OROFACIAL AGEING

DSC GERODONTOLOGY
(Alin & Marlin)

US (Dolan & Atchinson, 1993)
1958 60% of 65+ were edentulous
1985 41% of 65+ were edentulous
Australia (Carter, 1997)
1979 67% of 65+ were edentulous
1996 39% of 65+ were edentulous
Most teeth are lost as people
become long in the tooth because
of advancing periodontal disease
Age alone does not lead to a critical
loss of periodontal support.
-Burt, 1994
Severe periodontal destrustion occurs
in a minority of the elderly.
-Levy, 2002
MYTH / FACT?
Dental caries is not a common
disease in older adults, and
occurs mainly in the young
Dental caries is a chronic
progressive disease the causes and
pathogenesis of which are not
related to ageing

-Banting, 1991
MYTH / FACT?
Salivary flow is decreased in
older adults
Healthy, non-medicated older
adults do not have functionally
decreased salivary flow rates or
altered salivary composition due to
ageing alone

-Burt, 1994
All oral diseases and conditions are
not true ageing changes per se,
but may be considered age-related
changes
age-related changes
Accumulation of oral diseases over time
Stress, trauma
Polypharmacy
Psychological, neurogical conditions
Medical conditions
Oral health and function is commonly
altered in older adults.
Periodontal
disease
Salivary
disease
Oral health and function is commonly
altered in older adults.
Medications
Age-related changes in oral health
Oral Mucosa
The clinical appearance of the oral mucosa in
many health older persons is indistinguishable
from that of younger people.
Salivary disorders
The clinical appearance and histologic
character of the oral mucosa

Oral habits Mucosal diseases
Oral mucosal
trauma
Oral mucosal immunity is believed to
undergo some age-related changes
Age-related
structural and
immunologic
changes
Poor nutritional
status
Medication
Systemic
disease
Local trauma
Oral mucosal
diseases
Changes in the dentition
IN RESPONSE TO FUNCTIONAL
AND ENVIRONMENTAL
STRESSES
PATHOLOGIC CHANGES
NORMAL PHYSIOLOGIC
PROCESSES
Dentition
External tooth changes
Loss of enamel
Dentin changes
Cementum thickness
discoloration
sclerotic
erosion
abfraction
abrasion
attrition
Pulp dimension
Secondary dentin deposition
Pulpal calcification
External root resorption
Increased density and volume of pulpal
collagen fibers
Diminished nerve supply
Pulp dimension
Aged-related
pulpal changes
Tooth sensitivity
Pain perception
Coronal and root surface caries
A greater retention
of teeth among
elderly persons

a decline in caries
among younger
people
Coronal and root surface caries
Dental
plaque
Difficulty in
performing oral
hygiene
Disturbances in oral
motor function
Diminished salivary
gland function
Gingival recesion
Periodontium
The clinical appearance of periodontal
tissue in elderly individual reftects
age-related changes and an
accumulation of previous disease
experiences and trauma over time.
Periodontal disease
Age-related
immunological
changes
Systemic
condition
Gingival
recession
Medications
Socio-behavioal
factors
Salivary glands
Saliva plays critical role in the maintenance of
oral health
Difficulty in
chewing
Denture
retention
Sensory
disurbances
Dental caries
Speech
dysfunction
Oral mucosal
infections
Difficulty in
swallowing
Decreased
nutritional intake
Summary of Oropharyngeal Processes
in the Elderly Population
Process Healthy Older People Medically Compromised
Older People
Taste Unaffected Diminished

Smell Diminished Diminished

Food Enjoyment Unaffected Diminished

Salivary Output Unaffected Diminished

Chewing Efficiency Slightly Diminished Diminished

Swallowing Slightly Diminished Diminished

Pathological lessions of the orofacial
tissues are more often seen in the old than
in the young
Not be required to treat
To make an identification
May be life
saving
Sepeedy
referral
Oral Mucosal Lesions %
1 Leukoplakia 18.2
2 Palatal or Mandibular Torus 17.2
3 Inflammation or Irritation 10.8
4 Irritation Fibroma 7.4
5 Fordyces Granules 5.9
6 Hemangioma 3.4
7 Inflammatory Ulcer 3.2
8 Papilloma 2.9
9 Epulis Fissurata 2.6
10 Varicosities 2.1
Common Oral Mucosal Lesions in
Adults (US, 1991)
Oral Mucosal Lesions %
1 Denture stomatitis 22.3
2 Iritative hyperplasia 9.4
3 Oral varicosities 9.0
4 Frictional keratosis 6.0
5 Solitary pigmented lesion 4.0
6 Traumatic ulceration 3.5
7 Angular cheilitis 2.9
8 Multiple pgmented lesions 2.8
9 Hemangioma 2.3
10 Lichen planus 2.1
Prevalence of Oral Mucosal Lesions in
Elderly People in Santiago, Chile, 2003
Oral Mucosal Lesions %
1 Denture stomatitis 18
2 Leukoplakia 13
3 Hemangioma 11
4 Melanotic macula 8
5 Traumatic fibroma 7
6 Inflammatory papillary hyperplasia 7
7 Angular cheilitis 5
8 Erythematous candidiasis 4
9 Traumatic ulcer 3
10 Lichen planus 3
Prevalence of Oral Soft Tissue Lesions in
Elderly Venezuelan Population, 2008
Oral Mucosal Lesions %
1 Denture stomatitis 15.2
2 Denture hyperplasia 12.8
3 Epulis fissuratum 9.3
4 Denture related ulcer/ Traumatic ulcer 7.5
5 Frictional keratosis 7.5
6 Angular cheilitis 5.7
7 Inflammatory papillary hyperplsia 3.3
8 Leukoplakia 3.3
9 Acute pseudomembranous candidiasis 3
10 Median rhomboid glossitis 2.7
Oral Mucosal Alterations Among the
Institutionalized Elderl in Brazil, 2010
Denture-related lesion
Denture-induced stomatitis
Chronic atrophic candidiasis
Inflammatory papillary hyperplasia
Epulis fissuratum
Traumatic ulcer
Denture-related lesion
Pigmented Lesion
Lingual varicosities
Varix
Melanotic macula
Amalgam tatto
Nevus
Pigmented Lesion
Benign soft/hard tissue lesion
Tongue Condition
Geographic tongue
Hairy tongue
Glossitis
Fissured tongue
Crenated tongue
Tongue Condition
Vesico-ulcerative lesion
Lichen planus
Pemphigus vulgaris
Cicatrical pemphigoid
Drug-induced ulceration
Oral mucositis
Vesico-ulcerative lesion
Premalignant-malignant lesion
Leukoplakia
Erythro-leukoplakia
Actinic keratosis
Squamous cell carcinoma
Premalignant-malignant lesion
Infectious lesion
Herpes simplex infection
Herpes zoster
Wart / verruca vulgaris
Oral ulceration TB-Syphilis
Oral candidiasis
Infectious Lesion
Salivary Gland Dysfunction
Local and systemic disease
Head-neck radiation treatment
Chemotherapy
Immunoligic disorder
Medications
Salivary Gland Dysfunction
Vitamin deficiencies
Vitamin Disorders
Vitamin B2
(riboflavin)
Angular stomatitis
Cheilosis
Cracked and fissured lips
Glossitis
Papillary athropy
Magenta tongue
Vitamin B12 Glossitis
Angular cheilitis
Occasionally tongue ulcer
Folate Gingivitis
Vitamin C Bleeding, swollen, spongy gums
Vitamin deficiencies
Summary of Oral Disorders in Elderly
Oral Tissue or Function Disorders
Oral mucosa Cancers, Vesicobullous diseases, Ulcerative diseases
Oral and pharyngeal mucosa,
dentition
Viral diseases, Fungal diseases, Bacterial diseases
Dentition Root surface caries, Coronal caries, Attrition
Periodontium Gingivitis, Periodontitis, Abcesses
Salivary glands Obstructions, Bacterial infections, Hypofunction,
Cancers
Chemosensory function Taste dysfunctions, Smell dysfunctions
Swallowing Delayed swallowing, Aspiration
Edentulousness Osteoporosis, Atrophic mandible, Denture
difficulties, Pain over the mental foramen
Pain sensation Atypical facial pain, Burning mouth syndrome,
Postherapetic neuralgia, Trigeminal neuralgia