Trauma from occlusion: Pathogenesis, Clinical Implications, and Management – A review article

Trauma from occlusion (TFO) refers to injury of the periodontal supporting structures caused by excessive occlusal forces that exceed the adaptive capacity of the tissues. It manifests clinically as tooth mobility, fremitus, migration, wear facets, and discomfort, and radiographically as periodontal ligament widening and bone changes. Historically, the role of TFO in periodontal breakdown has been debated, with Glickman’s “co-destructive theory” suggesting that trauma modifies disease progression when inflammation is present. Waerhaug later argued that plaque is the sole initiating factor of attachment loss, while trauma may only influence bone morphology and tooth mobility. Contemporary reviews and consensus statements confirm that TFO alone does not initiate periodontitis but can exacerbate breakdown in the presence of inflammation. Diagnosis requires careful clinical and radiographic evaluation, including occlusal analysis, mobility assessment, and evaluation of periodontal status. Management principles emphasize elimination of inflammation, redistribution of forces through occlusal adjustment, splinting, orthodontic correction, or prosthetic rehabilitation, and maintenance therapy. In cases of acute TFO, immediate intervention may be required to relieve symptoms and prevent further damage. Prognosis is generally favorable when infection is controlled and traumatic forces are corrected, but untreated TFO may compromise periodontal and restorative outcomes. This review aims to summarize current evidence on the classification, biological basis, diagnosis, and management of TFO with emphasis on its interaction with periodontal disease and implications for long-term prognosis.