§Age changes in oral and dental tissues occur in the

oral hard and soft tissues as well as bone, TMJ and oral
mucosa.
§These changes vary from cell to cell and from tissues
to tissues.
§The most obvious change in the oral cavity is the loss
of the dentition.
§However, most of these changes are a combination of
physiologic age changes with superimposed
pathological and iatrogenic effects
¨ Age changes in:
¨ Oral hard tissues
¨ Oral soft tissues
¨ Bone
¨ TMJ
§ The enamel tends to become more brittle and
susceptible to chipping, cracking and fracture
§ The ridges of enamel are worn down with
advancing age leaving a smooth occlusal surface.
§ With advancing age there is adsorption of material
from saliva, diet, medicaments leading to a change
in the composition of enamel.
§ With advancing age the colour of the teeth
becomes darker and this has been suggested to
occur from the addition of organic materials from
bacteria and ingested foods
¨ In addition, the wearing down of enamel allows
the inner dentine core to become more obvious
thus giving the tooth a darker hue.
¨ With advancing age there is decreased
permeability of enamel to all substances.
¨ This has been said to occur as a result of a
reduction in the pores and spaces within the
enamel.
¨ The water content of enamel decreases with
increase in age.
¨ The incidence of new carious lesions decreases
with advancing age.
¨ This has been attributed to the fact that caries
susceptible surfaces have earlier on been
attacked when the individual was younger.
¨ Secondly, the process of natural attrition has
eliminated stagnation points on the occlusal
surfaces of the teeth.
¨ It has also been observed that there is a change
in dietary habits from refined to non-refined
food substances as individual ages.
¨ Similarly, the loss of some teeth allows
cleaning of difficult areas to be effectively
carried out and lastly increased mineralization
that takes place with advancing age reduces
the susceptibility of tooth to decay.
¨ The rate of deposition of dentine decreases with age as a
result there is reduction in the size of the pulp chamber and
pulpal canal.
¨ The reduced deposition of dentine with advancing age might
be caused by certain factors such as trauma, infections leading
to the formation of irregular secondary dentine or reactionary
dentine.
¨ With increase in age the diameter of the dentinal tubules
reduces due to the laying down of peritubular dentine.
¨ The rate of deposition of dentine might sometimes be
accelerated through various insults to the tooth - thermal,
mechanical and traumatic.
¨ The response through dentine deposition to these insults
might be so high as to give rise to complete closure or
occlusion of the dentinal tubules resulting in the formation of
sclerosed dentine.
¨ With advancing age there is loss of the
odontoblasts as a result of a generalized reduction
in the cellularity of the pulp.
¨ The elasticity of the tooth decreases with increase
in age due to increased mineralization.
¨ Subsequently, the tooth becomes more brittle.
¨ There is decreased permeability of the dentine with
advancing age.
¨ The water content of the dentine also reduces with
age.
¨ There is high probability as increased formation of
dead tracts – these are dentinal tubules that do not
contain odontoblastic process.
¨ There is decreased cellularity of the pulp.
¨ There is increase in the fibrous tissue content of the
pulp.
¨ There could be reticular atrophy or fatty degeneration
within the substance of the pulp.
¨ There is constriction and reduction in the size of the
dental pulp.
¨ The root canal may become completely obliterated.
¨ There is a higher incidence of calcification occurring
within the dental pulp.
¨ These calcifications are referred to as pulp
stones/denticles and they could be nodular, spherical,
or diffuse.
¨ They could occur freely within the pulp canal.
¨ Cementum is laid down throughout an
individual’s lifetime especially in the apical region
and bifurcation of multi-rooted teeth.
¨ The laying down of cementum is often times
regular but this could be affected by disease
conditions especially chronic infections in the
periapical regions of the teeth.
¨ This could lead to exuberant cementum formation
with obliteration of the periodontal space and
fusion of the root with the inner walls of the
alveolar sockets, a condition referred to as
Hypercementosis.
¨ With advancing age the thickness of cementum
increases with a narrowing of the apical foramen.
¨ The permeability of cementum also decreases
with age.
¨ Cementum exposure in the oral cavity
increases with advancing age because of the
increased incidence of gingival recession.
¨ This causes an apparent increase in the length
of the clinical crown.
¨ With advancing age there is a higher incidence
of caries attack in the cementum.
¨ This has been confirmed through various
studies which show an increased incidence of
root caries amongst the elderly.
¨ The periodontium consists of the supporting
structures of the tooth, the periodontal ligaments
and the surface of the alveolar bone to which the
periodontal ligaments are attached.
¨ All these structures undergo changes with
increasing age.
¨ Studies show that the prevalence and severity of
periodontal disease increases with advancing age
¨ There is a decrease in the width of the periodontal
ligaments.
¨ There could be calcifications occurring within
the substance of the periodontal ligament.
¨ The blood vessels of the periodontal ligament
may undergo atherosclerosis resulting in
ischemia of the periodontal ligament and
subsequent decay There is increase in the
fibrous tissue content of the periodontal
ligament.
¨ There is increased tendency for resorption to
occur on the inner surfaces of the alveolar bone
leading to loosening of the teeth.
¨ The ability of the periodontal ligament to fight
infectious diseases is decreased with advancing
age.
¨ There is a decrease in the cellularity of the
gingiva.
¨ The fibrous tissue content of the gingiva
increase with advancing age.
¨ There may also be loss of the stippling effect.
¨ There is decrease in keratinization
¨ There is increased predisposition to gingival
recession.
¨ The resistance of the gingiva to infections
decreases because of decreased cellularity,
reduction in blood supply, and reduced
keratinization.
¨ Oral mucosa changes with ages occur from
mucosal trauma, mucosal diseases and salivary
gland hypofunction
¨ The stratified squamous epithelium becomes
thinner, loses elasticity and atropies with age.
¨ With increase in age there is also dryness of the
oral mucosa from salivary gland hypofunction .
¨ There is abnormal taste perception and sometimes
burning sensation.
¨ The Fordyce granules on the cheek increase in size.
¨ A declining immunological responsiveness
further increases the susceptibility to infection
and trauma
¨ An increased incidence of oral and systemic
disorders along with the increased use of
medications may lead to oral mucosal
disorders such as vesicobullous, desquamative,
ulcerative, lichenoid and infectious lesions
¨ There is increase in laying down of collagen
fibers within the connective as a result the
fibrous tissue content increases.
¨ There is reduction in vascularity resulting in
decrease in the healing power of the oral
mucosa with advancing age.
¨ There is an increase in tendency for malignant
changes to occur as an individual ages.
¨ There is loss of the Filliform papillae
¨ There is a degeneration of taste buds and a
reduction of the number of taste buds
¨ The threshold for taste decreases
¨ There may be fissuring on the dorsum of the
tongue
¨ Like the oral mucosa, abnormal taste sensations
may be perceived
¨ Complaints of a dry mouth and diminished
salivary output are common in older people
¨ Approx 30% of people older than 65 years of age
experience these disorders and their oral and
pharyngeal consequences
¨ The viscosity of saliva decreases with advancing
age
¨ The calcium and phosphorus levels increases with
age
¨ The amount of ptyalin secreted is also reduced
¨ The salivary glands become more prone to
pathological conditions because of reduction in
vascularity and increase in the fibrous tissue
content
¨ Fatty degeneration may occur with increase in age
¨ The fibrous tissue content also increases
¨ There is decreased tendency for lymphocytic
infiltration into the ductal system
¨ muscle function is dependent on the performance of
the nervous system and both exhibit independent
age-related changes.
¨ Nerve cell lossis universal in old age and is
exhibited in the brain and spinal cord.
¨ There are also age related changes in
neurotransmitters resulting in motor dysfunction
¨ Peripheral nerve function reduces with age
¨ There is also reduction in conduction velocity,
increased latencies in multi-synaptic pathways ,
decreased conduction at neuromuscular junctions
and loss of receptors
¨ There is a reduction total muscle mass due to a
reduction in the number of muscle fibres rather than
a major reduction in muscle fibre size
¨ There is also a loss of motor units which manifests
as a reduction in muscle strength and reduced
masticatory forces.
¨ Age induces a lengthening of the chewing
process associated with a reduction in muscle
activity
q With advancing age, there is progressive reduction
in bone mass resulting in generalized osteoporosis
q Loss of dentition
q Reduced blood supply resulting in slow healing of
fractures in the jaw bones with increase in age
q Atrophy of the mandibular alveolar ridges and
adjacent basal bone reduces bony surface area,
strength, bone density and stock.
q There is falling in of the lips and cheeks with
advancing age due to alveolar resorption both in
height and width
q Subsequently there is loss of facial height with
upwards and forwards posturing of the mandible.
¨ Loss of alveolar bone occurs more rapidly in
the mandible than the maxilla
¨ Increased brittleness
¨ Levels of the cyclo-oygenase2 (COX 2) enzyme
essential for healing decline causing delayed
healing
q Inferior alveolar neurovascular bundle and
mental nerve travels near the top of the
remaining mandible.
q Hypertrophy of the genial tubercles is common
especially in atrophied mandibles
AGE CHANGES IN THE JAWS….....

¨ There is also resorption of the muscular

processes of the mandible
¨ The mental foramen becomes superficially due
to bony resorption in the mandible
¨ In the maxilla alveolar resorption causes a
flattening of the palatal vault
¨ Difficult to distinguish age changes from
osteoathrosis
¨ There is often remodelling of the articular surfaces
and disc in response to functional changes
following tooth loss
¨ Remodelling may result in disc displacement
particularly anterior displacement
¨ The retrodiscal tissues may show adaptive changes
associated with decreased cellularity and
vascularity and increased density of collagen and
may eventually function as an articular disc.
¨ Disc displacement may lead to perforation of the
disc particularly of its posterior attachment
resulting in progressive joint damage.
¨ With advancing age osteoclastic changes
(resorption) occurs within the substance of the
temporo-mandibular joint (TMJ) leading to an
increased prevalence or frequent episodes of TMJ
dislocations