[2] Mobility is graded clinically by applying pressure with the ends of two metal instruments (e.g. dental mirrors) and trying to rock a tooth gently in a bucco-lingual direction (towards the tongue and outwards again).
[3]: 220 Generally, the degree of mobility is inversely related to the amount of bone and periodontal ligament support left.
They produce an inflammatory response that has a negative effect on the bone and supporting tissues that hold the teeth in place.
Treatment for periodontal disease can stop the progressive loss of supportive structures but it can not regrow bone to make teeth stable again.
Severe infection at the apex of a tooth can again result in bone loss and this in turn can cause mobility.
It mainly presents following radiotherapy to the jaw or as a complication in patients taking specific anti-angiogenic drugs.
[16] Habits such as tobacco chewing/smoking and alcohol are the major causative agents, although human papillomavirus has also recently been implicated as one of them.
[18] Although it cannot cause periodontium damage in itself,[19] bruxism is known to be able to worsen attachment loss and tooth mobility if periodontal disease is already present.
Luxation injury and root fractures of teeth can cause sudden increase in mobility after a blow.
[24] Causes of tooth mobility other than pathological reasons are listed below: Hormones play a vital role in the homeostasis within the periodontal tissues.
[25] It has been advocated for a number of years that pregnancy hormones, the oral contraceptive pill and menstruation can alter the host response to invading bacteria, especially within the periodontium, leading to an increase in tooth mobility.
In a study conducted by Mishra et al, the link between female sex hormones, particularly in pregnancy, and tooth mobility was confirmed.
This does not usually cause problems as it is slight and will resolve after treatment; however, if oral hygiene is inadequate and the patient has a genetic susceptibility to periodontal disease, the effect can be more severe.
Occlusal adjustments will be unsuccessful if the mobility is caused by other aetiology such as loss of periodontal support or pathology.
Splinting should only be done when other aetiologies are addressed, such as periodontal disease or traumatic occlusion, or when treatments are difficult due to the lack of tooth stabilization.
A splint differs from a mouthguard as a mouth guard covers both gums and teeth to prevent injury and absorb shock from falls or blows.
In general, non-rigid immobilisation is preferred as it is passive, atraumatic and flexible which allows a certain degree of movement and thus advocates a functional re-arrangement of the periodontal ligament fibres and reduces the risk of external resorption and ankyloses.
However, in terms of a high mobility grade such as when there are cases of bone plate fracture and late replantation, a rigid splint might be needed.
[34] The acid-etched resin bonded splint is a relatively new alternative method to protect teeth from further injury by more stabilising them in a favourable occlusal relationship.
[37] According to Scottish Dental Clinical Effectiveness Programme (SDCEP) guidelines, when teeth have either over-erupted or drifted due to periodontal disease, it is recommended to check for fremitus or occlusal interference:[38] 1.
Once in maximum intercuspal position, the patient is asked to make lateral and protrusive movements with their jaw.
Protrusive Occlusal interference can be managed by removing the premature contact point or through restorative materials.