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DEN203 > A- Ageing > Flashcards

A- Ageing Flashcards

1
Q

What is Ageing (biological)?

A

‘Complex biological process in which changes at the molecular, cellular and organ levels results in a progressive inevitable and inescapable decrease in the body’s ability to respond appropriately to internal and/or external stressors’

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2
Q

Characteristics of ageing

A

Increased mortality
Increased susceptibility & vulnerability to disease
e.g. >65 years, 92 times more likely to get heart disease
Changes in biochemical composition of tissues
Increased protein crosslinking, aberrant folding, lipofuscin accumulaton
Decrease in physiological capacity
e.g. reduced glomerular filtration rate, max. heart rate
Reduced ability to respond to environmental stimuli

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3
Q

Old Theories of ageing (3)

A

> Galen (AD129- 199)
Changes in body humours beginning in early life
Slow increase in dryness & coldness of the body

> Roger Bacon (1220-1292)
Wear & tear theory
Result of abuses & insults to the body
Good hygiene may slow process

> Charles Darwin (1809-1892)
Loss of irritability in nervous & muscular tissue

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4
Q

Programmed theories of ageing

A
  • Biological clocks
  • Purposeful programme driven by genes

e.g. Evolutionary

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5
Q

Non programmed (error, stochastic) theories of ageing

A
  • Progressive random, accidental damage
  • Loss of molecular fidelity

e. g. Molecular/cellular
e. g. System

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6
Q

Evolutionary theory of ageing

A

Genome directs life until sexual maturity.

No selective pressure after this.

Late onset diseases eg Huntington’s disease (30-40 years) not selected in a way that early ones are eg sickle cell anaemia

Some genes selected early in life may be deleterious later (e.g. immune system, androgens)

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7
Q

Molecular/Cellular (non-programmed):

theory of ageing

A

Free radical damage to molecules

Increased frequency of senescence

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8
Q

System (non-programmed):

theory of ageing

A

Neuroendocrine alterations result in age related physiological changes.

Immunologic function declines- decreased resistance to infection, cancer & increased recognition of self.

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9
Q

Ageing genes: Syndromes

A

> Hutchinson-Guilford Progeria

> Werner syndrome

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10
Q

What is Hutchinson-Guilford Progeria?

A

Rare genetic disorder.
Mutation in LMNA encoding nuclear envelope protein: lamin A.

Affects RNA transcription & chromatin organisation.

Lack of DNA strand rejoining after irradiation.

Accelerated ageing (atherosclerosis).
Usually die by 13.
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11
Q

What is Werner syndrome?

A

Mutation in WRN, DNA helicase family
‘caretaker of the genome’: DNA repair and transcription.

Baldness, hair and skin ageing, calicification of vessels, cancers, cataracts, arthritis, diabetes.

Die by age 50
Central control of ageing?

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12
Q

How many times do cells usually divide?

A

Approx. 50 times

Decline in proliferative capacity
Senescence
Cancer cells have no limit (immortal)

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13
Q

What happens to telomeres with age?

Telomeres= DNA sequences
Protect the ends of chromosomes

A

Progressive shortening with age

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14
Q

What are telomerases?

A

Reverse transcriptase.
Stabilizes telomere length.

Telomerase activity in 90% tumours

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15
Q

Lifestyle effect on ageing?

A
  • sedentary= genetically old

- Telomeres shorter more quickly in inactive people

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16
Q

What is Molecular ageing?

A

Conformational change, aggregation, precipitation, amyloid formation

Ageing: catabolic chance driven?

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17
Q

Free radical effect on ageing?

A

Accumulation of oxidative damage in proteins & DNA

Damage to mitochondrial DNA.

Antioxidants to counter ageing (Vit C, E, β-carotene, 2-deoxy glucose)

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18
Q

Skin ageing features-

A

Wrinkles, pigmented lesions etc.

Sun exposure, air pollution, alcohol, poor nutrition.
Smoking- increase in metalloproteinase enzymes which break down collagen.

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19
Q

Calorific restriction to decrease ageing rate-

A

Reduced oxidant production by mitochondria- less ROS damage.

Induction of SIRT1- key regulator of cell defence.

Increased protein turnover- lack of accumulation of damaged protein.

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20
Q

Healthy life expectancy definition?

A

Summary measure of population health, estimates based on question ‘How is your health in general?’

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21
Q

Disability-free life expectancy definition?

A

Estimates based on those who answer yes to both:

Do you have any physical or mental health conditions or illnesses lasting or expected to last 12 months or more?

Does your condition or illness/do any of your conditions or illnesses reduce your ability to carry out day-to-day activities?

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22
Q

What is ‘Old age’?

A

What it means to age and be a particular age in a given society varies

This means that what ‘old age’ is varies and so it is socially constructed

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23
Q

What is ageing?

A

combination of biological, psychological and social processes that affect people as they grow older

  • Physical changes to the body
  • Shifts in mental processing capacity
  • Changes in society and the social context in which people are ageing
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24
Q

Laslett (1989) proposed different dimensions to age and ageing (5)

A

Chronological (length of life measured in years since birth)

Biological (physical ageing, based on changes in health, fitness, functioning and appearance)

Social (norms and expectations relating to age)

Personal (moment in the life course reached in relation to personal aims)

Subjective (how we feel ‘inside’)

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25
Q

( 1) What is the life course and how does this relate to ageing?

A

Ageing is a process that continues from birth to death, although the transitions between different phases are not pre-determined

A life course approach includes both consideration of people’s social surroundings, and stories of people’s lives over time

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26
Q

What is (2) Age strata and age cohorts and how does this relate to ageing?

A

Age strata – people who share similar social rights and duties by virtue of age

Age cohort – people born at a particular time who have experiences in common

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27
Q

Social contexts of dental treatment with ageing

Cumulative effect of experiences and events over the life course

A

Social contexts of dental treatment:

Prevalence of caries
Lack of equipment and pain relief
Multiple teeth removed under anaesthetic leading to lifelong fear

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28
Q

Various mechanisms that affect experiences of dentistry and oral health

A
  • Legal rule changes
  • Ongoing research
  • Social campaigning
  • Changes to beliefs > changes to social rules/norms (Shaped by social, cultural and material changes)
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29
Q

What are Theories of older age? (2)

A

Theories as a way of explaining particular phenomena

How ageing is viewed and experienced

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30
Q

Give 4 examples of theories of older age:

A
  1. Disengagement theory
  2. Structured dependency theory
  3. Cultural gerontology
  4. Critical gerontology
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31
Q

What is the disengagement theory?

A

Functionalist theory: focuses on how elements of society work together

  • Growing old is an inevitable mutual withdrawal or disengagement resulting in decreased interaction between an ageing person and others in the social system he belongs to…
  • Irreversible process
32
Q

What is the 2) Structured dependency theory?

A

Individuals are not free to act in any way they see fit.

  • focuses on ways in which social institutions shape people’s lives.

Dependency structured by retirement, poverty, institutionalisation in residential and nursing homes and the restriction of domestic and community roles.

33
Q

What are some Barriers faced by older people in accessing oral health care?

A

Limitations to domiciliary care,

lack of knowledge and training,

poor monitoring of care

Lack of equipment in care homes,

limited time and reimbursement for leaving private practice

34
Q

What is the 3. Cultural Gerontology theory?

A

Focus on role of culture (varied and complex systems of meaning that constitute everyday life).

Multiple cultures of ageing, with different representations of old age:

1) The third age
2) The challenge of individualisation
3) The fourth age

35
Q

What is the third age?

A

Life after responsibilities of paid employment and child rearing

Social and cultural phenomenon-
Social: Rests upon social practices (key structure of retirement)
Cultural: Given symbolic meaning

Varied experiences of ageing process, older people as active citizens and consumers?

36
Q

What is ii) The challenge of individualisation?

A

Social identity less of a ‘given’ and more of a
‘task’ to be achieved

– the individual is charged with ‘the responsibility for performing that task and for the consequences (also the side-effects) of their performance’

37
Q

What is the iii) fourth age?

A

Social imaginary – ‘a set of unstated but powerful assumptions concerning the dependencies and indignities of ‘real’ old age’

Meanings attributed to ageing bodies:
> Fourth age can appear to be ‘nothing but the body’
> Beauty work and distancing processes to avoid appearing ‘old’

38
Q

what is 4. Critical gerontology theory?

A

Critiquing and changing society

Three main areas

  • Structural pressures and constraints
  • Meaning
  • Empowerment

Ageing as socially constructed!

Ageing negotiated by the individual, but considering the role of economic and political systems in shaping power arrangements and inequalities.

39
Q

What are life stories?

A

Biographically informed approach to thinking about older age.

  • Interview transcripts
40
Q

List some Demographic Population Changes

A
  • Increase in numbers of older people
  • People are living longer
  • Medical intervention & treatment
  • Better social conditions
  • Improvements in public health
  • Women living longer than men
  • Baby boomers of 1940’s & 1960’s
41
Q

Describe the ‘old and very old gen’ in terms of their teeth (2)

A

Large proportion edentulous

Plastic tooth generation

42
Q

Describe the ‘entering old age’ in terms of their teeth (3)

A

Retained much/most of their natural dentition
Requires maintenance to avoid tooth loss
Heavy metal generation

43
Q

Describe the ‘future old people’ in terms of their teeth (4)

=Middle age and younger

A

Good oral health
Cosmetic dentistry
- White tooth generation

44
Q

Name some Influences on Ageing:

A
  • Genetic & environmental factors
    -Life-style
    -Effect of illness & disability
    -Effects of medication
    -Personality: Rigid/pessimistic or flexible/optimistic
    -Psychiatric history
    -Level of independence:
    Mobility
    Activities of daily living - washing, dressing, bathing, personal hygiene
45
Q

Frail Older AdultsBarriers to Dental Care

A 
Medical problems
Drug interactions
Ability to understand and tolerate treatment
Financial
Access
Low expectations
Acceptance of loss of function and pain
46
Q

NICE Guidance 48 (on oral care of older people)

A

This guideline covers oral health, including dental health and daily mouth care, for adults in care homes.

The aim is to maintain and improve their oral health and ensure timely access to dental treatment.

47
Q

Frail Older Adults-Benefits of Oral Health Care

A

Improve eating
Improve speech
Improve facial appearance
Decrease pain

All help to reduce social isolation.
Poor masticatory function may mean a poor/
restricted diet.

48
Q

Common Oral Health Problems of old people

A

Tooth loss and replacement

Tooth wear

Collapsing/failing/terminal dentition

Dry mouth due to medication

Compromised self-care due to disability

49
Q

Tooth loss and replacement- people are losing their teeth later on in life, why does this pose a greater challenge?

A

No previous denture wearing experience
Less able to learn skills
High expectations

50
Q

What problems does Tooth Wear in older people cause? Name 5

A 
Reduced face height
Pulp death
Sensitivity
Aesthetics
Sharpness to tongue
Brittle
Difficult extractions
51
Q

Dry Mouth in older adults- what can this cause? Name 5

  • due to medication/age
A 
Difficulty in wearing dentures
Root caries
Difficulty with mastication
Difficulty with speech
Soreness & ulcers
Lack of appetite
52
Q

Problems associated with Periodontal disease?

A 
Multiple abscesses
Bleeding gums
Mobility
Pain
Halitosis
Aesthetics
53
Q

What is Residential Oral Care in Sheffield (ROCS)?

A

Salaried service working jointly with GDPs in city to increase numbers of people in care homes able to access oral care

54
Q

Problems relating to treatment and patient management increase with the age of the patient.. some examples:

A
  • Knowing who actually needs tx
  • Don’t usually come to dentist bc of pathology
  • Physically proving the tx (transport)
  • The dental surgery environment may be difficult for the older patient to manage
  • Older patients have reduced ability to adapt to change
55
Q

Examples of pathology that may come up in older people (5)

A 
Denture stomatitis
Oral cancer
Denture granuloma
Lichen planus
Oral infections
56
Q

There are problems actually physically providing treatment?

A
  • Domiciliary care?
  • Ambulance/meditaxi to bring in
  • Capability travelling alone?
  • Neighbours/ family?
57
Q

What is Domiciliary dentistry

A

Easy for the patient but more difficult for the clinician.

Chaperone necessary
Take all equipment necessary including light and take all clinical waste away.

58
Q

is the surgery suitable for the elderly?

Things to think about:

A 
Access
Toilets
Lighting 
Busy environment
TIME
59
Q

The dental surgery environment may be difficult for the older patient to manage
problems it May lead to…:

A 
Confusion
Lack of compliance
Intolerant of long procedures
Bright light
Too noisy
Postural problems
60
Q

How to make the dental experience easier–patient management

(4)

A

Seating – keep upright, or slowly alter position

Noise – low tones, reduce noise and speed

Confusion – reduce speed, less instruction-
- check medical history (GP or family)

Timing of appointment – medication, capability,convenience

61
Q

How to Help older people adapt to change with dentures–

A

1) Make small changes to existing dentures
reline
adapt existing denture

2) Copy existing dentures, having made alterations
3) Make new dentures that are similar to some aspects of previous dentures

62
Q

Problems that actually affect treatment during stages of complete denture construction may be due to :
(2)

A

Age

Consequences of tooth loss

63
Q

Consequences of tooth loss affect: (4)

A
  • impression taking,
  • jaw registration,
  • retention and stability of the denture
  • ability to wear the denture
64
Q

How does Tooth loss affect alveolar resorption?

A

Following tooth loss, alveolar bone resorbs, rapidly at first but decreases with time

After loss of the teeth the remaining alveolar bone forms the alveolar ridge

  • gives support to a denture
  • part of the denture-bearing area.
65
Q

Where is there most bone resorp? max or mand?

A

Approximately 4 times as much resorption of mandible as maxilla

More in mandible!!!

66
Q

Describe the general pattern of alveolar bone resorption/loss?

A

Around an individual tooth, resorption is greater where the cortical plate is thinner….

i.e.:
Maxilla: LOSS buccally most; MOVES LINGUALLY

Mandible: (in at front, out at back)
- Anterior: LOST buccally… MOVES LINGUALLY

  • Posterior: Buccal plate is reinforced by external oblique ridge; there is resorp of thinner lingual plate–» movement of residual ridge => BUCCALLY!!
67
Q

The clinical significance of alveolar resorption depends on the degree to which it occurs. e.g:

(4)

A

Too little resorption
Irregular resorption
Excessive resorption
Normal resorption

68
Q

Denture problems if Too little resorption?

A

Too little resorption will lead to bulky alveolar ridges with little space in which to place dentures - adequate interalveolar space.

  • frequent denture fracture
  • excessive face height
  • Denture too big…
  • Compromised function to speak, eat

(Size of denture is usually increased to give strength…)

69
Q

Denture problems if Irregular resorption?

A

Bone may be sharp and the soft tissues may get traumatised under the denture leading to ulcers and discomfort.

Surgical reduction of the ‘knife-edge’ ridge may be needed.

70
Q

Denture problems if excessive resorption?

A

normal relationship of the posterior teeth may be changed?

With the increase in width of the mandible posteriorly, a ‘posterior crossbite’ is produced.

Anteriorly, where buccal resorption of the maxilla predominates, an edge-to-edge incisor relationship or prominent mandible may occur.

71
Q

Denture problems if excessive resorption in mandible?

A

atrophy of the alveolus causes the mental foramen to become superficial (nerve?)

the mylohyoid ridge on the lingual aspect of the mandible becomes sharp and prominent.

Both may cause pain during denture wear.

72
Q

Denture problems if normal resorption?

A

A few months after extraction resorption has taken place.

The dentures start to feel loose- the dentures need relining or replacing to improve the retention.

73
Q

Useful Clinical Techniques to Help Prosthetic Treatment

A 
Check record
Windowed trays
Neutral Zone Impression Technique
Retained roots
Polycarbonate
Soft Liners
74
Q

What is a windowed tray?

A

For anterior flabby ridges

An overall impression is taken in a ‘windowed’ tray constructed on a primary impression.

With the impression in the mouth the ‘window’ is filled with a fluid impression material (silicone, plaster etc.).

75
Q

Use of polycarbonate?

A

To reduce likelihood of midline fracture

76
Q

What is Soft liner?

A

More comfortable base over irregular ridges

Processed onto denture in laboratory.
Lasts 6/12 – 3 years.

77
Q

Oral surgery examples(may be the option for difficult prosthetics cases)

A

Implants
Sulcus deepening
Ridge augmentation

DEN203 (11 decks)

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