Tooth mobility

By- Dr Rohit Rai

 All teeth have a slight degree of physiologic mobility, which varies for different teeth and at different times of the day." It is greatest on arising in the morning and progressively decreases. The increased mobility in the morning is attributed to slight extrusion of the tooth because of limited occlusal contact during sleep.

 During the waking hours, mobility is reduced by chewing and swallowing forces, which intrude the teeth in the sockets. These 24-hour variations are less marked in persons with a healthy periodontium than in those with occlusal habits such as bruxism and clenching

 Single-rooted teeth have more mobility than multirooted teeth, with incisors having the most. Mobility is principally in a horizontal direction, although some axial mobility occurs, to a much lesser degree.

Tooth mobility occurs in two stages:

1. The initial or intrasocket stage is where the tooth moves within the confines of the periodontal ligament. This is associated with viscoelastic distortion of the ligament and redistribution of the periodontal fluids, interbundle content, and fibers . This initial movement occurs with forces of about 100 lb and is of the order of 0.05 to 0.10 mm (50 to 100 microns).

2. The secondary stage, which occurs gradually and entails elastic deformation of the alveolar bone in response to increased horizontal forces. When a force of 500 Ibs is applied to the crown, the resulting displacement is about 100 to 200 microns for incisors, 50 to 90 microns for canines, 8 to 10 microns for premolars, and 40 to 80 microns for molars

 When a force such as that applied to teeth in occlusion is discontinued, the teeth return to their original position in two stages: the first is an immediate, springlike elastic recoil; the second is a slow, asymptomatic recovery movement. The recovery movement is pulsating and is apparently associated with the normal pulsation of the periodontal vessels, which occurs in synchrony with the cardiac cycle.

 Many attempts have been made to develop mechanical or electronic devices for the precise measurement of tooth mobility. Even though standardization of the grading of mobility would be helpful in diagnosing periodontal disease and in evaluating the outcome of treatment, these devices are not widely used.

 As a general rule, mobility is graded clinically with a simple method such as the following: the tooth is held firmly between the handles of two metallic instruments or with one metallic instrument and one finger , and an effort is made to move it in all directions; abnormal mobility most often occurs faciolingually.

Tooth mobility checked with one metal instrument and one finger.

 Mobility is graded according to the ease and extent of tooth movement as follows: Normal mobility Grade I: Slightly more than normal. Grade II: Moderately more than normal. Grade III: Severe mobility faciolingually and/or mesiodistally, combined with vertical displacement.

 Mobility beyond the physiologic range is termed abnormal or pathologic. It is pathologic in that it exceeds the limits of normal mobility values; the periodontium is not necessarily diseased at the time of examination.

 Increased mobility is caused by one or more of the following factors: 1. Loss of tooth support (bone loss) can result in mobility. The amount of mobility depends on the severity and distribution of bone loss at individual root surfaces, the length and shape of the roots, and the root size compared with that of the crown. A tooth with short, tapered roots is more likely to loosen than one with normal-size or bulbous roots with the same amount of bone loss.

 Because bone loss usually results from a combination of factors and does not occur as an isolated finding, the severity of tooth mobility does not necessarily correspond to the amount of bone loss.

 2. Trauma from occlusion (i.e., injury produced by excessive occlusal forces or incurred because of abnormal occlusal habits such as bruxism and clenching) is a common cause of tooth mobility. Mobility is also increased by hypofunction. Mobility produced by trauma from occlusion occurs initially as a result of resorption of the cortical layer of bone, leading to reduced fiber support, and later as an adaptation phenomenon resulting in a widened periodontal space.

 3. Extension of inflammation from the gingiva or from the periapex into the periodontal ligament results in changes that increase mobility. The spread of inflammation from an acute periapical abscess may increase tooth mobility in the absence of periodontal disease.

 4. Periodontal surgery temporarily increases tooth mobility for a short period. 43-46 5. Tooth mobility is increased in pregnancy and is sometimes associated with the menstrual cycle or the use o f hormonal contraceptives. It occurs in patients with or without periodontal disease, presumably because of physicochemical changes in the periodontal tissues

 5. Pathologic processes of the jaws that destroy the alveolar bone and/or the roots o f the teeth can also result in mobility. Osteomyelitis and tumors of the jaws belong in this category

6. One study has suggested that pockets around mobile teeth harbor higher proportions of Campylobacter rectus and Peptostreptococcus micros, and possibly of Porphyromonas gingivalis than nonmobile teeth. This hypothesis needs further verification.