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