AGING RELATED TO ORAL TISSUES

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GOOD MORNING

AGING RELATED TO ORAL TISSUES:

AGING RELATED TO ORAL TISSUES PRESENTED BY:- RACHIT WALIA GUIDE:- DR.S.DATTA PRASAD CO-GUIDE:- DR.SANJAY YADAV DR.ARVIND GARG

INTRODUCTION:

INTRODUCTION INTRODUCTION

DEFINITIONS:

DEFINITIONS GROWTH :- Growth is increase in size. TODD DEVELOPMENT :- Development is progress towards maturity. TODD MATURATION :- The stabilization of the adult stage brought about by the growth and development.

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AGING DEFINITION :- Refers to irreversible and inevitable changes occurs with time It is also 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 ATHENS & PAPAS

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GERONTOLOGY :- Is the study of aging in all its aspects biologic, physiologic, sociologic & psychologic. PEDERSON & LOE Gerontologic studies allows one to distinguish healthy aging from the effects of disease.

BIOLOGIC AGING PROCESS:

BIOLOGIC AGING PROCESS The physiologic processes that take place from conception to death are continuous and do not occur stepwise. DEVELOPMENT merges gradually into MATURATION and ultimately AGING.

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BIOLOGIC AGING PROCESS IS UNIVERSAL :- A detectable in all members of the species INTRINSIC :- Independent of influences from outside to organism PROGRESSIVE :- Develop gradually & irreversibly DELETERIOUS :- Harmful to the survival of individual

WHEN DOES IT START………. ?:

WHEN DOES IT START………. ? According to Harrison, despite the biological controversy, from a physiological standpoint human aging is characterized by progressive constriction of the homeostatic reserve of every organ system. This decline, often referred to a HOMEOSTENOSIS ,is achieved by third decade of life and is gradual and progressive, although the rate and extent of decline vary.

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WHAT CAUSES AGING ? Medvedev listed 300 theories that have been offered in an attempt to answer this but nothing conclusive comes. The consensus today is that aging is the end result of multiple biological processes which includes

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GENETIC LEVEL :- Where information for the initiation & maintaince of cellular functions are encoded CELLULAR LEVEL :- Where integrity of somatic cells is maintained ORGAN&ORGAN SYSTEM LEVEL :- Where physiologic functions are performed COORDINATION LEVEL :- Physiologic functions are controlled & assembled into complex function

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GENETIC MUTATIONS :-Several mutations reduces life span 2. SPECIES SPECIFIC LIFE SPAN :-Each species is characterized by its own pattern of aging & maximum life span 3. HYBRID VIGOR :-The effect of genetic constitution on longevity is perhaps best exemplified where hybrid vigor is demonstrated FACTORS INFLUENCING AGING

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4. SEX :- In humans\animals, female lives longer. 5. PARENTAL AGE :- Like father like son. 6. PREMATURE AGING SYNDROME :- Single gene changes results in premature senscence in humans e.g. progeria, cockayne’s syndrome, werner’s syndrome.

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B ) ENVIRONMENTAL PHYSICAL AND CHEMICAL :- Pollution, radiations, working atmosphere etc BIOLOGICAL FACTORS :- Nutrition, general health etc PATHOGENS AND PARASITES :- They influence the rate of human development  low income group \ tropical countries SOCIOECONOMIC CONDITIONS :- Bad housing, stresses etc

LOVE IS IMMORTAL:

LOVE IS IMMORTAL love is immortal

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STUDYING AGING-AGESYOU…….WHY? AGING Vs OTHERS It has always been difficult for researchers to differentiate whether the changes in tissues/organ system are due to physiologic aging or pathologic . There is no precise method for determining the rate or degree of aging because

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AGING  SYSTEMIC DISEASES  SURGERIES,MEDICATIONS,CHEMOTHERAY,RADIOTHERAPY  ALTERATIONS IN BODY  CHANGES…SUPERIMPOSES

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SALIVARY GLANDS AND SALIVA THERE ARE 3 MAJOR PAIRED & SEVERAL MINOR SALIVARY GLANDS PRESENT IN ORAL CAVITY. MAJOR GLANDS ARE :- P AROTID,SUBLINGUAL,SUBMAND IBULAR MINOR GLANDS ARE:- LABIAL, BUCCAL, PALATAL PRIMARY FUNCTION-EXOCRINE PRODUCTION OF SALIVA.

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MAJOR ROLES OF SALIVA IN MAINTAINNCE OF ORAL HEALTH Preparation & translocation of food bolus. Lubrication of oral mucosa. Preservation of microbial ecologic balance. Mechanical cleansing .

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Antibacterial &antifungal activities. Maintainance of oral ph. Remineralization of dentition. Mediation of taste activity.

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SALIVARY FUNCTION DURING AGING There occurs a fairly linear loss of acinar cells, replaced by fatty or connective tissue. Submandibular gland – 40% loss of acinar cells Parotid gland - 30% loss of acinar cells Minor labial glands - 45% loss of acinar cells

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Unstimulated whole saliva flow rates are reduced but stimulated rates are increased. The salivary glands are known to undergo quantitative & qualitative histologic changes with age.

MORPHOMETRIC STUDIES SHOWS :

MORPHOMETRIC STUDIES SHOWS PROPORTION OF GLAND PARENCHYMA OCCUPIED BY ACINAR CELLS IS REDUCED BY 25% - 30%. ATROPY OF ACINAR CELLS. PROLIFERATION OF DUCTAL ELEMENTS. SOME DEGENERATIVE CHANGES.

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Earlier ,it was thought that salivary secretion is also reduced with age but recent functional studies showed , despite the appearance of age related morph metric changes in salivary glands - Functional out put & composition of saliva doesn't appear to be consistently altered in older but otherwise healthy persons. GERIATIC DENTISTRY(pederson & loe)

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THE DECREASE IN SALIVARY PRODUCTION IS MORE RELATED TO SALIVARY GLAND DYSFUNCTION & RELATED ORAL MORBIDITIES ASSOCIATED WITH SYSTEMIC DISEASES & MEDICATIONS.

ORAL MUCOSAL BARRIER:

ORAL MUCOSAL BARRIER THE ORAL MUCOSA PERFORMS ESSENTIAL PROTECTIVE FUNCTION THAT PROFOUNDLY AFFECT THE GENERAL HEALTH & WELL BEING OF HOST.

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It provides first line of defense. Specialized mucosal sensory detectors serve to warn us of many potentially harmful situations such as spoiled food stuffs,temprature extremes,sharp objects,etc. Any changes in O.M. barrier could expose the aging host to myriads of pathogens & chemicals that enter the oral cavity

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Both histologic layers of oral mucosa,epithelium,& connective tissue have important defensive functions. Stratified squamous epithelium containing attached oppose cells forms  PHYSICAL BARRIER  which restricts entry of microorganisms & toxic substances. Mucosal epithelial cells synthesize KERATIN & LAMININ

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LAMININ  P reserve structural integrity & restore wound healing . KERATIN  MASTICATORY MUCOSA  Protect against abrasive insults e.g. stiff foods. ALSO, Provide self cleansing mechanism by natural turn over of epithelial cells.

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But literature doesn’t give clear picture of histologic status of O.M. with normal aging. Reports says thinning of epithelium while others contradicts. Whether degree of mucosal keratinization increases, decreases or unchanged.

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Controversy exists to whether menopause is associated with alterations in oral epithelium maturation & subjective complaint in questionable women. CLINICAL SIGNIFICANCE :- Effects are mild & their clinical significance is inconsequential.

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EFFECTS OF AGING ON PERIODONTIUM A) GINGIVAL EPITHELIUM Thinning & decreased keratinization of the gingival epithelium Flattening of rete pegs, altered density. Migration of functional epithelium from its position in healthy individual (on enamel) to more apical position on the root surface with accompanying gingival recession

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CLINICAL SIGNIFICANCE An increase in epithelium permeability to BACTERIAL ANTIGENS Decrease resistance to trauma.

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B) GINGIVAL CONNECTIVE TISSUE :- Coarse & more dense gingival connective tissue. Quantitative & Qualitative changes in collagen:  R ate of conversion of soluble to insoluble collagen  M echanical strength  D enaturing temperature

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C) PERIODONTAL LIGAMENT (PDL ) A fibrous connective tissue that is noticeably cellular & vascular. It ‘s functions are: Attachment & Support Nutrition Proprioception Synthesis

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VARIOUS CELLS ARE SYNTHETIC: osteoblasts,cementoblasts,fibroblasts RESORPTIVE: osteoclasts,cementoclasts,fibroblasts OTHERS: progenitors,macrophages,mast cells

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EXTRACELLULAR SUBSTANCE ARE FIBERS collagen, oxytalan GROUND SUBSTANCE INTERSITIAL TISSUE

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AGE CHANGES ARE  no of fibroblasts  organic matrix production & epithelial cell rest  amount of elastic fiber

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C EMENTICLES Calcified bodies called CEMENTICLES are found in PDL in older individual. They may lie free in the connective tissue , may fuse into large calcified masses, or may be joined with cementum. EXCEMENTOSIS As cementum thickens with age it envelops these masses(CEMENTICLES) &called as EXCEMENTOSIS.

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D ) CEMENTUM . Cementum continous to be laid through out life but rate of formation diminishes with age A thickening of cementum is observed on teeth that are not in function(HYPERCEMENTOSIS).  in cemental width(5-10 times) as cementum deposition is continues after tooth eruption.  in width is greater APICALLY & LINGUALLY

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CEMENTAL HYPERTROPY If the overgrowth improves the functional qualities of the cementum , it may be known as CEMENTAL HYPERTROPY. CEMENTAL HYPERPLASIA If overgrowth occurs in nonfunctional teeth or if it is not related to  functions. LOCALIZE HYPERTROPY A spur or prong like extension of cementum may be formed, if are exposed to great stress.

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REPAIR OF CEMENTUM Cementum is more resistant to resorption than bone, as it is avascular & bone is richly. 2 TYPES OF REPAIR OCCURS ANATOMIC REPAIR Resorption of cementum can occur either after trauma or excessive occlusal force  Damage usually is repaired by either formation of cellular\acellular cementum known as ANATOMIC REPAIR . FUNCTIONAL REPAIR

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FUNCTIONAL REPAIR Sometimes only a thin layer of cementum is deposited on the deep resorption & entire root line is not constructed & a bay like recess remains. In these cases PDL space is restored to normal width by formation of bone projection so that proper functional relationship will result known as FUNCTIONAL REPAIR . (HERE,outline of alveolar bone will follow root surface)

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E) ALVEOLAR BONE ( in relation to periodontium)] A more irregular PDL surface of bone and less irregular insertion of collagen fibers. Healing of bone in extraction socket appears to be unaffected by aging. One recent observation is of view that bone graft preparation ( decalcified freeze dried bone ) from donors more than 50 years old possess significantly less osteogenic potential than graft material from younger donors .

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F) BACTERIAL PLAQUE Dentogingival plaque accumulation increase because increase in hard tissue surface area as a result of gingival recession and the surface characteristic of the exposed root surface for plaque formation compared to enamel.

MICROORGANISMS:

MICROORGANISMS One study suggest increase in number of enteric rods and pseudomonas in older adults particularly in subgingival plaque. There is shift in certain pathogens: a)  role of Pseudomonas gingivalis. b)  role of Actinobacillus actinomycetemcomitans.

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G) OTHER CHANGES  size of infiltrated connective tissue.  gingival crevicular fluid flow.  gingival index.

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EFFECTS OF AGING ON THE RESPONSE TO TREATMENT OF THE PERIODONTIUM. A purely biologic\physiologic review indicate effects of aging on the structure of periodontium, function of immune response, nature of either supragingival\subgingival plaque have negligible impact on the response. Currently 60% of population of older adults have natural teeth.

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Aging does not cause disease; however; age is associated with more disease. Periodontal disease in older adults is probably not due to greater susceptibility but instead is the result of cumulative disease progression over the time.

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PERIODONTAL TREATMENT Both gingivitis & periodontitis are infection initiated & maintained by bacterial colonizing the teeth & periodontal tissues. The aim of treatment is to eliminate & control gingivitis & to arrest the progression of periodontitis by removing the microbial plaque.

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CONSERVATIVE THERAPY INCLUDE a) Frequent tooth cleaning by DENTIST. b) Repeated individualized instructions in oral hygiene techniques constitute an appropriate therapeutic approach. c) PERIOSURGERY is sometimes necessary for proper debridement or to establish a gingival morphology that facilitates the patient’s self performed post surgical plaque control.

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d) ONLY AGE, is no contraindication for surgery. e) In medically\mentally compromised patient’s the aim of treatment should be to keep the patient free of PAIN & INFECTION and to maintain the dentition in functional equilibrium.

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AGING AND TEETH ENAMEL CHANGES CHEMICALLY  Levels of N 2 & FLOURINE’ therefore, organic matrix. Enamel near the surface become DARKER & DECAY RESISTANT There is reduced PERMEABILITY & enamel becomes BRITLLE.

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HISTOLOGICALLY THE PERIKYMATA & IMBRICATION LINES are lost ENAMEL RODS are reduced  This loss alters the light reflection of enamel & results in tooth color changes.

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ATTRITION It may be defined as physiological wear of occlusal or incisal surfaces and proximal contacts as a result of mastication, physiologic tooth movement, functional or para functional movements of mandible .

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CLINCAL FEATURE a ) Small polished facets on cusp tips\ridges\slight flattening of incisal ridges b) Because of slight mobility of teeth in their sockets & a manifestation of resiliency of PDL, facets also occur at proximal surface. c) Decreased cusp height

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d) Flattening of occlusal plane. e) Shortening of length of dental arch (All these changes occur more severely in men than women due to greater masticatory force)

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ABFRACTION RECENTLY, it has been proposed that the predominant causative factor of some of the cervical, wedge-shaped defects is a strong(heavy) eccentric occlusal force resulting in microfracture or abfracture ,such microfracture occur as the cervical area of the tooth flexes under such loads. This defect is termed as IDIOPATHIC EROSION OR ABFRACTION.

“IT IS NOT ENOUGH FOR A GREAT NATION TO HAVE ADDED NEW YEARS TO LIFE. OUR OBJECTIVE MUST BE TO ADD NEW LIFE TO THOSE YEARS” J.F KENNEDY:

“IT IS NOT ENOUGH FOR A GREAT NATION TO HAVE ADDED NEW YEARS TO LIFE. OUR OBJECTIVE MUST BE TO ADD NEW LIFE TO THOSE YEARS” J.F KENNEDY

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DENTIN CHANGES VITALITY OF DENTIN Since odontoblasts & its processes are integral part of dentin, therefore, there is no doubt that dentin is vital tissue. It is laid throughout life though as age progress dentinogenesis slows.

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AGING AND FUNCTIONAL CHANGES IN DENTIN REPARATIVE\SECONDARY DENTIN If attrition, abrasion, erosion, cavity cutting procedures causes odontoblast processes to cut or exposed, either they die or if they live they form dentin called as reparative dentin

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This reparative dentin seals of the zone of injury occurs as a healing process initiated by the pulp resulting in resolution of the inflammation process and removal of dead cells. The reparative dentine has fewer & more twisted tubules.

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DEAD TRACTS In dried ground section of normal dentin, the odontoblastic process disintegrate & the empty tubules are filled with air. They appear black in transmitted light & white in reflected light. They often observed in the area of narrow pulpal horns because of crowding of odontoblasts. These areas demonstrate decreased areas of sensitivity.

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SCLEROTIC OR TRANSPARENT DENTIN Various stimuli during aging & functions causes collagen fibres & apatite crystals to begin appear in dentinal tubules  this blocking of dentinal tubules is considered as defensive reaction of dentin. Apatite crystals fill up tubules leading to obliteration of the lumen. They are mainly found in roots & mineral density is more.

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PULP CELL CHANGES : Decrease in number, size,& cytoplasmic organelle. Fibroblast changes

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YOUNG FIBROBLAST Abundant RER Golgi complex Numerous mitochondria with well developed cristae AGED FIBROBLAST Less perinuclear cytoplasm & possess long, thin cytoplasmic processes. Intercellular organelle are reduced in number & size e.g. mitochondria & ER.

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FIBROSIS a) In aging pulp accumulations of both diffuse fibrillar components as well as bundles of collagen fibers usually appear. b) Fiber bundle arranged ::longitudinally ---radicular pulp ::diffusely--- coronal pulp c) INCREASED in fibers is generalized through out the pulp organ

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d) Collagen increases in medial & adventitial layers of blood vessels e) INCREASED in collagen fiber is more apparent than actual because of decreased in size of pulp which makes the fibres to occupy less space f) vascular changes in the aging pulp is same as occur in any other organ like PLAQUE CALCIFICATIONS

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PULP STONES \DENTICLES They are defined as nodular, calcified masses appearing in either or both the coronal or root portion of pulp organ. They are seen in otherwise normal tooth in other respects They are seen in functional as well as embedded unerupted teeth

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CLASSIFICATION OF PULP STONES TRUE Structure is similar to dentin i.e. containing dentinal tubules with odontoblast processes. Rare & usually located close to apical foramen The development of true denticle is caused by inclusion of remnants of the epithelial root sheath with in the pulp. These epithelial remnant induces the cells of pulp to differentiate into odontoblasts which then form dentin masses called true denticles.

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FALSE Don’t exhibit dentinal tubules but appear as concentric layers of calcified tissue. In center of these concentric layers of calcification there may be remnants of necrotic & calcified cells. Initially they are of smaller size but gradually increases in size & fill the substantial part of the pulp.

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DIFFUSE CALCIFICATION a) They appear as irregular calcific deposits in the pulp tissue usually following collagenous fibre bundle or blood vessels. b) More appear in radicular portion and coronal portion will appear without any signs of inflammation.

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OTHER CLASSIFICATON FOR PULP STONES FREE :- entirely surrounded by pulp tissues. ATTACHED:- partly fused with dentin. EMBEDDED:- entirely in dentin

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OCCURRENCE OF PULP STONES It has been shown to be more prevalent through histologic studies of human teeth rather than can be determined radiographically because only small number of them becomes large enough to be detected radiographically. AGE INCIDENCE (ORBAN,S) a) 10-30 Yr 66% b) 30-50 Yr 80% c) > 50 Yr 90%

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CLINICAL IMPLICATIONS As pulp chamber becomes smaller & there is excessive dentin formation at the roof & floor of the chamber  it becomes difficult to locate the canal orifices. Pulp stones blocking the canal orifice.

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Shape of the apical foramen plays vital role in ENDODONTICS,when apical foramen is narrowed by cementum,it is more readily located ,as broach\reamer will be stopped at the foramen but if apical opening shifts to the side of apex due to deposition of dentin\cementum on one side and resorption on the other side, this will lead to misjudgement of the length of canal and root canal filling.  Due to calcifications THERMAL\ELECTRIC PULP TESTING may give false negative response .

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As blood supply is reduced in aging,PULP CAPING is not successful RADIOGRAPHICALLY, most canals are wider buccolingually than mesio- distally, this may not be true for older adult because often root canals in older tend to disappear apically on x-rays because of thinning of canal & cementum deposition.

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TONGUE It seems to increase in size in edentulous mouth which may be because of result of transferences of some of the masticatory & phonetic function of the tongue. Enlarged tongue have negative effect on retention of denture.

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T here is DEPAPI LLATION which usually begin at apex & lateral border. FISSURING is also common. There is also reduction in taste buds

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TOOTH ERUPTION Tooth eruption doesn’t cease when teeth meet their antagonist but continuous throughout the life. It consists of 2 phases:- ACTIVE and PASSIVE ACTIVE :- is the movement of teeth in the direction of occlusal plane. PASSIVE :- exposure of teeth by apical migration of gingival

This concept distinguish between:

This concept distinguish between Anatomic crown Anatomic root Clinical crown Portion of crown covered by enamel. Portion of root covered by cementum. Portion of crown denuded by gingival & protrudes into oral cavity.

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When teeth reach their functional antagonist, the junctional epithelium & gingival sulcus are still on enamel & the clinical crown is approx. 2/3 of the anatomical crown.

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ACTIVE ERUPTION It is coordinated with attrition.The teeth erupt to compensate for tooth substance worn away by attrition.Attrition reduces the clinical crown & prevents it from becoming disproportionately long in relation to the clinical root, thus avoiding excessive leverage on periodontal tissue. As the teeth erupts, cementum is deposited at the apices & furcations of the root & bone is formed along the fundus of the alveolus & at the crest of the alveolar bone to replace the part of tooth lost by attrition.

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PASSIVE ERUPTION: It was earlier thought to be physiological process but currently it is considered as pathological process. IT IS DIVIDED INTO 4 STAGES :- STAGE 1 : The teeth reaches the line of occlusion. The J.E. and base of the gingival sulcus are on the enamel. STAGE 2: The J.E. proliferates so that part is on the enamel & part is on the cementum.The base of sulcus is still on the enamel .

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STAGE 3: The J.E. is on the cementum & base of the sulcus is on the CEJ. STAGE 4: The J.E. is farther proliferates on the cementum .The base of sulcus is on the cementum & part of it is exposed.

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The proliferation of the J.E. is on the root surface is accompanied by degeneration of gingival & PDL fibers and their detachment from the tooth. The cause of degeneration is not understood, earlier it was thought to be physiologic but now it is believed to be result of chronic inflammation and therefore is pathologic.

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ORAL MOTOR PERFORMANCE:    SPEECH MASTICATION SWALLOWING TISSUES INVOLVED ARE :-upper lip, lower lip , jaws, tongue, floor of oral cavity, soft palate etc.

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SPEECH Speech production is most resistant to aging but that doesnot mean there are no age related changes in speech. You can very well perceive differences when person of old age speaks but these are largely related to LARYNGEAL rather than oral events. OTHER SPEECH CHANGES MAY OCCUR DUE TO : EDENTULOUS PATIENT(partial or complete) ILL FITTING PROSTHESIS .

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SWALLOWING\ORAL MOVEMENT I N OLD AGE People chew slowly as they get older . Although the duration of the total chewing cycle does not seem to change, it does seem that vertical displacement of mandible is shortened. (karlsson & carlsson 1990) Movements of the mandible are governed by a generator in the brainstem & influenced by the proprioception in the muscles, joints, & mucosa. Age may impair the central processing of nerve impulses, impede the activity of striated muscles & retard the ability to make decisions .

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Poor motor coordination & weak muscles.  no of functional motor units, fast muscle fibers &  in cross sectional area of masseter & medial pterygoid muscles. Muscle tone decrease by 20-25% which probably explains the shorter chewing stroke & prolonged chewing time if it is there.

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Some individuals who assumes the characteristic STOOP of old age experience PAIN on swallowing because of osteophtes & spurs growing on the upper spine adjacent to the pharynx. Abnormal mandibular movements consequent to teeth loss,use of complete denture, deflective occlusal contacts.

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AGE CHANGES IN MAXILLA AND MANDIBLE MAXILLA It resorbs in UPWARD & INWARD direction to become progressively smaller because of the direction & inclination of the roots of teeth & alveolar processes. Longer the maxilla is edentulous,smaller the denture bearing area will be. Incisive foramen becomes closer to the residual ridge

RESORPTION PATTERN:

RESORPTION PATTERN

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MANDIBLE It resorbs in DOWMWARD & OUTWARD so as to become progressively wider thereby leading to class- lll relation.

BLOOD SUPPLY OF :

BLOOD SUPPLY OF DENTATE MANDIBLE EDENTULOUS MANDIBLE Principally, CENTRIFUGAL arising from inferior alveolar artery and periodontal arcade. Principally, CENTRIPETAL arising from subperiosteal plexus of vessels

CHANGES REGARDING MENTAL FORAMEN AND ANGLE OF MANDIBLE::

CHANGES REGARDING MENTAL FORAMEN AND ANGLE OF MANDIBLE : INFANTS & CHILDREN ADULTS OLD AGE The halves of mandible fuses during the first year of age. The mental foramen lies midway between upper & lower border because the alveolar & sub alveolar parts are equally developed Teeth fall out & the alveolar border is resorbed,so that the height of the body is markedly reduced.

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At the birth, mental foramen opens below the sockets of two deciduous molars. The mandibular canal runs near the lower border The mandibular canal runs parallel with the mylohoid line. The mental foramen and canal again close to the alveolar border

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The angle is obtuse(140 deg or more because the head is in line with the body.The coronoid process is large & projects upwards above the level of condyle. The angle reduces to about 110 or 120deg because the ramus becomes almost vertical The angle again becomes obtuse 140 deg because the ramus is oblique.

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CONSEQUENCES OF RESIDUAL RIDGE RESORPTION Apparent loss of sulcus width & depth. Displacement of muscle attachment closer to the crest of the residual ridge. Loss of vertical dimensions of occlusion. Decrease of lower facial height.

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Increase in relative prognathia. Ant. rotation of the mandible (class-lll) Changes in interalveolar ridge relationship Location of mental\incisive foramen close to the crest of residual ridge

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According to Press report, in DONGZI (a remote village of Tibet) Nobody has died in the last 50 years. Out of the population of tiny village, one is already 142 years of age & 188 people are aged over 130 years .

TEMPOROMANDIBULAR JOINT:

TEMPOROMANDIBULAR JOINT

AGE CHANGES IN TEMPOROMANDIBULAR JOINT:

AGE CHANGES IN TEMPOROMANDIBULAR JOINT The cartilage of the TMJ is essentially completely replaced by bone around the 4th decade of life. The articular tissue remains relatively unchanged in appearance throughtout adulthood,it may undergo metaplastic transformation into fibrocartilage, depending on the biomechanical loading to which joint was subjected .

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The articular eminence,in particular,is characterized by the presence of chondroid bone and very occasionally cartilage cell islands. Up through the 5th decade , the mandibular fossa even becomes more deep as the articular eminence continues to grow inferiorly,however after that time the articular eminence tends to become flatter,especially in individual who have become partially or completely edentulous and have reduced loading force on the eminence.

Difference between young & adult condyle:

YOUNG CONDYLE Condylar head more vascular Neck absent Bone is soft & pliable Cartilage is predominant in the child Difference between young & adult condyle

ADULT CONDYLE:

Less vascular Neck is thicker Bone is less pliable Fibrous tissue predominant ADULT CONDYLE

AGE CHANGES IN MAXILLARY SINUS:

AGE CHANGES IN MAXILLARY SINUS The maxillary sinus(ANTRUM OF HIGHMORE) is apparent by 17th day in utero. At birth each sinus is quite small & slit like,lying in the most medial aspect of the maxilla. The greatest dimensions in the AP direction is not more than 8mm

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With growth sinus enlarge laterally under the orbit & by the 2ndyear, they reach laterally to the infraorbital canals. By 9th year they extend to the zygomatic bones & to the level of the floor of the nasal fossae. Lateral growth ceases by the 15th year

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A large sinus may extend into zygomatic processes of the maxilla & into alveolar processes so that roots of molars & even premolar teeth lie immediately beneath the floor or project into it. In old age, bone enclosing the roots of posterior teeth sometimes resorbs leading to apex lie in the direct contact with mucous membrane & extraction of such teeth may lead to fistula formation.

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THE LEVEL OF FLOOR OF THE MAXILLARY SINUS VARIES WITH AGE INFANTS & CHILDREN - HIGHER THAN NASAL FLOOR ADOLESCENCE - LEVEL WITH NASAL FLOOR

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ADULTS - LOWER LEVEL THAN NASAL FLOOR OLD AGE - LEVEL WITH NASAL FLOOR

HOW TO TREAT….?:

HOW TO TREAT….? TREAT PLAN Delineates the role of the family members in the maintainence & care of oral health care. Must be realistic. Is dynamic: anticipating the decline & using aggressive prevention to minimize decline in oral health status.

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Minimize the stress of dental visits, short appointments,good communication,altered pharma therapy according to need, antianxiety drugs. Emphasizes hopefulness in the maintainence of oral health & function. In case of long term mental & physical deterioration, dentist should welcome short improvement.

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PROGNOSIS

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CONCLUSION Management of problems encountered in managing older population can seem like a series of objectionable compromises but compromises for elderly patients may be an acceptable part of everyday life. AND LIFE AT ANY AGE DOES HAVE PLEASANT SURPRISES & REWARDS

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THANK YOU

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DENTAL CARIES It develops as a result of repeated attacks of acid on the tooth surface by microorganisms . FISSURE CARIES Occlusal fissure caries appears darkly stained,may be result of previous active caries that has become inactive,for e.g. occlusal attrition often smoothen out occlusal relief which reduces microbial accumulation in the occlusal surface

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ROOT CARIES Increasing age leads to gingival recession & root surface become exposed to the oral envoirment.Most pronounced in the buccal surface. Cementum layer is frequently abraded exposing the dentin.

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CLINICAL FEATURES THEY RANGES FROM Needle point small,slightly softened & discolored spots on the root surface to extensive, brownish or very dark color areas encircling the entire root Found frequently at CEMENTOENAMEL JUNCTION.

ACTIVE INACTIVE CARIES:

ACTIVE INACTIVE CARIES a) Yellowish\light brown in color a) Dark brown\black in color b) Covered by microbial plaque,soft on probing b) surface is smooth,shiny ,hard

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c)consistency leathery c) consistency hard d) Rarely extend in apical direction,encircles the tooth d)sometimes only discoloration is present e)restorative treatment is indicated e) No treatment is indicated

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CLINICAL IMPLICATIONS If the active caries lesion can be kept free of bacterial plaque by proper ORAL HYGINE MEASURES HOMELY OR PROFESSIONALLY,tissue turns black,dark & becomes hard & shiny. THUS,changes in the envoirmental conditions enhances the biological response in the dentin leading to dentinal sclerosis & therefore PAIN also diminishes or disappear

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Topical floridation ( DENIFRICES, GELS ,PROFESSIONALLY APPLIED) PREVENTION(REGULAR CHECK UPS CAN PREVENT ACTIVE LESION)

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WHY RESTORATION SHOULD BE AVOIDED IN OLDERS Marginal adaptation of restoration is weak point. Etching cannot be done may lead to hypersensitivity. Root surface is highly irregular to achieve the smooth cavosurface magins ,therefore, risk of secocondary caries.

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Best material is FLOURIDE RELEASING GLASS IONOMER CEMENTS. Pulp caping or Pulpotomy shold be avoided

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