Prevalence of periodontal disease among the elderly in India
The prevalence of periodontal disease was found to be increasing with age.
- 79.9% of elderly patients in India was found to have some form of periodontal disease.
- Moderate periodontitis was seen in 21.4%, in the 65-74 years group; whereas severe disease, defined as at least one tooth with ≥6 mm probing depth, was seen in 18.1% in the 65-74 years group.2
Enhanced susceptibility to periodontal disease in the elderly
Numerous changes occur in the tissues of the periodontium with increasing age. When the microbial plaque can accumulate, the elderly person accumulates more and develops gingival inflammation more rapidly and more severely than do younger individuals. This observation and the high prevalence of periodontitis among the elderly have led to the idea that the periodontium of the elderly is more highly susceptible to microbial challenge and destruction than is that of younger individuals.3
The Connection between Physiological changes and Periodontal disease in the elderly
Age-related alterations are present in the periodontium, and these must be differentiated from true oral/dental disease. Age alone does not cause critical periodontal attachment loss. 4
There are several significant physiological changes in the body that can lead to worsening periodontal disease4
- There is an arrest in proliferative capabilities of cells, the oral epithelium is thinning, and there is less keratinization, with fibroblast alteration and less production of collagen.
- The blood supply to the dental structures is degenerative, and there are signs of arteriosclerotic changes.
- The periodontal ligament space gets narrower with less organized periodontal fibres, less cellular presence, and areas of calcification.
- Type I collagen, the most abundant protein in the periodontium, decreases with age.
- Decreasing mineral density in the alveolar bone and remodelling activity due to less osteoblast chemotaxis and less osteoclast differentiation.
- Aged periodontal tissues show important deficiencies in the wound healing response
- Tissues damaged from the inflammatory process will not get restored in the proper way.
The effects of periodontal disease are usually found to be more severe in older ages. This can be mainly due to biological alteration of the tissues and immune response or indirectly via physical, cognitive, and socio-economical impairment.4
Changes in salivary glands and salivary secretion with ageing
With age, there is a decrease in the function of the salivary gland. The implications of disordered salivary gland have a major impact on the maintenance of oral health. Saliva helps In the protection of the oral cavity and facilitates numerous sensorimotor phenomenon. However, the absence of saliva can have many deleterious consequences to the host.5
With increasing age, there are several changes in the salivary glands5
- There is atrophy of acinar tissue
- The proliferation of ductal elements
- Some degenerative changes in both the major and minor salivary glands
This causes a normal, uniform decrease in the acinar content of salivary gland tissue.
This is most common in old age because high proportions of older adults take at least one medication that causes salivary dysfunction. The drugs which can cause dry mouth are6
- Tricyclic antidepressants,
- Beta-blockers and
Thus, the complaints of dry mouth are particularly frequent in those treated for hypertension, psychiatric or urinary problems.6
Systemic sequelae of periodontal disease in older adults
The presence of periodontal disease can affect the body in two ways:
- Dissemination of bacteria into the bloodstream and
- Through the effect of inflammatory mechanisms.
However, systemic diseases can also affect the oral cavity and vice versa.
The mechanism by with it affects periodontal health
- Diabetes and periodontal disease have a bi-directional relationship
- Diabetic patients have an increased predisposition to the manifestation of oral diseases, which is associated with poor glycaemic control and therapeutic dentures.
- The increased glucose level in the oral fluids makes it a breeding ground for microbes.
- Dental plaque can act as a reservoir of respiratory pathogens, especially in patients with periodontal disease.
- Respiratory infection depends on the aspiration of oropharyngeal flora into the lower respiratory tract and failure of host defence mechanisms to eliminate the contaminating bacteria, which then multiply to cause infection.
- Periodontal infections can aggravate the pathogenesis of atherosclerosis and thromboembolic events by providing repeated systemic challenges with liposaccharides and inflammatory cytokines.
- Streptococcus sanguis and Porphyromona gingivalis infection induces platelet aggregation and activation and can lead to atheroma formation and thromboembolic events
- Bacteria from periodontal pockets can enter the bloodstream and trigger systemic inflammation.
- These inflammations can be an indicator of stroke risk
Periodontal treatment planning for the elderly
The main end goal of periodontal treatment in the elderly is to
- To preserve function
- Eliminate or prevent the progression of inflammatory disease and
- Providing comfort, function, aesthetics, and ease of maintenance of oral health
Guidelines for the treatment of periodontal disease in older adults
Periodontal infection and inflammation diminish oral function, reduce the quality of life, imperil nutrition, and increase the patient’s risk of developing several chronic systemic diseases. Many research says that older adults generally respond to periodontal therapy similar to the way younger adults do.11
Therefore, it is vital to carefully review the patient’s medical history and prescribe medicines judiciously to prevent unwanted drug interactions.11