As age affect the our body parts similary it also affect the periodontium. To treat people with different age efficiently we need to understand the changes associated with periodontim.

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3.  AGING :- It is defined as the sum of all
morphologic & functional alterations that occur
in an organism and lead to functional
impairment which decline the ability to survive
stress.
 GERONTOLOGY:- Is the study of aging in all its
aspects biologic, physiologic, sociologic &
psychologic.
Definitions
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4. Periodontium ???
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6. The changes in aging periodontium
can be categorized into
 Intrinsic changes
 Stochastic changes
 Physiologic changes
 Functional changes
 Clinical changes
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7. 1. Intrinsic changes
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8. Cell Renewal Cycle
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9. Hay flicks limit/ Telomere
shortening
 Hayflick, an American microbiologist.
 Replicative senescence   the number of
progenitor cells.
 The decreased cellular component has a
concomitant effect to decrease cellular reserve
and protein synthesis.
 This affects the oral epithelium in that the
tissue becomes thin, with reduced
keratinization.
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10. Stochastic changes
Due to changes within the cell
 Structure become stiffer
 Loss of elasticity and
 Increased mineralization (fossilization).
With loss of regenerative power,
 structures become less soluble and
 more thermally stable.
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11.  Somatic mutations lead to decreased protein
synthesis and structurally altered proteins.
 Free radicals contribute to the accumulation of
waste in the cell.
 All these changes produce a decline in the
physiological processes of the tissue.
 Primarily: due to aging
 Secondarily: due to physiological deterioration.
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12. Physiologic changes
 Gingival epithelium:
 Thinning and
decreased
keratinization
 Increase in epithelial
permeability to
bacterial antigens
 Flatting of rete pegs
and altered cell
density
 Decreased resistance
to functional trauma
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13.  Gingival connective
tissue:
 Quantitative &
Qualitative changes in
collagen.
 Coarser and denser
gingival connective
tissue.
 ↑ denaturing
 ↑ rate of conversion of
soluble to insoluble
collagen
 ↑ mechanical strength
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14.  Periodontal ligament:
 Decrease in the no of
collagen fibers: reduction
or loss in tissue elasticity.
 Increased amounts of
elastic fiber.
 Decreased organic matrix
(mucopolysaccharides)
production
 Decreased Epithelial cell
rests
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15.  Cementum:
 Increase in cemental
width/ thickness
 Upto 5 to 10 times with
increasing age
 The increase in width is
greater in apically and
lingually.
 Increasing surface
irregularity.
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16.  Alveolar bone:
 Decrease in bone density
 Increase in bone resorption
 Decrease in vascularity.
 Irregular periodontal surface
of bone
 Less regular insertion of
collagen fibers.
 Healing rate of bone in
extraction sockets appears
to be unaffected by
increasing age.
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17.  Dentogingival plaque accumulation has been
suggested to increase with age-
 Increased hard tissue surface area resulting from
gingival recession
 Surface characteristics of the exposed root surface
compared to enamel
 Subgingival plaque: increased numbers of rods
and pseudomonads
 Periodontal pathogens:
 Increased Porphyromonas gingivalis
 Decreased Actinobacillus actinomycetemcomitans
Relation of Bacterial plaque with aging
periodontium17

18. Relation of Immune responses with
aging periodontium
 Immunosenescence
 Difference between young and older
individuals can be demonstrated for T and B
cells, cytokines and natural killer cells, but not
for polymorphonuclear cells and macrophage
activity.
 McArthur in 1999: no evidence for age related
in host defenses correlating with periodontitis
in an elderly group of individuals, with and
without disease.
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19. Functional changes
 Abnormality in T cell function: more susceptible
for viral and fungal infection.
 Inflammation, when persist, develops more
rapidly and more severely.
 Decrease the healing capacity and rate.
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20. Clinical changes
 Migration of junctional epithelium from its
position in healthy individual (on enamel) to
more apical position on the root surface with
accompanying gingival recession.
 The consensus is that gingival recession is not
an inevitable physiologic process of aging but
is explained by cumulative effects of
inflammation or trauma on the periodontium.
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21. Attached gingiva
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22. Width of attached gingiva
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23. Xerostomia
 Saliva plays an essential role in maintaining
oral health.
 Antimicrobial activity
 Buffering capacity
 Lubrication of the oral cavity
 Transport of taste sensors
 Digestive function
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24.  Loss of acinar cells with aging.
 Medications: tricyclic antidepressants,
antihistamines, antihypertensives, and
diuretics.
 Radiation treatment, Sjohren’s syndrome,
poorly controlled diabetes, bone marrow
transplantation, thyroid disorders, and
depression-
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25.  Xerostomia screening by
 Sialometry
 Oral examination
 Sialometry:
 Precise collection of saliva for 5 to 15 min from
gland
 Parotid gland-Stensen’s duct: modified Carlson-
Crittenden collectors
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26.  Oral examination: tongue blade
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27.  Signs of xerostomia:
 Intraoral dryness
 Burning sensations
 Altered tongue surface
 Dysphagia
 Cheilosis
 Alterations in taste
 Difficulty with speech
 Root caries
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28. Candidiasis
 Cause by Candida albicans.
 A pathogenic infection occurs when C.
albicans infiltrates into the oral mucosal layers.
 Any condition compromising a patient’s
immune system can be considered a risk
factor for candidiasis.
 Pseudo membranous
candidiasis.
 Chronic atrophic candidiasis
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29. Periodontal disease in older
adults
 Age is either nonexistent or provides a small
and clinically insignificant increased risk of
loss of periodontal support.
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30.  Chronic periodontitis
 Prevalence of periodontal disease is expected
to increase with age, as a result of cumulative
disease progression over time, not
susceptibility.
 Severe or moderate chronic periodontitis???
 Systemic disease
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31. On progression of periodontal
disease
 Greater inflammatory response in older adults-
 Greater size of infiltrated connective tissue
 Increased gingival crevicular fluid flow
 Increased gingival index
 Increased loss of connective tissue:
 Chronic mechanical trauma from toothbrushing
 Iatrogenic damage from unfavorable restorative
dentistry or repeated scaling and root planing
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32. Periodontal treatment planning
 Prevention, comfort, function, esthetics and
ease of maintenance are the criteria for
successful management of an older adult.
 To preserve
function
 Eliminate or
prevent the
progression of
inflammatory
disease.
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33.  Factors which influence periodontal treatment
outcome or progression of the disease :
 medical and mental health status,
 medications,
 functional status,
 lifestyle behaviors that.
 Periodontal disease severity, ability to perform
oral hygiene procedures and ability to tolerate
treatment should be evaluated.
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34.  The risks and benefits of both surgical and non
surgical therapy should be considered.
 Nonsurgical approach is often the first
treatment choice.
 Age alone is not a contraindication of surgery.
 Maintenance of surgical results.
 Pallative support periodontal care.
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35. Response to treatment of the
periodontium
 The successful treatment of periodontal
requires both meticulous plaque control by the
patient at home and meticulous supragingival
debridement by therapist.
 Despite the histologic changes in the
periodontium with aging, no differences in
response to nonsurgical or surgical treatment
have been shown for periodontitis
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36. Prevention of periodontal disease and
maintenance of periodontal health in older
adults
 Oral hygiene maintenance
 Chemotherapeutic agents
 Antiplaque agents
 Fluoride
 Saliva substitutes
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37. Antiplaue agents
 Chlorhexidine
 Subantimicrobial tetracycline: periostat
 Listerine or its generic counterparts
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38.  Fluoride:
 Natural cavity fighter
 Reduce enamel solubility
 Promotes remineralization of early carious
lesions
 Is bactericidal to bacterial plaque
 OTC: 230-1500 ppm
 Professional: 9050-22,600 ppm
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39. Saliva substitutes
 They are intended to
match the chemical and
physical traits of saliva.
 Composition: salt ions, a
flavoring agent, paraben
(preservative), cellulose
derivative or animal
mucins and fluoride.
 ADA approved: Salivart
 Xylitol chewing gum
 Parotid-sparing radiation
therapy
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40. 5 golden rules for healty teeth
1. Brush your teeth twice daily
2. Rinse your mouth after every meal
3. Eat fresh fruits and vegetables
4. Do not eat sweet in between meals
5. Visit your dentist every six months
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