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3rd yr- CSB- Occlusion > clinical occlusal investigation > Flashcards

clinical occlusal investigation Flashcards

1
Q

Define occlusion

A

The static relationship between the incising and masticating surfaces of the maxillary or mandibular teeth or tooth analogues

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2
Q

Define articulation

A

The static and dynamic contact relationship between the occlusal surfaces of the teeth during function

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3
Q

Give examples of some occlusal examinations we can carry out

A
  1. Basic occlusal examination

2. Detailed occlusal examination

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4
Q

When is a basic occlusal examination carried out?

A

Performed at every examination for every patient

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5
Q

What does a basic occlusal examination consist of ?

A
  1. Screen for TMJ pathology and muscle pain extra orally
  2. Screen for signs of parafunction or occlusal trauma intra orally
  3. Assess ICP and lateral movement intra orally
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6
Q

When is a detailed occlusal examination carried out?

A

Carried out based on screening findings from a basic occlusal exam
Can be carried out when considering large reconstructive work or repeated history of restoration failure

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7
Q

What does a detailed occlusal examination include?

A
  1. Fill TMJ and muscles of mastication assessment (extra orally)
  2. Lateral and protrusive tooth contacts interferneces
  3. Wear faucets and signs of parafunciton intra orally
  4. Retruded contact (RCP) assessment
  5. Special tests
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8
Q

Give examples of some special tests we can carry out in a detailed occlusal examination

A
  1. Occlusal paper/wax/foil
  2. Articulated study models
  3. Tooth sleuth
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9
Q

Talk through the extra oral steps of a basic occlusal examination

A
  1. History taking including any complaints
  2. Observations eg masseter hypertrophy
  3. TMJ clicks, crepitus and deviations
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10
Q

Talk through the intra oral steps of a basic occlusal examination

A
  1. Look at soft tissues
  2. Look at teeth
  3. Record patients occlusion in ICP
  4. Look at lateral excursion
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11
Q

Name some soft tissue indications that a person with occlusal problems may present with

A
  1. Buccal mucosa ridging

2. Tongue scalloping

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12
Q

What is buccal mucosa ridging also called?

A

Occlusal line or linea alba

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13
Q

What is buccal mucosa ridging associated with?

A

Clenching and bruxism
OR
Increased over jet and crowding

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14
Q

What can tongue scalloping be caused by?

A

Multiple causes including bruxism and clenching

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15
Q

Name some non dental related conditions that can cause tongue scalloping

A
  1. Sleep apnoea
  2. Dehydration
  3. Hypothyroidism
  4. Congenital disordered eg downs syndrome
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16
Q

What is tongue scalloping sometimes called?

A

Lingua indentata

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17
Q

What is linea alba

A

Buccal muscosa ridging

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18
Q

What does ICP stand for?

A

Intercuspal postion

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19
Q

What is the intercuspal position

A

The complete intercuspation of the opposing teeth independent of the condylar position

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20
Q

From an occlusal point of view describe a healthy ICP

A
  1. Multiple occluding units balanced around the arch

2. The ICP is stable and can be repeatably found

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21
Q

What questions might you ask yourself when looking at a patients ICP

A
  1. Does ti look healthy
  2. Is it stable and repeatable
  3. Will the ICP get I. the way of any planned restorations
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22
Q

What is lateral excursion

A

Guidance

23
Q

Name the 2 types of guidance a patient may present with

A
  1. Canine guidance

2. Group function

24
Q

How can we check lateral excursion

A

By making the patient bite together then grind their teeth slightly in a side to side motion

25
Q

Describe canine guidance

A

Working side: only the canines contact in lateral motion

Non working side: No contacts

26
Q

Describe group function n

A

Multiple contact relations between the maxillary and mandibular teeth in lateral movement on the working side

27
Q

Which type of guidance is healthier?

A

Both are healthy

But group function is technically harder to conform to when planning restorations

28
Q

If a patient has a group function occlusion what must you also be alert to

A

Any non working side interferences

29
Q

Talk through the extra oral steps of a detailed occlusal examination

A
  1. TMJ examination

2. Muscles of mastication

30
Q

What would you look for in a detailed TMJ examination

A
  1. Deviations on opening
  2. Clicks
  3. Degree of opening
  4. Crepitus (crunching)
31
Q

How do we examine the muscles of mastication

A

Palpate them

32
Q

What are we looking for when palpate the muscles of mastication

A

Masseter insertion when patient is clenching

Temporalis origin and insertion

33
Q

What do we look for when investigating protrusion

A

Looking for whether any of the posterior teeth are kinda clattering or being involved in the intrusive movement

34
Q

When is it important to look at protrusion

A

When we are doing anterior restoration work such as crowns, bridges etc

35
Q

What are wear faucets good at telling us

A

How the patient bites usually

36
Q

What is a retruded position

A

The position where the condyle is fully seated in the glenoid fossa

37
Q

Name some operator led techniques that can help you position your patient in a retuned position

A
  1. Bimanual manipulation

2. Chin point guidance

38
Q

Name some patient led techniques that can help you position your patient in a retuned position

A

Anterior deprogrammer

39
Q

How does the anterior de programmer work

A

It is placed on the maxillary anterior teeth and it forces the brain to forget there the teeth are

40
Q

What is RCP-ICP slide

A

The slide between the rested condyle position and ICP

41
Q

What is the normal RCP-ICP slide distance

A

Usually 1mm anterior and downward

42
Q

What can cause large RCP-ICP slides?

A

Premature contacts eg over erupted molar

43
Q

How would you carry out fremitus test

A

Use your fingertips or flesh of finger and ask the patient to bite down feeling fro vibrations on the tooth you are touching

44
Q

How much can a patient feel between their teeth

A

10 Microns

45
Q

How thick is thick articulating paper

A

250 micro metres

46
Q

How thick is thin articulating paper

A

40 micro metres

47
Q

Name a tool Better than articulating paper for measuring perception and occlusion

A

Shimstock occlusal foil

48
Q

How thick is shim stock foil

A

8 micro metres

49
Q

What is lingua indentata

A

Tongue scalloping

50
Q

What is linea alba

A

Buccal muscosa ridging

51
Q

What is tooth sleuth used to investigate

A

Investigates cracks on individual tooth cusps (cracked tooth syndrome)

52
Q

How do you carry out tooth sleuth

A
  1. Cup on one side and tell patient to bite on the other
  2. Cup located over suspect cusp
  3. Patient closes on the tooth sleuth
  4. On release any pain is noted
53
Q

What happen sin cracked tooth syndrome

A
  1. Occlusal loading of cusp associated with crack open the crack
  2. Crack fills with fluid eg saliva
  3. Release of occlusal load causes crack to rapidly close
  4. Some fluid is expelled onto surface of tooth
  5. Some fluid is forced into dentinal tubules leading to stimulation of pulp and pain on release of biting

3rd yr- CSB- Occlusion (7 decks)

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