Occlusal trauma is the damage to

teeth A tooth ( : teeth) is a hard, calcified structure found in the jaws (or mouths) of many vertebrates and used to break down food. Some animals, particularly carnivores and omnivores, also use teeth to help with capturing or wounding prey, tear ...

when an excessive force is acted upon them and they do not align properly.Bibb, CA: Occlusal Evaluation and Therapy in the Management of Periodontal Disease. In Newman, MG; Takei, HH; Carranza, FA; editors: ''Carranza’s Clinical Periodontology'', 9th Edition. Philadelphia: W.B. Saunders Company, 2002. pages 698-701. When the jaws close, for instance during chewing or at rest, the relationship between the opposing teeth is referred to as

occlusion Occlusion may refer to: Health and fitness * Occlusion (dentistry), the manner in which the upper and lower teeth come together when the mouth is closed * Occlusion miliaria, a skin condition * Occlusive dressing, an air- and water-tight trauma ...

. When trauma, disease or dental treatment alters occlusion by changing the biting surface of any of the teeth, the teeth will come together differently, and their occlusion will change.Hinrichs, JE: Occlusal The Role of Dental Calculus and Other Predisposing Factors. In Newman, MG; Takei, HH; Carranza, FA; editors: ''Carranza’s Clinical Periodontology'', 9th Edition. Philadelphia: W.B. Saunders Company, 2002. page 192. When that change has a negative effect on how the teeth occlude, this may cause tenderness, pain, and damage to or movement of the teeth. This is called traumatic occlusion. Traumatic occlusion may cause a thickening of the cervical margin of the alveolar boneCarranza, FA: Bone Loss and Patterns of Bone Destructions. In Newman, MG; Takei, HH; Carranza, FA; editors: ''Carranza’s Clinical Periodontology'', 9th Edition. Philadelphia: W.B. Saunders Company, 2002. page 362. and widening of the

periodontal ligament The 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. It inserts into root cementum one side and onto alveolar b ...

, although the latter can also be caused by other processes.

Signs and symptoms

Clinically, there is a number of physiological results that serve as evidence of occlusal trauma:, *Progressive Tooth mobility *

Fremitus Fremitus is a vibration transmitted through the body. In common medical usage, it usually refers to assessment of the lungs by either the vibration intensity felt on the chest wall (''tactile fremitus'') and/or heard by a stethoscope on the chest ...

*Tooth migration *

Pain Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ...

*Thermal sensitivity *Pain on chewing or percussion * Wear facets

Diagnosis

Microscopically, there will be a number of features that accompany occlusal trauma: *

Hemorrhage Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...

Necrosis Necrosis () is a form of cell injury which results in the premature death of cells in living tissue by autolysis. Necrosis is caused by factors external to the cell or tissue, such as infection, or trauma which result in the unregulated dige ...

*Widening of the

, or PDL (also serves as a very common radiographic feature) *

Bone A bone is a Stiffness, rigid Organ (biology), organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red blood cell, red and white blood cells, store minerals, provid ...

resorption *

Cementum Cementum is a specialized calcified substance covering the root of a tooth. The cementum is the part of the periodontium that attaches the teeth to the alveolar bone by anchoring the periodontal ligament.Illustrated Dental Embryology, Histology, a ...

loss and tears It was concluded that widening of the periodontal ligament was a "functional adaptation to changes in functional requirements".

Primary vs. secondary

There are two types of occlusal trauma, primary and secondary.

Primary

Primary occlusal trauma occurs when ''greater than normal occlusal forces'' are placed on teeth, as in the case of parafunctional habits, such as bruxism 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 apparatus and, thus, ''no periodontal disease''.Carranza, FA; Bernard, GW: The Tooth-Supporting Structures. In Newman, MG; Takei, HH; Carranza, FA; editors: ''Carranza’s Clinical Periodontology'', 9th Edition. Philadelphia: W.B. Saunders Company, 2002. page 53.

Secondary

Secondary occlusal trauma occurs when ''normal or excessive 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''.

Cause 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.Trauma from Occlusion Handout, Dr. Michael Deasy, Department of Periodontics, NJDS 2007. page 4 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 primary occlusal trauma, the cause of the trauma must be eliminated. Likewise for teeth subject to secondary occlusal trauma, though these teeth may also require splinting together to the adjacent teeth so as to eliminate their mobility. In primary occlusal trauma, the 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 cause 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 involve altering one's 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 A crown is a traditional form of head adornment, or hat, worn by monarchs as a symbol of their power and dignity. A crown is often, by extension, a symbol of the monarch's government or items endorsed by it. The word itself is used, partic ...

bridge A bridge is a structure built to span a physical obstacle (such as a body of water, valley, road, or rail) without blocking the way underneath. It is constructed for the purpose of providing passage over the obstacle, which is usually somethi ...

. 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 cause 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 Toothlessness, or edentulism, is the condition of having no teeth. In organisms that naturally have teeth, it is the result of tooth loss. Organisms that never possessed teeth can also be described as edentulous. Examples are the members of the ...

areas. As with primary occlusal trauma, treatment may include either a removable prosthesis or implant-supported crown or bridge.

References

External links

{{Periodontology Acquired tooth disorders Periodontology