“Fremitus Test in Periodontics” – one of the significant sign for Diagnosis of Trauma from Occlusion.!
In periodontics, the assessment of occlusal forces and their impact on the periodontium is crucial for diagnosing and managing various periodontal conditions.
One important clinical tool used for this purpose is the fremitus test. Fremitus refers to the palpable or visible vibration and movement of a tooth when subjected to occlusal forces, especially during functional movements such as biting or chewing.
This test helps clinicians evaluate occlusal trauma, tooth mobility, and the overall health of the supporting structures of teeth.
This comprehensive overview will discuss the principle, procedure, clinical significance, interpretation, limitations, and applications of the fremitus test in periodontics.
Understanding Fremitus & Fremitus Test in Periodontics
The term fremitus originates from the Latin word fremere, meaning “to murmur” or “to buzz.” In dentistry, fremitus specifically denotes the palpable or visible movement of a tooth in response to occlusal contact during functional activities such as mandibular movements.
Fremitus occurs when occlusal forces are excessive or improperly distributed, causing lateral or vertical displacement of a tooth. This movement can be detected by placing a finger on the tooth surface or by observing the tooth under direct vision or with the aid of instruments.
Principle of Fremitus Test in Periodontics
The fremitus test is based on the principle that teeth subjected to abnormal occlusal forces, such as parafunctional habits (e.g., bruxism) or malocclusion, may exhibit increased mobility and vibration during occlusion. These forces can cause trauma to the periodontal ligament (PDL), alveolar bone resorption, and subsequent pathological tooth mobility.
When a patient closes their jaws or performs lateral or protrusive mandibular movements, the teeth that experience excessive occlusal contacts may move slightly. This movement, if detectable, indicates a positive fremitus and suggests occlusal trauma or instability.
Indications for Fremitus Test
The fremitus test is indicated in several clinical scenarios:
- Assessment of Occlusal Trauma: To evaluate whether occlusal forces are contributing to periodontal destruction.
- Diagnosis of Tooth Mobility: To differentiate mobility caused by occlusal trauma from mobility due to periodontal attachment loss.
- Evaluation Before Prosthetic or Orthodontic Treatment: To identify teeth with compromised stability.
- Monitoring Periodontal Therapy: To assess improvements or deterioration of occlusal function post-treatment.
- Investigating Functional Contacts: To detect premature or heavy contacts during mandibular movements.
Equipment and Materials
The fremitus test is simple and requires minimal equipment:
- Index finger or fingertip of the examiner
- Cotton rolls or articulating paper (optional, for occlusal marking)
- Dental mirror (for visual observation)
- Transillumination devices or magnification (optional)
Procedure for Fremitus Test in Periodontics
The fremitus test can be performed as follows:
Step 1: Explain the procedure to the patient and obtain consent.
Step 2: Seat the patient comfortably in the dental chair with adequate lighting.
Step 3: Identify the teeth to be tested, usually the anterior teeth, as they are more susceptible to lateral forces.
Step 4: Place the index finger or the fingertip of the examiner on the labial or buccal surface of the tooth. Ensure the finger is stable but gentle.
Step 5: Ask the patient to gently tap their teeth together, bite firmly, or perform functional mandibular movements such as lateral excursions or protrusion.
Step 6: Observe or feel for any vibrations, movements, or palpable shifting of the tooth under the finger.
Step 7: Optionally, visually inspect the tooth for movement or deviations during occlusion, using a mirror or magnification.
Step 8: Repeat the procedure for all relevant teeth.
Interpretation of Results for Fremitus Test in Periodontics
The fremitus test results are typically described on a scale based on the degree of tooth movement or vibration:
- Grade 0 (Negative): No palpable or visible fremitus; tooth remains stable during occlusion.
- Grade 1 (Slight): Slight vibration felt but no visible movement.
- Grade 2 (Moderate): Vibration felt easily but no visible movement of the crown.
- Grade 3 (Severe): Vibration felt with obvious visible movement; movement may be side-to-side or up-and-down / Vibration Visible to the naked eye .
A positive fremitus indicates that the tooth is subjected to excessive or abnormal occlusal forces. This may be due to:
- Premature occlusal contacts
- Parafunctional habits such as bruxism or clenching
- Malocclusion or orthodontic relapse
- Defective restorations or prosthetics
- Periodontal attachment loss leading to decreased tooth stability
Clinical Significance of Fremitus Test in Periodontics
-The fremitus test holds significant clinical value in periodontics as an essential diagnostic tool for assessing occlusal trauma and the functional stability of teeth under masticatory forces.
Fremitus refers to the palpable or visible vibrations of a tooth when subjected to occlusal contact during functional movements, such as biting or lateral excursions.
Detecting fremitus is crucial because it indicates abnormal mobility or excessive occlusal forces acting on a tooth, which can contribute to the progression of periodontal disease.
In periodontics, the presence of fremitus suggests that occlusal forces may be detrimental to the periodontium, potentially causing microtrauma to the supporting structures, including the periodontal ligament and alveolar bone.
This trauma can result in widened periodontal ligament spaces, increased tooth mobility, and alveolar bone loss, complicating the existing inflammatory destruction caused by periodontal pathogens.
Thus, identifying fremitus early allows clinicians to intervene promptly to prevent further periodontal breakdown.
The fremitus test is simple, non-invasive, and can be performed chairside using tactile and visual inspection during occlusion. During the examination, the clinician places a finger on the facial surface of a tooth while the patient performs mandibular movements. Any vibration or movement detected signals fremitus.
This test aids in diagnosing occlusal discrepancies, identifying teeth subjected to excessive functional loads, and evaluating the success of occlusal adjustments or periodontal therapy.
Moreover, the clinical significance of the fremitus test extends to treatment planning. It helps periodontists determine the need for occlusal therapy, such as selective grinding, splinting of mobile teeth, or orthodontic intervention to redistribute occlusal forces evenly.
Conclusion
Addressing fremitus can enhance periodontal healing, reduce tooth mobility, and improve long-term prognosis.
In summary, the fremitus test is a vital clinical assessment in periodontics that assists in detecting occlusal trauma, guiding therapeutic decisions, and ultimately preserving periodontal health by minimizing mechanical stresses on compromised teeth.
FAQ On Fremitus Test in Periodontics. –
What is fremitus test in periodontics?
The fremitus test in periodontics assesses the mobility of a tooth during occlusion.
By placing a finger on the tooth while the patient taps or grinds their teeth, the clinician detects vibrations or movements indicating occlusal trauma or periodontal instability.
This simple clinical test helps identify excessive forces affecting the periodontium, guiding diagnosis and treatment planning for periodontal health.
What is fremitus in dentistry?
Fremitus in dentistry refers to the palpable or visible vibration of a tooth when a patient bites or grinds. It indicates mobility and the health of the periodontal ligament. Detecting fremitus helps dentists assess occlusal forces, identify potential trauma from occlusion, and evaluate the stability of teeth, aiding in diagnosis and treatment planning for periodontal and restorative care.
How is a fremitus test done?
A fremitus test is performed by placing the palms or ulnar edges of the hands on a patient’s chest while they repeat phrases like “ninety-nine.” Vibrations felt through the chest wall indicate lung density and air flow. Increased or decreased fremitus helps identify abnormalities such as fluid, consolidation, or obstruction in the lungs.
What is normal fremitus?
Normal fremitus is the palpable vibration felt on the chest wall when a person speaks. It occurs as sound waves travel through the lungs and are transmitted to the chest surface. During a physical exam, decreased or increased fremitus can indicate underlying lung conditions, but normal fremitus suggests healthy lung tissue and clear airways without obstruction or consolidation.
What is a tension test in periodontics?
A tension test in periodontics assesses the mobility and attachment of teeth by applying gentle pressure or tension to the gingiva or periodontal ligament. It helps diagnose the integrity of the periodontal support structures, detect inflammation, and identify areas of tissue damage or disease. This simple clinical test aids in planning appropriate periodontal treatment and monitoring healing progress.
What is Realeff effect in dentistry?
The Realeff effect in dentistry refers to the phenomenon where local anesthesia provides prolonged pain relief beyond its expected duration. This occurs due to reduced nerve sensitivity and temporary nerve blockade, helping patients experience extended comfort during and after dental procedures. Understanding this effect aids dentists in managing pain effectively and improving patient care during treatments.
How do you check for fremitus?
To check for fremitus, place your hands or fingers firmly on the patient’s chest while they repeatedly say a phrase like “ninety-nine.” Feel for vibrations transmitted through the chest wall. Increased fremitus may indicate lung consolidation, while decreased fremitus suggests air or fluid outside the lung. Compare symmetrical areas for differences during the examination.
How do you treat fremitus in teeth?
Treating dental fremitus involves identifying and addressing the underlying cause, often occlusal trauma. Your dentist may adjust your bite by reshaping or equilibrating teeth to reduce excessive forces. In some cases, splinting loose teeth or providing orthodontic treatment can stabilize them. Managing inflammation and ensuring good oral hygiene are also essential to prevent further damage and restore comfort.
What is the fremitus technique?
The fremitus technique is a clinical method used to assess vibrations transmitted through the chest wall when a patient speaks. By placing hands or a device on the patient’s thorax, healthcare providers detect changes in vibration patterns, helping identify lung abnormalities such as consolidation, pleural effusion, or pneumothorax. It aids in diagnosing respiratory conditions by evaluating tactile fremitus intensity and symmetry.
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