Movable tooth. Tooth mobility: degrees, causes and treatment Requirements for splinting structures

Even normal healthy teeth somewhat mobile. Data histological structure periodontal disease confirm the possibility of such mobility. Periodontium or pericementum, consisting of connective tissue, permeated with a dense network of numerous blood vessels 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 contacts only 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 depends, as stated, on various reasons, including from an 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 number of teeth modern man 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. With a developmental anomaly, the rudiments of teeth are absent in the jaw (edentia or anodontia), with pathology of eruption, the teeth are retained in the thickness bone tissue jaws (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 were obviously 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 upper incisors or lower jaw and more often in permanent than in 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 may be over 16,000 various options 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, class II, a fixed prosthesis design may be indicated in all cases, and for subclass II, a removable design or removable dentures in combination with fixed ones, except for a defect in the area of ​​the anterior teeth, in which a fixed design is indicated, even in the absence of four incisors.

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

Thanks to the mobility of the teeth, the load is distributed evenly to each molar and incisor. If they fluctuate excessively, we can talk about the presence of pathology. It is necessary to understand what physiological mobility teeth is permissible, and what to do if their stability is impaired. This article will be devoted to this topic.

Physiological and pathological mobility

The natural movement of the dentition is imperceptible to the human eye. The fact that it exists will be indicated by the polished areas between adjacent incisors and molars. Teeth move when chewing. This reflex allows you to keep them in good condition. Its absence will lead to the destruction of tooth enamel and bone tissue.

The main cause of tooth mobility is periodontitis. It causes destruction of the jaw bones and ligamentous apparatus. In parallel, there is an infectious lesion of periodontal tissue. Will need emergency treatment. If it is missing, you can lose all your teeth. If the inflammatory process is not started, after its elimination there is a high probability that the loosening of the dentition will stop.

The initial stages of the disease can be cured. If the socket and periodontium are preserved, it is prescribed long-term treatment. After this, the loosening of teeth stops. But first of all, the doctor must find out the cause of periodontitis. If it is not eliminated, treatment will not work positive result or worsen the patient's condition.

1. Periodontitis develops in the absence of the required amount of vitamins and minerals in the human body. Contribute to disease disorders gastrointestinal tract, especially with a severe course.
2. The disease often manifests itself against the background of vascular atherosclerosis and pathological diseases blood, due to a sudden change in lifestyle or place of residence, as well as on nerves.
3. Periodontitis often occurs due to low or high periodontal load. There have been cases where the disease progressed due to the negligence of the doctor. Sometimes it is a consequence of excessive intake medicines or just a side effect.

Loose teeth occur due to poor oral hygiene. This, in turn, leads to various dental diseases and the inflammatory process. The result is loosening of the dentition. Increased mobility may occur at the site where one of the incisors or molars is removed. If the implant is not installed soon, bone loss will occur in this area. For this reason, neighboring teeth will begin to loosen.

Determination of tooth mobility is possible only in dental clinic. Therefore, when the first symptoms of periodontitis appear, do not delay a visit to the dentist. He will examine with instruments oral cavity, will pay attention to possible inflammation of the gums and determine the degree of tooth mobility.

Dentists divide pathological mobility into severity levels:

1. The tooth moves back and forth. The amplitude is small.
2. The amplitude of oscillation increases.
3. Teeth move in different sides except for swaying back and forth.
4. Circular movements appear.

Artificial dental mobility

Not every person is born with straight upper or lower teeth. Sometimes the bite and dentition require correction, so people turn to an orthodontist. Loosening of teeth in braces is normal, because the essence of orthodontic treatment is precisely the movement of teeth. Thanks to this, they take the correct position.

The duration of wearing the device will depend on the severity of the defect. Sometimes the procedure takes up to 2-3 years. After braces, the teeth may remain mobile for some time. Don't worry, your teeth will gradually stop loosening. To prevent them from moving, retainers are usually put on immediately to secure the result. Retention devices help to avoid a situation where teeth move apart again after braces.

Treatment of tooth mobility

Many people are interested in the question of how quickly loose teeth can be eliminated and by what methods. The treatment process is long. It depends on the severity of the disease. It can be said with certainty that when large quantity treatment of mobile teeth was started late. Their loss indicates the process of destruction. It is important to consult a dentist in time before losing the first incisor or molar.

Currently, the last stages of periodontal disease are treated surgically And special drugs. Splinting of teeth, which involves fixing them together, has proven itself well. It can be removable or non-removable. In the first case, the tire can be removed for cleaning, but in the second this is not possible. The doctor decides which option to use. This largely depends on the condition of the patient’s dentition.

Our teeth have little physiological mobility - in order to evenly distribute the load on the bone when chewing, they spring a little. However, mobility can also have an unhealthy, pathological nature. Teeth can move back and forth and left and right, and in especially severe cases, even up and down and around its axis. Usually, tooth mobility is a sign of serious dental diseases that are at the very last stage. This problem not only interferes with chewing function and the aesthetics of a smile, but can also lead to tooth loss.

Causes of tooth mobility

• acute inflammation of the gums,
• inflammation of the ligaments that hold the tooth in the socket (periodontitis),
• poor oral hygiene, which causes inflammation of the gums and tissues around the tooth,
• malocclusion, in which the teeth interfere with each other and often push opponents out of the row,
• the appearance of periodontal pockets - the gums peel off from the surface of the teeth,
• orthodontic treatment: incorrectly selected structures can put too much pressure on the teeth,
• atrophy of the jaw bone, in which the condition of the bone and metabolic processes inside the fabric
• jaw or tooth injuries,
• decreased immunity, some diseases of the body: osteoporosis, diabetes, arthritis, endocrine and cardiovascular systems, diseases internal organs,
• pregnancy and associated hormonal changes.

Stages

There are three stages of tooth mobility. The very first one is not clearly expressed - the teeth wobble a little back and forth. In the second stage, mobility increases, while the teeth also move sideways. The third stage is characterized by vertical mobility of the teeth - they fall out of the socket and even scroll around their axis. In this case, it is almost impossible to restore their natural position and healthy state - this stage is also called “periodontal disease” or “generalized periodontitis”

How to prevent tooth mobility?

Tooth mobility, as a rule, does not occur as an independent symptom. At the same time that the tooth has become loose, you will probably see black carious spots on the teeth, the presence of a large amount of yellow or dark deposits, reddened and bleeding gums. But if you have not consulted a doctor if you have all the listed symptoms, if your teeth are moving, this should be done as quickly as possible.

Treatment for mobility will depend on what is underlying the problem. But, as a rule, the patient undergoes dental plaque removal (including plaque and tartar removal from under the gums - the procedure is called “gingival curettage”), while rinsing with antibacterial solutions and taking antibiotics are prescribed. Mobile teeth are combined with healthy and strong ones into one group - this way the load on them is distributed and they are fixed in a stationary state. For this purpose, special tires are used - thin aramid strips that are glued with inside groups of teeth.

Dental implantation is a panacea for high mobility and tooth loss.

In cases where there is high mobility and tooth loss, the most optimal solution is to remove them, sanitize the entire oral cavity, treat periodontal tissues and install artificial roots (implants). The fact is that at this stage, splinting teeth is only a short-term, painful and, moreover, expensive solution - the process of mobility is already irreversible.

Implants are installed in the deep layers of bone tissue and do not require additional connective tissue to hold them in the mouth, like natural teeth. In addition, titanium roots interfere with the formation and development inflammatory processes, and artificial dentures installed on them look much more aesthetically pleasing than damaged mobile teeth.

To avoid loosening of teeth and their further loss, you must carefully maintain oral hygiene and be attentive to your health. Movable teeth cannot be completely restored. Alas, almost all methods allow you to secure teeth only temporarily. That is why the patient’s main task is to monitor the condition of his teeth, be sure to clean them regularly and efficiently, remove plaque and tartar in a timely manner, and do not forget about preventive examinations at the dentist.

Tooth mobility: Prices

As mentioned earlier, physiological mobility does not require treatment, as it is a natural process. In the case of a pathological condition, it is very difficult to single out one main cause; there are often several of them. The trigger can be poor hygiene, incorrect dental treatment by the dentist, structural features of the jaw bones, etc.

Consequently, the etiology (causes) is established only by the dentist based on the collected data about the patient, his lifestyle and based on the results of previous treatment. The most common reasons:

• insufficient dental care/lack of it: there is a constant accumulation of microorganisms, plaque and stones form, therefore, teeth and gums are destroyed;
• inflammatory processes in the gums;
• improper development of the jaw bones;
• periodontal disease/periodontitis;
• crowded teeth, improper closing of the jaws;
• injuries of the maxillofacial area;
• poor quality dental treatment;
• illiterate selection of personal hygiene products;
• diseases of the endocrine glands;
• one or more teeth removed;

Do not forget that with age, teeth lose their ability to cope with constant chewing load, so to speak, they wear out. Because of this, most patients with mobility complaints are elderly.

Degrees of development of tooth mobility

Dentistry has now developed several classifications of tooth mobility. But the classification according to the degree of mobility has gained great popularity. It is used in both children and adults. There are degrees such as:

• Idegree

It is the first stage when slight loosening is observed: up to 1 mm of uneven location to neighboring teeth. Despite your slight mobility, this is not a reason not to see a doctor.

• IIdegree

The loosening is already more than 1 mm in two directions: back and forth, left and right.

• IIIdegree

The tooth is mobile in all directions over 1 mm.

• IVdegree

Free movement of the tooth in any direction even with a light touch.

What measures to take if a tooth is loose?

When suddenly you feel that the tooth is very mobile, then you need to abandon personal hygiene products for the cavity, so as not to aggravate the situation, but you need to carefully rinse your mouth with water and go to the doctor.

Is it possible to cure such a tooth?

Each clinical case is unique, so only a specialist can make a decision about preserving such a tooth in the oral cavity. Often mobility occurs due to external reasons, by eliminating which, you can save even a very mobile tooth. In order for dental treatment to be quick, inexpensive and pain-free, you need to immediately contact a doctor and not delay such a visit.

The main criterion for the safety of a tooth will be the condition of the jaw bones, gums, and tissues surrounding the tooth. It is their integrity that the doctor will pay attention to, and a decision will be made about the safety of the tooth in the oral cavity.

There are physiological and pathological mobility of teeth. The first is natural and invisible to the naked eye. Its existence is confirmed by indirect signs in the form of erasing contact points and the formation of contact pads or by special complex devices. Pathological mobility is characterized by noticeable displacement of teeth with little effort, for example when rocking them with tweezers or fingers.

Tooth mobility is a very sensitive indicator of periodontal condition. Based on its degree and increase, one can to some extent get an idea of ​​the state of the supporting apparatus of the teeth, the direction of development pathological process or its aggravation. Therefore, studying the severity of pathological tooth mobility has great value for diagnosing the disease, assessing treatment results and for prognosis. It is very important to record the degree of tooth mobility. This will make it possible to diagnose periodontal damage in its initial stage. Severe pathological mobility is noticed not only by the doctor, but also by the patient himself and indicates either acutely developing inflammation of the periodontium or its advanced dystrophy.

Pathological mobility is examined as if open mouth, and during various movements of the lower jaw from one occlusal position to another. The latter sometimes allows us to identify the cause of periodontal pathology and associated pathological mobility. These reasons may be violations of occlusion with the formation of blocking moments in one or another phase of articulation.

There are four degrees of pathological mobility of teeth (D. A. Entin). With the first degree of mobility, tooth displacement occurs in one direction (vestibular-oral). With pathological mobility of the second degree, the tooth has visible displacement in both the vestibulo-oral and mesiodistal directions. With pathological mobility of the third degree, the tooth also moves in the vertical direction: when pressure is applied, it sinks into the socket and then returns to its original position. With the fourth degree of pathological mobility, the tooth not only has visible mobility in the three indicated directions, but when light influence It can also rotate. The third and especially the fourth degree of mobility indicate far-reaching and mostly irreversible changes in the periodontium. Pathological tooth mobility is closely related to the presence of pathological gum pockets. Their presence and depth are checked with a probe. At the same time, the nature of the discharge and the condition of the gum edge are clarified.

The results of the dental examination are recorded using a dental formula. In it, milk teeth are designated by Roman numerals, and permanent teeth by Arabic numerals. Full dental formula milk bite looks like this:

The dental formula of permanent dentition is as follows:

The numbers located in the upper right corner represent the person's upper left teeth. The numbers located in the upper left corner, on the contrary, represent the person's upper right teeth, etc.

When examining teeth, attention is paid to their closure, position in relation to neighbors and antagonists. In the anterior section, in addition, you should pay attention to the depth of the overlap. The examination allows you to get a preliminary idea of ​​the nature of the occlusal plane and its possible deformation of a primary or secondary nature.

With complete or partial loss of teeth, examination of the oral cavity has its own characteristics. First, the condition of the mucous membrane, the position of the frenulum and its lateral folds on the upper and lower jaws are examined in detail.

Then the surface of the toothless alveolar processes and hard palate, which will serve as the basis for the prosthesis (prosthetic bed), is examined. It should be carefully examined and be sure to feel. The mucous membrane of the prosthetic bed is first examined using a mouth mirror. Then the hard palate and alveolar processes are carefully palpated to identify bony elevations on the hard palate (torus palatinus, see Fig. 102), exostoses (see Fig. 99), sharp edges of the sockets after tooth extraction, sharp edges of the internal oblique line, scars etc.