Experimental consequences of occlusal trauma to the pulp have already been described. As far as the authors know, this is the first described clinical case of apical periodontitis caused purely by bruxism. Typical dental problems caused by bruxism are abrasion, chipping of teeth and/or prosthetic restorations, orofacial pain, teeth sensitivity, pulpal pathology, fractures of teeth and restorations, and damage of implants. Stress, personality characteristics, smoking, disease, trauma, genetics, alcohol, caffeine consumption, illicit drugs and medications may be involved in its aetiology. describe a 6–20% prevalence of bruxism in the population in all age groups. In their bibliographic review Demjaha et al. Considering neuromuscular activity, a toned, periodic and combined type of bruxism can be classified. A multifactorial etiopathogenesis is discussed and a mild, moderate and severe bruxism distinguished. īruxism is described as a nightly orofacial motor function leading to an occlusal trauma, fractures of teeth, headache, muscle pain and periodontal problems. The main objective of endodontic treatment is to preserve the tooth in the oral cavity in healthy conditions. Recovery, repair, or necrosis may follow. Trauma can injure a dental pulp by damaging apical blood vessels (from luxation, avulsion injuries, or rupture of intra-pulpal blood vessels), leading to an intra-pulpal haemorrhage. A variety of important factors can account for this, including short and long-term irritations (initiated during treatment) or trauma. So, besides cavities, broken fillings and cracks in fillings, this is one of the first things I check when patients have pain on chewing or unusual temperature sensitivity, both of which can be caused by too much chewing pressure.The prevalence of apical periodontitis is as high as 34–61%, it increases with age and is often associated with pulp diseases. This additional movement is more common in patients with bone loss due to periodontal disease.

I have noticed that some patients need to be checked in a month or so to make sure that the teeth haven’t moved again. Within a few minutes the pain subsided and he should be fine. Although this patient has had no dental work since that period, that tooth had shifted enough to create a hyperocclusion (too much tooth contact upon chewing)which needed to be adjusted (this is known as equilibration in all of these examples). I took an x-ray of the area which looked totally normal, then I checked the bite. In this case, the patient had been coming for many years, and I had done a dental bridge approximately 8 years ago. Last month I had a patient come in for a similar kind of pain. That is how profound the discomfort can be. I checked the bite, found them to be high, and she couldn’t believe the relief she experienced in just a few minutes of adjustment. She had a complaint of pain on those teeth. I had a new patient who came in a few years ago who had crowns placed on 2 adjacent lower molars 2 years before that. This pain can also cause pain on the opposing tooth since chewing works in pairs. It is now in “ hyperocclusion” or too much tooth structure hitting the opposing tooth. There is no place for the inflammation fluids to go but between the root and the bone, and that lifts the tooth out of the socket a bit. With inflammation there is increased swelling around the root. This extra pressure causes an inflammation on the ends of the root. The immediate treatment is to adjust the crowns to get the bite more comfortable and so it doesn’t stand out. On both of these patients I noticed large areas of dark blue marks that indicated that the patient was putting extra pressure on these teeth when chewing, and that can hurt a lot. But after time, they were still feeling something when they chewed.īesides making sure that the teeth look OK on an x-ray, I have the patient bite on articulating paper (that’s the blue carbon paper that makes marks on the teeth to see if a patient is biting too hard on the tooth).

They had crowns placed on the teeth, as is recommended for strength and protection of these teeth. This week I have had 2 patients who have had root canal therapy. One common condition is occlusal trauma, which means that the bite is too high someplace. I ask them what is going on, try to isolate where the pain is coming from, find out how long they have had the pain and how often. When an emergency patient comes into my dental office with some unwanted dental pain, it is important to listen carefully to the patient. Pain on Chewing: It Could Be Occlusal Trauma

Occlusal trauma signs