Introduction

Ageing is the irreversible, inevitable change that occurs with time. Ageing involves morphological and functional changes that lead to functional impairment. It is universal, progressive and deleterious. Age changes in the oral structures play a significant role in diseases, their treatment and prognosis.

Age changes in enamel

Macroscopic changes includes

• Attrition or wear of occlusal and proximal surfaces due to mastication – structural loss in facial and lingual surfaces is more rapidly than proximal surfaces; anteriors more rapidly than posteriors.

• Loss of perikymata completely

• Enamel become darker from white to yellowish white due to loss oif enamel rods thereby affecting the reflection of enamel.

Microscopic changes includes

• Fluoride and nitrogen content of enamel increases while water and organic content decreases – leading to increased resistance to decay.

• Due to increased size of crystals, there is the decreased permeability of fluids (decreased pores)

Age changes in dentin

• Increase in number of dead tracts

• Increase in sclerosed dentin

• Increase in reparative and reactionary dentin

• Reduced vitality of dentin

Age changes in pulp

• Cellular changes: decrease in size and number of cell organelles; fewer cells

• Fibrocyte/ fibroblast: decrease in perinuclear cytoplasm with long, thin cytoplasmic process.

• As ages, fibrosis occurs

• Vascular changes: atherosclerotic plaques; increased collagen fibers; calcification of blood vessel walls

• Endothelium shows increased pinocytic vesicles, microvesicles, microfilaments

• Blood flow decreases with age

• Formation of pulpal stones or denticles

• Diffuse calcifications of pulp.

Age changes in cementum

• Cementicle formation – calcification of degenerated PDL or epithelial rests of Malassez; it can be free, attached, embedded

• Hypercementosis – cementum hypertrophy if the overgrowth improves the function of cementum; cementum hyperplasia if it is not corelated with function

• Reduced permeability

• Cementum resorption – after trauma or excessive occlusal forces. It is followed by repair

• If repair establishes the former outline of root – anatomic repair; if only a thin layer of cementum is deposited – functional repair

Age changes in periodontal ligament

• Decreased cell number

• Decreased cellular activity

• Cementicle formation

Age changes in alveolar bone

• Bone resorption

• Fatty infiltration of the marrow

• Loss of maxillary bone due to invasion of sinus

• Loss of internal trabecular arrangements – bone is more porous and fragile.