AGING &

PERIODONTIUM
Khushi Desai (809)
IIIrd BDS
 TABLE OF CONTENTS

01 Gingival Epithelium

Effects Of Aging 02 Gingival Connective Tissue

On: 03 Periodontal Ligament

04 Cementum
 TABLE OF CONTENTS

05 Alveolar Bone

Effects Of Aging 06 Tooth-Periodontium Relationship

On: 07 Bacterial Plaque

08 Immune & Inflammatory Response

 01
Gingival
Epithelium
• Thinning and decreased keratinization of the gingival epithelium due to
increase in epithelial permeability to bacterial antigens, a decreased
resistance to functional trauma or both. Such changes might influence
long term periodontal outcomes.
• Flattening of rete pegs and altered cell density.
LOCATION CHANGES:
 Migration of the functional from its position in the healthy individual (on
enamel) to a more apical position on the root surface with accompanying
gingival recession.
 Gingival recession increases the width of attached gingiva with age.
 The migration of the junctional epithelium to the root surface could be
caused by the tooth erupting through the gingiva to maintain occlusal
contact as a result of tooth surface loss.
 CLINICAL CASES

Overeruption with Over-eruption without

Extensive recession in a recession in older
recession in older younger individual (32
individual (68 years individual (72 years
years male) male)
female)
02
Gingival Connective
Tissue
• Courser and denser gingival connective
tissue with age.
• Collagen Changes:
- Increase rate of conversion of
soluble to insoluble collagen
- Increased mechanical strength
- Increased denaturation temperature
- Increased collagen stabilization
caused by changes in
macromolecular conformation
- Increased amount of collagen
content.
03 Periodontal Ligament
1. Decreased numbers of fibroblasts and more irregular
structure
2. Paralleling the changes in the gingival connective
tissue.
3. Decreased organic Matrix production and epithelial
cell rests
4. Increased amount of elastic fibres.
Width of periodontium might be dependant on the
functional status of teeth, because the width of space
decreases if the tooth is unopposed (hypofunction) or
increase with excessive occlusal loading.
 04 Cemetum

 Increase in cemental width by 5 to 10 times

as deposition continues after tooth
eruption as well.
 The increase is more apically and lingually.
 Increased surface irregularities due to
accumulation of resorption bay.
05 Alveolar Bone

1. More irregular periodontal surface of bone and

less regular insertion of collagen fibres
2. Healing rate of bone in extraction sockets
appears to be unaffected by increasing age.
3. Bone graft preparation (decalcified freeze-dried
bone) from donors more than 50 years old
possessed significantly less osteogenic potential
than graft material from younger donors.
 06
Tooth-Periodontium
Relationship
 Loss of tooth structure due to attrition leading to reduction in cuspal height and
inclination due to wear.
 The degree of attrition is influenced by the musculature, consistency of food, tooth
hardness, occupational factors and habits such as grinding & clenching.
 The rate of attrition can be co-related with continuous tooth eruption and gingival
recession. As the tooth erupts, cementum is usually deposited in apical region of the
root.
 Bone loss due to aging can cause increase in crown to root ratio.
 Wear of teeth can occur on the proximal surfaces accompanied by mesial migration
of teeth. Proximal wear reduces the antero-posterior length of dental arch by approx.
0.5 cm by the age of 40 years.
 Progressive attrition and proximal wear results in a maxillary mandibular overjet in
the molar area & edge-to-edge bite anteriorly.
 07
Plaque Control
1. Increase in dento-gingival plaque accumulation with age due to increased
hard tissue surface area resulting from gingival recession and the
substrate characteristics of the exposed root surface as a substrate for
plaque formation compared with enamel.
2. No quantative difference for supragingival plaque.
3. For subgingival plaque, increased number of enteric roads and
pseudomonads in older adults. There is also increase in oral carriage of
these species among older adults.

There occurs a shift in the importance of certain periodontal pathogens

with age, specifically including an increased role for Porphyromonas
gingivalis and decrease role for Actinobacillus actinomycetemcomitans
 08
Immune &
Inflammatory
Responses
 Age has much less effect on the alteration of host response.
 Difference between younger and older individuals can be demonstrated for T
and B cells, cytokines and natural killer cells but not for polymorphonuclear
cells and macrophage activity.
“Measurement of age indicators of immune and inflammatory competency suggest
that, within the parameters tested, there was no evidence for age related changes in
host-defenses corelating with periodontitis in elderly group individuals, with or
without disease.” – McArthur

 In relation to systematic inflammatory responses, C-reactive protein (CRP) is

an acute phase protein that is widely regarded as a marker of inflammatory
burden and response to bacterial infection.
CRP levels are increased in those with progressive periodontitis and no other
systemic conditions. This may indicate that inflammatory burden can be
investigated with the use of CRP although there is growing evidence that CRP
alone may not be as reliable a marker in older people.
THANK YOU
RESOURCES:
Carranza FA Newman MG Takei HH Klokkevold PR. Carranza's Clinical Periodontology. 10th ed. St.
Louis Mo: Saunders Elsevier; 2006.