Bruxism is the habitual grinding or clenching of teeth during sleep or while awake. It can cause physical injuries to teeth like fractures, cracked tooth syndrome, and tooth ankylosis. Fractures of teeth are commonly caused by trauma, large dental restorations, or internal resorption. Cracked tooth syndrome involves an incomplete crack in the tooth that causes sharp fleeting pains. Tooth ankylosis is a fusion between the tooth and bone caused by root resorption and repair with cementum or bone. Treatments depend on the specific injury but may include splints, crowns, endodontic treatment, or extraction.

1. Dr Nagarathinam AE
Department of Oral Pathology
SRM DENTAL COLLEGE,Ramapuram, Chennai
PHYSICAL INJURIES OF
THE TEETH
 BRUXISM
 FRACTURE OF TEETH
 CRACKED TOOTH SYNDROME
 TOOTH ANKYLOSIS

2. • Bruxism is the habitual grinding or clenching of the
teeth, either during sleep or as an unconscious habit
during waking hours.
Actual grinding/
Clamping of teeth/
Repeated Tapping
of teeth
Pressure is exerted
on the TEETH &
PERIODONTIUM
BRUXISM
• Common Sleep disorder
• Bruxism is defined as “diurnal or nocturnal
parafunctional activity including clenching, bracing,
gnashing, and grinding of the teeth.”

3. Actual grinding/
Clamping of teeth/
Repeated Tapping
of teeth
Pressure is exerted
on the TEETH &
PERIODONTIUM

4. TYPES OF BRUXISM
•Awake bruxism may be due to emotions such as anxiety, stress, anger, frustration or tension. Or it may
be a coping strategy or a habit during deep concentration.
•Sleep bruxism may be a sleep-related chewing activity associated with arousals during sleep.

5. ETIOLOGY
BRUXISM
Local
Occlusal Disturbances
Systemic
Gastrointestinal
disturbance
Subclinical
nutritional
deficiencies
Allergy
Endocrine
disturbances
hereditary
Psychologic
Anxiety
Fear
Stress
Anger
Occupational
Indoor Workers- Watch
making, Carpenters etc.

6. RISK FACTORS:
• Psychology: Not able to cope up with pressure.
• Voluntary bruxism is also recognized in those persons who habitually chew gum,
tobacco, or objects such as toothpicks or pencils. Although voluntary, this too is a
nervous reaction and may +eventually to involuntary or subconscious bruxism.
• Stress
• Age
• Personality type
• Medications and other substances: Bruxism may be an uncommon side
effect of some psychiatric medications, such as certain antidepressants.
Smoking tobacco, drinking caffeinated beverages or alcohol, or using
recreational drugs may increase the risk of bruxism.
• Family members with bruxism. Sleep bruxism tends to occur in families. If
you have bruxism, other members of your family also may have bruxism or
a history of it.
• Other disorders. Bruxism can be associated with some mental health and
medical disorders, such as Parkinson's disease, dementia,
gastroesophageal reflux disorder (GERD), epilepsy, night terrors, sleep-
related disorders such as sleep apnea, and attention-deficit/hyperactivity
disorder (ADHD).

7. CLINICAL FEATURES
• Teeth grinding or clenching
• Teeth that are flattened, fractured, chipped or loose
• Worn tooth enamel, exposing deeper layers of your
tooth
• Increased tooth pain or sensitivity
• Tired or tight jaw muscles, or a locked jaw that won't
open or close completely
• Jaw, neck or face pain or soreness
• Pain that feels like an earache, though it's actually
not a problem with your ear
• Dull headache starting in the temples
• Damage from chewing on the inside of your cheek
• Sleep disruption

8. BRUXISM
DENTITION
PERIODONTIUM
MASTICATORY
MUSCLES
TMJ
HEAD ACHE
PSYCHOLOGICAL
AND BEHAVIOURAL
EFFECTS

14. TREATMENT AND PROGNOSIS
• Treat the underlying cause:
• Emotional & psychological
• Removable splints
• Botox

16. FRACTURES OF TEETH

17. ETIOLOGY
• TRAUMA – FALL, BLOW, ACCIDENT
• TEETHH WEAKENED DUE TO LARGE RESTORATION
• TEETH WEAKING DUE TO INTERNAL RESORPTION
• PREVIOUSLY ROOT CANAL TREATED TEETH

18. CLINICAL FEATURES
• AGE: ANY AGE DUE TO TRAUMA. CHILDREN MAY BE MORE PRONE.
• SEX : MORE COMMON IN BOYS
• CLINICALLY MAY INVOLVE MINOR CHIPPINGS TO LARGE FRACTURES.
• ELLIS CLASSIFICATION OF TOOTH FRACTURE

19. • Class 1: Simple fracture of the crown, involving little or no dentin.
• Class 2: Extensive fracture of the crown, involving considerable
dentin but not the dental pulp.
• Class 3: Extensive fracture of the crown, involving considerable
dentin and exposing the dental pulp.
• Class 4: The traumatized tooth becomes nonvital, with or without
loss of crown structure.
• Class 5: Teeth lost as a result of trauma.
• Class 6: Fracture of the root, with or without loss of crown
structure.
• Class 7: Displacement of a tooth, without fracture of crown or
root.
• Class 8: Fracture of the crown en masse and its replacement.
Class 9: Traumatic injuries to deciduous teeth.

21. FRACTURE
NO PULP
INVOLVEMENT
+ Vitality is maintained by
secondary dentin
+ Mild hyperaemia (thick dentin)
+ Bacterial penetration in case of
thin dentin > pulpitis > pulp death
+ Sore tooth & slight mobility
No severe pain
PULP INVOLVED
PAINFUL
PULPAL EXPOURE
CAN BE CAPPED
WITH CaOH
Pulpotomy or
pulpectomy as the
pulp may be infected
following exposure
ROOT FRACTURES
Young children –
incompletely formed
and resilience in
their sockets
10-20 years
Fracture - Middle
third of root
(common)

22. • Tooth is loose and sore and there may be
displacement of the coronal portion of the
tooth.
• Most of the time tooth becomes nonvital after
fracture.
• Some teeth may be repaired by forming a
layer of reparative dentin along the pulp wall
and cementum on the outer surface, or form
granulation tissue between the fractured
segments.
• Few may remain vital with resorption of the
sharp edges of the fractured fragments.
• In certain situations where the injury is
sufficient to cause root fracture, fragments of
cementum may be severed from dentin and is
called cemental tear

23. • The coronal segment may be mobile and may be
displaced.
• The tooth may be tender to percussion.
• Bleeding from the gingival sulcus may be noted.
• Sensibility testing may give negative results initially,
indicating transient or permanent neural damage.
• Monitoring the status of the pulp is recommended.
• Transient crown discoloration (red or grey) may occur.

25. HISTOLOGY
• Union of the two fragments by calcified
tissue, and this is analogous to the healing of
a bony fracture.
• The clot between the root fragments is
organized, and this connective tissue is
subsequently the site of new cementum or
bone formation.
• There is nearly always some resorption of
the ends of the fragments, but these
resorption lacunae ultimately are repaired.
• If the apposition between the two fragments
is not close, the union is by connective tissue
alone.
• It appears likely that the repair process can
be organized from connective tissue cells in
both the pulp and the periodontal ligament.

26. CRACKED TOOTH SYNDROME

27. • Cracked tooth is defined as an incomplete fracture of the dentine in a vital posterior tooth that
involves the dentine and occasionally extends into the pulp. The term “cracked tooth syndrome”
(CTS) was first introduced by Cameron in 1964.
• Incomplete fractures that are too small to be seen on radiographs
CHARACTERISED BY “SHARP PAIN” - caused by a ‘hidden’ crack of the tooth

28. Sharp fleeting pain
when release pressure
on an object
WHEN BITING
DOWN : SEGMENTS
MOVE APART AND
REDUCE PRESSURE
ON THE NERVES OF
THE PULP
ON RELEASE OF
BITE:
SEGMENTS SNAP
BACK TOGETHER >
INCREASING THE
PRESSURE ON
NERVES > PAIN

29. Pain inconsistent, and frequently hard to reproduce.
ETIOLOGY:
• Causes of CTS include attrition
• Bruxism
• Trauma
• Accidental biting on a hard object
• Presence of large restoration
• Improper endodontic treatment.
• The American Association of Endodontists have classified five specific variations of
cracked teeth; craze line, fractured cusp, cracked tooth, split tooth, and vertical root
fracture.

30. CRAZE LINES

38. TREATMENT
Site, direction, and size of the crack or fracture dictates the choice of the treatment.
Stabilization with a stainless steel band or crown to endodontic treatment and
restoration. I
f untreated, CTS can lead to severe pain, possible pulpal necrosis and periapical
abscess.
Poor prognosis in treatment
In some cases, such as in vertical root fractures (split root) in single rooted teeth, the
only treatment option is tooth extraction.

39. TOOTH ANKYLOSIS
• Fusion between the tooth and bone, termed ankylosis
is an uncommon phenomenon in the deciduous
dentition and even more rare in permanent teeth.
• Ankylosis ensues when partial root resorption is
followed by repair with either cementum or bone that
unites the tooth root with the alveolar bone.
• It must not be inferred that root resorption invariably
leads to ankylosis. Actually, it is an uncommon
sequela, and the cause for this sporadic happening is
unknown.

41. • Ankylosis does occur rather frequently after a traumatic injury to a tooth, particularly
occlusal trauma, but it is also seen as a result of periapical inflammation subsequent to pulp
infection.
• Periapical inflammation is a well-recognized cause of root resorption.
• Ankylosis sometimes also follows root canal therapy if the apical periodontal ligament is
irritated or seriously damaged.
• Resorption and ankylosis is more common in replanted teeth.

42. CLINICAL FEATURES:
• Ankylosis of the permanent tooth seldom manifests clinical symptoms unless there is a
concomitant pulp infection which may be the underlying cause.
• If there is an extensive area of the root surface involved, the tooth may give a dull,
muffled sound on percussion rather than the normal sharp sound.
• The fact that this condition exists may become apparent only at the time of extraction
of the tooth, when considerable difficulty will be encountered, sometimes necessitating
surgical removal.

43. • Radiographic Features. If the area of ankylosis is of sufficient size, it may be visible
on the radiograph. There is loss of the normal thin radiolucent line surrounding the
root that represents the periodontal ligament, with a mild sclerosis of the bone and
apparent blending of the bone with the tooth root.

44. HISTOLOGY
Microscopic examination reveals an area
of root resorption which has been
repaired by a calcified material, bone or
cementum, which is continuous with the
alveolar bone.
The periodontal ligament is completely
obliterated in the area of the ankylosis.
Treatment and Prognosis:
Ankylosed teeth have a good prognosis and,
unless removed for some other reason.

45. THANK YOU