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EFFECTS OF AGING ON
EDENTULOUS PATIENT
Presentation by:Maliha Tahir
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THE AGING POPULATION
In the population of western countries 10% of populationis older than 65 years.
Women continue to outnumber men by nearly 2:1because they live longer , the average life expectancy ofwoman is 80 years , while man is only expected to live 73years !!
Everyone by age 75 is burdened to some extent by atleast one chronic disorder that could limit their access todental care or influence their response to dentaltreatment.
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Biomechanics of the
Edentulous State
Support mechanism for natural dentition.
Support mechanism for complete denture.
Changes in Morphological face height and the TMJ.
Esthetic, Behavioural and Adaptive responses.
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Support Mechanism For Natural
Dentition
The principal functions of the
periodontium are support andpositional adjustment of teeth together
with secondary and dependent
function ofsensoryperception.
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Periodontium As A Supporting
Element
Soft tissue=PDL
Highly organized and
oriented.
Highly vascularized. Highly innervated( touch,
pain &pressure).
Contain elastic fibers.
Approximately uniformthickness.
Hard tissue=bone+cementum
Cementum hard to resorb.
Bone well vascularized.
Normally they receivetensile loads.
Provide excellent medium
for PDL attachment
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Support mechanism for
complete denture
Alveolar mucosa:
Uneven thickness.
Uneven attachment &resiliency.
Less vasularization &innervations.
Diminished proprioceptive nerve
endings.
Reduced elasticity.
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Masticatory support and masticatory loads:
Total surface area: 22.96 cm2 edentulous maxilla
12.25 cm2 edentulous mandible
45 cm2 PDL
Tolerance and adaptability: reduced by systemic and
metabolic disease.
Masticatory loads: 44Ib(20 kg) natural teeth
13 to 16 Ib(6 to 8kg) complete denture.
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The residual ridges:
Consists of denture-bearing mucosa, the submucosa and
periosteum, and the underlying bone.
Following teeth loss, the alveolar ridge is subjected toongoing resorption.
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Denture movement -- resiliency of mucosa & instability of
complete denture can cause tissue damage
Factors affecting retention:
Maximal extension of denture base
Maximal intimate contact of denture base & its basal seat
Muscular factors (actions of buccinator, orbicularis oris,
and the extrinsic and intrinsic muscles of the tongue) with
appropriate impression techniques.
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Viscoelastic Behavior Of The
Alveolar Mucosa
Oral mucosa is displaced under
load about 10 times more than
the periodontium. Mucosa has less elasticity than
PDL.
A slower recovery rate to
sustained loads.
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Occlusion
Primary components:
- Dentition.
- Neuromuscular system.
- Craniofacial structures.
These are disturbed by the substitution of a complete
denture for the teeth/periodontium.
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DEVELOPMENT AND ADAPTATION OF THE
OCCLUSION
Developing dentition
Healthy adult dentition
Deteriorating adult dentition
The edentulous state
1- extensive sensory input
2-development of motor skills&
neuromuscular learning.
3- dental , alveolar, craniofacial adaptability
1-dental adaptation (wear, drift, extrusion)2-bone adaptation is reparative.
3-learned protective reflexes.
1-partial edentulism.
2-periodontal disease.
3-diminished dental reflex adaptation.
1-residual ridge reduction..
2-compromised reflex.
3-increase in parafunctional movements.
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Changes In Morphological Face
Height And TMJ
Premature reduction occurs with attrition/abrasion of teeth.
Reduction is more conspicuous in edentulous & complete
denture wearers.
Most of edentulous patients experienced a spectrumvariation as a result of mutilated dentition.
In the course of such periods, pathological and/or adaptive
structural alterations may take place.
Continued loading beyond adaptive capability of thearticular tissues may lead to osteoarthritis.
TMJ could undergo degenerative joint disease, however
other investigators consider it as a process rather than
disease entity.
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Esthetic, Behavioral & Adaptive
Responses
Esthetic changes: Deepening of the nasolabial sulcus.
Loss of labioincisal angle. Narrowing the lip.
Increase in columella philtral angle.
Prognathic appearance.
Decrease in horizontal labial angle.
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Adaptive & psychological responses: Complete denture requires adaptation of learning, muscular skill &
motivation
Patients ability & willingness to accept & learn to use dentures.
Also Habituation gradual diminution of responses to continued or
repeated stimuli.
In old ageMemory & Storage is difficult, so adaptation to complete
denture becomes difficult (as progressive atrophy of elements in
cerebral cortex & consequent loss in facility of coordination occurs)
So Dentists role is to MOTIVATE the patients & make understand
their NEEDS has proven to be of greatest clinical value
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The Impact Of Age On The
Edentulous Mouth
Mucosa Bone Saliva
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MUCOSA
Becomes thin, easilyabraded, and frequentlyreacts unfavorably to thepressure of dentures.
Stomatitis and other mildinflammation are the mucosallesions encountered mostfrequently in older edentulousmouths, especially of oldermen who wear dentures,smoke tobaccos and drinkalcohol excessively.
High risk of oral cancer in
such patients.
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BONE
Lessefficient
osteoblast
Decreaseestrogen
Decreasecalcium
absorption
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Increase in porosity i.e. osteoporosis
Types of osteoporosis
- Type 1 (post menopausal)- Type 2 (senile or idiopathic)
Treatment of osteoporosis
- Bisphosphonates, estrogen
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Decreases in quantity and changes inquality
Lack of lubrication or viscous or soapysaliva decreases the retention of
dentures and increases frictional traumato the thin mucosa
Causes of change in saliva:
1. Xerostomic medication
2. Xerostomia
3. Sjogren syndrome4. Stress
5. Depression
6. Tobacco use
7. Alcohol abuse
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JAW MOVEMENTS IN OLD AGE
Decrease inactivity of brain
Poor motorcoordination &weak muscles
Short chewingstrokes &prolonged
chewing time
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Pain on swallowing due to
- osteophytes
- spurs growing on the upper spine
adjacent to the pharynx.
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Taste and Smell
Senstation of taste and smell are frequently confused
because the sensory mechanisms are closely related
and dependant.
Olfactory cells damage with age.
Decreased sensitivity to taste seen more commonly in
ALZHEIMER.
Associated cranial nerves VI, IX, X can be disturbed and
damaged by tumors and viruses.
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Nutrition And Diet
As one ages people become less active sincemuscle activity is limited canonic requirementis lower
It is time for more protein and fewercarbohydrates
There is risk of malnutrition because of varietyof factors ranging from socioeconomic statusto over consumption of drugs
Obesity can result from excessive intake ofreturned carbohydrate
Patients who are successfully using denturesare suddenly find that dentures are no longercomfortable because of the supporting tissuechange with the weight loss.
Angular cheilitis and stomatitis caused bymalnutrition.
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Aging Skin And Teeth
Skin: Skin becomes thin, wrinkled and
dried.
Upper lip shows decreasedconcavity, pouting and flat
philtrum, drooping of upper lip.
Naso-labial groove deepens,
which produce a sagging look to
the middle third of the face.
Atrophy at subcutaneous endbuccal pads of fat hollows thecheeks
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Teeth: Altered chroma and value
Abraded enamel
Brownish appearance of dentition
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Summary
Need of complete denture will increase in coming centuries.
Poor healing in old age i.e. trauma of ill fitting dentures heals slowly.
Prosthodontics requires good diagnosis of systemic and localproblems.
New dentures are not accepted easily by older patients so try modify
the older one .
Patients identity should be embedded.
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Life at any age does not have pleasant
surprises and rewards so adaptationshould be the hallmark of successful aging.
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