The impact of change on the edentoulous patient

1. THE IMPACT OF AGE ON THE
EDENTULOUS MOUTH
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2. Jaw Movements in Old Age
1. Chewing is slower
2. Vertical displacement of the mandible is shortened, Although the duration
of the total chewing cycle does not appear to change (Karlsson and Carlsson,
1990).
3. Poor motor coordination and weak muscles due to:
i. Delay in the central processing of nerve impulses, impede the activity of
striated muscle fibers, and inhibit decisions.
ii. Reduce the number of functional motor units and fast muscle fibers, and
decrease the cross-sectional area of the masseter and medial pterygoid
muscles (Newton et al.,1987).
4. Muscle tone can decrease by as much as 20% to 25% in old age, which
probably explains the shorter chewing strokes and prolonged chewing time
(Sonies, 1992).

3. 5. Older persons also have a less coordinated chewing stroke close to
maximum intercuspation, probably because of a general deficit in the
central nervous system which controls the mandible movement.
6. Pain on swallowing because of osteophytes and spurs growing on the
upper spine adjacent to the pharynx. A noticeable change in swallowing
strongly suggests that there might be an underlying pathosis, such as
Parkinson’s disease or palsy that is not a part of normal aging (Sonies,
1992).

4. Taste & Smell In Old Age
• Taste and smell are frequently confused because the sensory
mechanisms are closely related and dependent.
• The sensation of “tasting” rarely occurs in isolation, but results from
the interaction of proprioception, taste, and smell.
• Texture is felt, chemical constituents stimulate taste, and aromatic
gases smell. Bitter, sweet, sour, and salty tastes stimulate receptors
independently, so one may be damaged without disturbing the others.
Olfactory cells send projections directly to the brain so they can be
traumatized anywhere along the way.

5. 1. Sensitivity to taste declines with age, and especially in older persons with
Alzheimer’s disease (Murphy, 1993).
2. preference for specific flavors changes over time to favor higher concentrations
of sugar and salt.
3. Complaints of an impairment affecting the sense of taste at any age should
be investigated thoroughly because they forebode an upper respiratory infection
or a serious neuro-logical disorder.
4. The three cranial nerves (VI, IX, and X) carrying sensations of taste can be dis
turbed and damaged by tumors, viruses (e.g., Bell’s palsy and herpes zoster),
and trauma (e.g., head injury and ear washing), but, fortunately, damage
in one part of the system can be compensated readily by increased sensitivity
elsewhere.

6. Nutrition In Old Age
• There is some evidence, largely from animal studies, that diet
influences longevity and aging, with the weight of evidence favoring
restrictions on fat and protein.
• The relationship between diet and prolonged life in human beings is
complex and, as yet, inadequately explained. Currently, the recom
mended daily allowances for the various vitamins, minerals, fats,
carbohydrates, and proteins are probably inaccurate because most of
the data on intake of specific nutrients have been estimated for
young adults.

7. • The elderly population is at particular risk for malnutrition due to:
1. Socioeconomic stress
2. Overconsumption of drugs,
3. State of the dentition(in some cases)
• A national survey in the United States around 1970 (Rhodus and
Brown, 1990) revealed that older people frequently had inadequate
calories or calcium in their diet and that many of them absorbed
vitamins (notably A, B, and C) and minerals poorly
(Figure 3-1).

9. The role of the dentition in mastication and food selection is complex.
Some edentulous persons with faulty dentures restrict themselves to a
soft diet high in fermentable carbohydrates, whereas others, even with
uncomfortable and well-worn dentures, can eat nearly all of the food
available to them (Millwood and Heath, 2000).
A recent population-based study in the United Kingdom found that
edentulous older persons, compared with older persons with natural
teeth, had significantly lower levels of plasma ascorbate and plasma
retinol, which could disturb their skin and eyesight (Sheiham and Steele,
2001).

10. AGING SKIN AND TEETH
A. Skin
• The scars of a lifetime are revealed dramatically on the skin as wrinkles, puffiness,
and pigmentations, but the changes are not all manifestations of degeneration. For
example, fewer Langerhans’ cells in older skin can prevent undesirable
immunological responses, whereas mottling of the skin protects
against the sun.
• The leathery look characteristic of the older sun worshipper is caused by
epidermal
growths with large melanocytes—solar lentigines— that thicken in the epidermis.
Gradually the dermis thins, enzymes dissolve collagen and elastin, and wrinkles
appear when layers of fat are lost.
• Age reduces the concavity and “pout” of the upper lip, and it flattens the philtrum.
• Thenasolabial grooves deepen, which produces a sagging look to the middle third
of the face.

11. • Atrophy of the subcutaneous and buccal pads of fat hallows the
cheeks.
• Subsequently, as the loss of fat continues, support for the
presymphyseal pad of fat disappears, and the upper lip droops
(cheiloptosis) over the maxillary teeth (Figure 3-2).
• The above changes are accentuated even more dramatically when teeth
are missing or when there is a loss of occlusal vertical dimension
(Figure 3-3).

13. B. Teeth
The color of healthy, natural teeth ranges in hue from yellow to orange, with large variation
in chroma and value (MacEntee and Lakowski,
1981).
1. The chroma, and occasionally the hue, will change as the enamel is abraded, exposing the
underlying dentine to extrinsic stains.
2. The chroma may also deepen by a systemic distribution of various medications,
particularly those containing heavy metals.
3. Ultimately, natural teeth take on the jagged brownish appearance of an aging dentition
when the incisal edges break and the exposed dentine gathers extrinsic stains.
It is not always easy to reproduce this rugged appearance in artificial teeth. In fact, some
patients in conflict with the esthetic sense of their dentist prefer to have complete dentures
with teeth that are smaller, straighter, and whiter than natural teeth.

14. Thank you
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