Aging and the periodontium

AGING AND THE PERIODONTIUM

1. AGING AND THE PERIODONTIUM PRESENTED BY- PARTHA PROTIM SINGHA (FINAL YEAR)

2. CONTENTS Introduction Periodontium Age changes in the gingival epithelium Age changes in gingival connective tissue Changes in the periodontal ligament Changes in the cementum Changes in the bone Effects of aging on the progression of the periodontal diseases Aging and the response to treatment of the periodontium Reference

3. Increased awarness and improvements in preventive dentistry have led to decreasing tooth loss for all age groups. The effects of this shift in tooth retention need to be considered carefully. In particular,increased life expectancy and greater health expectations may lead to changes in demand from older individuals for periodontal treatment and potentially a substansial increase for supportive periodontal therapy. Aging causes changes in the periodontium;therefore broader aspects aging are examined,as well as the possible effects on treatment outcomes. INTRODUCTION

4. PERIODONTIUM The normal periodontium provides the support necessary to maintain teeth in function. It consists of four principle components: Gingiva Periodontal ligament Cementum Alveolar bone

5. 1.AGE CHANGES IN GINGIVAL EPITHELIUM Thinning and decreased keratinization of the gingival epithelium have been reported with age. - This is because of the increase in epithelial permeability to bacterial antigens,a decreased resistance to functional trauma,or both. Flattening of rete pegs and altered cell density. According to some reports,there is migration of the junctional epithelium from its position in healthy individuals(i.e. On enamel)to a more apical position on the root surface with accompanying gingival recession. - With continuing gingival recession,the width of the attached gingiva would be expected to decrease with age,but the opposite appears to be true.

6. 2.CHANGES IN GINGIVAL CONNECTIVE TISSUE Increasing age results in coarser and denser gingival connective tissues. Qualitative and quantitative changes to collagen have been reported. - These include an decreased rate of conversion of soluble to insoluble collagen,increased mechanical strength and increased denaturing temperature. -These results indicate increased collagen stabilization caused by changes in the macromolecular conformation.

7. 3. CHANGES IN THE PERIODONTAL LIGAMENT Decreased number of fibroblasts and a more irregular structure,paralleling the changes in the gingival connective tissues. Decreased organic matrix production and epithelial cell rests and increased amounts of elastic fiber . Decreased cell proliferation.

8. 4. CHANGES IN THE CEMENTUM Increase in the cemental width;this maybe 5-10 times with increasing age. - The increase in width is greater apically and lingually .

9. 5. CHANGES IN THE ALVEOLAR BONE More irregular periodontal surface of bone and less regular insertion of collagen fibres. - Although age is a risk factor for the bone mass reductions in osteoporosis, it is not causative and therefore,should be distinguished from physiologic aging processes. - Overriding the diverse observations of bony changes with age is the important finding that the healing rate of bone in extraction sockets appears to be unaffected by increasing age.

10. EFFECTS OF AGING ON THE PROGRESSION OF PERIODONDAL DISEASES In a classic experimental gingivitis study, subjects were rendered plaque and inflammation free through frequent professional cleaning. Once this was achieved,the subjects abstained from oral hygiene measures for periods of 3 weeks to allow gingivitis to develop. In this experimental model,a comparison of developing gingivitis between young and older individuals demonstrated a greater inflammatory response in older subjects. In older age groups(60-80 years), the findings included a greater size of infiltrated connective tissue,increased gingival crevicular fluid flow,and increased gingival index. Even at the basement level of excellent gingival health before commencing plaque accumulation,differences may exist between groups,with older individuals demonstrating more inflammation. The phrase, “getting long in the tooth” expresses a widespread belief that age is inevitably associated with an increased loss of connective tissue attachment.

11. A “risk factor” is defined as ‘ any characteristic,behaviour,or exposure with an association to a particular disease’. Some risk factors like smoking, can be modified to reduce one’s risk of initiation or progression of disease; while othre factors cannot be modified such as genetic factors . Therefore,age has been suggested to be not a true risk factor but a background or an associated factor for periodontitis .

12. AGING AND THE RESPONSE TO TREATMENT OF THE PERIODONTIUM The successful treatment of periodontitis requires both meticulous home-care plaque control by the patient and meticulous supragingival and subgingival debridement by the therapist. 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.

13. REFERENCE Carranza’s Clinical Periodontology – 11 th edition Essentials of Clinical Periodontology & Periodontics – by Shantipriya Reddy