Physiological mobility of teeth is normal. Movement of teeth in pathologies. How can we help you

In an adult, tooth mobility can occur for various reasons, but in any case it is not very pleasant and most of those who have such an anomaly want to eliminate it. Quite often, periodontal disease can be considered the reason that teeth begin to become loose.

If this is the case, then treatment for tooth mobility must be carried out. But before you begin treatment for tooth mobility, you need to understand exactly what causes it and what degree of the disease it is. This will allow you to choose the optimal tactics to combat the problem and achieve good results.

Physiological and pathological mobility of teeth

There are physiological and pathological mobility of teeth. The emergence of a physiological form of mobility is associated with the need to evenly distribute the load on the dentofacial apparatus. But pathological tooth mobility is an abnormal phenomenon and requires mandatory elimination.

Degrees of tooth mobility: 1, 2, 3, 4 degrees

Dentists distinguish different degrees of tooth mobility:

1. Mobility of the 1st degree is manifested by the movement of teeth in one direction and the amplitude of movement is less than 1 millimeter.
2. Tooth mobility of the 2nd degree is the movement of teeth sideways and back and forth with an amplitude of more than 1 mm.
3. Tooth mobility of the 3rd degree also represents movement in the vertical direction.
4. Mobility 4 degrees - the tooth can not only wobble, but also rotate.

Different degrees of tooth mobility, combined with bleeding and swelling of the gums, indicate the activity and neglect of the pathological process. So, if you have grade 2 tooth mobility, you should definitely see a doctor and have the anomaly eliminated. If you have been diagnosed with grade 3 tooth mobility, treatment should be urgent. Otherwise, you risk losing loose teeth and involving other teeth in the pathological process.

Periodontal disease and tooth mobility

Many people believe that periodontal disease can lead to loose teeth. Tooth mobility, however, with this disease can occur only in the most extreme stages. Most often, periodontitis can be considered the cause of pathological loose teeth!

Both periodontitis and periodontal disease are characterized by the fact that the periodontium is affected, but a disease characterized by the development of an inflammatory process is periodontitis, and damage to periodontal tissues without inflammation is periodontal disease. Tooth mobility due to periodontal disease occurs due to damage to the ligaments that secure the tooth in the socket.

One of the signs of periodontitis is bleeding. Mobility of teeth in the presence of blood from the gums is a double signal that you have periodontitis. But periodontal disease is very rarely accompanied by bleeding gums.

If periodontitis is not treated, tooth loss is possible within 2 years. Therefore, if you find bleeding, mobility of teeth, swelling of the gums and a feeling of discomfort in them, you should immediately contact a periodontist and deal with the problem.

Elimination of tooth mobility

Eliminating tooth mobility may involve different treatment approaches. If the cause is the presence of periodontitis, then measures must be taken to treat this disease. They massage the gums, splint teeth, apply injections to eliminate bleeding and relieve inflammation, and much more.

In very difficult situations, when eliminating tooth mobility is impossible, basal implantation or removable prosthetics may be recommended.

At the PerioCenter dental center you will meet highly qualified specialists who will select the most effective treatment for your illness and help eliminate loose teeth.

Teeth have physiological activity that is not noticeable to a non-specialist. Teeth movement occurs due to the fact that the tooth is not tightly fixed into the bone alveolus, but has a shock-absorbing fastening system in the form of periodontal tissue. That is why the chewing load is evenly distributed over the surface, and the teeth maintain their integrity. However, tooth mobility sometimes becomes pathological. Most often, if parents did not make obvious mistakes in childhood, this phenomenon occurs in people of mature or middle age. Movements that are very difficult to visually record are considered normal for tooth mobility. When mobility becomes noticeable even to the owner of the teeth, then we are talking about a disease.

A classification of this pathological process of tooth movement has been created:

• During first stage teeth move back and forth or, in medical terms, have vestibulo-orally directed mobility.
• When, in addition to this, the teeth make movements in lateral directions, second stage.
• At the most dangerous third stage, vertical and circular movements are added to those mentioned earlier. The teeth are already beginning to emerge from the bone alveoli.

If the first two stages are subject to treatment and have a certain chance of recovery, then the last stage of mobility is a kind of sentence - the tooth should be removed.

What is the cause of pathological mobility of teeth?

The well-known disease periodontitis is the main cause of this problem. This disease is inflammatory in nature and is characterized by destruction and reduction of tissue adjacent to the tooth.
Dental deposits cause inflammation of the gums, which spread to the surrounding bone and ligaments. Inflamed tissue dissolves very quickly and is replaced by granulation tissue. And as a result of the fact that there is no more bone, the teeth acquire pathology in the form of mobility.

How do teeth move during orthodontic treatment?

A little theory about tooth movement

With the help of connective tissue fibers, the tooth is secured in the dental socket. This ligament is called the priodontal ligament. When the walls of the tooth socket are constantly exposed to the force coming from the aligners to straighten the teeth, areas of tension and pressure appear in the periodontium. Restructuring processes of bone tissue begin to occur in the tooth socket, which trigger bone resorption (resorption) and then its construction (osteogenesis). In the area of ​​pressure, the periodontal fissure contracts, and in the area of ​​tension, expansion occurs. Under pressure, the fibers of the ligament of the tooth and the nerves and blood vessels located in these places are compressed. The surface of the alveoli, located at the root of the tooth, experiences resorption.

In the area of ​​tension, the ligaments of the tooth are stretched, and the process of bone tissue formation occurs. Both of these processes occur simultaneously, but with varying intensity, depending on the stage of treatment. The desired movement can only be achieved by applying a certain force to the jaw and teeth. It has been empirically found that less force exerted results in faster tooth movement. This is explained by the specific processes of regeneration and resorption of dental tissue and alveolar structures. That is why orthodontic movement of teeth is a slow process, carried out in the desired direction under the influence of small forces. If you make a greater load to move the teeth, the neurovascular bundles will not have time to rebuild in time. Without sufficient innervation and proper blood flow, the position of the tooth is difficult to correct.

Now let's see how teeth move in practice when treating orthodontic pathologies.

Tooth movement in the treatment of dental crowding

How crowded teeth are moved into a straight position using aligners

The clinical director of Star Smile, orthodontist Alexander Veniaminovich, comments on the process of tooth movement:

Let's pay attention in the upper video to how the upper and lower jaws come into contact with each other at the end of the treatment situation: we see an excellent position, excellent inclination of the front teeth, excellent shape, coincidence of all midlines, all linear parameters. Which, in general, allows us to think that the patient as a whole should be satisfied with this result.

The most important thing - as you have already noticed by watching the video - is that one of the key points of treatment technology using aligners is the creation 3D virtual setup. That is, you and I sit in front of the computer and see WHAT will happen as a result of treatment BEFORE it starts. This emphasis is made on purpose, since many of us find it difficult to understand in principle how teeth move.

This kind of technology, this kind of 3D image, provides the answers. Therefore, look, analyze and begin your orthodontic journey in correcting your not very straight teeth!

Tooth movement during crossbite treatment

This patient has a crossbite. We see not a very narrow, but on the contrary, a very wide skirt-like shape of the upper central incisors. In aligner technology, we very often use a variety of different ways to adjust the size of teeth in order to create room for alignment. Therefore, here, as they say, “your hands are itching” to intervene in the situation and a little - let’s say - “file” the teeth on the sides to make them more attractive. And thereby create the optimal place for leveling.

A 3D virtual setup shows how straight his teeth will become with a crossbite

Quite classic tasks are faced by every doctor who shows a 3D virtual setup to a patient. The setup shows how the position of the teeth changes, how the shape changes slightly. On the lower jaw and on the upper jaw on the left, we see the not entirely correct position of the last two teeth, two molars: the upper one tilts very strongly towards the buccal side, and the lower one, on the contrary, tilts towards the tongue. This is a crossbite. The video shows the movement of all teeth to their normal position.

Did you know that all dental pathologies can be cured with aligners?

Star Smile company is a leading Russian manufacturer of aligners. The design of each set of aligners for patients is based on accurate mathematical modeling of the physiology of patient tooth movement, taking into account the existing pathology. What does it mean?

This means that your teeth will be put in place as quickly and comfortably as possible with the help of Star Smile aligners!

Star Smile specialists work in more than 70 (!) cities of Russia. We can always advise you in your city for free. And the main thing is to cure it with aligners once and for all!

Healthy teeth appear absolutely motionless. However, in reality, they elastically shift during chewing, ensuring uniform distribution of the load on the dentition.

But this physiological shift is so insignificant that it is not noticed by a person. In contrast, pathological mobility is clearly felt when pressing on the tooth with a finger or tongue.

Sustainability standards

The periodontal ligamentous apparatus is responsible for the stability of the teeth, ensuring their fixation in the alveolar socket. Its main element is collagen fibers, which are attached to the root cement at one end and to the alveolar bone at the other.

On the one hand, they keep the tooth from significant movements in any direction, and on the other, they perceive the chewing load and gently transfer it to the alveolus, protecting the bone tissue from overload.

In a normal state, the periodontal fissure (the space between the cement of the tooth and the bone of the alveolus) is within the physiological norm. At the root apex its thickness is 0.2-0.25 mm, in the middle part - 0.15-0.2 mm, in the cervical region - 0.3 mm.

If you try to shake a healthy tooth, it will seem immobile. Its displacement under load can only be determined using a special test.

The surrounding tissues are pink-coral in color, there are no swellings or gum pockets.

Causes of loosening

Pathological mobility of teeth is caused by the following reasons:

1. Periodontal diseases.
2. Abnormal position of some units. Often this is a malocclusion that disrupts the occlusion.
3. Loss of adjacent units, depriving the problematic tooth of lateral support.
4. Injuries to the oral cavity.
5. Resorption (resorption) of the jaw bone.
6. A dentist's mistake is accidental damage to a tooth with dental instruments or the negative impact of medications.

Most often, tooth mobility is a consequence of periodontal disease, and late, in the 2nd or 3rd stage. Mobility caused by changes in the periodontium indicates its significant damage.

The periodontium ensures the stability of the position of the teeth in the gums, protects them from infections, and maintains normal trophism and metabolic processes. When it is damaged, the ligament ceases to perform its function, the teeth lose stability and become mobile.

Factors causing periodontitis:

1. Poor oral hygiene, leading to decay of food debris and the development of pathogenic microflora.
2. Bactericidal properties of saliva, causing the formation of tartar.
3. Overload or underload of the periodontium. In the first case, hypertrophy (expansion) of the periodontal fissure occurs with a change in the structure of the alveolar bone. Underloading is dangerous due to jaw bone resorption.
4. Reduced immunity or vitamin deficiency.
5. Diseases of various organs– Gastrointestinal tract, cardiovascular system, pancreas, etc.

Determining the complexity of a clinical case

There are several ways to determine tooth mobility. According to the classification of D. A. Entin, there are 4 degrees of pathology:

1. I degree. The movement of the top of the tooth in the oral-vestibular direction (“right-left” for lateral units, “back and forth” for anterior units) does not exceed 1 mm. There is no mobility in other directions.
2. II degree. Mobility of the 1st degree + movement of no more than 1 mm in the palatal-distal (“back-forward” for lateral units, “right-left” for anterior) direction.
3. III degree. Mobility of degrees I and II is joined by vertical mobility.
4. IV degree. The first 3 mobility + rotation of the tooth around its axis. Thus, degree IV is characterized by mobility in all possible directions.

Attention! The third and especially the fourth degree indicate far-reaching and, most likely, irreversible changes in the periodontium.

Prohibited actions and diagnostics

Typically, patients consult a doctor about tooth mobility when it reaches the 3rd or 4th stage. If its cause is periodontal disease, this means that 5-6 years have passed since the onset of the disease.

Typically, periodontal disease begins with bleeding gums that appear after brushing your teeth. It is at this moment that you should consult a doctor to prevent the development of the disease.

Late treatment makes the prognosis uncertain. It is possible that proper treatment will help avoid extraction, but this is not guaranteed.

Having discovered that a tooth is loose, the patient should do the following:

1. Rinse your mouth with warm water.
2. Avoid any physical impact on the problematic tooth - do not touch it with a brush when cleaning, do not touch it with your hands or tongue.
3. See a doctor as soon as possible.

The doctor determines the degree of mobility and the cause that caused it by examining the oral cavity, and, if necessary, using fluoroscopy.

If there is significant mobility, it is easy to establish by rocking the tooth with tweezers or a finger placed on the top. The condition of the surrounding tissue is also determined by inspection and palpation.

Bright red gum color may indicate gingivitis. Gray color usually indicates its transition to the ulcerative-necrotic stage. A dark red-burgundy shade speaks in favor of periodontal disease.

This usually results in gum pockets. The doctor measures their depth and assesses the condition of the gum edge. The appearance of pockets may be accompanied by destruction of bone tissue.

Diagnosis is carried out not only with the mouth open, but also with the mouth closed - to check occlusion, determine the nature and depth of the bite. This is necessary to determine whether there is an anomaly in the structure and position of the teeth, which may cause mobility.

X-rays can confirm or refute a previously made diagnosis. Sometimes a blood test is required.

Treatment methods

In general, treatment of tooth mobility comes down to eliminating the cause that caused it and ensuring the stability of the tooth by mechanically fixing it. In each case, an individual decision is made, depending on the specific clinical situation.

Treatment begins with measures that eliminate the cause of the pathology. Therapeutic (medicinal), microsurgical and hardware methods of treatment are used.

Hardware treatment

This method of treatment involves the use of devices operating on physical principles:

1. Laser treatment. A modern, low-traumatic type of treatment of lesions, which can be used for most pathologies.

   It is an excellent alternative to the old drill. The laser beam destroys pathogenic microflora, sterilizes the affected area, and promotes accelerated tissue regeneration. This minimizes the risk of complications

2. Ultrasound treatment. Sound pulses and water supplied by an ultrasonic scaler destroy and remove tartar, plaque, microbial films, and toxins from the surface of the enamel. Ultrasound can be used to clean gum pockets up to 11mm deep.
3. Ozone therapy. Relieves inflammation and disinfects the source of the disease with ozone generated by a special device. Ozone therapy is often used in conjunction with ultrasound and laser treatments.

Curettage

Curettage is the cleaning of gum pockets from germs, decayed food debris and diseased tissue. After cleaning, drugs are injected into the gap between the gum and the root to accelerate the regeneration processes.

Splinting

The main way to eliminate tooth mobility (but not its cause) is splinting - installing a removable or permanent splint that ties healthy and diseased teeth together, ensuring the stability of the latter.

There are many types of splinting:

• Semi-ring and ring tires. In the case of the latter, thin metal bushings connected to each other are placed on the teeth. Half-ring tires are installed on the inside, remaining invisible from the front. This makes splinting more aesthetically pleasing.
• Cap splinting. It is made in the form of caps soldered together and placed on the teeth. Their difference from semi-ring and ring structures is that they simultaneously cover the cutting surfaces along with the side ones.
• Intradental splints. The most modern designs are connected to dentin with inserts implanted into it.
• Inlay tires. They are a metal inlay installed on the edges of the teeth and connected at the edges with full crowns placed on supporting units. Thus, the tab takes on the function of a common cutting edge.
• Crown splints. They cover the teeth from all sides right up to the gums. Durable and aesthetic designs, but require healthy gums for installation.
• Splinting structures made of fiberglass and aramid threads. The link connecting the teeth is a fiberglass tape or aramid thread, which is inserted into grooves sawn into the enamel and dentin. Fastened with composite material.
• Pin tires. They are caps attached to pins inserted into the pulpless canals. These are reliable and aesthetic designs, most often used at the front. A serious drawback is the need for depulpation.
• Splinting clasp dentures. Structurally, they are a developed metal arch fixed from the inside of the jaw. The arch is equipped with various fastening elements (clasps, claws, etc.) that provide fixation of problematic units.

Removal of a mobile tooth followed by prosthetics is used in cases where restoration of its function is impossible, and delay in excretion threatens neighboring units.

This usually happens in advanced stages of periodontal disease with atrophy of the alveolar bone tissue.

The video provides additional information on the topic of the article.

Prevention

The main measures to prevent mobility are high-quality oral hygiene, and timely consultation with a doctor at the first signs of disease - be it caries, pulpitis, periodontitis or other pathology.

When several adjacent units are removed, the destruction of the jawbone can be stopped by installing implants that provide loading to the jaw, which helps preserve the bone structure.

Cost of therapy

Prices for treating loose teeth vary greatly depending on the number of teeth, the degree of damage, the complexity of the work, the methods and equipment used, the location of the clinic and other conditions.

Without pretending to be particularly accurate, we provide approximate prices for some types of work.

Fixing teeth with splinting is not such a common operation compared to drug or hardware treatment. Few people can “boast” of having a fiberglass or other splint in their mouth.

Even normal healthy teeth somewhat mobile. Data from the histological structure of the periodontium confirm the possibility of such mobility. The periodontium or pericementum, consisting of connective tissue penetrated by a dense network of numerous blood and lymphatic vessels and impregnated with tissue fluid, is a loose soft layer that allows the tooth, under the influence of chewing pressure, to move in different directions around the longitudinal and transverse axes.

Such micro-excursions, invisible to the naked eye and not detected by palpation of teeth, are confirmed by the existence of approximal facets on a tooth located in the middle of the dentition. So, for example, the 7th tooth has contact surfaces on the mesial and distal sides and facets on the side of the 6th and 8th teeth, the 8th tooth is in contact only with the 7th and therefore has only one facet on the mesial side. These facets are apparently formed as a result of naturally occurring microexcursions of the teeth around the vertical axis.

Pathological mobility of teeth. When examining a patient, teeth with pathological mobility are revealed. D. A. Entin distinguishes three degrees of tooth mobility. He defines slight rocking of the tooth with fingers or tweezers, accompanied by a visible displacement of its crown in one direction (vestibular-oral), as mobility of the first degree. Visible displacement of the crown in two directions - vestibulo-oral and mesio-distal - indicates the second degree of tooth mobility. Tooth mobility in three directions - vestibulo-oral, medio-distal and apical - is assessed as the mobility of the third stele and.

Magnitude and topography dental defects. The size of the dentition defect and its location depend, as stated, on various reasons, including the anomaly in the number of erupted teeth.

Anomaly in the number of erupted teeth.

Anomaly in the number of teeth expressed in a decrease or increase in their number. Normally, the number of teeth in a primary dentition is 20, and in a permanent dentition - 32.

As a result of the reduction masticatory apparatus the number of teeth in modern humans has decreased to 32. The dental system tends to further reduction, in the process of adapting to the new functional needs of the masticatory apparatus. In this regard, the upper lateral incisors, upper and lower wisdom teeth disappear, and some authors believe that there is a reduction of the lower small molars. The transitional stages of reduction of these teeth are expressed in the spiky shape of the lateral incisors and the altered morphology of wisdom teeth. A decrease in the number of teeth may be the result of pathological processes. It is sometimes caused by pathology of development or eruption. In case of a developmental anomaly, the rudiments of teeth are absent in the jaw (edentia or anodontia); in case of pathology of eruption, the teeth are retained in the thickness of the bone tissue of the jaw (retention) and are detected only by palpation or x-ray examination.
Adentia can be complete or incomplete. The same can be said about retention. Retention occurs more often in the upper canines and second premolars.

Adentia and retention are rare, but usually a decrease in the number of teeth is associated with their loss or removal. This fact should also be clarified through a survey. If teeth fall out on their own and entirely, then in most cases they have obviously been affected by periodontal disease. If gradually decaying teeth were removed, then we are talking about teeth affected by caries.

Anomaly in the number of teeth is also expressed in an increase in their number, which is also rare. Supernumerary teeth are most often found in the area of ​​the incisors of the upper or lower jaw and more often in the permanent than in the primary dentition. If there is space, supernumerary teeth are located in the dentition; if there is no space, they erupt orally or vestibularly. The eruption of four molars instead of three is sometimes also observed. Supernumerary canines and premolars are rare (Pekkert).

Etiology of supernumerary teeth is still unclear, and there are many theories to explain this issue. Some (Osborne) explain the formation of supernumerary teeth by the growth of the epithelium of the dental plate, others (Walkhoff) by the bifurcation of a normal tooth germ into parts capable of development; still others (Bolk) - atavism. Classification of dentition defects. The size of the defects and their location are determined by the dental formula. However, they vary so much that there is a need to systematize and classify them.

According to calculations by A.L. Grozovsky, there can be over 16,000 different combinations dental defects. Classifications have been proposed by many authors.

For class I defects it is possible use of prostheses only a removable structure, and in subclass I a bilateral prosthesis is indicated, and in subclass II - a unilateral prosthesis. For defects of subclass I of class II, a fixed prosthesis design can be indicated in all cases, and for subclass II, a removable structure or removable dentures in combination with fixed ones is indicated in most cases, except for a defect in the area of ​​the anterior teeth, in which a fixed structure is indicated, even in the absence four incisors.

Certainly, when choosing a design the anatomical and physiological characteristics of the teeth, the nature of the mucosa and the condition of other elements of the prosthetic field should be taken into account.

Tooth mobility is determined by palpation or using instruments and reflects the degree of destruction, inflammation and swelling of periodontal tissue. It is assessed by the direction and magnitude of tooth deviation. In everyday clinical practice, pathological tooth mobility is determined according to Platonov using tweezers.

Determination of tooth stability. The physiological mobility of the tooth is so insignificant that it is not possible to establish this mobility using the methods available to the dentist. Evidence of the physiological mobility of the tooth is the formation of polished areas at the contact points of the teeth with neighboring teeth. The occurrence of pathological tooth mobility is usually determined by instrumental or palpation examination. Determination of tooth mobility using these methods characterizes an advanced pathological process in the supporting tissues of the tooth. In the early stages, the appearance of reduced tooth stability can be determined radiographically. Clinically, pathological tooth mobility is determined in four directions: medial, distal, lingual or palatal, labial or buccal. D.A. Entin also distinguishes between vertical mobility. Tooth mobility is a removable process if the periodontium and tooth socket are preserved. The tooth acquires stability after the elimination of the inflammatory process, if this process caused the occurrence of pathological mobility, or after the tooth is removed from overload, which is a common cause of pathological mobility.

Traditional assessment of tooth mobility is based on the subjective feelings of the doctor or patient [D.A. Entin, 1953]. The exact value of tooth mobility is obtained only with special devices. Devices for determining tooth mobility can be divided into static and dynamic. Static devices are usually fixed to adjacent teeth. The technique for measuring tooth mobility using static methods is complex, and its use is limited in dental practice.

The degree of tooth mobility is determined as follows: placing tweezers on the crown of the tooth, perform rocking movements. With mobility of the tooth in the anteroposterior (vestibulo-oral) direction - I degree, with mobility in the anteroposterior and lateral (vestibulo-oral and medial-distal) directions - II degree, and if mobility along the axis of the tooth (in the superior-inferior direction) is added to these movements - III degree.

All teeth have some mobility, but it is necessary to distinguish normal (physiological) tooth mobility from pathological, which is a sign of periodontal disease.

D. A. Entin proposed the following classification of tooth mobility.

1. Physiological mobility of a tooth is considered to be one that is not accompanied by visible displacement of its crown.

2. With first degree mobility, slight rocking of the tooth captured with tweezers leads to a visible displacement of its crown in the bucco-lingual direction.

3. With mobility of the second degree, the tooth moves not only in the bucco-lingual direction, but also in the anteroposterior.

4. With mobility of the third degree, the tooth moves in three directions: buccolingual, anterior-posterior and vertical (apical).

According to D.A. Entina is distinguished into 4 degrees of pathological mobility.