8 - Occlusal Trauma Flashcards
1
Q
the periodontium attempts to adapt to what
A
occlusal forces
2
Q
effects of occlusal forces are influenced by what
A
- magnitude
- direction
- duration
- frequency
3
Q
increased magnitude of occlusal forces on peridontium results in what
A
- WIDENED PDL space (increase # and width of PDL fibers)
- INCREASED DENSITY of alveolar bone
4
Q
PDL best accomodates forces along what axis of tooth
A
LONG AXIS
5
Q
___ and ___ can INJURE the periodontium (in terms of direction)
A
LATERAL FORCES (horizontal) and TORQUE (rotational) can injury the periodontium
6
Q
what forces are more damaging than intermittent forces
A
constant forces (increased frequency is more damaging)
7
Q
what are microscopic alterations of PDL that result in increased tooth mobility
A
occlusal trauma
8
Q
tissue injury to ___, ___, and ___ results when occlusal forces exceed the adaptive capacity of periodontium
A
PDL, alveolar bone, and cementum
9
Q
tissue injury is also called what
A
occlusal trauma
10
Q
what is the INJURY to periodontal tissues (PDL, alveolar bone, cementum) from excessive occlusal forces
A
occlusal trauma
11
Q
is occlusal trauma visible histologically
A
YES
12
Q
what is the “effect”? what is the “cause”?
A
effect = occlusal trauma
cause = traumatic occlusion or traumatic occlusal force
13
Q
what is the FORCE the produces injury to the periodontal tissues
A
traumatic occlusion or traumatic occlusal force
14
Q
what does this show
A
necrosis of PDL (chronic occlusal trauma)
15
Q
what does this show
A
cemental tear (acute occlusal trauma)
16
Q
are dental implants capable of adapting to occlusal forces
A
NO
17
Q
does dental implant have PDL
A
no
18
Q
in dental implant, there is [horizontal OR vertical] crestal bone loss with traumatic occlusal forces
A
VERTICAL
19
Q
acute occlusal trauma results from what type of occlusal impact
A
ABRUPT
20
Q
what are examples of acute occlusal trauma
A
tooth pain, sensitivity to percussion or cold, increased tooth mobility
21
Q
a patient with a recent restoration on #3, hyperocclusion, and reports exterme sensitivity to biting pressure and percussion has what type of trauma?
treatment?
A
acute occlusal trauma
tx: occlusal adjustment (tissue injury heals and symptoms subside)
22
Q
what trauma is more common that acute
A
chronic occlusal trauma
23
Q
what develops gradually from occlusal changes
A
chronic occlusal trauma
24
Q
what are examples of chronic occlusal trauma
A
tooth attrition
drifiting
extrusion
bruxism
clenching
25
what is periodontal inury to a tooth with PREVIOUSLY HEALTHY PERIODONTIUM
primary occlusal trauma
26
in primary occlusal trauma, does the tooth have loss of attachment of bone loss?
NO!
27
primary occlusal trauma occurs when occlusal trauma is a result of what?
alterations in occlusal forces
28
T/F: in primary occlusal trauma, occlusal forces are excessie
TRUE
29
what is periodontal injury to a tooth with bone loss or attachment loss
secondary occlusal trauma
30
in what trauma does the tooth have a reduced ability to withstand occlusal forces
secondary occlusal trauma
31
in secondary occlusal trauma, do previously well-tolerated forces become traumatic
YES
32
T/F: in secondary occlusal trauma, occlusal forces may be normal or excessive on the tooth
true
33
what is this an example of:
patient has previously healthy periodontium, new restoration was in hyperocclusion
primary occlusal trauma
34
what is an example of:
missing posterior teeth, no bone loss, excessive occlusal forces applied to premolars, teeth #4 and #5 are moblie
primary occlusal trauma
35
what is this example of:
toth #8 have been loss and cannot withstand normal occlusal forces, #8 is mobile and extruded, pathologic tooth migration present
secondary occlusal trauma
36
what type of occlusal trauma
primary
37
what type of occlusal trauma
secondary
38
what type of occlusal trauma
secondary
39
what are signs of occlusal trauma
1. widened PDL
2. angular (vertical) defects in bone)
3. moibile teeth
4. thick lamina dura
5. root resorption
6. fremitus
40
what is the vibration of movement felt on crown of tooth as patient occludes
fremitus
41
how to check for fremitus
1. place finger on facial of tooth
2. ask pt to gently tap up and down
3. feel for vibration or movement of tooth
42
what is the mobility scale (each class)
Class I = <1 mm
Class II = tooth moves B-L 1-2 mm
Class III - tooth moves B-L >2 mm or is depressible in socket
43
what are the stages of tissue response to increased occlusal forces
Stage I - injury
Stage II - repair
Stage III - adaptive remodeling
44
what stage of tissue response:
tissue injury produced by excessive occlusal forces
stage I - injury
45
what is the most susceptible to Stage I injury from excessive occlusal forces
FURCATIONS
46
Stage I (injury) results in what
DECREASED:
- mitotic activity
- proliferation of fibroblasts
- collagen formation
- bone formation
47
can repair occur if forces are diminished or if tooth drifts away from forces?
YES
48
what stage of tissue response:
damaged tissues removed, new CT fibers, bone, cementum are formed
stage II: Repair
49
what stage of tissue response:
forces remain traumatic only as long as damage produced exceeds the reparative capacity of the tissues
stage II: repair
50
what is buttressing bone
response to excessive occlusal forces
51
what stage of tissue response:
peridontium is remodeled in an effort to create a relationship in which forces are no longer injurious to tisseus
adaptive remodeling
52
results of adaptive remodeling
Widened PDL, funnel- shaped at osseous crest
Angular defects in bone with no pocket formation
Mobile tooth
53
what is insufficient occlusal force
hypofunction
54
what is hypofunction
open bite, absence of tooth antagonist
55
what happens with hypoofunction
Thinning of PDL
Atrophy of PDL fibers
Osteoporosis of alveolar bone
Reduced bone height
56
is occlusal trauma reversible
yes
57
what must occur for occlusal trauma repair to occur
injurious force must be relieved
58
presence of imflammation from plaque impairs what?
reversibility of traumatic lesions
59
dental biofilm initiates what
gingivitis and periodontitis
60
is the marginal gingival affected by occlusal trauma
no
61
does occlusal trauma cause periodontal pockets or gingivitis
no
62
occlusal trauma can increase periodontal destruction induced by___
periodontitis
63
does occlusal trauma cause pocket formation
no
64
in the presence of plaque induced periodontitis, can traumatic occlusion accentuate periodontitisu
YES
65
in occlusal trauma, it is important to eliminate ___ AND ___
inflammation and traumatic occlusion
66
what are factors involved in pathologic tooth migration
1. Weakened periodontal support
2. Changes in forces exerted on teeth (occlusion, pressure from lips, cheek, tongue)
67
is drifting the same as tooth migration
NO
68
does drifting result in destruction of periodontal tissues
NO
69
what is a common sequela when missing teeth are not replaced
drifting
70
what is an example of drifting pathway
open contacts -> food impaction -> periodontal disease
71
what are the genetic disorders associated with periodontitis
1. Leukocyte Adhesion Deficiency - Defective transendothelial migration
2. Chédiak-Higashi syndrome - Impaired killing of microorganisms by neutrophils
3. Papillion-Lefèvre syndrome
4. Down syndrome
5. Ehlers-Danlos syndrome
6. Cyclic Neutropenia
7. Hypophosphatasia
72
is there a genetic component to chronic periodontitis
yes some studies show
twin studies: periodontal conditions of identical twins were often similar
73
do the genes and enviornment interact to affect periodontitis
yes
74
is periodontitis a multi-factorial disease
yes
75
what can be used to determine perio genetics
1. oral DNA labs
2. MyPerioID report
3. interleukin genetics
4. perio predict
76
what do perio positive test results show
patients who test positive overproduce IL-1beta, which triggers heightened inflammation
77
what are limitations of perio genetic testing
small effects of IL-1 polymorphism makes up tiny fraction of genetic component risk
78
do smokers have increased expression of clinical inflammation?
NO!! they have DECREASED expression
79
do smokers have increased or decreased BOP
DECREASED
80
what is the major risk factor for perio prevalence, extent, and severity
smoking
81
what is more prevalent and severe in smokers compared to non-smokers
pocket depth, attachment loss, bone loss, tooth loss
82
former smokers are ___ times more likely to have periodontitisu
1.7
83
smokers (
2.8
84
heavy smokers (>/=31 cigs/day) are ___ times more likely to have periodontotis
6 times
85
smoking associated with generalized aggressive periodontitis occurs in what age
young adults (19-30)
86
on average, smokers are ___times more likely to have periodontitis than non-smokers
4 times
87
risk for periodontitis [increases or decreases] with the increasing number of years since quitting smoking
DECREASE
88
are smoking cessation programs part of periodontal therapy
YES
89
are cigar and pipe smoking effects similar to cig smoking
yes (the disease severity is intermediate between cig smoker and non smoker)
90
what to e-cig liquid contain
E-liquid contains: Nicotine, flavorings,
propylene glycol or vegetable glycerin
91
inhalation of flavorings in e-cig are associated with what
Inhalation of flavorings (diacetyl)
associated with bronchiolitis obliterans
(irreversible; "popcorn lung")
92
do e-cig promote a unique microbiome
yes
93
do e-cigs provide a more faborable perio tx response compared to non-smokers? how?
NO! less favorable!
- more sites with PD >/= 5 mm
- similar response to tx as smokers
94
how do e-cigs lead to oral health harms
may lead to tobacco use in adolsecents who try e-cig
95
can the benefits of quitting tobacco smoking outweigh oral health harms caused by short-term used of e-cig
yes
96
frequent recreational cannabis use is associated with what
1. deeper DP
2. increased CAL
3. increased odds of severe periodontitis (compared to non-cannabis users)
97
topical application of CBS (cannabidiol) can results in what
1. decreased periodontal inflammation (by downregulating TNF-alpha)
2. may promote gingival enlargement by increasing gingival fibroblast production and inhibiting MMP
98
what is associated with oral leukoplakia and carcinoma
chewing tobacco
99
chewing tobacco has increased risk of what
severe periodontitis
100
what occurs at the site of chewing tobacco placement
localized attachment loss and recession
101
what this
recession from chewing tobacco
102
smokers may have increased numbers of what organisms
1. Tannerella forsythia
2. A.a.
3. Porphyromonas gingivalis
4. Treponema denticola
5. Fusobacterium nucleatum
6. Prevotella intermedia
7. Parvimonas micra
103
what are the effects of smoking on immune response
1. Impaired neutrophil chemotaxis, phagocytosis, and killing
2. Decreased lgG2 production
3. Increased release of tissue-destructive enzymes by host
104
what are examples of tissue-destructive enzymes by host
Tumor necrosis factor-a
Prostaglandin E2
MMP-8 (collagenase)
105
how is the physiology of smoking affected
1. Constriction of gingival blood vessels
2. Decreased blood flow to gingival tissues
3. Smokers have less oxygen concentration in gingival tissues
106
what are effects of smoking on response to periodontal therapy
1. Less pocket depth reduction following scaling and root planing
2. Less bone fill in vertical defects following bone graft
3. Increased risk of implant complications and failure (double the risk)
107
do smokers respond well to perio therapy as non-smokers
NO
108
what are the 5 A's to smoking cessation
1. Ask (smoking status in med hx)
2. Advise (smokers of associations between oral disease and smoking)
3. Assess (pt interest in and readiness to quit smoking)
4. Assist (brief advice, NRT, rx)
5. Arrange (follow-up visit, referral to professional smoking cessation services)
109
smoking cessation approahces
1. willpower
2. selfhelp materials
3. brief intervention by entist
4. nicotine replacement therapy
5. varenicline or bupropion
6. counseling, cognitive behavioral therapy, hypnosis, acupuncture
110
occlusal trauma is an injury to what
periodontium
111
how can primary occlusal trauma be treated
occlusal adjustment
112
secondary occlusal trauma results from what
inadequate bone support to resist normal or excessive occlusal forces
113
what genetic disorders is periodontitis associated with
LAD, Trisomy 21, etc.
114
what is the #1 modifiable risk factor associated with periodontitis
smoking
