occlusion diseases consist commonly attrition,abrasion,abfraction

1. Perspectives on Occlusion
and “Everyday Dentistry
Occlusal Disease
Dr Vikram

2. Occlusal disease is deformation or disturbance
of function of any structures within the
masticatory system that are in disequilibrium
with a harmonious interrelationship between
the TMJs, the masticatory musculature, and
the occluding surfaces of the teeth.

3. Occlusal disease
• Most common destructive dental disorder.
• Contributing factor to eventual loss of teeth.
• Reason for needing extensive restorative dentistry.
• Factor associated with discomfort within masticatory system
structures.
• This includes pain/discomfort in the musculature, the teeth, and
the region of the temporomandibular joints (TMJs).
• Instability of orthodontic treatment.
• Tooth soreness and hypersensitivity.
• Most commonly missed diagnosis leading to unnecessary
endodontics.
• Undiagnosed dental disorder until severe damage becomes too
obvious to ignore.

4. • According to Grippo et al, deformation of tooth structure results from
three basic physical and chemical mechanisms that can act alone or in
combination:
1. Stress results in compression, flexure, and tension. It can produce
microfracture and abfraction as a dental
manifestation.
2. Friction includes abrasion from exogenous material
empty mouth bruxing and parafunction. The end point
and attrition, which is endogenous and results from of both is wear of
tooth surfaces.
3. Corrosion is the result of chemical or electrochemical degradation.

5. Attrition
Attrition is wear due to tooth-to-tooth friction. This is the kind
of wear that results from bruxism and empty mouth
parafunction.
The implication is that enamel is the hardest structure in the
body.
When wear penetrates enamel into softer dentin, wear increases
seven times faster.

6. Attritional wear
This type of wear on the lower anterior teeth is one of the
most common untreated problems. It is also a typical sign of
two prevalent causes for such wear. The first place to look is
at the posterior teeth where deflective incline interferences
to centric relation are so often the cause of a forward slide
of the mandible during closure to maximum intercuspation.

7. Abrasion
Abrasion is wear due to friction between a tooth and
an exogenous agent.
This is the kind of wear that comes from chewing on a
food bolus or from tobacco chewing.
It can also come from overzealous toothbrushing or
improper use of dental floss, toothpicks, pencils, or
any foreign object.

9. Erosion
Erosion is tooth surface loss due to chemical or
electrochemical action.
It can be endogenous or exogenous. By
definition, it does not include association with
bacterial activity.

10. Dental erosion is distinguished as a separate
cause that excludes bacterial action.
• Endogenous erosion. This can result from bulimia and is recognizable by a
unique pattern of enamel loss on the palatal surfaces of the upper
anterior teeth from forceful projection of vomitus.
Gastroesophageal reflux disease (GERD).
This condition produces hydrochloric acid and the proteolytic enzyme
pepsin from gastric juices. Erosion may occur wherever the
acid reflux juice is permitted to pool. Erosion on the lingual
of molars is diagnostic.

11. • Gingival crevicular fluid. This has an acidic pH and can be erosive in
combination with non-carious cervical lesion
• Exogenous erosion.
Any food or liquid with a pH of less than 5.5 can demineralize teeth.
The tremendous increase in sale and consumption of soft drinks is taking
its toll on patients who bathe their teeth in citric acid solutions on a daily
basis.
The “Coke swishers” and “fruit mullers” described by Abrahamsen2 are
classic examples of exogenous exposure to acidic products.
Other examples are chewable vitamin C
tablets, aspirin, and other acidic drugs.

12. Erosion of enamel
A combination of acid from fruit, abrasion from mulling fruit between end-to-
end anterior contacts, and attrition from bruxing produces invagination of
incisal enamel.
Evidence of erosion is obvious because cupped-out dentin areas cannot be
contacted by opposing teeth.

13. Abfractions
• The role of occlusal overload on non-carious cervical lesions has not been
as incontrovertible as many have assumed.
• Characteristic of abfractions as wedge-shaped lesions with sharp line
angles is actually characteristic of toothpaste abrasion, according to
Dzakovich

14. • lesions are caused by forces placed on the teeth during biting, eating,
chewing and grinding; the enamel, especially at the cementoenamel
junction (CEJ), undergoes large amounts of stress, causing micro fractures
and tooth tissue loss.
• Abfraction appears to be a modern condition, with examples of non-
carious cervical lesions in the archaeological record typically caused by
other factors

15. • Side from restoring the lesion, it is equally
important to remove any other possible
causative factors.
• Adjustments to the biting surfaces of the
teeth alter the way the upper and lower teeth
come together, this may assist by redirecting
the occlusal load.

16. Anterior guidance attrition
This occurs when anterior teeth that either interfere with centric relation
closure or interfere with functional jaw movement patterns (envelope of
function) develop early signs of attritional wear of the lingual enamel on
upper anterior teeth
(A). This type of occlusal disease
too often goes undiagnosed until
the incisal edges become so thin
they start to chip and fracture
(B). Patients are rarely aware of
the problem until major damage
has been done

17. Splayed teeth
The same type of mandibular deflection that causes wear problems can, in a
different patient, force the upper anteriorteeth forward.
Splaying of teeth is a common sign of occlusal
disease that should be diagnosed and treated early by eliminating the
deflective interferences that force the mandible forward.

18. Destroyed Dentition
This is the result of not intercepting occlusal disease early.
Signs of severe wear,
fractured maxillary (A) and mandibular(B) teeth, and elongated alveolar
processes are typical
when treatment of delta-stage bruxism is delayed. This is one of the most
demanding occlusal problems to treat even if diagnosed early.

19. Advanced occlusal disease
This disease results from a combination of attritional wear and moved teeth.
This is occlusal disease left undiagnosed and untreated until the late stage of
progressive damage has occurred.

20. Sensitive teeth
One of the most missed diagnoses is failure to recognize that
a common cause of hypersensitivity is occlusal overload. A
tooth subjected to occlusal pounding or wiggling can become
extremely sensitive even though the pulp is vital.
The sensitivity can result from pulpal hyperemia or from the effects of non-
carious cervical cracks.
Coleman et al.16 showed that sensitivity to a measured puff of air at cervical
lesions was completely eliminated when occlusal equilibration corrected
the occlusal overload.

22. Sore teeth
Compression of periodontal ligaments can be combined
with pulpal hyperemia to cause considerable soreness or
pain on biting. If empty mouth clenching causes any discomfort
in a tooth, it is an indication that the sore tooth is in
occlusal interference.

23. Note: The simple clench test to determine if occlusion is a
cause of hypersensitivity or soreness in a tooth will eliminate
a misdiagnosed need for endodontic treatment in a surprisingly
large number of teeth that do not have radiographic
evidence of pathology.

24. Hypermobility
• An early sign of occlusal disease is tooth hypermobility.
• It can result in widened periodontal space and greater susceptibility to
periodontal disease.
• Patients are rarely aware of mobility in teeth until later stages of bone
loss

25. Split teeth and fractured cusps
• Note the fracture lines that routinely develop when a cusp incline
interferes with strong occlusal forces . Thisis a typical sign of occlusal
disease that precedes cusp fracture or split tooth

26. Painful musculature
A common symptom of occlusal disease results from
disharmony
between the occlusion and the TMJs. Deflective occlusal
interferences that require the jaw joints to displace to
achieve maximum intercuspation are a potent cause for
painful masticatory musculature. The term for this is
occlusomuscle
disorder.

28. References
Dawson-Functional occlusion from
TMJ to smile design 1st edition