Aging and

the Periodontium
Effect of aging on
the periodontium
Gingiva
Gingival epithelium
Gingival connective tissue
Periodontal ligament
Cementum
Alveolar bone
Salivary glands
 Gingiva
Gingiva is a keratinized stratified squamous
epithelium.

It is pink colored, shiny and moist in

younger, healthy populations.

It is tough, also it resist abrasion.

The gingiva is that part of the masticatory
mucosa which covers the alveolar process and surrounds
the cervical portion of the teeth. It consists of
an epithelial layer and an underlying connective tissue
layer called the lamina propria.
Two parts of the gingiva can be differentiated:
1. the free gingiva (FG)
2. the attached gingiva (AG)
The attached gingiva is in apical
direction demarcated by the mucogingival junction (MGJ).
Age changes of the oral
mucosa shows:
Smoother and drier surface.

Decrease in vascularity & salivary flow.

Thinner epithelium with more flat
ridges.

Decrease No. of Langerhanse cells; thus

decreasing the cell mediated immunity.

Decreased cellularity and vascularity of

lamina propria with increase of
collagen fibers.
Fordyce's spots increased with age
at the buccal & labial mucosa.

Eldery persons may complain from

xerostomia, alteration in taste &
burning sensation.
 Gingival epethelium
Thinning and decrease keratinization have been
reported.

Which could mean increase in epithelium

permeability to bacterial antigen.

Decreased resistance to functional trauma.

such changes could influence long-term periodontal
treatment.
Aging lead to apical migration of the
junctional epithelium with accompanying
gingival recession,

Alternatively,the migration of the junctional

epithelium to the root surface could be caused
by the tooth erupting through the gingiva in an
attempt to maintain with its opposing tooth
(passive eruption)
as a result of tooth surface loss from attrition
(f-1)
Aging and the
Connective tissues
Increasing age result in coarser and denser
connective tissues.

Qualitative and quantitative changes to collagen

include an increased rate of conversion of soluble
collagen to insoluble collagen.
Increased mechanical strength.

Increased denaturing temperature.

These results indicate collagen

stabilization caused by change in the
macromolecular conformation.
Periodontal
ligament
A soft specialized C.T forms shortly
after root formation.

Its width ranged from 0.15 to

0.38mm with its thinnest portion at
the middle third of the root
Average width 0.21mm in adolescents
life; progressively showing a decrease
with age with an average 0.15 in elderly
patients.

PDL is a well vascularized, which

reflects the high rate of TURNOVER of
its cellular & extracellular constituents.
By age there is:

Apical migration of the junctional epithelium, causing

detachment of the cervical fibers of PDL.
Decrease vascularity.
Thinner PDL ; as it decreases in its activity,
Presence of Cementicles, which may fuse
into large calcified masses or they may be adherent to
the Cementum {exocementosis}
Aging cause decrease number of fibroblast
with a more irregular structure, paralleling the
change in the gingival connective tissues.

Other finding include:

Decrease organic matrix production and
epithelial rests and increase amounts of elastic
fiber.

Changes in the periodontal ligament width.

Cementum
Hard, Avascular connective tissue
that covers the root of human teeth.

Normally; it is light yellow in color. It has a thickness

ranged about 50 µm at cervical margins CEj, gradually
increases in thickness
as it progress apically to about 200 µm.

Acellular afibrillar Cementum is limited to the cervical

Enamel surface.
Cellular cementum is confined to the apical
portion.

Mixed cementum appears at tooth apex &

bifurcation areas.
It has a functional adaptation rule in response to
occlusal wear. Periodic formation cementum
occurs; as a new layer of cementoid is formed, the
old one calcified.
Cementum is more resistant to resorption than
bone.
Portion of a root with adjacent
periodontal ligament (PDL). A thin layer of acellular,
extrinsic fiber cementum (AEFC) with densely packed
extrinsic fibers covers the peripheral dentin. Cementoblasts
and fibroblasts can be observed adjacent to
the cementum
Scanning electron micrographof AEFC.
Note that the extrinsic fibers attach to the
dentin (left) and are continous with the collagen fiber
bundles (CB) of the periodontal ligament (PDL)
By Aging:
Surface cementum become more irregular.
Greater amounts of cementum found at the
apical region.
An older root surface is less populated with
PDL bundles than a young one.
Cementocytes only at the surface appear
viable; while all other lacunae appear empty.
Alveolar process
Developed after root formation, near the end of the 2nd
month of fetal life.
During growth, when it is formed in fetal life; alveolar bone
is in the form of irregular woven bone.

Later, when teeth erupt, alveolar bone gradually take its

adult form and is made up of interior zone of cancellous
bone embedded in a cortical layers of
dense bone becoming fine-fibered Lamellar bone
Continued presence of alveolar bone require continued
presence of tooth; surrounding & nourishing it
alveolar process (arrows).
Note how the bone on the incisor and premolar regions, the
bone plate at the buccal
and lingual aspects of the alveolar process buccal aspects of
the teeth is considerably thinner than varies in
thickness from one region to another
The old bone reveals:
The alveolar socket appear Jagged and
Scalloped.
Bone marrow appears to have a fatty
infiltration.
Osteoporosis refers to loss of some bony
elements.
Internal trabecullar arrangement is more open,
indicating much bone loss
Decreased vascular supply and cellular
activity in the bone.

Decreased bone remodeling process.

Loss of single tooth, or many teeth is

coupled with resorption & loss af the
alveolar bone surrounding.
Salivary glands
Major salivary glands develop during 6th to 8th
week I.U .

Parotid gland first appears, Submandibular,

sublingual, & minor gland follows.

Parotid & Submandibular gland secret saliva by

a nerve mediated harmony which is altered with
aging. Sublingual & minor salivary glands
spontaneously secrete saliva 7%.
All the components constituting the
major and minor salivary glands
show age changes, which occur mainly
in the following manner:

The terminal portions

the No. of the secretory ends decreased from
the age of 40
serous acini may be replaced by mucous or
fatty cells
Atrophy, partial or complete of a
terminal portion of a lobule may be
replaced by fibrous tissue as secretory
cells decreases in height & width, the
lumen of the same terminal portion
decome wider.

The nuclei of such cells show pyknosis

and their cytoplasm are faintly stained
with the appearance of lipoid
inclusions.
The duct system
most of the intercalated ducts may
disappear due to the transformation of
the cells epithelial lining into secretory
cells, which are mostly mucous.
The striation of some striated ducts
may may disappear also or become
less conspicuous.
Epithelial lining of the excretory
ducts may undergo metaplasia.

Some duct walls become thin with

excessive fibrous connective tissue
around them.

Some ducts with large lumen show

stagnated mucous secretion.
the connective tissue of
the salivary glands
Connective tissue encapsulating the the parotid
and Submandibular glands become

thicker, showing fatty inclusions and a large

No. of chronic inflammatory cells

There is an increase in the fibers of the salivary

glands, especially around the duct system
Bacterial plaque
Dentogingival plaque accumulation increase with
age as a result of increase in hard tissue surface area
resulting from gingival recession , and the surface
characteristics of the exposed root surface as a
substrate for plaque formation compared with
enamel.
Effect of aging on the
masticatory efficiency
Slight atrophy of the musculature.

Reduction of efficiency due to loss of teeth,

or poor replacement.

Poor chewing ability associated with,

digestive disorders and dietary changes.

May develop avitaminosis.

Effect of aging on the
masticatory efficiency
Slight atrophy of the musculature.

Reduction of efficiency due to loss of teeth or poor

replacement.

Poor chewing ability associated with digestive

disorders and dietary changes
May develop avitaminosis.
Cumulative effects of aging
Important to differentiate pathology
from the aging process.

Increased plaque accumulation due to architecture, medication a

reduction in immune response.

Inflammation develop more quickly and

wound healing more slowly.

Rapid form of periodontal disease seen in young people while

older individuals suffer from
more slowly progressive forms.
General features of aging
found in all tissues
Tissue desiccation.

Diminished reparative abiliy.

Reduced elasticity.

Altered cell permeability.

Aging and tooth-
periodontium relationship
Loss of tooth substance due to attrition
Reduction in cusp height and inclination
due to wear.

Bone loss result in increase in crown /root ratio

Tooth wear tend to modify increase
in crown /root ratio.
Wear on proximal surfaces results in
physiological mesial drifting.

Most pronounced wear in teeth that taper

towards the CEJ (incisors).

Reduced maxillary/mandibular molar

overjet and edge to edge bite anteriorly.
Thank u