Mobile Teeth: Pathology, Grading, and Management

Mobile Teeth: Pathology, Grading, and Management

Tooth mobility refers to the degree of movement of a tooth in its socket. While a slight degree of physiologic mobility is normal (especially in anterior teeth), increased mobility usually indicates underlying pathology.

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🦷 I. PATHOLOGY OF MOBILE TEETH

1. Physiological Mobility

• Slight movement (up to 0.2 mm) is considered normal.

• Due to periodontal ligament elasticity.

2. Pathological Causes

A. Periodontal Causes (Most common)

• Chronic periodontitis: destruction of periodontal ligament and alveolar bone.

• Acute periodontal abscess

• Trauma from occlusion (TFO)

B. Periapical Pathology

• Apical periodontitis

• Periapical abscess

C. Traumatic Causes

• Dental trauma (accident or sports injuries)

• Bruxism (grinding of teeth)

D. Orthodontic Treatment

• Excessive or uncontrolled orthodontic forces

E. Systemic Conditions

• Osteoporosis

• Diabetes mellitus

• Leukemia

• Hormonal changes (e.g., pregnancy, menopause)

F. Neoplastic Conditions

• Malignancies invading jawbones

G. Iatrogenic Causes

• Over-instrumentation in endodontics or surgery

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🧪 II. GRADING OF TOOTH MOBILITY (MILLER'S CLASSIFICATION)

Grade	Description
Grade 0	Normal mobility (physiologic)
Grade I	Slight mobility (<1 mm in horizontal direction)
Grade II	Moderate mobility (>1 mm but <2 mm in horizontal direction)
Grade III	Severe mobility (>2 mm in horizontal direction and/or vertical mobility – i.e., depressible in socket)

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🛠️ III. MANAGEMENT OF MOBILE TEETH

A. Diagnosis & Investigations

• Complete history & clinical examination

• Radiographs (IOPA, OPG)

• Periodontal probing

• Occlusal analysis

• Blood tests (CBC, glucose, HbA1c if systemic cause suspected)

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B. Management Based on Cause

1. Periodontal Therapy

• Scaling & Root Planing: To remove plaque and calculus

• Periodontal Surgery: Flap surgery, regenerative procedures if bone loss is present

• Splinting: Temporary or permanent splints to stabilize mobile teeth

• Occlusal Adjustment: Eliminate traumatic occlusion

2. Endodontic Therapy

• RCT if mobility is due to periapical pathology

3. Orthodontic Correction

• Re-evaluate and reduce excessive orthodontic forces

4. Restorative Measures

• Replace missing adjacent teeth to distribute occlusal load

• Crown placement to reinforce structure (in certain cases)

5. Extraction

• Grade III mobility with severe bone loss and hopeless prognosis

6. Treatment of Systemic Causes

• Diabetes control, hormonal therapy, managing osteoporosis

• Hematological evaluation for leukemia if suspected

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🪷 IV. AYURVEDIC VIEW (Optional - if needed for integrative practice)

In Ayurveda, mobile teeth can be considered under "Danta Chala" – a symptom seen in diseases like Dantaharsha, Dantashotha, and Asthigata Rogas.

Management may include:

• Gandusha/Kavala: Oil pulling with Tilataila or medicated decoctions (e.g., Triphala)

• Dantadhavana: Herbal tooth powders (Triphala, Lavanga, Saindhava, etc.)

• Local lepa or pratisarana with astringent herbs

• Rasayana Therapy: Ashwagandha, Shatavari for bone health

• Asthidhatu Vardhaka Chikitsa: Use of Laksha, Guggulu, Shankha Bhasma, etc.

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🧾 V. PREVENTION AND MAINTENANCE

• Good oral hygiene (brushing, flossing, mouthwash)

• Regular dental check-ups

• Control of systemic conditions

• Night guards in bruxism

• Balanced occlusion

• Adequate calcium and Vitamin D intake