Occlusion and Periodontal Disease Lecture Notes PDF

Occlusion and Periodontal Disease DH 308 1 Look Up The Following Terms Centric occlusion Centric relation Malocclusion Lateral movement Working side Non-working side Group function Canine protection or Canine guidance Protrusive occlusion...

Occlusion and Periodontal Disease DH 308 1 Look Up The Following Terms Centric occlusion Centric relation Malocclusion Lateral movement Working side Non-working side Group function Canine protection or Canine guidance Protrusive occlusion 2 Review of Occlusion Video Occlusion for Dental Staff http://www.youtube.com/watch?v=ruj_5MrQIUM 3 Parafunctional Habits Bruxism: A type of parafunctional habit Unconscious grinding and/or clenching of the teeth when patient is not swallowing or chewing. Nocturnal bruxism = bruxism during sleep Only 5 to 20 % of patients with sign of bruxism are aware of bruxism Nail biting Tongue thrusting Thumb sucking Chewing foreign objects 4 Bruxism Bruxism is classified into one of two categories: Nocturnal (nighttime) Diurnal (daytime) The results of bruxism may be tooth wear, tooth fracture, restoration fracture, myalgia, hypertrophy of the masticatory muscles, and headache. 5 Parafunctional Habits 6 Parafunctional Habits 7 Bruxism Bruxism treatments include: Occlusal splints Pharmacologic therapy Physical therapy Behavioral modification therapy 8 Oral Habits Oral habits can contribute to periodontal and dental damage in the oral cavity. The amount of damage is related to the intensity and duration of the habit. Oral habits are repetitive masticatory activities outside the normal range of function and can involve tooth-to-tooth contact or contact with foreign objects. These habits can lead to tooth damage, muscular hypertrophy, muscular pain and tenderness, and periodontal tissue injury. 9 Trauma from Occlusion Traumatic occlusion does not refer to a malocclusion as described by Angle’s three classifications. Angle’s Class I, II, and III occlusions classify and describe the skeletal relationship of the maxillary to the mandibular teeth. The occlusal relationship of the teeth is not a predictor of pain or problems in the TMJ. 10 Classification of Occlusal Trauma Primary Occlusal Trauma Injury to the supporting structures (PDL, cementum, and bone) caused by excessive occlusal forces placed on a tooth or teeth with normal periodontal tissue support. e.g. High restoration, faulty restorations, fixed or removal prostheses, bruxism, clenching Secondary Occulsal Trauma Normal occlusal forces exceed the capability of a periodontium that is already affected by periodontal disease. e.g. Severe periodontitis 11 Signs of Occlusal Trauma Tooth mobility Fremitus Vibrational movement of a tooth under occlusal function Place an index finger on the gingival-tooth junction area Pain Tooth migration Attrition and Abfraction Muscle/Temporomandibular Joint Tooth Structure Widening of PDL 12 Occlusal Therapy Selective grinding (Occlusal equilibration) Reshaping of the occlusal or incisal surfaces of teeth Control of habits Orthodontic tooth movement Splinting Restorative procedures Monitoring without treatment 13 Occlusal Trauma and Periodontal Disease Occlusal trauma alone does not cause gingivitis, periodontitis, loss of connective tissue attachment, or pocket formation. With the presence of inflammation, occlusal trauma may accelerates the periodontal destruction. Secondary occlusal trauma has a potential to accelerated the destruction of bone. 14 Checking Occlusal Trauma Check functioning cusps (on Mandible). Check fremitus Recession? Abfraction? Muscle soreness? Headache? Neck pain? ShouLder pain? 15 Temporomandibular Disorders TMDs are a grouping of musculoskeletal conditions that produce pain or dysfunction in the masticatory system. When the muscles, not the joint, are involved, the condition is referred to as extracapsular. A problem occurring within the TMJ is known as intracapsular. 16 Causes of Temporomandibular Disorders The cause of TMDs is multifactorial. Stress is often a factor. Arthritis and psychologic problems can also be involved. A history of macrotrauma or microtrauma may exist. Macrotrauma is a single event. Microtrauma is a number of minor habits or events. 17 Categories of Temporomandibular Disorders Four main diagnostic categories for TMD are listed: 1. Muscle and fascial disorders of the masticatory system This group includes myalgia, trismus, spasm, dyskinesia (difficulty performing voluntary movements), bruxism, and other muscle disorders. 2. Internal derangements that impair mechanical function of the TMJ Arthritis conditions 18 Categories of Temporomandibular Disorders 3. Disorders of mandibular mobility Ankylosis, muscular fibrosis, internal derangements, and adhesion in the joint 4. Disorders of maxillomandibular growth Neoplastic and non-neoplastic conditions 19 Signs and Symptoms of Temporomandibular Disorders Four primary symptoms are commonly reported in patients with TMDs and include the following: 1. Pain and tenderness in the muscles of mastication 2. Pain and tenderness in the TMJ 3. Painful clicking of the joint during function 4. Limitation of mandibular motion 20 Signs and Symptoms of Temporomandibular Disorders A number of additional symptoms are found in patients with TMDs: Uncomfortable bite Incoordination of the jaw (dyskinesia) Ringing in the ears Muscle swelling In the dentition, signs include tooth wear, tooth mobility, and pulpitis. 21 Signs and Symptoms of Temporomandibular Disorders Tenderness or pain in the TMJ (arthralgia) is another common finding in TMDs. The pain arises from the soft tissues surrounding the joint because the articular surfaces of the joint are not innervated. Arthralgic pain is sharp, sudden, and associated with the jaw in function. 22 Signs and Symptoms of Temporomandibular Disorders A common dysfunction observed in the TMJ is a joint sound caused by a disruption of the normal movement of the condyle and articular disk in the joint. A single sound is known as a click or a pop. A grating sound is known as crepitus. 23 Signs and Symptoms of Temporomandibular Disorders Other inflammatory joint disorders include osteoarthritis and polyarthritis. The pain of these disorders in the TMJ is dull, aching, and constant, and is increased with function. 24 Radiographic Evaluation Changes observed in periapical radiographic images include: Widening of the periodontal ligament This is caused by the resorption of bony support from excessive occlusal forces. Increased density of the surrounding bone (osteosclerosis) Increased cementum at the apical areas of the root (hypercementosis) Osteosclerosis and hypercementosis are hypertrophic responses to occlusal 25 forces. Radiographic Evaluation 26 Radiographic Evaluation 27 Radiographic Evaluation 28 Treatment of Temporomandibular Disorders A commonly used approach is conservative, using simple, noninvasive methods. Initial therapy consists of a soft diet, limited movement of the jaw, application of moist heat to the affected area, and a nonnarcotic analgesic. Stronger drugs may be prescribed if symptoms do not respond to the nonnarcotic analgesic agents. Patients frequently improve after 2 to 3 29 weeks of initial therapy. Treatment of Temporomandibular Disorders Home Therapy Home therapy includes a soft diet, heat or ice packs, nonnarcotic analgesics, rest, and some jaw movement exercises. The jaw movement exercises are demonstrated to the patient, and a daily program is recommended. The exercises both relax and stretch the sore muscles to enable them to regain their original function. 30 Treatment of Temporomandibular Disorders Physical Therapy Physical therapy treatments include: Ultrasound Massage Electrical stimulation of the muscles Soft-tissue manipulation Exercise programs 31 Treatment of Temporomandibular Disorders Occlusal Appliances Occlusal appliances are made of hard acrylic resin. They fit over the occlusal and incisal surfaces of the maxillary or mandibular teeth. The appliance may be called a splint, night guard, or bite guard. An occlusal appliance protects the teeth and provides a stable position for them. 32 Treatment of Temporomandibular Disorders Occlusal Appliances Night-Guard / Occlusal-Guard 33 Treatment of Temporomandibular Disorders Occlusal Appliances NTI Device (Nociceptive Trigeminal Inhibition) 34 Treatment of Temporomandibular Disorders Occlusal Adjustment Limited occlusal adjustment may be appropriate in some patients, but it is rarely considered a primary treatment for TMDs. Behavioral Therapy Behavioral methods include: Stress or anxiety counseling Depression counseling Psychiatric therapy 35 Treatment of Temporomandibular Disorders Pharmacologic Therapy Groups of medications prescribed include: Analgesic medications Antianxiety drugs Antiinflammatory agents Muscle relaxants Local anesthetic medications 36 Treatment of Temporomandibular Disorders Irreversible Treatments Irreversible treatments for TMD, such as surgery to the joint or disk, are permanent alterations. Surgical treatments are indicated only in a small percentage of patients. Occlusal adjustment is irreversible, and no evidence suggests that this approach is effective. 37 Dental Hygiene Appointment The patient with TMD requires a series of short dental hygiene appointments, rather than one long appointment, to minimize trauma to the masticatory muscles and joint. The use of a bite-block to maintain the oral opening is one alternative for a patient with a history of jaw pain and fatigue. The use of a toothbrush with a small head or the use of other interdental cleaning devices can simplify daily oral hygiene care for patients with limited opening. 38