THERAPEUTIC ADAPTATIONS IN ELDERLY SUBJECTS (PERIODONTAL TREATMENTS)
I-INTRODUCTION
In the elderly, oral pathology is characterized, in addition to periodontal diseases, by an increased prevalence of cervical caries and wear lesions (attrition, abrasion, erosion), with a consequent decrease in the functional capacity of the masticatory system.
These structural modifications which accompany the maturation and then the aging of the dental organ are due as much to physiological senescence as to functional stimuli or pathological aggressions and must be taken into account in the diagnosis and the therapeutic approach.
Age does not constitute a contraindication to any of the different modalities of periodontal treatment.
However, the therapeutic approach must take into account the patient’s general condition, their ability to maintain satisfactory oral hygiene, their motivation, as well as the therapeutic objective.
II-GENERAL OBJECTIVES
- Treat emerging problems early to avoid further complications
- Ensure infection control, i.e. minimize or eliminate gingival, periodontal or endodontic inflammation
- Minimize disruption to functions
- Maintaining the aesthetics of the elderly patient.
THERAPEUTIC ADAPTATIONS IN ELDERLY SUBJECTS (PERIODONTAL TREATMENTS)
III- AGING and THE PERIODONTAL
1-AT THE CELLULAR LEVEL
Cellular aging results from the intertwined effects of genetic and environmental factors to which the organism is subjected . ! Aging affects all the constituents of the cell: DNA, membranes and proteins.
2-AT THE LEVEL OF THE PERIODONTAL
A- The gum
- A decrease in mitotic activity responsible for epithelial thinning of approximately 30% compared to young adults,
- Changes in vascularization due to a reduction in the number of gingival microvessels.
- A decrease in cell turnover
This results in a loss of elasticity of the gum with a smoother appearance of recessions, increased fragility to microbial and mechanical attacks.
B- PERIODONTIS:
- The effect of aging on the periodontal ligament is characterized by:
- A slowdown in cell turnover,
- A limitation of its regenerative potential
- A decrease in vascularization
- A decrease in the number of desmodontal fibers.
- A decrease in cell density
- Changes in the desmodontal space related to variations in the occlusal load: reduction in the desmodontal space in the dentate and widening of the desmodontal space in the partially edentulous.
C- CEMENT:
- The cementum increases in thickness by apposition of secondary cementum, particularly at the apical third and distal level. This hypercementosis is linked to age but also to a compensatory mechanism of passive mesial eruption and dental attrition.
- Furthermore, the physiological retraction of the gum promotes the exposure of the cementum.
- This is often sclerotic and presents numerous irregularities such as loss of substance linked to traumatic brushing.
D-ALVEOLAR OS:
- Alveolar bone loss is linked to tooth loss . In fact, during aging, bone mass gradually decreases. Osteoblasts decrease in number, size and activity.
- The balance between resorption and apposition phenomena is altered in favor of an increase in resorption resulting in an increase in the number of resorption cavities.
- The capacity for healing and remodeling is then limited.
THERAPEUTIC ADAPTATIONS IN ELDERLY SUBJECTS (PERIODONTAL TREATMENTS)
IV-ADAPTATION OF PERIODONTAL TREATMENTS
There are three factors to consider:
- Periodontal status
- The general condition
- The ability of the elderly patent to maintain good hygiene
1-Non-surgical treatment
Frequent cleaning and oral hygiene instruction are an appropriate treatment approach for elderly patients. Appropriate instrumentation, particularly an electric toothbrush, flossing with a floss port, and interdental brushes facilitate plaque control, which is particularly indicated for multiple prosthetic restorations. Chlorhexidine may be administered to patients who have difficulty maintaining good oral hygiene.
2-Surgical treatment
In the case of deep pockets, conservative treatment by scaling and root planing may be insufficient and surgical treatment for appropriate debridement or to ensure a gingival morphology that facilitates plaque control may be indicated.
Surgical treatments such as bone surgery, guided tissue regeneration, bone grafts and implants can be applied as indicated, if the patient’s general condition allows it. The patient’s age is not a contraindication to periodontal surgery, the principles remaining the same, but a more conservative approach is preferred to minimize exposure of the root surface and the increased risk of root caries.
Finally, it should be noted that the decisive factor for the success of periodontal surgery remains the control of bacterial plaque and professional follow-up. This excludes surgical treatment in patients who do not have adequate hygiene, which, unfortunately, is often the case in elderly patients.
VI-Conclusion:
Physiological changes related to senescence affect the dental organ as a whole. These structural changes have repercussions on pathologies as well as on oral therapy.
The treatment will take into account the general condition of the patient and the therapeutic objective, however it remains classic but it should adapt to the specificities of the “old” tooth and the elderly patient.