ISSN: 2456-8090 (online)

REVIEW ARTICLE
International Healthcare Research Journal 2018;2(1):6-9
DOI: 10.26440/IHRJ/02_01/156
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Geriatrics and Periodontics: A Review

MAYANK JAIN1, KESARI SINGH2
A
B Oral health is an important aspect of general well being and in the elderly population compromised oral care has been considered
S a major risk factor for various health problems. Hence oral-systemic diseases linkage is a special health concern for this elderly
T population and high quality of oral health care should be available to all regardless of age or circumstances.
R
A
C KEYWORDS: Oral care, Periodontitis, Geriatrics, Older population, Dental plaque
T

INTRODUCTION
The world's population is in transformation with various risk factors, which include microbiological
inescapable move in all societies towards an aging factors, behavioural, medical and social factors.
population. Due to increased life expectancy there is With advancing age various changes have been seen
increase in aging population which further leads to in oral hard and soft tissues as well as in bone, the
explosion of the aging population that will continue temporomandibular joint and the oral mucosa.
even in the future.1,2,3 An increase in proportion of These age changes affecting orofacial structures are
older adults in rural areas is 3% larger when of clinical importance as some of these limit the
compared to urban areas as people in villages use prognosistofttreatment.1,5
less dental services. In order to improve the quality
of life of neglected and socioeconomically deprived AGE RELATED CHANGES IN
population, there is requirement of dental health PERIODONTIUM EPITHELIUM
education with emphasis on preventive measures. Changes in the oral epithelium relate to a thinning
of the epithelium and diminished keratinisation and
Oral health is an integral part of general health as flattening of the rete peg. With advanced age
it’s been said that oral cavity is referred to as a formation of epithelial cross-ridges are seen in
gateway of overall health and compromised oral care papillae involved. Moreover increased cellular
in the elderly population has been considered a risk density has been seen in the oral epithelium. The
factor for various general health problems.4 Oral mitotic activity increases with increasing age.6,7
health is a lifetime concept and high quality of oral
health care should be available to all regardless of Connective tissue: Connective tissue shows a
age or circumstances. In the elderly population gradual transition with age to a denser, coarsely
because of physical and neurological changes, oral textured tissue in the higher age groups. There is
hygiene is compromised and oral-systemic diseases reduction in cellular elements with increase in age.
linkage became a special health concern. The rate of maturation of the synthesized collagen
changes with age. The periodontal ligament of
The tissues that invest and support the teeth are young individuals is well organized and regularly
called the periodontium. The most important tissue structured. With increasing age, the fiber and
types forming part of the periodontium are: cellular contents decrease and the structure of the
epithelium, connective tissue, cementum and bone. ligament becomes more and more irregular.6,8,9
With age, changes may occur in each of these
tissues.5 Cementum: With age, the cementum increases in
width along with greater cemental apposition in the
As the ligament and bone resorption is irreversible, apical region of the tooth.10,11,12 Cementum is
accumulated tissue damage of periodontitis is acellular except at the toot apices and in the
reflected in a prevalence and severity that increases furcation areas of multirooted teeth. With
with age. In older adults periodontitis depicts increasing age, the process of cementum formation

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Geriatrics and Periodontics: A Review Jain M et al.

becomes essentially acellular, remodeling of Goal behind Periodontal Therapy: Regardless of

cementum does not normally take place, local age, the overall objective of periodontal therapy is to
resorption at the cementum surface followed by preserve a functional dentition by preventing the
cementum opposition is often observed.4,10 ,11 progression of periodontal diseases. Periodontal
treatment needs may also depend upon the general
Bone: With increasing age, the periodontal surfaces goals of dental therapy.20
of the alveolar bone become jagged and less
insertion of collagen fibers into the bone. An Approach to therapy: Independent of the age of
increase in the number of interstitial lamellae has the patient, the treatment provided must be
been found.13 beneficial and cause no or minimal harm to the
patient. Hence it is very important that the planning
Width of periodontal ligament space with age: of the treatment should be preceded by a careful
A few number of teeth are left with increased age analysis of factors that may influence the outcome
that leads to increased forces on the remaining and prognosis of therapy. The re-evaluation
teeth. This could explain an increasing width of the performed after cause-related periodontal therapy
periodontal ligament space with age. It has also been will determine the need for further treatment.
noted that the masticatory forces decrease with Commonly remaining clinical signs of disease such
age.14,15 as periodontal pockets ≥6 mm and bleeding
following pocket probing are used as criteria for
Aging and the location of the junctional additional periodontal therapy, such as surgical
epithelium: In a healthy periodontium, the apical pocketttherapy.
termination of the junctional epithelium is located
at the cementoenamel junction, just coronal to the Decision Tree for Periodontal Treatment of
connective tissue fiber attachment. But in case of Older Adults18: Kindly refer figure 1.
periodontitis, there is break down of dentogingival
fibers and the junctional epithelium migrates Surgical periodontal therapy: The main objective
apically along the root surface.8,10 of surgical periodontal therapy is to preserve the
periodontium in long term manner by easing the
Physiological versus pathological apical plaque removal and plaque control. An additional
migration of the epithelium: As age advances, a aim may be the regeneration of periodontal support.
gradual physiological recession of the gingiva occurs Age is not a contraindication to periodontal surgery,
concomitantly with an apical migration of the and the healing obtained following therapy is not
epithelium. The recession of the gingiva is a result of different in older adults as compared with younger
occlusal migration of the teeth compensating for individuals.
occlusal wear and a stable location of the gingival
margin. The degree of recession increases with Supportive periodontal therapy: Supportive
age.16,17 periodontal therapy is a significant component in
the treatment of the periodontitis patient. Kerry
VARIOUS TREATMENT MODALITIES OF 199520 described three therapeutic objectives of
PERIODONTAL DISEASE IN OLDER ADULTS18 supportive periodontal treatment:
Epidemiological data reveal that the prevalence and 1. To prevent the progression and recurrence of
severity of chronic periodontal disease increase with periodontal disease among patients who have
age.6 This observation has primarily been previously been treated for periodontitis;
interpreted as an accumulated effect due to lack of 2. To reduce the incidence of tooth loss;
adequate periodontal care. However, longitudinal 3. To increase the probability of recognizing and
data showing an increased annual rate of treating other diseases or conditions found
destruction of periodontal bone support in within the oral cavity.
individuals older than 70 years as compared with
younger age groups. It has been suggested through Prognosis: It is generally believed that in patients
various studies that systemic factors and/or general with the same amount of periodontal disease, the
health problems in aging individuals may influence rule holds: the older the patient, the better the
disease progression.18,19 prognosis in terms of no recurrence of the

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Geriatrics and Periodontics: A Review Jain M et al.

disease.21,22 This belief is based mainly on the 8. Loe H, Karring T. The three-dimensional
reasoning that the resistance to periodontal morphology of the epithelium-connective tissue
breakdown must be higher in older individuals, interlace of the gingiva as related to age and sex.
since the process of periodontal destruction takes Scandinavian Journal of Dental Research 1972;79:
much less time in younger individuals. In spite of age 315-26.
changes in the periodontal tissues and retarded 9. Meyer J, Marwah AS, Weinmann JP. Mitotic rate
wound healing, periodontal treatment including of gingival epithelium in two age groups. Journal of
surgical elimination of pathologically deepened Investigative Dermatologv 1956;27:237-47.
pockets has a favourable prognosis in old patients 10. Grant D, Bernick S. The periodontium of aging
since they do not represent individuals who are humans, Journal of Periodontology 1972;43:660-7.
highly susceptible to periodontal disease. In this 11. Levy BM, Dreizen S, Bernick S. Effect of aging on
respect, it is important to know the level of the marmoset periodontium. Journal of Oral
maintenance of oral hygiene in order to avoid Pathology 1972;1:61-5.
recurrence of periodontal breakdown.23,24 12. Gargiulo AW, Grant D. Aging changes in the
periodontium. Illinois Dental Journal 1973;42:780-5.
CONCLUSION 13. Severson JA, Moffet BC, Kokich V, Selipsky H. A
Today’s day’s biggest challenge is dental care needs histological study of age changes in the adult human
of these older subjects to our society and its care periodontal joint (ligament). J Periodontol. 1978
providers. A compromised general condition is very Apr;49(4):189-200.
common among elderly population that may 14. Helkimo F, Carlsson GF, Helkimo M. Bite force
negatively affect the patient’s ability to maintain oral and state of dentition. Acta Odontologica
health. Moreover in case of response to periodontal Scandinavica 1977;35:297-303.
treatment; the older adults differ from younger 15. Herring SW. Mastication and maturity. A
individuals. To manage the health care needs of the longitudinal study in pigs. Journal of Dental
elderly, coordination between medical and dental Research. 1977;56:1377-82.
care providers will become necessary to design a 16. McDonagh AJ. Periodontology with special
careful program for supportive therapy. reference to recession of the gums. Journal of Dental
Research 1919;1:423-39.
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Geriatric restorative care- the need, the demand and 20. Kerry GJ. Supportive periodontal treatment.
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4. Yeh CK, Katz MS, Saunders MJ. Geriatric 21. Goldman HM, Cohen DW. (1973) Periodontal
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2008;3(3):182-92. Periodontal Disease. Basic Phenomena, Clinical
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6. Van der Velden U. Effect Of Age On The 23. Nyman S, Lindhe J, Rosling B. Periodontal
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1982:9(6):455-9.

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Geriatrics and Periodontics: A Review Jain M et al.

Cite this article as:

Jain M, Singh K. Geriatrics and Periodontics: A Review. Int Healthcare Res J
Source of support: Nil, Conflict of interest: None declared 2018;2(1):6-9. doi: 10.26440/IHRJ/02_01/156

K
AUTHOR AFFILIATIONS:
1. Senior Lecturer, Department of Oral Medicine and Radiology, JN Kapoor DAV(C) Dental College, Yamuna Nagar
2. MDS (Oral Medicine and Radiology), Consultant Dental Surgeon, Greater Noida

KCorresponding Author: For article enquiry/author contact details, e-mail at:

Dr. Kesari Singh manuscriptenquiry.ihrj@gmail.com
MDS (Oral Medicine and Radiology)
B-27 Delta 1st, Silver Oak Estate
Greater Noida U.P 201308

Figure 1. Decision Tree for Periodontal Treatment of Older Adults.18

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