Aging and The Periodontium

CONTENTS
 Introduction
 Periodontium
 Age changes in the gingival epithelium
 Age changes in gingival connective tissue
 Changes in the periodontal ligament
 Changes in the cementum
 Changes in the bone
 Effects of aging on the progression of the
periodontal diseases
 Aging and the response to treatment of the
periodontium
 Reference
Increased awarness and improvements in preventive dentistry have led to
decreasing tooth loss for all age groups.
The effects of this shift in tooth retention need to be considered carefully.
In particular,increased life expectancy and greater health expectations may lead
to changes in demand from older individuals for periodontal treatment and

potentially a substansial increase for supportive periodontal therapy.
Aging causes changes in the periodontium;therefore broader aspects aging are
examined,as well as the possible effects on treatment outcomes.

PERIODONTIUM
 The normal periodontium provides the support necessary to maintain
teeth in function.
 It consists of four principle components:
• Gingiva
• Periodontal ligament
• Cementum
• Alveolar bone
1.AGE CHANGES IN GINGIVAL EPITHELIUM
 Thinning and decreased keratinization of the gingival epithelium have
been reported with age.
- This is because of the increase in epithelial permeability to bacterial

antigens,a decreased resistance to functional trauma,or both.
 Flattening of rete pegs and altered cell density.
 According to some reports,there is migration of the junctional epithelium from
its position in healthy individuals(i.e. On enamel)to a more apical position on
the root surface with accompanying gingival recession.
- With continuing gingival recession,the width of the attached gingiva

would be expected to decrease with age,but the opposite appears to be true.
2.CHANGES IN GINGIVAL CONNECTIVE TISSUE
 Increasing age results in coarser and denser gingival

connective tissues.
 Qualitative and quantitative changes to collagen have been reported.
- These include an decreased rate of conversion of soluble to

insoluble collagen,increased mechanical strength and increased denaturing
temperature.
-These results indicate increased collagen stabilization caused

by changes in the macromolecular conformation.
3. CHANGES IN THE PERIODONTAL LIGAMENT
 Decreased number of fibroblasts and a more irregular

structure,paralleling the changes in the gingival connective tissues.
 Decreased organic matrix production and epithelial cell rests and
increased amounts of elastic fiber.
 Decreased cell proliferation.
4. CHANGES IN THE CEMENTUM
 Increase in the cemental width;this maybe 5-10 times with increasing

age.
- The increase in width is greater apically and lingually.

5. CHANGES IN THE ALVEOLAR BONE
 More irregular periodontal surface of bone and less regular insertion

of collagen fibres.
-Although age is a risk factor for the bone mass reductions in
osteoporosis, it is not causative and therefore,should be distinguished from
physiologic aging processes.
-Overriding the diverse observations of bony changes with age
is the important finding that the healing rate of bone in extraction sockets
appears to be unaffected by increasing age.
EFFECTS OF AGING ON THE PROGRESSION OF
PERIODONDAL DISEASES
In a classic experimental gingivitis study, subjects were
rendered plaque and inflammation free through frequent professional
cleaning.
Once this was achieved,the subjects abstained from oral hygiene measures for
periods of 3 weeks to allow gingivitis to develop.
In this experimental model,a comparison of developing gingivitis between
young and older individuals demonstrated a greater inflammatory

response in older subjects.
In older age groups(60-80 years), the findings included a greater size of

infiltrated connective tissue,increased gingival crevicular fluid flow,and
Even at the basement level of excellent gingival health before commencing
plaque accumulation,differences may exist between groups,with older
individuals demonstrating more inflammation.
The phrase, “getting long in the tooth” expresses a widespread belief that age is
inevitably associated with an increased loss of connective tissue
attachment.
A “risk factor” is defined as ‘any characteristic,behaviour,or exposure with an
association to a particular disease’. Some risk factors like smoking, can
be modified to reduce one’s risk of initiation or progression of disease;
while othre factors cannot be modified such as genetic factors.
Therefore,age has been suggested to be not a true risk factor but a

background
or an associated factor for periodontitis.
AGING AND THE RESPONSE TO TREATMENT OF
THE PERIODONTIUM
 The successful treatment of periodontitis requires both meticulous home-

care plaque control by the patient and meticulous supragingival and
subgingival debridement by the therapist.
 If plaque control is not ideal, continued loss of attachment is
inevitable.
 Furthermore, without effective periodontal therapy,progression of
diseases might be faster with increasing age.

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CONTENTS

to changes in demand from older individuals for periodontal treatment and

examined,as well as the possible effects on treatment outcomes.

- This is because of the increase in epithelial permeability to bacterial

- With continuing gingival recession,the width of the attached gingiva

 Increasing age results in coarser and denser gingival

- These include an decreased rate of conversion of soluble to

-These results indicate increased collagen stabilization caused

 Decreased number of fibroblasts and a more irregular

 Increase in the cemental width;this maybe 5-10 times with increasing

- The increase in width is greater apically and lingually.

 More irregular periodontal surface of bone and less regular insertion

young and older individuals demonstrated a greater inflammatory

In older age groups(60-80 years), the findings included a greater size of

Therefore,age has been suggested to be not a true risk factor but a

 The successful treatment of periodontitis requires both meticulous home-

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