Tooth mobility – Wikipedia

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medical condition

Tooth mobility
Periodontal terms diagram gingival recession.png
1: Total loss of attachment (clinical attachment loss, CAL) is the sum of 2: Gingival recession, and 3: Probing depth (using a periodontal probe)
Specialty Dentistry

Tooth mobility is the horizontal or vertical displacement of a tooth beyond its normal physiologic boundaries [ 1 ] around the gingival area, i.e. the medical term for a loose tooth. Tooth passing implies in loss of respective orofacial structures, such as bone tissues, nerves, receptors and muscles and consequently, most orofacial functions are diminished. [ 2 ] Destruction of the supporting tissues of the tooth may progress to necrosis ( tissue end ) of the alveolar consonant bone, which may result in a decrease of the count of teeth. The decrease in the number of teeth of a patient may find his chew ’ second ability become importantly less effective. They may besides experience poor lecture, pain and dissatisfaction with the appearance, lowering their quality of animation. [ 2 ]

classification [edit ]

Mobility is graded clinically by applying atmospheric pressure with the ends of two metallic element instruments ( e.g. dental mirrors ) and trying to rock a tooth lightly in a bucco-lingual guidance ( towards the tongue and outwards again ). Using the fingers is not reliable as they are besides compressible and will not detect little increases in motion. [ 3 ] : 184 The placement of the fulcrum may be of interest in alveolar consonant injury. Teeth which are mobile about a fulcrum half way along their root likely have a fracture ancestor. [ 3 ] : 184

Normal, physiologic tooth mobility of about 0.25 millimeter is present in health. This is because the tooth is not fused to the bones of the chew the fat, but is connected to the sockets by the periodontic ligament. This rebuff mobility is to accommodate forces on the tooth during chewing without damaging them. [ 4 ] : 55 Milk ( deciduous ) tooth besides become looser naturally precisely before their scale. [ 3 ] : 197 This is caused by gradual resorption of their roots, stimulated by the developing permanent wave tooth underneath. Abnormal, pathological tooth mobility occurs when the attachment of the periodontic ligament to the tooth is reduced ( attachment passing, see diagram ), or if the periodontic ligament is inflamed. [ 3 ] : 220 Generally, the degree of mobility is inversely related to the sum of bone and periodontic ligament support left. Grace & Smales Mobility Index [ 5 ]

  • Grade 0: No apparent mobility
  • Grade 1: Perceptible mobility <1mm in buccolingual direction
  • Grade 2: >1mm but <2mm
  • Grade 3: >2mm or depressibility in the socket

Miller Classification [ 6 ]

  • Class 1: < 1 mm (horizontal)
  • Class 2: > 1 mm (horizontal)
  • Class 3: > 1 mm (horizontal+vertical mobility)

Causes [edit ]

pathological [edit ]

There are a act of pathological diseases or changes that can result in tooth mobility. These include periodontic disease, periapical pathology, osteonecrosis and malignancies .

periodontic disease [edit ]

periodontic disease is caused by ignition of the gums and the supporting tissue due to alveolar consonant plaque. [ 7 ] periodontic disease is normally caused by a build up of brass on the tooth which contain specific diseased bacteria. They produce an inflammatory response that has a negative effect on the bone and supporting tissues that hold your teeth in place. One of the effects of periodontic disease is that it causes bone resorption and wrong to the supportive tissues. This then results in a personnel casualty of structures to hold the teeth firm in plaza and they then become fluid. discussion for periodontic disease can stop the progressive passing of supportive structures but it can not regrow to bone to make teeth stable again. [ 8 ]

Periapical pathology [edit ]

In cases where periapical pathology is show teeth besides may have increased mobility. dangerous infection at the apex of a tooth can again result in cram loss and this in change state can cause mobility. [ 9 ] Depending on the extent of wrong the mobility may reduce following endodontic treatment. If the mobility is hard or caused by a combination of reasons then mobility may be permanent wave .

Osteonecrosis [edit ]

Osteonecrosis is a condition in which lack of rake provision causes the cram to die off. It chiefly presents following radiotherapy to the jaw or as a complication in patients taking specific anti-angiogenic drugs. [ 10 ] As a result of this necrosis the patient might experience several symptoms including tooth mobility. [ 11 ]

oral cancer [edit ]

oral cancer is a malignant abnormal excessive growth of cells within the oral cavity, which arises from premalignant lesions through a multistep carcinogenesis action. [ 12 ] Most oral cancers involve the lips, lateral pass margin of the tongue, floor of the mouth, and the area behind the third molars i.e. the retromolar sphere. [ 13 ] Symptoms of oral cancer can include velvet bolshevik patches and white patches, loose teeth and non-healing talk ulcers. [ 14 ] The risk factors of oral cancer may include caries preponderance, oral hygiene status, alveolar consonant trauma, alveolar consonant inflict, stress, kin history of cancer, and body multitude exponent ( BMI ), etc. [ 15 ] Habits such as tobacco chewing/smoking and alcohol are the major causative agents, although homo papillomavirus has besides recently been implicated as one of them. [ 5 ] note that alcohol itself is not carcinogenic but it potentiates the effects of carcinogens by increasing the permeability of the oral mucous membrane. [ 13 ] oral cancers have a range of symptoms including crimson and ashen patches, ulcer and non-healing sockets. Another symptom that patients might experience is unaffixed teeth with no apparent induce. [ 16 ] Loss of attachment :

  • By far the most common cause is periodontal disease (gum disease). This is painless, slowly progressing loss of bony support around teeth. It is made worse by smoking and the treatment is by improving the oral hygiene above and below the gumline.
  • Dental abscesses can cause resorption of bone and consequent loss of attachment. Depending on the type of abscess, this loss of attachment may be restored once the abscess is treated, or it may be permanent.
  • Many other conditions can cause permanent or temporary loss of attachment and increased tooth mobility. Examples include Langerhans cell histiocytosis.[4] : 35

Parafunctional habits [edit ]

Bruxism, which is an abnormal repetitive bowel movement disorderliness characterised by chew clench and tooth grate, [ 17 ] is besides a causative factor in the exploitation of alveolar consonant issues, including tooth mobility. [ 18 ] Although it can not cause periodontium price in itself, [ 19 ] bruxism is known to be able to worsen attachment loss and tooth mobility if periodontic disease is already present. [ 20 ] furthermore, the severity of tooth mobility caused by bruxism besides varies depending on the teeth grinding practice and intensity of bruxism. [ 21 ] however, the tooth mobility is typically reversible and the tooth returns to normal tied of mobility once the bruxism is controlled .

Dental injury [edit ]

Dental injury refers to any traumatic injuries to the dentition and their load-bearing structures. coarse examples include injury to periodontal tissues and crown fractures, specially to the cardinal incisors. [ 22 ] These trauma may besides be isolated or associated with early facial trauma. Luxation injury and etymon fractures of teeth can cause sudden increase in mobility after a blow. however, this depends on the type of alveolar consonant trauma, as clinical findings show some types of injury may not affect mobility at all. [ 23 ] For case, while a subluxation or alveolar fracture would cause increase mobility, an enamel fracture or enamel-dentin fracture would still show normal mobility. [ 23 ]

physiological [edit ]

physiological tooth mobility is the tooth motion that occurs when a moderate force out is applied to a tooth with an integral periodontium. [ 24 ] Causes of tooth mobility early than pathological reasons are listed below :

hormonal [edit ]

Hormones play a vital character in the homeostasis within the periodontic tissues. [ 25 ] It has been advocated for a phone number of years that pregnancy hormones, the oral contraceptive pill and menstruation can alter the host response to invading bacteria, specially within the periodontium, leading to an increase in tooth mobility. This has been presumed to be as a leave of the physiological change within the structures surrounding the dentition. In a analyze conducted by Mishra et al, the link between female sex hormones, particularly in pregnancy, and tooth mobility was confirmed. It was found that the most substantial change in mobility occurred during the concluding month of pregnancy. [ 26 ]

Occlusal trauma [edit ]

excessive occlusal stresses refer to forces which exceed the limits of tissue adaptation, therefore causing occlusal trauma. [ 21 ] Tooth contact may besides cause occlusal tension in the postdate circumstances : parafunction/bruxism, [ 27 ] occlusal interferences, dental treatment and periodontic disease. Although occlusal injury and excessive occlusal forces does not initiate periodontal disease or induce loss of connection tissue attachment alone, there are certain cases where occlusal trauma can exacerbate periodontal disease. [ 28 ] furthermore, preexistent plaque-induced periodontal disease can besides cause occlusal injury to increase the rate of conjunction tissue loss, [ 29 ] which in turn may increase tooth mobility .

chief tooth scale [edit ]

When primary teeth are cheeseparing exfoliation ( shedding of chief teeth ) there will inescapably be an increase in mobility. Exfoliation normally occurs between the ages of six and thirteen years. It normally starts with the lower anterior teeth ( incisors and canines ) ; however, exfoliation times of the basal dentition can vary. The time depends on the permanent tooth underneath .

dental treatments [edit ]

A coarse scenario of dental treatment causing aggravation of tooth mobility, is when a fresh fill or crown which is a fraction of a millimeter excessively outstanding in the pungency, which after a few days causes periodontic pain in that tooth and/or the opposing tooth. [ 30 ] Orthodontic treatment can cause increased tooth mobility a well. One of the risks of orthodontic discussion, as a leave of inadequate access for clean, is gingival excitement. [ 31 ] This is most likely to be seen in patients with fixed appliances. Some loss of conjunction tissue attachment and alveolar cram loss is normal during a biennial class of orthodontic treatment. This does not normally cause problems as it is little and will resolve after treatment, however if oral hygiene is inadequate and the patient has a genetic susceptibility to periodontic disease, the consequence can be more austere. [ 31 ] Another gamble of orthodontic treatment that can lead to an increase in mobility is root resorption. The gamble of this is thought to be greater if the following factors are portray :

  • Radiographic evidence of previous root resorption
  • Roots of short length prior to orthodontic treatment
  • Previous trauma to the tooth
  • Iatrogenic: use of excessive forces during orthodontic treatment [31]

management [edit ]

The treatment of tooth mobility depends on the etiology and the grade of mobility. The causal agent of mobility should be addressed to obtain an optimum treatment result. For exemplar, if the tooth mobility is associated with periodontal disease, periodontic discussion should be carried out. In the presence of a periapical pathology, treatment options include drain of abscess, endodontic discussion or extraction. [ 32 ] Occlusal adjustment Occlusal allowance is the process of selectively modifying occlusal surfaces of teeth through grinding to eliminate discordant blockage between amphetamine and lower teeth. [ 32 ] Occlusal adaptation is entirely argue when mobility is associated with periodontic ligament turnout. Occlusal adjustments will be abortive if the mobility is caused by early etiology such as loss of periodontic support or pathology. [ 33 ] Splinting

This is the routine of increasing resistance of tooth to an applied force out by fixing it to a neighbor tooth or tooth. Splinting should only be done when other aetiologies are addressed, such as periodontic disease or traumatic occluded front, or when treatments are unmanageable due to the miss of tooth stabilization. Splinting allows healing and functions during weave healing. The main disadvantage of splinting is it makes removal of plaque more unmanageable, as there will be increased plaque retention at the margins of the splint, which can cause periodontic disease and further loss of periodontic support. [ 32 ] A dental splint works by evening out blackmail across a patients chew the fat. A splint can be used to protect teeth from far damage as it creates a physical barrier between lower and upper dentition. In order to treat mobility, teeth can be joined or splinted together in order to distribute biting forces between respective teeth rather than the individual mobile tooth. A splint differs from a mouthguard as a mouthpiece guard covers both gums and teeth to prevent injury and absorb shock from falls or blows. [ 32 ]

Types of splints [edit ]

There are versatile techniques to splint teeth, and they are classified based on several criteria ; the substantial used, location of splint teeth, flexibility and the longevity of the splint : A ) material

  • Resin by itself
  • Resin with flexible arch of nylon or metal wire
  • Acid-etched resin-bonded splints
  • Orthodontic brackets with malleable arch
  • Vestibular arches or bars

B ) flexibility :

  • Flexible
  • Semi-rigid
  • Rigid

The use of each type is based on the level of tooth mobility. In general, non-rigid immobilization is preferred as it is passive, atraumatic and compromising which allows a certain degree of movement and frankincense advocates a functional re-arrangement of the periodontic ligament fibres and reduces the risk of external resorption and ankyloses. however, in terms of a senior high school mobility grade such as when there are cases of bone plate fracture and late replantation, a inflexible splint might be needed. flexible splints are normally made out of composite resin and nylon weave. Semi rigid splints are normally made with complex resin and orthodontic wire/nylon weave. inflexible splints are made with composite and inflexible wires or Erinch bars and orthodontic appliances. The variations in these splints that are made out of similar materials are chiefly the diameters of the wires and the weight of the threads ; more flexible splints are made of wires that are of lesser diameter while more rigid splints are made of wires with a larger diameter, alike for the threads. In addition, the wires could besides be twisted in a interlock like direction to make it more inflexible. [ 34 ] The acid-etched resin bonded splint is a relatively raw alternative method acting to protect teeth from further injury by more stabilising them in a favorable occlusal relationship. The main goal in this technique is to replace the missing tooth and provided maximum conservation for the structure of remaining tooth. The acid-etching provides a mechanical retention for the resin. Splints are classified into three groups according to their longevity and determination : 1. Temporary

  • In general, these are the ones that used less than six months during the periodontal treatment.
  • They may or may not require further and different types of splinting.
  • Extra-coronal splints which are attached to enamel of several teeth
  • Intra-coronal splints which are placed into a small channel within the tooth and bonded or cemented into place

2. Provisional:

  • They may be used for a long yet limited time-scale, whether months or several years for diagnostic purposes.
  • According to Amsterdam and Fox. (Amsterdam M, Fox L. Provisional splinting: Principles and techniques. Dent Clin North Am 1959;4:73-99.) This is a phase of restoration therapy using tooth dressing coverage and stabilisation of teeth in combination as an immediate and temporary measure.
  • They are used in borderline cases, where dentist cannot predict a certain final outcome for the periodontal treatment during the preliminary treatment-planning.
  • They inform the dentist on whether splinting will be beneficial before any comprehensive treatment.
  • Such examples are night guards, ligature wires, and composite resin splints.

3. Permanent:

  • They are worn indefinitely and may be fixed or removable.
  • This is to increase functional stability as well as improving aesthetics for the long-term basis. However, they are often placed only after successful achievement of occlusal stability.
  • Loose teeth are crowned and fused or joined together[35]
  • Examples of such technique is Pin ledge type of abutment, and the clasped supported partial denture.

Final classification is based on the location of the splinted teeth 1. Extra-coronal splints:

  • which are attached to enamel of several teeth
  • They used stabilising wire, fibre-optic ribbon or similar stabilisation devices to bond the outside of the teeth like a fixed orthodontic retainer.
  • Further examples include nigh guard and tooth-bonded plastic.

2. Intra-coronal splints:

  • The stabilising device is placed into a small chamber within the tooth that are milled by the dentist, and bonded or cemented into place.
  • This means the splint is less visible, making it more aesthetically acceptable option.
  • Examples: Inlays, and nylon wires.

management of occlusal injury associated with periodontic disease [edit ]

Occlusal injury occurs when excessive storm is put on teeth. With periodontic disease there can be irreversible injury to teeth. [ 36 ] According to SDCEP guidelines, when tooth has either over erupted or drifted due to periodontic disease, it is recommended to check for fremitus or occlusal hindrance : [ 37 ] 1.     Fremitus test Allows the diagnosis of injury caused by patient ’ second occlusal forces. The exponent finger is placed on to the buccal/labial surface of the upper jaw tooth. once in maximum intercuspal position, the affected role is asked to make lateral and protrusive movements with their chew the fat. The oscillation of the tooth is felt when it is in the maximum intercuspal put. The vibrations are graded as follows : grade I : slight movement ( + ) Grade II : palpable motion ( ++ ) Grade III : Movement visible with naked eye ( +++ ) [ 38 ] 2.     Occlusal interference When a tooth occludes in an undesirable reach point, it prevents early teeth from achieving the ideal and harmonious contact points. There are four types of occlusal interference : 1.     Centric 2.     Working 3.     Non-working 4.     Protrusive Occlusal noise can be managed by removing the premature contact point or through renewing materials. [ 39 ]

References [edit ]

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