IN
ORAL TISSUES
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

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Contents
•
•
•
•

Introduction
Definition
Theories of ageing
Age changes in oral tissues
tissue changes : teeth
periodonti...
• Prosthodontic considerations
• Summary
• Conclusion
• References

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Introduction
• Increase in awareness among the medical and
dental practitioners that, older age group
constitute a growing...
Definition
• Ageing is defined as a process of morphological
and physiological disintegration as distinguished
from infant...
General Effects Of Ageing

Tissue desiccation
Decreased elasticity.
Diminished reparative capacity
Altered cell permeabili...
Ageing leads to limitations in the adaptive capacity
of the organism

Reduced adaptive capacity

Development of age relate...
Theories of Ageing
1.

Wear and tear theory

2.

Neuro-endocrine theory

3.

Genetic control theory

4.

Free radical theo...
theories…
8. Errors and repairs theory
9. Redundant DNA theory
10. Cross linkage theory
11. Auto immune theory
12. Gene mu...
Wear and tear theory
• Given by August Weihmann(1882)
• Proposed that organs and tissues were damaged by
continuous use an...
Neuroendocrine theory
• Given by Vladimir Dilman.
• In neuroendocrine system, a complicated network
of biochemicals govern...
Free radical theory
• Introduced by R.Gerschman,1954
• Free radical is a molecule that has one free
electron…
• Free radic...
• The telomerase theory of ageing – recent.
• Monumental progress in ageing research,but there
is yet to be a unanimous de...
Age changes in oral tissues

Tissue changes

Functional changes

1. Teeth

1. Salivary

2. Periodontium

2. Taste

-bone

...
Changes in Tissues

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Age changes in teeth
Regressive alterations
Attrition
Abrasion
Erosion

Enamel
Dentin
Cementum
Pulp

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Attrition
• Physiologic wearing
away of tooth as a
result of tooth to tooth
contact.
• Causes-masticatory stress
-para-fun...
Stages of Attrition
1. Stage I
Wear of enamel of cusps and incisal edges without
exposure of dentin.
2. Stage II
Wear of e...
Abrasion
• It is the pathological
wearing away of tooth
through abnormal
mechanical processes.
• e.g.- abrasive dentifrice...
Toothpick abrasion

Bobby pin abrasion
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Erosion
• Loss of tooth
substance by a
chemical process that
does not involve known
bacterial action.

Lingual erosion

• ...
Age changes in Enamel
• Macroscopic –
-becomes darker
-attrition, abrasion, erosion
-longitudinal cracks
• Microscopic –
-...
Age changes in Dentin
• Dentin is laid down through out life.
• Dentin laid down after birth is Secondary Dentin.
• Pathol...
Reparative Dentin
• Also called as Irregular Dentin/ Tertiary Dentin/
Irritation Dentin
. Localised close to the irritated...
How does Reparative Dentin form?
insult/injury to the tooth
odontoblasts
Degenerate

form repararive dentin
Seals off the ...
Dead Tracts
• Empty tubules filled with air, where ododntoblsts
have degenerated.
• In ground sections, they entrap air ,s...
Dead Tracts - ground section

Dead tracts

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Sclerotic Dentin
• Protective changes in response to any injury in
primary dentin itself.
• Collagen fibrils and apatite c...
Sclerotic dentin under a zone of
caries
Carious lesion

Sclerotic dentin
pulp

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Age changes in Dental Pulp
1. Reduction in size and
volume of pulp :
Reduction in pulpal
area in coronal pulp
because of c...
Young tooth
Reparative dentin

Old tooth

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Decrease in size of pulp
2. Reduction in cell number :
-fewer cells with reduced number of organelles
like RER, mitochondria, etc.
-odontoblasts, f...
4. Changes in blood vessels :
-narrowing of circumference of vessels.
-atherosclerotic changes in small arteries.
-intimal...
5.Changes in nerve distribution :
-nerves aggregating at the core appear prominent.
-degeneration and loss of pulpal nerve...
6.Pulp calcifications :
- Calcified masses appearing in coronal and root
portions of pulp.
- seen in functional as well as...
Based on histolological
appearance
True pulp stones

False pulp stones

• Resemble
secondary dentin

• Don’t exhibit denti...
Based on location, pulp
calcifications are

Attached pulp stone

Free pulp stone

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Amorphous calcifications
around blood vessels

Pulp chamber

dentin

Diffuse calcifications
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Age changes in Cementum
• Thickness of cementum is one of the criteria to
assess age of an individual.
• Increase in thick...
Hypercementosis
• It is the abnormal thickening
of cementum.
Occlusal stress
Spike like projections formed
Increase surfac...
Age changes in Bone
• Adapts to meet the functional demands.
• Histologically there is decrease in bone forming
cells.
• B...
Osteoporosis
• It is a disorder that adversely affects the collagen
metabolism with concomitant decrease in bone
mass.
• M...
www.indiandentalacademy.com
Residual ridge resorption
• With age, number of teeth present in the oral cavity
decreases.. so the force acting on the re...
• Annual rate of reduction in height is 0.1 to 0.2mm
and in general four times less in edentulous
maxilla.
• Etiology : an...
Changes in Maxilla
- Maxillary teeth are directed downward and outward
thus bone reduction is upward and inward.
- Resorpt...
• Maxillary bone resorbs
on the crest and labial
and buccal cortices.
• Thus, maxillary ridge
loses height and
becomes nar...
Changes in Mandible
- The mandibular ridge resorbs primarily on the crest
of the ridge.
- Because the mandible is wider at...
Mental foramen :
• With the resorption of the alveolar process the
mental foramen lies at or near the level of the upper
b...
• The residual alveolar
ridge becomes wider
with resorption.
• Resorption away from
centre.

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- Density of mandibular bone decreases from 1.9 to
1.5% between 45 and 90yrs,value being 8% less in
females…

Henrikson an...
Age changes in mandible

adulthood
At childhood
In birth
old age
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Age changes in periodontal ligament
• Increase in number of fibroblasts.
• Greater collagen and elastic fibre content.
• D...
Periodontitis
• It reflects the age related change and accumulation
of previous dental experiences.
• Gingival recession
•...
Age Changes in Oral Mucous
Membrane
• Surface of oral cavity is mucous membrane and its
structure varies in apparent adapt...
According to Massler- tissue friability arises from
three sources –
1. A shift in water balance from the intracellular to
...
• Histologically : -thinning of epithelium
-loss of cohesiveness of epithelial
cells – vitamin A deficiency
-decreased pro...
Migration of Junctional Epithelium
• Migration of junctional epithelium from its normal
position to a position more apical...
Changes in Function

www.indiandentalacademy.com
Salivary glands
• Appear less compact with ducts occupying major
portion.
• Increased focal adenitis.
• Rate of production...
Xerostomia
• Dryness of mouth.
• Is usually not seen in healthy non medicated
individuals.
• Associated with persons on me...
• Xerostomia causes
dryness of the mucosa.
• Fissured tongue.

Fissured tongue

• Angular chelitis.

Angular chelitis
www....
Tongue and Taste sensation
• Number of taste buds decline with age.
• At 70yrs, taste buds decrease to 1/6th of those
pres...
• One of the common age change is nodular
varicose enlargement of veins on ventral surface of
the tongue (caviar tongue).
...
Mastication and deglutition
1. Most frequent oral motor disturbance in older
persons is related to mastication
2. Masticat...
• The biting force reduces from 300lb/in2 to 50lb/in2
with age… Kaplan .
*

• Lip seal is less efficient in older subjects...
Prosthodontic
considerations

www.indiandentalacademy.com
• Thin friable epithelium may not be able to tolerate
the forces imposed on it by the hard unyielding
acrylic denture base...
• Lammie (1960) postulated the theory of epithelial
atrophy results in decrease in number of epithelial
cells, thus decrea...
• Residual ridge resorption is centripetal in maxilla
and centrifugal in mandible making maxilla
comparatively narrower an...
www.indiandentalacademy.com
• In cases of severe attrition and abrasion, there is
loss of vertical dimension..results in aged
appearance.
• Prosthodon...
www.indiandentalacademy.com
Summary
• Age changes in oral tissues can be broadly
classified into TISSUE and FUNCTIONAL changes.
• Tissue – teeth
- per...
Conclusion
• A thorough understanding of the morphological
alterations that occur during ageing is important,
for, such kn...
References
1. Boucher ( 2004)Prosthodontic Treatment for
Edentulous Patients 12 edition . Mosby
2. Sheldon Winkler(2004) E...
7. Shafer (1999) A Textbook of Oral Pathology 4
edition W B Saunder.
8. Geriatric Dentistry – The Dental Clinics Of North
...
12. Orban’s Oral Histology and Embryology(1990),
tenth edition.
13. Stopping the clock(1997),Dr.Donald Klatz and
Dr.Robert...
‘Youth is a gift of nature,
but age is the work of art.’

Thank you
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  • Age changes in oral tissues/ /certified fixed orthodontic courses by Indian dental academy

    1. 1. IN ORAL TISSUES INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
    2. 2. Contents • • • • Introduction Definition Theories of ageing Age changes in oral tissues tissue changes : teeth periodontium functional changes :salivary taste deglutition mastication www.indiandentalacademy.com
    3. 3. • Prosthodontic considerations • Summary • Conclusion • References www.indiandentalacademy.com
    4. 4. Introduction • Increase in awareness among the medical and dental practitioners that, older age group constitute a growing proportion …. • An understanding of ageing and the morphological alterations that occur during ageing is important to diagnose, plan and treat the older population. www.indiandentalacademy.com
    5. 5. Definition • Ageing is defined as a process of morphological and physiological disintegration as distinguished from infant, childhood and adolescence which are typified by processes of integration and coordination…Carranza. • A disintegration of the balanced control and organisation that charecterises the young adult. www.indiandentalacademy.com
    6. 6. General Effects Of Ageing Tissue desiccation Decreased elasticity. Diminished reparative capacity Altered cell permeability www.indiandentalacademy.com
    7. 7. Ageing leads to limitations in the adaptive capacity of the organism Reduced adaptive capacity Development of age related pathological conditions…death. www.indiandentalacademy.com
    8. 8. Theories of Ageing 1. Wear and tear theory 2. Neuro-endocrine theory 3. Genetic control theory 4. Free radical theory 5. Mitochondrial theory 6. Waste accumulation theory 7. Limited number of cell division theory www.indiandentalacademy.com
    9. 9. theories… 8. Errors and repairs theory 9. Redundant DNA theory 10. Cross linkage theory 11. Auto immune theory 12. Gene mutation theory 13. Telomerase theory www.indiandentalacademy.com
    10. 10. Wear and tear theory • Given by August Weihmann(1882) • Proposed that organs and tissues were damaged by continuous use and abuse. • When a person ages, body’s mechanism to repair the damage caused by wear and tear is reduced. • Hence, in old age people die of diseases which they could have resisted when they were young. www.indiandentalacademy.com
    11. 11. Neuroendocrine theory • Given by Vladimir Dilman. • In neuroendocrine system, a complicated network of biochemicals governs release of hormones. • Hormones in turn work together to regulate body functions. • Ageing causes drop in hormone production. • Hormone production is interactive i.e, one hormone level falls leading to the fall in others. • Decline in ability of the body to repair itself. www.indiandentalacademy.com
    12. 12. Free radical theory • Introduced by R.Gerschman,1954 • Free radical is a molecule that has one free electron… • Free radical activity is required to produce energy, maintain immunity, nerve transmission…. • But free radicals also attack cell membranes producing metabolic waste products – LIPOFUSCHINS. • Lipofuschins interfere with the ability of the cells to repair and reproduce themselves. www.indiandentalacademy.com
    13. 13. • The telomerase theory of ageing – recent. • Monumental progress in ageing research,but there is yet to be a unanimous decision on which theory holds good. • Age related changes do not occur uniformly in individuals, but they are under the influence of genetic and environmental factors. www.indiandentalacademy.com
    14. 14. Age changes in oral tissues Tissue changes Functional changes 1. Teeth 1. Salivary 2. Periodontium 2. Taste -bone 3. Deglutition -periodontal ligament 4. Mastication -oral mucous membrane www.indiandentalacademy.com
    15. 15. Changes in Tissues www.indiandentalacademy.com
    16. 16. Age changes in teeth Regressive alterations Attrition Abrasion Erosion Enamel Dentin Cementum Pulp www.indiandentalacademy.com
    17. 17. Attrition • Physiologic wearing away of tooth as a result of tooth to tooth contact. • Causes-masticatory stress -para-functional habits • Common in males www.indiandentalacademy.com
    18. 18. Stages of Attrition 1. Stage I Wear of enamel of cusps and incisal edges without exposure of dentin. 2. Stage II Wear of enamel and exposure of dentin on incisal edges and isolated area over individual cusps. 3. Stage III Wear of enamel forming a broad strip on incisal edges and the confluence of two are more areas of wear over adjacent cusps. 4. Stage IV Wear of enamel and dentin on incisors to form a plateau and on the teeth to form a central area of dentin www.indiandentalacademy.com surrounded by a peripheral rim of enamel.
    19. 19. Abrasion • It is the pathological wearing away of tooth through abnormal mechanical processes. • e.g.- abrasive dentifrice - occupational - improper flossing Dentifrice abrasion www.indiandentalacademy.com
    20. 20. Toothpick abrasion Bobby pin abrasion www.indiandentalacademy.com
    21. 21. Erosion • Loss of tooth substance by a chemical process that does not involve known bacterial action. Lingual erosion • e.g. -chronic vomiting -acidic carbonated beverages www.indiandentalacademy.com Labial erosion
    22. 22. Age changes in Enamel • Macroscopic – -becomes darker -attrition, abrasion, erosion -longitudinal cracks • Microscopic – - decreased - enamel rod ends - perikymata - permeability to fluids - increase in nitrogen and fluorine • Increased resistance to decay www.indiandentalacademy.com
    23. 23. Age changes in Dentin • Dentin is laid down through out life. • Dentin laid down after birth is Secondary Dentin. • Pathologic effect of dental caries, abrasion, attrition or other operative procedures cause variable changes in dentin - Reparative Dentin - Dead Tract - Sclerotic Dentin www.indiandentalacademy.com
    24. 24. Reparative Dentin • Also called as Irregular Dentin/ Tertiary Dentin/ Irritation Dentin . Localised close to the irritated zone of the tooth. • Clinically : decreased sensitivity in tooth. incidence in anteriors is higher …Bevelender and Benzer* • Histopathologically : dentinal tubules lesser in number, irregular, tortuous • Radiologically : decreased size of pulp chambers and root canals * J.Am.Dent.Assoc., 1943 www.indiandentalacademy.com
    25. 25. How does Reparative Dentin form? insult/injury to the tooth odontoblasts Degenerate form repararive dentin Seals off the zone of injury Initiating healing process In pulp www.indiandentalacademy.com
    26. 26. Dead Tracts • Empty tubules filled with air, where ododntoblsts have degenerated. • In ground sections, they entrap air ,so appear black in transmitted light and white in reflected light. • Decreased sensitivity in these areas. • Probably the initial step to form sclerotic dentin. www.indiandentalacademy.com
    27. 27. Dead Tracts - ground section Dead tracts www.indiandentalacademy.com
    28. 28. Sclerotic Dentin • Protective changes in response to any injury in primary dentin itself. • Collagen fibrils and apatite crystals apppear in dentinal tubules. • Therefore their lumen is obliterated. • With the obliteration of dentinal tubules, the refractive indices of the dentin are equalised….thus called TRANSPARENT DENTIN. • Transparent in transmitted light and dark in reflected light. www.indiandentalacademy.com
    29. 29. Sclerotic dentin under a zone of caries Carious lesion Sclerotic dentin pulp www.indiandentalacademy.com
    30. 30. Age changes in Dental Pulp 1. Reduction in size and volume of pulp : Reduction in pulpal area in coronal pulp because of continual apposition of dentin occlusally and in furcation area www.indiandentalacademy.com
    31. 31. Young tooth Reparative dentin Old tooth www.indiandentalacademy.com Decrease in size of pulp
    32. 32. 2. Reduction in cell number : -fewer cells with reduced number of organelles like RER, mitochondria, etc. -odontoblasts, fibroblasts degenerate. 3. Changes in collageneous elements : -increase in collagen fibers. -von Korff’s fibers are accentuated. -pulpal fibrosis in old teeth is not because of continual formation of collagen fibers ,instead it can be attributed to persistance of connective tissue sheath….. …Shroff , Stanley and Ranney # # Oral Surg. 1953 * Oral Surg. 1962 www.indiandentalacademy.com *
    33. 33. 4. Changes in blood vessels : -narrowing of circumference of vessels. -atherosclerotic changes in small arteries. -intimal layer of the vessel is thickened which results in a small lumen. www.indiandentalacademy.com
    34. 34. 5.Changes in nerve distribution : -nerves aggregating at the core appear prominent. -degeneration and loss of pulpal nerve fibers affects transmission from pulpal structures and results in increase in threshold for pain stimulus. -axonal and perineural changes are also seen. - Myelin sheath changes and terminal axon remolding due to age related axon injury could be sources of abnormal pain in the oral region. www.indiandentalacademy.com
    35. 35. 6.Pulp calcifications : - Calcified masses appearing in coronal and root portions of pulp. - seen in functional as well as embedded teeth. - two types 1. Pulp Stones/Denticles 2. Diffuse calcifications. -histologically -does not resemble similar to dentin. dentin. -common in coronal -common in root pulp. pulp. -amorphous unorganised columns paralleling blood vessels and nerves www.indiandentalacademy.com
    36. 36. Based on histolological appearance True pulp stones False pulp stones • Resemble secondary dentin • Don’t exhibit dentinal • Fewer tubules • Irregular tubules tubules • Usually larger than true denticles www.indiandentalacademy.com
    37. 37. Based on location, pulp calcifications are Attached pulp stone Free pulp stone www.indiandentalacademy.com
    38. 38. Amorphous calcifications around blood vessels Pulp chamber dentin Diffuse calcifications www.indiandentalacademy.com
    39. 39. Age changes in Cementum • Thickness of cementum is one of the criteria to assess age of an individual. • Increase in thickness at the root by 5 to 10 times with age. • Greater apically and lingually and in the bifurcation in molars. • Permeability decreases with age. www.indiandentalacademy.com
    40. 40. Hypercementosis • It is the abnormal thickening of cementum. Occlusal stress Spike like projections formed Increase surface area for Periodontal ligament attachment www.indiandentalacademy.com
    41. 41. Age changes in Bone • Adapts to meet the functional demands. • Histologically there is decrease in bone forming cells. • Blood capillary walls supplying the bone, thickened with age…..in old age, bone derives its nutrition mainly from periosteal blood supply. • Increased resorption which is not balanced by adequate formation of bone. • Increase in the porosity of bone… Hallsworth*. www.indiandentalacademy.com Atkinson and
    42. 42. Osteoporosis • It is a disorder that adversely affects the collagen metabolism with concomitant decrease in bone mass. • May be due to negative calcium balance. • Common in females. • Reduces the bone mineral content of jaws and associated with periodontal attachment loss and tooth loss. • One of the reason for increased residual ridge resorption. www.indiandentalacademy.com
    43. 43. www.indiandentalacademy.com
    44. 44. Residual ridge resorption • With age, number of teeth present in the oral cavity decreases.. so the force acting on the remaining teeth is more. • The changes in the alveolar processes of edentulous persons are more marked. • In the first year after tooth extraction reduction of height in the mid sagittal plane is about 2 to 3 mm for maxilla and 4 to 5 mm for mandible . • Decrease in vertical dimension at occlusion. • Decrease in lower facial height www.indiandentalacademy.com
    45. 45. • Annual rate of reduction in height is 0.1 to 0.2mm and in general four times less in edentulous maxilla. • Etiology : anatomic factors -short square face related to elevated masticatory forces -alveoloplasty prosthodontic factors -intensive denture wearing -unstable occlusal conditions metabolic and systemic factors -osteoporosis -calcium and vitamin D supplements www.indiandentalacademy.com
    46. 46. Changes in Maxilla - Maxillary teeth are directed downward and outward thus bone reduction is upward and inward. - Resorption on outer cortex is greater and more rapid because outer cortical plate is thinner than the inner cortical plate - Thus the maxilla becomes smaller in all dimensions and the denture bearing area (basal seat) decreases. www.indiandentalacademy.com
    47. 47. • Maxillary bone resorbs on the crest and labial and buccal cortices. • Thus, maxillary ridge loses height and becomes narrower in transverse and antero posterior direction. • Resorption towards centre www.indiandentalacademy.com
    48. 48. Changes in Mandible - The mandibular ridge resorbs primarily on the crest of the ridge. - Because the mandible is wider at its inferior border than at the residual alveolar ridge in the posterior part of the mouth, resorption, in effect, moves the opposite sides of the ridges farther apart. www.indiandentalacademy.com
    49. 49. Mental foramen : • With the resorption of the alveolar process the mental foramen lies at or near the level of the upper border of ridge. Genial tubercles : . The genial tubercles project above the upper border of the mandible in the symphyseal region. www.indiandentalacademy.com
    50. 50. • The residual alveolar ridge becomes wider with resorption. • Resorption away from centre. www.indiandentalacademy.com
    51. 51. - Density of mandibular bone decreases from 1.9 to 1.5% between 45 and 90yrs,value being 8% less in females… Henrikson and Wallenius* - Lamina dura is often lost and cortical bone at angle of mandible becomes thinner… * Sharpio et al# J. oral Rehabil. 1, 1974 # Gerodontics 1, 1985 www.indiandentalacademy.com
    52. 52. Age changes in mandible adulthood At childhood In birth old age www.indiandentalacademy.com
    53. 53. Age changes in periodontal ligament • Increase in number of fibroblasts. • Greater collagen and elastic fibre content. • Decrease in organic matrix production. • Width of periodontal space increases with occlusal loading. • Age may be a probable risk factor for periodontitis. www.indiandentalacademy.com
    54. 54. Periodontitis • It reflects the age related change and accumulation of previous dental experiences. • Gingival recession • Loss of periodontal attachment and alveolar bone. www.indiandentalacademy.com
    55. 55. Age Changes in Oral Mucous Membrane • Surface of oral cavity is mucous membrane and its structure varies in apparent adaptation to function… • Clinically : -dry -friable -thin smooth mucosal surfaces -loss of elasticity and stippling. -predisposed to trauma and infection. www.indiandentalacademy.com
    56. 56. According to Massler- tissue friability arises from three sources – 1. A shift in water balance from the intracellular to the extracellular compartment and diminished kidney function results in dehydration of the oral mucosa. 2. Progressive thinning of the epithelial layers which increases tissue vulnerability to mild stress. 3. Nutritionally deficient cell. www.indiandentalacademy.com
    57. 57. • Histologically : -thinning of epithelium -loss of cohesiveness of epithelial cells – vitamin A deficiency -decreased prominence of retepegs -loss of submucosal elastin and fat -increased fibrous connective tissue -degenerative alteration of collagenvitamin C deficiency • Result in a mucosa which is more prone for traumatic injuries and delayed wound healing. www.indiandentalacademy.com
    58. 58. Migration of Junctional Epithelium • Migration of junctional epithelium from its normal position to a position more apical… gingival recession. Occlusal plane Original gingival margin location Original cementoenamel junction Mucogingival junction www.indiandentalacademy.com
    59. 59. Changes in Function www.indiandentalacademy.com
    60. 60. Salivary glands • Appear less compact with ducts occupying major portion. • Increased focal adenitis. • Rate of production of secretory proteins is decreased by slowing secretory activity of the gland. • In normal, healthy, non medicated individuals – secretion does not change. • Composition does change –Na+ lower… - Cl _,protein lower …Chauncey et al # * Adv. Physiol. Sci., 1981 # Am. J. Physiol., 1984 www.indiandentalacademy.com Baum et al*
    61. 61. Xerostomia • Dryness of mouth. • Is usually not seen in healthy non medicated individuals. • Associated with persons on medications like diuretics tranquilizers anti histaminics • Also seen in patients with sjogren’s syndrome. www.indiandentalacademy.com
    62. 62. • Xerostomia causes dryness of the mucosa. • Fissured tongue. Fissured tongue • Angular chelitis. Angular chelitis www.indiandentalacademy.com
    63. 63. Tongue and Taste sensation • Number of taste buds decline with age. • At 70yrs, taste buds decrease to 1/6th of those present at the age of 20yrs. • Acuity of taste sensation is decreased because: - of depapillisation,which usually begins at apex and lateral regions - of hyperkeratinisation of epithelium - of degeneration of nerves gradually. www.indiandentalacademy.com
    64. 64. • One of the common age change is nodular varicose enlargement of veins on ventral surface of the tongue (caviar tongue). • Threshold for sweet and acid are not affected by ageing, but salt and bitter are… * J Gerodontology, 1982 www.indiandentalacademy.com Weiffenbach et al*.
    65. 65. Mastication and deglutition 1. Most frequent oral motor disturbance in older persons is related to mastication 2. Masticatory ability is further decreased in those who are partially or fully edentulous. 3. Biting force is said to be decreased by 16% of its original value in older patient. 4. Ultrasound imaging has estimated the oral and pharyngeal phases of swallowing to be longer in www.indiandentalacademy.com older than younger adults
    66. 66. • The biting force reduces from 300lb/in2 to 50lb/in2 with age… Kaplan . * • Lip seal is less efficient in older subjects… Baum and Bodner#. • Swallowing time is increased by 25 to 50% in subjects over age of 55years… sonies et al . ^ * Geriatrics, 1971 # J dent Res. 1983 ^ Gerodontology, 1984 www.indiandentalacademy.com
    67. 67. Prosthodontic considerations www.indiandentalacademy.com
    68. 68. • Thin friable epithelium may not be able to tolerate the forces imposed on it by the hard unyielding acrylic denture base. Hence, such areas must be relieved. • Improper impression techniques may distort the tissues. • Compression of the tissues during denture wearing leads to denture sore mouth. www.indiandentalacademy.com
    69. 69. • Lammie (1960) postulated the theory of epithelial atrophy results in decrease in number of epithelial cells, thus decreasing the surface area. • This in turn applies pressure onto the residual ridge. • Xerostomia affects the denture retention …. • Sore spots are seen under the denture as there is lack of lubrication. www.indiandentalacademy.com
    70. 70. • Residual ridge resorption is centripetal in maxilla and centrifugal in mandible making maxilla comparatively narrower and mandible broader. • The surface of the arches maybe resorbed out of parallelism which can result in diminished stability of dentures. • Severe ridge resorption can also result in increased inter arch space. www.indiandentalacademy.com
    71. 71. www.indiandentalacademy.com
    72. 72. • In cases of severe attrition and abrasion, there is loss of vertical dimension..results in aged appearance. • Prosthodontic reconstruction restablishes vertical dimension and lip support,gives esthetic appearance. www.indiandentalacademy.com
    73. 73. www.indiandentalacademy.com
    74. 74. Summary • Age changes in oral tissues can be broadly classified into TISSUE and FUNCTIONAL changes. • Tissue – teeth - periodontium • Functional – taste - salivation - mastication - deglutition •Various alterations in mouth due to ageing have various prosthodontic implications. www.indiandentalacademy.com
    75. 75. Conclusion • A thorough understanding of the morphological alterations that occur during ageing is important, for, such knowledge will help in understanding of the functional changes that may lead to decreased activity and in assessing the health of the subjects and identify reasons for departures from the normal. www.indiandentalacademy.com
    76. 76. References 1. Boucher ( 2004)Prosthodontic Treatment for Edentulous Patients 12 edition . Mosby 2. Sheldon Winkler(2004) Essentials of complete denture prosthodontics :second edition 3. Sharry J.J. – ‘Complete denture prosthodontics’ 1962 4. Age changes and the Complete Lower Denture – J Prosth Dent 1956;6:(4)450 5. Ferguson D B ( 1987 )The Aging Mouth Vol 6 Karger,Basel 6. Burket (2003) Oral Medicine 10 edition B C Decker www.indiandentalacademy.com
    77. 77. 7. Shafer (1999) A Textbook of Oral Pathology 4 edition W B Saunder. 8. Geriatric Dentistry – The Dental Clinics Of North America ; 89;33:1 Clinical decision making in Geriatric Dentistry The Dental Clinics Of North America: 1997:41:4 9. V.V Frolkis(1984) Physiology of cell ageing: Vol 18 karger 10. Lavaelle(1988) Applied Oral physiology: second edition; Wright 11. Langlais and Miller: Color Atlas of common oral diseases; third edition: Wolters Kluwer www.indiandentalacademy.com
    78. 78. 12. Orban’s Oral Histology and Embryology(1990), tenth edition. 13. Stopping the clock(1997),Dr.Donald Klatz and Dr.Robert Goldman www.indiandentalacademy.com
    79. 79. ‘Youth is a gift of nature, but age is the work of art.’ Thank you www.indiandentalacademy.com

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