Trauma from Occlusion: Symptoms, Diagnosis and Treatment

Symptoms of Trauma from Occlusion

• Thermal sensitivity: Trauma from occlusion leads to pressure on venous return which causes venous hyperplasia and increase blood pressure in pulp and pain. When teeth are pushed together scratching or squeaky sound is heared.
• Habits: Occlusal prematurities can lead to the habit pattrn which is injurious to periodontium. Due to tension, patient grinds or clenches the teeth.
• Muscle hypertonicity: Occlusal interferences lead to muscle spasm or discomfort. Subluxation and crepitus in TMJ associated with muscle spasm occur by cuspal interferences.
• Loosening teeth: In advanced cases, patient is aware of loosening of teeth and complains of soreness and tenderness in some of the areas.
• Effect of excessive occlusal forces on dental pulp: Complete calcification of pulpal canal occur in cases of long standing severe trauma or following single serious traumatic accident to tooth resulting in gross disturbances of circulation.
• Effect of insufficient occlusal forces: They causes thinning of periodontal ligament, atrophy of fibers, osteoporosis of alveolar bone and reduction in bone height.

Signs of Trauma from Occlusion

• Visual signs: Signs that can be seen in wear registration, as transparencies are points of contact and not broad areas. Excessively large areas of contact can also be detected by using a variety of marketing materials such as carton paper, tape, ribbon or a dye.
• Auditory sign: In centric relation, there is a distinct ringing sound; in maximum tooth contact with deflections present, the sound is dull or perceptible.
• Tactile sign: In centric relation and in normal excessive movements, response to figer contact is smooth, with deflection present, a roughness can be detected.
• Migration of teeth: Loss of inter – proximal contacts and migration of teeth may be the sequela of traumatic occlusal relations. Unusual habit pattrn may lead to tooth migration and trauma from occlusion beyond the functional range of normal occlusal contacts.
• Mobility: Most common clinical sign of trauma to periodontium is increased tooth mobility. In injury stage of trauma from occlusion, there is destruction of periodontal fibers, which will increase the mobility of the tooth. In the final stage, the accommodation of the periodontium to increased forces entails a widening of periodontal ligament, which also leads to increased tooth mobility.
• Fremitus: This is an important tool. Fremitus means palpable vibration or movements. A tooth with fremitus has excess contact, possibly related to a premature contact.
• Wear patterns: Facets and abnormal wear patterns must be differentiated from attrition caused by a coarse diet. Shiny and irregular facets indicate tooth-to-tooth wear that is associated with bruxism. These worn and abraded teeth are invariably fim with no sign of mobility.
• Gingival recession: Gingival recession may be provoked by direct contact of the teeth with the gingiva, as in severe overbite, where the upper incisors damage the buccal gingiva of the lower incisors.
• Gingival clefts: These cleft are a combination of conditions caused by toothbrush abrasion. This initially produces a linear act injury that eventually develops into a gingival cleft

Classify Trauma from Occlusion (TFO)

Definition of Trauma from Occlusion

When occlusal forces exceeds the adaptive capacity of tissues, tissue injury results which is called as trauma from occlusion or occlusal trauma.

Trauma from Occlusion is defined as “damage in the periodontium caused by stress on the teeth produced directly or indirectly by the teeth of the opposing jaw”.

Management of Trauma from Occlusion

• Management of symptoms of occlusal traumatism is appropriate during any phase of periodontal therapy.
• Except in case of acute conditions, treatment is usually first addressed during initial therapy following efforts to reduce or minimize the inflmmatory lesion. Evaluation of occlusal symptoms should continue throughout the course of therapy.
• Management should be needed to repeated or revised.
• Occlusal therapy should be accomplished via various different approaches. Choice of these therapies depends on the various factors such as characteristics of forces, underlying cause of these forces, amount of periodontal support to remaining teeth and functioning of remaining teeth.

Treatment considerations for trauma from occlusion are:

• • Occlusal adjustments
  • Management of parafunctional habits
  • Coronoplasty
  • Temporary, provisional or long-term stabilization of mobile teeth by removable or fied appliances
  • Orthodontic tooth movement
  • Occlusal reconstruction
  • Extraction of selected teeth
  • Occlusal bite planes
  • Permanent or temporary splint application.