FOOD IMPACTION AND TREATMENT

ITS A TOPIC IN PERIODONTICS AT UG LEVEL , DO ACCEPT MY SINCERE APOLOGIES IF ANY MISTAKES ARE THERE.

1. FOOD IMPACTION AND TREATMENT NANDANA S BABU THIRD YEAR BDS

2. CONTENTS INTRODUCTION TYPES OF FOOD IMPACTION MECHANISM OF FOOD IMPACTION FACTORS CAUSING FOOD IMPACTION SEQUELAE OF FOOD IMPACTION SIGNS AND SYMPTOMS DETECTION OF FOOD IMPACTION MANAGEMENT CONCLUSION

3. INTRODUCTION Food impaction is defined as forceful wedging of food into the periodontium .

4. It is caused by: anatomy related , inadequate interproximal restoration , prosthetic related implant related factor

5. Anatomic related factors include: diastema , tooth movement , occlusion discrepancy , interdental papilla support or recession.

6. Inadequate interproximal restoration due to inappropriate design of marginal ridges and contact area.

7. Prosthetic related factors like: proximal filling related , fractured restoration , inadequate prosthetic crown ,

8. d) faulty design impression or laboratory procedure fabrication , e) fracture of prosthesis at proximal contact

9. Implant related factors are : excessive distance between implant / implant and adjacent tooth inappropriate distance between contact point and alveolar bone crest

10. FOOD IMPACTION Is the forceful wedging of food into the periodontium by occlusal forces. It may occur interproximally or in relation to the facial or lingual tooth surfaces .

11. Is very common cause of gingival inflammation . Failure to recognize and eliminate food impaction is responsible for the unsuccessful outcome of an otherwise thoroughly treated case of periodontal disease

12. TYPES OF FOOD IMPACTION Vertical impaction by occlusal forces 2. Lateral food impaction by pressure from tongue ,cheek, lip

13. LATERAL FOOD IMPACTION May occur when gingival embrassure is enlarged by tissue destruction in periodontal diseases or by recession. Food impaction results when food forced into such embrassure are retained instead of passing through that embrassure .

14. MECHANISM OF FOOD IMPACTION Forceful wedging of food is prevented by : I ntegrity and location of proximal contact. C ontour of marginal ridge and developmental grooves. Contour of facial and lingual surfaces. An intact, firm proximal contact relationship prevents the forceful wedging of food inter-proximally .

15. The location of the contact is also important in protecting the tissues against food impaction. The optimal cervico-occlusal location of the contact is at the longest mesiodistal diameter of the tooth , close to the crest of the marginal ridge.

16. The proximity of the contact point to the occlusal plane reduces the tendency towards food impaction in the smaller occlusal embrassure . The absence of contact or the presence of an unsatisfactory proximal relationship is conducive to food impaction

17. The contour of the occlusal surface estabilished by the marginal ridges and related developmental grooves normally serves to deflect food away from the interproximal spaces.

18. As the teeth wear down and flattened surfaces replace the normal convexities, the wedging effect of the opposing cusp into the interproximal space is exaggerated and food impaction results.

19. Cusps that tend to forcibly wedge food interproximally are known as plunger cusps . The plunger cusp effect may occur with wear , as indicated, or may be the result of a shift in tooth position following failure to replace missing teeth.

20. Wedging effect upon food bolus that results f rom wearing away of n ormal occlusal convexities And protective marginal ridges Food impaction corrected by restoring Occlusal convex surfaces And marginal ridges and Directing food into The occlusal surface

21. Excessive anterior overbite is a common cause. Forceful wedging of food into gingival surfaces of mandibular anterior teeth and the lingual surfaces of the maxillary teeth produces varying degrees of periodontal involvement.

22. Gingival changes in the mandibular anterior region, due to excessive anterior overbite - easily detectable.

23. However the effects of food impaction on the lingual surface of the maxilla are often overlooked. Inflammation caused by lingual food impaction may spread to the contiguous facial gingival margin.

24. Possibility that lingual food impaction may be contributory factor should always be explored when the etilogy of gingival disease in anterior maxilla is being considered.

25. A classic analysis of the factors leading to food impaction has been made by Hirschfeld (1928) . He recognised the following factors: 1.Uneven occlusal wear 2.Opening of the contact point as a result of loss of proximal support or from intrusion.

26. Congenital morphological abnormalities and improperly constructed restorations.

27. A. removal of maxillary third molar permits second molar to be forced distally when teeth contact in occlusion B. Bolus of food forced interproximally as maxillary second molar is wedged distally

28. However t he presence of the previously mentioned abnormalities does not necessarily lead to food impaction and periodontal diseases.

29. A study of interproximal contacts and marginal ridges relationships in three group of periodonyally healthy males revealed that from 61.7 to 76 % of the proximal contacts were defective and that 33.5 % of adjacent marginal ridges were uneven

30. Lateral food impaction : In addition to food impaction that is due to occlusal forces, lateral pressure from the lips, cheeks and tongue may force food interproximally .

31. This is more likely to occur when the gingival embrassure is enlarged by tissue destruction in periodontal disease or by recession; into this embrassure during mastication , food is retained instead of passing through.

32. According to Hirschfield, food impaction can occur in the following conditions. Class I : UNEVEN OCCLUSAL WEAR Can lead to food impaction because deflection of food away from the proximal areas doesnot occur.

33. Subdivided into 3: TYPE A: wedging action produced by transformation of occlusal convexities into oblique facets , exaggerating the action of plunger cusps.

34. TYPE B: remaining obliquely worn cusp of a maxillary tooth overhanging the distal surface of its functional anatagonists .

35. TYPE C: obliquely worn cusp of a mandibular tooth overhanging the distal surface of its functional antagonists

36. CLASS II : LOSS OF PROXIMAL CONTACT this is one of the most common cause for food impaction. It may due to periodontal disease, non-replaced missing teeth, proximal caries and abnormal biting habits.

37. Subdivided into 4 : TYPE A: loss of distal support through the removal of a distally adjacent tooth. TYPE B: loss of mesial support due to extraction of mesial tooth

38. TYPE C: oblique drifting due to non replacement of a missing tooth. TYPE D : permanent occlusal openings to interdental spaces: Drifting after extraction of adjacent tooth.

39. ii. Habit of forcing teeth out of position. iii. Periodontal diseases. iv. Caries .

40. CLASS III : EXTRUSION BEYOND THE OCCLUSAL PLANE. Extrusion of a tooth which was previously retaining with the adjacent mesial and distal teeth result in occlusal step deformity between marginal ridges of extruded and non intruded teeth.

41. CLASS IV : CONGENITAL MORPHOLOGIC ABNORMALITIES OF TEETH. Any congenital morphologic abnormalities in size , shape , form and position of tooth leads to open proximal contact and food impaction.

42. Subdivided : TYPE A: position of a tooth in torsion . TYPE B: emphasized embrassures between thick neck teeth.

43. TYPE C: faciolingual tilting. TYPE D : improperly constructed cantilever restoration. TYPE E : scalloped cervical bevels on the tissue borne areas of prosthetic restorations

44. SEQUELAE OF FOOD IMPACTION Food impaction serves : to initiate gingival and periodontal disease . aggrevates the severity of pre-existent pathological changes.

45. Signs and symptoms associated with food impaction are: Feeling of pressure Urge to dig the material from between the teeth Vague pain radiating deep in the jaws Gingival inflammation with bleeding Gingival recession

46. Periodontal abcess formation Destruction of alveolar bone. Root caries

47. Varying degrees of: a. Inflammatory involvement of the PDL with an associated elevation of tooth in its socket. b. Prematurity in functional contact. c. Sensitivity to percussion.

48. SEQUALAE FOLLOWING LOSS OF PROXIMAL CONTACT

49. SIGNS AND SYMPTOMS Discomfort -feeling of pressure -vague pain -root caries Periodontal changes -gingival inflammation -bleeding -gingival recession -periodontal abcess formation -alveolar bone loss- vertical

50. DETECTION OF FOOD IMPACTION check proximal contact relation -clinical observation -X-rays -dental floss -dental casts Look for plunger cusps

51. MANAGEMENT PERIODONTAL TREATMENT a. scaling and root planing

52. b. flossing

53. c. interproximal brushing

54. d. curettage

55. OCCLUSAL ADJUSTMENT a. adjusting plungers cusp b. levelling of occlusal height of marginal ridges

56. RESTORING AN IDEAL CONTACT PERMANENT RESTORATION

57. CONCLUSION An intact proximal contact relationship, prevents forceful wedging of food interproximally . The proximity of the contact point to the occlusal plane reduces the tendency towards food impaction in the smaller occlusal embrassure .

58. Proper restoration by restoring the contour and contact points of tooth can help to prevent food impaction in certain patients.