Tooth mobility: etiologies and classifications
Plan
- Introduction
- Definition
- Types of tooth mobility
- Etiologies
- Assessment of dental mobility
- Classifications
- Conclusion
- Bibliographic references
- Introduction :
Tooth mobility is often one of the symptoms of periodontal disease .
The destruction of the supporting tissues of the tooth results in a change in the clinical root-clinical crown relationship and often promotes tooth mobility. Tooth mobility can then lead to difficulties when eating, and this discomfort is often one of the main reasons for consultation.
- Definition :
Tooth mobility is defined as an increase in the amplitude of movement of the dental crown under the effect of the forces exerted.
- Types of tooth mobility:
Tooth mobility is divided into two categories: physiological and pathological.
- Physiological dental mobility:
Physiological or normal tooth mobility refers to the limited tooth movement or tooth displacement, which is permitted by the resilience of an intact and healthy periodontium, when a moderate force is applied to the crown of the tooth under examination.
In the morning, physiological mobility is greatest in all teeth, but it decreases throughout the day. Individuals with healthy tissues generally have lower mobility than those with parafunctional habits. Pregnancy primarily causes physiological changes associated with increased mobility, and prolonged unilateral dental function may contribute to increased mobility.
- Pathological dental mobility:
Pathological mobility refers to a progressive increase in tooth mobility and can be caused by various factors, such as progression of periodontal disease, loss of supporting alveolar bone, bruxism, occlusal trauma, root pathology, and pulpal inflammation.
- Etiologies of dental mobility:
- Periodontitis:
Periodontitis results in resorption of the periodontal tissues that support the teeth, and thus eventually causes tooth mobility in the most severe cases. The mechanism by which periodontitis induces tooth mobility includes inflammatory destruction of periodontal tissues, loss of attachment, and occlusal trauma.
- Occlusal trauma:
Primary or secondary, it is not recognized as an etiology in itself of dental mobility but as a factor favoring its appearance. It is important to specify that it is currently clearly accepted that occlusal forces do not influence the triggering of attachment loss or the level of attachment loss for teeth with reduced and healthy periodontium. However, occlusal forces can aggravate attachment loss if periodontal inflammation is already present.
Parafunctions such as bruxism and tics act with the same mechanism as occlusal trauma.
Tooth mobility: etiologies and classifications
- Pulp pathologies:
Aseptic or non-aseptic pulp inflammation can also spread into the desmodontal space and cause increased mobility of the incriminated tooth. In these cases, treatment of periodontal or endodontic inflammation is sufficient to restore physiological conditions.
- Others :
We can cite:
- Trauma: accidents or shocks.
- Tumor processes: such as squamous cell carcinomas , etc.
- Hemopathies: cyclic neutropenia, Lagherhans cell histiocytosis, etc.
- Phosphocalcic imbalance: hypophosphatasia.
- Certain genetic diseases: Down syndrome, Le Fèvre butterfly syndrome, etc.
Mobility must always be linked to its etiology. For this, periodontal, occlusal, radiographic examinations, accompanied by a pulp vitality test are essential in the face of dental mobility.
- Mobility assessment:
- The Miller test:
During a routine clinical examination, tooth mobility is assessed by immobilizing the tooth between the metal handles of two instruments and moving it buccolingually or buccopalatinally.0
Along with methods for classifying tooth mobility, various devices have been developed to assess tooth mobility more objectively.
- Periodontometers
Used by Muhelmann uses a small force that is applied to the crown of a tooth. The crown then begins to tilt in the direction of the force. This technique required custom clutches or plates, limiting their use mainly to research purposes.
- The Periotest
Consists of tapping the tooth with a handheld device that applies a tapping load of 8 g at a speed of 0.2 m/s. The contact time between the tapping load and the tooth is measured by software and converted into the Periotest Value (PTV) which is a biophysical parameter that represents the reaction to impact on periodontal tissues. The Periotest is suitable for measuring tooth mobility due to its ease of application, its ability to measure horizontal and vertical dimensions, and its reproducibility.
Tooth mobility: etiologies and classifications
- Classifications of tooth mobility:
- Miller classification:
It gives a score of 0 for a so-called physiological horizontal mobility (< 0.2 mm), therefore little or not detectable . A score of 1 is given for a mobility greater than physiological mobility. A score of 2 for a horizontal mobility up to 1 mm. Beyond 1 mm in the vestibulo-lingual direction with more or less a vertical component showing the depressible aspect of the tooth in its alveolus, a score of 3 is then given.
- Muhelmann index:
0: Ankylosis
1: physiological mobility perceptible between two fingers
2: transverse mobility visible to the naked eye less than 1 mm.
3: transverse mobility greater than 1mm.
4: axial mobility.
- ARPA Index
Grade I: physiological mobility, perceptible to the fingers and not visible to the naked eye.
Grade II: transverse mobility, visible to the naked eye and less than 1 mm.
Grade III: transverse mobility, visible to the naked eye and greater than 1 mm.
Grade IV: axial mobility.
- Conclusion :
Tooth mobility must always be related to its etiology in order to establish an effective treatment plan . For this, a careful clinical examination must be conducted.
Finally, dental mobility must be expressed by a mobility index which will reflect the degree of mobility and its severity and contribute alongside other factors to the prognosis of the mobile tooth and the treatment plan.
Bibliographic references:
[1] Bartala Michel, Michau Charles, Periodontal retention, Clinical realities review, No. 4, December 15, 2024.
[2] Gi Youn Kim 1 , Sunjai Kim 1 , Jae-Seung Chang 1 , Se-Wook Pyo , Advances in classification and measurement methods used to assess tooth mobility: a narrative review, Journal of clinical medicine, December 27, 2023.
[3] Elfarouki M, Amine K., Kissa J., the overall prognosis of periodontal diseases: what decision criteria, AOS 267, March 2014.
[4] Glargia M. Lidhe J., Tooth mobility and periodontal disease, journal of clinical periodontology,1997.
[5] Niklaus P. Lang, Lidhe Jan, Clinical periodontology and implant dentistry, sixth edition, Wiley Blackwell edition, 2015.