GERODONTOLOGY

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PREFACE - in industrial countries prolonged life reached 76 years for men and 81 years for women - over 85 years of age has shown the most dramatic increase by almost doubling between 1981 and 2001 expectation : that will triple : from 400.000 in 2001 to 1.6 million by 2041

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UN-Population Devision :
population of >60 years is 600 million 2 billion in 2050 more than children popution To day , at age 65 a healthy man expect 16 more years and healthy woman 20 years In most countries : an elderly population larger than ever before an increasing in the proportion of very old needing health service

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In Indonesia the increasing elderly population is 20 million Contrary to popular believe , only 6% of the elderly

(> 65 years) population live in nursing or

other long-term care facilities

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DEFINITION Gerodontology is the study of the gradual disappearance of oral tissues ability to repair itself and maintain the structure and the normal functions can not withstand with the lesions (including infection) Human progressively lose their durability against infection will be more distortion of metabolic and structural.

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Elderly diseases degenerative diseases such as hypertension, arteriosclerosis , DM and cancer. Usually died with a stroke, a myocardial infarct, commas, metastasis cancer etc

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Aging Process Theories

1. Genetic Clock Theory is a process which has been genetically determined on each species.

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2. Somatic mutations Theory

Aging is caused by errors streak during the life the error occurred in transcription (DNA RNA ) and translation (RNA protein/enzyme) led to the wrong formation of an enzyme reaction wrong metabolism reaction the reduction of functional cells ability

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3. Damage of the body's immune system

recurring mutations or changes in protein posttranslational reducing the ability of the immune system to recognize her own autoimmunes increased prevalence of autoimmune events of various autoantibodies on the elderly the body's own immune system defenses decreased power attack againsts cancer decreased cancer cells divide freely cancer in the elderly

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4. The theory of aging due to metabolism

Research: extension of age associated with delays in the process of degeneration. Extension of age because of decreased caloric number, due to the decline of one or several metabolic processes

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5. Damage caused by free radicals

Free radicals (RB) formed naturally in the environment and in the body cells destructive because it highly reactive with DNA, proteins, unsaturated fatty acids The body has the ability againsts RB in the form of enzym : catalase, glutathione peroxida, superoxide dismutase There is a prophylactic non enzym agent: Vit C, Vit E , Vit A (beta karoten )

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WHO ARE ELDER PEOPLE ???

The older people in terms used by the National Service Framework for older people is falling into three groups a. Entering old age - from the official retirement age - active , independent b. Transitional phase - between healthy active life and frailty - functionally dependent

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c. Frail older people

vulnerable as a result of health problems such as: - stroke or dementia - social care needs - combination of both The transition through three phase is not agedependent

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The gerontologist divides the geriatric population into 3 groups : a. the young-old ( 65-74 years ) b. the old ( 75-84 years) c. the old-old (85 years and above)

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Depending on the degree of disability, the aged have been classified into 4 catagories: a. Well elderly ( one or two minor chronic medical conditions; independent living) b. Frail elderly (simultaneous minor and mayor chronic, debiliting medical conditions, with drugs: selfsufficient living with support, a minority instutionalized)

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c. Functionally dependent elderly (same as category b, but patient independence is not possible: homebound or institutionalized) d. Severely disabled, medically compromised elderly, requiring steady maintenance : - sanatorium - skilled nursing facility

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Frailty
The determinants of HEALTH are a broad mix of : - economic - social - invironmental - biological factors Advancing age is accompanied by a decline in biophysical capabilities and reserves but can be minimized by external supports

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Hypertension and heart disease are the common precipitants The less dramatic impact of memory lapses restricted mobility hearing loss poor eyesight insomnia Frail people cope with their daily needs on energy levels due to impared neurological control and physical strength ( result of chronic disease and disability) Frailty is attributed to social and cultural limitation

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Frailty is influenced by balancing multitude of biopsychososial assets ( strength, wealth, social support) and deficits (chronic disease, poverty, social isolation)
that support or disturb an older individuals level of social independence and quality of life

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Polypharmacy
The combination of multiple medications (polypharmacy) can disturb the biopsychosocial balance of old age to induce premature frailty In Sweden population over 65 years take 5 or > different prescription drugs of the cardovascular disorders, nervous and gastrointestinal system Polypharmacy has become problem in most industrialized countries

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ORAL HEALTH IN THE ELDERLY

The oral cavity reflects the generalized systemic state of the intire body Oral health affects general health, wellbeing and quality of life. The condition of a persons mouth and teeth affects his or her comfort, communication, smiling, socialising and self-confidence. If people cannot chew food adequately, they are likely to become malnourished.

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Owing to age-related systemic diseases and functional changes more vulnerable to oral disorder Oral health and function is distorted in the elderly Dental , periodontal and oral mucosal diseases, salivary disfunction as well impaired chewing, tasting and swallowing harmfull effect on oral health

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Alteration in the oral mucosa are most noticeable after age 70 Epithelium thins, the tissue is more prone to injury Individuals tend in shun hard foods and often have a protein deficiency Elderly individuals may exhibit: - delayed wound healing - delayed regeneration of tissue owing to nutritional and vascular deficiencies --deterioration of immune systtem

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Teeth
Yellowish brown discoloration, loss of enamel due to attrition, abrasion and erosion A steady reduction in cups height with a constant flattening of the oclusal plane The enamel exhibits : - less permeability - become more brittle The pulp is stimulated by dentine exposure to lay down secondary dentin

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The age-associated decrease in tooth sensitivity can be atributed to secondary dentin formation Pulpa proportion and cementum thickness decrease with advancing age The pulp space may be entirely annihilated by 75 years of age The sensitivity of the aging pulp declines due to alteration in the blood and nerve supply Commonly seen are the presence of pulp stones

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Dental caries and tooth loss

Older people are also more vulnerable to root caries because of gum recession The oral health of older people is changing; retain some natural teeth and fewer rely on complete dentures Tooth loss with ageing is not inevitable. Good oral hygiene and regular dental attendance help to keep teeth and gums in good condition.

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Periodontium
Gingival recession , loss of periodontal attachment and alveolar bone The frequency of occurence and severity of periodontitis The bacterial composition of periodontal pocket is altered as gram + facultative cocci , gram anaerobic rods Momentous attachment loss tooth mobility can lead to tooth drifting and occlusal interferences Medical problems and medications may have a hazard effect on periodontal health
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Streptococcus mutans, Lactobacillus , Porphyromonas gingivalis, Treponema denticola, Staphylococcus aureus and Streptococcus viridans have been linked to new and recurrent dental caries, periodontal disease and salivary infection Gradualy progressing senile atrophy of bone true loss of bone dimension, osteoporosis - complexity of denture fabrication - non union of mandibula fracture of the eldery (20% cases)

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Oral mucosal disease

The use of numerous drugs with underlying systemic disorders prone to oral dryness The dry mouth syndrome represent one of the most common grievances after age 65 The increase occurance of burning sensation of the mouth, dental caries, candidiasis, inability to wear dentures , and decreased sensitivity of the taste buds .

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Obstruction with atrophy of salivary ducts, infection or disease within the stoma of the glands diminished in salivary flow Another cause of decreased flow is Sjogerns syndrome. Chronic sialadenitis may result in destruction of the gland acini cause decreased saliva production DM , Alzheimer s disease and dehidration cause xerostomia

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The drugs commonly implicated in xerostomia are antidepressants, antihypertensives, antiparkinsonian drugs, antipsychotic and antihistaminis Edentulous patients have higher salivary immunoglobulin A, immunoglobulin M, amylase and lyzozyme concentration Greater yeast count in the aged with poorer salivary flow rates

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Increased occurance of melanotic macules, fibromas, Fordyces granules and as well as exostoses Glossitis , geographic tongue, fissured tongue, black hairy tongue, atrophy of fungiform and filiform papillae, angular stomatitis and oral hyperpigmentation . These change may signal underlying nutritional deficiencies of iron, antioxidants as well as vitamin B

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A number of ulcerative and vesiculobullous conditions . Denture-related irritation, accidental biting and sharp dental the chief causes Lichen planus, pemphigus vulgaris, cicatriciai pemphigoid Allergic reaction often manifest in the oral cavity to some form of drug therapy

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These may manifest as oral candidiasis , oral ulceration, erythema multiforme, angioudema; gingival hyperplasia pemphigus-like reaction, oral mucosal pigmentation, lichenoid reaction, pemphigoid-like reactions Ill-fitting dentures may lead to dentue stomatitis, papillary hyperplasia, atrophy Epulis fissuratum result from persistent low-grade irritation by ill-fitting dentures Leukoplakia is the most premalignant lesion in the elderly

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Squamous cell carsinoma is the most common malignant neoplasm in the oral cavity. Therapy employing some combination of surgery, radiaton or chemoterapy salivary hypofunction, mucositis, osteoradionecrosis, radiation caries

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The aged to be at a greater risk for developing opportunistic oral infections Herpes simplex virus and varicella zoster infection the most common oral infection Post herpetic neuralgia occurs more commonly in the elderly patients and may last for months or even years Candidiasis is the most common fungal infection

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Epidemiologic survey have implicated both acut and chronic orofacial pain among the aged Disorders of TMJ and muscles of mastication, trigeminal and glossopharyngeal neuralgias, atypical facial pain and migraine constitute the extra oral disorders

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Dental health management in the elderly

Emergency crises during treatment may be precipitated by : hypertension anticoagulation therapy hypoglycemia Infection of replaced joints and cardiac prosthetic valve may be avoided by antibiotic prophylaxis prior to dental procedures in feeble elder

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Precise health problem management with treatment of oral diseases: drugs with a long duration of action and those with eminent central nervous system effects are best avoided

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Advances in dental materials must be known to the dentist In patients with a high caries risk, hybrid /resin ionomer recently developed restorative material that liberates fluoride Problem related to construction of complete dentures and implant placement continue to exist in patients with atrophic alveolar ridges The chief aim of preventive dentistry should be directed towards primary or recurrent caries

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Managing the aged is a problem for practitioners Understanding of geriatric disease and care coupled with increasing awareness of patients have helped in reducing the burden of several ailments affecting the old

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Oral Manifestation of Systemic Diseasein Related to Prosthetic Treatment

1. Cardiovascular Disease - Oral manifestation are not specific - the consequence of drug treatment raher than of a specific disease: * erythema multiforme, xerostomia, loss of taste, pharyngitis, burning sensation, angioedema

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- Problem to prosthetic treatment: * xerostomia impair removeble prostheses retention, adhesion of food to prosthetic material 2. Cerebrovascular Disease - oral manifestation : - unilateral paralyse - reduced oral hygiene - drug-related abnormalities - secondary to nutritional disturbances

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Problem to prosthetic treatment - removable prosthetic in stroke patients: *in ability to control the position * loss of sensitivity ulcus decubitis

3. Diabetes Mellitus - Oral Manifestation : - periodontal disease : *chr. periodontitis - salivary gland dysf : * xerostomia - fungal infection : * rhomboid glossitis * angular cheilitis * prosthetic stomatiti - oral alteration : * oral burning * altered taste * lichenoid lesion

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Problem to prosthetic Treatment - Diabetes is not a significant risk factors apart from causing a delay in wound healing - Implant failure has been observed in onlay 6% to 7% of patient

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Neoplastic Diseases -The increased incidence and survival of patients , the dentist is more frquently faced with the treatment of patients affected by malignant tumor -Problem in prosthetic treatment : - Multiple and generally caused by chemoterapy or radiotherapy - to postphone rehabilitative intervention until the terapy is completed

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TERIMA KASIH
SEMOGA BERMANFAAT

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