agechangesinprosthodontics-150305234548-conversion-gate01.pptx

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Age Changes In Prosthodontics
Good
morning

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Introduction
 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 .

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

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Definition
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.”

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Scope of the problem
 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.

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Scope of the problem
 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.

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Scope of the problem
male female male female
0
10
20
30
40
50
60
black
white
Number
per
100
population
45-64 years 65 years and over

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Psychologic and psychiatric
aspects of aging
 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 .

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Psycho logic and psychiatric
aspects of aging
 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 .

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Psycho logic and psychiatric
aspects of aging
 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 .

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Psycho logic and psychiatric
aspects of aging
 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 .

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Classification of elderly people
 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.

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Aging and nutrition
 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 .

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Aging and nutrition
 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.

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Aging and nutrition

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Aging and nutrition
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.

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Aging and nutrition
 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.

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Aging and nutrition
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.

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Aging and nutrition
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.

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Oral aspects of aging
 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 .

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Oral aspects of aging

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Oral aspects of aging

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Oral aspects of aging
 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 .

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Prosthetic diagnosis
 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 .

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Prosthetic diagnosis
 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 .

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Prosthetic diagnosis
 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 .

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Prosthetic diagnosis
 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 .

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Clinical judgment
 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 .

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The satisfied wearer of old
denture
 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 .

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The geriatric patients who
doesnot want dentures .
 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 .

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The geriatric prosthetic patient
 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 .

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Esthetics
 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 .

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Esthetics
 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 .

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Complete denture construction
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 .

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Complete dentures construction
 The finished dentures should be as
large as possible within the functional
limitation of the patients with no
impingement on functional borders.

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Complete dentures construction
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 .

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Complete dentures construction
 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 .

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Complete dentures construction
 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.

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Complete dentures construction
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.

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Complete dentures construction
 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

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Complete dentures construction
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 .

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Complete dentures construction
 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.

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Complete dentures construction
 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 .

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Complete dentures
construction

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Complete dentures construction
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 to
Vinton ,frequently reaches the magnitude of
400%.

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Complete dentures construction
 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 .

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Complete dentures construction
 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.

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Complete dentures
construction
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.

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Summary
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 .

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REFERENCES
 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 Prosthodontic Treatment for Edentulous
Patients (13th Edition)
 "Food Pyramids: What Should You 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

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THANK U