Trauma From Occlusion- Natural Teeth

Question 1

What is trauma from occlusion?

Answer 1

an injury to the attachment apparatus as the result of excessive occlusal forces
May also be a “normal amount of force” but when applied to a damaged periodontium it is excessive and has the same effect

Question 2

______ occlusal trauma is classified as excessive force on a normal periodontium

Answer 2

primary

Question 3

______ occlusal trauma is classified as “normal force” applied to a weakened periodontium.

Answer 3

secondary

Question 4

Secondary occlusal trauma is associated with which two conditions?

Answer 4

1. with periodontitis

2. with reduced, but otherwise healthy periodontium

Question 5

Clinical signs of occlusal trauma may represent ____ or an _____ __ ____.

Answer 5

injury

adaptation to injury

Question 6

What are the 5 clinical signs of “trauma from occlusion”?

Answer 6

1. progressive tooth mobility
2. teeth moving teeth
3. pathologic migration
4. infrabony pockets (controversial)
5. buttressing bone (controversial)

Question 7

What are 4 radiographic signs of possible trauma from occlusion?

Answer 7

1. Widened PDL space
2. Thickened Radicular Lamina Dura
3. Trabecular Bone (hypo or hyperfunction)
4. Angular Bone Loss and Furcation Loss

Question 8

True or False: Some of the radiographic changes may represent adaptation to occlusal trauma and some may be due to extension of periodontal disease without occlusal trauma.

Answer 8

True

Question 9

True or False: The Widening of the PDL space is not necessarily a bad thing because it creates a more resistant periodontium.

Answer 9

True

Question 10

Increased impact results in _____ trabecular bone. Decreased impact (anti-gravity of astronauts) results in _____ trabecular bone.

Answer 10

increased. ..hyperfunction (trauma from occlusion)

decreased. ..hypofunction (astronauts)

Question 11

Why is angular bone on radiographs controversial in its relation to trauma from occlusion?

Answer 11

angular bone loss may purely be due to tooth and bone anatomy and the progression of inflammatory perio disease

Question 12

What is the “co-destruction theory” involving occlusal trauma?

Answer 12

occlusal trauma may be a CO-destructive factor that ALTERS the severity and pattern of inflammatory periodontal disease

Question 13

In the co-destruction theory, bacteria initiate periodontitis in the zone of _______ and the addition of trauma from occlusion causes progression toward periodontal disease in the zone of ________.

Answer 13

irritation

co-destruction

Question 14

True or False: According to the co-destruction theory, periodontal disease follows the same path but is more rapidly progressing in the presence of trauma.

Answer 14

False:
Perio Disease without TFO progresses facial to the bone
Perio Disease with TFO progresses in the PDL space**

Question 15

The co-destruction theory predicts that perio disease will find a pathway into the _____ when trauma from occlusion is also present.

Answer 15

PDL

Question 16

What is the “Advancing Plaque Front” theory?

Answer 16

occlusal trauma has NO ROLE in the severity or pattern of inflammatory periodontal disease inflammation

Question 17

Trauma from occlusion causes tipping of the tooth and subsequent injury to the ________ at sites of ______ and ______.

Answer 17

Periodontal Ligament

pressure and tension

Question 18

What are the three models for “role of occlusal trauma”?

Answer 18

1. TFO without periodontitis
2. TFO with periodontitis but no co-destruction
3. TFO with periodontitis and co-destruction

Question 19

Which model for occlusal trauma is described as “injury that results in acute inflammation, PDL collagen destruction, cementum resorption, bone loss, no attachment loss, and possible mobility?”

Answer 19

TFO without periodontitis

• no attachment is lost*
• *NOT PLAQUE ASSOCIATED destruction**

Question 20

True or False: If TFO occurs without periodontitis, occlusal therapy will result in diminished signs and a return to normal.

Answer 20

True, no attachment was lost

Question 21

In TFO without periodontitis, when does the spike in resorption occur?

Answer 21

at the time of injury

Question 22

True or False: If TFO occurs on a healthy but reduced periodontium, signs of trauma will not go away even after occlusal therapy.

Answer 22

False: splinting and bite guards MAY diminish signs of trauma

Question 23

Which model for occlusal trauma is classified as having “supracrestal periodontitis with occlusal trauma acting independently”?

Answer 23

TFO with periodontitis but no co-destruction

Question 24

If there is no co-destruction, what does that mean?

Answer 24

one situation is not being potentiated by the other

Question 25

When treating TFO with periodontitis, which must be controlled first?

Answer 25

Control perio FIRST

then, occlusal therapy may be attempted

Question 26

What is the difference between “TFO + Perio without co-destruction” and “TFO + Perio + Co-destruction”?

Answer 26

without co-destruction =
SUPRAcrestal periodontitis
two diseases act at sep. locations
no enhancement of attachment loss
with co-destruction =
SUBcrestal periodontitis
two diseases act at same location
enhancement of attachment loss

Question 27

Methods of Occlusal Therapy can be ______ or _____.

Answer 27

Reversible

Irreversible

Question 28

Name four reversible methods of occlusal therapy.

Answer 28

1. Night Guards/bite planes
2. Extracoronal Splints
3. Muscle Relaxants
4. Muscle Exercises

Question 29

Name four irreversible methods of occlusal therapy.

Answer 29

1. Intracoronal splints (with tooth prep)
2. Occlusal adjustments/selective grinding
3. Orthodontics
4. Orthognathic surgrery

Question 30

Periodontal occlusal trauma, post-orthodontics, prior to extension, types of TMD, and specific wear patterns are indications for _____ ______.

Answer 30

selective grinding

Question 31

What are the contraindications to selective grinding?

Answer 31

severe malocclusion
non-ideal but tolerated occlusion
severe wear (bruxers)
patient in pain
end-point can't be reached (articulator attempt)

Question 32

True or False: If a tooth wiggles, it is bad.

Answer 32

False. Not always the case.

Question 33

True or False: Occlusal trauma without periodontitis may be reversible and may result in a mobile but otherwise healthy tooth.

Answer 33

True

Question 34

True or False: Occlusal therapy is indicated prior to periodontal regeneration therapy.

Answer 34

True

Question 35

True or False: Occlusal adjustment is justified in the absence of perio disease as a perio disease preventative measure.

Answer 35

FALSE, do not change the occlusion unless they are experience occlusion-related symptoms