Oral changes by age

1. 1 Oral changes by age Oral changes by age Prepared by: Prepared by: Dr Mohammed Alruby Dr Mohammed Alruby مهاطخا هيلع نوقلعي ام نودجي يتح سانلا هعرتخلا ادوجوم ريغ ناطيشلا ناك ول O Oral ral changes by age changes by age Dr. Mohammed Alruby Dr. Mohammed Alruby

2. 2 Oral changes by age Bone T M J Nerve and musculatures Oral mucosa Salivary glands Sensory changes Periodontium Teeth: enamel, dentino-pulpal complex, cementum Dentition: -Drifting and malocclusion -Arch width and tooth size -Overjet and overbite -Occlusal pattern -Molar relation O Oral ral changes by age changes by age Dr. Mohammed Alruby Dr. Mohammed Alruby

3. 3 The proportion of older people is growing faster than any other group age Poor oral hygiene among older people has traditionally been manifest in high level of tooth loss, dental caries, and periodontal disease as well as xerostomia and oral cancer 1-Bone: = Increasing age is associated with progressive reduction in bone mass resulting in osteoporosis = atrophy of alveolar bone is related mainly to tooth loss and increase by age that resulting in: -Absence of denture -Loss of facial height -Upward and forward posturing of mandible = loss of alveolar bone occurs more rapidly in mandible than maxilla = level of cyclo-oxygenase 2(cox2) enzyme, which play essential role in bone repair, decline dramatically with age, this explain the delayed bone healing in older age 2-T M J: = The main age changes related to remodeling of the articular surface and disc in response to functional changes following tooth loss = remodeling may result in disc displacement, particularly anterior displacement = the retrodiscal tissue may show decreased vascularity and cellularity and increased density of collagen = in severe cases displacement may lead to perforation of the disc resulting in progressive damage 3-Nerve and musculature: = continued muscle function in a major requirement for the maintenance of speech and mastication, in all patient with advancing age, there is reduction in total muscle mass which occurs through a reduction in the number of muscle fiber rather than a major reduction in muscle fiber size = by age there is a loss of motor unit specially over 60 age = manifestations: -Reduced masticatory force -Reduce muscle strength -Lengthening of chewing process -Changes in chewing behavior 4-Oral mucosa: = the clinical appearance of the oral mucosa in older patients is indistinguishable from younger one, however changes by time as: -Mucosal trauma -Mucosal disease -Salivary gland hypo-function Can alter the clinical features and character of oral tissues = the stratified squamous epithelium become thinner, loss of elasticity and atrophies with age with increased oral disorders 5-Sensory changes: = it is known that taste and smell sensitives changes throughout life and often decline with aging = these changes can make the foods become tasteless resulting in reduction in appetite = diminution of taste results from degeneration of taste buds and reduction of their total numbers O Oral ral changes by age changes by age Dr. Mohammed Alruby Dr. Mohammed Alruby

4. 4 = elderly people cannot detect the pleasantness of food compared with younger people, this can lead to the older people to added more ingredients such as sugar or salts to food stuff that can lead to adverse health effect 6-Salivary glands: Dry mouth –xerostomia and diminished salivary glands output are common in older age, some cases have decreased salivary output due to high intake of drugs as: -Anti-depressant -Anti-hypertensive -Cytotoxic and anti-parkinsonism Some cases with neck cancer may exposed to irradiation which cause: -Severe and permanent salivary hypo-function -Xerostomia Some disease as: Diabetes mellitus, Alzheimer disease, Syogran syndrome cause salivary gland disease with reduction in salivary output N: B: consequence of salivary hypo-function: -Dental caries -Dry lips -Dry mouth -Dysphagia -Gingivitis -Halitosis -Mucositis -Difficulty in speech and sleep -Problem with mastication -Difficulty with removable prosthesis 7-Periodontium: Increase the severity of periodontal disease with age as: gingivitis, periodontitis, bad periodontal health 8-Teeth: a-Enamel: Enamel tends to become: -More brittle -Susceptible to chipping -Cracking and fracture -Less permeable -Darking of enamel and staining due to absorption of organic materials b-Dentino-pulpal complex: = Formation of secondary dentine = Reduction of size of pulp and some cases obliteration of chamber = Dentine sclerosis that lead to brittle root, they may fracture during extraction = Reduction of height of pulp horn, pulp stone = With age pulp become: -Less vascular -Less cellular O Oral ral changes by age changes by age Dr. Mohammed Alruby Dr. Mohammed Alruby

5. 5 -More fibrotic -Reduced nerve supply -Difficult pulp test c-Cementum: = cementum continues to be formed throughout the life, especially in apical half of roots, resulting in gradual increase in thickness to compensate inter-proximal and occlusal attrition = the amount of secondary cementum at the apex of tooth is a factor taken into account during taking the working length of orthodontic treatment and in forensic dentistry in age estimation Changes in dentition by age 1-Drifting and malocclusion: = migration of anterior teeth leads to: spacing, increased overjet, deeping of bite = due to conical form of their roots, even horizontal forces acting on these teeth leads to combination of sagittal and vertical movement that lead to: -Gingival trauma -Increasing in crowding of lower anterior that lead to developed secondary malocclusion = unavoidable extraction of one or more permanent teeth due to caries: Sequlea: ----- no replacement ------ loss of arch continuity ----- migration of adjacent teeth ----- more deep bite OR: no replacement ------ increased activity of tongue ------- development of anterior spacing 2-Arch width and tooth size: In general: changes in dental arch dimension are small in childhood a-Between 6 weeks and 2 years of age, before complete eruption of deciduous dentition, there were significant increase in the maxillary and mandibular anterior and posterior arch widths in both girls and boys b-Intercanine and Intermolar widths significantly increased between 3 to 13 yaers of age in both maxillary and mandibular arches After complete eruption of permanent dentition, there was slight decrease in arch width: more in intercanine than Intermolar width c-Mandibular intercanine width, established by 8 years of age. After eruption of permanent dentition, no change or minimal decrease can be expected in dental arch d-Bolton index does not change by age 3-Overjet and overbite: The variability in overjet is greater than overbite at the age of both 12 and 20 years The age changes for both overjet and overbite show some individual differences: -Some individuals have forward displacement of lower arch more pronounced (4.8mm) -Some individuals have backward displacement of lower arc (2.6mm) Overbite with age show certain relationship with primary type of bite as: -Deepbite ------- tend to open than normal overbite -Openbite ------ tends to close 4-Occlusal pattern: By age, enamel tends to become: -More brittle -Cracking and fracture O Oral ral changes by age changes by age Dr. Mohammed Alruby Dr. Mohammed Alruby

6. 6 -Less permeable -Darking and staining -Susceptible to chipping Straight terminal plane relationship predominated at all ages, the termination pattern seemed to change with age and this was caused by mesial migration of the mandibular arch and by mesial mandibular shift 5-Molar relation: = Studies done by Bashara 1988, the finding indicates that: from 424 sides evaluated in deciduous dentition: -61% developed class I -43% developed class II -4.1% developed class III Distal step ------ class II molars Flush terminal plane 56% -- class I, 44% ---- class II Mesial step -------- class I = the magnitude of changes in molar relationship, 1.9mm in males and 1.6 in females = favorable differences between upper and lower leeway space, 1.3mm in males and 1.1mm in females = decrease in wits appraisal, 1.2mm in males, and 0.6mm in females O Oral ral changes by age changes by age Dr. Mohammed Alruby Dr. Mohammed Alruby