AGING IN

PERIODONTIUM
Dr.Hoor Munaf
Department of Periodontology
 LEARNING OBJECTIVES
• To identify the impact of aging on periodontal tissues, including
changes in the gingiva, PDL, and alveolar bone
• To study the alterations in immune and inflammatory response
• To understand the physiological and functional changes that occur
with aging
• To discuss clinical based scenario
• To discuss BCQ
WHAT IS AGING?
• Deeping of the nasolabial fold
• Drooping eyelids
• Decreased lip volume and fullness
• Upper lips wrinkles
• Lips border definition
 INTRODUCTION
• Alterations in oral tissues do occur with age
• These physiologic and clinical alterations in the oral cavity associated
with age must be different from pathologic conditions.
• It is only in the presence of periodontal inflammation that changes in these
clinical parameters are exacerbated and lead to loss of function.
• Elderly individuals exhibit increased susceptibilities to a number of
autoimmune, infectious and inflammatory diseases including
periodontitis.
 AGING AND PERIODONTIUM
• The periodontium also known as ‘attachment apparatus’ or ‘the supporting
tissues of the teeth’ includes epithelium, PDL, cementum and alveolar
bone.
• Normal aging of the periodontium is the result of cellular aging which is
the basis for the intrinsic changes seen in oral tissues over time
• The aging process does not affect every tissue in the same way
 KEY PERIONDNTAL CHANGES WITH AGING

• Thinning of oral epithelium and reduced

keratinization
• Increased cell permeability
• Loss of periodontal ligament elasticity
• Gingival recession
• Attachment and bone loss
• Thickening of cementum
 THE CHANGES CAN BE CATEGORIZED INTO:

• Intrinsic
• Stochastic
• Physiologic
• Functional
• Clinical
 PHYSIOLOGIC CHANGES
• Decrease in number of collagen fibers leads to loss of tissue elasticity
• With aging, alveolar bone shows decreased density and an increase in
bone resorption
• In contrast, cementum shows increased cemental thickness
• Increased prevalence of gingival recession
• Width of the attached gingiva increases with age
FUNCTIONAL CHANGES CLINICAL CHANGES
• Reduced effieciency of • Attrition is a compensatory
mastication change that acts as a stabilizer
JUNCTIONAL EPITHELIUM
 GINGIVAL EPITHELIUM
• Thinning and decreased keratinization
• Increased epithelial permeability to antigens
• Decreased resistance to functional trauma
• Flattening of rete pegs
 PDL
• Decreased number of fibroblasts with a more irregular structure
• PDL fibers get thickened
• Calcified bodies become common
• Width of pdl space is decreased if unopposed (hypofunction) or increase
with excessive oclclusal loading
• Both the width of the pocket and cementum increased with age.
 ALVEOLAR BONE
• Reduction in bone height
• Bone undergoes osteoporosis with aging
• Loss of bone density
• Decreased vascularity and water content
• Cortical plates are thinned
• Increased susceptibility to fractures
 AGE AND BACTERIAL PLAQUE
• Plaque accumulation has been suggested to increase with age
• Increased plaque accumulation due to:
o Gingival recession
o Physiologic age changes with salivary composition and flow rate
• Increased number of P.Gingivalis
 AGING AND IMMUNE RESPONSE
• Immunosenescence: deterioration of immune system with increasing age
leading to a greater susceptibility to infections
• This reduction in the capability to cope with antigenic stimuli is known as
Inflammaging
• Neutrophil chemotaxis is significantly impaired in aged individuals
• Antigen presenting functions is dysfunctional
• Impaired phagocytosis
• Decreased number of T and B cell lymphocytes
• Decline of antigen specific immunity
• Thus, the heightened inflammation in the periodontium of an older patient might be a secondary effect
rising from inability to elicit of effective adaptive immune responses

INFLAMMATORY MEDIATORS

The levels of IL1a, IL-1B, IL-6 and IL-8 plaque accumulation, gingival fluid and inflammation is
significantly higher in older adults
 AGING AND INFLAMMATORY
RESPONSE
• Experimental model demonstrated increased GCF, gingival index and
greater size of infiltrated connective tissue in individuals 65 to 80 years
old.
• Increased periodontal tissue destruction measured as Clinical attachment
loss
• Increased serum CRP (C- reactive protein) levels in people with
progressive periodontitis with no other systemic conditions
• AGE HAS BEEN SUGGESTED NOT A TRUE RISK FACTOR BUT AN
ASSOCIATED FACTOR FOR PERIODONTITIS.
 AGING AND RESPONSE TO
TREATMENT
• Successful treatment requires both precise home plaque control by the
patient and supra and sub gingival debridement by the dentist.
 CLINICAL SCENARIO
 54 years old female patient comes to the OPD having a complain of mobility in teeth with no
sign of inflammation, upon examination there is a generalized gingival recession with chunks
of calculus attached below the cervical margin of the mandibular incisors , medical history tells
that patient has uncontrolled diabetes . What is a reason behind the tooth mobility. Choose
your best answer

A. Uncontrolled diabetes

B. Plaque deposition

C. Deceased salivary flow

D. Hyper cementosis