Age-Related Changes in Occlusion and the Clinical Management and Prevention Strategies

Occlusion refers to the contact relationship between the upper and lower teeth. Its biomechanical properties influence motor function, most often in the orofacial and cervical regions, and the patient’s psychological well-being as well. In this review, we summarized age-related changes in occlusion and the corresponding clinical management and preventive strategies from three perspectives—the functional characteristics of normal occlusion and their age-related changes, the effects of abnormal occlusion on health and the potential neurophysiological mechanisms involved, and age-related changes in occlusion and the corresponding preventive and therapeutic approaches. Abnormal wear of the occlusal surfaces alters the biomechanical relationship of occlusion. Animal studies have shown that abnormal biomechanical occlusion may result in the following problems: 1) periodontal trauma; 2) dysfunction of the orofacial and cervical muscles and vagus nerve-related visceral motor dysfunction through synaptic connections between neurons in the mesencephalic trigeminal nucleus and motor neurons in the trigeminal motor, facial, accessory, hypoglossal, and dorsal vagal nuclei; and 3) psychological responses such as anxiety, mediated via effects on neuronal activity in the lateral habenular nucleus. The wear coefficients of dental restorative prostheses differ from those of natural teeth. Long-term use of dental prostheses increases the risk of wear mismatch between natural and artificial teeth, which may lead to increased risk of occlusal interference. Tooth wear is the most common manifestation of age-related changes in occlusion. In addition to malocclusion, missing teeth, and pre-existing prostheses, many older patients also present with periodontal disease. Prolonged failure to replace missing teeth may lead to progressive occlusal disturbances, characterized by tilting of adjacent teeth and elongation of opposing teeth. When age-related wear is superimposed on malocclusion, periodontal disease, and missing teeth, it not only exacerbates the adverse health effects of abnormal occlusion but also substantially complicates treatment. Therefore, early diagnosis and treatment of malocclusion and periodontal diseases are essential to the prevention of situations where orthodontic intervention becomes extremely challenging in old age. Missing teeth should be restored promptly to prevent secondary occlusal disorders. For dental prostheses, careful attention should be paid to material selection and biomechanical design. Excessively hard materials should be avoided to prevent the development of interfering occlusal contacts. In addition, prostheses should be replaced regularly to reduce occlusal problems arising from uneven physiological wear and the associated secondary health consequences.