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Indices to Assess Tooth Mobility-A Review

Article · January 2019

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 ISSN: 2581-5989
PubMed - National Library of Medicine - ID: 101738774

International Journal of Dental Science and Innovative Research (IJDSIR)

IJDSIR : Dental Publication Service
Available Online at: www.ijdsir.com
Volume – 2, Issue – 2, March - April - 2019, Page No. : 630 - 635
Indices to Assess Tooth Mobility-A Review
1
Dr. Shubhangi Mani, Professor & HOD, Department of Orthodontics, Rural Dental College, Loni
2
Dr. Amit Mani, Professor & HOD, Department of Periodontology, Rural Dental College, Loni
3
Dr.Shivani. Sachdeva, Department of Periodontology, Rural Dental College, Loni
4
Dr.Shalakha Maniyar, III year Post Graduate, Department of Periodontology, Rural Dental College, Loni
5
Dr. Anuraga.S, III year Post Graduate, Department of Periodontology, Rural Dental College, Loni
6
Dr. Preeti Kale, III year Post Graduate, Department of Periodontology, Rural Dental College, Loni
Corresponding Author: Dr.Shalakha Maniyar, III year Post Graduate, Department of Periodontology, Rural Dental
College, Loni
Type of Publication: Review Paper
Conflicts of Interest: Nil
Abstract
There has been an effort by the dental profession working Introduction
in the field of gingival and periodontal disease to find a Tooth mobility indicates the beginning of destructive
method of recording the extent and degree of pathological periodontal diseases. It is the most common condition
change in tissues leading from gingivitis to periodontitis with which the patients report. Mobility can be due to
and to measure reversible as well as irreversible changes. inflammation of the periodontium or underlying
Indices are an important tool to measure, quantify and pathology. It may also be due to the decreased adaptive
treat mobile tooth in both epidemiological and clinical capacity of the periodontium due to occlusal forces.1 The
situations. The index required should have the following ideal treatment plan for the mobile tooth or teeth would
criteria: (1) Simplicity, (2) Accuracy, (3) Quantitativeness, require a thorough knowledge to understand etiology and
(4) Reproducibility, (5) Speed, (6) Objectivity, and (7) the prognosis of the tooth. There are different available
Amenability to statistical analysis. Indices must also give methods to assess mobility of tooth such as; direct
data that make it possible to verify the nature, severity and visualization when tooth is held between two rigid
etiology of the disease process and to evaluate therapeutic instruments, direct observation of movement due to
measures. It gives information about the success or failure occlusal forces, percussion sound, and electronic device.
of control and prevention of disease, affecting the This review mainly focuses on the indices that can be used
gingivae and the periodontal tissues. However, there is to measure or grade the mobility of tooth. According to
dearth of literature on collective information of tooth Russell an index can be defined as a numerical value
mobility indices formulated. This article collectively describing the relative status of a population on a
describes the evolution and the present concept that have graduated scale with definite upper and lower limits,
been formulated to assess tooth mobility. which is designed to permit and facilitate comparison with
Page 630

Keywords: Tooth mobility, Index.

Corresponding Author: Dr.Shalakha Maniyar, ijdsir Volume-2 Issue-2, Page No. 630 - 635
Dr.Shalakha Maniyar, et al. International Journal of Dental Science and Innovative Research (IJDSIR)

other populations classified by the same criteria and F. Should define clinical conditions objectively.
2
methods. G. Should be reproducible.
Objectives of an index2 H. Should be amenable to statistical analysis; have
1. To increase understanding of the disease process and validity and reliability.
lead to a method of control and prevention. I. Should relate numerically with the clinical disease.
2. Population can be grouped as low or high risk J. It should not cause discomfort to the patient and
3. To define the specific problem under investigation. should be acceptable to the patient.
Ideal requisites of an index 2 Types of dental indices3
1. Validity: Index should be able to measure accurately 1) Individual assessment: The purpose is to evaluate and
so as it should relate to the clinical stage of disease at monitor the progress and maintenance of oral health.
each point of study. Monitors progress of disease healing, patient
2. Reliability: Index should be reliable and should be education and motivation.
able to measure at different times at different 2) Clinical trial: It determines the effect of an agent or
conditions. It should be reproducible and maintain procedure on prevention, progression, or control of
consistency. disease. It also compares an experimental group with
3. Clarity, simplicity and objectivity: The criteria should control group
be clear and unambiguous, with mutually exclusive 3) Epidemiologic survey: The survey is done for
categories. Ideally, it should be readily memorized by characteristics of disease in population. It is not
an examiner after some practice. designed for individual patient.
4. Quantifiability: The index must be amenable to History
4
statistical analysis so that the status of a group can be Elbrecht in 1939 Measured tooth mobility by fixing a
expressed by a distribution, mean, median or other tripod with large dial indicator in front of patients mouth.
statistical measures. The dial registered bucco-lingual crown movement which
5. Sensitivity: Sensitive enough to measure small shifts. were produced by digital pressure. Movement of head
6. Acceptability: It should not be demanding or painful caused inaccuracy. Only values over 0.75mm would be
to the subject. identified by this method. Werner in 19425 Used an
Criteria for selecting an index 2 "oscillometer" which has a rod with scale attached and
A. It should be simple to use and calculate. held in anterior teeth. When the neighboring or proximal
B. Should allow examination of many people in short tooth is moved labio-lingually with a force of 700 grams,
period of time. the resultant difference of tooth position could be read on
C. Require minimum armamentarium and expenditure. the scale. Differences of tooth position smaller than 0.2 5
D. The components should be clear and readily mm could not be evaluated. Manly et al in 19516 however
understandable so as to promote maximum intra and with still higher and variable frequencies. Their reported
inter examiner reproducibility and standardization. preliminary clinical results were inconsistent. Zwirner in
19497 studied axial tooth mobility on separated rat jaws
631

E. Should be as free as possible from subjective

interpretation. with an electronic device. His method is highly sensitive.
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Dr.Shalakha Maniyar, et al. International Journal of Dental Science and Innovative Research (IJDSIR)

The probable cause for the lack of reports on human TM Mobility Index by Ramfjord:11
is the technical difficulties which have been encountered. Ramfjord in 1967 developed this index. (Table:2)
Cross in 19518 demonstrated tooth mobility measuring
Code Criteria
device about which no details have been published to our
knowledge. Jung's in experiments were concerned with M0 Physiologic mobility; firm tooth
measurements more of the elastic deformation of the
M1 Slightly increase mobility
mandible during mastication than of TM of individual
teeth. Muhlemann9 (1951) used intra-orally attached dial M2 Definite to considerable increase
in mobility but no impairment of
indicators to determine the degree of crown excursions
function.
that were produced by known static forces which was
called periodontometry. Certain indices were developed to M3 Extreme mobility; a loose tooth
that cannot be used for normal
evaluate the tooth mobility to overcome the problems with
function.
devices. However, a degree of subjectivity could be
observed when evaluating tooth mobility. Mobility Index by Laster:12
Measurement using Index This index was given in 1975. Mobility is assessed by the
Mobility is simply graded by holding the tooth between application of lateral horizontal forces. (Table:3)
the two metallic instruments or one finger and one Code Criteria
metallic instrument and effort is made to move the tooth in
0 Normal.
all directions.
Then mobility is graded according to any one of the 1 Movement greater than normal.

indices as follows: 2 Mobility of 1mm in lateral direction.

10
Tooth mobility Index: The most subjective method
3 Mobility greater than 1mm laterally plus
used to assess tooth mobility was described by Miller SC
rotation and/or axial depression.
in 1950.(Table:1)
Table 1:
Mobility Index by Grace and Smales: (Table:4)
This index can be useful to track the amount of mobility in
Code Criteria
teeth over a period of time.
0 No detectable movement when force is
Grade Mobility index
applied.
1 Barely distinguishable tooth movement. 0 No apparent mobility

2 The crown of the tooth moves up to 1mm 1 Tooth mobility is perceptible, but less
in any direction. than 1mm buccolingually.
3 Movement more than 1mm in any
2 Mobility is between 1 and 2mm
direction or the teeth can be depressed or
632

rotated in their sockets.

3 Mobility exceeds 2mm buccolingually
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Dr.Shalakha Maniyar, et al. International Journal of Dental Science and Innovative Research (IJDSIR)

or vertically 0 Normal – less than 0.2 mm

Tooth mobility Index by Lindhe: (Table:5). 1 Horizontal / Mesiodistal mobility of 0.2

– 1mm
Degree Interpretation of tooth mobility by
Lindhe 2 Horizontal / Mesiodistal mobility of 1-2
mm.
1 Movability of the crown of the tooth 0.2-
1 mm in horizontal direction. 3 Horizontal / Mesiodistal mobility
exceeding 2mm and / or vertical
2 Movability of the crown of the tooth
mobility.
exceeding 1 mm in horizontal direction.
Flezar’s Index (1980): (Table:9)
3 Movability of the crown of the tooth in
vertical direction as well. Grade Interpretation of tooth mobility by
Flezar
Tooth mobility Index by Prichard (1972):13 ( Table:6)
Degree Interpretation of tooth mobility by M0 Firm Tooth
Prichard
M1 Slight increased mobility
1 Slight mobility
M2 Definite to considerable increase in
2 Moderate mobility mobility but not impairment of
function.
3 Extensive movement in a lateral or
mesio-distal direction combined with M3 Extreme mobility, a loose tooth that
vertical displacement in the alveolus. would be incomparable in function.

Wasserman’s Index (1973): 14 (Table:7)

Glickman’s Index (1972):15 (Table:10)
Degree Interpretation of tooth mobility by
wasserman Grade Interpretation of tooth mobility by
Glickman
1 Normal
Normal mobility
2 Slight mobility less than approximately ¾
mm of movement bucco-lingually Pathologic mobility
3 Moderate mobility – up to approximately Grade I slightly more than normal
2 mm of bucco-lingual movement.
Grade II moderately more than normal
4 Severe mobility – more than 2 mm of
movement. Grade III Severe mobility faciolingually and or
/ mesiodistally combined with
Nyman’s Index (1975)14 ( Table:8) vertical displacement.
Degree Interpretation of tooth mobility by
633

Nyman
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Dr.Shalakha Maniyar, et al. International Journal of Dental Science and Innovative Research (IJDSIR)

Grant, Stern, and Everett:16 (Table:11) diseases, to find out the incidence, prevalence and severity
Degree Interpretation of the diseases.

0 No perceptible movement References

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Dr.Shalakha Maniyar, et al. International Journal of Dental Science and Innovative Research (IJDSIR)

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