Lect 6-Aging and the Periodontium.pdf

 Aging is slowing of natural function, a disintegration of the balanced control and organization that characterize the young adults (Little C.c. 1947). Aging of an organ is defined as post maturational deteriorative changes that with time, lead to an increased vulnerability to challenge...

 Aging is slowing of natural function, a disintegration of the balanced control and organization that characterize the young adults (Little C.c. 1947). Aging of an organ is defined as post maturational deteriorative changes that with time, lead to an increased vulnerability to challenges, there by decreasing the functional ability of the organ EFFECTS OF AGING ON THE PERIODONTIUM EFFECTS OF AGING ON THE PROGRESSION OF PERIODONTAL DISEASES AGING AND THE RESPONSE TO TREATMENT OF THE PERIODONTIUM  Thinning of gingival epithelium and decreased keratinization: Increased epithelial permeability to pathogens. Decreased resistance to functional trauma. Altered cell density Decreased cellular component →decreased cellular reserves and protein synthesis → affects oral epithelium →tissue becomes thin with decreased keratinization. Increase in the width of the attached gingiva. constant location of the mucogingival junction throughout the life. Increase (or) no change in mitotic index of gingival epithelium. Reduced (or) no change in stippling.  More dense and coarse connective tissue: Qualitative and quantitative changes to collagen include; -Increased rate of conversion of soluble to insoluble collagen. -Increased mechanical strength increased denaturing temperature. These results indicate increased collagen stabilization caused by the changes in the macromolecular conformation  Decreased number of fibroblasts. Irregular structure. Decreased organic matrix production. Decreased epithelial cell rests. Decreased number of collagen fibers ↓ reduction or loss in tissue elasticity Cells of PDL have reduced mitotic activity. Changes in the width of PDL. Decreased vascularity. Greater no. of elastic fibers.  Increase in cementum width. Increase may be 5 to 10 times with increasing age. Increase in width is greater apically and lingually. Greater irregularity in the surface facing periodontal ligament. (an accumulation of resorption bays).  Changes occurring in alveolar bone are similar to remainder of skeletal system: Increased osteoporosis. Decreased vascularity. Bone resorption increased (or) decreased. Greater irregularity in the surfaces of alveolar bone facing periodontal ligament. Bone graft preparations from donors more than 50 yrs old possess less osteogenic potential than younger donors. Less regular insertion of collagen fibers.  Dentogingival plaque accumulation increases: with increase in age with Increase in hard tissue surface area resulting from gingival recession the surface characteristics of the exposed root surfaces a substrate for plaque formation. For supragingival plaque, no real qualitative differences have been shown for plaque composition. For sub gingival plaque ,increased number of enteric rods and pseudomonad's in older adults. Periodontal pathogens specifically including an increased role for P.GINGIVALIS, and decreased role for A.ACTINOMYCETEMCOMITANS.  Difference between younger and older individuals can be demonstrated for T and B cells, cytokines, and natural killer cells, but not polymorphonuclear cells and macrophages activity  Older individual demonstrate more inflammation: Long standing exposure include chronic mechanical trauma from tooth brushing. Iatrogenic damage from unfavorable restorations or repeated scaling and root planning. plaque associated periodontitis. Age is not a true risk factor but a background or associated factor for periodontitis  No differences in response to non surgical or surgical treatment have been shown for periodontitis. However 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.  Advanced age does not decrease plaque control; however, older adults may have difficulty performing adequate oral hygiene because of; Compromised health. Altered mental status. Medications. Altered mobility and dexterity. Older adults may change tooth brush habits because of disabilities such as hemiplegia secondary to CVA, visual difficulties, dementia and arthritis.  A purely biologic or physiologic review indicates that aging has some impact on the structure and function of the periodontium, as well as the immune response, and nature of either supragingival or subgingival plaque. However, these changes have an eligible impact on an individual 's responsiveness to treatment. Interestingly , a recent study has identified greater compliance with supportive maintenance among older individual s than younger patients.