Aging Introduction and Overview

Destructive periodontal disease has been consistently associated with aging that many came to see it as an inevitable consequence of growing older. Most studies from the early days found a close association between age, periodontal disease and tooth loss. Recent research has questioned the association between age and periodontitis. With age, some gingival shrinkage and loss of periodontal attachment and bony support are expected, but age alone in a healthy adult does not lead to a critical loss of periodontal support. Severe periodontitis should not be regarded as a natural consequence of aging.

Burt, B. Periodontitis and Aging: reviewing recent evidence. JADA. 125: 273; 1994.

This is a review article that examines the most recent epidemiologic and clinical research to define the role of aging in adult periodontitis. It concludes that some loss of periodontal attachment and alveolar bone is to be expected in older persons, but age alone in a healthy adult does not lead to a critical loss of periodontal support. Although moderate loss of alveolar bone and periodontal attachment is common in the elderly, severe periodontitis is not a elderly, severe periodontitis is not a natural consequence of aging. Early study of periodontal research found a close association between age periodontal disease and tooth loss. But the data were aggregated and cross-sectional. Recent research has questioned the association between age and periodontitis.

Loss of alveolar bone and periodontal attachment

• In all cross-sectional studies show more severe condition in older population, such as 1985-5-6 National survey of oral health in U.S Employed adults and seniors.
• 1980's Swedish report: no more than 8% in each 10-year age group in Swedish population showed evidence of severe periodontitis. The small proportion with severe disease in the older age was only slightly higher than in the younger.
• Piedmont study in North Carolina LPA was more extensive in persons aged 65 or older. But only 15% of persons aged 70 or older had one site with LPA of 7 mm or more.
• Age is a risk indicator in cross-sectional studies or a predictor in longitudinal studies.
  But reported by Halling and Bjorn found that radiographic bone loss was slightly less in older women than in middle-aged women during the 12 years study in Swedish women.
• Hunt, in a 18-month Iowa Rural Health study reported that periodontal conditions were weak predictors of tooth loss.
• In a 15-year longitudinal study 480 tea workers in Sri-Lanka showed a wide range of susceptibility to periodontitis. This group had no dental treatment.
  8% rapid, 81% moderate, 11% no progression.
  This study showed LPA became severe only for a small group, age was much smaller factor

Probing pocket depth

• Christersson studied 508 adults in N.Y. age was correlated with supragingival plaque but less related than gender, race or presence of periodontitis. No correlated with subgingival calculus.
• Goodson's model: adult periodontitis that began with shallow pockets in early adulthood, LPA mostly increase by recession without further pocket deepening.
• 1986 study of Sheiham, et al. Revisited a group of English factory workers 14 years after initial exam and found peridental index scores better because of improved O.H.
• National health and Nutrition Exam survey, age was a less important determinant of perio status in the elderly than was O.H.
• NIDR analysis of an 1981 survey, deep pockets were no more extensive in people over 65 than in middle-aged groups.

Discussion

• Page stated that periodontitis in most elderly is slowly progressing, begins in early adulthood and progresses slowly.
• Individual susceptibility is more important than the age effects.
• Age alone in not a major factor in severe periodontitis.
• S.D of LPA measurements is about 0.8 mm. So LPA change needs to be at least 2 mm to be significant rather than error. But this level of LPA is so common.
  Therefor 2-mm level of LPA as a threshold for 'disease' not fruitful.
• Longitudinal studies for perio risk factors are difficult to do.

Conclusion

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