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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TERIMA KASIH
SEMOGA BERMANFAAT
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