Age related Oral Changes

Question 1

What important things should be considered with older patients?

Answer 1

Psychological and physical aspects.

Question 2

What are the general hallmarks of aging?

Answer 2

Age related changes that manifest themselves during normal aging.

Its experimental aggravation should accelerate aging.

its experimental amelioration should retard the normal ageing process and, hence, increase healthy lifespan

Question 3

What are the theories associated with aging?

Answer 3

DNA damage

Free radical theory (oxidative stress)

Telomeres

Question 4

How does risk of death increase with age?

Answer 4

After 30 chance of death doubles every 8 years.

Question 5

What is the most effective proven way to slow down aging?

Answer 5

Caloric restriction associated with slowing down aging.

Question 6

What happens to risk of diseases with age?

Answer 6

They peak at age 70

Question 7

What are the factors that contribute to aging process?

Answer 7

Genomic instability

Telomere attrition

Epigenetic alterations

Loss of proteostasis

Deregulated nutrient-sensing

Mitochondrial dysfunction

Cellular senescence

Stem cell exhaustion.

Question 8

What is genomic instability?

Answer 8

Accumulation of genetic damage throughout life.

Premature aging diseases such as Werner syndrome and Bloom syndrome are a result of increased DNA damage accumulation.

Question 9

What causes genomic instability?

Answer 9

Can be internal.

The integrity and stability of DNA is continuously
challenged by exogenous physical, chemical and
biological agent

Question 10

What kind of changes happen in the genome leading to instability?

Answer 10

Somatic mutations accumulate within cells from aged humans and
model organisms

Other forms of DNA damage, such as chromosomal aneuploidies
and copy-number variations have also been found associated with
aging

All these forms of DNA alterations may affect essential genes and
transcriptional pathways, resulting in dysfunctional cells that, if not
eliminated by apoptosis or senescence, may jeopardize tissue and
organismal homeost

Question 11

What does oxidative stress do to lead to aging?

Answer 11

ROS can affect proteases and lead to aggregation of proteins.

Question 12

How do hallmarks lead to formation of aged cells?

Answer 12

Primary hallmarks (genomic instability, telomere attrition, and epigenetic alterations) associated with causing damage, antagonistic hallmarks are altered thus response to damage is altered, and integrative hallmarks are culprits of the phenotype.

Question 13

What happens during aging (overview)?

Answer 13

A decrease in the amount of tissue, usually secondary to an acquired imbalance in matrix synthesis and breakdown.

Altered molecular composition of the matrix,
particularly post-translational modification of structural proteins such as collagen and elastin.

Accumulation of degraded molecules in the matrix.

Reduced efficiency of function

Question 14

What common conditions are related to age?

Answer 14

Atherosclerosis and CVDs.

Hypertension

T2DM

Cancer

Arthritis

Cataracts

Osteoporosis

Alzheimer’s disease

Question 15

What is the effect of atherosclerosis and CVD?

Answer 15

Fatigue and less resistance to stress

Question 16

What effect has fluoridated water and routine dental care had on oral health?

Answer 16

Reduced edentulism rate

Question 17

What happens to patients that are edentulous?

Answer 17

They have reduced masticatory efficiency (300 lbs/square inch with natural teeth to 50 lbs/square inch with dentures)

Alveolar ridge absorption (50% within 2 years of extractions)

Speech function

Loss of vertical dimension

Candidosis is common condition (denture caused mucositis)

Epithelial hyperplasia

Question 18

What are the oral manifestations of aging.

Answer 18

Hyperkeratosis

Dental caries (root caries)

Salivary glands

Periodontal disease

Oral cancer

Issues related to dentures

Lips

Oral mucosa

Tongue

Enamel

Cementum

Dentin

Pulp

Alveolar bone

Question 19

What happens to dental hard tissue with aging?

Answer 19

Increased dentin thickness and permeability (sclerosis of dentinal tubules causes this) leading to diminished pulp space, diminished sensitivity of dentin to effects of bacterial metabolites, and increased tooth brittleness.

Question 20

What happens to dental pulp with aging?

Answer 20

Decreases in volume and shift in proportion of nervous, vascular, and connective tissues leading to diminished reparative capacity as well as sensitivity, and alteration in nature of sensitivity.

Question 21

What happens to salivary glands with aging?

Answer 21

Fatty replacement of acini leading to possibly less physiologic reserve.

Question 22

What happens to the tongue with aging

Answer 22

Atrophic glossitis which means atrophy of the lingual papillae and reduced taste sensations as well as increased threshold for sweet and salty food.

No reduction in number of taste buds.

In some cases there are sublingual varicosities.

Question 23

What other changes can affect oral mucosa with age?

Answer 23

Decreased salivary secretion (can be primary or secondary to disease or meds)

Atrophic changes (thiinner, less vascular, less elastic, and appears smoother and shinier)

Hyperkeratosis (due to chronic irritation)

Candidiasis

Capillary fragility (leading to haematomas and petechiae)

Question 24

What other chagnes can affect the lips with age?

Answer 24

Tissue changes such as dryness, loss of elasticity, and a thin vermillion border

Angular cheilitis ?caused by? loss of vertical dimension and candidiasis / vitB

Question 25

What happens to enamel with aging?

Answer 25

Enamel becomes brittle and thin due to reduced blood flow. Loss of translucence Abrasion and attrition

Question 26

What happens to dentin with aging?

Answer 26

Formation of secondary dentin (response to prior trauma, and decreased pulp chamber) Increased thickness Yellowing (due to increased thickness of dentin)

Question 27

What happens to pulp with aging?

Answer 27

Narrowing of pulp chambers due to entry of 2ndary dentin Fibrotic Reduced blood supply (less cellular) Pulp stones

Question 28

What happens to cementum with aging?

Answer 28

Attachment is lost (periodontal ligament) leading to increased incidence of periodontal disease. Increased thickness of cementum.

Question 29

What happens to alveolar bone with aging?

Answer 29

Decreased blood flow Osteoporosis (bone quality that is less dense) Bone loss is not an inherent part of aging.

Question 30

What happens to incidence of caries witha ge?

Answer 30

Increases with age in root but decreases in crown. (Gum recession) These are due to xerostomia and reduced physical dexterity

Question 31

What are the risk factors for caries that increase in elderly?

Answer 31

Dry mouth Poor oral hygiene Gingival recession Cognitive or physical impairments High number of bacteria High carbohydrate diet Partial dentures Access to care

Question 32

What increased risk of periodontal disease in elderly?

Answer 32

Potential for osteoporosis Decreased tissue vascularity Increased risk for infection Xerostomia Chronic disease and reduced physical dexterity (altered immune response, medication side effects, and plaque removal skills)

Question 33

Who is oral cancer more common in?

Answer 33

Increased incidence with age (increased at age 40 and again at age 60) Males more than females

Question 34

What are the oral side effects of cancer treatment?

Answer 34

Xerostomia Oral ulcerations Osteoradionecrosis Mucositis, trismus, and radiation caries.

Question 35

What issues are related to dentures?

Answer 35

Loss of vertical dimension Angular cheilitis Denture stomatitis Inflammatory papillary hyperplasia (mainly seen on the hard palate) Epulis fissuratum

Question 36

What is epulis fissuratum?

Answer 36

Flanks of excessive mucosal tissue where the denture clamps are

Question 37

What structure's function can be affected by polypharmacy most intensely?

Answer 37

Salivary glands; mainly the minor salivary glands.

Question 38

What causes xerostomia?

Answer 38

Xerostomia is secondary to disease/medications: caries, dry lips, painful mucosa, dysphagia, taste acuity Xerostomia is NOT a part of normal aging

Question 39

What drugs can induce drug related changes commonly affecting the gingiva?

Answer 39

Drug induced gingival hyperplasia can be caused by: Phenytoin (for epilepsy) Ca2+ channel blockers Cyclosporin

Question 40

Which illnesses often have an oral-systemic link?

Answer 40

Diabetes Cardiovascular disease Respiratory illness

Question 41

What does porphorymonas gingivalis infection do?

Answer 41

Reported to be involved in the development of systemic diseases Due to systemic inflammation with Increased circulating cytokines and mediators Direct infection Cross-reactivity/molecular mimicry between bacterial antigens and self-antigens

Question 42

What effect can diabetes have on the oral cavity?

Answer 42

Oral complications Exacerbation of periodontal disease (periodontal disease more frequent, progression of periodontal disease more rapid, healing following surgery may be delayed, Increased likelihood of infection) Candidiasis is more common in diabetic patients Xerostomia issues (possibly due to poor glycaemic control)

Question 43

What link has been found between periodontal disease and CVD that have been observed?

Answer 43

From the Oral Cavity: Macrophages, Neutrophils, Toxins, anaerobic bacteria in plaque Circulating inflammatory mediators (fatty acids, interleukin 1, tumor necrosis factor alpha) Acute phase proteins – CRP, SAA, IL6, TNF alpha To the Heart: Heart and blood vessels, endothelial injury, lipid deposition, monocyte migration, smooth muscle proliferation Atherosclerosis, CVD, stroke

Question 44

What association has been seen between respiratory illness and the oral cavity?

Answer 44

Good evidence that improved oral hygiene and frequent professional oral healhcare reduces progression or occurence of respiratory diseases in high risk elderly patients (relative risk reduction 34 - 83%)