Age changes in periodontium /certified fixed orthodontic courses by Indian dental academy


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Age changes in periodontium /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing Dental
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  3. 3. DEFINITION• Aging is slowing of natural function, a disintegration of the balanced control and organization that characterize the young adults (Little C.c. 1947)• Aging of an organ is defined as post maturational deteriorative changes that with time, lead to an increased vulnerability to challenges, there by decreasing the functional ability of the organ.
  4. 4. AGE CHANGESExternalHair - Brittle, Less abundant, graySkin - Dehydration, decreased elasticity, thermo sensitiveEyes - Diminished vision, enopthalmosNose - Diminished sense of smellSecretary glands - Diminished epithelial activity
  5. 5. InternalRenal - Decreased renal blood flow Leading to water retention Difficulty in removing waste productsVascular - Rise in systolic blood pressureGIT - Constipation and gas accumulation due to hypotonic musculatureGonads - Decrease estrogen and androgen secretionLiver - Decrease hepatic functionPancreas - Decrease function (diabetes)
  6. 6. Alternations in oral motor functionsLip posture - Drooling, angular chelosisMuscles of mastication - Efficiency of masticationTongue - Speech, dysphagia, traumatic bite injurySwallowing - DysphagiaTaste - Loss of sensation
  7. 7. Periodontal changes associated with agingGingiva• Thinning and decreased keratinization of gingival epithelium.• Increase in the width of the attached gingiva, with constant location of the mucogingival junction throughout the life• More dense and coarse connective tissue• Increase (or) no change in mitotic index of gingival epithelium• Reduced (or) no change in stippling
  8. 8. Periodontal Ligament• Greater no of elastic fibers• Decrease in vascularity• Decrease in mitotic activity• Decrease in fibroplasia• Decrease in number of collagen fibers• Width of periodontal ligament increased or decreased
  9. 9. Alveolar bone• Changes occurring in alveolar bone are similar to remainder of skeletal system• Increased osteoporosis• Decreased vascularity• Bone resorption increased (or) decreased• Greater irregularity in the surfaces of alveolar bone facing periodontal ligament• Healing rate of bone in extraction sockets appears to be unaffected• Recent observations with bone graft preparations from donars more than 50 yrs old possess less osteogenic potential than younger donars.
  10. 10. CEMENTUM• Greater irregularity in the surface facing periodontal ligament.• Continuous increased in amount of cementum ORAL MUCOUS MEMBRANE• Thinning of the oral epithelium or no change• Increased keratinization of lip and cheek mucosa- it may be related to smoking• Atrophy of connective tissue with loss of elasticity• Increased in number of mast cells
  11. 11. SALIVARY GLANDS• There is no reduction in potential of salivary gland functionTOOTH –PERIODONTIUM RELATIONSHIPS• Loss of tooth substance – Attrition• Degree of attrition is influenced by • Musculature • Consistency of food • Tooth hardness • Occupational factors • Habits like bruxism • Continuous tooth eruption • Gingival recession
  12. 12. • By reducing the clinical crown length, attrition appears to preserve the balance between the tooth and its bony support.INTERACTIONS BETWEEN PERIODONTAL DISEASES, MEDICAL DISEASES AND IMMUNITY IN THE ELDERLY:• Host immunity is the key factor in evaluating the interplay between dental if medical diseases.• Age having much less effect in altering the host response.
  13. 13. PERIODONTAL DISEASE AND ASPIRATION PNEUMONIA• Aspiration pneumonia caused by infection of anaerobic organism usually occurs in patient with periodontal disease.• Aspiration pneumonia results when oro pharyngeal secretions, food, gastric contents are aspirated into the lungs and causes infection• Commonly seen in elderly patients.• Salivary duct as a medium of delivery of organism from the oral cavity into the lungs.• P.gingivals, pseudomonas A.eruginaso capnocytophaga species fusobacterium nucleatum are commonly isolated species.
  14. 14. PERIODONTAL DISEASE AND HEART DISEASE:Relationship between the periodontal diseases and heart disease.Study done by InferenceLoesche et al Individuals with the most medical problems - highest rates of dental diseases A patient without teeth was 1.84 times > coronary heart disease 2.4 times > peripheral vascular disease 1.57 times> history of stroke
  15. 15. ROLE OF POOR ORAL HYGIENE Poor oral hygiene ↓ periodontal disease ↓ Elevated level of WBC ↓ Predispose Cardiovascular disease• Supra gingival plaque – give rise to caries in presence of sucrose• Sub gingival plaque provoke inflammatory response, giving rise to periodontal disease
  16. 16. ROLE OF SUPRAGINGIVAL PLAQUE IN HOST DISEASE Most of the gram positive facultative species ↓ Survive high PO2 (if they penetrate oral epithelium) ↓ Not scavanged by phagocytes ↓ Gain access to periodontal circulation ↓ Symptomatic bacteremia
  17. 17. ROLE OF SUBGINGIVAL PLAQUE Subgingival plaque flora ↓ Increased access to flora (compared to supra gingival plaque) ↓ VIA ulcerated epithelial lining of the pocket ↓ Underlying connective tissueAntimicrobial potential Cellular debrisIn the tissues ↓ Enter ↓ Systemic circulationDestroyed ↓ cause Alterations in serum components Of clotting mechanisms ↓ Such as Elevated levels of fibrinogen ↓ Predict Risk of future coronary heart disease
  18. 18. AGING AND SUBGINGIVAL MICROBIOLOGY• Holm pederson et al (1975) - Gingival recession was more frequent in the older individual. Gingival recession ↓ Altered Hard tissue morphology ↓ Provides a large dentine surface for plaque accumulation ↓ Higher plaque index in the older individuals ↓ Developmental of gingivitis
  19. 19. COMPOSITION OF SUBGINGIVAL MICROBIOTARodenburg et al (1990) Actinobacillus actinomycetumslots et al comitance ↓ with ageSavitt of Kent (1991) Porphyromonas gingivalis – ↑ with age & blacksPERI IMPLANT MICROBIOTA- Microbiota in the oral cavity before implantation determines the composition of the newly established microbiota on implants- Bacteria colonizing implants originate from the adjacent soft tissues- Ecological considerations affecting the periodontal microbiota with age may be significant for the peri implant microbiota
  20. 20. TREATMENT PLANNING IN ELDERLYOral hygiene instruction• Establish daily routine of brushing• Fluoride dentifrices• Instruments can be adapted as – Handles can be customized – Electrical (or) interproximal brushes
  21. 21. PERIODONTAL TREATMENT PLANNING IN OLDER INDIVIDUALS- Goal of periodontal treatment is preserve function and prevent the progression of inflammatory disease- Factors must be considered in treatment planningPatients - Medical and health status - Medications - Life style behaviors - Ability to perform oral hygiene procedures - Ability to tolerate treatment - Amount of remaining periodontal support, tooth typeOperator side - Decrease the length of surgical time - Maintain open communication - Minimize trauma - medication dosages - Schedule morning appointment
  22. 22. -Non surgical approach – first treatment of choice-Surgical approach – depends on nature and extent ofdisease-Palliative supportive periodontal care – patients who arenot comply with treatment, have poor oral hygiene,medically or mentally compromised, functionally impaired.ROOT CARIESRoot caries – slow progress, rare pulp involvement, painlessTo arrest caries – single topical fluoride and daily use of fluoride tooth pasteIn high incidence – Daily brushing with fluoride tooth pasteof caries or 0.4% fluoride gel APF rinse followed by 1.64% stannous fluoride rinse once weekly
  23. 23. XEROSTOMIAFluoride rinses and dentifricesReduced consumption of alcohol, tobacco, spicyand acidic foodsFrequent water in takeArtificial salivary substitutesBurning mouthSalivary substitutesDiphenhydramine, koalin, lidocaine mouth wash
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