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23 Periodontology > 8 - Occlusal Trauma > Flashcards

8 - Occlusal Trauma Flashcards

1
Q

the periodontium attempts to adapt to what

A

occlusal forces

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2
Q

effects of occlusal forces are influenced by what

A
  1. magnitude
  2. direction
  3. duration
  4. frequency
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3
Q

increased magnitude of occlusal forces on peridontium results in what

A
  1. WIDENED PDL space (increase # and width of PDL fibers)
  2. INCREASED DENSITY of alveolar bone
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4
Q

PDL best accomodates forces along what axis of tooth

A

LONG AXIS

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5
Q

___ and ___ can INJURE the periodontium (in terms of direction)

A

LATERAL FORCES (horizontal) and TORQUE (rotational) can injury the periodontium

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6
Q

what forces are more damaging than intermittent forces

A

constant forces (increased frequency is more damaging)

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7
Q

what are microscopic alterations of PDL that result in increased tooth mobility

A

occlusal trauma

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8
Q

tissue injury to ___, ___, and ___ results when occlusal forces exceed the adaptive capacity of periodontium

A

PDL, alveolar bone, and cementum

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9
Q

tissue injury is also called what

A

occlusal trauma

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10
Q

what is the INJURY to periodontal tissues (PDL, alveolar bone, cementum) from excessive occlusal forces

A

occlusal trauma

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11
Q

is occlusal trauma visible histologically

A

YES

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12
Q

what is the “effect”? what is the “cause”?

A

effect = occlusal trauma
cause = traumatic occlusion or traumatic occlusal force

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13
Q

what is the FORCE the produces injury to the periodontal tissues

A

traumatic occlusion or traumatic occlusal force

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14
Q

what does this show

A

necrosis of PDL (chronic occlusal trauma)

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15
Q

what does this show

A

cemental tear (acute occlusal trauma)

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16
Q

are dental implants capable of adapting to occlusal forces

A

NO

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17
Q

does dental implant have PDL

A

no

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18
Q

in dental implant, there is [horizontal OR vertical] crestal bone loss with traumatic occlusal forces

A

VERTICAL

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19
Q

acute occlusal trauma results from what type of occlusal impact

A

ABRUPT

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20
Q

what are examples of acute occlusal trauma

A

tooth pain, sensitivity to percussion or cold, increased tooth mobility

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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)

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22
Q

what trauma is more common that acute

A

chronic occlusal trauma

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23
Q

what develops gradually from occlusal changes

A

chronic occlusal trauma

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24
Q

what are examples of chronic occlusal trauma

A

tooth attrition
drifiting
extrusion
bruxism
clenching

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25
Q

what is periodontal inury to a tooth with PREVIOUSLY HEALTHY PERIODONTIUM

A

primary occlusal trauma

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26
Q

in primary occlusal trauma, does the tooth have loss of attachment of bone loss?

A

NO!

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27
Q

primary occlusal trauma occurs when occlusal trauma is a result of what?

A

alterations in occlusal forces

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28
Q

T/F: in primary occlusal trauma, occlusal forces are excessie

A

TRUE

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29
Q

what is periodontal injury to a tooth with bone loss or attachment loss

A

secondary occlusal trauma

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30
Q

in what trauma does the tooth have a reduced ability to withstand occlusal forces

A

secondary occlusal trauma

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31
Q

in secondary occlusal trauma, do previously well-tolerated forces become traumatic

A

YES

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32
Q

T/F: in secondary occlusal trauma, occlusal forces may be normal or excessive on the tooth

A

true

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33
Q

what is this an example of:

patient has previously healthy periodontium, new restoration was in hyperocclusion

A

primary occlusal trauma

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34
Q

what is an example of:

missing posterior teeth, no bone loss, excessive occlusal forces applied to premolars, teeth #4 and #5 are moblie

A

primary occlusal trauma

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35
Q

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

A

secondary occlusal trauma

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36
Q

what type of occlusal trauma

A

primary

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37
Q

what type of occlusal trauma

A

secondary

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38
Q

what type of occlusal trauma

A

secondary

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39
Q

what are signs of occlusal trauma

A
  1. widened PDL
  2. angular (vertical) defects in bone)
  3. moibile teeth
  4. thick lamina dura
  5. root resorption
  6. fremitus
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40
Q

what is the vibration of movement felt on crown of tooth as patient occludes

A

fremitus

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41
Q

how to check for fremitus

A
  1. place finger on facial of tooth
  2. ask pt to gently tap up and down
  3. feel for vibration or movement of tooth
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42
Q

what is the mobility scale (each class)

A

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

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43
Q

what are the stages of tissue response to increased occlusal forces

A

Stage I - injury
Stage II - repair
Stage III - adaptive remodeling

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44
Q

what stage of tissue response:

tissue injury produced by excessive occlusal forces

A

stage I - injury

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45
Q

what is the most susceptible to Stage I injury from excessive occlusal forces

A

FURCATIONS

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46
Q

Stage I (injury) results in what

A

DECREASED:
- mitotic activity
- proliferation of fibroblasts
- collagen formation
- bone formation

47
Q

can repair occur if forces are diminished or if tooth drifts away from forces?

A

YES

48
Q

what stage of tissue response:

damaged tissues removed, new CT fibers, bone, cementum are formed

A

stage II: Repair

49
Q

what stage of tissue response:

forces remain traumatic only as long as damage produced exceeds the reparative capacity of the tissues

A

stage II: repair

50
Q

what is buttressing bone

A

response to excessive occlusal forces

51
Q

what stage of tissue response:

peridontium is remodeled in an effort to create a relationship in which forces are no longer injurious to tisseus

A

adaptive remodeling

52
Q

results of adaptive remodeling

A

Widened PDL, funnel- shaped at osseous crest
Angular defects in bone with no pocket formation
Mobile tooth

53
Q

what is insufficient occlusal force

A

hypofunction

54
Q

what is hypofunction

A

open bite, absence of tooth antagonist

55
Q

what happens with hypoofunction

A

Thinning of PDL
Atrophy of PDL fibers
Osteoporosis of alveolar bone
Reduced bone height

56
Q

is occlusal trauma reversible

A

yes

57
Q

what must occur for occlusal trauma repair to occur

A

injurious force must be relieved

58
Q

presence of imflammation from plaque impairs what?

A

reversibility of traumatic lesions

59
Q

dental biofilm initiates what

A

gingivitis and periodontitis

60
Q

is the marginal gingival affected by occlusal trauma

A

no

61
Q

does occlusal trauma cause periodontal pockets or gingivitis

A

no

62
Q

occlusal trauma can increase periodontal destruction induced by___

A

periodontitis

63
Q

does occlusal trauma cause pocket formation

A

no

64
Q

in the presence of plaque induced periodontitis, can traumatic occlusion accentuate periodontitisu

A

YES

65
Q

in occlusal trauma, it is important to eliminate ___ AND ___

A

inflammation and traumatic occlusion

66
Q

what are factors involved in pathologic tooth migration

A
  1. Weakened periodontal support
  2. Changes in forces exerted on teeth (occlusion, pressure from lips, cheek, tongue)
67
Q

is drifting the same as tooth migration

A

NO

68
Q

does drifting result in destruction of periodontal tissues

A

NO

69
Q

what is a common sequela when missing teeth are not replaced

A

drifting

70
Q

what is an example of drifting pathway

A

open contacts -> food impaction -> periodontal disease

71
Q

what are the genetic disorders associated with periodontitis

A
  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
Q

is there a genetic component to chronic periodontitis

A

yes some studies show

twin studies: periodontal conditions of identical twins were often similar

73
Q

do the genes and enviornment interact to affect periodontitis

A

yes

74
Q

is periodontitis a multi-factorial disease

A

yes

75
Q

what can be used to determine perio genetics

A
  1. oral DNA labs
  2. MyPerioID report
  3. interleukin genetics
  4. perio predict
76
Q

what do perio positive test results show

A

patients who test positive overproduce IL-1beta, which triggers heightened inflammation

77
Q

what are limitations of perio genetic testing

A

small effects of IL-1 polymorphism makes up tiny fraction of genetic component risk

78
Q

do smokers have increased expression of clinical inflammation?

A

NO!! they have DECREASED expression

79
Q

do smokers have increased or decreased BOP

A

DECREASED

80
Q

what is the major risk factor for perio prevalence, extent, and severity

A

smoking

81
Q

what is more prevalent and severe in smokers compared to non-smokers

A

pocket depth, attachment loss, bone loss, tooth loss

82
Q

former smokers are ___ times more likely to have periodontitisu

A

1.7

83
Q

smokers (</= 9 cigs/day) are ___ times more likely to have periodontitis

A

2.8

84
Q

heavy smokers (>/=31 cigs/day) are ___ times more likely to have periodontotis

A

6 times

85
Q

smoking associated with generalized aggressive periodontitis occurs in what age

A

young adults (19-30)

86
Q

on average, smokers are ___times more likely to have periodontitis than non-smokers

A

4 times

87
Q

risk for periodontitis [increases or decreases] with the increasing number of years since quitting smoking

A

DECREASE

88
Q

are smoking cessation programs part of periodontal therapy

A

YES

89
Q

are cigar and pipe smoking effects similar to cig smoking

A

yes (the disease severity is intermediate between cig smoker and non smoker)

90
Q

what to e-cig liquid contain

A

E-liquid contains: Nicotine, flavorings,
propylene glycol or vegetable glycerin

91
Q

inhalation of flavorings in e-cig are associated with what

A

Inhalation of flavorings (diacetyl)
associated with bronchiolitis obliterans
(irreversible; “popcorn lung”)

92
Q

do e-cig promote a unique microbiome

A

yes

93
Q

do e-cigs provide a more faborable perio tx response compared to non-smokers? how?

A

NO! less favorable!
- more sites with PD >/= 5 mm
- similar response to tx as smokers

94
Q

how do e-cigs lead to oral health harms

A

may lead to tobacco use in adolsecents who try e-cig

95
Q

can the benefits of quitting tobacco smoking outweigh oral health harms caused by short-term used of e-cig

A

yes

96
Q

frequent recreational cannabis use is associated with what

A
  1. deeper DP
  2. increased CAL
  3. increased odds of severe periodontitis (compared to non-cannabis users)
97
Q

topical application of CBS (cannabidiol) can results in what

A
  1. decreased periodontal inflammation (by downregulating TNF-alpha)
  2. may promote gingival enlargement by increasing gingival fibroblast production and inhibiting MMP
98
Q

what is associated with oral leukoplakia and carcinoma

A

chewing tobacco

99
Q

chewing tobacco has increased risk of what

A

severe periodontitis

100
Q

what occurs at the site of chewing tobacco placement

A

localized attachment loss and recession

101
Q

what this

A

recession from chewing tobacco

102
Q

smokers may have increased numbers of what organisms

A
  1. Tannerella forsythia
  2. A.a.
  3. Porphyromonas gingivalis
  4. Treponema denticola
  5. Fusobacterium nucleatum
  6. Prevotella intermedia
  7. Parvimonas micra
103
Q

what are the effects of smoking on immune response

A
  1. Impaired neutrophil chemotaxis, phagocytosis, and killing
  2. Decreased lgG2 production
  3. Increased release of tissue-destructive enzymes by host
104
Q

what are examples of tissue-destructive enzymes by host

A

Tumor necrosis factor-a
Prostaglandin E2
MMP-8 (collagenase)

105
Q

how is the physiology of smoking affected

A
  1. Constriction of gingival blood vessels
  2. Decreased blood flow to gingival tissues
  3. Smokers have less oxygen concentration in gingival tissues
106
Q

what are effects of smoking on response to periodontal therapy

A
  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
Q

do smokers respond well to perio therapy as non-smokers

A

NO

108
Q

what are the 5 A’s to smoking cessation

A
  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
Q

smoking cessation approahces

A
  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
Q

occlusal trauma is an injury to what

A

periodontium

111
Q

how can primary occlusal trauma be treated

A

occlusal adjustment

112
Q

secondary occlusal trauma results from what

A

inadequate bone support to resist normal or excessive occlusal forces

113
Q

what genetic disorders is periodontitis associated with

A

LAD, Trisomy 21, etc.

114
Q

what is the #1 modifiable risk factor associated with periodontitis

A

smoking

23 Periodontology (13 decks)

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