The Role of Occlusion in the Development and Progression of Periodontal Disease

Question 1

What does the periodontium do?

Answer 1

It attached the tooth to the alveolar bone

This soft tissue dissipates forced of occlusion to surrounding tissues

Question 2

Define occlusal trauma

Answer 2

Describes injury resulting in tissue changes within the attachment apparatus (including the periodontal ligament, supporting alveolar bone and cementum) as a result of occlusal forces

Question 3

Define traumatic occlusal force

Answer 3

Any occlusal force resulting in injury of the teeth and or the periodontal attachment apparatus

Question 4

How do define and diagnose trauma from occlusion

Answer 4

By histological changes

We do this through clinical and radiographic findings

Question 5

Give examples of clinical findings that may indicate occlusal trauma

Answer 5

1. Mobility
2. Wear facets
3. Root resorption
4. Occlusal discrepancias
5. Discomfort/ pain on chewing
6. Fremitus
7. Thermal sensitivity
8. Cemental tears
9. Fractured tooth
10. Tooth migration

Question 6

What is fremitis

Answer 6

The tooth moving as occluded teeth slide laterally or in protrusion

Question 7

What radiographic sighs might indicate occlusal trauma

Answer 7

1. Widening of PDL space
2. Vertical infra bony defects
3. Crescent shaped bone loss

Question 8

What might the patient complain of that could indicate occlusal trauma

Answer 8

TMJ pain or tenderness of the muscles of mastication (Hypertrophy)

Question 9

Name the 2 types of occlusal trauma

Answer 9

1. Direct

2. Indirect

Question 10

What is direct trauma

Answer 10

Trauma directly applied to the periodontal tissues

Question 11

What is indirect trauma

Answer 11

Trauma indirectly applied to the periodontal tissue eg through the teeth

Question 12

How do we classify developmental or acquired deformities and conditions

Answer 12

Armitage classification 1999

Question 13

Talk through the Armitage classification

Answer 13

A. Localised tooth related factors that modify or predispose to plaque-induced gingival diseases/periodontitis
B. Mucogingival deformities and conditions around teeth
C. Mucogingival deformities and conditions on edentulous ridges
D. OCCLUSAL TRAUMA

Question 14

What is occlusal trauma split into according tot eh Armitage classification

Answer 14

1. Primary occlusal trauma

2. Secondary occlusal trauma

Question 15

Which category does periodontal disease due to occlusal trauma fall under

Answer 15

other conditions affect the periodontium

Question 16

What categories fall under other factors affecting the periodontium

Answer 16

1. Systemic disease or conditions affecting the periodontal supporting tissue
2. Periodontal abscesses and Endodontic-Periodontal lesions
3. Mucogingival Deformities and Conditions
4. Traumatic occlusal forces
5. Tooth and prosthesis related factors

Question 17

What is primary traumatic occlusal force

Answer 17

Excessive occlusal forces on teeth with normal periodontal support

Question 18

What is secondary traumatic occlusal force

Answer 18

Normal or excessive forces on teeth with reduced periodontal support

Question 19

What concepts were discovered following cadaver studies looking at traumatic occlusal forces

Answer 19

1, Glickman concept

2. Waerhaug’s Concept

Question 20

What is the glickman concept

Answer 20

Postulated that the type of attachment loss was different for teeth undergoing the application of forces of abnormal magnitude than for those undergoing normal loading

Question 21

What does Glickmans concept not take into account

Answer 21

Does not take into account form of interdental bone or thickness of bone

Question 22

What did Waerhaug’s Concept lok at

Answer 22

Autopsy material and apical extension of sub gingival plaque relative to the inflammatory cell infiltrate and the level of the adjacent alveolar bone

Question 23

What did Waerhaug’s Concept conclude

Answer 23

That the loss of attachment was entirely due to inflammatory factors

Question 24

What are the problems with cadaver studies

Answer 24

1. Impossible to accurately assess the pre death occlusion
2. No way to establish cause and effect
3. No knowledge of cadavers habits or parafunction