Influences of occlusal trauma on the periodontium Flashcards
Define primary occlusal trauma
Injury to a periodontium of normal height as a result of excessive occlusal forces
Define secondary occlusal trauma
Injury to a periodontium of reduced height as a result of excessive occlusal force
Causes of occlusal trauma
Premature contact: high restoration, tooth malposition, denture, orthodontics
Parafunctional habits such as bruxism and clenching
Tooth drifting following tooth loss or periodontal disease
Loss of posterior teeth = anteriors used for chewing = heavy occlusal loads
Occlusal discrepancy e.g. crossbite
Clinical features of occlusal trauma?
Increased mobility Fremitis = movement of a tooth or teeth subjected to functional occlusal forces - check fremitis by putting finger on tooth and get pt to tap teeth - if it moves = fremitis Tooth migration Pain and tenderness TSL Temporomandibular signs
Radiographic features of occlusal trauma?
Primary occlusal trauma - adequate bone support but PDL widening
2ndry occlusal trauma = bone loss and PDL widening
Pathogenesis of occlusal trauma?
Abnormal occlusal forces can change the course of plaque induced perio disease = angular bone defects in teeth with periodontitis (glickman)
OR
Angular bony defects and pockets develop equally in teeth with or without occlusal trauma (Waerhaug)
What are the types of occlusal forces?
Orthodontic type force = constant force applied to one part of the tooth
Jiggling type trauma = more destructive
What can jiggling forces do and cannot do?
Jiggling forces do not affect supracrestal CT attachments and do not cause pocket formation in healthy periodontium - may cause PDL widening and increased mobility
Long term high intensity jiggling type trauma with active periodontal disease = acts as a destructive co-factor, enhances rate of disease progression
What can tooth mobility be?
Physiological or pathological
What is physiological mobility?
Physiological = increased occlusal load and PDL widening in the absence of any active inflammatory disease
What is pathological/progressive mobility?
Associated with actively progressing inflammatory periodontal disease and can be characterised by:
- Increasing tooth mobility, tooth migration or drifting
- Fremitus
- Persistent discomfort on eating
Which mobility can be managed by occlusal adjustment if necessary?
Physiological mobility, normal periodontal bone height, mobile tooth with increased PDL width and reduced bone height after successful tx of PD
Which mobile teeth do not require no tx?
Mobile tooth with normal PDL width but reduced height of bone in the absence of inflammatory PD = no tx if asymp or they can be splinted to adjacent teeth if the mobility causes discomfort
How to manage teeth with progressive pathological mobility?
= Active bone loss and inflammatory disease = poorer prognosis:
- Maintain tooth, tx of PD and consider splinting the tooth to reduce mobility
- Extraction and replacement of the tooth
How to adjust the occlusion?
Selective grinding (in ICP and excursions) Restorations Orthodontic
