age changes in prosthdontics

1. BY -: Dr. BARUN KANT
MDS I3/6/2015 1

2.  Introduction
 Defintion
 Scope of the problem
 Psychologic and psychiatric aspects of aging
 Aging and nutrition
 Oral aspects of aging
 Prosthetic diagnosis
 Complete denture construction
 Summary
3/6/2015 2

3.  Because we are born ,we grow old and because
grow old ,we die.
 It is unfortunate that the geriatric patients generally
needs most of the necessary dental and medical
services at an age when he is least able to tolerate
them and possibly least able to afford them.
 Although fluoridation and other preventive
measures will undoubtedly have an affect on the
incidence of dental caries and the resultant tooth
loss of our population ,the benefits to the geriatric
patients of today are negligible .
3/6/2015 3

4.  The prosthetic needs of our geriatric
population are monumental and most
probably will remain that way at least for the
next generation.
3/6/2015 4

5. Gerontology(gerodontological society in 1959):
“The branch of knowledge which is concerned
with situations and changes inherent in
increments of time ,with particular reference to
post maturational stages.”
3/6/2015 5

6.  In 1900 ,only 3.1 million , or one of every 25
,Americans were 65 years of age or older .
 In 1984 ,27.9million ,or one of nine ,fell into
this category.
 If present population trends continue ,those
over 65 should account for 64.5 million ,or
21.2 %,of the population by the yer 2030.
3/6/2015 6

7.  The majority of elderly persons in their
younger retirements years are relatively
healthy and not limited in activity ,even if
they have a chronic illness .
 By the end of 8th and 9th decade of life ,the
chances of being limited in activity and in the
need of health services increases
significantly.
3/6/2015 7

8. 0
10
20
30
40
50
60
male female male female
black
white
Numberper100population
45-64 years 65 years and over
3/6/2015 8

9.  The problems of adjusting to old age in our
society is becoming extremely difficult owing
to the high values placed on youth .,beauty
,and virility.
 Members of the medical and dental
profession in some cases have fallen pray to
these existing attitudes ,perhaps partially
because of personal fears regarding their own
aging process .
3/6/2015 9

10.  For the aged themselves ,these are
frustrating years .
 They realize that they are beyond their
productive peak and many of their goals
,ideals ,ambitions, and hopes can never be
attained .
 As certain physical attributes decline ,others
becomes stronger .
3/6/2015 10

11.  Memory may decline ,but judgment may
improve with age .
 Experience ,being dependent on time
,inevitably increase with age .
 Retirees should be encouraged to participate
in creative activities as long as they are able
,especially in the social ,economic ,and
political life of their community .
3/6/2015 11

12.  Lonely patients can turn to the dentist for aid in
their ever ending struggle against illness and old
age .
 Weekly and monthly appointments can become
the most significant aspects of their lives .
 It gives them a reason for having to do
something or go somewhere ,and they look
forward to it .
 A sympathetic word when inserting dentures
into the mouth often does wonders .
3/6/2015 12

13.  Hardly elderly – many of our modern aged
are in excellent physical and psycho logic
condition .
 The senile aged syndrome –these people are
disadvantaged physically and emotionally
and may be described as handicapped
,chronically ill ,disabled ,infirm and truly aged
.
 Between these two extremes are millions of
elderly.
3/6/2015 13

14.  Nutrition is one of the factors under human
control that can influence the health of the aging
.
 It is essential for the geriatric patient to retain an
interest in food .
 He must be prevented ,because of dental
difficulties ,from gradually changing his diet to
softer foods that require little or no chewing and
are easy to swallow .
 A lack of protein can result .
3/6/2015 14

15.  A reduction of fats in the diet limits the
deposition of cholesterol in the arterial walls .
 An adequate dentition ,either natural or artificial
,is not essential for sufficient food intake for
maintaining a good nutritional balance during
normal health.
 However ,an adequate dentition ,either natural
or artificial, may be necessary to support the
extra demands of illness and is definitely needed
as an aid to the enjoyment of food.
3/6/2015 15

16. 3/6/2015 16

17. Nutritional guidelines for the patients
undergoing removable prosthodontic
treatment.
 Eat a variety of foods .
 Build diet around complex carbohydrates .
 Eat at least five serving of fruits and
vegetables daily.
 Select fish, poultry ,lean meat,eggs,or dried
peas and beans everyday.
3/6/2015 17

18.  Consume four serving of calcium –rich food
daily.
 Limit intake of bakery products high in fat
and simple sugars .
 Limit intake of prepared and processed foods
high in sodium and fat.
 Drink several glasses of water,juice ,or milk
daily.
3/6/2015 18

19. Risk factors for malnutrition in patients with
dentures
 Eating less than two meals per day ,
 Difficulty chewing and swallowing .
 Unplanned weight gain or loss of more than
10 lb in the last 6 month.
 Undergoing chemotherapy or radiotherapy.
 Alcohol or drug abuse.
 Unable to shop for,cook for ,or feed oneself.
3/6/2015 19

20. Nutritional requirement of the elderly
 carbohydrates should compromise 45-65% of
total calories.
 Fat should compromise 20-35% of total
calories .
 Protein should compromise 10-35%of total
calories .
 Fluid should compromise 30ml/kg/day or
1ml/kcal intake.
3/6/2015 20

21.  Loss of teeth-due primarily to degeneration
of periodontal structures.
 Attrition –rate is influenced by diet and
masticatory habits (bruxism)
 Oral mucosa –loss of elasticity with dryness
and atrophy .Tendency to hyperkeratosis .
 Gingivae-loss of stippling .edematous
appearance .Keratinized layer thin or absent
.Tissue friable or easily injured .
3/6/2015 21

22. 3/6/2015 22

23. 3/6/2015 23

24.  Saliva –diminished function of salivary glands
with relative or absolute xerostomia due to
atrophy of cells lining the intermediate ducts
.Xerostomia also result in abnormal taste
sensation and stomatodynia.
 Tongue –atrophic glossitis ,probably due to
concurrent vitamin B complex deficiency.
 Lips –angular chelitis is very common and is
probably related to concurrent vitamin B
complex deficiency. Chelitis due to dehydration .
3/6/2015 24

25.  Contrary to the belief of many patients and
some dentists ,the loss of teeth is not an
inevitable consequence of growing old .
 Unfortunately there are many in the dental
profession who are radical in their attitudes
towards the elderly .
 Even when the loss of all the remaining
natural teeth are inevitable ,they are too
quick in diagnosing complete dentures .
3/6/2015 25

26.  Although the patients no doubt will adapt
better to complete dentures at an earlier age
,conservatism and the construction of partial,
transitional ,or overdenture is the treatment
of choice .
 It is better to retain the natural teeth for as
long as possible and eventually accept the
complete dentures with their decreased
efficiency .
3/6/2015 26

27.  The longer a patient retain some of his
natural teeth ,the shorter the time he will be
edentulous ,and better the residual ridges will
be.
 Patients motivation cannot be
underestimated
 The patient must realize his need for
prosthetic treatment ,want dentures, accept
the prosthesis ,and attempt to learn to use it .
3/6/2015 27

28.  The dentist, in turn , must adapt his
technique to fit the patient, perhaps
changing his original diagnosis as treatment
progresses ,and concern himself with the
construction of a functional and comfortable
prosthesis .
3/6/2015 28

29.  Many times nothing is as important as good
clinical judgment in prosthetic diagnosis for
the geriatric patients .
 Complete denture should not be constructed
if a patient is under extreme physical or
mental stress .
 Too little treatment can be just as harmful as
too much treatment .
3/6/2015 29

30.  The majority of practicing dentists have
probably seen wearers of old dentures with
vulcanite or early acrylic dentures that
actually float in the patient’s mouth.
 It is an error to try to talk to these geriatric
patients into having new dentures
constructed .
3/6/2015 30

31.  An elderly person who has been without
teeth for many years and has no desires for
complete dentures is best left alone .
 If facial appearance is unimportant to these
patients and being without teeth does not
alter their personalities ,it is an error to
convince them to have complete dentures
constructed .
3/6/2015 31

32.  Jamieson wrote that “fitting the personality
of the aged patient is often more difficult
than fitting the dentures to the mouth .”
 Older patients are often more irritable and
demanding than younger patients .
 Geriatric patients should not be promised too
much .
3/6/2015 32

33.  It has been written and said many times that
esthetics is unimportant or secondary in
fabrication of dentures for the aged .
 The loss of tooth is a traumatic experience .
 Although we know that dentures can and do
improve facial appearance ,dentist are not
plastic surgeons .
3/6/2015 33

34.  If the final dentures are not what the patients
want or expects esthetically ,they may be
immediately rejected .
 If the patient cannot be convinced to accept
the dentures on esthetic grounds ,improved
function and other features should be
stressed .
3/6/2015 34

35. Impressions
 Prior to making edentulous impression for
geriatric patients ,the denture bearing tissues
must be thoroughly examined .
 Although it is true that age tolerate change
badly and it is wise to avoid major changes
,this does not mean that new dentures should
be under extended , no matter how short the
patients old dentures were .
3/6/2015 35

36.  The finished dentures should be as large as
possible within the functional limitation of
the patients with no impingement on
functional borders.
3/6/2015 36

37. Vertical dimension
 The determination of vertical dimension in a
young healthy individual is difficult.
 With the geriatric patients ,much more time
and efforts are required to ensure an accurate
physiologic recording .
 The interocclusal distance increases with age
.
3/6/2015 37

38.  It is claimed by some investigators that
continuous eruption of the teeth will
adequately maintain the vertical dimension .
 The falling-in of the lips ,due to loss of
adequate support and muscle tone
,complicates the difficulty of determining
vertical dimension.
 Geriatric patients needs more than the
average 3-mm inter occlusal distance of the
young adult with a full complement of teeth .
3/6/2015 38

39.  If severe difficulty exists in the determination
of vertical dimension ,the patient’s old
dentures, if available ,can be used as a guide .
 In some elderly patients ,even though the
vertical dimension is carefully and to the best
of our knowledge correctly determined,
“clicking” of the dentures may still occur
because of muscular incoordination or habit.
3/6/2015 39

40. Centric relation
 The correct recording and duplication of
centric relation is parmount to the success of
complete denture .
 A prognathic position of the mandible with a
resultant convenience eccentric bite is often
acquired by the geriatric patients ,usually the
result of a closed occlusal vertical dimension.
3/6/2015 40

41.  The patients must be seated in an upright
position ,if at all possible ,before centric relation
can be recorded .
 Although many prosthodontics recommend a
gothic arch or arrow point tracing for the
determination of centric relation of the elderly
,the author favors interocclusal wax check bites
after the initial tentative centric relation has
been recorded by wax occlusal rims constructed
on shellac ,gutta –percha ,or resin recording
bases
3/6/2015 41

42. Posterior tooth selection
 The posterior teeth are responsible for the
occlusion of a complete denture .
 The arrangement of the posterior teeth plays a
significant part in the retention and stability of
the dentures and the condition of the supporting
tissues .
 Many prosthodontics recommend zero degree
posterior teeth for the edentulous geriatric
patients .
3/6/2015 42

43.  Several non anatomic modification of
posterior tooth forms constructed wholly or
partially of chromium cobalt alloy are
available that are claimed to be
advantageous for patients with less than
average closing pressure .
 And where it is necessary to reduce the force
of the denture on the bearing surface during
function.
3/6/2015 43

44.  Hardy has designed blocks of upper and
lower acrylic posterior teeth in which curved
metal cutting blades are embedded.
 Although the chromium cobalt modification
of posterior tooth are enjoying some degree
of popularity ,they must be used with
reservation and only in specially selected
cases .
3/6/2015 44

45. 3/6/2015 45

46. Adjustment
 No matter how much care and skill are
incorporated into the fabrication of complete
denture ,their insertion is usually followed by
irritation and trauma in varying degrees .
 The soft tissue pain threshold changes
greatly after menopause and the male
climacteric ,with an increase in the sensitivity
,which according toVinton ,frequently
reaches the magnitude of 400%.
3/6/2015 46

47.  The geriatric patients should be seen the day
after insertion or, at the latest ,the second
day
 If the patients is a new complete denture
wearer ,mastication should not be attempted
until the denture can be worn comfortably
and speech presents no problems .
 During the adjustment visits ,the patients
should be asked for pointing out areas of
soreness .
3/6/2015 47

48.  However ,patients are poor judges and usally
cannot locate exact areas of discomfort .
 Geriatric patients can remove one or both
dentures during the day if their mouth feel
tired after the adjustment periods.
 If the patients is unable to care for his denture
or is afraid to try because of the fear of
dropping and breaking them ,oral hygiene
will be entirely dependent on another person.
3/6/2015 48

49. Relines
 If the dentures of the geriatric patients must
be relined because of the inability of the
dentist to construct new denture for any
reason, the existing jaw relation and the
arrangement of the teeth must be
satisfactory.
3/6/2015 49

50. Dental care of the aging patients presents a
number of problem not encountered in
younger patients . Most of these problems
result from tissue changes that occur during
aging.The dentist, especially the
prosthodontics ,is in a strategic position to
evaluate and correct many of the dietary and
nutritional deficiencies that promote
premature aging of tissues .
3/6/2015 50

51.  Sharry J.P. : Complete denture prosthodontics. 3rd Ed. Mc Graw
Hill Book Co., 1974.
 Sheldon Winkler: Essentials of complete denture prosthodontics
2nd Ed.
 Detroit Mich : Nutrition for the aging patient. J. Pros. Dent., 10 :
53-60, 1960.
 Perry C. : Nutrition for senescent denture patients. J. Pros. Dent.,
11 : 73-78, 1961.
 Ramsay W.D. : Role of nutrition in conditions of edentulous
patients. J. Pros. Dent., 23 : 130, 1970.
 Carl O Boucher: Boucher's ProsthodonticTreatment for
Edentulous Patients (13th Edition)
 "Food Pyramids:What ShouldYou Really Eat?".
www.hsph.harvard.edu. Retrieved 2009-12-25
 Dental Clinics Of North America volume 49 number 2 april 2005:
GERIATRICS: contemporary and future concerns
3/6/2015 51

52. 3/6/2015 52