Perio Other – Occlusal Trauma

Occlusal trauma occurs when the teeth are damaged from excessive force and are no longer properly aligned as a result.

When the jaws close together, the relationship between the teeth is an occlusion. In situations where trauma, disease or a dental treatment alters the occlusion through the modification of the surface of the teeth, it is possible for the teeth come together differently. When this occurs, the occlusion is changed. In cases where the change in the teeth has a negative impact on how the teeth occlude, it may result in discomfort, tenderness, pain or even cause damage to or result in movement of the teeth. These cases are referred to as traumatic occlusion.

In addition to a widening of the periodontal ligament, a traumatic occlusion can also cause a thickening of the cervical margin of the alveolar bone.

There are a number of signs and symptoms which occur when occlusal trauma takes place including:

  • Discomfort when chewing
  • Fremitus
  • Mobility or migration of the teeth
  • Pain
  • Sensitivity to hot or cold

Diagnosis

Microscopically, there are various features which often occur along with an occlusal trauma. These features include:

  • Bone resorption
  • Cementum loss or tears
  • Hemorrhage
  • Necrosis
  • Widening of the periodontal ligament

The two different types of occlusal trauma are primary and secondary. Primary occlusal trauma occurs when a great occlusal force is applied to the teeth. This can occur from parafunctional habits, such as bruxism or other chewing and biting habits. The excessive forces can be grouped into three different categories:

  1. Duration
  2. Frequency
  3. Magnitude

Secondary occlusal trauma occurs when normal or excessive occlusal forces are applied to teeth which have a compromised periodontal attachment. This adds harm to an already damaged system. Secondary occlusal trauma typically occurs in cases where a pre-existing periodontal condition is present.

Cause and treatment

The teeth continually exposed to both horizontal and vertical occlusal forces. With the center of rotation of the tooth which acts as a fulcrum, the surface of the bone adjacent to the pressured side of the tooth can experience resorption and or even disappear. Meanwhile, the surface of bone which is adjacent to the tensioned side of the tooth can undergo apposition and eventually grow in size.

In both primary and secondary occlusal trauma, tooth mobility can develop over time. However, tooth movement typically occurs earlier and is more prevalent in secondary occlusal trauma. In order to properly treat mobility due to primary occlusal trauma, the cause of the trauma must first be eliminated.

In primary occlusal trauma cases, the mobility was from an excessive force being applied to a tooth with a normal attachment apparatus, also known as a periodontally-uninvolved tooth. It is important to identify and eliminate the cause of the pain and mobility. Once identified, the mobility of the tooth or teeth should stop. Treatment may involve minor adjustments like eliminating a high spot on a tooth which was recently restored. It could also involve the adjustment of a patient’s habits, such as chewing on objects or biting fingernails. For patients with bruxism, the treatment may involve the use of a night guard to protect the teeth from the chronic occlusal forces. For patients with a missing tooth, the treatment may include a removable denture or an implant restoration.