Effects of age on the edentulous state/cosmetic dentistry courses

THE EFFECT OF AGE ON THE
EDENTULOUS STATE
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

Introduction
A complete denture prosthesis depends
ultimately upon the health and integrity of the
denture-bearing tissues for successful function and
comfort to the patient. Thin and friable epithelium
covering the edentulous ridge may not be able to
tolerate the forces imposed upon it by the hard
unyielding acrylic base of the complete denture
prosthesis. The connective tissue pad between the
underlying bone and the epithelium covering may not
be thick enough to absorb the forces placed upon
the area. The alveolar ridge may be so extensively
resorbed that the prosthesis rests directly upon the
basal bone. www.indiandentalacademy.com

THE IMPACT OF AGE ON THE
EDENTULOUS MOUTH
Mucosa {GEORGE A. ZARB}
Stomatitis and other mild inflammations are
the mucosal lesions encountered most frequently
in older edentulous mouths, especially of older
men who wear dentures, smoke tobacco, and
drink alcohol excessively. Oral cancer or
precancerous lesions are unusual in Western
countries, although they are the most common
forms of cancer on the Indian sub-continent and in
other parts of Asia.

External carcinogens, such as nicotine and
alcohol, should be more damaging to the oral
mucosa in old age because of atrophy, increased
mitosis with slow turnover of cells, and increased
number of elastic fibers.
{CHARLES M. HEARTWELL}
The oral mucosa undergoes changes similar
to those in the skin, it becomes thin, is easily
abraded, and frequently reacts unfavorably to the
pressure of dentures.www.indiandentalacademy.com

{SHELDON WINKLER}
The oral environment must be moist and the
oral mucosa must be firm, and able to resist mild
abrasions if the prosthesis is to feel comfortable.
It is almost impossible for patients to tolerate
even a perfectly balanced and carefully
constructed prosthesis if the mouth is dry (lacking
saliva) and the tissues have a burning sensation
(especially the tongue) and are friable (especially
the buccal and lingual mucosa).www.indiandentalacademy.com

Bone {GEORGE A. ZARB}
Bone mass is at its maximum in midlife, with
substantially more in men than in women, and in
some racial groups more than others. However,
even within individuals, the quality of bone in all
parts of the skeleton, including the jaws, varies
greatly and decreases with age. The decrease
occurs because osteoblasts are less efficient,
estrogen production declines, and there is an
overall reduction of calcium absorption from the
intestine in old age.

The turnover and metabolism of bone are
influenced by many factors, including exercise,
genes, hormones and nutrition, but usually resorption
surpasses formation somewhere around midlife in
both men and women. The jaws of both sexes also
become more porous with time probably because of
metabolic rather than functional changes in the bone.
The most common systemic bone condition occurring
in both sexes is osteoporosis. It is likely to appear
earlier and more frequently in women than in men.

In the advanced disease state spontaneous
fractures occur. The atrophy of bone is particularly
noticeable in the residual alveolar ridge, more so
when the ridge is subjected to the continuous
pressure of dentures.
{SHELDON
WINKLER}
Functions of Bone
Bone has two important functions.
•It serves as the skeletal structure to which the
muscles are attached.www.indiandentalacademy.com

Calcium is an essential mineral which is
necessary for many functions in the body, including
transmission of nerve impulses (lack of calcium
leads to convulsions), cell membrane integrity, and
blood coagulation. Bone serves as the internal
source of calcium when the exogenous sources
(dietary) become deficient. Osteoporosis results
when the internal bony sources of calcium are
drawn upon to compensate for the lack of calcium
intake, failure in absorption, or deficient transport.

The Prosthodontist should obtain a detailed
daily dietary record from his patient, in writing, to
determine whether the patient's mineral intake is
adequate to support his prosthesis. Verbal
questioning of the elderly is not enough. Patients
tend to deny dietary indiscretions. Education of
the elderly is as important as the prosthesis in
rendering quality health service to the patient.

Saliva {GEORGE A. ZARB}
The role of saliva as a lubricant and as a
chemical buffer is central to the comfort and
function of the mouth. The electrolytes,
glycoproteins, and enzymes of mucous saliva
lubricate, cleanse, and protect the mucosa, and
they ease the passage of food around the mouth
while contributing to the sense of taste. Inadequate
quality or quantity of saliva is particularly difficult
for complete denture wearers because mucous
saliva produced by the minor glands of the palatal
helps to retain and lubricate the denture
prosthesis. www.indiandentalacademy.com

Older persons take a vast array of potentially
xerostomic medications for depression, sleeping
disorders, hypertension, allergies, heart problems and
many other geriatric problems. Indeed, stress,
depression, tobacco use, and abuse of alcohol alone
can disturb salivary flow, whereas hyposalivation of
the minor salivary glands of the palate, which disturbs
denture retention, is a common side effect of digitalis
preparations, tranquillizers, and antidepressants.

{SHELDON WINKLER}
When the salivary flow is deficient and
xerostomia occurs, the food must be prepared in
liquid or semiliquid form before it can be
swallowed. The elderly tend to prefer soft foods
and soups. In severe xerostomia, the mouth
must be lubricated with artificial saliva.

JAW MOVEMENTS IN OLD AGE
{GEORGE A. ZARB}
People chew more slowly as they get older.
Although the duration of the total chewing cycle
does not appear to change, it does seem that the
vertical displacement of the mandible is shortened.
Advancing age may delay the central processing of
nerve impulses, impede the activity of muscle fibers,
and inhibit decisions. It can also reduce the number
of functional motor units and decrease the cross
sectional area of the masseter and medial pterygoid
muscles.

Consequently, older people tend to have poor
motor coordination and weak muscles. Muscle
tone can decrease by as much as 20% to 25% in
old age, which probably explains the shorter
chewing strokes and prolonged chewing time.
Older persons also have a less coordinated
chewing stroke, probably because of a general
deficit in the central nervous system, and some
individuals experience pain on swallowing
because of osteophytes and spurs growing on the
upper spine adjacent to the pharynx. A noticeable
change in swallowing strongly suggests that there
might be an underlying pathosis, such as
Parkinson's disease or palsy that is not a part of
normal aging. www.indiandentalacademy.com

Muscle activity lacks coordination, and the
muscles lose tonus. The cheeks sag, and the
mandible, when at rest, appears to drop slightly
more in a protruded position. The decrease in
nerve conduction, loss of muscle tonus, "slowing
down" of muscle activity, lack of moisture in the
skin, and lack of muscle coordination all influence
the recording of maxillomandibular relations.

TASTE {GEORGE A. ZARB}
The sensation of "tasting" rarely occurs in
isolation, but results from the interaction of
proprioception, taste, and smell. Texture is felt,
chemical constituents stimulate taste, and aromatic
gases smell. Bitter, sweet, sour, and salty tastes
stimulate receptors independently, so one may be
damaged without disturbing the others. Sensitivity to
taste declines with age, and especially in older
persons with Alzheimer's disease. Also, the
preference for specific flavors changes over time to
favor higher concentrations of sugar and salt.www.indiandentalacademy.com

Complaints of an impairment affecting the
sense of taste at any age should be investigated
thoroughly because they may be due to an upper
respiratory infection or a serious neurological
disorder. The three cranial nerves (VI, IX, and X)
carrying sensations of taste can be disturbed and
damaged by tumors, viruses (e.g., Bell's palsy
and herpes zoster), and trauma (e.g., head
injury). www.indiandentalacademy.com

{SHELDON WINKLER}
The impairment of taste results from
degeneration of taste buds and reduction in their
total number. Sense of taste for salty and sweet
foods disappears early. Taste buds react only to
dissolved compounds. Bitter taste receptors in
the circumvallate papillae at the posterior base of
the tongue persist much longer. As age and
xerostomia progress, the tongue sheds its
epithelial coat and becomes smooth (bald) and
atrophic. www.indiandentalacademy.com

Young adults have approximately 245
taste buds on each papilla of the tongue, but by
the age of 75 to 80 years the number has
declined by 64%. The loss of taste buds results in
a decrease in perception of all four taste
attributes- salt, sweet, bitter, and sour.

NUTRITION {GEORGE A. ZARB}
The elderly population is at particular risk for
malnutrition because of a variety of factors that
range from socioeconomic stress to an over
consumption of drugs, and including, to some
extent, the state of the dentition. The role of the
dentition in mastication and food selection is
complex. Some edentulous persons with faulty
dentures restrict themselves to a soft diet,
whereas others, even with uncomfortable and
wellworn dentures, can eat nearly all of the food
available to them.www.indiandentalacademy.com

{CHARLES M.
HEARTWELL}
Nutrition and diet are important factors with all
edentulous patients, but particularly with geriatric
persons. Their diet often presents a challenge, not
only to the dentist but also to those who are
responsible for their care. Many geriatric patients
live alone and do not have the energy or the desire
to prepare wellbalanced meals for themselves.
They may eat only one meal a day, and symptoms
of dietary deficiencies may develop.

Vitamin therapy, so essential as a diet
supplement for them, may be looked upon as
medicine that they often refuse to take. The
cooperation of the family is frequently the only
solution to treating these patients. Obesity can
result from an excessive intake of refined
carbohydrates. This excessive intake may be
caused by emotional disturbances. Metabolic
disorders and/or atrophy of the taste buds for
sweets. Patients who will not discipline themselves
in diet control may not be very cooperative in
carrying out the instructions given for the care and
use of denture prosthesis.www.indiandentalacademy.com

{SHELDON WINKLER}
In the elderly, protein depletion of body is seen
primarily as a decrease of skeletal muscle mass.
Muscle accounts for 45 percent of body weight in
young adults. This drops to 27 percent in the very
old. Infection, trauma, and disease increase the need
for protein as well as other nutrients. The best
sources of protein for the elderly diet are meats and
fish. These foods should be boiled, not fried. Boiling
prepares these foods for the elderly gastrointestinal
tract by breaking down the complex proteins to the
more easily digested proteoses, while frying
coagulates the proteins and makes them difficult to
digest. www.indiandentalacademy.com

Skin {GEORGE A. ZARB}
Age reduces the concavity and "pout" of the
upper lip, and it flattens the philtrum. The
nasolabial grooves deepen, which produces a
sagging look to the middle third of the face,
whereas atrophy of the subcutaneous and buccal
pads of fat hallows the cheeks. Subsequently, as
the loss of fat continues, support for the
presymphyseal pad of fat disappears, and the
upper lip droops over the maxillary teeth.www.indiandentalacademy.com

{SHELDON WINKLER}
Skin Subcutaneous connective tissues provide
the main storehouse for water. The skin wrinkles
with aging usually due to water loss from the
subcutaneous connective tissues. This changes
the firm, soft tissues of children and young adults
to the pale, dry, and wrinkled cheeks, neck, arms,
and thighs, of the elderly. The face shows the
wrinkling effects of negative water balance and
dehydration early because it is readily visible and
is exposed to sun and weather.www.indiandentalacademy.com

As one ages, the skin becomes thin, wrinkled,
dry, and freckled. The wrinkled skin of the face,
particularly around the mouth, may be cause for
great mental anguish for some aging persons. To
eliminate wrinkles, the patient frequently requests
the dentist to place the artificial teeth in
undesirable relations to the support, to overextend
or overcontour the borders, or to decrease the
interocclusal distance. It is far better to discuss
this normal phenomenon of aging during the
diagnostic interview rather than later in the
prosthodontic procedures.

CONCERNS FOR PERSONAL APPEARANCE IN
OLD AGE {CHARLES M. HEARTWELL}
Older persons worry about their selfimage as
much, if not more, than at any other stage of life.
The changes influencing one's appearance seem
to affect women more than men. Women
frequently voice their concern over the loss of hair
and face height, wrinkling of the skin, changes in
tooth appearance, and the loss of the natural
teeth. A man may not vocally register his concern;
however, his reaction may be more dramatic but
concealed.

{GEORGE A. ZARB}
An attractive appearance is considered
important to selfsatisfaction. Healthy older persons
frequently admit that they try hard to feel and look
young. A healthy person will accept the natural
consequences of aging without undue disturbance,
although psychosocial pressures can cause an
unhealthy obsession with appearance, even to the
point of anorexia surfacing for the first time in old
age. www.indiandentalacademy.com

SUMMARY
Management of edentulous elderly patients
involves a constant sensitivity to the potential
impact of a multitude of medical disorders. The
mouth is a fine sensor of systemic stability, and
occasionally it offers the first physical
manifestation of a disease. Wounds heal more
slowly and possibly less effectively in old age
because of decreased turnover of cells or poor
blood circulation. Consequently, the mucosa and
underlying bone supporting complete denture
prosthesis heal more slowly from the trauma of ill
fitting dentures.

Vitamin A Cellular
differentiation,
integrity,growth,
antikeratinizing,
vision
Xerostomia,
Enamel
Hypoplasia, Tooth
eruption,cancer
Vitamin D Calcium &
Phosphorous
metabolism
Cementum &
dentin
Vitamin E Antioxidant
Vitamin K Clotting factors Bleeding in surgery
VITAMINS

Vitamin C Collagen synthesis,
adrenal cortical
hormones
Scurvy,
Enamel & dentin
defects
Vitamin B
complex
Coenzyme in many
biological reactions,
DNA synthesis
Glossitis, angular
cheilitis, RAS,
Ulceration,
Infection,
keratinocyte
maturation

Carbohydrate 50-70%
Protein 1gm/kg/day
Fat 20%
Vitamin A
Beta carotene
750mcg
3000mcg
Vitamin D 2.5mcg
5 mcg
Vitamin E 10mg
Vitamin K 45mcg
Vitamin C 40mcg
Thiamine 0.5mg/1000 C
RECOMMENDED DAILY ALLOWANCE

Calcium Bone, tooth
formation , blood
clotting, muscle,
nerve.
Bone density,
hypoplasia
Phosphorous Bone tooth
formation
rare
Iron Hemoglobin Anemia glossitis,
chelitis
Zinc Wound healing, Taste, smell,wound
healing,
Fluorine Bone, tooth
formation
Susceptibility to
dental caries
MINERALS

Copper Antioxidant, iron
absorption
anemia
Selenium antioxidant Predisposition
Cardiac disease

Cereals: Rice, wheat
Millets Jowar, bajra, ragi
Non-vegetarian Eggs, milk , fish , meat
Vegetables and
pulses
Roots and tubers, green leaves
Fruits Banana, mango, musambi, grapes, apples,
oranges
Beverages Coffee, tea,
Fats and oils Butter, ghee, dalda
Condiments Cardamom, garlic, chilies, turmeric pepper
NORMAL INDIAN DIET

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