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Age Changes 2017

This document discusses the impact of dental age changes on restorative and endodontic treatment. It notes that as people age, their dentition undergoes physiological and pathological changes that present challenges for dental treatment. These include decreased bone mass and density, changes to the salivary glands and oral mucosa, increased dentine sclerosis, and alterations to the dental pulp. The document outlines how these anatomical changes can make procedures like root canal treatment, vitality testing, and working length determination more difficult in older patients. It also addresses other factors like medical history and ability to consent that must be considered in treatment planning for the elderly.

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David McMahon
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38 views31 pages

Age Changes 2017

This document discusses the impact of dental age changes on restorative and endodontic treatment. It notes that as people age, their dentition undergoes physiological and pathological changes that present challenges for dental treatment. These include decreased bone mass and density, changes to the salivary glands and oral mucosa, increased dentine sclerosis, and alterations to the dental pulp. The document outlines how these anatomical changes can make procedures like root canal treatment, vitality testing, and working length determination more difficult in older patients. It also addresses other factors like medical history and ability to consent that must be considered in treatment planning for the elderly.

Uploaded by

David McMahon
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Dental Age Changes:

The Impact on Restorative and


Endodontic Treatment
Dr. Graham Quilligan
B.D.S N.U.I , MFDS RCS.Ed, M.Sc (Endodontics) UCL, PGCTLHE

Registrar in Restorative Dentistry


CUDSH
The Elderly- ? age
Dental Age Changes

• Physiological

• Pathological
Projected Dentate (%)

Age 65-74 75+


1998 64 42
2008 77 61
2018 88 74
2028 95 85

ADH1998
Oral Conditions
• Oral Pathology
• Xerostomia
• Periodontal Disease
• Caries
• Root Caries
• Apical Pathology
• NCTSL
• Aesthetic Concerns
• Tooth Loss
• Inadequate Function
True Age Change

• Not necessarily deleterious

• Progressive

• Seen in all members of the species

• Irreversible
Social History
- Ability to attend the surgery

- Ability to keep mouth open for prolonged

periods

- Ability to pay for treatment

- Desire to keep teeth

- Ability to maintain restorations

- Future direction of dentition


Medical History

- Ability to consent to treatment

- Polypharmacy

- Ability to lie back on chair -COPD etc

- Warfarinised - xla

- Bisphosphonates

- Radiotherapy?
Dental History
- Previous RCT?

- Ability to wear Rubber Dam

- Previous RCT - quality/success/retention?


Treatment Planning
-1.Patients rendered edentulous in old age are unlikely to adapt

successfully to complete dentures

-2. There is a high non-compliance rate (20–40%)with bilateral

free-end saddle partial dentures.

- 3. Older adults may reject implant therapy for reasons of fear

or cost

- Overall state of dentition

- Strategic retention of teeth

- ?Transition to edentulousness
Treatment Planning
Treatment Planning
Age Changes - Bone
Decreased bone mass and density
• Decreased osteoblasts and bone-forming
capacity

• slower healing
• Increased brittleness
• effects of periodontal disease, tooth loss, poor
prostheses, overeruption
Age Changes - Bone
Age Changes - Bone
Age Changes - Salivary Glands
• epithelial degeneration
• atrophy
• loss of acini
• fibrosis

• variable effect on function


• Decreased resting whole saliva, stimulated
unaffected
• main cause of xerostomia is drugs
Age Changes - Oral Mucosa

• prominent sebaceous glands


• smooth appearance of mucosal surface
• Decreased epithelial thickness
• simpler epithelial structure - no rete pegs

• thinner - more susceptible to change


Age Changes - Enamel
Increased fluoride, nitrogen
Increased caries resistance
Additional etching time

• Increased staining, characterisation –


prosthodontic challenges
Age Changes- Periodontal Response

• more rapid development of gingivitis


• immune response
but
individual susceptibility to periodontal
destruction is more important than age
Endodontic Challenges

- Narrow canals

-Sclerosis - where does it start?

- Canal location

- Canal preparation

-Bonding to dentine
Age Changes - Dentine
increased intra-tubular dentine
• dentine thickness

• pulp chamber depth

• sclerosis of canals

• root canal width


Effects of Dentine Age Changes

• difficulty vitality testing


• difficulty pulp chamber location
• difficulty canal location and negotiation
Age Changes - Pulp

• number of blood vessels


• diameter of blood vessels
• nerves
• fibroblasts
• pulpal calcifications
Effects of Pulpal Age Changes

? Reduced reparative capacity of pulp

? reduced effectiveness of vital pulp therapy


• Increased difficulty vitality testing

• Increased difficulty in canal negotiation


Other Changes With Age
• apical thickening of cementum
→ affects working length estimation
0.5mm – 0.8mm (Kutler et al)

Increased restorations or tooth breakdown


More difficulty in chamber/canal location
Endodontic Challenges
Questions??

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