Periodontology – Occlusal Trauma

Occlusal trauma occurs when the teeth are damaged from extreme amounts of force and no longer properly align.

When the jaws are closed, while at rest or chewing, the relationship between the opposing teeth is called an occlusion. When there is trauma, disease or dental treatment, it can alter the occlusion through a modification of the biting surface on the teeth. This results in the teeth coming together in a different way and ultimately, their occlusion is modified. This change in the teeth can have a negative effect on how the teeth occlude and can result in tenderness, pain or even cause damage to the teeth. When this occurs, it is called a traumatic occlusion.

A traumatic occlusion can also cause a thickening of the cervical margin of the alveolar bone and result in a widening of the periodontal ligament. The following symptoms are often evidence of occlusal trauma:

  • Fremitus or vibration
  • Migration of teeth
  • Mobility of the teeth
  • Pain and tenderness
  • Pain while chewing
  • Sensitivity to hot or cold
  • Wear facets

Diagnosis

Microscopically, there are various features which accompany occlusal trauma. These features include the following:

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

The two different types of occlusal trauma are primary and secondary. When a greater than normal occlusal force is placed on the teeth, this is called primary occlusal trauma. This condition can occur from parafunctional habits, including bruxism, chewing and biting habits. The associated excessive forces are classified into three different categories which include duration, frequency and magnitude. Primary occlusal trauma occurs when periodontal disease is not present.

When normal or excessive occlusal forces are applied to the teeth with compromised periodontal attachment, this is called secondary occlusal trauma. This contributes harm to a system which is already damaged. Secondary occlusal trauma typically occurs when there is a pre-existing periodontal condition.

Cause & Treatment

The teeth continuously experience horizontal and vertical occlusal forces. The center of rotation of the tooth serves as a fulcrum, and the surface of bone adjacent to the side of the tooth experiencing pressure can undergo resorption and eventually disappear. While the surface of bone adjacent to the side of the tooth which has tension, it can experience apposition and ultimately increase in size.

In cases of primary and secondary occlusal trauma, the tooth mobility may develop slowly over time. In secondary occlusal trauma, the tooth movement occurs sooner and is more prevalent. In order to treat mobility from primary occlusal trauma, it is critical to first eliminate the cause of the trauma.

In primary occlusal trauma cases, the cause of the tooth’s mobility was the excessive force being applied with a normal attachment apparatus. This may also be referred to as a periodontally-uninvolved tooth. It is important to identify and eliminate the cause of the pain and mobility. Once this is done, the mobile tooth or teeth should soon stop demonstrating any signs of mobility. Treatment for this may include adjusting or removing a high spot from a recently restored tooth. It may also involve training the patient to modify their habits, including chewing on pen caps or biting their fingernails. For patients with bruxism, treatment can be as simple as introducing a night guard to protect the teeth. Patients who are missing a tooth or multiple teeth may need restorative treatment using a denture or dental implants.