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Aging:
Is a slowing of natural function, a disintegration
of the balanced control and organization that characterize the
young adult.
Is the process by which a person grows old, irrespective
of the time required. It includes the complex interaction of
biologic, psychologic, and sociologic process over time.
Is an energy process beginning at conception that is
directed
by
endowments
and
impelled
by
perceived
Functionally
dependent
elderly
(with
illness
impairment)
2.
3.
4.
Old (75-85years)
5.
or
Demographics:
The elderly population has increased in an explosive
fashion. In 1900, three million people were considered aged.
Currently the number is 23 million or 11.3%of u.s.population.
It is estimated that by 2030, 67 million persons or 20%of the
population will be 65 years of age or older.
The A.D.A. has reported an increase in the number of
elderly patients seeking restorative and preventive care, yet
older people use fewer dental services than younger adults.
70 % of elderly persons require some dental treatment; yet
only 25%-40% perceive this need, and only 20% -35%
actually seek treatment. Socioeconomic status seems to play a
role, as do functional dependence and poorer health status.
95%of dentulous individuals older than 65 years have
periodontal disease.
Theories of aging:
Biologic theories of aging:
These theories constitute the cellular aging process which
results in mechanical failure of non-replaceable parts in organ
systems, and morphological problems of the cell development
that gives organs size, shape and structure.
Stochastic theories:
These theories suggest that aging events occur randomly
and accumulate with time. These theories include
2
1. Gene theory
2. Disposable soma theory
3. Free radical theory and
4. Connective tissue theory.
1. Gene theory: (kyriazis, 1994) supporters of this theory
believe
that
we
disadvantageous
have
at
pool
birth.
of
Natural
advantageous
selection
and
protects
to
reproduction,
disadvantageous
genes
but
once
cause
this
has
deleterious
taken
effects
place
almost
oxygen
interacts
with
lipoproteins
(substance
in
environmental
sources
thought
to
cause
harmful
cross-links.
Aging
collagen
becomes
increasingly
is
the
connective
tissue
mirrors
collagen
that
regulate
the
biological
clock
during
or
activity
imbalance
of
pacemaker
neurons
in
the
2. Disengagement theory:
Cumming
and
Henry
(1961)
stated
that
aging
is
spots
due
to
localized
proliferation.
Dry mucous membrane and decreased.
Thinner sweat gland output.
melanocyte
2. HAIR:
Brittle.
Less abundant.
Decreased pigment causing gray or white hair.
Thinning as the number of melanocytes declines.
Pubic hair loss resulting from hormonal changes.
Facial hair increases in post menopausal women and
decreases in men.
3. EYES:
Enopthalmos.
Presbyopia.
Baggy and wrinkled eyelids due to decreased elasticity,
with eyes sitting deeper in the sockets.
Thinner and yellow conjunctiva.
Decreased tear production due to loss of fatty tissue in
lacrimal apparatus.
Corneal flattening and loss of luster.
Fading or irregular pigmentation of iris.
scleral thickening and rigidity, yellowing due to fat
deposits.
Impaired color vision due to deterioration of retinal
cones.
10
Decreased
reabsorption
of
intra
ocular
fluid
predisposing to glaucoma.
11
6. CARDIOVASCULAR SYSTEM:
Slightly smaller heart size.
Loss of cardiac contractile strength efficiency.
30-35%diminished cardiac out put by the age of 70
years.
Heart valve thickening, causing incomplete closure
(systolic murmer).
5.25%decrease
in
left
ventricular
wall
thickness
12
7. GASTROINTESTINAL SYSTEM:
Nutrition:
Decreased salivary flow and decreased sense of taste.
Diminished absorption of calcium and vitamin b1 and
b12, due to reduced pepsin and Hcl secretion.
Decreased intestinal motility and peristalisis of colon.
Decreased gag reflex.
Decreased
gastro
intestinal
secretions,
affecting
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testosterone
production,
resulting
in
changes
in
neurons
of
central
and
less
effective
at
regulatory
body
temperature.
Increased pain threshold.
12. IMMUNE SYSTEM:
Blood:
Increased RBC count and Hb% owing to reduced activity
of bone marrow, and increased fragility of cells.
Anaemias are common.
Loss of ability to recognize and destroy mutant cells.
15
Decreased
antibody
response,
resulting
in
greater
susceptibility to infection.
Tonsillar atrophy.
Lymphadenopathy.
Lymphnode and spleen size slightly decreased.
Some active blood forming bone marrow replaced by
fatty bone marrow.
Decreased vitamin b12 absorption results in reduced
erythrocyte
mass
and
decreased
haemoglobin
and
haematocrit.
RELATED
CHANGES
IN THE
GINGIVA AND
cellular
component
of
connective
tissue
also
increased
mechanical
denaturing temperature.
3. Periodontal ligament:
17
strength,
increased
in
the
number
of
collgen
fibres
and
mucopolysaccharides.
Decrease number of fibroblasts and more irregular
structure.
Decrease organic matrix production and epithelial cell
rests.
Increase in arteriosclerotic changes.
Both in increase and decrease in the width of the
ligament has been described with aging.
Unopposed tooth-hypofunction and masticatory forces
decrease with age, which may contribute to reduction in
the width of the periodontal ligament.
Increase in width may be due to the availability of fewer
teeth to support the entire functional load.
A
decrease
in
the
width
may
also
result
from
19
from
young
patients
contains
more
viable
stages of
increase
in
Porphyromonalis
age,
gingivalis
they
are
and
increase
decrease
in
role
of
role
of
Actinobaccilus actinomycitocomitans.
7. Tooth-periodontal Relationships:
The most obvious change in the teeth with aging is a
loss of tooth substance caused by attrition. Attrition is
defined as the physiologic wearing of a tooth as a result of
tooth contact, as in mastication. The degree of attrition is
influenced by musculature, consistency of the food, tooth
hardness, occupational factors, and habits such as grinding
(bruxism) and clenching.
The rate of attrition may be coordinated with other
aging related changes such as continuous tooth eruption and
gingival recession.
21
the
anteroposterior
length
of
dental
arch
by
22
such
as
gingival
recession,
attrition
and
function.
Elderly
individuals
have
slowly
23
SOCIAL AND
MENTAL EXAMINATION
OF AGING
INDIVIDUALS:
Elderly
patients
attitude
toward
therapy
have
24
Dental
practioners
of
the
21 s t
century
should
be
25