gerodontology baru.ppt

8/13/2019 gerodontology baru.ppt

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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 doublingbetween 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 beforean increasing in the

proportion of very old needing health

service


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Elderly diseasesdegenerative diseases such

as hypertension, arteriosclerosis , DMand 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(RNAprotein/enzyme)led to the wrong formation of an enzyme

reactionwrong 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 post- translationalreducing 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 theelderly


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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 severalmetabolic processes


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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

WHO ARE ELDER PEOPLE ???


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c. Frail older peoplevulnerable as a result of health problems such as:

- stroke or dementia

- social care needs

- combination of both

The transition through three phase is not age-

dependent


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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: self-sufficient 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 reservesbut can be minimized by

external supports


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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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Owing to age-related systemic diseases and

functional changesmore vulnerable to oraldisorder

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 injuryIndividuals 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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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

Teeth


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The age-associated decrease in tooth sensitivity

can be atributed to secondary dentinformation

Pulpa proportion and cementum thickness

decrease with advancing age

The pulp space may be entirely annihilated by 75

years of ageThe 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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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 andfewer 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.

Dental caries and tooth loss


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Gingival recession , loss of periodontalattachment and alveolar bone

The frequency of occurence and severity of

periodontitis

The bacterial composition of periodontal pocketis altered as gram + facultative cocci ,

gramanaerobic rods

Momentous attachment losstooth mobility can

lead to tooth drifting and occlusal

interferencesMedical problems and medications may have a

hazard effect on periodontal health

Periodontium


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Streptococcus mutans, Lactobacillus ,

Porphyromonas gingivalis, Treponema

denticola, Staphylococcus aureus andStreptococcus 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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The drugs commonly implicated in xerostomia areantidepressants, antihypertensives,

antiparkinsonian drugs, antipsychotic and

antihistaminis

Edentulous patients have higher salivary

immunoglobulin A, immunoglobulin M, amylaseand 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, blackhairy tongue, atrophy of fungiform and filiform

papillae, angular stomatitis and oral

hyperpigmentation .

These change may signal underlying nutritionaldeficiencies of iron, antioxidants as well as

vitamin B


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A number of ulcerative and vesiculobullous

conditions .

Denture-related irritation, accidental biting andsharp dentalthe chief causes

Lichen planus, pemphigus vulgaris, cicatriciai

pemphigoid

Allergic reaction often manifest in the oral cavity tosome 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-gradeirritation 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 infectionthe most common oral infection

Post herpetic neuralgia occurs more commonly in

the elderly patients and may last for months

or even yearsCandidiasis 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 andmigraine constitute the extra oral

disorders


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Emergency crises during treatment may beprecipitated by : hypertension

anticoagulation therapy

hypoglycemia

Infection of replaced joints and cardiac prostheticvalve may be avoided by antibiotic

prophylaxis prior to dental procedures in

feeble elder

Dental health management in the elderly


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Precise health problem management withtreatment of oral diseases:

drugs with a long duration of action and

those with eminent central nervous systemeffects 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 ionomerrecently 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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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

- 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 stomatit

- 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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gerodontology baru.ppt

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