Ageing Dentition

• enamel revision:

  • highly mineralised tissue
  • 96% mineral, 4% organic
  • crystal - hydroxyapatite
  • ions - strontium, magnesium, lead, fluoride
• how does enamel change with ageing?

  • discolouration
  • less permeable
  • lower water content
  • more brittle
  • surface layer changes
  • longitudinal cracks/stress cracks
  • wear facets
• dentine-pulp revision:

  • bulk of tooth
  • mature dentine 70% inorganic, 20% organic, 10% water
  • high elasticity
• inorganic - hydroxyapatite
• organic - type 1 collagen, glycoproteins, proteoglycans, phosphoproteins, plasma proteins
• primary dentine:

  • most of tooth
  • outlines pulp chamber
  • outermost layer known as mantle dentine - less mineralised
• secondary dentine:

  • developes after root formation
  • continuous, slow deposition by odontoblasts
  • incremental pattern tubular structure, less regular than primary
  • greater deposition on roof and floor of pulp chamber
  • scleroses more readily protecting the pulp
• tertiary dentine:

  • reactive/reparative or irregular secondary dentine
  • produced in reaction to noxious stimuli
  • produced by cells only affected
  • intensity affects quality and quantity
• how does pulp change with age?

  • reduction of pulp chamber + root canal
  • can become completely obliterated
  • collagen levels within pulp stable
  • less axon nerves
  • lower blood supple to pulpal cells
• How does dentine change with age?

  • irregular areas of dystrophic calcification
  • intratubular dentine deposition leading to complete closure
  • sclerotic dentine formed
  • dead tracts
• physiological changes of tooth leads to:

  • increased resistance to environmental injury
  • dentine-pulp less able to repair itself
  • issues with etching and bonding
• What makes up the periodontium?

  • cementum
  • PDL
  • alveolar bone
  • gingiva facing the tooth
• where does the PDL form?

  dental follicle after root formation
• PDL is a specialised connective tissue containing collagen, elastin, fibroblasts and epithelia cells
• how does the periodontium change with age?

  • dentogingival epithelium migrates apically onto cementum = gingival recession
  • PDL decreases fibroblasts, increased collagen
  • increased cementum width
  • increases susceptibility to resorption
• major salivary glands?

  • parotid
  • submandibular
  • sublingual
• salivary gland changes:

  • fatty degenerative changes
  • fibrosis
  • accumulation of lymphocytes
  • oncocytes?
  • fibrous connective tissue of labial salivary glands
• jaw changes

  • + osteoporosis
  • atrophy of alveolar bone in edentulous pt
  • loss of lip support
  • sharp genial tubercles
  • muscular atrophy after tooth loss
  • less stength
• tmj?

  • remodelling following tooth loss
  • displacement of disc = osteoarthiritis and joint damage
• function of oral mucosa:

  • protection
  • sensation
  • secretion
  • thermal regulation
• oral mucosa changes?

  • smoother and dryer
  • epithelial thinning
  • burning mouth syndrome
  • + trauma, candida, vasular nodules
• tongue?

  • loss of filiform/ smoother,
  • fissured
  • lingual varicosities - prominant lingual veins
• causes of tooth loss?

  • extensive caries
  • periodontal disease
  • lack of motivation
  • missed appointments
  • lack of transportation
  • finanical
• treating elderly:

  • good communication
  • hearing difficulties? - lipread, slow
  • visual difficulties
  • stabilty? - stairs?
  • thorough MH, SH and DH
  • dementia?
• root caries:

  • difficult to restore - location, moisture, proximity to pulp, bonding
  • reoccurrence rate higher
  • tooth lost ultimately
• prevention root caries?

  • dietary modification
  • effective plaque control
  • stimulate salivary flow
  • fluoride application
• toothwear?

  • increases with age
  • exacabated with GORD, alcoholism, asthma, diabetes
• restoring tooth wear?

  • cosmetic
  • pulp protection
  • problems associated with restoring
• failing restoration?

  • plaque retentive
  • secondary caries
• dry mouth?

  • true salivary problems? issues eating
  • induced?
  • denture fit, comfort
• increased candida infections?

  • linked to poor denture hygiene
  • SE of meds
  • poor health
• denture issues?

  • denture stomatitis
  • poor fit - poor diet
  • ulcers/frictional keratosis
  • cosmetics
  • candida
  • issues with other teeth? perio/caries
• Oral hygiene?

  • lower motivation and manual dexterity
  • poor oh
  • perio, caries, mobility, infection
  • furcations harder to clean
  • diet habits?
  • decreased immune system and poorer healing
• orofacial pain?

  more common in older people

  eg Neuralgias, burning mouth
• considereations for elderly care?

  • pt attitude
  • compliance ability
  • concurrent disease
  • weight cost/risks
  • extended appointments
  • carers?
  • drug interactions
  • LA dose - liver/kidney disease
• cracks in the enamel surface

  
• loss of filiform papillae or smooth tongue

  
• fissured tongue

  
• lingual caricosities

  
• root caries