Occlusal trauma
Encyclopedia
Occlusal trauma is a dental term that refers to the damage incurred when teeth are left in traumatic occlusion without proper treatment.
When the maxilla
ry and mandibular dental arches approach each together, as they do, for example, during chewing or at rest, the relationship between the opposing teeth is referred to as occlusion
. If this occlusal relationship is not balanced properly it may result in pain, tenderness and even mobility of the affected teeth.
When the natural course of trauma, disease and dental treatment alters an individual's occlusion by removing or changing the occlusal
(biting) surface of any of the teeth, that individual's teeth will come together, or occlude, differently, and their occlusion will change. When that change is detrimental to the manner in which the teeth occlude, the patient is said to possess a traumatic occlusion. Traumatic occlusion may cause a thickening of the cervical margin of the alveolar bone and widening of the periodontal ligament
, although the latter is not pathognomonic
for this condition.
It was concluded that widening of the periodontal ligament was a "functional adaptation to changes in functional requirements".
or various chewing or biting habits, including but not limited to those involving fingernails and pencils or pens.
The associated excessive forces can be grouped into three categories. Excesses of:
Primary occlusal trauma will occur when there is a normal periodontal attachment
apparatus and, thus, no periodontal disease.
Secondary occlusal trauma occurs when normal occlusal forces are placed on teeth with compromised periodontal attachment, thus contributing harm to an already damaged system. As stated, secondary occlusal trauma occurs when there is a compromised periodontal attachment
and, thus, a pre-existing periodontal condition.
In both primary and secondary occlusal trauma, tooth mobility might develop over time, with it occurring earlier and being more prevalent in secondary occlusal trauma. To treat mobility due to occlusal trauma, whether it be primary or secondary, the affected teeth are splinted together and to the adjacent teeth so as to eliminate their mobility.
In primary occlusal trauma, the etiology
, or cause, of the mobility was the excessive force being applied to a tooth with a normal attachment apparatus, otherwise known as a periodontally-uninvolved tooth. The approach should be to eliminate the etiology of the pain and mobility by determining the causes and removing them; the mobile tooth or teeth will soon cease exhibiting mobility. This could involve removing a high spot on a recently restored tooth, or even a high spot on a non-recently restored tooth that perhaps moved into hyperocclusion
. It could also involved altering ones parafunctional habits, such as refraining from chewing on pens or biting one's fingernails. For a bruxer
, treatment of the patient's primary occlusal trauma could involve selective grinding of certain interarch tooth contacts or perhaps employing a nightguard to protect the teeth from the greater than normal occlusal forces of the patient's parafunctional habit. For someone who is missing enough teeth in non-strategic positions so that the remaining teeth are forced to endure a greater per square inch occlusal force, treatment might include restoration with either a removable prosthesis or implant
-supported crown
or bridge
.
In secondary occlusal trauma, simply removing the "high spots" or selective grinding of the teeth will not eliminate the problem, because the teeth are already periodontally involved. After splinting the teeth to eliminate the mobility, the etiology of the mobility (in other words, the loss of clinical attachment
and bone) must be managed; this is achieved through surgical periodontal procedures such as soft tissue and bone grafts, as well as restoration of edentulous areas. As with primary occlusal trauma, treatment may include either a removable prosthesis or implant
-supported crown or bridge.
When the maxilla
Maxilla
The maxilla is a fusion of two bones along the palatal fissure that form the upper jaw. This is similar to the mandible , which is also a fusion of two halves at the mental symphysis. Sometimes The maxilla (plural: maxillae) is a fusion of two bones along the palatal fissure that form the upper...
ry and mandibular dental arches approach each together, as they do, for example, during chewing or at rest, the relationship between the opposing teeth is referred to as occlusion
Occlusion (dentistry)
Occlusion, in a dental context, means simply the contact between teeth. More technically, it is the relationship between the maxillary and mandibular teeth when they approach each other, as occurs during chewing or at rest....
. If this occlusal relationship is not balanced properly it may result in pain, tenderness and even mobility of the affected teeth.
When the natural course of trauma, disease and dental treatment alters an individual's occlusion by removing or changing the occlusal
Commonly used terms of relationship and comparison in dentistry
There are numerous commonly used terms of relationship and comparison that refer to different aspects of teeth and are frequently utilized in articles about dentistry...
(biting) surface of any of the teeth, that individual's teeth will come together, or occlude, differently, and their occlusion will change. When that change is detrimental to the manner in which the teeth occlude, the patient is said to possess a traumatic occlusion. Traumatic occlusion may cause a thickening of the cervical margin of the alveolar bone and widening of the periodontal ligament
Periodontal ligament
The periodontal fiber or periodontal ligament, commonly abbreviated as the PDL, is a group of specialized connective tissue fibers that essentially attach a tooth to the alveolar bone within which it sits...
, although the latter is not pathognomonic
Pathognomonic
Pathognomonic is a term, often used in medicine, that means characteristic for a particular disease. A pathognomonic sign is a particular sign whose presence means that a particular disease is present beyond any doubt...
for this condition.
Histologic features associated with occlusal trauma
Microscopically, there will be a number of features that accompany occlusal trauma:- Hemorrhage
- NecrosisNecrosisNecrosis is the premature death of cells in living tissue. Necrosis is caused by factors external to the cell or tissue, such as infection, toxins, or trauma. This is in contrast to apoptosis, which is a naturally occurring cause of cellular death...
- Widening of the periodontal ligamentPeriodontal ligamentThe periodontal fiber or periodontal ligament, commonly abbreviated as the PDL, is a group of specialized connective tissue fibers that essentially attach a tooth to the alveolar bone within which it sits...
, or PDL (also serves as a very common radiographic feature) - Bone resorption
- CementumCementumCementum is a specialized calcified substance covering the root of a tooth. Cementum is excreted by cells called cementoblasts within the root of the tooth and is thickest at the root apex. These cementoblasts develop from undifferentiated mesenchymal cells in the connective tissue of the dental...
loss and tears
It was concluded that widening of the periodontal ligament was a "functional adaptation to changes in functional requirements".
Clinical signs and symptoms associated with occlusal trauma
Clinically, there are a number of physiologic results that serve as evidence of occlusal trauma:- Tooth mobility
- Fremitus
- Tooth migration
- PainPainPain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
- Wear facets
Primary vs. secondary occlusal trauma
There are two types of occlusal trauma, primary and secondary.Primary occlusal trauma
Primary occlusal trauma occurs when greater than normal occlusal forces are placed on teeth, as in the case of parafunctional habits, such as bruxismBruxism
Bruxism is characterized by the grinding of the teeth and typically includes the clenching of the jaw. It is an oral parafunctional activity that occurs in most humans at some time in their lives. In most people, bruxism is mild enough not to be a health problem...
or various chewing or biting habits, including but not limited to those involving fingernails and pencils or pens.
The associated excessive forces can be grouped into three categories. Excesses of:
- Duration
- Frequency and
- Magnitude
Primary occlusal trauma will occur when there is a normal periodontal attachment
Periodontium
Periodontium refers to the specialized tissues that both surround and support the teeth, maintaining them in the maxillary and mandibular bones. The word comes from the Greek terms peri-, meaning "around" and -odons, meaning "tooth." Literally taken, it means that which is "around the tooth"...
apparatus and, thus, no periodontal disease.
Secondary occlusal trauma
Periodontium
Periodontium refers to the specialized tissues that both surround and support the teeth, maintaining them in the maxillary and mandibular bones. The word comes from the Greek terms peri-, meaning "around" and -odons, meaning "tooth." Literally taken, it means that which is "around the tooth"...
and, thus, a pre-existing periodontal condition.
Etiology and treatment
Teeth are constantly subject to both horizontal and vertical occlusal forces. With the center of rotation of the tooth acting as a fulcrum, the surface of bone adjacent to the pressured side of the tooth will undergo resorption and disappear, while the surface of bone adjacent to the tensioned side of the tooth will undergo apposition and increase in volume.In both primary and secondary occlusal trauma, tooth mobility might develop over time, with it occurring earlier and being more prevalent in secondary occlusal trauma. To treat mobility due to occlusal trauma, whether it be primary or secondary, the affected teeth are splinted together and to the adjacent teeth so as to eliminate their mobility.
In primary occlusal trauma, the etiology
Etiology
Etiology is the study of causation, or origination. The word is derived from the Greek , aitiologia, "giving a reason for" ....
, or cause, of the mobility was the excessive force being applied to a tooth with a normal attachment apparatus, otherwise known as a periodontally-uninvolved tooth. The approach should be to eliminate the etiology of the pain and mobility by determining the causes and removing them; the mobile tooth or teeth will soon cease exhibiting mobility. This could involve removing a high spot on a recently restored tooth, or even a high spot on a non-recently restored tooth that perhaps moved into hyperocclusion
Occlusion (dentistry)
Occlusion, in a dental context, means simply the contact between teeth. More technically, it is the relationship between the maxillary and mandibular teeth when they approach each other, as occurs during chewing or at rest....
. It could also involved altering ones parafunctional habits, such as refraining from chewing on pens or biting one's fingernails. For a bruxer
Bruxism
Bruxism is characterized by the grinding of the teeth and typically includes the clenching of the jaw. It is an oral parafunctional activity that occurs in most humans at some time in their lives. In most people, bruxism is mild enough not to be a health problem...
, treatment of the patient's primary occlusal trauma could involve selective grinding of certain interarch tooth contacts or perhaps employing a nightguard to protect the teeth from the greater than normal occlusal forces of the patient's parafunctional habit. For someone who is missing enough teeth in non-strategic positions so that the remaining teeth are forced to endure a greater per square inch occlusal force, treatment might include restoration with either a removable prosthesis or implant
Dental implant
A dental implant is a "root" device, usually made of titanium, used in dentistry to support restorations that resemble a tooth or group of teeth to replace missing teeth....
-supported crown
Crown (dentistry)
A crown is a type of dental restoration which completely caps or encircles a tooth or dental implant. Crowns are often needed when a large cavity threatens the ongoing health of a tooth. They are typically bonded to the tooth using a dental cement. Crowns can be made from many materials, which...
or bridge
Bridge (dentistry)
A bridge, also known as a fixed partial denture, is a dental restoration used to replace a missing tooth by joining permanently to adjacent teeth or dental implants....
.
In secondary occlusal trauma, simply removing the "high spots" or selective grinding of the teeth will not eliminate the problem, because the teeth are already periodontally involved. After splinting the teeth to eliminate the mobility, the etiology of the mobility (in other words, the loss of clinical attachment
Periodontium
Periodontium refers to the specialized tissues that both surround and support the teeth, maintaining them in the maxillary and mandibular bones. The word comes from the Greek terms peri-, meaning "around" and -odons, meaning "tooth." Literally taken, it means that which is "around the tooth"...
and bone) must be managed; this is achieved through surgical periodontal procedures such as soft tissue and bone grafts, as well as restoration of edentulous areas. As with primary occlusal trauma, treatment may include either a removable prosthesis or implant
Dental implant
A dental implant is a "root" device, usually made of titanium, used in dentistry to support restorations that resemble a tooth or group of teeth to replace missing teeth....
-supported crown or bridge.