The Role of Occlusion in Periodontal Disease

The relationship of occlusal trauma causing the progression of periodontal disease has a controversial history.  Initially it was believed that heavy occlusal contacts were responsible for periodontal disease.  Another group stated that deeper pockets and bone loss occurred when occlusal trauma was in the presence of gingival inflammation (co-destructive force).  Finally, a group argued that all periodontal bone loss was caused solely by subgingival bacteria.  In fact, the 1996 World Workshop in Periodontics concluded that there was no proof that occlusal trauma played a role in the progression of periodontal disease.

Occlusal examination, evaluation, and treatment should be an important part of the treatment of periodontal disease.

Recent research and retrospective evaluation of the available data reveals the following:

1. In patients diagnosed with periodontal disease but not having any treatment, the rate of deepening pockets were greater with occlusal discrepancies compared to teeth without occlusal trauma.
2. In patients that received root planning and occlusal adjustment, significant reduction of the rate of deepening pockets was seen compared to the group with root planning with no occlusal adjustment.
3. Studies show teeth with centric prematurity or nonworking contacts have greater pocket depths than similar teeth lacking these contacts.

The 1996 Workshop noted that ethical research to determine the definitive role of occlusion in periodontal disease progression was impossible since a group in the study diagnosed with periodontal disease and occlusal trauma would be withheld from treatment during the clinical trial.  Current data reveals that occlusal trauma and certain occlusal contacts does play a role in the progression of periodontal disease, and the treatment to remove the occlusal prematurity has a beneficial effect.

Future blogs will discuss the various modes of treatment to correct or reduce occlusal discrepancies.