Occlusal Trauma

Occlusion is the clinical term for the relationship between the top row of the teeth and the bottom row while the jaw is closed. It may be more commonly referred to as a person’s bite. If the teeth are subjected to excessive force that adversely affects the occlusal alignment, this is known as occlusal trauma. Occlusal trauma and can lead to pain or tenderness, or it may damage the teeth or cause mobility of the teeth. Traumatic occlusion may also affect the thickness of the alveolar bone and the periodontal ligament and lead to uneven wear on the teeth. Occlusal trauma may be accompanied by bleeding, tissue necrosis, loss of or damage to the cementum, and bone resorption.

The two larger categorizations of occlusal trauma are primary and secondary occlusal trauma. Primary occlusal trauma results when greater than normal forces are exerted on the teeth. Primary occlusal trauma can occur when a person grinds or clenches their teeth, or if they have certain habits that involve biting or chewing. Secondary occlusal trauma results when normal forces or excessive forces are exerted on teeth that have a compromised periodontal attachment. Excessive force is categorized as excessive in either duration, frequency, or magnitude.

We may not think about it a lot, but our teeth are constantly subjected to force that comes from a variety of directions and sources, and they are designed to function well in resistance to these forces. When occlusal trauma is present, the teeth may become mobile if the bone that supports the teeth and holds them in place becomes damaged. This is far more likely to happen with secondary occlusal trauma than with primary occlusal trauma, as secondary occlusal trauma occurs only on periodontally involved teeth, or teeth whose mobility and structural integrity is already compromised by periodontal disease.

Whether occlusal trauma is primary or secondary, the first step of treatment is removing the cause of the trauma. If the teeth have become mobile due to secondary occlusal trauma, they may need to be splinted to the adjacent teeth; if mobility is due to primary occlusal trauma, removing the cause of trauma will eliminate their mobility. This may require modifying the size or shape of a recently restored tooth that is affecting the occlusion, or it may require modifying destructive habits. If the habit is an involuntary chewing behavior, like biting one’s nails or chewing on pens, behavior modification is recommended. If the habit is unconscious, like grinding or clenching the teeth while sleeping, dentists may recommend the use of a night guard while sleeping. If a person is missing many teeth and is using the remaining teeth to compensate, thereby increasing the amount of force these teeth are subjected to, a removable or implant-supported prosthesis may be recommended to more evenly distribute this force. If the occlusal trauma is secondary, treatment may be similar but must be preceded by stabilization of the affected tooth or teeth, which can be temporarily achieved by splinting traumatized teeth to adjacent teeth, and which necessitates surgical periodontal procedures for resolution over the longer term.