Ageing & Its Effects on teeth

Ageing is a normal, genetically dictated physiological process. Sixty-five years was selected as the dividing line between middle-aged and elderly individuals by Germany in 1880s & United States in 1900s; people above 65 are termed as geriatric. Any citizen above 60 is considered as a ‘Senior Citizen’ or ‘Elderly’ in India.

There is a gradual 2.3% increase in the population of those 65 years or older. Currently, there are about 600 million people aged 60 years or older; this figure is expected to double by 2025. India has a vast population of more than 1.2 billion and around 100 million elderly in 2012, and the number is expected to increase by 323 million by 2050. It is constituting 20% of the total population of our country.

As dentists, we mainly provide dental treatment in the form of preventive and restorative measures to the elderly. The preventive measures include enforcing oral health-maintaining behaviour such as toothbrushing twice daily, use of fluoride toothpaste, daily interdental cleaning and avoidance of sugar.

It is highly recommended that geriatric patients make dental visits at least every six months for clinical re-evaluation irrespective of their dentate status. The restorative measures include restoring jaw structures, gingival margins, discoloured teeth, missing teeth, etc. So, while we are at it, let us see the age-related oral changes the elderly group of patients undergo.

Age-related Oral Changes

Teeth

Tooth gets affected due to wear and attrition; colour gets altered due to changes in dentin thickness, loss of translucency and pigmentation of anatomical defects. The changes in enamel include attrition, erosion, abrasion, fluoride content increases, enamel cracks and enamel lamellae increase. The changes in the dentin are due to the pathologic effect of dental caries, abrasion, attrition or other operative procedures leading to the formation of reparative dentin, dead tracts and sclerotic dentin.

In the case of pulp, there is a reduction in the size of the pulp chamber and the number of cells. There is an increase in collagen fibres, narrowing of blood vessels, degeneration and loss of nerve fibres and pulp calcifications. An increase in cementum thickness at the root is seen by 5 to 10 times with increased incidences of hypercementosis.

Periodontal Ligament

An increase in the number of fibroblasts with more significant collagen and elastic fiber content, by contrast, a decrease in organic matrix production. The width of the periodontal space increases with occlusal loading.

Alveolar Bone

As we age there is thinning of cortical bone, increase in porosity, loss of trabeculae, cellular atrophy and sclerosis. In the case of the maxilla, maxillary teeth are directed downward and outward due to which bone reduction is upward and inward. The resorption on the outer cortex is more significant and more rapid because the outer cortical plate is thinner than the inner cortical plate.

Thus, the maxilla becomes smaller in all dimensions and the denture bearing area decreases. Whereas the mandibular ridge resorbs primarily on the crest of the ridge leading to a reduction in the residual ridge height. As a result, the mental foramen lies at or near the level of the upper border of the ridge. The genial tubercles appear projected above the upper border of the mandible in the symphyseal region. The cortical bone at the angle of mandible becomes thinner.

Oral Mucosa

Oral mucosa in the elderly turns thin, smooth, dry-satin like with the loss of elasticity and stippling making it more susceptible to injury and decreased repair potential. The gingiva loses stippling and becomes edematous in appearance. Due to the thin keratinized layer, gingival tissue is easily injured. Gingival recession and loss of periodontal attachment are common findings.

Salivary Changes and Challenges

Salivary flow reduces due to salivary gland atrophy. There is a decrease in ptyalin and increase in mucin. The viscous and ropy saliva results in plaque formation and growth of cariogenic bacteria. Xerostomia is a common finding either due to systemic disease, medications or therapeutic head and neck radiation.

Tongue and Taste Changes

The tongue has a smooth, glossy or red and inflamed appearance with disturbed taste sensation. Soreness and burning sensation are commonly encountered in post-menopausal women. Another common finding is the presence of varicose veins on the ventral surface of the tongue.

Mastication and Deglutition

In partially or fully edentulous patients, the masticatory ability further decreases. Biting force is said to be decreased by 16% of its original value in older patients. Ultrasound imaging studies have assessed that the oral and pharyngeal phases of swallowing are longer in the elderly than younger adults.

Common Oral Disorders in Older Adults

  • Oral Mucosa Cancers, Vesiculobullous, Ulcerative, Inflammatory diseases
  • Dentition Root caries, attrition, fracture/chipping
  • Periodontium Gingivitis, Periodontitis, abscesses, tooth loss.
  • Salivary Glands Hypofunction, Cancers
  • Sensory Function Olfactory dysfunction, Dysgeusia
  • Motor Dysfunction Dysphagia, aspiration, masticatory muscle weakness
  • Pain Sensation Atypical facial pain, Burning mouth syndrome, Trigeminal neuralgia, TMDs
  • Prosthesis Atrophic mandible, ill-fitting dentures, inflammatory lesions secondary to ill-fitting dentures, poor denture hygiene

Special Considerations

Geriatric patients should be explained about the treatment plan in simple language. Begin with the most critical information to be conveyed first and try to limit new information as much as possible. Write instructions in a language understood by them or their caretaker and provide useful educational material. Use teach-back method to confirm patient understands.

Teach–Back Method: Confirmation of Understanding

Do not ask a patient “Do you understand.”

Ask the patient to explain or demonstrate

Avoid closed-ended yes/no questions, instead, ask questions that begin with “How” and “What.”

Information should be organised such that the most important points stand out and repeat this information.

Conclusion

Older adults are the most rapidly growing segment of the world population. Hence, dentists must possess the knowledge to manage older adults, age-related oral changes and the common oral disorders affecting the elderly to enhance their quality of dental treatment.

References

  • Dhankar K, Ingle N A. Geriatric Dentistry: A Review. J Oral Health Comm Dent 2013; 7(3)170-173
  • Issrani R, Ammanagi R, Keluskar V. Geriatric Dentistry – Meet the need. Gerodontology 2012; 29: e1–e5
  • Greenberg MS, Glick M, Ship JA. Burket’s Oral Medicine. 10thed. New Delhi: CBS
  • Greenberg MS, Glick M, Ship J A. Burket’s Oral Medicine. 12thed. New Delhi: CBS

Ozone in Dentistry – A Paradigm Shift

Abstract

Today we are suffering from one problem or another repeatedly. Given this situation, how would it sound if someone says that one can cure any health hazard by using some home ingredients after following some small procedures? Wouldn’t it be great? This article will elaborate on how to prepare a one stop solution for your problems – ozonated olive oil – at home, its benefits and also its application in dentistry.

Introduction

Ozone is basically a protective shield of earth which protects us from harmful UV radiations. It also helps to control air pollution. Symbol of Ozone is O3 .It contains three atoms of oxygen molecules. We all have felt many a times, a particular fresh smell after every rainfall – that is because of Ozone only. The first Ozone generator was developed by Werner Von Siemens in Germany in 1857 and in 1870 there is the first report therapeutically of Ozone being used to purify blood by C Lender in Germany. In 1881, certain evidences were found for use of Ozone as a disinfectant which was mentioned by in a book on Diphtheria. The world’s first water treatment plant using Ozone was installed in Ousbaden Holland in 1893. Ozone was used medically to treat wounds and other infections during World War 1. The name ozone was given to a gas (a Greek word that means “smell”) by the German chemist Christian Frederick Schonbein of the University of Basel in Switzerland 1840 (Seidler et al.; Veranes et al., 1999).2

Medical grade Ozone is a mixture of pure of three atoms of oxygen versus two atoms in a normal oxygen molecule.1 Due to presence of this extra oxygen atom, Ozone has anti-microbial properties, it act as a stimulator for immune system, act as a analgesic, has anti- hypnotic properties, antibacterial and anti-fungal properties.

Due to its properties, it is used for sterilisation and disinfection. It is nowadays used in every field including medical, veterinary and dental field also. Ozone has these amazing properties due to which dentists are ready to transform and become the part of revolutionary ozone therapy by using Ozone in very controlled application.

Generation of Ozone

There are three different systems of generating Ozone gas.

  1. The Ultra violet system which produces low concentrations of Ozone used in aesthetics and air purification.
  2. Cold plasma system used to purify air and water.
  3. Corona discharge system produces high concentration of Ozone. 1

The bacteria and viruses lack protective layers. So Ozone can easily penetrate and play a role of antibacterial property here. Whereas, healthy normal cell contain their protective layers, so Ozone causes no harm to it. The ozone oxidant potential induces the cellular walls destruction and cytoplasmic membranes of bacteria (Thanomsub et al., 2002). 2

How to make ozonated Olive Oil at home?

Yes, it’s possible to prepare Ozonated olive oil at home. For this, high quality extra-virgin oil is required. This extra-virgin olive oil is putting through the process of ozonation. Because Ozone is hard to stabilize, passing it through a tight container with lead helps, after which Ozone gas begins to stabilize in olive oil. An Ozone generator is required ideally to create Ozonated olive oil because Ultraviolet machines are not quite strong and effective to prepare Ozonated olive oil. Place olive oil in the glass jar or in a container that comes along with generator. The jar should be connected to the generator and should be covered before the generator is turned on. Initially tiny bubbles will appear on the top of jar which signifies the process of Ozonation has begun. This process is time consuming and when the color of the olive oil becomes clear and thick, it indicates the complete formation of Ozonated olive oil. This Ozonated olive can be stored easily.

Among the various systems of ozone production, coronal discharge system is used for the production of ozone gas in ozone generator. It releases high concentration of oxygen which is required for antimicrobial and healing properties in medical and dental field. The other system of ozone production is cold plasma system, ultraviolet system, electrolyte system which is low concentration ozone generation (below 2 ppm) used for air purification and water purification and not same as coronal discharge. So, Coronal discharge system is comparatively much batter then others.

Properties of Ozone

  • Immunostimulator
  • Antimicrobial
  • Disinfectant and used in sterilisation
  • Analgesic
  • Anti-inflammatory and natural antibiotic
  • Ozonated olive oil can be use for cosmetic purpose and has a fast healing effect.

Various forms used in Dentistry

  1. Gaseous Ozone: Gaseous form is used to sterilise instruments, disinfection of instruments and surfaces, sterilisation of lesions, cavities & in RCT, for air purification in clinic.
  2. Injectable ozone: This form is used for fast healing in surgeries cases, trauma, implant placements, fracture, large lesion, intralesional injections, submucosal injections.1
  3. Aqueous: This form is used to purify water, as a carrier medium for grafts, hair follicles.
  4. It replaces antibiotics and analgesics
  5. Ozonated activation of NaOCL, EDTA, grafts at site in oral cavity, activation of grafts during hair transplants.

Application of Ozone in Dentistry

  • Periodontics: It is used for complete oral prophylaxis which includes scaling and root planing. It can be recommended for patients to cure hypersensitivity and as a mouth rinse also. In periodontal diseases, the gingival, sulcus and pocket depth can be irrigated with ozonated water and ozonated gas . For some lesions, ozonated oil is recommended for topical application. Single visited inflamed lesion can be cured.
  • Aesthetic dentistry: It is used for topical application on scars of skin for effective healing. It is used as a hemostat, to control bleading during surgical procedure and to disinfect cavities and margins of the lesion.
  • Endodontics: Ozonated water can be used to irrigate the canals. To sterilise the canal ,ozonated olive oil works efficiently. Infected canals with complete remission of periapical lesion is also treated with ozonetherapy. With its direct application it prevent caries on tooth,which is applied with the help of silicon cups.1
  • Oral surgery: No worries after extraction, because of ozonetherapy! It accelerates the process of healing after surgical procedure without complications. In case of noninvasive surgical procedure, pre and postsurgical cycles of Ozone therapy can be conducted. These cycles consist of eight sessions lasting for about 3 minutes each. Besides this, its antibiotic and anti fungal therapies have been applied for the treatment of bisphosphonate induced osteonecrosis of jaw.1
  • Prosthodontics: In case of edentulous patients, to cure the ulcers because of impingement of denture, ozone gives magical effects if topically applied. Ozone is also used to disinfect the denture due to it properties. Also ozonated water is used to disinfect the crown and bridges. To prepare a vital tooth, as a desensitizer, ozone can be use.
  • Oral medicine: It provide relief from ulcerated oral mucosal lesions. Intralesional injection and topical application both gives positive results. It is used as a carrier medium to carry a graft for biopsy and further surgical procedures.
  • Orthodontics: During orthodontic treatment there are more chances of caries as there is more chance of food accumulation. To prevent caries, patients are given mouth rinses with ozonated water.
  • Implants: It is used to disinfect the surgical area and surgical instruments as well. After the surgical procedure, a controlled amount of ozonated oil is used and applied on the surgical area. It promoted the healing without complications. In case of peri-implantitis, ozone therapy is indicated as it have antimicrobial, antibacterial properties. A study of gaseous Ozone showed the selective efficacy to reduce adherent bacteria on Titanium and Zirconia implants without any interferences in their adhesion properties. It also induced proliferation of osteoblastic cells. Ozone eliminates Porphyromonas gingivalis from all surfaces with in 24 sec to below the detection limit (99.94%), while Streptococcus sanguis showed the highest reduction on zirconia substrates (90%) and was more resistant. 3

Conclusion

Ozonated oil has some amazing properties and gives excellent results. It is used in every field related to human care and medical science due to its unique properties. All its properties are due to the presence of enriched oxygen. Ozonated olive oil even can be prepared at home. By using ozone therapy in dentistry, treatment time is reduced and side by side it reduces the complications along with fast healing effect on the operating site. This new era of ozone world may change the way we treat patients in the future.

References

  1. Komali G. Ozone Therapy-A Revolutionary Noninvasive Therapy in Dentistry. Open access Sci Rep.2012:1(10):1-3.
  2. German I, Rodrigue A, Andreo J, Pomin K et al. Ozone therapy in dentistry: A systematic review. Int. J. Odontostomat.,2013:7(2):267-278.
  3. Hauser-Gerspach I, Vadaszan J, Deronjic I, Gass C, Meyer J, et al. Influence of gaseous ozone in peri-implantitis: bactericidal efficacy and cellular response. An in vitro study using titanium and zirconia. clin Oral Investig 2012:16: 104-59.

 

Changing your mouth and teeth with age

Changing your mouth and teeth with ageChanging your mouth and teeth with age

Over time, there is loss of brightness and cracks in the enamel. Teeth also tend to turn yellow and wear away as a result of attrition, erosion or abrasion. With wear, the dentine of the tooth is more and more exposed and can cause hypersensitivity.

Gums and alveolar bone

With age, the gum loses its elasticity and becomes thinner. These changes make it more susceptible to bacterial infections and loosening (recession) thus helping to bare the roots of your teeth. This exposure of the roots can lead to dentin hypersensitivity.

The bone, for its part, may show signs of resorption thus giving less support and support to the tooth.

Mouth mucosa, cheeks and tongue

Becoming thinner and slimmer, they are more vulnerable to ulcers, trauma and different infections. The ability to heal is also slower.

Saliva

Saliva has antibacterial and antifungal properties. The older we get, the less saliva we produce. This decrease in salivary flow may result in difficulty swallowing, chewing and digestion, impairing your speech and causing dry mouth (xerostomia). This lack of saliva can also be accentuated by various medications or treatments (radiotherapy), mouth breathing and certain diseases. In addition, xerostomia increases the carious risk.

Well sealant and cracks

If you look closely in your child’s mouth, it is possible to notice cracks on the top of the permanent molars and premolars. The presence of these furrows causes food debris and bacteria to accumulate more easily and promote the formation of tooth decay.

Preventative application of sealant inside pits and crevices helps protect the tooth against attack by decay-causing bacteria. For good dental hygiene, we recommend that you combine this process with the daily use of dental floss, as well as regular brushing.

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DISCLAIMER : “Views expressed above are the author’s own.”

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