Effects of Ageing on edentulous mouth

The changes that occur in the oral cavity concomitant with age need to be
understood in order to treat this condition successfully.
Changes in the following structures are important for the construction of CD.

Bone:
Generally, bone quantity and quality decrease with age.
This occurs due to decrease in efficiency of osteoblasts, less estrogen production
and reduction in calcium absorption from intestine.
The jaws independently of gender also become more porous with time probably
because of metabolic rather than functional changes in the bone.
Osteoporosis is a disorder caused by an accelerated loss of trabecular bone. It
happens usually, but not exclusively, in women after menopause and is discovered
frequently when an older person breaks a vertebra, hip, or forearm.
The more prevalent type I (postmenopausal) form affects women for a decade or so
after menopause, whereas the type II (senile or idiopathic) form can attack men
and women alike at any age for no obvious reason.

Residual ridge resorption:

Definition:
The diminishing quantity and quality of the residual ridge after teeth are removed
(GPT8).
Classification:
Atwood classified the progression of residual ridge resorption (RRR) as follows
(Fig. 1.1):
• Order 1: Pre extraction
• Order 2: Post extraction
• Order 3: High, well rounded
• Order 4: Knife-edged
• Order 5: Low, well rounded
• Order 6: Depressed

Resorption pattern:
Generally, women show more RRR than men.
During the first year following extraction, reduction in residual ridge height is 2–3
mm in maxilla and 4–5 mm for mandible. After this, the process will continue but
with reduced intensity.
Mandible shows 0.1–0.2 mm resorption annually, which is four times more than
edentulous maxilla
Etiology:
1) Anatomic factors: These are more pronounced in mandible than maxilla;
associated more in patients with short and square face with increased masticatory
forces
2) Metabolic factors: RRR varies directly with bone resorption factors and
inversely with bone formation factors.
3) Mechanical factors: Though RRR may be inevitable due to ‘disuse atrophy’, it
can also be caused due to excessive force transmitted through dentures because of
continuous denture wearing and unstable occlusal conditions
Consequences of residual ridge resorption:
1. Apparent loss of sulcus width and depth.
2. Displacement of muscle attachment closer to crest of the residual ridge.
3. Loss of vertical dimension of occlusion.
4. Reduction in the lower face height.
5. Anterior rotation of mandible and increase in relative prognathism.
6. Mental foramen may come to lie at or near the level of the upper border of the
body of mandible.
7. The genial tubercles project above the upper border of the mandible in the
symphyseal region.
8. Flattening of the vault of the palate
9. Reduction in the height of both the maxillary and mandibular edentulous arches.
While the maxillary arch resorbs buccally and labially with a concomitant
reduction in perimeter or circumference of the arch, the mandibular arch resorbs in
a labial and lingual direction resulting in widening of the arch posteriorly.
This will lead to confinement of maxillary arch within the mandibular arch in
longstanding edentulous situations, giving a pseudo-class 3 ridge relationship
(Fig. 1.2 A and B).
Treatment:
• Due to this continuous process, a maintenance phase comprising of relining and
rebasing the dentures is essential throughout the life of a CD patient.
• Overdentures help in minimizing ridge resorption and contribute towards
enhanced retention, stability, support of prosthesis along with preservation of
proprioception. Clinicians must try to retain residual roots whenever possible.
• A severely resorbed ridge may require vestibuloplasty, but prosthetic
rehabilitation with osseointegrated implants is the best solution to prevent this
process and preserve the bone.

Oral mucosa:
The age changes seen in the oral mucosa are less acute than those seen in the skin
because the moist environment of the mouth helps to maintain the turgor of the
tissue. It can become thin and can be easily abraded.
Stomatitis and other mild inflammations are the mucosal lesions encountered most
frequently in older edentulous mouths, especially of older men who wear dentures,
smoke tobacco, and drink alcohol excessively.
External carcinogens, such as nicotine and alcohol, and viral infections, such as
human papillomavirus, might be more damaging to the oral mucosa in old age
because of atrophy, increased mitosis with slow turnover of cells, and an increased
number of elastic fibers.

Taste:
There is a 60% reduction in taste buds by the age of 75–80 years and especially
with Alzheimer’s.
Rule out upper respiratory infection or a serious neurological disorder
Food may have a metallic or salty taste, and an unpleasant sensitivity to bitter and
sour foods increases when salivary flow is poor, whereas reduced sensitivity to
sweet tastes can generate an unhealthy craving for sugar.
Saliva:
Salivary flow decreases and quality changes with age. It affects denture retention
and may be caused more by the medications than age.
Sjogren’s syndrome and radiation treatment also cause dry mouth.
Management of hyposalivation is difficult, but recent evidence indicates that
secretion of mucous saliva from the palate improves measurably after drinking 2
liters of water, when chewing, or when taking estrogen or pilocarpine.

Mastication and deglutition:

It has been observed that older adults are capable of fewer swallows in a 10-s
period of time than younger adults. Even healthy older persons open their mouth
less wide and chew with less power, which is related to loss of muscle bulk with
age.
Movements of the mandible are governed by a generator in the brain stem
influenced by proprioceptors in muscles, joints, and mucosa.
Advancing age may delay the central processing of nerve impulses, impede the
activity of striated muscle fibers, and inhibit decisions.
It can reduce also the number of functional motor units and fast muscle fibers, and
decrease the cross-sectional area of the masseter and medial pterygoid muscles.
Consequently, older people tend to have poor motor coordination and weak
muscles. Muscle tone can decrease by as much as 50% between middle and old
age, which probably explains the shorter chewing strokes and prolonged chewing
time

Nutrition:
As age advances, there is a 30% reduction in energy needs and food intake.
But, with the exception of carbohydrates, the requirement for other nutrients does
not significantly reduce. As a consequence, the dietary intake by elderly
individuals frequently shows some nutritional deficiencies.

Aging skin and teeth:

Skin:
Wrinkles, puffiness and pigmentation are associated with ageing.
Philtrum is flattened and nasolabial grooves are deepened which lead to sagging of
middle third of the face.
Upper lip droops over the maxillary teeth.
All these are accentuated with edentulousness and loss of vertical dimension.

Teeth:
The color of healthy natural teeth ranges in hue from yellow to orange, with large
variation in chroma and value.
The chroma, and occasionally the hue, changes with abrasion of enamel, which
exposes the dentine to extrinsic stains.
Various medications, particularly those containing heavy metals, also can deepen
the chroma.