Lesson 1

Question 1

Average life expectancy continues to increase at

Answer 1

2 years every 10 years
5 hrs every day

Question 2

World population over 65 years old is growing at rate of

Answer 2

2.4% per year faster than the global total population
In year 2000 age pyramid
Age pyramid of future with a shift in historical pyramid shape to square like or rectilinear form

Question 3

Increase in life expectancy can be explained by

Answer 3

Dramatic changes in familial social economic political organization of societies
Improvements in medicine and sanitation
Better healthcare
Less water and food pollution

Question 4

Geriatric dentistry or gerondontology

Answer 4

Delivery of dental care to older adults involving diagnosis prevention management treatment of problems associated with age related diseases
Interdisciplinary team work to provide palliative and symptomatic relief

Question 5

Principles of geriatric care

Answer 5

Age-related changes
Disease-related changes
Interactions of age and disease
Disease chronicity
Atypical presentation of disease
Multiple pathology
Multiple medications
Functional loss

Question 6

What is aging and why does it occur

Answer 6

Aging is a progressive generalized impairment of function resulting in a loss
of adaptive response to stress and in a growing risk of age-associated
disease.
• The overall sum of the changes occurring with aging increases the
probability of dying within the population.

Question 7

Difference between biological age and chronological age

Answer 7

Physiologic/ functional age/ biological age (based on biomarkers like diet,
exercise, etc.) is not always consistent with chronological age
oChronological age (number of years a person has been alive) remains the
best predictor of age related changes

Question 8

Different Views of Aging Origin

Answer 8

Different Views of Aging Origin:
 age-dependent wear and tear.
 adaptive theories of aging
 disposable soma theory

Question 9

Classification of Old People:

Answer 9

Classification of Old People:
 Elderly (Young-Old)- age 65-74
 Aged( Middle-Old) - age 75-84
 Very old (Old-Old) - over age 85

Question 10

several components within the cells have been identified which
are particularly susceptible to

Answer 10

several components within the cells have been identified which
are particularly susceptible to wear and tear and to the apparent failure of
maintenance mechanisms within cells which occurs with aging.

Question 11

The following molecular mechanisms has been proposed:

Answer 11

Somatic mutation and DNA damage theories
The oxidative stress theory of aging
The role of mitochondria in aging
Cell renewal and the telomere loss theory

Question 12

Somatic mutation and DNA damage theories

Answer 12

• The idea of aging being caused by a loss of ability to repair cellular components has been
the basis of the concept that chromosomal abnormalities might underlie the aging
process.
• The modifications to which DNA may be subjected can be of two types: mutations and
damage
Mutations - point mutations insertions and deletions

Question 13

Mutations are

Answer 13

any changes in the sequence of genomic DNA and can be of three sorts:
point mutations, which occur when only a single DNA base pair is changed;
deletions, which occur when DNA base pairs are deleted from the genome and
insertions, which occur when sequences of DNA (often so-called ‘transposable
elements’) move from one region of the genome into another.

Question 14

DNA damage, refers to any

Answer 14

refers to any chemical alterations occurring in DNA
which do not affect the polynucleotide sequence.
These include pyrimidine dimers,
single and double strand breaks,
covalent cross-linking of DNA strands,
oxidative modifications of certain nucleotides.

Question 15

The oxidative stress theory of aging

Answer 15

Free radicals are very reactive chemical species mostly derived from molecular oxygen, which have an impaired electron on the outer orbital- associated with aging
• Are free radicals responsible for aging? Oxygen metabolism does lead to production of reactive oxygen species, but cells possess antioxidant defenses able to eliminate them.
• So perhaps aging could be caused by:
the rate of aging being dependent on the level of antioxidant
defenses
the level of reactive oxygen species produced

Question 16

The role of mitochondria in aging

Answer 16

• Mitochondria possess enzymes that together catalyse the oxidation of organic components by molecular oxygen (O2). These oxidations are used to generate ATP.
• There is a price to pay for the utilization of oxygen as incomplete reduction of molecular oxygen can generate univalently reduced oxygen O2 or superoxide radicals, which can in turn be converted into other reactive oxygen species which damage the major cellular macromolecules such as proteins, lipids and carbohydrates.

Question 17

Cell renewal and the telomere loss theory

Answer 17

2 types of cells in an organism: those which are able to divide and those which cannot divide.
• A decline in adult stem cell function has been shown to occur during aging, likely contributing to the decline in organ homeostasis and regeneration with age.
• Experiments showed that the amount of telomeric DNA declines with aging of human fibroblasts and ectopic expression of the catalytic subunit of telomerase, an enzyme able to counteract telomere shortening, can lead to cell immortalization on its own.
• short telomere length (in peripheral blood cells) is associated with an increased risk of various age-related diseases including myocardial infarction, atherosclerosis and alzheimer’s disease
• Several studies have clearly shown that telomeres have a role in stem cell

Question 18

Aging of Organ Systems

Answer 18

Organ physiology and morphology alter considerably with age.
• It has been reported that the weight of various organs declines with age, as a consequence of cell loss.
• Moreover, the amount of fat in the body increases with age and the
amount of water decreases

Question 19

Cardiovascular changes:
Common age changes:

Answer 19

• Atrophy of muscle fibers that line the endocardium
• Atherosclerosis of vessels Increased systolic blood pressure
• Decreased arterial elasticity
• Ventricular hypertrophy
• Reduced adrenergic responsiveness

Question 20

Cardiovascular changes implications

Answer 20

oIncreased blood pressure
oIncreased arrhythmias
oIncreased risk of hypotension during position change
oDecreased exercise tolerance
oDecreased maximum cardiac out pu

Question 21

Respiratory Changes:
Common age changes

Answer 21

• Decreased lung tissue elasticity
• Thoracic wall calcification
• Cilia atrophy
• Decreased respiratory muscle strength
• Decreased partial pressure of arterial oxyge

Question 22

Respiratory implications of change

Answer 22

Implication of changes:
oDecreased efficiency of ventilatory exchange
oIncreased susceptibility to infection and atelectasis
oIncreased risk of aspiration
oDecreased ventilatory response to hypoxia and hypercapnia
oIncreased sensitivity to narcotic

Question 24

Gastrointestinal changes
Common age changes

Answer 24

• Decreased liver size Less efficient cholesterol stabilization and absorption
• Fibrosis and atrophy of salivary glands and Atrophy of and decrease in number of taste buds and Altered ability to taste sweet and salty foods; bitter and sour tastes remain
• Slowing in esophageal emptying
• Decreased gastric acid secretion
• Atrophy of the mucosal lining
• Decreased absorption of calcium
• Decreased muscle tone in bowel

Question 25

Got implications

Answer 25

Implication of changes: o Change in intake caused by decreased appetite o Discomfort after eating related to slowed passage of food o Decreased absorption of calcium and iron o Alteration of drug effectiveness o Increased risk of constipation, esophageal spasm, and diverticular disease

Question 26

Neurological changes: Common age changes:

Answer 26

• Decreased number of neurons and increase in size and number of neuroglial cells • Decline in nerves and nerve fibers • Atrophy of the brain and increase in cranial dead space

Question 27

Neurological implications

Answer 27

Implication of changes: • Increased risk for neurological problems: cerebrovascular accident • Parkinsonism • Slower conduction of fibers across the synapses • Modest decline in short-term memory • Alterations in gait pattern: wide based, shorter stepped, and flexed forward • Increased risk of hemorrhage before symptoms are apparent

Question 28

Musculoskeletal changes: Common age changes:

Answer 28

• Decreased muscle mass • Decreased myosin adenosine triphosphatase activity • Deterioration and drying of joint cartilage • Decreased bone mass and osteoblastic activity

Question 29

Musculoskeletal implications

Answer 29

Implication of changes: • Decreased muscle strength and bone density • Loss of height • Joint pain and stiffness and Increased risk of fracture • Alterations in gait and posture

Question 31

Urinary system age related

Answer 31

Urinary System changes: Common age changes: • Reduced renal mass Loss of glomeruli • Decline in number of functioning nephrons • Changes in small vessel walls • Decreased bladder muscle tone

Question 32

Urinary implications

Answer 32

Implication of changes: • Decreased GFR • Decreased sodium-conserving ability • Decreased creatinine clearance • Increased BUN • Decreased renal blood flow and Altered drug clearance • Decreased ability to dilute urine • Decreased bladder capacity and increased residual urine Increased urgency

Question 33

Endocrine changes: Common age changes:

Answer 33

• Decreased testosterone, GH, insulin, adrenal androgens, aldosterone, and thyroid hormone • Decreased thermoregulation • Increased fibrosis of thyroid and Decreased basal metabolic rate

Question 34

Endocrine implications

Answer 34

Implication of changes: o Decreased ability to tolerate stressors such as surgery o Decreased sweating and shivering and temperature regulation o Lower baseline temperature; infection may not cause an elevation in temperature o Decreased insulin response and glucose tolerance o Decreased sensitivity of renal tubules to antidiuretic hormone o Weight gain o Increased incidence of thyroid disease

Question 35

Oral cavity, plays an important role in

Answer 35

in digestion by providing mechanical maceration of food by teeth. • The oral environment serves as a barrier against infection. • more than 66% of older adults now retain their natural dentition, which differs from previous generations.

Question 36

Oral cavity is comprised of all types of tissue. • Oral Cavity -age changes - do not target only on the specific structures. • Changes include the

Answer 36

Oral cavity is comprised of all types of tissue. • Oral Cavity -age changes - do not target only on the specific structures. • Changes include the structural and histological changes related to the: Teeth, Gingiva, Mucous membrane, Alveolar bones, Salivary Glands, and Tongue • Functional alterations in: Taste, Swallowing, and Speech can be correlated with other factors such as loss of teeth entire systemic diseases influencing muscle

Question 38

Common clinical presentation : of oral cavity

Answer 38

Common clinical presentation : Tooth loss, dental caries, gingival inflammation, plaque accumulation Altered taste, speech, smell, and swallowing Dentures less likely to be worn and older, unfitted and uncleaned dentures and Difficulty adjusting to new dentures Prone for soft tissue lesions Xerostomia

Question 39

Selected signs of adr

Answer 39

Dry mouth Sialorrhea Bleeding Orthostatic hypotension Allergies Lowered stress tolerance Oral soft tissue lesions Movement disorders Mental disorders altered host resistance

Question 40

Epithelium become

Answer 40

Epithelium become thinner, fragile, and altered keratinization, - decrease in resiliency and elasticity- prone for injury with minimal insult. • Loss of collagen and elastin fibers - weaken the mucosa. • Pathological change such as loss of papillae and taste buds in the tongue-glossitis • Reduction in the Minor salivary glands. • Oral Lesions due to Inflammations, irritation and infections are more common and the healing is delayed • Thinning of mucous membranes makes use of dentures very painful. • Also, elderly persons will avoid hard food.

Question 41

Mucosal diseases commonly reported in elderly patients

Answer 41

Lichen planus or lichenoid reactions- • Mucous Membrane Pemphigoid • Pemphigus vulgaris • Herpes Zoster • Burning Mouth Syndrome • Idiopathic Leukoplakia and Erythroplakia • Candidiasis • Medication-related Osteonecrosis • Carcinoma

Question 42

Lichenoid reactions can be caused by

Answer 42

Lichenoid reactions is one of the common complaints from medication ( mostly from captopril, capoten). Other drugs: phenytoin, tegretol, Antibiotics (Ampicillin, Azithromycin , Ciprofloxacin , Metronidazole & Tetracycline).

Question 43

Atrophy of filiform papillae and inflammation, may be associated

Answer 43

Atrophy of filiform papillae and inflammation, may be associated with the smooth lobulated tongue

Question 44

Atrophy of the papillae with taste buds may be associated Increased varicosity at which surface

Answer 44

Atrophy of the papillae with taste buds may be associated altered taste and decreased appetite • Increased varicosity at the ventral surface

Question 46

Glossodynia:

Answer 46

Glossodynia: Redness and Burning sensation- may be due to vitamin deficiency vit b12 folate iron

Question 47

Age Changes in Swallowing, Speech, Taste, and Smell:

Answer 47

Consequence of stroke motor neuron diseases, Parkinson’s, and arthritis can all result in dysphagia. • Speech is a complex process and involves coordination of several components (visual & auditory input, central processing and motor output, muscles of expression, etc). • Aging changes in speech – slowness, deepening of voice, and may develop an increasing tremor • Reduction in taste discrimination - decline in ability to detect salty and fine tastes. Ability to taste is also affected by smoking, dentures diseases, oral hygiene and certain medications. • Reductions in smell are generally more profound and more consistent than changes in taste. The reduced olfactory ability has been suggested as a marker for cognitive decline. Smell and taste are linked to the enjoyment of food. • Loss of taste and smell is not life-threatening, but alter eating habits and nutrition

Question 48

Marker for cognitive decline

Answer 48

Olfactory

Question 49

Age related changed in teeth

Answer 49

age-related changes in teeth can be defined as changes occurring only in functional, intact teeth from older individuals. • Tooth decay with aging may be due to the failure of the immune system with aging. However , the root tooth decay is mainly due to recession of the gums, which makes the root of the teeth more exposed to bacteria. • The Changes in the: • Enamel-Aging results in physical loss of tissue through wear and acid erosion. Ex: Attrition, Abrasion, Abfraction and Erosion. • Dentin - Increase of secondary and tertiary dentin, more dead tracts and sclerotic dentin. • Pulp-collagen fibers-increased and vascularity-reduced • Periodontium- changes are associated with the Cementum, Gingiva, Periodontal ligaments and alveolar bone

Question 51

Age Changes in the Dental Pulp

Answer 51

Reduction in size of the pulp chamber, caused by the continual secretion of dentinal matrix (physiological secondary dentinogenesis) by odontoblasts • Fewer blood vessels and nerves • Reduced capacity to respond to trauma • Reduced immunocompetence • Increase in collagen fibrous tissues • Pulp stones are relatively more and larger • Reticular atrophy: reduced vitality of the pulp tissue and a lessened response to stimulation.

Question 52

Age Changes in the Periodontium:

Answer 52

• Loss of teeth alter the alveolar bone and the gingival positions • Clinical crown become longer with age - due to apical migration of periodontal ligament attachment. • Increased interdental spaces making the cleaning more difficult and increase the food accumulation. • Experimental evidence reported–width of PDL decreases with age but is very responsive to function and there is a strong relation between load and PDL width- Rate of damage increases with gingival disease and co-morbidities. • Associated neuropathies and comorbidities will reduce the sensation of the food accumulation further delaying the cleaning and oral hygiene maintenance. (inform to care-givers). • Increases Cementum thickness-Resulting in Hypercementosis in some elderly

Question 53

Age Changes in Salivary Glands and Saliva:

Answer 53

• Major / Minor Salivary Glands -change in number, mass and activity • Loss of Function or hypo-function, Fatty Degeneration and Fibrosis • Saliva: Changes in Quantity - reduced Changes in Composition (physical properties; leads to effects on taste/ plaque accumulation/ dental caries, etc) Salivary flow rates appear to decline with age when external factors such as medications, smoking or disease are not accounted. Effects of saliva:- On - Taste sensation, Oral mucosal integrity, and formation of Plaque and Caries to be considered

Question 54

Age Changes in TMJ:

Answer 54

Age Changes in TMJ: • Various changes in the TMJ over time put older individuals at a greater risk of developing temporomandibular disorders (TMD). • TMD is characterized by chronic pain, discomfort in the jaw, and limited joint function. • The aging process exacerbates many factors that contribute to TMD, including: 1. Jaw Misalignment: As muscles and ligaments weaken, the TMJ becomes more prone to misalignment. Jaw misalignment can lead to uneven pressure on the joint, which may cause pain and dysfunction. Aging individuals may also experience changes in their bite due to tooth loss or shifting teeth, further contributing to jaw misalignment and TMD. 2. Increased Risk of Arthritis: Older adults are more susceptible to arthritis, particularly osteoarthritis, which can affect the TMJ. Joint inflammation, pain, and stiffness occur when cartilage breaks down in an osteoarthritis joint. Since cartilage degradation is a common effect of aging, individuals are more likely to experience arthritis-related TMJ problems as they grow older. 3. Chronic Jaw Pain: Aging individuals are likelier to experience chronic jaw pain due to cartilage degradation, bone density loss, and muscle weakening. Chronic pain can make everyday activities difficult. • • Evaluate the prosthesis to prevent TMJ damage

Question 55

Immunological changes with aging

Answer 55

Immune status will be altered in elderly. • Autoimmunity increases with age, as the loss of self-tolerance increases with aging It has been shown that there is an age- dependent increase in the percentage of T-cells binding to autologous antigens and in the expression of autoreactive B-cells. • Increased susceptibility to infection, which is a major cause of death in the elderly

Question 56

Aging of Bone and Muscle

Answer 56

Among the inevitable consequences of aging in humans are the loss of bone (osteopenia), bone mineral density (BMD) and muscle (sarcopenia). • These tissue losses are accompanied by increased fragility and fracture risk in bone and a marked decline in contractile strength in muscle (e.g. in hand grip and walking speed). • The degree and rate of musculoskeletal tissue decline can vary as a function of many different extrinsic and intrinsic factors including diet, disease, medications, hormone levels, clinical interventions and exercise

Question 57

Osteopenia and osteoporosis

Answer 57

osteopenia and osteoporosis are terms used to describe the loss of bone. • In both cases, the gold standard for determining and describing the degree of loss is dual X-ray absorptiometry or DXA. • DXA provides information on bone mineral density (BMD), most often in values (a T-score) that relate the density level of the patient to the mean BMD of individuals at age 25. • Persons are described as osteopenic if they have a BMD 1 to 2.5 SD (standard deviations) below that of the younger control group; they are classified as osteoporotic if the deviation is greater than −2.5 SD. • A person with low BMD and an existing bone fracture not related to trauma may be described as having severe or established osteoporosis

Question 58

Bone loss in the craniofacial skeleton:

Answer 58

Tooth loss results in localized bone loss, in part because it eliminates a source of mechanical loading (force) and perhaps stem cells and growth factors(in the periodontium) important in maintaining bone mass, particularly in the alveolar bone. • Periodontal disease has a similar consequence because as a bacterial infection it is a source of inflammatory cytokines (e.g. prostaglandin, interleukins) that stimulate osteoclastic activity and bone resorption

Question 59

Sarcopenia in elderly

Answer 59

Sarcopenia: • Muscle, like bone, undergoes marked, senescent changes with age. In addition to the loss in mass (sarcopenia), there is also a loss in strength. • The muscles of the lower body experience more sarcopenia than those associated with the upper appendicular skeleton; a change that undoubtedly contributes to the losses observed in mobility and balance. • The age-related loss in skeletal muscle mass is a function of a reduction both in fiber size and number

Question 60

Loss of cardiac and smooth muscle

Answer 60

Loss of cardiac and smooth muscle: • As with skeletal muscle, cardiac muscle also undergoes changes with age and, in general, it is of a similar type. • Cardiomyocytes are lost with age, at a slower rate in women than men. • There is also a lengthening of the contraction and relaxation cycle and a decline in cardiac power and reserve under conditions of stress . • The situation with smooth muscle is less clear, in part because it seems to have been less well studied. • Age-related thickening (hypertrophy) of the smooth muscle layer in blood vessels and intestine has been reported along with increased muscle tone and changes in the collagen (increased cross-linking) and elastin components (reduced in amount and more fragmented) of the extracellular matrix. All of these changes contribute to increased vascular resistance

Question 61

Sarcopenia in the jaw musculature:

Answer 61

Sarcopenia in the jaw musculature: • It is difficult to directly compare age-related changes in jaw muscles with the changes observed elsewhere in the body. this is because of: • The presence of myosin heavy chains (MyHCs) • The presence of hybrid fibers that contain more than one type of MyHC and exhibit intermediate contractile properties. • While the aging jaw musculature (e.g. the masseter), like muscles elsewhere in body, shows a reduction in the cross-sectional area, the pattern of fiber type change differs from that seen in typical skeletal muscle. Specifically, the loss in masticatory muscle is related to a decline in the proportion (and size) of type I fibers and a gain in the number of type II fibers; a pattern opposite to that seen in skeletal myofibers in the trunk and limbs. ( • The exception to this may be the digastric muscle that shows changes in fiber composition similar to that of other skeletal muscles • Functionally, there are also changes. Jaw muscle contraction time is increased with age along with the latency period, and the number and amplitude of reflex responses is reduced

Question 62

Immobilization and muscle and bone loss:

Answer 62

• Immobilization leads to both muscle and bone loss. • Immobilization can be the consequence of prolonged bed rest, exposure to zero gravity, of paralysis and the placement of a fractured limb in a plaster. • The possibility of a common mechanism or, if not, perhaps a cause- and-effect relationship between sarcopenia and osteopenia

Question 63

Sensory changes with aging

Answer 63

Sensory changes with aging • Changes in visual function • Changes in auditory function

Question 64

Cognitive changes with aging:

Answer 64

Cognitive changes with aging: • Learning and memory change

Question 65

Implications of sensory and cognitive declines for the dental practitioner

Answer 65

**A. Compensating for vision problems:** 1) Use bold, large print for written text. 2) Use contrasting colours for written messages. 3) When speaking in person, face the patient directly and maintain eye contact. 4) Stand closer to older patients. 5) Use touch as a way to reduce the distance. **B. Compensating for auditory decline:** 1) Speak more slowly and clearly, but without exaggerating each syllable. 2) Raise voice slightly but without shouting. 3) Speak with older patients and their caregivers in a quiet, relaxed setting. 4) Avoid physical barriers between the patient and dentist. **C. Compensating for cognitive decline:** 1) Structure the message. 2) Take more time with older patients. 3) Do not present too much information at once. **D. Compensating for sensory and cognitive decline:** Use multiple channels of communication and multiple modes of presentation.