EFFECTS OF AGING ON EDENTULOUS PATIENT

Presentation by: Maliha Tahir

THE AGING POPULATION

In the population of western countries 10% of population is older than 65 years.

Women continue to outnumber men by nearly 2:1 because they live longer , the average life expectancy of woman is 80 years , while man is only expected to live 73 years !! Everyone by age 75 is burdened to some extent by at least one chronic disorder that could limit their access to dental care or influence their response to dental treatment.

Biomechanics of the Edentulous State

Support mechanism for natural dentition.

Support mechanism for complete denture.

Changes in Morphological face height and the TMJ.

Esthetic, Behavioural and Adaptive responses.

Support Mechanism For Natural Dentition

The principal functions of the periodontium are support and positional adjustment of teeth together with secondary and dependent function of sensory perception.

Periodontium As A Supporting Element

Soft tissue=PDL Highly organized and oriented. Highly vascularized. Highly innervated( touch, pain &pressure). Contain elastic fibers. Approximately uniform thickness. Hard tissue=bone+cementum Cementum hard to resorb. Bone well vascularized. Normally they receive tensile loads. Provide excellent medium for PDL attachment

Support mechanism for complete denture

Alveolar mucosa:
Uneven thickness. Uneven attachment &resiliency. Less vasularization &innervations. Diminished proprioceptive nerve endings. Reduced elasticity.

Masticatory support and masticatory loads:

Total surface area: 22.96 cm2 edentulous maxilla 12.25 cm2 edentulous mandible 45 cm2 PDL Tolerance and adaptability: reduced by systemic and metabolic disease. Masticatory loads: 44Ib(20 kg) natural teeth 13 to 16 Ib(6 to 8kg) complete denture.

The residual ridges:

Consists of denture-bearing mucosa, the submucosa and periosteum, and the underlying bone. Following teeth loss, the alveolar ridge is subjected to ongoing resorption.

 Denture movement -- resiliency of mucosa & instability of complete denture can cause tissue damage
Factors affecting retention: Maximal extension of denture base Maximal intimate contact of denture base & its basal seat Muscular factors (actions of buccinator, orbicularis oris, and the extrinsic and intrinsic muscles of the tongue) with appropriate impression techniques.

Viscoelastic Behavior Of The Alveolar Mucosa

Oral mucosa is displaced under load about 10 times more than the periodontium. Mucosa has less elasticity than PDL. A slower recovery rate to sustained loads.

Occlusion
Primary components: - Dentition. - Neuromuscular system. - Craniofacial structures. These are disturbed by the substitution of a complete denture for the teeth/periodontium.

DEVELOPMENT AND ADAPTATION OF THE OCCLUSION

Developing dentition
1- extensive sensory input 2-development of motor skills& neuromuscular learning. 3- dental , alveolar, craniofacial adaptability

Healthy adult dentition

1-dental adaptation (wear, drift, extrusion) 2-bone adaptation is reparative. 3-learned protective reflexes.

Deteriorating adult dentition

1-partial edentulism. 2-periodontal disease. 3-diminished dental reflex adaptation.

The edentulous state

1-residual ridge reduction.. 2-compromised reflex. 3-increase in parafunctional movements.

Changes In Morphological Face Height And TMJ

Premature reduction occurs with attrition/abrasion of teeth. Reduction is more conspicuous in edentulous & complete denture wearers. Most of edentulous patients experienced a spectrum variation as a result of mutilated dentition. In the course of such periods, pathological and/or adaptive structural alterations may take place. Continued loading beyond adaptive capability of the articular tissues may lead to osteoarthritis. TMJ could undergo degenerative joint disease, however other investigators consider it as a process rather than disease entity.

Esthetic, Behavioral & Adaptive Responses

Esthetic changes:
Deepening of the nasolabial sulcus. Loss of labioincisal angle. Narrowing the lip. Increase in columella philtral angle. Prognathic appearance. Decrease in horizontal labial angle.

Adaptive & psychological responses:

Complete denture requires adaptation of learning, muscular skill & motivation Patients ability & willingness to accept & learn to use dentures. Also Habituation gradual diminution of responses to continued or repeated stimuli. In old age Memory & Storage is difficult, so adaptation to complete denture becomes difficult (as progressive atrophy of elements in cerebral cortex & consequent loss in facility of coordination occurs) So Dentists role is to MOTIVATE the patients & make understand their NEEDS has proven to be of greatest clinical value

The Impact Of Age On The Edentulous Mouth

Mucosa

Bone

Saliva

MUCOSA
Becomes thin, easily abraded, and frequently reacts unfavorably to the pressure of dentures. Stomatitis and other mild inflammation are the mucosal lesions encountered most frequently in older edentulous mouths, especially of older men who wear dentures, smoke tobaccos and drink alcohol excessively. High risk of oral cancer in such patients.

BONE
Less efficient osteoblast

Decrease estrogen

Decrease calcium absorption

 Increase in porosity i.e. osteoporosis Types of osteoporosis - Type 1 (post menopausal) - Type 2 (senile or idiopathic) Treatment of osteoporosis - Bisphosphonates, estrogen

Decreases in quantity and changes in quality Lack of lubrication or viscous or soapy saliva decreases the retention of dentures and increases frictional trauma to the thin mucosa Causes of change in saliva: 1. Xerostomic medication 2. Xerostomia 3. Sjogren syndrome 4. Stress 5. Depression 6. Tobacco use 7. Alcohol abuse

JAW MOVEMENTS IN OLD AGE

Decrease in activity of brain

Poor motor coordination & weak muscles

Short chewing strokes & prolonged chewing time

 Pain on swallowing due to - osteophytes - spurs growing on the upper spine adjacent to the pharynx.

Taste and Smell

Senstation of taste and smell are frequently confused because the sensory mechanisms are closely related and dependant. Olfactory cells damage with age. Decreased sensitivity to taste seen more commonly in ALZHEIMER.

Associated cranial nerves VI, IX, X can be disturbed and damaged by tumors and viruses.

Nutrition And Diet

As one ages people become less active since muscle activity is limited canonic requirement is lower It is time for more protein and fewer carbohydrates There is risk of malnutrition because of variety of factors ranging from socioeconomic status to over consumption of drugs Obesity can result from excessive intake of returned carbohydrate Patients who are successfully using dentures are suddenly find that dentures are no longer comfortable because of the supporting tissue change with the weight loss. Angular cheilitis and stomatitis caused by malnutrition.

Aging Skin And Teeth

Skin:
Skin becomes thin, wrinkled and dried. Upper lip shows decreased concavity, pouting and flat philtrum, drooping of upper lip. Naso-labial groove deepens, which produce a sagging look to the middle third of the face. Atrophy at subcutaneous end buccal pads of fat hollows the cheeks

Teeth:
Altered chroma and value Abraded enamel Brownish appearance of dentition

Summary
Need of complete denture will increase in coming centuries.
Poor healing in old age i.e. trauma of ill fitting dentures heals slowly.

Prosthodontics requires good diagnosis of systemic and local problems.

New dentures are not accepted easily by older patients so try modify the older one . Patients identity should be embedded.

Life at any age does not have pleasant surprises and rewards so adaptation should be the hallmark of successful aging.