Aging and Gum Changes

Introduction

As people age, there is an increased likelihood of experiencing periodontal issues. The exact role of aging in this process remains a question without a definitive answer. As individuals age, various changes occur in their periodontal tissues, such as signs of aging within the tissues. There are also hints that the composition of dental plaque may change with age, and the response of the periodontium to the presence of plaque might evolve. While there is not yet substantial evidence for a natural downward shift of the epithelial attachment in human subjects, it is plausible that periodontal breakdown primarily occurs in the presence of plaque, leading to inflammation of the periodontium, or due to trauma.

Research findings indicate that the degree of periodontal breakdown tends to increase with age. With advancing age, inflammation of the periodontium appears to develop more rapidly, and the healing of wounds in the periodontium is slower. However, these factors are overshadowed by an individual’s susceptibility to periodontal disease. This implies that:

• Susceptibility to periodontal disease has a more significant influence on the rate of destruction than the duration of plaque presence.

• As the susceptibility of periodontal disease increases, the wound healing rate decreases, and the development of periodontal inflammation becomes more rapid.

How Is Aging Related to Gum Changes?

Aging is strongly linked to the development of chronic diseases and age-related health issues, that significantly affect the well-being and quality of life of older individuals. It is noted that individuals aged 65 and older typically have at least one chronic condition. In the United States, approximately 38 percent have either no chronic conditions or just one, while 47 percent have two to three chronic conditions. Chronic diseases linked to oral health also play a vital role in the overall health of the elderly. Periodontal disease (gum changes) is the most widespread chronic disease worldwide and tends to become more common as people age. Proper oral health care is essential for older populations to preserve their quality of life, functional abilities, and overall systemic health.

The prevalence and severity of periodontal disease are associated with the aging process, affecting a significant portion of the adult population aged 50 and above. While the immune system plays an important role in overall health balance, aging is marked by both quantitative and qualitative variations in the immune system. This process, known as ‘immunosenescence’, represents a gradual transformation of the immune system, making individuals more susceptible to infections, cancer, and autoimmune conditions. This susceptibility is believed to result from prolonged exposure to antigens and stress responses over one’s lifetime.

Interestingly, as the host’s ability to effectively respond to challenges diminishes due to immunosenescence, there is a simultaneous increase in a generalized proinflammatory state, often called ‘inflammation’. In line with the concept of immunosenescence, it is proposed that the cumulative impact of prolonged exposure of the periodontium (the tissues surrounding teeth) to microbial challenges is, in part, responsible for the effects of aging on these tissues. Therefore, it is recommended that changes in the function of immune and non-immune cells in the periodontium present the appearance of inflammation in periodontal disease.

While most aging research has focused on the adaptive immune response, it is increasingly evident that the innate immune system is also significantly affected by aging. Thus, understanding the phenomenon of immunosenescence and inflammation related to age-related changes in the periodontium is crucial in the era of precision and personalized medicine and dentistry.

How Is Inflammation Related to Periodontal Disease?

The precise mechanisms responsible for the age-related increase in periodontal disease remain unclear. Periodontal disease typically results from an imbalanced or excessive inflammatory response by the host to microbial pathogens in the gums. Therefore, it is reasonable to suggest that the dysregulated inflammation characteristic of inflammation may contribute to the development of periodontal disease.

To understand how inflammation directly impacts bone health, it is important to examine its local effects within various tissues. In the case of periodontal disease, the clinical hallmark is bone loss, and it is essential to explore how inflammation directly influences bone health. Osteoarthritis, osteoporosis, periodontal disease, and reduced regenerative capacity after injury are age-related conditions that impact bone health. In osteoarthritis cases, the age-related rise in pro-inflammatory mediators is thought to play a role in elevating the presence of damage-associated molecular patterns in the synovial fluid, which subsequently intensifies the innate immune response.

What Is the Prevalence of Periodontal Disease in Older Individuals?

Periodontal disease is widely acknowledged as one of the most prevalent chronic health conditions. In the last decade, it was found that 47 percent of US adults over 30 years old had periodontal disease. Notably, the prevalence varied significantly across age groups, with a rate of 24 percent among individuals aged 30 to 34 and 70 percent among those aged 65 and older. Gender differences were also noted, with severe periodontal disease being more common in older men than women. Additionally, smokers in the 65 and older age group exhibited higher levels of total periodontal disease (including severe and mild or moderate forms) compared to non-smokers.

Periodontal disease poses concerns for older adults due to its association with issues like root caries, tooth loss, and decreased chewing ability, which can, in turn, affect nutrition and speech, ultimately impacting an individual’s quality of life. Of particular concern in older populations is the impact of periodontal disease on systemic health. It has been linked to increased systemic inflammation, nutritional deficiencies, disability, cardiovascular disease, reduced physical function, cognitive impairment, and other coexisting health conditions.

What Is the Role of Immune Cells in Aging and Gum Changes?

1. Neutrophils: Age-related alterations in neutrophils may play a role in developing periodontal disease through various mechanisms. With increasing age, the antimicrobial abilities of neutrophils tend to decrease. This decline includes reduced phagocytosis and diminished formation of neutrophil extracellular traps (NET), making individuals more vulnerable to the pathogenic microbes present in the periodontium. When these microbes are not effectively cleared, the periodontium's inflammatory response can persist for an extended period. Furthermore, the increased apoptosis (natural cell death) of aging neutrophils can further hinder the clearance of microbes from the periodontium. The resolution of inflammation relies on properly removing apoptotic neutrophils from the tissue by other phagocytic cells.

2. Macrophages: Inflammation of the periodontium can affect crucial macrophage functions, including cytokine secretion, phagocytosis, and wound healing. These altered processes could play a role in developing periodontal disease in older individuals.

3. T and B Cells: The aging process impacts the adaptive immune response by diminishing the repertoire of T and B cells, particularly the naive ones, when responding to microbial infections. Furthermore, aging is marked by a shift in T cell phenotypes towards the pro-inflammatory TH1 and TH17 subpopulations, which exhibit a cytokine profile that encourages bone resorption and plays a role in developing periodontal disease.

4. Senescent Cells: Research indicates that senescent cells tend to build up in the periodontium, and the senescence-associated secretory phenotype (SASP) they produce releases cytokines known to play a role in developing periodontal disease. Senolytic drugs have shown promise in treating age-related inflammatory conditions.

Conclusion

Aging is closely linked to a range of changes in gum health and periodontal disease. These age-related shifts in the immune response, inflammatory processes, and the accumulation of senescent cells within the periodontium can contribute to the pathogenesis of gum diseases. Understanding these mechanisms is essential for preventive and therapeutic strategies to maintain oral health in an elderly population.