3. Oral Changes

Question 1

Main feature of aging in cells

Answer 1

• Gradual cell loss

- Reduced mitotic activity

Question 2

Physiologic systems most affected by aging are those containing post-mitotic cells which are what organs

Answer 2

• Heart
• Brain
• Muscle
• Skeletal system (less so than the other three)

Question 3

When does the thymus begin to atrophy

Answer 3

Sexual maturity

Question 4

entire thymus is involuted at what age

Answer 4

40

Question 5

Lymphoid tissues (other than the thymus) reach max size at

Answer 5

puberty

Question 6

Function of immune system (increases/decreases) with age

Answer 6

decreases (reduced number of t cells)

Question 7

People with autoimmune diseases will (improve/decline) with age and why

Answer 7

improve because increase in auto anti-isotypic antibodies are present which fight off autoantibodies

Question 8

B cell numbers (increases/decreases) with age

Answer 8

either stays same or increases

Question 9

Primary immune system (increases/decreases) with age

Answer 9

decreases (inital response to antigen)

Question 10

Secondary immune response (increases/decreases) with age

Answer 10

no change (may explain why few childhood diseases afflict the elderly

Question 11

Rate of attrition in dentition is dependent on

Answer 11

diet and habits (not age)

Question 12

Cause of higher incidence in abfraction in elderly is

Answer 12

unknown

Question 13

Longitudinal cracks in enamel are caused by

Answer 13

thought to be caused by age related change in water content

Question 14

Reasons why teeth are darker in color for elderly

Answer 14

• Thinning of enamel
• Increased optical density of dentin due to secondary dentin
• Secondary dentin considered reactive and no intrinsic aging
• Shrinkage of pulp

Question 15

Hydration status of teeth (increases/decreases) with age

Answer 15

decreases

Question 16

Dentin becomes more (flexible/brittle) with age

Answer 16

brittle

Question 17

Reason dentin is more brittle with age

Answer 17

may be due to closure of tubules by crystal sedimentation

Question 18

Sclerosed dentin is (more/less) translucent than normal dentin

Answer 18

more 9contrary to secondary dentin)

Question 19

Reason for increased translucency of sclerotic dentin is

Answer 19

reduced refractory index difference between peri and intratubular dentin

Question 20

Translucency of sclerotic dentin begins where

Answer 20

at the apex

Question 21

Denticles and pulp stones (increases/decreases) in number in elderly

Answer 21

increases

Question 22

Implications of pulp changes in elderly with performing dentistry

Answer 22

• Pulp is less able to repair after pulp cap
• Harder to find/navigate canals
• Less need for local anesthesia in many cases

Question 23

Describe the degenerative changes that occur in the periodontium with age

Answer 23

• Less BVs
• Reduced cells
• Coarse and irregular formations of Sharpey’s fibers
• Moderate structural changes in alveolar bone/cementum

Question 24

T/F Periodontal disease always worsens with age

Answer 24

F- sometimes reverse effect

Question 25

Describe the reverse effect of periodontal disease seen in some elderly patients

Answer 25

- Minimal loss of marginal soft tissue - Narrowing of periodontal space - Firmly attached teeth (almost ankylosed) * *This is commonly seen in patients with significant attrition** Sometimes increased cementum deposition

Question 26

Changes in alveolar bone with age

Answer 26

- Loss of trabeculation - Cellular atrophy in osteocytes - Increased bone loss (3% every decade past 40) - Decreased blood supply (significant inferior alveolar artery arteriosclerosis

Question 27

When the inferior alveolar artery is blocked due to atherosclerosis the alveolus will be supplied by what vessels

Answer 27

- Perisoteum - Facial - Buccal - Lingual arteries

Question 28

Changes in oral mucosa with age

Answer 28

- Atrophy of basal rete pegs (smoother surface) - Submucosal loss of cells and vascular supply - Thickening of collagen bundles and elastin fibers - Degeneration of vessel walls (esp in tongue) --> senile amyloidosis

Question 29

Changes in tongue with age

Answer 29

- Loss of lingual papilla (smoother dorsum) --> smooth dorsum can also be related to nutrient deficiency - Increased filliform papilla which cluster --> fissured tongue - Senile amyloidosis - Increased varicosities

Question 30

Systems involved in declined sense of taste in elderly

Answer 30

- Saliva **major - Olfactory -- not very significant - Thermal sensory - Tactile sensory - Textural sensory - Multiple types of taste receptors - Nutritional (zinc involved with taste acuity)

Question 31

Prominent reduction in smell is seen in the early stages of what diseases

Answer 31

Alzheimers or Parkinson's

Question 32

What tastes don't decline with age

Answer 32

sweet and sore (old people eat more sweets)

Question 33

Role of saliva in taste

Answer 33

-Dissolve in order for taste bud perception and breakdown by enzymes

Question 34

Functions of saliva

Answer 34

- Remineralization - Anti-microbial - Lubricaiton - Digestion (bolus formaiton , breakdown) - Mucosal repair (epidermal growth facto) - Buffering capacity

Question 35

Consequence of salivary hypofunction

Answer 35

- Rampant caries - Candidiasis - Mucosal friability (tears more easily without lubrication) - Dysphagia - Complaints or oral dryness - Complaints of altered taste - Difficulty wearing prosthesis

Question 36

T/F Xerostomia is a normal part of aging

Answer 36

f

Question 37

Xerostomia is mostly caused by _ in elderly

Answer 37

meds

Question 38

Aging changes in salivary system

Answer 38

- Stimulated whole saliva unchaged with aging | - Non-stimulated saliva is reduced

Question 39

Saliva release from which glands are affect the most to least by aging

Answer 39

minor salivary glands> submandibular> Parotid

Question 40

Parotid changes with age

Answer 40

- Some degeneration and loss of acinar glandular tissue | - Replacement of lost tissue with fibro-adipose tissue

Question 41

Submandibular changes with aging

Answer 41

- More degeneration and loss of acinar tissue | - Replacement of lost tissue with fibro-adipose tissue

Question 42

Minor salivary gland changes with agining

Answer 42

- extensive degeneration and loss of acinar glandular tissue - Ductal proliferation

Question 43

Changes in salivary immunoglobulins with age

Answer 43

- Salivary IgA conc. changes with flow rate (no change from aging alone) - IgG and IgM antibodies decline

Question 44

Changes in non-immunoglobulin defenses in saliva

Answer 44

None (same lysozyme, lactoferrin, and lacto-peroxidase)

Question 45

T/F Blocked salivary ducts with plugs of degerative tissue ususally passes

Answer 45

t

Question 46

T/F No age connection to sialolithiasis

Answer 46

t

Question 47

Elderly have (higher/lower) biting forces

Answer 47

lower

Question 48

Changes in muscle contractility in elderlys lead to

Answer 48

- Impairment higher in prostehesis wearers - Increased time for bolus prepatation - Increased chocking hazard

Question 49

increased choking hazard in elderly enhanced by

Answer 49

- Reduced sensory perception - Reduced proprioception - Oral dryness

Question 50

Change in voice with age is the result of

Answer 50

laryngeal stiffening

Question 51

Speech in elderly also affected by

Answer 51

- Hearing loss - Teeth loss - Neuromuscular loss (dysarthria) - Dysphagia

Question 52

Alterations in posture that occur with age are

Answer 52

- Drooping lower face - Hanging lower jaw - Leads to drooling and spilling food