Traumatic Occlusal Forces- Final Flashcards
Injury resulting in tissue changes within the attachment apparatus (PDL, cementuman supporting bone) as result of occlusal forces:
Occlusal trauma
Occlusal forces=
teeth
T/F: OT may occur in an intact periodontal or in a reduced peridontium affected by perio disease
True
Reduced periodontium =
60% of bone loss
What is the gold standard for determining periodontal disease?
attachment loss
Terminology in the 2017 AAP world workshop changed the word “excessive” to:
traumatic
T/F: OVerall, past studies showed lack of “cause & effect” such as OT did NOT cause pocket formation or lead to loss of connective tissue
True
List the parts of the periodontium affected by occlusal forces:
- cementum
- PDL
- Alveolar bone proper
T/F: The gingiva and JE are NOT affected by occlusal forces
true
List the categories of occlusal trauma:
1A: primary occlusal trauma
1B: secondary occlusal trauma
1C: orthodontic
Controlled occlusal trauma to change the relationship of the teeth to one another
Orthodontics
What are the variables of occlusal trauma?
- DIRECTION of force
- MAGNITUDE of force
- DURATION of force
- FREQUENCY of occurrence
DIRECTION, MAGNITUDE, DURATION, FREQUENCY
Bone should be ____ from the CEJ
1-2mm
Trauma from occlusion is considered to be:
pathologic
Forces of occlusion ____ the adaptive capacity of the periodontium
exceed
List from pathological to physiological:
PATHOLOGICAL
- occlusal trauma
- hyperfunction
- normal
- hypofunction
- disuse atrophy
PHYSIOLOGICAL
Occlusal trauma & hyper function are considered:
pathological
Hypofunction & disuse atrophy are considered:
physiological
Placing a high amalgam restoration is an example of:
hyperfunction
A tooth that is barely occluding is an example of:
hypofunction
traumatic occlusal forces applied to a tooth or teeth with normal periodontal support:
primary occlusal trauma
With PRIMARY occlusal trauma, we may clinically see ____ that ___
ADAPTIVE mobility that does NOT progress
Give an example of PRIMARY occlusal trauma:
high restoration with mobility resolving following reduction
T/F: SECONDARY occlusal trauma tends to happen in a fairly late stage of nearly 60% bone loss
True
Injury resulting in tissue changes from normal or traumatic occlusal forces applied to a tooth or teeth with reduced periodontal support
secondary occlusal trauma
SECONDARY occlusal trauma may be seen as:
progressive mobility and or pain
Moving tooth #19 towards tooth #18
Compression side =
Tension side =
compression side = direction tooth is moving
tension side = direction opposite that tooth is moving
Direction that the tooth is moving due to OT:
compression
Direction OPPOSITE to moving tooth due to OT:
tension
As fibers are compressed due to OT, ____ is reduced
PDL space
Compression side results in loss of:
fiber orientation
Compression side results in increased capillary permeability, rupture of blood vessels and hemorrhage into PDL perivascular spaces ultimately resulting in:
edema
T/F: With compression, resorption of alveolar bone proper (root resorption if severe) and widening of the PDL will occur
True
- increased capillary permeability, dilation
- edema, disturbed fluid exchange
- vascular damage with stasis, clotting, thrombosis
- lowered periodontal resistance
- accompany tissue effects, usually inor
minor trauma from occlusion
What happens to the PDL on the tension side?
lengthening resulting in increased in PDL space
Lengthening occurs on the tension side resulting in:
increased PDL space
- increase in PDL space
- Rupture of PDL fiber bundles
- Compression of PDL blood vessels and hemmorheage in perivascular
- Deposition of new alveolar bone and DECREASE in PDL space (if severe, cemental tears)
Tension side
This act results in RESORPTION of alveolar bone proper and WIDENING of the PDL space (root resorption if severe):
This act results in DEPOSITION of new alveolar bone and DECREASE of the PDL (if severe cemental tears)
compression side
tension side
- Crushing (pressure injury)- necrosis at furca, alveolar crest
- Extravasated RBCs, hematoma, necrosis, & vascular damage
SEVERE trauma from occlusion
Traumatic occlusal forces applied to tooth or teeth with NORMAL periodontal support
PRIMARY occlusal trauma
What is the manifestation of PRIMARY occlusal trauma?
adaptive mobility (NOT PROGRESSIVE OR PATHOLOGIC)
example: Hyper occlusion
NORMAL or TRAUMATIC occlusal forces applied to a tooth or teeth with REDUCED peridontial support
SECONDARY occlusal trauma
What is the manifestation of SECONDARY occlusal trauma?
progressive mobility
What is the only TRUE way to determine occlusal trauma occurrence?
Biopsy
PROPOSED clinical and radiographic indicators of occlusal trauma:
- fremitus
- mobility
- occlusal discrepancies
- wear facets
- tooth migration
- fractured tooth
- thermal sensitivity
- discomfort/pain on chewing
- widened PDL ligament space
- root resoprtion
- cemental tear
A palpable or visible movement of a tooth when subjected to occlusal force:
fremitus
Clinical signs and symptoms of occlusal trauma:
- MOBILITY of affected teeth
- radiographic evidence of THICKENED PDL
- positive history of clenching or bruxism
- missing or tilted teeth
- evidence of occlusal interferences
What is the mobility index we currently use for occlusal trauma:
miller
Classify miller status:
First distinguishable sign of movement greater than normal
miller 1
Classify miller status:
movement which allows crown to move 1mm from its normal position in any directon
miller 2
Classify miller status
tooth may be rotated or depressed in alveoli
miller 3
T/F: It is acceptable to use fingers to determine miller classifciation
False- MUST USE 2 RIGID INSTRUMENTS
Grinding, clenching, or clamping of teeth. The force may damage tooth or attachment apparatus:
bruxism
- Increased mobility
- pulpal sensitivity
- bite tenderness
- non-masticatory/ excessive occlusal wear
- dull percussion sound
- muscle tenderness/spasm/hypertrophy/tiredness
- TMJ pain
- Jaw lock
- audible sounds
bruxism indicators
What type of percussion sound will be heard with a bruxir?
dull
Other manifestations of traumatic occlusal force include:
- malocclusions
- tooth migration
- fractured teeth
Radiogrpahic signs of traumatic occlusal forces =
- WIDENED PDL space
- THICKENED lamina dura
- vertical (angular) bone loss
- furcal bone loss
- alveolar radiolucency &/or condensation
The PDL is thickest at the ___ &___
apices & alveolar crest (0.20mm)
What is the measurement of the PDL at the mid root?
0.15mm
What is the biggest contraindication to occlusal adjustment?
WHen periodontal inflammation has NOT been controlled
(other contraindications include)
- abscence of pre-treatment diagnosis
- prophylactic therapy or sole treatment of periodontal disease
- as primary treatment of bruxism
- severe extrusion or malpositioned teeth
T/F: Tooth mobility positively affects the outcome of periodontal therapy and maintenenance
FALSE- negatively affects
T/F: Tooth mobility will generally decrease once inflammation is controlled
true
Occlusal adjustment is best done in conjunction with:
periodontal therapy
Hypefunction is a slight increase in occlusal force. This is considered to be a ____ adaptation
PHYSIOLOGIC
Trauma from occlusion in the absence of inflammation does NOT cause:
- gingivitis
- peridontitis
- pocket formation
T/F: There is NO EVIDENCE that TOF causes non-carious cervical lesions (NCCLs). Most studies use finite element analysis
TRUE
NCCLs may result from:
- abrasion
- erosion
- corrosion
T/F: evidence form observational studies reveal that traumatic occlusal DOES cause gingival recession
FALSE- TOF does NOT cause gingival recession