Aging and the periodontium

Aging and Periodontium

The aging process takes a toll on everybody's body eventually, whether it's from loss of memory or thinning of the hair, or reduced mobility and hearing. However, one particular occurrence as time progress onward is one's dental records, in particular, the periodontium. The periodontium affects an individual's dental and overall well being by undergoing physical, functional, nutritional, and medical modifications.

Such changes take place either in the regions of the periodontium or the byproduct of such altercations due to aging.

Physically, the periodontium is made up of various parts, which include the alveolar bone, cementum, gingiva, and the periodontal ligament. As time progresses, negative changes are seen in the aforementioned parts, which affect the individual him or herself. The features of aging found in tissues are desiccation, diminished reparative ability, reduced elasticity, and altered cell permeability. The alveolar bone may undergo osteoporosis, decreased vascularity, reduction in metabolic rate and healing capacity, and density change. Diminished heratinization, reduced stippling, and increased width of attached gingiva indicate aging in the gingiva. In addition, there is decreased connective cellular tissue, reduced oxygen consumption, and the epithelium is thinned. In the cementum, aging will cause greater irregularity, continuous deposition with age, and the width becomes thicker.

In a study led by Gilmore, the aged animals revealed changes in the tooth socket, and buccal and lingual plate with the presence of incremental lines, which were not present in the young. As well, dark-stained appositional lines appeared only in aged animals where the bones formed the manibular canal. In the physicality of the cementum, the thickness increased with age, and the epithelium undergoes progressive atrophy. In an investigation led by Toto (2007), he noted the average number of cells on the mesial surface of the eponymous root was reduced from "1003.9 for the young group, and 689.8 for the older group." As for the periodontium, the average labeled cells per section for the young was 3.95 and a reduction for the older group, which was 1.35.

The amount of connective tissue cells in the periodontal ligament was reduced in the aged group along with having less regenerative cells in the periodtonium compared to the young group. As well, collagen fibers became increasingly more insoluble with age, which increases density of the connective tissues, and results in reduced movement of the periodontium. In a study led by Sims, it was shown that the width of the periodontal ligament decreased with age, from 119.9 to 60.0. Furthermore, there were recorded declinations that indicate the progression of age in the periodontium, which was noted by Sims (2007), "the average cross-sectional tissue area...decreased from 2117 micrometer squared to 1451...average ligament thickness...dropped from 52.5 micrometer to 27.5."

Functionally, aging has an effect on the periodontium by impacting on the masticatory functions an individual may exhibit. As people become older, there's a reduced ability to chew and bite food, which is due to muscle loss. The efficiency of mastication becomes less productive because as one ages, he or she experiences teeth loss or denture replacements, which impairs and prohibits eating in an adept manner. In a study led by Dutour, it was shown that in the aged group, they had to chew and use more energy when crushing down on food. Dutour (2007) noted, "the increased muscular work may also be due to decreased oral sensitivity, causing older subjects to take greater care to be sure of swallowing a safe bolus." Furthermore, as people age, the production of saliva is reduced so it takes longer to reach a desired flow, which Dutour (2007) wrote, "a deficit in mucin content could...lengthen the time needed to constitute a cohesive food bolus." As for denture wearers, the investigation showed they had a hard time chewing to the consistency of the non-denture wearers, especially with foods like carrots. So, they were using more energy but producing large food particles. However, when meat came into play, the group had a definite hard time so they refused to continue chewing the food.

Nutritionally, Dutour noted that because the denture wearers had such a hard time masticating certain foods, it would impact their overall health. It is because when people can't chew or eat the foods that are beneficial to their health, the body suffers. As a result, he or she would make alterations, which Dutour (2007) wrote, "changing diet leads to inadequate food intake and may induce a specific nutrient deficiency. Chewing less may also result in a lower nutrient bioavailability and an impaired nutritional status."

Medically, the deficiency in masticatory abilities impacts elderly people by increasing the risk of mortality. Nakanishi and his team led a study who noted, those who were seventy-five years and older had a significant risk linking the aforementioned conditions. In the Gilmore study, he noted the incidence of inflammation with elder animals found in the connective tissue at the sulcus due to irritation from the food debris. The inflammation in the gingiva led to the formation of pockets on the periodontium in old animals, and the irritation spread to the root surface. As well, "the cementum adjacent to the epithelium and for a considerable distance apical to it was thinned and often absent. The tooth surface was eroded and in some instances, the erosion extended into the dentin." As one ages, he or she may experience more exposure and risk to periodontal diseases, for example gum disease. The American Academy of Periodontology posted 50% of those who were not institutionalized and over the age of fifty-five years old have periodontitis. As well, one out of four people ages sixty-five and older do not have teeth. The majority of elders are affected by receding gum tissue, and most of tooth loss is due to periodontal disease and tooth decay. In a study led by Grossi to assess the risk of periodontal disease, age was the most significant fact that had the most influence with "odds ratios for subjects 35 to 44 years old ranging from 1.72 to 9.01 for subjects 65 to 74 years old."