern of aging &
maximum life span

2.

B) ENVIRONMENTAL
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 \ tropical countries

4.

SOCIOECONOMIC
CONDITIONS:- Bad housing,
stresses etc

SEX:- In humans\animals,
female lives longer.

3.

PARENTAL AGE:- Like father like

son.

4.

PREMATURE AGING SYNDROME:Single gene changes results in

premature senscence in humans
e.g. progeria, cockaynes
syndrome, werners syndrome.

Salivary glands and saliva

There are 3 major paired &

several minor salivary glands

present in oral cavity.

Major glands are:-

Parotid,sublingual,submandibu
lar
Minor glands are:-

Labial, buccal, palatal

MAJOR ROLES OF SALIVA

IN MAINTAINNCE OF ORAL
HEALTH
Preparation & translocation of food
bolus.
Lubrication of oral mucosa.
Preservation of microbial ecologic
balance.
Mechanical cleansing.
Antibacterial &antifungal activities.
Maintainance of oral Ph.
Remineralization of dentition.
Mediation of taste activity.

SALIVARY FUNCTION DURING

AGING
There occurs a fairly linear loss of acinar cells (30-40%), replaced by fatty

or connective tissue --- decreased saliva production.

Increase in intralobular ducts, dilation of extralobular ducts

Glands become hypo activeresults in pain and burning sensation of

mucosa

Reduced salivary flow ---inflammation and ulceration of mucosa. leading to

dryness and increased viscosity.

Gradual atropy of minor and reduced activity of major glands.

Submandibular gland
Parotid gland
Minor labial glands

40% loss of acinar cells

- 30% loss of acinar cells
- 45% loss of acinar cells

ORAL MUCOSAL BARRIER

It provides first line of defense.
Specialized mucosal sensory detectors serve to warn about many potentially harmful

situations such as spoiled food stuffs,temperature extremes,sharp objects,etc.

Any changes in O.M. barrier could expose the aging host to pathogens & chemicals that
enter the oral cavity.

Becomes atrophic and friable, smoother and dry.

Epithelium Thinner, smooth C.T interface
Variation in cell and nuclear sizes and flat interface.
Reduction in filiform papillae of tongue, foliate becomes prominent.
Caviar tongue- varicose veins on the under surface of tongue
Dryness of mouth, burning sensation and abnormal taste

EFFECTS OF AGING ON
PERIODONTIUM
GINGIVAL EPITHELIUM
Thinning & decreased keratinization of the gingival epithelium
Flattening of rete pegs, altered density.
Migration of functional epithelium from its position in healthy individual (on enamel) to more

apical position on the root surface with accompanying gingival recession

Reduced stippling, increased width of attached gingiva.

OTHER CHANGES

size of infiltrated connective tissue.

gingival crevicular fluid flow.

gingival index.

PERIODONTAL LIGAMENT (PDL)

A fibrous connective tissue that is noticeably cellular & vascular.
Functions are:
Attachment & Support
Nutrition
Proprioception
Synthesis

AGE CHANGES
No of fibroblasts

Organic matrix production & epithelial cell rest

Amount of elastic fibers.

Decreased vascularity, mitotic activity.

There is reconstrution and re orientation of PDL to compensate for mesial drift as age

advances

CEMENTUM.
Cementum continues to be
laid through out life but rate
of formation diminishes with
age
A thickening of cementum is
observed on teeth that are
not
in
function(HYPERCEMENTOSIS)
.
in cemental width(5-10
times)
as
cementum
deposition continues after
tooth eruption.
in width is greater APICALLY
& LINGUALLY

ALVEOLAR BONE (in relation to

periodontium)
A more irregular PDL surface of bone and less irregular

insertion of collagen fibers.

Healing of bone in extraction socket appears to be unaffected

by aging.
One recent observation is of view that bone graft preparation

( decalcified freeze dried bone ) from donors more than 50

years old possess significantly less osteogenic potential than
graft material from younger donors.
Resorption increases and deposition decreases ---bone porosity

AGING AND TEETH

ENAMEL CHANGES

CHEMICALLY
Levels of N2 & FLOURINE therefore, organic matrix.

Masticatory attrition due to worn off enamel in aged individuals.

Enamel near the surface become DARKER due to addition of organic material &
DECAY RESISTANT.

There is reduced PERMEABILITY & enamel becomes BRITLLE.

Occlusal wear facets appear.

HISTOLOGICALLY

THE PERIKYMATA & IMBRICATION LINES

are lost .

ENAMEL RODS are reduced

This loss alters the light reflection of enamel & results in tooth color changes.

 Since odontoblasts & its processes are integral

part of dentin, therefore, there is no doubt that

dentin is vital tissue.
It is laid throughout life. As age progress,

dentinogenesis slows.
Increased

thickness due to secondary and

reproductive dentin.

Continuous deposition of intrtubular dentin,

leading to complete closure of tubule and dentin

becoming translucent or sclerotic.
Sclerosis increases the brittleness and decreases

the permeability of dentin-to maintain pulp

vitality
Dead tracts increase with age in coronal dentin.

DENTIN CHANGES

PULP
CELL CHANGES:
Decrease in number, size,& cytoplasmic

organelle.
Obliteration of pulp chambers due to dentin
deposition
Fibrosis
Formation of pulp stones
Formation of dystrophic calcifications in pulp

CLASSIFICATON FOR PULP STONES

FREE:- entirely surrounded by pulp tissues.
ATTACHED:- partly fused with dentin.
EMBEDDED:- entirely in dentin

Dentin pulp complex

Decreased volume of pulp chamber and root canal due to

continuous deposition of dentin

Older teeth root canal is a thin channel or completely

obliterated.
Reduces vascularity to pulp.
20 yrs to 70 yrs cell density reduced to half
Loss of axons reduced sensitivity in aged.

TONGUE
It seems to increase in size in edentulous mouth which may be because of
result of transferences of some of the masticatory & phonetic function of the
tongue.
Enlarged tongue have negative effect on retention of denture.
There is DEPAPILLATION which usually begin at apex & lateral border

(Filiform).
FISSURING is also common.
There is reduction in taste buds.
Nodular varicose veins due to prominent vascular change --- Cavier tongue
Increased Fordyce spots.

TOOTH ERUPTION
Tooth eruption

doesnt cease when teeth meet

their antagonist but continuous throughout the life.

It consists of 2 phases:- active and passive

Active:- is the movement of teeth in the direction of

occlusal plane.

Passive:- exposure of teeth by apical migration of

gingival

SPEECH
Speech production is most resistant to aging but

that
doesnot mean there are no age related changes in speech.

One can very well perceive differences when person of old

age speaks but these are largely

rather than oral events.

related

to LARYNGEAL

OTHER SPEECH CHANGES MAY OCCUR DUE TO:

EDENTULOUS PATIENT(partial or complete)

ILL FITTING PROSTHESIS.

SWALLOWING \ ORAL MOVEMENT I N

OLD AGE
People chew slowly as they get older .
Although the

duration of the total chewing cycle

does not seem to change, it does seem that vertical
displacement of mandible is shortened.
(karlsson & carlsson 1990)

Age may impair the central processing of nerve

impulses, impede the activity of striated muscles &

retard the ability to make decisions.

AGE CHANGES IN MAXILLA AND

MANDIBLE
MAXILLA
It resorbs in UPWARD & INWARD direction to become

progressively smaller because of the direction & inclination

of the roots of teeth & alveolar processes.

Longer the maxilla is edentulous, smaller the denture

bearing area will be.

Incisive foramen becomes closer to the residual ridge

MANDIBLE
It resorbs in DOWMWARD & OUTWARD so as to become

progressively wider thereby leading to class- lll relation.

AGE CHANGES IN
TEMPOROMANDIBULAR JOINT
The cartilage of the TMJ is essentially completely replaced by bone
around the 4th decade of life.
The articular tissue remains relatively unchanged in appearance
throughtout adulthood,it may undergo metaplastic transformation into
fibrocartilage, depending on the biomechanical loading to which joint
was subjected.
The articular eminence,in particular,is characterized by the presence
of chondroid bone and very occasionally cartilage cell islands.
Up through the 5th decade , the mandibular fossa even becomes more
deep as the articular eminence continues to grow inferiorly,however
after that time the articular eminence tends to become
flatter,especially in individual who have become partially or completely
edentulous and have reduced loading force on the eminence.

Difference between young & adult

condyle
YOUNG CONDYLE
Condylar

head

ADULT CONDYLE
more

vascular
Neck absent
Bone is soft & pliable
Cartilage is predominant in

Less vascular
Neck is thicker
Bone is less pliable
Fibrous tissue predominant

the child

Reduction in masticatory efficiency due to stress on

capsular ligament.

AGE CHANGES IN MAXILLARY SINU

The maxillary sinus(ANTRUM OF HIGHMORE) is apparent by

17th day in utero.

At birth each sinus is quite small & slit like, lying in the most

medial aspect of the maxilla.

The greatest dimensions in the AP direction is not more than

8mm

With growth sinus enlarge laterally under the orbit & by the

2ndyear, they reach laterally to the infraorbital canals.

By 9th year they extend to the zygomatic bones & to the

level of the floor of the nasal fossae.

Conclusion
Aging does not cause disease; however; age is associated with more disease.
Periodontal disease in older adults is probably not due to greater susceptibility but instead is
the result of cumulative disease progression over the time.

RESTORATION S IN OLDERS

Marginal adaptation of restoration is weak point.

Etching cannot be done may lead to hypersensitivity.

Root surface is highly irregular to achieve the smooth cavosurface magins ,therefore, risk of
secondary caries.

Best material is FLOURIDE RELEASING GLASS IONOMER CEMENTS.

Pulp capping or Pulpotomy should be avoided

THANK YOU

Management of problems related to aging must be a part of day to day life .