Tooth Mobility : A Review Dr. Sajili Mittal Dr. Prerna Kataria Dr. Vishal Arya Dr. Lavina Taneja Arya Reader & Acting HOD Reader Reader Reader Dept. of Public Health Dentistry, Dept. of Periodontics Dept. of Paediatric Dentistry Dept. of Oral Medicine Inderprastha Dental College D.J. Dental College & Research Centre PDM Dental College & Research Institute Diagnosis & Radiology & Hospital, Ghaziabad Modinagar, Ghaziabad Bahadurgarh, Haryana PDM Dental College & Research Institute Bahadurgarh, Haryana Introduction periodontal structures become adapted to an due to reduced stresses. 2, 4 ncreased tooth mobility has altered functional demand. It is self limiting.4 7. Periapical Pathology: An acute concerned dentists since the 19th 9. Hypermobility is a form of increased inflammatory response within the Icentury1. The stability of the dentition mobility persisting after completion of periodontal ligament as occurs with a is dependent on the resistance of the periodontal treatment. It is often referred to periapical or periodontal abcess, can cause supporting structures of the teeth and the as 'residual mobility'.4, 7 disorganization & destruction of principle magnitude, frequency, duration and the 10. Increasing or Progressive Mobility fibres. 2, 4 direction of forces acting upon them2. To is of a progressive nature and can be identified 8. Para-functional Habits such as evaluate the effectiveness of periodontal only through a series of repeated tooth Bruxism treatment, the examination of tooth mobility mobility measurements carried out over a 9. Supporting Structures of the is significant & should therefore be accurate. period of several days or weeks.4, 7 Teeth: A decrease in the supporting structures Examination of tooth mobility is an important 11. Initial and Secondary Tooth of teeth or an increase in the magnitude, diagnostic aid in determining the severity of Mobility - Muhlemann (1954) in a series of direction, duration and frequency of forces, or periodontal disease3 studies, while using progressively increasing a combination of both may result in tooth Pathophysiology of Tooth Mobility forces (50-1500g) showed that the force / mobility.2 Types of Tooth Mobility displacement relationship had a typical 10. Tooth Morphology: The degree of 1. Physiologic Tooth Mobility is the pattern which could be illustrated by a double mobility depends upon the number of roots; limited tooth movement or tooth sloped curve which had two points defined as their length & diameter as well as the displacement that is allowed by the resilience "initial" (ITM) and "secondary" (STM) tooth relationship of the alveolar crest to the of a healthy and intact periodontium when a mobility components. During ITM forces cement-enamel junction. moderate force is applied to the crown of the smaller than 100g moved the crown by 0.05 to The contour of the root i.e. flat, conical or tooth. It is 4-12/100 mm for 500 g force 0.1 mm and is the result of intra alveolar dilacerated and the relationship of two or applied with incisors have the highest (10- displacement of the root. On the other hand, more roots of a multi rooted tooth to each 12/100 mm) and molar the lowest (4-8/100 during STM part forces ranging between 100- other i.e. divergent or convergent, may also mm). Children and females obtain higher 1500 g allowed additional tooth movement by influence tooth resistance.2, 4 values than adults & males respectively. The the distortion and compression of the 11. Overjet & Overbite are directly greatest tooth mobility is observed upon periodontium on the pressure side .4 During proportional to tooth mobility.4 arising, and decreases during the day5 mastication, teeth & their supporting 12. Loss of Supporting Bone can be due 2. Pathologic Tooth Mobility includes structures are generally subjected to severe to gingival inflammation or trauma from any degree of movement that may be reduced occlusal forces, upto 50 Kgs.8 occlusion4. or eliminated once the pathologic cause is Causes of Tooth Mobility 14. Occlusal Prematurities: A gross identified and corrected.5 Tooth mobility can I. Local Factors: prematurity between two occluding teeth be detected by holding the ball of a finger on 1. Marginal inflammation: Disruption often results in pathologic mobility of one or the facial surface of a tooth while the patient of the gingival, transseptal and circular fibres both of the involved teeth.6 goes through various mandibular which contribute significantly to the firmness 15. Afunctional Occlusal Habits: movements.6 of the tooth.6 Grinding, clamping & “doodling” (grinding 3. Altered Tooth Mobility represents a 2. Periodontal inflammation & on one tooth) habits can result in marked transient or permanent change in periodontal Trauma from Occlusion: The excessive elevations in tooth mobility in the absence of tissues as a result of therapy e.g. after occlusal forces change the pathway of the clinically detectable gingival inflammation surgery4. spreading inflammation so that it extended and bone loss.6 4. Functional Mobility or fremitus is the directly into the periodontal ligament leading 16. Tooth Loss: When a large number of movement of teeth during function or para- to angular resorption of the alveolar bone and teeth have been lost, the remaining teeth must function 4 and signifies occlusal traumatism2. infrabony pocket formation (Glickman and assume all functional demands. These teeth 5. Adaptive Mobility is the absence of Smulow 1962). It was observed that the often display pathologic mobility values.6 an etiologic factor that might be improved furcation regions were the most susceptible to 17. Transient Increases In Tooth upon to directly improve stability by trauma from occlusion (Glickman, Stein and Mobility: Large increases in tooth mobility decreasing or eliminating tooth mobility, Smulow, 1961). This was known as may be seen after the insertion of large example, short roots, poor crown to root Glickman's codestruction hypothesis. restorations, after endodontic treatment, on ratio5. 3. Trauma From Occlusion 7 contiguous teeth after extractions, 6. Passive Mobility relates to how loose 4. Pathology of Jaws like tumours, periodontal therapeutic procedures and after teeth are on palpation, while Dynamic cysts, osteomyelitis etc4. traumatic injuries to the teeth.12 The injury Mobility defines how loose teeth are during 5. Traumatic Injuries to dentoalveolar may be transient or lasting depending on the functional and parafunctional movements.5 units. Torquing force applied to clasped teeth intensity and nature of the insult to the 7. Reduced tooth Mobility is seen in an by removable partial dentures can result in supporting tissues. 4, 6,9 ankylosed tooth after failing reimplantation marked increase in tooth mobility in the II. Systemic Factors or if autogenous bone grafts are placed in absence of bone loss. 1. Age: In the absence of periodontal contact with detached root surfaces. 4, 7 6. Hypofunction: The periodontal disease, older individuals showed somewhat 8. Increased / Static Tooth Mobility is ligament of a non-functional tooth undergoes more mobility for both maxillary central usually due to trauma from occlusion, but disuse atrophy with a concomitant loss of incisor and second molar.4,10 may be due to periodontal diseases where the resistance. In teeth without antagonists there 2. Sex & Race: Mobility has higher is widening of periodontal ligament initially 40 Heal Talk | November-December 2012 | Volume 05 | Issue 02 Mittal, et al. : Tooth Mobility : A Review incidence in females and in Negroes.4,10 relative to the adjacent teeth was detected anterior and posterior teeth in reasonable 3. Menstrual Cycle: Increased by the two strain gauges. alignment through the second molar in horizontal tooth mobility has been suggested 8. Parfitt (1958)15 recorded the tooth both arches. during 4th week of menstrual cycle. 4, 10 movement in an axial direction using the 12. Korber and Korber (1963)19 and 4. Oral Contraceptives: Periodontal adjacent tooth as the reference point. The K.H.Korber (1970)20 have described and disease and attachment loss are more instrument was fastened to the posterior employed a system that employs common among women on pills.4, 11 teeth with impression compound. Both electronic transducers of an inductive 5. Pregnancy: Tooth mobility can systems used transducers, and test output non-contact design. Extremely small increase during the course of pregnancy and could be read on D.C. meters, strip-chart movements can be detected and recorded post-partum.4 recorders or X-Y recording force and with this system. 6. Systemic Diseases: Certain systemic movement. Parfitt stated that the axial diseases aggravate periodontal disease viz movement could be measured with an Papilon Lefevre syndrome, Down's accuracy of 0.001mm +7 percent. syndrome, Neutropenia, Chediak Higashi s y n d r o m e , H y p o p h o s p h a t a s i a , Hyperparathyroidism, Acute leukaemia, Pagets disease etc.4 Measurement of Tooth Mobility Method for Measuring Tooth Mobility 1. Direct visualization when tooth is held between two rigid instruments. 2. Direct observation of movement Fig. 5: During measurement the Periotest handpiece must resulting from occlusal forces (functional always be held perpendicular to the tooth axes. An audible mobility). signal from the computer indicates unacceptable deviations. The point of impact, that is, the point of 3. Percussion sound measurement, is the middle of the anatomical crown. 4. Electronic devices.12 Fig. 4: Periodontometer positioned