Unilateral Mastication - Silent Messenger of Periodontal Status

Case Report DOI: 10.18231/2457-0087.2018.
0017
Unilateral mastication - Silent messenger of periodontal status

Divya Singh Hada1,*, Subhash Garg2
1PG Student, 2Professor & HOD, Dept. of Periodontology, Government College of Dentistry, Indore, Madhya Pradesh, India
*Corresponding Author:
Email: [email protected]
Abstract
Unilateral mastication is commonly encountered on daily routine by all dentist. Various causes for unilateral mastication can be
enumerated, but it’s seldom the reason for dental visit by the patient. Such negligence’s can be avoided by generating awareness
as to how early treatment of a single diseased tooth might save half of the dentition from being severely compromised with the
help of this case series.
Keywords: Atrophy, Dental calculus, Dental caries, Periodontal diseases, Periodontitis.
Introduction alveolar bone, and reduction of bone height.3

Atrophy or wasting is defined as a decrease in size Radiographically, as thinning of the periodontal
of an organ or tissue. It may result from death and ligament space.
resorption of cells, diminished cellular proliferation, Howsoever beneficial the above observations may
pressure, ischemia, malnutrition, decreased activity, or be, in terms of destruction to the attachment apparatus
hormonal changes. related to calculus deposition, gingivitis & pocket
Periodontal atrophy is defined as the quantitative depths due to UM, have been seldom viewed
degenerative changes that occur in the periodontium of appropriately, especially in the light of duration of UM.
a tooth as a result of disease or disuse. When a tooth On intraoral examination, the non masticatory side
loses its antagonist, osteoporotic changes in the shows heavy calculus deposits sometimes covering the
supporting bone occurs, leading to an afunctional occlusal surfaces, mobile teeth and severely
change in the direction of periodontal fibers, and a compromised periodontal conditions of almost the
narrowing of the periodontal ligament. entire half of the dentition, whereas the masticatory side
The periodontal ligament adapt to functional is calculus free and has relatively good periodontal
changes by increase in the width with increasing status. Severely decayed tooth and its related
functional demand and vice versa. Modifications of the consequences is mostly the culprit for worsening of
periodontal ligament to functional changes are observed periodontal status due to UM, depriving almost entire
with corresponding adaptive changes in the cementum half of the jaw from the benefits of mastication, and its
and alveolar bone.1 stimulation on periodontium of the remaining healthy
Unilateral mastication (UM) is a common dental teeth of the affected side.
finding encountered by dental professionals on daily
routine. Although, this is generally never the reason for Case Series
which patients approach to seek treatment, pain is the Case 1: A 35 year old female reported to the
principle reason mostly. Various causes can be department with the chief complain of bleeding gums
enumerated like deep carious lesions, gingival from past 3 months.
overgrowths covering occlusal surface, pericoronal and
periodontal abscess, food lodgment, missing antagonist
teeth, habitual usage of only one side, improperly
fabricated prosthesis, etc.
Thus, what so ever may be the cause, unilateral
mastication leads to hypofunction of the attachment
apparatus on the neglected or unused side. Insufficient
occlusal forces are injurious to the attachment apparatus
of the tooth. Prolonged effect of reduced functional
loads differentially affect morphology and mechanical
properties, and mineral variations of the local load-
bearing sites in a bone-PDL-cementum complex.2 The
effects of nonfunction on periodontium have been
studied on humans and animals,2-6 indicating narrowing
of the periodontal membrane, loss of functional
orientation of the principle fibers, osteoporosis of
IP International Journal of Periodontology and Implantology, April-June 2018;3(2):80-83 80
Divya S. Hada et al. Unilateral mastication - Silent messenger of periodontal status
Fig. 1
Case 2: A 28 year old male reported to the department

with the chief complain of pain in left upper back tooth
from past 10 days.
Fig. 4
Case 5: A 28 year old male reported to the department

with the chief complain of pain in left upper back tooth
from past 15 days.
Fig. 2
Case 3: A 30 year old female reported to the

department with the chief complain of bleeding gums
from past 15 to 20 days.
Fig. 5

department with the chief complain of swelling gums in
right upper back region from past 2 months.
Fig. 3

department with the chief complain of pain in right
upper back tooth from past 2 weeks.
Fig. 6

With the help of 6 cases reported to the Department from 0 to 3 for anterior as well as posterior teeth. Index
of Periodontology, Government College of Dentistry, of tooth - total score of all surfaces / no. of surfaces
Indore, the effect of UM on the health of underlying scored. For posterior teeth- 3 surfaces & anterior teeth-
periodontium is explained using Modified oral hygiene 2 surfaces are scored. Index of one tooth may vary from
index (OHI-M) proposed by Garg S. It comprises of 0 to 6 for anterior tooth, 0 to 9 for posterior tooth. Index
two parts debries index-modified (DI-M) and calculus of all teeth- total score of all teeth’s / no. of teeth scored
index-modified (CI-M).7
Modified calculus index is recorded surface wise, Modified debris index
posterior tooth is divided into 3 surfaces. Criteria for scoring debries index:
Criteria for scoring-scoring present on Bu or Li 0. No debris or stain present on Oc surface of a tooth,
surfaces – same as described by Green & Vermillion in 1. Soft debris covering not more than 1/3rd of Oc
original Oral Hygiene Index. surface of a tooth being examined or soft debris
Scoring calculus on posterior teeth- 4 scores possible: present on pit & fissure areas or the presence of
0. No calculus present on Oc surface of the tooth, extrinsic stains without debris regardless of surface
1. Calculus covering not more than 1/3rd of Oc area covered,
surface of tooth or calculus present only on pits & 2. Soft debris covering more than 1/3rd but not more
fissures present on Oc surface of tooth, than 2/3rd of Oc surface of the tooth,
2. Calculus covering more than1/3rd but less than 2/3rd 3. Soft debris covering more than 2/3rd of Oc surface
of Oc surface of tooth, of the tooth
3. Calculus covering more than 2/3rd of Oc surface of
the tooth. Results
Method of calculating score: after scores for calculus Modified oral hygiene index (OHI-M) for 6
are recorded, index values are calculated separately on patients is tabulated on masticatory and non masticatory
masticatory side and non-masticatory side. For each sides by diving it into anterior and posterior regions and
side, calculus scores are totaled & divided by number of average of each side (Table 1).
surfaces scored. Index of one surface - score may vary
Table 1
Case Masticatory side Non-masticatory side
No. Posterior Anterior Average Posterior Anterior Average
1 0.6 0.8 0.66 2.23 1.00 1.88
2 0.7 1.17 0.83 2.56 1.42 2.24
3 0.1 0.66 0.93 2.40 1.16 2.04
4 0.2 0.4 1.51 2.02 1.10 1.76
5 1.1 1.4 0.57 2.93 2.33 2.76
6 0.67 2.16 1.09 1.73 2.33 1.91
Interpretation important aspects to create a condition of disuse

1. Oral hygiene score of non-masticatory side is atrophy or UM.
greater than that of masticatory side. Calculus deposition, gingival inflammation and
2. As we move from non masticatory posterior to non pocket depth increases with the duration of unilateral
masticatory anterior, masticatory anterior & to mastication. It proves that the destruction of attachment
masticatory posterior, oral hygiene score of patient apparatus is directly proportional to the duration of
improves. UM. It is also observed that females are suffering more
with this problem compared to males.
Discussion In substance, clinicians should pay more attention
It is observed that carious and its related lesions are towards the obturation of primary carious lesion and for
the major cause of avoiding chewing from the affected the treatment of initial gingival and periodontal
side. In 20% cases of UM has shown gingival & problems; at the same time patients should be motivated
periodontal lesions as causative factor. It was observed to accept the treatment of the dental problems at their
that the negligence or carelessness to get the proper initial stage.
dental treatment at initial stage is an important factor to
develop the habit of UM. It has also come to notice that Conclusion
fear of pain is another aspect of avoiding chewing from Such negligence’s can be avoided by generating
the affected side. Lack of awareness regarding awareness as to how early treatment of a single
consequences of a small lesion is also one of the diseased tooth might save half of the dentition from

being severely compromised with the help of this case

series.
Conflict of interest: None to declare
References
1. Nanci A, Bosshardt DD. Structure of periodontal tissues
in health and disease. Periodontol 2000. 2006;40:11–28.
2. Eric LN, Narita Leong, Janelle Greene, Donald
Curtis, Mark IR, and Sunita PH. Reduced functional
loads alter the physical characteristics of the bone-PDL-
cementum complex. J Periodontal Res. 2011;46(6):730–
741.
3. Glickman. Textbook of clinical Periodontology 5th edition
1979.
4. Larato DS. Effects of unilateral mastication on tooth and
periodontal structures. J Oral Med. 1970;25(3):80-3.
5. Pihlstrom BL, Ramfjord SP. Periodontal effect of
nonfunction in monkeys. J Periodontol. 1971;42(12):748-
56.
6. Cohn SA. Disuse Atrophy of the Periodontium in Mice.
Arch Oral Biol 1965;10:909-919.
7. Garg S. Unilateral Mastication & Periodontal Health;
Introduction of Modified Oral Hygiene Index. ISP
Bulletin 1987;2(1):13-17.

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Case Report DOI: 10.18231/2457-0087.2018.

Unilateral mastication - Silent messenger of periodontal status

Keywords: Atrophy, Dental calculus, Dental caries, Periodontal diseases, Periodontitis.

Introduction alveolar bone, and reduction of bone height.3

Case 2: A 28 year old male reported to the department

Case 5: A 28 year old male reported to the department

Case 3: A 30 year old female reported to the

Case 6: A 32 year old female reported to the

Case 4: A 25 year old female reported to the

IP International Journal of Periodontology and Implantology, April-June 2018;3(2):80-83 81

Interpretation important aspects to create a condition of disuse

IP International Journal of Periodontology and Implantology, April-June 2018;3(2):80-83 82

being severely compromised with the help of this case

Conflict of interest: None to declare

IP International Journal of Periodontology and Implantology, April-June 2018;3(2):80-83 83

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