Trauma From Occlusion Flashcards
What is Occlusal Trauma?
Occlusal trauma refers to injury to the periodontium resulting from occlusal forces that exceed the adaptive capacity of the attachment apparatus.
What causes trauma from occlusion?
Alterations in occlusal forces, a reduced capacity of the periodontium to withstand occlusal forces, or both.
What are the causes (etiology) of acute occlusal trauma?
Results from an abrupt occlusal impact such as that produced by:
- Biting on a hard object (e.g., olive pit).
- Restorations or prosthetic appliances that alter occlusal forces.
What are the clinical signs of acute occlusal trauma?
- Tooth pain
- Sensitivity to percussion
- Increased tooth mobility
How does chronic occlusal trauma develop?
Results from gradual changes in occlusion due to:
- Tooth wear
- Drifting movement
- Extrusion of teeth
- Parafunctional habits (e.g., bruxism, clenching)
What happens in chronic occlusal trauma?
Chronic forces lead to:
Destruction > Repair → Periodontium struggles to keep up.
Remodeling happens, but damage continues.
What are the effects or radiographic changes that occur in chronic occlusal trauma?
- Widened periodontal ligament.
- Angular bone defects without periodontal pockets.
- Tooth becomes loose.
What is primary occlusal trauma?
Trauma caused by excessive occlusal forces on a previously healthy periodontium.
What is secondary occlusal trauma?
Trauma occurring due to reduced capacity of the periodontium to withstand occlusal forces, often in periodontitis-affected teeth.
What are some common causes of primary occlusal trauma?
High fillings, ill-fitting prosthetic replacements, drifting movement or extrusion of teeth and orthodontic movement.
Does primary occlusal trauma lead to periodontal pockets?
No, it does not initiate pocket formation because supracrestal fibers prevent apical migration of the junctional epithelium.
What are the three stages of tissue response to occlusal trauma?
- Injury: Excessive forces widen the PDL and cause angular bone defects.
- Repair: Damaged tissues are removed and replaced by new bone, fibers, and cementum.
- Adaptive Remodeling: Thickening of the PDL (funnel-shaped at the crest), angular defects in the bone with no pocket formation, involved teeth become loose and increased vascularization.
What happens if repair does not keep up with destruction?
The periodontium remodels to create a structural balance, resulting in thickened PDL and angular bone defects.
What are the clinical signs of occlusal trauma?
- Mobility
- Pain on chewing
- Fremitus
- Occlusal discrepancies
- Wear facets & abfractions
- Tooth migration
- Chipped or fractured teeth
- Thermal sensitivity
What are the radiographic signs of occlusal trauma?
- Widened PDL space (funnel-shaped coronally)
- Thickened lamina dura
- Angular bone loss
- Radiolucency in furcation areas
- Root resorption
Is occlusal trauma reversible?
Yes, if the excessive force is removed, tissues can repair. However, inflammation from plaque can impair reversibility.
How does occlusal trauma affect periodontitis?
It affects only the PDL and bone, but it does not cause pockets or increase gingival fluid flow.
What is pathologic tooth migration?
Tooth displacement due to an imbalance among the factors maintaining physiologic tooth position, due to periodontal disease.
What factors contribute to maintaining normal tooth position?
- Health and normal height of the periodontal attachment apparatus.
- Forces exerted on the teeth (occlusal forces and pressure from the lips, cheeks, tongue).
What happens when periodontal support is weakened?
- A tooth with weakened support (due to periodontitis) cannot maintain its normal position and may shift unless restrained by adjacent teeth.
- Normal occlusal forces can become injurious.
- Abnormal proximal contacts create unwanted forces, causing the tooth to shift in an occlusal or incisal direction.
- Pathologic migration may occur after a tooth loses contact with its opposing tooth.
- Pathologic migration is an early sign of localized aggressive periodontitis.
What is the goal of periodontal therapy for occlusal trauma?
To maintain the periodontium in comfort and function.
What treatment options are available?
- Occlusal adjustment
- Management of parafunctional habits
- Splinting/stabilization of mobile teeth
- Orthodontic tooth movement
- Occlusal reconstruction
- Extraction of selected teeth
What is the most common clinical sign of trauma from occlusion?
Tooth Mobility
Does trauma from occlusion increase gingival fluid flow?
No, trauma from occlusion does not increase gingival fluid flow.
