Age Changes in

Dental tissues
Foluso J Owotade
 Introduction
• Ageing is the irreversible and inevitable change that occurs
with time

• Ageing involves morphological and functional changes that

lead to functional impairment

• Biologic ageing process is universal, progressive and

deleterious

• Age changes in the oral and dental structures play a

significant role in the clinical conditions affecting the oral and
dental structures and the dental practitioner needs to be
aware of these changes
Age Changes in Enamel

• Age changes in enamel can be summarised into

1. Attrition

2. Discoloration

3. Change in permeability

4. Chemical and surface changes

• The most apparent age change in enamel is attrition of
the occlusal surfaces and proximal contact points as a
result of mastication

• Attrition is shown by a loss of vertical dimension of the

crown and flattening of the proximal contour of teeth

• Newly erupted teeth are covered with pronounced rod

ends and perikymata but these start to disappear soon
after eruption

• In severe attrition, the dentine may be exposed

Perikymata
Age changes in enamel- attrition
• The facial and lingual teeth surfaces lose their structure
much more rapidly than proximal surfaces and anterior
teeth lose their structure more rapidly than the posterior
teeth

• Young enamel is semi permeable, allowing water and

molecular substances to pass between the pores within
the crystal

• With age, the enamel crystals increase in size and the

spaces get obliterated leading to reduced permeability
• With age, enamel becomes darker changing from white to
yellowish white

• Darker colour is due to the loss of enamel rods thereby

affecting the reflection of enamel

• The gradual wearing away of enamel also leads to the

darker colour of underlying dentine showing more with
age
• With age, the fluoride and nitrogen content of enamel
increases while water and organic content decreases

• Reduced organic content make the teeth less prone to

caries
Age Changes in Dentin

• Can be summarised as

1. Increase in the number of dead tracts

2. Increase in sclerosed dentin

3. Increase in reparative and reactive dentin

4. Reduced vitality of dentine

1. Dead Tracts

✤ In normal dentin the odontoblast processes may

disintegrate, and the empty tubules are filled with air

✤Odontoblast degeneration is often observed in the area

of narrow pulpal horns because of crowding of
odontoblasts

✤Dead tracts appear black in transmitted and white in

reflected light

✤ Dead tracts are probably the initial step in the

formation of sclerotic dentin.
Dead tracts
2. Sclerotic or transparent dentin

✤ These are dentinal tubules that have become

occluded with calcified materials

✤When it is due to ageing, this is referred to as

physiologic dentin sclerosis

✤When sufficient stimuli from caries, attrition, abrasion,

erosion, or cavity preparation cause collagen fibers and
apatite crystals to be deposited in dentin, this is called
reactive dentin sclerosis
• Slerotic dentin may appear glassy and transparent when
several tubules become sclerotic in the same area

• Transparent or sclerotic dentin can be observed in the

teeth of elderly people, especially in the roots, it may also
be found under slowly progressing caries

• Sclerosis reduces the permeability of the dentin and may

help prolong pulp vitality
• Sclerosed dentin is harder than normal dentin, the
crystals present in the sclerotic dentin are smaller than
those present in the normal dentin

• Sclerotic dentin appears transparent in transmitted light

and dark in reflected light.
3.Reparative and reactive dentin

✤ When exposed to extensive abrasion, erosion,

caries, or operative procedures the odontoblast
processes are exposed or cut

✤The odontoblasts may die or survive, depending on

the intensity of the injury. If odontoblasts survive, the
dentin that is produced is known as reactionary,
reactive or regenerative dentin
✤ When odontoblasts are killed, they are replaced by
the migration of undifferentiated cells arising in
deeper regions of the pulp to the dentin interface

✤ The newly differentiated odontoblasts then begin

deposition of reparative dentin

✤Dentin is laid down throughout life after the teeth

have erupted, dentinogenesis slows, and further
dentin formation is at a much slower rate
Age changes in the pulp

• Can be summarised into

1. Formation of pulp stones

2. Increased fibrosis

3. Vascular changes

4. Cellular changes
• Pulp stones (denticles)

✤ These are nodular, calcified masses appearing in either or

both the coronal and root portions of the pulp organ

✤ They often develop in teeth that appear to be quite normal in

other and are usually are asymptomatic unless they impinge
on nerves or blood vessels

✤Structurally, they can be classified as true denticles or false

denticles.

✤True denticles are similar in structure to dentin in that they

have dental tubules and contain the processes of the
odontoblasts that formed them, usually located close to the
apical foramen
✤ False denticles do not exhibit dentinal tubules but
appear instead as concentric layers of calcified tissue
within a bundle of collagen fibers

✤In the center of these concentric layers of calcified tissue

there may be remnants of necrotic and calcification of
thrombin in blood vessels, called phleboliths, may also
serve as nidi for the false denticles.
• Fibrosis

✤As the pulp ages, accumulations of both diffuse

fibrillary components as well as bundles of collagen
fibers usually appear

✤ Fiber bundles may appear arranged longitudinally in

bundles in the radicular pulp , and in a random more
diffuse arrangement in the coronal area.

✤The increase in fibers in the pulp organ is gradual and

is generalised throughout the organ
• Vascular Changes

✤Vascular changes occur in the aging pulp organ as in other

parts of the body in form of atherosclerotic plaques

✤Alternatively the outer diameter of vessel walls become greater

as collagen fibers increase in the medial and adventitial layers

✤Calcification in the walls of blood vessels is found most often in

the region near the apical foramen

✤ The capillary endothelium in the elderly shows numerous

pinocytic vesicles, microvesicles and microfilaments, lipid like
vacuoles, glycogen granules and many golgi complexes

✤ Blood flow decreases with age

• Cellular Changes

✤ With age, there are fewer cells in the pulp, the cells are
characterised by a decrease in size and number of cytoplasmic
organelles

✤ The typical active pulpal fibrocyte or fibroblast has abundant

rough surfaced endoplasmic reticulum, notable Golgi complex,
and numerous mitochondria with well-developed cristae

✤ However, the fibroblasts in the aging pulp exhibit less

perinuclear cytoplasm and possess long, thin cytoplasmic
processes

✤The intracellular organelles such as the mitochondria and

endoplasmic reticula are reduced in number and size
Age Changes in Cementum

• May be summarised as

1. Hypercemetosis

2. Formation of cementicles

3. Reduced permeability

4. Cementum resorption
• Hypercementosis

✤ It is an abnormal thickening of the cementum which

may be generalised or localised

✤ Hypercementosis is termed cementum hypertrophy if

the overgrowth improves the functional qualities of the
cementum and is termed cementum hyperplasia if it is
not correlated with increased function
• Cementicles:

✤They are ovoid or round calcified structure that are

formed as a result of calcification of the degenerated
periodontal tissue or the epithelial rests of Malassez

✤Cementicles may be,

• Free in the periodontal ligament

• Attached to the cementum

• Embedded in the cementum

• Permeability

✤ The permeability of cementum decreases gradually by

age

✤The permeability from the periodontal side is lost

except in the most recently formed layer of cementum,
while that from the dentin side remains only in the
apical region.
• Cementum Resorption and Repair

✤cementum resorption can occur after trauma or

excessive occlusal forces

✤After the resorption ceases the damage is usually

repaired

✤If the repair establishes the former outline of the root

surface it is called anatomic repair. However if only a
thin layer of cementum is deposited and the root
outline is not constructed it is called functional repair
Age changes in the alveolar
bone
• Can be summarised as

• Bone resorption

• Fatty infiltration of the marrow

• Loss of maxillary bone due to invasion by the sinus

• Loss of internal trabecular arrangements making the

bone more porous and fragile
 Credits
• Jananee J, Deepika R- Age Changes of Enamel, Dentin, Pulp,
CementumInternational Journal of Science and Research
(IJSR) 2017 (Online): 2319-7064

• Timsina J. Age changes in dental hard tissues, Heath and

medicine 2015

• Roa Ignacio, del Sol Mariano. Perikymata: A Non-existent

Term. A Scientific Literature Invention? Terminology Analysis
and Proposal. Int. J. Morphol. [Internet]. 2017 Dec
[cited 2021 Aug 30] ; 35( 4 ): 1230-1232. Available from:
http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717
-
95022017000401230&lng=en. http://dx.doi.org/10.4067/S07
17-95022017000401230.