AGING AND THE PERIODONTIUM

1. PRESENTED BY-
PARTHA PROTIM SINGHA
(FINAL YEAR)

2. CONTENTS
 Introduction
 Periodontium
 Age changes in the gingival epithelium
 Age changes in gingival connective tissue
 Changes in the periodontal ligament
 Changes in the cementum
 Changes in the bone
 Effects of aging on the progression of the periodontal
diseases
 Aging and the response to treatment of the periodontium
 Reference

3. Increased awarness and improvements in preventive
dentistry have led to decreasing tooth loss for all age groups.
 The effects of this shift in tooth retention need to be
considered carefully.
 In particular,increased life expectancy and greater health
expectations may lead to changes in demand from older
individuals for periodontal treatment and potentially a
substansial increase for supportive periodontal therapy.
Aging causes changes in the periodontium;therefore
broader aspects aging are examined,as well as the possible
effects on treatment outcomes.

4. PERIODONTIUM
 The normal periodontium provides the support necessary to maintain
teeth in function.
 It consists of four principle components:
• Gingiva
• Periodontal ligament
• Cementum
• Alveolar bone

6. 1.AGE CHANGES IN GINGIVAL EPITHELIUM
 Thinning and decreased keratinization of the gingival epithelium
have been reported with age.
- This is because of the increase in epithelial permeability to
bacterial antigens,a decreased resistance to functional trauma,or
both.
 Flattening of rete pegs and altered cell density.
 According to some reports,there is migration of the junctional
epithelium from its position in healthy individuals(i.e. On enamel)to
a more apical position on the root surface with accompanying
gingival recession.
- With continuing gingival recession,the width of the attached
gingiva would be expected to decrease with age,but the opposite appears
to be true.

7. 2.CHANGES IN GINGIVAL CONNECTIVE TISSUE
 Increasing age results in coarser and denser gingival connective
tissues.
 Qualitative and quantitative changes to collagen have been reported.
- These include an decreased rate of conversion of soluble to
insoluble collagen,increased mechanical strength and increased denaturing
temperature.
-These results indicate increased collagen stabilization caused
by changes in the macromolecular conformation.

8. 3. CHANGES IN THE PERIODONTAL LIGAMENT
 Decreased number of fibroblasts and a more irregular
structure,paralleling the changes in the gingival connective tissues.
 Decreased organic matrix production and epithelial cell rests and
increased amounts of elastic fiber.
 Decreased cell proliferation.

10. 4. CHANGES IN THE CEMENTUM
 Increase in the cemental width;this maybe 5-10 times with increasing
age.
- The increase in width is greater apically and lingually.

12. 5. CHANGES IN THE ALVEOLAR BONE
 More irregular periodontal surface of bone and less regular insertion
of collagen fibres.
- Although age is a risk factor for the bone mass reductions in
osteoporosis, it is not causative and therefore,should be distinguished from
physiologic aging processes.
- Overriding the diverse observations of bony changes with age
is the important finding that the healing rate of bone in extraction sockets
appears to be unaffected by increasing age.

14. EFFECTS OF AGING ON THE PROGRESSION OF
PERIODONDAL DISEASES
In a classic experimental gingivitis study, subjects were rendered plaque and
inflammation free through frequent professional cleaning.
Once this was achieved,the subjects abstained from oral hygiene measures for
periods of 3 weeks to allow gingivitis to develop.
In this experimental model,a comparison of developing gingivitis between
young and older individuals demonstrated a greater inflammatory response in
older subjects.
In older age groups(60-80 years), the findings included a greater size of infiltrated
connective tissue,increased gingival crevicular fluid flow,and increased gingival
index.
Even at the basement level of excellent gingival health before commencing plaque
accumulation,differences may exist between groups,with older individuals
demonstrating more inflammation.
The phrase, “getting long in the tooth” expresses a widespread belief that age is
inevitably associated with an increased loss of connective tissue attachment.

15. A “risk factor” is defined as ‘any characteristic,behaviour,or exposure with an
association to a particular disease’. Some risk factors like smoking, can be
modified to reduce one’s risk of initiation or progression of disease; while
othre factors cannot be modified such as genetic factors.
Therefore,age has been suggested to be not a true risk factor but a background
or an associated factor for periodontitis.

16. AGING AND THE RESPONSE TO TREATMENT OF
THE PERIODONTIUM
 The successful treatment of periodontitis requires both meticulous
home-care plaque control by the patient and meticulous supragingival
and subgingival debridement by the therapist.
 If plaque control is not ideal, continued loss of attachment is
inevitable.
 Furthermore, without effective periodontal therapy,progression of
diseases might be faster with increasing age.

17. REFERENCE
 Carranza’s Clinical Periodontology – 11th edition
 Essentials of Clinical Periodontology & Periodontics – by
Shantipriya Reddy