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Primary Occlusal Trauma

What is Primary Occlusal Trauma?

Primary occlusal trauma of the dentition manifests as chipped and crazed teeth with normal periodontal structures.

Chipped, crazed front (anterior) teeth reflect the primary occlusal trauma forces the patient has brought to bear on them.

When a patient exerts abnormally heavy biting forces on the teeth, stress cracks, chips and wear (attrition) may result. This is known as primary occlusal trauma. Primary occlusal trauma implies there has been no loss of the periodontal attachment (gingival attachment fibers, periodontal ligament, or bone), and the teeth themselves are damaged by the excessive forces on them.

This condition is related to secondary occlusal trauma, in that both produce changes in the patient’s bite relationship (occlusion). However, secondary occlusal trauma occurs when there has been some degree of periodontal attachment loss, and even normal biting forces that were once tolerated by the gums, periodontal ligaments and bone are now too excessive for those structures to withstand. The result is loosening, tipping and movement of the teeth.

How does the dentist diagnose Primary Occlusal Trauma?

Note: ToothIQ.com contains general information. Only a dentist can properly diagnose your specific condition.

Tooth enamel is extremely durable, and is normally thick enough to withstand a lifetime of chewing forces. If the dentist notices abnormal wear (attrition), chipping or cracking, he/she may suspect a clenching or grinding habit (bruxism), or factitious habits (use of the teeth for purposes other than chewing for nutrition). If it is apparent that the wear, chipping, and/or cracking are not due to external trauma, a diagnosis of occlusal trauma is supported.

It is possible to develop wear on the teeth with normal chewing forces if the teeth are poorly aligned (malocclusion). The dentist will evaluate the bite relationship between the upper and lower teeth when abnormal wear is noted.

The dentist will also evaluate the condition of the periodontal structures (gums and bone) around your teeth. A periodontal measuring probe is used to measure the depth of gum pockets around the teeth. Measurements of 4 millimeters or more support indicate attachment loss, which support a diagnosis of periodontal disease (periodontitis). If there is inflammation (red, puffy gums that bleed easily when gently stimulated) and attachment loss, active periodontal disease is diagnosed. If the teeth are also loose, abnormally tipped, and/or have moved, the diagnosis of secondary occlusal trauma will also be established.

If periodontal health is normal, and a diagnosis of occlusal trauma is made, the condition is called primary occlusal trauma. It is possible for a patient to have both primary and secondary occlusal trauma simultaneously if one area of the mouth is periodontally healthy, and another area is not.

How is Primary Occlusal Trauma treated?

Primary occlusal trauma can be treated on multiple levels. First, the damage to the teeth may be treated with fillings, crowns, or onlays. The underlying cause of the damage may also need to be treated. If the patient is actively bruxing, an occlusal guard may be recommended. If malocclusion is diagnosed, an occlusal adjustment, occlusal guard, and/or orthodontic treatment may be recommended. If factitious habits are present, avoidance of the habits will be stressed.

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Author: Thomas J. Greany, D.D.S. / Editor: Ken Lambrecht

This page was last updated on March 6, 2018.

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