OROFACIAL AGEINGDSC 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, 1994Severe 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
Dental disease
Oral health and function is commonly altered in older adults.
Medications
Medical
problems Medical
treatments
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 habitsMucosal 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 CHANGESNORMAL 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
Hystologic alteration
Socio-behavioal factors
Salivary glands
Saliva plays critical role in the maintenance of oral health
Difficulty in chewing
Denture retention
Sensory disurbancesDental 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 18.22 Palatal or Mandibular Torus 17.23 Inflammation or Irritation 10.84 Irritation Fibroma 7.45 Fordyce’s Granules 5.96 Hemangioma 3.47 Inflammatory Ulcer 3.28 Papilloma 2.99 Epulis Fissurata 2.610 Varicosities 2.1
Common Oral Mucosal Lesions in Adults (US, 1991)
Oral Mucosal Lesions %1 Denture stomatitis 22.32 Iritative hyperplasia 9.43 Oral varicosities 9.04 Frictional keratosis 6.05 Solitary pigmented lesion 4.06 Traumatic ulceration 3.57 Angular cheilitis 2.98 Multiple pgmented lesions 2.89 Hemangioma 2.310 Lichen planus 2.1
Prevalence of Oral Mucosal Lesions in Elderly People in Santiago, Chile, 2003
Oral Mucosal Lesions %1 Denture stomatitis 182 Leukoplakia 133 Hemangioma 114 Melanotic macula 85 Traumatic fibroma 76 Inflammatory papillary hyperplasia 77 Angular cheilitis 58 Erythematous candidiasis 49 Traumatic ulcer 310 Lichen planus 3
Prevalence of Oral Soft Tissue Lesions in Elderly Venezuelan Population, 2008
Oral Mucosal Lesions %1 Denture stomatitis 15.22 Denture hyperplasia 12.83 Epulis fissuratum 9.34 Denture related ulcer/ Traumatic ulcer 7.55 Frictional keratosis 7.56 Angular cheilitis 5.77 Inflammatory papillary hyperplsia 3.38 Leukoplakia 3.39 Acute pseudomembranous candidiasis 310 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 deficienciesVitamin Disorders
Vitamin B2(riboflavin)
Angular stomatitisCheilosisCracked and fissured lipsGlossitisPapillary athropyMagenta tongue
Vitamin B12 GlossitisAngular cheilitisOccasionally tongue ulcer
Folate Gingivitis
Vitamin C Bleeding, swollen, spongy gums
Vitamin deficiencies
Summary of Oral Disorders in ElderlyOral 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