Orofacial Aging

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OROFACIAL AGEING DSC GERODONTOLOGY (Alin & Marlin)

Transcript of Orofacial Aging

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OROFACIAL AGEINGDSC GERODONTOLOGY

(Alin & Marlin)

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•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

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Most teeth are lost as people become ‘long in the tooth’ because

of advancing periodontal disease

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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

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MYTH / FACT?

Dental caries is not a common disease in older adults, and occurs mainly in the young

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Dental caries is a chronic progressive disease the causes and

pathogenesis of which are not related to ageing

-Banting, 1991

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MYTH / FACT?

Salivary flow is decreased in older adults

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Healthy, non-medicated older adults do not have functionally decreased salivary flow rates or

altered salivary composition due to ageing alone

-Burt, 1994

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All oral diseases and conditions are not true ‘ageing’ changes per se,

but may be considered ‘age-related changes’

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‘age-related changes’

• Accumulation of oral diseases over time• Stress, trauma• Polypharmacy• Psychological, neurogical conditions• Medical conditions

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Oral health and function is commonly altered in older adults.

Periodontal disease

Salivary disease

Dental disease

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Oral health and function is commonly altered in older adults.

Medications

Medical

problems Medical

treatments

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Age-related changes in oral health

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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

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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

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Changes in the dentition

IN RESPONSE TO FUNCTIONAL AND ENVIRONMENTAL

STRESSES

PATHOLOGIC CHANGESNORMAL PHYSIOLOGIC PROCESSES

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Dentition

• External tooth changes• Loss of enamel• Dentin changes• Cementum thickness

discoloration

sclerotic

erosion

abfraction

abrasion

attrition

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Pulp dimension

• Secondary dentin deposition• Pulpal calcification• External root resorption• Increased density and volume of pulpal

collagen fibers• Diminished nerve supply

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Pulp dimension

Aged-related pulpal changes

Tooth sensitivity

Pain perception

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Coronal and root surface caries

• A greater retention of teeth among elderly persons

• a decline in caries among younger people

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Coronal and root surface caries

Dental plaque

Difficulty in performing oral

hygiene

Disturbances in oral motor function

Diminished salivary gland function

Gingival recesion

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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.

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Periodontal disease

Age-related immunological

changes

Systemic condition

Gingival recession

Medications

Hystologic alteration

Socio-behavioal factors

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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

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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

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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

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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)

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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

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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

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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

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Denture-related lesion

• Denture-induced stomatitis• Chronic atrophic candidiasis• Inflammatory papillary hyperplasia• Epulis fissuratum• Traumatic ulcer

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Denture-related lesion

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Pigmented Lesion

• Lingual varicosities• Varix• Melanotic macula• Amalgam tatto• Nevus

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Pigmented Lesion

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Benign soft/hard tissue lesion

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Tongue Condition

• Geographic tongue• Hairy tongue• Glossitis• Fissured tongue• Crenated tongue

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Tongue Condition

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Vesico-ulcerative lesion• Lichen planus• Pemphigus vulgaris• Cicatrical pemphigoid• Drug-induced ulceration• Oral mucositis

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Vesico-ulcerative lesion

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Premalignant-malignant lesion

• Leukoplakia• Erythro-leukoplakia• Actinic keratosis• Squamous cell carcinoma

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Premalignant-malignant lesion

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Infectious lesion• Herpes simplex infection• Herpes zoster• Wart / verruca vulgaris• Oral ulceration – TB-Syphilis• Oral candidiasis

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Infectious Lesion

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Salivary Gland Dysfunction• Local and systemic disease• Head-neck radiation treatment• Chemotherapy• Immunoligic disorder• Medications

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Salivary Gland Dysfunction

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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

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Vitamin deficiencies

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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