EFFECTS OF AGING EFFECTS OF AGING ON EDENTULOUS ON EDENTULOUS

STATESTATE

Dr shabeel pn

DEPARTMENT OF PROSTHODONTICS

GERODONTOLOGYGERODONTOLOGY

It is the branch of dentistry It is the branch of dentistry that deals with the oral that deals with the oral health problems of the old health problems of the old people. one of the problems people. one of the problems of aging is that some of the of aging is that some of the bodily functions do not bodily functions do not maintain their efficiency.maintain their efficiency.

CLASSIFICATIONCLASSIFICATION

THE CHANGES IN GERIATRIC PATIENTS CAN BE THE CHANGES IN GERIATRIC PATIENTS CAN BE CLASSIFIED ASCLASSIFIED AS

• physiologicphysiologic• psychologicpsychologic• pathologicpathologic

THE AGING PATIENT USUALLY FITS INTO THE AGING PATIENT USUALLY FITS INTO ONE OF THE THREE GROUPS:ONE OF THE THREE GROUPS:

• those who are well preserved physically and those who are well preserved physically and emotionally.emotionally.

• those who are really aged and chronically ill.those who are really aged and chronically ill.• those who fall between the two extremes.those who fall between the two extremes.

Another way of grouping is the Another way of grouping is the psychological reaction to aging process,psychological reaction to aging process,

1.1. realists: philosophic and exacting typerealists: philosophic and exacting type

2.2. resenters: indifferent and hysterical typeresenters: indifferent and hysterical type

3.3. resigned: vary in their emotional and resigned: vary in their emotional and systemic status. end treatment plan may be systemic status. end treatment plan may be palliative and definitive in nature.palliative and definitive in nature.

PHYSIOLOGIC CHANGESPHYSIOLOGIC CHANGES

More prevalent changes areMore prevalent changes are loss or graying of hairloss or graying of hair loss of teethloss of teeth dimenision of senses of light, hearing and dimenision of senses of light, hearing and

tastetaste

SENSESSENSES

Difficulty in hearing and diminishing vision Difficulty in hearing and diminishing vision can be offset by artificial aids such as can be offset by artificial aids such as complete dentures hearing aids and eyeglasses. complete dentures hearing aids and eyeglasses. in many instances those who will not wear a in many instances those who will not wear a hearing aid or glasses will reject dentureshearing aid or glasses will reject dentures

LOSS OF TEETHLOSS OF TEETH 60% of men and 70%of women 60% of men and 70%of women

over 65 years of age are over 65 years of age are edentulous edentulous

in old age chroma and hue of in old age chroma and hue of teeth will change as enamel is teeth will change as enamel is abraded, exposing the abraded, exposing the underlying dentin to extrinsic underlying dentin to extrinsic stains. chroma also deepens due stains. chroma also deepens due to medication containing heavy to medication containing heavy metals metals

natural teeth take on a jagged natural teeth take on a jagged brownish appearance of an aging brownish appearance of an aging dentition when the incisal edges dentition when the incisal edges break and the exposed denture break and the exposed denture gather extrinsic stainsgather extrinsic stains

some patient in conflict with the esthetic sense some patient in conflict with the esthetic sense of the dentist prefer to have complete dentures of the dentist prefer to have complete dentures with teeth that are smaller, straighter and with teeth that are smaller, straighter and whiter than natural teeth. whiter than natural teeth.

the loss of teeth and also some taste sense the loss of teeth and also some taste sense often leads to malnutrition.often leads to malnutrition.

SKINSKIN skin becomes thin, skin becomes thin,

wrinkled and driedwrinkled and dried to eliminate wrinkles the to eliminate wrinkles the

patient frequently patient frequently requests the dentist to requests the dentist to place the artificial teeth place the artificial teeth in undesirable relation to in undesirable relation to the support, to over the support, to over intend or over contain the intend or over contain the borders, or to decrease borders, or to decrease the interocclusal distancethe interocclusal distance

age reduces the concavity age reduces the concavity and past of the upper lipand past of the upper lip

Naso-labial groove deepens, which produce a sagging Naso-labial groove deepens, which produce a sagging look to the middle third of the face.look to the middle third of the face.

atrophy at subcutaneous end buccal pads of fat atrophy at subcutaneous end buccal pads of fat hollows the cheekshollows the cheeks

due to loss of fat support for the pre symphysial pad due to loss of fat support for the pre symphysial pad of fat disappears and upper lip drops over maxillary of fat disappears and upper lip drops over maxillary teethteeth

changes are accentuated more dramatically when changes are accentuated more dramatically when teeth are missing or when teeth is lost at occlusal teeth are missing or when teeth is lost at occlusal vertical dimensionvertical dimension

ORAL MUCOSAORAL MUCOSA becomes thin, easily becomes thin, easily

abraded, and frequently abraded, and frequently reacts unfavorably to the reacts unfavorably to the pressure of denturespressure of dentures

stomatitis and other mild stomatitis and other mild inflammations are the inflammations are the mucosal lesions mucosal lesions encountered most encountered most frequently in older frequently in older edentulous mouths, edentulous mouths, especially of older men especially of older men who wear dentures, smoke who wear dentures, smoke tobaccos and drink alcohol tobaccos and drink alcohol excessivelyexcessively

oral cancer or precancerous oral cancer or precancerous lesions are unusual in western lesions are unusual in western countries, although they are countries, although they are the most common forms of the most common forms of cancer on the Indian cancer on the Indian subcontinent and in other parts subcontinent and in other parts of Asiaof Asia

external carcinogens such as external carcinogens such as nicotine and alcohol could be nicotine and alcohol could be more damaging to the oral more damaging to the oral mucosa in old age because of mucosa in old age because of atrophy, increase mitosis with atrophy, increase mitosis with slow turnover of cells, and slow turnover of cells, and increased number of elastic increased number of elastic fibers. therefore it is likely that fibers. therefore it is likely that there is risk of oral cancer is there is risk of oral cancer is increased among edentulous increased among edentulous denture wears.denture wears.

SALIVASALIVA decreases in quantity and decreases in quantity and

changes in quality changes in quality lack of lubrication or viscous lack of lubrication or viscous

or soapy saliva decreases the or soapy saliva decreases the retention of dentures and retention of dentures and increases frictional trauma to increases frictional trauma to the thin mucosathe thin mucosa

causes of change in salivacauses of change in saliva1.1. xerostomic medication. xerostomic medication.

eg: digitaliseg: digitalis2.2. stressstress3.3. depressiondepression4.4. tobacco usetobacco use5.5. alcohol abusealcohol abuse

NEUROMYAL CHANGESNEUROMYAL CHANGES

generalized slowing down of normal activitygeneralized slowing down of normal activity muscle activity lacks coordination and muscle loss tonemuscle activity lacks coordination and muscle loss tone the cheeks sag and the mandible when at rest appears to drop the cheeks sag and the mandible when at rest appears to drop

slightly more in a protruded positionslightly more in a protruded position conduction of nerve impulse diminished in nerve conduction, conduction of nerve impulse diminished in nerve conduction,

loss of muscle tones, slowing down of muscle activity, lack of loss of muscle tones, slowing down of muscle activity, lack of muscle coordination all influences the recording of maxillo muscle coordination all influences the recording of maxillo mandibular relationmandibular relation

OSTEOPOROSISOSTEOPOROSIS the most common systemic born the most common systemic born condition occurring in both sexes condition occurring in both sexes

it is likely to appear earlier in it is likely to appear earlier in women than in menwomen than in men

accelerated loss of trabecular boneaccelerated loss of trabecular bone back pain, loss of bodyweight, back pain, loss of bodyweight,

facial height and some types of facial height and some types of deformity are some of the deformity are some of the symptomssymptoms

spontaneous fracture in advanced spontaneous fracture in advanced casescases

atrophy of bone is particularly atrophy of bone is particularly noted in residual alveolar ridge noted in residual alveolar ridge more so when ridge is subjected to more so when ridge is subjected to continuous pressure of denturecontinuous pressure of denture

MEMORYMEMORY

decreases in mental capacity to remember decreases in mental capacity to remember recent events, new names and new placesrecent events, new names and new places

recall of past events and placesrecall of past events and places

CIRCULATION, CIRCULATION, ALIMENTATION AND ALIMENTATION AND

ELIMINATIONELIMINATION flow of blood and lymph slows downflow of blood and lymph slows down gastric juice becomes less acidicgastric juice becomes less acidic digestion slows downdigestion slows down elimination of waste products becomes regularelimination of waste products becomes regular

NUTRITION AND DIETNUTRITION AND DIET as one ages people become less active since muscle activity is as one ages people become less active since muscle activity is

limited canonic requirement is lowerlimited canonic requirement is lower it is time for more protein and fewer carbohydratesit is time for more protein and fewer carbohydrates there is risk of malnutrition because of variety of factors there is risk of malnutrition because of variety of factors

ranging from socioeconomic status to over consumption of ranging from socioeconomic status to over consumption of drugsdrugs

decline in taste sensation results in appetite loss which leads to decline in taste sensation results in appetite loss which leads to malnutritionmalnutrition

obesity can result from excessive intake of returned obesity can result from excessive intake of returned carbohydratecarbohydrate

dieting may have side effects as a result of vitamin dieting may have side effects as a result of vitamin deficiencydeficiency

patients who are successfully using dentures are patients who are successfully using dentures are suddenly find that dentures are no longer comfortable suddenly find that dentures are no longer comfortable because of the supporting tissue change with the because of the supporting tissue change with the weight lossweight loss

patient who do not discipline themselves in diet patient who do not discipline themselves in diet control may not be very cooperative in carrying out control may not be very cooperative in carrying out instructions given for the case and use od denturesinstructions given for the case and use od dentures

PSYCHOLOGIC CHANGESPSYCHOLOGIC CHANGES

psychological reactions to any or all of biologic psychological reactions to any or all of biologic changes determine into which groups the patinet changes determine into which groups the patinet will fall – well preserved, chronically ill or in will fall – well preserved, chronically ill or in between groupbetween group

the psychological problems influencing the the psychological problems influencing the behavior of aging can be divided intobehavior of aging can be divided into

1.1. reactions to psychological changesreactions to psychological changes2.2. reaction to social changes, changes in reaction to social changes, changes in

environment and changes in mental environment and changes in mental capacitycapacity

REACTION TO REACTION TO PHYSIOLOGIC CHANGESPHYSIOLOGIC CHANGES

the changes influencing one’s appearance seems to the changes influencing one’s appearance seems to affect women more than menaffect women more than men

women frequently make their concern over their loss women frequently make their concern over their loss of hair and face height, wrinkling of the skin changes of hair and face height, wrinkling of the skin changes in tooth and loss of natural teethin tooth and loss of natural teeth

a man may not vocally register his concern. however a man may not vocally register his concern. however his reaction may be more dramatic but concealed. the his reaction may be more dramatic but concealed. the dentist must be aware of this concern for appearance dentist must be aware of this concern for appearance and strive to meet the esthetic requirement of all and strive to meet the esthetic requirement of all patientpatient

providing dentures for the patient providing dentures for the patient who has a justified belief in his who has a justified belief in his appearance and a proper sense of appearance and a proper sense of personal dignity is a pleasurepersonal dignity is a pleasure

in pleasant experience with in pleasant experience with someone who has developed a someone who has developed a vain personalityvain personality

malrelated jaws are not malrelated jaws are not connected by extracting to a connected by extracting to a natural teeth and replacing with natural teeth and replacing with artificial teethartificial teeth

not only may the support fot the not only may the support fot the dentures be destroyed but also dentures be destroyed but also the teeth may be placed in the teeth may be placed in position that are out of harmony position that are out of harmony with mandibular movements and with mandibular movements and the functions of the lips, tongue the functions of the lips, tongue and cheeksand cheeks

Malrelated jaws

REACTIONS TO SOCIAL REACTIONS TO SOCIAL CHANGESCHANGES

severance of social ties lead to isolation severance of social ties lead to isolation particularly for those who where habitually particularly for those who where habitually unsociable or who no longer derive pleasure unsociable or who no longer derive pleasure from activities enjoyed in former yearsfrom activities enjoyed in former years

isolation can lead to resentfulness and isolation can lead to resentfulness and unreasonable demands on the time of othersunreasonable demands on the time of others

retirement can lead to anxiety and loss of retirement can lead to anxiety and loss of income and fear that they will have to depend income and fear that they will have to depend upon someone else for supportupon someone else for support

during the diagnostic procedures it is therefore during the diagnostic procedures it is therefore important for the prosthodontist to be alert for important for the prosthodontist to be alert for dues that will reveal the patient’s dues that will reveal the patient’s psychological response to agingpsychological response to aging

if the problems are severe the patient may have if the problems are severe the patient may have to be referred to psychiatric counselingto be referred to psychiatric counseling

PATHOLOGIC CHANGESPATHOLOGIC CHANGES

The pathologic disorders or changes most The pathologic disorders or changes most frequently encountered are frequently encountered are

1.1. metabolicmetabolic2.2. skeletalskeletal3.3. muscularmuscular4.4. circulatorycirculatory5.5. neoplasticneoplastic6.6. psycologicpsycologic

The principle cause of disability in persons of 65The principle cause of disability in persons of 65

years and above are years and above are heart diseaseheart disease hypertensive vascular diseasehypertensive vascular disease tuberculosistuberculosis disease of the bones and joints, accidents, disease of the bones and joints, accidents,

nephritis, diabetes, cancer and eye diseasenephritis, diabetes, cancer and eye disease

The commonest cause of death after the age of 65 years The commonest cause of death after the age of 65 years are are

Cerebral hemorrhageCerebral hemorrhage Heart diseaseHeart disease CancerCancer General arteriosclerosisGeneral arteriosclerosis AccidentAccidentWhen any of the signs and symptoms of disease are When any of the signs and symptoms of disease are

observed in the face, complexion, posture, voice, observed in the face, complexion, posture, voice, walking or breathing pattern of an aging person a walking or breathing pattern of an aging person a more thorough investigation of the systemic status more thorough investigation of the systemic status should be instituted prior to detailed dental diagnostic should be instituted prior to detailed dental diagnostic procedures.procedures.

INTRAORAL CHANGESINTRAORAL CHANGES

Many of the physiologic and pathologic changes ofMany of the physiologic and pathologic changes ofthe aging are reflected in the oral mucosathe aging are reflected in the oral mucosa1.1. in majority of edentulous patients 65 years of age in majority of edentulous patients 65 years of age

and older there is a marked resorption of the and older there is a marked resorption of the residual alveolar ridge. the overlying mucosa residual alveolar ridge. the overlying mucosa shows sign of use and age, particularly if the shows sign of use and age, particularly if the mucosa has supported denturesmucosa has supported dentures

2. In the presence of ill fitting dentures one will find inflammatory hyperplasia.

palatal inflammatory hyperplasia is also associated with ill fitting dentures.

3.3. the thinning of the mucosa of the geriatric patient allows the thinning of the mucosa of the geriatric patient allows Fordyce spots to become more apparentFordyce spots to become more apparent

4.4. Macroglosia usually Macroglosia usually results from results from relaxation of the relaxation of the tongue musculature. tongue musculature. this occurs in this occurs in disturbance of the disturbance of the endocrine glands as endocrine glands as hyperpituitarism. hyperpituitarism. however the however the extraction of the extraction of the mandibular posterior mandibular posterior tooth allows the tooth allows the musculature to relax musculature to relax and is preferably the and is preferably the most prevalent most prevalent etiologic factoretiologic factor

5.5. As the serous gland As the serous gland decrease in activity the decrease in activity the saliva becomes more saliva becomes more mucous and soapy. When mucous and soapy. When the salivary glands the salivary glands atrophy the reduction of atrophy the reduction of the saliva flows result in the saliva flows result in dry mouth.dry mouth.