Tooth Mobility

Loosening of teeth in its socket refers to tooth mobility. Tooth mobility could be pathological or physiological. Physiological tooth mobility is normal to a certain level while pathological tooth mobility occurs due to underlying diseases.

The term ‘Tooth Mobility’ describes the ability of a tooth to move inside a socket. This is usually a sign of unseen dental problems. Tooth mobility is seen because of unhealthy supporting tissues due to periodontal disease, trauma, or significant bone loss. The tooth is often gently pushed in the opposite direction to determine the degree of mobility. Tooth mobility is graded as per MILLER’s classification. This can help dentists in treatment planning.

Tooth Mobility Grading

MILLER’s classification of tooth mobility is routinely used in dental practices to determine the degree of mobility.

Grading of Tooth Mobility by MILLER

• Grade 0: No detectable mobility
• Grade 1: Detectable mobility in horizontal direction <1 mm
• Grade 2: Detectable mobility in horizontal direction <1 mm
• Grade 3: Detectable mobility in horizontal and vertical directions <1 mm

Causes of Tooth Mobility

The following are the common tooth mobility causes in patients:

1. Gum Disease

Gum diseases are the major causes of tooth mobility. Gum diseases lead to alveolar bone resorption due to untreated inflammation, which, in turn, compromises tooth support. Wearing gums can also occur if gum diseases are left untreated.

2. Trauma or Injury

An accidental fall or injury to the face or mouth can damage periodontium and jaw bones. Damage to the supporting bone of the tooth can initiate tooth mobility after injury.

3. Bone disease

Bone diseases like osteoporosis decrease bone density and make bone fragile. Bone diseases reduce bone mass and induce tooth mobility.

4. Teeth Grinding (Bruxism)

Teeth grinding can erode teeth and loosen them in sockets. Tooth mobility is significant at night due to unintentional teeth grinding. This mobility is temporary initially but might become permanent if ignored.

5. Poor Oral Hygiene

Improper brushing leads to plaque and tartar buildup and can damage gum tissues. Plaque and tartar buildup can slowly pull gums away from teeth and initiate bone resorption causing tooth mobility.

Symptoms of Tooth Mobility

Tooth mobility is often painless but can damage periodontal ligaments and surrounding bone. Tooth mobility of grades 0 and 1 are asymptomatic and unnoticed by patients. While Grades 2 and 3 show the following tooth mobility symptoms:

• Tenderness of surrounding gums
• Discomfort and pain
• Difficulty in chewing
• The tooth appears longer in the oral cavity
• Sensitivity

Diagnosis of Tooth Mobility

Tooth mobility can be easily diagnosed in a clinical setting with a dental examination set. Different methods are available to assess the degree of tooth mobility.

Four methods to assess tooth mobility are:

Mouth mirror and probe

Dentists place the handle of the mouth mirror on one side of the tooth and the handle of the dental probe on the other side. Dentists apply a gentle force in a facio-lingual direction and notice mobility.

Mouth mirror and finger

In this method, dentists use the handle of a mouth mirror and a fingertip on each side of a tooth. Apply gentle pressure in a facio-lingual direction and feel the movement through the fingertip.

Two fingers

In this method, no dental instrument is used to see tooth mobility. Dentists use two fingertips on each side of a tooth and move in a facio-lingual direction.

Periotest

Periotest is an instrument to determine the mobility or stability of a tooth. This instrument is usually used to measure osteointegration of dental implants but can also give efficient results for tooth mobility.

Treatment Options for Tooth Mobility

Tooth mobility treatment depends on the grade of mobility. Grades 0 and 1 are typically managed by homecare or non-invasive dental procedures. While grades 2 and 3 require invasive dental treatments. Following are the possible treatment options for tooth mobility.

1. Scaling and Root Planning

Dental scaling and root planning is the first step to treat tooth mobility of any grade. Removing plaque and tartar buildup from tooth and root surfaces helps gum tissues to become healthy. Scaling and root planning are also necessary before any other dental treatment.

2. Dental Splinting

Dental splinting is a painless procedure in which loosened teeth are attached together to work as a single unit. It increases teeth strength and can reverse minor tooth mobility. Dental splinting should not be done for more than 2-3 weeks because permanent changes in the bite might occur.

3. Periodontal Surgery

Gum grafting or flap surgeries are performed where the periodontal bone is in good shape, but gum recession has induced tooth mobility. Gum grafting helps to regain the gingival support and prevent further damage to surrounding tissues.

4. Dental Implant

Replacement of mobile teeth with dental implants is performed in cases of advanced teeth mobility. A dental implant is performed when there are no traces of dental infections.