PERIODONTAL TREATMENTS IN THE ELDERLY
Aging is a biological phenomenon that is highly conserved throughout life. Periodontal tissue ages at the same rate and with the same physiological processes as other body tissues.
Oral health is an important component of quality of life and contributes to the preservation of the general health of the elderly.
The treatment of the elderly patient must be adapted to their general state of health and their own progress in the process of senescence.
- DEFINITION OF ELDERLY PERSON :
The WHO (World Health Organization) defines an older person as a person over 60 years of age.
Aging is an inevitable, slow, and progressive physiological process that leads to the weakening of the body. It results from the intertwined effects of intrinsic (genetic) and extrinsic (dietary habits, environment, etc.) factors. It is by no means a pathological condition. However, it exacerbates the effects of diseases and their consequences.
- PERIODONTAL SENECENCE :
- Epithelium :
The effect of age on epithelial tissue is reflected by a decrease in thickness and a decrease in the degree of keratinization, which indicates less resistance to the daily aggressions suffered by the periodontium. The junctional epithelium is little modified and can be maintained at the level of the enamel-cementum junction if periodontal health is preserved. It should nevertheless be noted that there is a decrease in the proliferative activity of gingival epithelial cells. This results in limited healing capacities that require more time compared to a young patient.
- Connective tissue :
The extracellular matrix that makes up periodontal connective tissue is profoundly altered by senescence. The gingival collagen network increases with age, leading to significant tissue fibrosis. Collagen turnover is reduced, resulting in tissue with reduced defense and healing capabilities.
The density and renewal rate of fibroblasts are decreased. A decrease in the synthesis of chondroitin sulfate (glycosaminoglycan responsible for maintaining hydration and elasticity)
This results in less cellularization of connective tissue, reduced turnover and reduced elasticity.
- Desmodontis :
Periodontal cells and extracellular matrix undergo a process of senescence. With increasing age, cell and fibril densities decrease. The fibers have a less elastic structure, reduced remodeling, the number of fibers decreases but the ultrastructure of the ligament is preserved. Vascularization is reduced. Malassez epithelial remnants are present in smaller quantities in the elderly than in young people.
- Cement :
Cementum undergoes apposition throughout the individual’s life. This apposition leads to a depletion of the nutrient supply of cementocytes, which, in addition, see their capacity to evacuate their cellular waste reduced. This results in progressive cell death of these cells. The cementum then becomes less and less cellular.
- Bone tissue :
Bone mass gradually decreases due to a decrease in turnover and an imbalance in this process resulting from a decrease in bone formation. Osteoblastic number and activity are reduced. There are numerous areas of resorption, widening of the Haversian canals, a decrease in the number and volume of bone trabeculations, and an increase in adipocytes and adipose tissue in the bone marrow.
- PHYSIOLOGICAL AGING
- Salivary senescence :
The effect of aging on the salivary glands is characterized by atrophy and decreased volume of the acini, irregularity of the secretory ducts, and an increase in fibrous connective tissue and adipose tissue. Age-related hyposialia appears to be of little significance, unlike iatrogenic hyposialia, which appears to be more readily implicated.
Qualitatively, the concentrations of sodium and chlorine ions decrease with age. Similarly, the concentration of salivary proteins (mucins) also decreases, leading to increased fragility of the mucous membranes of older people.
- Immune senescence :
All components of the body’s immune system are affected by age. Since periodontal diseases involve an inadequate host response to periodontal aggressors, any change in the host response can promote the onset or progression of these conditions.
- AGING AND MICROBIOLOGY :
Environmental conditions change with age. There is a decrease in brushing efficiency, decreased unstimulated salivary flow, a change in diet (soft texture), and injuries related to wearing removable resin prostheses.
Plaque deposits are greater in the elderly patient and the supragingival bacterial load is greater.
In the case of edentulous patients, the oral flora evolves towards one with less pathogenic characteristics.
- CLINICAL ASPECTS OF ORAL SENESCENCE :
- Oral mucous membranes :
The oral mucosa becomes atrophic, loses its elasticity, and takes on a smooth, thin appearance. The specialized mucosa of the tongue also takes on a smooth appearance. A loss of taste sensitivity occurs and is likely to promote malnutrition in the elderly. All of these changes lead to increased vulnerability to trauma and reduced tolerance of removable dentures. These physiological changes facilitate the development of painful ulcerative lesions, reinforcing these phenomena.
- Toothlessness :
The incidence of toothlessness is high in older people. However, it is considered that toothlessness is not a consequence of physiological aging.
- Dental cavities and fractures :
The incidence of caries in people over 65 years of age remains high. A high prevalence of root caries located at the cementoenamel junction, which is complicated by erosions and abrasions, has been observed. The progression of these caries can lead to tooth fracture, which is often asymptomatic due to age-associated atrophy and pulp calcification.
- Periodontal diseases :
Epidemiological studies reveal an increase in the prevalence and severity of periodontal disease with age. The prevalence of moderate chronic periodontitis also increases with age. However, periodontal disease is not a direct consequence of aging per se.
- PERIODONTAL TREATMENTS IN THE ELDERLY :
- License plate check :
In the elderly, physical and mental deterioration linked to senescence has direct consequences on the patient’s effectiveness and compliance with oral hygiene strategies.
The oscillating-rotating electric toothbrush is known for its effectiveness in removing plaque. Its shape (large handle, small head) is adapted to the needs of the elderly.
The use of dental floss mounted on a floss holder and interdental brushes with suitable handles helps the patient control plaque.
Due to the increasing prevalence of dental caries, the use of highly fluoridated toothpaste is recommended. In the presence of periodontal disease, the use of Triclosan-based toothpaste and mouthwashes containing Chlorhexidine can limit the progression of these pathologies in at-risk individuals.
- Non-surgical treatment :
The weakening of patients and their lower tolerance to pain require treatments in short sessions.
During scaling and root planing, root instrumentation should be limited to avoid iatrogenic damage to the root surface. Fluoride applications are then indicated.
- Surgical treatments :
The patient’s age is not a contraindication to periodontal surgery, unlike general health. The surgical principles remain the same but must be adapted to the patient’s changes related to aging.
Periodontal healing appears to be very little modified in the elderly despite the numerous modifications of senescence (reduction in fibroblastic activity and therefore collagen formation, alteration of terminal vascularization).
Therapeutic results after periodontal treatment (surgical or not) do not differ depending on age. However, healing times will be longer than in younger patients.
- Implant treatments :
Implant-supported dental restorations appear to be a safe and long-lasting treatment option for the elderly. Implant placement increases prosthetic comfort and also ensures the long-term durability of prosthetic restorations, which can be difficult to re-operate on for patients with progressive dementia.
CONCLUSION :
Periodontal management of elderly patients takes into account their health status and their progress in the senescence process.
Standard treatment for chronic periodontitis in the elderly includes increased plaque control. A non-surgical approach to periodontal treatment should be preferred.
Periodontal monitoring in elderly subjects should be the subject of more frequent regular visits than in the general population due to the difficulty of individual plaque control.
PERIODONTAL TREATMENTS IN THE ELDERLY
Untreated cavities can cause painful abscesses.
Untreated cavities can cause painful abscesses.
Dental veneers camouflage imperfections such as stains or spaces.
Misaligned teeth can cause digestive problems.
Dental implants restore chewing function and smile aesthetics.
Fluoride mouthwashes strengthen enamel and prevent cavities.
Decayed baby teeth can affect the health of permanent teeth.
A soft-bristled toothbrush protects enamel and sensitive gums.