16. Pathologic Occlusion Flashcards
Masicatory function = teeth and TMJ
Parafucntion = ____
Occlusal trauma = relates to ____
Occlusion encompasses ____, which may sound weird but is when patient is AWARE of their occlusion, it can become a real physiological problem. Known as ____. Hard to treat this!
bruxism
perio
psychophysiologic status
positive occlusal awareness
3.
At first in school we learn IDEAL forms for everything (negative carve, anatomy, tooth realtions etc.)
A. However when we look at general public we see there is a difference from ideal and normal
B. We break it down into ____ and ____
C. You may see an occlusion that looks strange but its working for a patient,
there is NO ____ associated with it. It is not ideal but it is physiologic
physiologic
pathologic
pathology
Physiologic occlusion:
the adult occlusion that has demonstrated its ability to survive despite ____ from a preconceived hypothetical ideal of a normal occlusion
departure
- Determine whether one of these causes something to break down, causes pathology. If it is then it is pathologic.
A. Must determine if it is ____ (not caring problems) and can leave it or if its pathologic, which means you have to think how to treat it to ____ pathology.
physiologic
reverse
Occlusion can affect masticatory system in 3 ways
◦ ____: periodontal damage can be from occlusion not just Periodontal
disease
◦ ____: occlusal activity, like bruise can affect dentition
◦ ____: can also be affected
‣ A pathology can affect 1 or all 3
periodontal
dentition
TMJ
Parafunctional activity differs from normal occlusal activity:
- ____
- ____
- ____
intensity
frequency
duration
Parafunction:
activity of the ____ system outside the range of normal function
parafunction: an example of an occlusal activity that can cause pathology in periodontist,
dentition or TMJ. How does this look? How do you see this in patient?
A. Chewing, normal swallow, speaking = NOT ____
B. Grinding, clenching, biting nails, biting object (opening seeds with teeth = ____
masticatory
parafunction
parafunction
Parafunction habits
- ____
- ____
- ____
tooth-to-tooth
tooth-to soft tissue
tooth-to-foreign object
What are the potential effects of parafunction on the periodontium?
Specifically how might parafunction affect the ____?
periodontal attachment apparatus
Peridontal attachment apparatus
In periodontal damage occurs in Attachment apparatus: ____ (goes into bone), ____ (around tooth), ____
cementum
periodontal ligament
alveolar bone
Responses of the Attachment Apparatus to Parafunction
- ____
- ____ trauma
A can respond in 2 ways: lot of force put on it or orthodontic treatment (also lots of occlusal force out on tooth)
• Hyperfunction: normal physiologic response to heavy forces
◦ There is a ____ with break down and repair.
◦ If put excess force on tooth, the periodontal ligament can absorb the forces it can cause
hyper function.
• Occlusal trauma:
◦ If the body cannot respond or ____ those excessive forces it causes breakdown. If breaks down ____ it cause occlusal trauma.
hyperfunction occlusal homeostasis withstand withstand homeostasis
Hyperfunction Thicker \_\_\_\_ Thicker \_\_\_\_ (lamina dura) Increased \_\_\_\_ of supporting bone
PDL
alveolar bone
trabeculation
Clinical signs of occlusal trauma
- increasing ____
- tooth ____
- tooth ____, thermal ____
tooth mobility
migration
tenderness
sensitivity
Radiographic Signs of Occlusal Trauma
Widened ____ space Indistinct ____
Alveolar bone ____
Root ____
When you look at a radiograph for occlusal trauma see 1 thing in common with hyperfunction: widened ____ space
PDL lamina dura resorption resorption ligament
Occlusal trauma
- ____
- ____
primary
secondary
Primary Occlusal Trauma
- ____
- ____ forces
- forces in range of ____ psi
Primary: ____ attachment apparatus (no bone loss, good supporting teeth structure) with
break down due to ____/ heavy forces (bruxer, nail biter)
◦ There are ____ forces, or heavier than normal, can cause PRIMARY occlusal trauma
◦ This can cause break down, mobility, bone/ root resorption, tooth ____,
sensitivity
parafunction isometric 250 normal parafunction isometric mobility
Secondary Occlusal Trauma
- ____ function
- ____ forces
- forces in the range of ____ psi
- compromised ____ supprot
Secondary: ____ attachment levels and break down due to heavy OR ____ forces
◦ Radiograph shows ____ disease, ____ bone loss
◦ Therefore, forces from normal function (just chewing), can cause occlusal trauma and
make teeth ____
◦ Excess forces can really make a bad impact!
normal isotonic 2-15 periodontal compromised normal
periodontal
horizontal
loose
Effects of Occlusal Activity on the Dentition
- ____ wear
- ____ lesions
- tooth ____
- ____ pathology
retrograde
abfraction
fracture
pulpal
Tooth wear
• Top left: Show lots of wear exposure of ____
• Top right: thinning edges of teeth ____ due to wear
• Bottom left: wear and ____ (patient was burger and had Gerd)
• Retrograde wear: depends on how much wear you see if it is appropriate for patient!
◦ It is BEYOND wear you EXPECT to see
for a patient
dentin
anterior
erosion
Retrograde wear
Occlusal ____
____ occlusal tables
Esthetic and ____ concerns
Occlusal interferences:
a. If person wore down buccal cusps (functional cusps), cause lingual cusps to look extra high –> cause occlusal interference (____ interference)
B. Widened occlusal table
a. Cusp on this PM is palatal cusp: this distal lingual cusp is MISSING
b. Excessive wear make occlusal table wide
1. wider occlusal table –> increase surface area for ____–> wear goes FASTER!
2. Exposed ____ (softer) –> wear goes even faster!
3. Forces are NO LONGER over long axis of teeth –> more ____
C. Esthetic concern
a. Wear can make it an esthetic problem
b. This person had a lip problem
c. Person had bridge on top, opaque was exposed, which lead to
wear on bottom
1. When worn away incised third, lead to spaces in between
interferences
widened
phonetic
cross tooth
grinding
dentin
breakdown
Abfraction Lesions
- are ____-shaped in cervical areas
- may occur on ____ areas
- may occur on ____ tooth or all teeth
- may occur in ____ sites/tooth
- usually occur on teeth with ____ mobility
They occur on teeth with MINIMAL mobility. Normal teeth can move around with forces. If teeth
cannot move, excessive forces causes flexure of tooth at cervical area. Over time the forces causes enamel and dentin to fracture out.
cervical cuspal one multiple minimal
Abfraction lesions
Picture top left: This is a prior abfraction lesion that was filled. Then got an abfracture lesion apical to that one. This was because occlusion was NOT ____!
• Bottom left: occlusal abfraction lesions. From crushing enamel, fracture enamel out, exposing of ____
• right: 2 abfraction lesions on 1 tooth
◦ ____, cross tooth, nonworking interference on this tooth ◦ Multiple ____ caused different abfraction lesions
◦ Teeth like these show CLASSIC ____ shaped lesion
adjusted dentin working interferences wedged
Abfraction lesions
- ____ and ____ stresses result from biomechanical loading of the teeth
- stresses lead to ____ and flexure of enamel and dentin
- deformation and microfracture of enamel and dentin follows
- erosion and/or abrasion accelerate loss of affected tooth structure
(Last bullet) Erosion abrasion: due to drinking ____ water, sucking on lemons, bulimia, drinks
a lot of soda, seltzer water
tensile
lateral
fatigue
lemon
Tooth fracture
- fracture of ____ tooth structure
- ____ or horizontal root fracture
- fracture of ____
coronal
vertical
restorations
Tooth fracture
ou can see fracture medially distally. Treat this tooth by ____. It is a hopeless vertical fracture. This fracture is due to the habit ____, which does NOT cause a lot of ____. This patient should wear a night guard. Even if put an implant in can loose the ____ due to her occlusal forces.
• Right picture: patient has big restoration. He has crack on EVERY posterior tooth. This is sue to ____ and maybe some grinding.
◦ Solution: significant crown and bridge and full ____ treatment.
extraction clenching wear implant clenching ortho
Effect on Masticatory Muscles
Periodontal receptors program the ____ muscles to position the jaw so that the elevator muscles can close directly into MIP .
Occlusal interferences may trigger masticatory muscle incoordination and ____ to allow the jaw to reach MIP.
There is a unique relationship between the ____ and the lateral pterygoid muscle that overrides the tendency of the muscle to ____ when fatigued.
• Periodontal receptors program lat pterygoid muscle so that we close correctly into MIP.
• Interference causes lat pterygoid muscle pull jaw to ____ interference to get to MIP
◦ Interferences cause different closure pattern, ____ and incoordination ◦ Cause muscle to fatigue in time
‣ Periodontal receptors CAN ____ muscle to fatigue, allowing muscle to keep moving in abnormal way leading to pain, such as in the TMJ
lateral pterygoid
hyperactivity
periodontal receptors
rest
avoid
hyperactivity
override
Effect on the TMJ
With incoordinated musculature there is usually some form of ____ structural change.
Often the teeth wear, become loose or move, however remodeling can also change the shape of the disk or the ____.
Mongini has shown that there is a direct relationship between the shape of the condyle after remodeling and abrasion patterns of the teeth due to abnormal or dysfunctional ____.
• Captive changes of TMJ
◦ changes in: ____ of bone, ____ of disk
• Teeth can wear or become loose, but if it can manifest itself in the ____ internally (with TMJ
instead of tooth problems)
• Reads last bullet: correction with things that happened with tooth level with things that happened at ____ level
adaptive
condyles
occlusal contact
level
position
condyle
condylar
