Chapter 3 Flashcards
What changes are seen on the tension side of the periodontium?
- Elongation of the PDL fibres
* Apposition of alveolar bone and cementum i.e. side by side.
Histologically, what kind of changes occur when there is sustained occlusal trauma?
- Decreased density of the alveolar bone
- Width of PDL space increases —> leads to increased tooth mobility and often a radiographic widening of the PDL space, either limited to the alveolar crest or through the entire width of the alveolar bone.
- Hence fremitus or palpable functional mobility of the affected tooth (teeth) is a clinical sign of occlusal trauma
What is primary occlusal trauma?
Injury resulting in tissue changes from excessive occlusal forces applied to a tooth or teeth with normal periodontal support.
When does primary occlusal trauma occur?
It occurs in presence of normal clinical attachment levels, normal bone levels and excessive occlusal forces
What is secondary occlusal trauma?
Injury resulting in tissue changes from normal or excessive occlusal forces applied to a tooth or teeth with reduced periodontal support. (Differs from primary as primary occlusal trauma —> normal periodontal support).
What is the criteria to distinguish between normal and reduced periodontal support?
Specific criteria to distinguish between normal and reduced periodontal support have not been identified. It has been reported that periodontal ligament stress increased significantly after reducing 60% of bone support.
What is fremitus?
Palpable or visible movement of a tooth when subjected to occlusal forces.
Why may fremitus occur?
May result from occlusal inferences causing occlusal trauma, normal occlusion and occlusal forces but with reduced periodontium.
How do you check for fremitus?
Place finger gently on labial or buccal surface of the teeth, ask pt to bite down gently and feel whether the tooth is pushing against the finger.
What is bruxism?
Habit of grinding, clenching or clamping the teeth. Force generated may damage both tooth and attachment apparatus
In what circumstance does occlusal trauma not cause irreversible bone loss or loss of connective tissue attachment?
Without plaque-induced inflammation, occlusal trauma does not cause irreversible bone loss or connective tissue attachment. Therefore, occlusal trauma is not a causative agent of periodontitis.
What is seen in moderate to severe chronic periodontitis patients with occlusal discrepancies?
They have significantly deeper initial probing depths, more mobility, and poorer prognosis than teeth without occlusal discrepancies. Teeth with occlusal discrepancies demonstrated a significant increase in probing depth and a worsening prognosis with time.
Clinical studies have shown what other treatment is beneficial in conjunction with periodontal treatment?
Clinical studies demonstrated that it may be beneficial to perform occlusal therapy in conjunction with periodontal treatment in the presence of clinical indicators of occlusal trauma, especially relating to patients comfort and masticatory function. It may help to slow the progression of periodontitis and improve prognosis.
