effect of aging on edentulous state

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effect of aging on edentulous state

  1. 1. EFFECTS OF AGING ON EDENTULOUS STATE Dr shabeel pn DEPARTMENT OF PROSTHODONTICS
  2. 2. GERODONTOLOGY <ul><li>It is the branch of dentistry that deals with the oral health problems of the old people. one of the problems of aging is that some of the bodily functions do not maintain their efficiency. </li></ul>
  3. 3. CLASSIFICATION <ul><li>THE CHANGES IN GERIATRIC PATIENTS CAN BE CLASSIFIED AS </li></ul><ul><li>physiologic </li></ul><ul><li>psychologic </li></ul><ul><li>pathologic </li></ul>
  4. 4. <ul><li>THE AGING PATIENT USUALLY FITS INTO ONE OF THE THREE GROUPS: </li></ul><ul><li>those who are well preserved physically and emotionally. </li></ul><ul><li>those who are really aged and chronically ill. </li></ul><ul><li>those who fall between the two extremes. </li></ul>
  5. 5. <ul><li>Another way of grouping is the psychological reaction to aging process, </li></ul><ul><li>realists: philosophic and exacting type </li></ul><ul><li>resenters: indifferent and hysterical type </li></ul><ul><li>resigned: vary in their emotional and systemic status. end treatment plan may be palliative and definitive in nature. </li></ul>
  6. 6. PHYSIOLOGIC CHANGES <ul><li>More prevalent changes are </li></ul><ul><li>loss or graying of hair </li></ul><ul><li>loss of teeth </li></ul><ul><li>dimenision of senses of light, hearing and taste </li></ul>
  7. 7. SENSES <ul><li>Difficulty in hearing and diminishing vision can be offset by artificial aids such as complete dentures hearing aids and eyeglasses. in many instances those who will not wear a hearing aid or glasses will reject dentures </li></ul>
  8. 8. LOSS OF TEETH <ul><li>60% of men and 70%of women over 65 years of age are edentulous </li></ul><ul><li>in old age chroma and hue of teeth will change as enamel is abraded, exposing the underlying dentin to extrinsic stains. chroma also deepens due to medication containing heavy metals </li></ul><ul><li>natural teeth take on a jagged brownish appearance of an aging dentition when the incisal edges break and the exposed denture gather extrinsic stains </li></ul>
  9. 9. <ul><li>some patient in conflict with the esthetic sense of the dentist prefer to have complete dentures with teeth that are smaller, straighter and whiter than natural teeth. </li></ul><ul><li>the loss of teeth and also some taste sense often leads to malnutrition. </li></ul>
  10. 10. SKIN <ul><li>skin becomes thin, wrinkled and dried </li></ul><ul><li>to eliminate wrinkles the patient frequently requests the dentist to place the artificial teeth in undesirable relation to the support, to over intend or over contain the borders, or to decrease the interocclusal distance </li></ul><ul><li>age reduces the concavity and past of the upper lip </li></ul>
  11. 11. <ul><li>Naso-labial groove deepens, which produce a sagging look to the middle third of the face. </li></ul><ul><li>atrophy at subcutaneous end buccal pads of fat hollows the cheeks </li></ul><ul><li>due to loss of fat support for the pre symphysial pad of fat disappears and upper lip drops over maxillary teeth </li></ul><ul><li>changes are accentuated more dramatically when teeth are missing or when teeth is lost at occlusal vertical dimension </li></ul>
  12. 12. ORAL MUCOSA <ul><li>becomes thin, easily abraded, and frequently reacts unfavorably to the pressure of dentures </li></ul><ul><li>stomatitis and other mild inflammations are the mucosal lesions encountered most frequently in older edentulous mouths, especially of older men who wear dentures, smoke tobaccos and drink alcohol excessively </li></ul>
  13. 13. <ul><li>oral cancer or precancerous lesions are unusual in western countries, although they are the most common forms of cancer on the Indian subcontinent and in other parts of Asia </li></ul><ul><li>external carcinogens such as nicotine and alcohol could be more damaging to the oral mucosa in old age because of atrophy, increase mitosis with slow turnover of cells, and increased number of elastic fibers. therefore it is likely that there is risk of oral cancer is increased among edentulous denture wears. </li></ul>
  14. 14. SALIVA <ul><li>decreases in quantity and changes in quality </li></ul><ul><li>lack of lubrication or viscous or soapy saliva decreases the retention of dentures and increases frictional trauma to the thin mucosa </li></ul><ul><li>causes of change in saliva </li></ul><ul><ul><ul><li>xerostomic medication. eg: digitalis </li></ul></ul></ul><ul><ul><ul><li>stress </li></ul></ul></ul><ul><ul><ul><li>depression </li></ul></ul></ul><ul><ul><ul><li>tobacco use </li></ul></ul></ul><ul><ul><ul><li>alcohol abuse </li></ul></ul></ul>
  15. 16. NEUROMYAL CHANGES <ul><li>generalized slowing down of normal activity </li></ul><ul><li>muscle activity lacks coordination and muscle loss tone </li></ul><ul><li>the cheeks sag and the mandible when at rest appears to drop slightly more in a protruded position </li></ul><ul><li>conduction of nerve impulse diminished in nerve conduction, loss of muscle tones, slowing down of muscle activity, lack of muscle coordination all influences the recording of maxillo mandibular relation </li></ul>
  16. 17. OSTEOPOROSIS <ul><li>the most common systemic born condition occurring in both sexes </li></ul><ul><li>it is likely to appear earlier in women than in men </li></ul><ul><li>accelerated loss of trabecular bone </li></ul><ul><li>back pain, loss of bodyweight, facial height and some types of deformity are some of the symptoms </li></ul><ul><li>spontaneous fracture in advanced cases </li></ul><ul><li>atrophy of bone is particularly noted in residual alveolar ridge more so when ridge is subjected to continuous pressure of denture </li></ul>
  17. 18. MEMORY <ul><li>decreases in mental capacity to remember recent events, new names and new places </li></ul><ul><li>recall of past events and places </li></ul>
  18. 19. CIRCULATION, ALIMENTATION AND ELIMINATION <ul><li>flow of blood and lymph slows down </li></ul><ul><li>gastric juice becomes less acidic </li></ul><ul><li>digestion slows down </li></ul><ul><li>elimination of waste products becomes regular </li></ul>
  19. 20. NUTRITION AND DIET <ul><li>as one ages people become less active since muscle activity is limited canonic requirement is lower </li></ul><ul><li>it is time for more protein and fewer carbohydrates </li></ul><ul><li>there is risk of malnutrition because of variety of factors ranging from socioeconomic status to over consumption of drugs </li></ul><ul><li>decline in taste sensation results in appetite loss which leads to malnutrition </li></ul><ul><li>obesity can result from excessive intake of returned carbohydrate </li></ul>
  20. 21. <ul><li>dieting may have side effects as a result of vitamin deficiency </li></ul><ul><li>patients who are successfully using dentures are suddenly find that dentures are no longer comfortable because of the supporting tissue change with the weight loss </li></ul><ul><li>patient who do not discipline themselves in diet control may not be very cooperative in carrying out instructions given for the case and use od dentures </li></ul>
  21. 22. PSYCHOLOGIC CHANGES <ul><li>psychological reactions to any or all of biologic changes determine into which groups the patinet will fall – well preserved, chronically ill or in between group </li></ul><ul><li>the psychological problems influencing the behavior of aging can be divided into </li></ul><ul><ul><ul><li>reactions to psychological changes </li></ul></ul></ul><ul><ul><ul><li>reaction to social changes, changes in environment and changes in mental capacity </li></ul></ul></ul>
  22. 23. REACTION TO PHYSIOLOGIC CHANGES <ul><li>the changes influencing one’s appearance seems to affect women more than men </li></ul><ul><li>women frequently make their concern over their loss of hair and face height, wrinkling of the skin changes in tooth and loss of natural teeth </li></ul><ul><li>a man may not vocally register his concern. however his reaction may be more dramatic but concealed. the dentist must be aware of this concern for appearance and strive to meet the esthetic requirement of all patient </li></ul>
  23. 24. <ul><li>providing dentures for the patient who has a justified belief in his appearance and a proper sense of personal dignity is a pleasure </li></ul><ul><li>in pleasant experience with someone who has developed a vain personality </li></ul><ul><li>malrelated jaws are not connected by extracting to a natural teeth and replacing with artificial teeth </li></ul><ul><li>not only may the support fot the dentures be destroyed but also the teeth may be placed in position that are out of harmony with mandibular movements and the functions of the lips, tongue and cheeks </li></ul>Malrelated jaws
  24. 25. REACTIONS TO SOCIAL CHANGES <ul><li>severance of social ties lead to isolation particularly for those who where habitually unsociable or who no longer derive pleasure from activities enjoyed in former years </li></ul><ul><li>isolation can lead to resentfulness and unreasonable demands on the time of others </li></ul>
  25. 26. <ul><li>retirement can lead to anxiety and loss of income and fear that they will have to depend upon someone else for support </li></ul><ul><li>during the diagnostic procedures it is therefore important for the prosthodontist to be alert for dues that will reveal the patient’s psychological response to aging </li></ul><ul><li>if the problems are severe the patient may have to be referred to psychiatric counseling </li></ul>
  26. 27. PATHOLOGIC CHANGES <ul><li>The pathologic disorders or changes most frequently encountered are </li></ul><ul><ul><li>metabolic </li></ul></ul><ul><ul><li>skeletal </li></ul></ul><ul><ul><li>muscular </li></ul></ul><ul><ul><li>circulatory </li></ul></ul><ul><ul><li>neoplastic </li></ul></ul><ul><ul><li>psycologic </li></ul></ul>
  27. 28. <ul><li>The principle cause of disability in persons of 65 </li></ul><ul><li>years and above are </li></ul><ul><li>heart disease </li></ul><ul><li>hypertensive vascular disease </li></ul><ul><li>tuberculosis </li></ul><ul><li>disease of the bones and joints, accidents, nephritis, diabetes, cancer and eye disease </li></ul>
  28. 29. <ul><li>The commonest cause of death after the age of 65 years are </li></ul><ul><li>Cerebral hemorrhage </li></ul><ul><li>Heart disease </li></ul><ul><li>Cancer </li></ul><ul><li>General arteriosclerosis </li></ul><ul><li>Accident </li></ul><ul><li>When any of the signs and symptoms of disease are observed in the face, complexion, posture, voice, walking or breathing pattern of an aging person a more thorough investigation of the systemic status should be instituted prior to detailed dental diagnostic procedures. </li></ul>
  29. 30. INTRAORAL CHANGES <ul><li>Many of the physiologic and pathologic changes of </li></ul><ul><li>the aging are reflected in the oral mucosa </li></ul><ul><li>in majority of edentulous patients 65 years of age and older there is a marked resorption of the residual alveolar ridge. the overlying mucosa shows sign of use and age, particularly if the mucosa has supported dentures </li></ul>
  30. 31. 2. In the presence of ill fitting dentures one will find inflammatory hyperplasia. palatal inflammatory hyperplasia is also associated with ill fitting dentures.
  31. 32. <ul><li>3. the thinning of the mucosa of the geriatric patient allows Fordyce spots to become more apparent </li></ul>
  32. 33. <ul><li>4. Macroglosia usually results from relaxation of the tongue musculature. this occurs in disturbance of the endocrine glands as hyperpituitarism. however the extraction of the mandibular posterior tooth allows the musculature to relax and is preferably the most prevalent etiologic factor </li></ul>
  33. 34. <ul><li>5. As the serous gland decrease in activity the saliva becomes more mucous and soapy. When the salivary glands atrophy the reduction of the saliva flows result in dry mouth. </li></ul>
  34. 35. THANK YOU

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