EFFECTS OF AGING ON EDENTULOUS STATE.pptx

in detail explanation on effects of aging in edentulous patients

1. EFFECTS OF AGING ON EDENTULOUS STATE

2. INTRODUCTION The process of aging is a normal process for living organisms. Throughout the life of the organism there is a constant interplay between the anabolic & catabolic processes. The intermittent dominance of one process over other determine the character of health of the individual at the given time. And which is physiologic or pathologic activity in one age period is not constant for other age periods.

3. Physiologic changes associated with Aging In geriatric patients, following are some of the physiologic changes observed :- a) At cellular level : -Decline in cell division -Decreased ability of cell to grow and repair -Decreased metabolic rate -Increased tissue desiccation and cellular atrophy -Loss of tissue tone and elasticity

4. b) At cardio – vascular level - flow of blood and lymph slows down - Atherosclerosis of blood vessels with decreased elastic recoil c) In digestive system Decreased sensitivity and destruction of taste buds Decreased intestinal motility Less acidic gastric juices

5. PHYSIOLOGIC CHANGES IN CONTEXT TO COMPLETE DENTURE 1) Deterioration of taste buds: In diseases like Alzheimer’s disease, upper respiratory tract infections and any disturbance/infection/damage to the cranial nerves (VI, IX, X) like by tumors, viruses (herpes zoster) and trauma (head injury) may cause alteration in taste sensations. Proper counseling of the patient regarding the problem is the most effective step towards favorable prognosis . BALD TONGUE

6. 2) Salivary hypofunction and xerostomia XEROSTOMIA produces- Difficulty in bolus formation and difficult swallowing Decreased retention of dentures Burning of mucosa with increased mechanical irritation Alteration of taste Aggravation of gastro esophageal reflux disease Altered taste with difficulty in swallowing forces the elderly to change his food habit Increased caries esp. root caries Decreased resistance to infection .

7. ETIOLOGY OF XEROSTOMIA Medications which the elderly take for hypertension, depression, psychosis etc are the most common cause of xerostomia in this age group. Medication usually have anticholinergic and diuretic actions which leads to xerostomia. Autoimmune disease- Sjogren`s syndrome Radiation therapy MANAGEMENT Firstly determine the cause In preventive measures advice patient to have a check on excessive sugar intake, advice fluoride supplement if teeth are present Ask patient to sip water through out the day. Saliva can be stimulated by sugarless candies ,mints, gums, pilocarpine or cevimeline .

8. 3) Loss of muscle bulk In geriatric patient, loss of muscle bulk with reduced vigor of muscle contraction is a common finding with marked limitation in range of movement, in this situation muscle trimming / border molding may lead to under extended borders. 4) Changes in keratinisation In geriatric patient , degree of keratinisation of mucosa is often reduced which leads to reduced protective capacity of mucosa. In these patients use of non anatomic teeth will be much kinder to mucosa.

9. MORPHOLOGIC-AL AND SKIN CHANGES Because of loss of teeth and resultant pattern of loss of alveolar bone support (in maxilla & mandible) following morphological changes are seen - 1. Deepening of nasolabial groove 2. Loss of labiodental angle 3. Decrease in horizontal labial angle 4. Narrowing of lips 5. Increase in columella-philtrum angle 6. Prognathic appearance 7. Reduced concavity & pout of upper lip 8. Flattening of philtrum

10. 9. Hollowing of cheeks (due to atrophy of subcutaneous & buccal pad of fat) 10. Cheiloptosis (drooping of upper lip over maxillary teeth – because of loss of presymphyseal fat support, which thus accentuates the mandibular incisors Above changes are further accentuated when there is loss of vertical dimension of occlusion . The influence of vertical dimension of occlusion on appearance of face

11. Skin changes i ) As one ages there is gradual thinning of dermis, enzymatic dissolution of collagen & elastin occurs and ultimately wrinkles appear as layers of fat are lost. ii) Melanin pigmentation increases with aging which is further accentuated because of thinning of skin. iii) Solar-lentigines – Are epidermal growths with large melanocytes which give leathery appearance to skin in patients who are exposed to sun very much.

12. (C) Oral changes in geriatric patients These are discussed under the following headings – Mucosa Alveolar bone & residual bone resorption Tongue Saliva Taste buds

13. Mucosa Stomatitis & other mild inflammation are most frequent mucosal lesions especially in persons who drink alcohol, smoke tobacco and wear dentures. Oral cancer and precancerous lesions are most common form of cancer on Indian sub-continent and Asia. Nicotine and alcohol are more damaging to oral mucosa in old age because of atrophy decreased mitosis and slow turnover of cells and increased number of elastic fibers Oral mucosa is thin & easily abraded in advanced elderly. Mucosa demonstrates a reduced pain threshold.

14. Alveolar bone and residual ridge resorption (RRR) Bone mass is maximum in midlife and decreases with age. The decrease in quality occur mainly because as one ages osteoblasts become less efficient, estrogen production declines, and reduced calcium absorption from intestine. Generalized osteoporosis results in facial height reduction with accelerated residual ridge resorption. Residual ridge resorption : Following extraction of teeth there is ridge resorption which advances at different paces ,at different moment of time, in different individuals or at different locations in same indivdual . Atwood (1963) described 6 orders of ridge resorption patterns:

15. Jaw movements in geriatric patients Chewing get slower as one ages, however duration of chewing cycle doesn't change but vertical displacement do changes. Decreased muscle tone is an important factor for this phenomenon . Older people have poor motor coordination and weak muscles as aging slows down the central processing of nerve impulses , impede activity of striated muscle fibers , decrease in the number of motor units and may also decrease the cross sectional area of masseter and medial pterygoid.

16. NUTRITION PROBLEMS IN GERIATRIC PATIENT Geriatric population is at particular risk for malnutrition because of socioeconomic stress, state of dentition, faulty prosthesis etc. Because of reduced masticatory efficiency, reduced muscle tone, lack of proper muscular coordination, reduced pain threshold of oral mucosa, etc elderly patients change their diet to less fibrous , rich carbohydrate, and liquid diet. Also absorption of minerals, vitamins, and nutrients from the intestine decreases with age. Geriatric patients also exhibit increased incidence of chronic gastritis which hampers digestion. Intestinal wall shows atrophy which leads to malabsorption. Atherosclerosis or cardiac in sufficiency may reduce blood supply to digestive tract. Thus nutrition is elderly patient is much hampered than expected. Hence proper instructions on diet is necessary .