NMDA Journal Summer 2018

18 New Mexico Dental Journal, Summer 2018 By: Charles Tatlock, DDS, MPH You examine an 85 year-old in your office. You sit her in your examination chair, pick up your dental mirror and take a look inside her mouth. What do you see? Chances are you may see some natural teeth. The condition of her oral health is perhaps another story. As opposed to previous generations, an increasing number of “well elderly” are able to retain their natural teeth and enjoy normal oral function throughout old age. During the past 50 years, one of the major changes in patterns of oral disease in the United States has been a steady decrease in the rate of edentulism. It is likely that, for the first time in recorded history, there are now more older adults with natural teeth than without teeth.  1 What we know is that a number of significant physical changes occur during aging. Fortunately, most of these normal changes do not cause oral diseases.  1, 2 Instead, it is the cumulative effects of both oral and systemic diseases that result in the prevalence of oral disease among the elderly.  1 The current Baby Boomer generation (those born between 1946 and 1964) is becoming increasingly aware of the fact that oral health is important, both in terms of one’s general health status and the effects of oral health on physical appearances and the development of positive self-concepts.  3 Aging has an impact on oral tissues just as it has on other tissues throughout the body.  4 As teeth age, the enamel, dentin and pulp undergo progressive changes. The enamel becomes less hydrated (drier). In addition, the thickness of the enamel decreases as enamel is lost from abrasion and attrition (Fig 1). Dentin changes more profoundly over a lifetime. The dentin volume expands into the pulp chamber as secondary dentin forms in response to decay and mastication. Microscopically, it is noted Oral Changes Associated with Aging Fig 1—Age related changes to natural dentition. Attrition of dental enamel, cervical erosion at the gumline, with accompanying exposed dentin and cementum is seen frequently in this aged population. (Photograph courtesy of Dr. Andrew Bruner, DMD) many dentinal tubules narrow and others close altogether, forming sclerotic dentin. These changes make the older tooth more brittle, less resilient, less soluble, less permeable, and darker in color.  5, 6 The pulp chamber also undergoes significant