The document discusses the effects of aging on the periodontium. It describes age-related changes to the five main components of the periodontium: gingiva, periodontal ligament, cementum, and alveolar bone. These changes include thinning of the gingival epithelium, increased density of gingival connective tissue, decreased cells and irregular structure in the periodontal ligament, increased cementum width, and more irregular bone surface. The document also notes that aging may lead to a greater inflammatory response and faster progression of periodontal diseases, but periodontitis risk is associated with rather than caused by age. Effective treatment and plaque control are still needed for positive outcomes in older patients.

2. AGING AND THE
PERIODONTIUM
Presented by,
Dr. Syed Sarosh Hussain
House Officer HUDH

3. CONTENTS
 Introduction
 Periodontium
 Aging Effects
 Effects of aging on the progression of the periodontal diseases
 Aging and the response to treatment of the periodontium
 Reference

4. INTRODUCTION
 Increased awareness and improvements in preventive dentistry have led
to decreasing tooth loss for all age groups.
 The effects of this shift in tooth retention need to be considered carefully.
 In particular, increased life expectancy and greater health expectations
may lead to changes in demand from older individuals for periodontal
treatment and potentially a substantial increase for supportive periodontal
therapy.

5. PERIODONTIUM
 The normal periodontium provides the support
necessary to maintain teeth in function.
 It consists of four principle components:
• Gingiva
• Periodontal ligament
• Cementum
• Alveolar bone

6. AGING EFFECTS
1. Age changes in the gingival epithelium.
2. Age changes in gingival connective tissue.
3. Age Changes in the periodontal ligament.
4. Age Changes in the cementum.
5. Age Changes in the bone.

7. 1. AGE CHANGES IN THE
GINGIVAL EPITHELIUM
 Thinning and decreased keratinization
of the gingival epithelium have been
reported with age.
 This is because of the increase in
epithelial permeability to bacterial
antigens, a decreased resistance to
functional trauma, or both.
 Flattening of rete pegs and altered cell
density.

8. 2. AGE CHANGES IN GINGIVAL
CONNECTIVE TISSUE
 Increasing age results in coarser and denser
gingival connective tissues.
 Qualitative and quantitative changes to
collagen have been reported.
 These include an decreased rate of
conversion of soluble to insoluble collagen,
increased mechanical strength and increased
denaturing temperature.
 These results indicate increased collagen
stabilization caused by changes in the
macromolecular conformation.

9. 3. AGE CHANGES IN THE
PERIODONTAL LIGAMENT
 Decreased number of fibroblasts and a more
irregular structure, paralleling the changes in
the gingival connective tissues.
 Decreased organic matrix production and
epithelial cell rests and increased amounts of
elastic fiber.
 Decreased cell proliferation.

10.  Increase in the cemental width; this maybe 5-
10 times with increasing age.
 The increase in width is greater apically and
lingually.
4. AGE CHANGES IN THE
CEMENTUM

12.  More irregular periodontal surface of bone and less regular
insertion of collagen fibres.
 Although age is a risk factor for the bone mass reductions
in osteoporosis, it is not causative and therefore, should be
distinguished from physiologic aging processes.
 Overriding the diverse observations of bony changes with
age is the important finding that the healing rate of bone in
extraction sockets appears to be unaffected by increasing
age.
5. AGE CHANGES IN THE
BONE

14. EFFECTS OF AGING ON THE PROGRESSION
OF PERIODONDAL DISEASES
 In older age groups(60-80 years), the findings included a greater size
of infiltrated connective tissue, increased gingival crevicular fluid flow,
and increased gingival index.
 In a classic experimental gingivitis study, subjects were rendered
plaque and inflammation free through frequent professional cleaning.
 Once this was achieved, the subjects abstained from oral hygiene
measures for periods of 3 weeks to allow gingivitis to develop.
 In this experimental model, a comparison of developing gingivitis
between young and older individuals demonstrated a greater
inflammatory response in older subjects.

15.  Even at the basement level of excellent gingival health before
commencing plaque accumulation, differences may exist between
groups, with older individuals demonstrating more inflammation.
 The phrase, “getting long in the tooth” expresses a widespread belief
that age is inevitably associated with an increased loss of connective
tissue attachment.
 Therefore, age has been suggested to be not a true risk factor but a
background or an associated factor for periodontitis.

16.  The successful treatment of periodontitis
requires both meticulous home-care plaque
control by the patient and meticulous supra-
gingival and sub-gingival debridement by the
therapist.
 If plaque control is not ideal, continued loss of
attachment is inevitable.
 Furthermore, without effective periodontal
therapy, progression of diseases might be faster
with increasing age.
AGING AND THE RESPONSE TO
TREATMENT OF THE
PERIODONTIUM

17. REFERENCE
 Carranza’s Clinical Periodontology – 11th edition
 Internet Source

19. THANK YOU