|Year : 2017 | Volume
| Issue : 2 | Page : 62-65
Tooth mobility in a nigerian specialist periodontology clinic
Clement Chinedu Azodo1, Oseremen Gabriel Ogbebor2
1 Department of Periodontics, University of Benin, Benin City, Edo State, Nigeria
2 Department of Oral Diagnosis and Radiology, University of Benin, Benin City, Edo State, Nigeria
|Date of Web Publication||25-Jan-2018|
Dr. Clement Chinedu Azodo
Department of Periodontics, Room 21, 2nd Floor, Prof Ejide Dental Complex, University of Benin Teaching Hospital, P.M.B. 1111 Ugbowo, Benin City, Edo State
Source of Support: None, Conflict of Interest: None
Objective: Tooth mobility, which is a common problem among patients seeking dental health-care attention, causes occlusal instability, masticatory disturbances, esthetic challenges, and impaired quality of life. The objective of this study was to determine the prevalence and pattern of tooth mobility among patients attending a Nigerian specialist periodontology clinic. Materials and Methods: All the patients who visited the Periodontology Clinic of University of Benin Teaching Hospital, Benin City, from January to December 2014, were retrospectively studied. Those with recorded tooth mobility assessed using Miller tooth mobility index were further analyzed. Results: Of the 736 records assessed, 75 patients, aged between 18 and 94 years with median age of 56 years and mean age of 53.89 ± 17.82 years, had tooth mobility, giving a prevalence of 10.2%. The greater proportion of the patients were elderly (32.0%), females (58.7%), ever married (82.7%), indigenous (61.3%), and completely dentate (53.3%). The leading primary presenting complaints were toothache (37.3%), teeth replacement (14.7%), and shaking teeth (13.3%). Nearly half (48.0%) of the patients had one or more underlying medical condition. About two-thirds (61.3%) cleaned their teeth once daily, and 58.7% had previous visits to the dentist. The total number of mobile teeth was 202. Incisors (59.4%) and first molars (7.4%) were found to be the dominant mobile teeth. The mean debris score, calculus score, and oral hygiene score were 1.40 ± 0.09, 1.49 ± 0.12, and 2.78 ± 0.18, respectively, using simplified oral hygiene index. Conclusion: Data from this study revealed that one out of every ten patients attending Nigerian periodontology clinic had tooth mobility of varying grades, and teeth of esthetic (incisors) and masticatory ( first molars) value were mainly affected. Prompt and effective care should be rendered to facilitate retention of the affected teeth.
Keywords: Oral hygiene, presenting complaint, tooth mobility
|How to cite this article:|
Azodo CC, Ogbebor OG. Tooth mobility in a nigerian specialist periodontology clinic. Indian J Oral Health Res 2017;3:62-5
| Introduction|| |
Tooth mobility, which is undue horizontal and vertical tooth displacement due to examiners force, occurs when the periodontium is primarily diseased, secondarily involved by diseases or traumatized. It is primarily caused by periodontitis which is a severe form of periodontal disease but may be caused by dental trauma, occlusal trauma, pregnancy, diabetes mellitus, and local and metastatic jaw tumors.
Tooth mobility may cause occlusal instability, masticatory disturbances, and impaired quality of life, thereby prompting dental attendance. However, individuals experiencing tooth mobility may resort to unilateral mastication and dietary restriction as their coping mechanisms. It has been reported that 1.8%–3.0% of patients seeking dental health-care service do so due to tooth mobility.,
Tooth mobility assessment is an integral part of periodontal evaluation because it is one of the important signs in the diagnosis of periodontal diseases. Teeth cleaning is directly related to oral hygiene by helping in plaque and plaque retentive factors removal and indirectly related to periodontal disease as accumulated plaque favors tissue destruction which consequently leads to tooth mobility. Tooth mobility is one of the features of periodontal disease that heralds tooth loss if it is left untreated or improperly treated. It is one of the indicators of periodontal health and thus its evaluation is important in dental treatment planning. In clinical dental diagnosis, tooth mobility is established when it exceeds 1 mm as seen in Miller tooth mobility index. The review of literature revealed few studies on tooth mobility among Nigerian periodontal patients, and studies were on tooth mobility in diagnosed cases of aggressive periodontitis and pattern of mobility with type of teeth and periodontal pocketing., The objective of this study was, therefore, to determine the prevalence and characteristics of patients with tooth mobility attending the Periodontology Clinic of University of Benin Teaching Hospital, Benin City, Nigeria.
| Materials and Methods|| |
The protocol for this study was reviewed, and the approval was obtained from the Ethics and Research Committee of University of Benin Teaching Hospital, Benin City, Nigeria.
Study design/study setting
This retrospective study was conducted using the records of patients who attended the Periodontology Clinic of University of Benin Teaching Hospital, Benin City, Nigeria, between January and December 2014.
Using the Cochran statistical formula  (N = Z2Pq/d2), where n = sample size, z = z statistics for a level of confidence (set at 1.96 corresponding to 95.0% confidence level), P = prevalence = 1.8% (0.018)4, q = 1 − P, and d = degree of accuracy desired (error margin) =5% (0.05), the calculated sample size for the study was 27. However, 75 cases were studied.
Data collection tool
Data were collected through a self-developed pro forma. The information retrieved from the patient's case notes include age, gender, marital status, ethnicity, medical condition, primary presenting complaints, daily teeth cleaning frequency, dental visit history, tobacco use, and tobacco consumption. Information on tooth mobility assessed using Miller tooth mobility index, number of mobile teeth, type of mobile teeth, and the quadrant and arch of the mobile teeth were also obtained. The debris score, calculus score, and oral hygiene score based on simplified oral hygiene index by Greene and Vermillion  were also collected. Patient diagnosis was also noted. The worst Miller tooth mobility score was considered as the patients' score in determining the pattern of tooth mobility.
Data obtained were subjected to frequency, percentages, means, and standard error of mean using IBM SPSS version 21.0. (IBM Corp. Armonk, NY). The patients were categorized into young adults (18–40 years), middle-aged adults (41–64 years), and the elderly (≥65 years) using their age which is in consonance with age categorization in Nigerian medical and dental practice.
| Results|| |
Of the 736 records assessed, 75 patients, aged between 18 and 94 years with median age of 56 years and mean age of 53.89 ± 17.82 years, had tooth mobility, giving a prevalence of 10.2%. The greater proportion of the patients were elderly (32.0%), females (58.7%), ever married (82.7%), and of indigenous ethnic population (61.3%). Nearly half (48.0%) of the patients had one or more underlying medical condition with hypertension and diabetes mellitus being the most common [Table 1]. The leading primary presenting complaints were toothache (37.3%), teeth replacement (14.7%), and shaking teeth (13.3%) [Table 2]. About two-thirds (61.3%) of the patients indulged in once-daily teeth cleaning and more than half (58.7%) had previous visits to the dentist. A total of 22.7% and 8% consumed alcohol and used tobacco, respectively. Among the patients assessed, 46.7% were partially dentate [Table 3]. The total number of teeth that were mobile was 202. More than half (52.0%) of the patients had Miller Grade 1 tooth mobility [Figure 1]. Mobile teeth were more in mandibular than maxillary arch. Mandibular left quadrant was the predominantly affected quadrant in the mouth. Incisors and first molars were found to be the dominant mobile teeth [Table 4]. The mean debris score, calculus score, and oral hygiene score were 1.40 ± 0.09, 1.49 ± 0.12, and 2.78 ± 0.18, respectively.
|Table 3: Oral health behavior, dentate status, and diagnosis among the patients|
Click here to view
| Discussion|| |
Tooth mobility is a common problem among patients seeking dental health-care attention with the presenting complaints as shaking tooth, mobile tooth, or painful tooth in some cases., The high prevalence of tooth mobility in this study may be related to the high prevalence of severe periodontal disease in Nigeria  and the contributions of nonperiodontal causes of tooth mobility such as trauma and tumors in this study. The high prevalence of tooth mobility may also be related to the high prevalence of risk factors for periodontal disease among patients in terms of age, tobacco use, alcohol consumption, nonregular dental attendee, suboptimal teeth cleaning frequency, chronic medical condition, and nonoptimal oral hygiene status. The main cause of tooth mobility being periodontitis which increases with aging among dentate individuals explains why a greater proportion of the patients who had tooth mobility were older in age. A report found tooth mobility to be one of the main symptoms of periodontal disease after the age of 40 years.
Gender difference was noted among the patients with female predilection. Although reports of more dental attendance among females than males exist in the literature, increasing age and hormonal changes which result in adverse changes in bones may have tilted females toward higher predisposition for tooth mobility. The higher tolerance of pain exhibited by males than females may also have a role to play in the variation observed as pain was the main presenting complaint, thereby facilitating more female attendance. The local indigenous population had more tooth mobility than their nonindigenous population. The diet, oral health behavior, and cultural differences in different ethnic group may explain variations observed in oral diseases, in which tooth mobility is a feature. The prevalence of tobacco use (8.0%) was higher than reported values (4.3%) in a Nigerian dental health-care setting.
A reasonable number of the studied patients had chronic medical condition. This highlights the need for caution in the treatment and drug prescription in order not to precipitate emergency in the clinic, worsen their medical condition, or alter their optimized medication. Diabetes mellitus was outstanding among the chronic medical condition, and this may have contributed to periodontal disease by impairing immunity and healing and promoting microbial proliferation. This also brings to fore the need to educate diabetic patients on the prevention of periodontal diseases.
Toothache has remained the overriding reason for dental attendance and the leading presenting complaints among dental patients in this study. This may be attributed to the tooth tenderness experienced on mastication followed by pain on sudden tooth displacement when biting on hard foods or from inadvertent trauma. Patients with missing tooth/teeth, seeking tooth/teeth replacement treatment are expected to undergo dental prophylaxis in the form of scaling and polishing preparatory to their definitive treatment. This preparatory periodontal treatment is very important in the long-term success of prosthetic treatment. It restores the periodontal health of abutment teeth and motivates the patients toward good oral hygiene through adequate counseling and instruction. It is established that periodontal health is a major factor in selecting patients for fixed and removable prosthetic tooth/teeth appliance. The unreplaced missing teeth result in adverse periodontal effects due to attendant stagnation area. Patients seeking tooth or teeth replacement treatment with tooth mobility undergo necessary definitive periodontal treatment before they are considered fit for the prosthesis. The teeth replacement demand among patients receiving care in periodontology clinic signifies the interdisciplinary relationship between periodontists and prosthodontists necessary for optimal dental health-care delivery. Shaking tooth or tooth mobility ranked as the third most common presenting complaint is similar to a report where true periodontitis symptom was found to be the third most common presenting complaints. This is attributed to the fact that nonpainful dental symptoms are largely responsible for delayed dental attendance. Previous study reported a prevalence of 8.9% as against 13.3% recorded in this study.
The pattern of presentation in this study revealed that Grade 1 and Grade 2 tooth mobilities constituted more than three-quarters of the cases. The dominance of less severe tooth mobility that is amenable to periodontal disease may be explained by the fact that tooth mobility causes occlusal instability, masticatory disturbances, and impaired quality of life, thereby prompting dental attendance. However, the severe tooth mobility that is rarely amenable to periodontal treatment and frequently recommended for extraction is fewer in number and may be related to the delayed dental attendance which is common among Nigerians.
The incisors and first molars are among the first sets of permanent teeth to erupt in the mouth and therefore have the likelihood to succumb to the cumulative destructive effect of insults from oral deposits, more specifically plaque. This may be due to the ineffective plaque removal from the dominant once-daily teeth cleaning. Apart from erupting early, incisors have shorter root and less resistance to mobility than other teeth in the dentition. The mandibular teeth also erupt ahead of maxillary teeth explaining why mobile teeth were more in mandibular than maxillary arch. Similarities and differences existed between the findings of this study and that reported by Arowojolu  in South West, Nigeria.
| Conclusion|| |
Data from this study revealed that one out of every ten patients attending Nigerian periodontology clinic had tooth mobility of varying grades, and teeth of esthetic (incisors) and masticatory ( first molars) value were mainly affected. Prompt and effective care should be rendered to facilitate retention of the affected teeth.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Dombret J, Marcos E. Tooth mobility and containment. Rev Belge Med Dent (1984) 1989;44:98-109.
Azodo CC, Erhabor P. Management of tooth mobility in the periodontology clinic: An overview and experience from a tertiary healthcare setting. Afr J Med Health Sci 2016;15:50-7. [Full text]
Maheswaran T, Ramesh V, Krishnan A, Joseph J. Common chief complaints of patients seeking treatment in the government dental institution of Puducherry, India. J Indian Acad Dent Spec Res 2015;2:55-8. [Full text]
Ogbebor OG, Azodo CC. Reasons for seeking dental healthcare services in a Nigerian missionary hospital. Sahel Med J 2016;19:38-43. [Full text]
Oka H, Yamamoto T, Saratani K, Kawazoe T. Application of mechanical mobility of periodontal tissues to tooth mobility examination. Med Biol Eng Comput 1989;27:75-81.
Arowojolu MO. Prevalence of periodontal pocketing and tooth mobility according to tooth types in Nigerians – A pilot study. Afr J Med Med Sci 2002;31:119-21.
Savage KO, Ayanbadejo PO. Pattern of tooth mobility and missing teeth types among juvenile periodontitis patients in Lagos university teaching hospital dental centre. Odontostomatol Trop 2007;30:11-5.
Cochran WG. Sampling Techniques. 3rd
ed. New York: John Wiley and Sons, Inc.; 1977.
Greene JC, Vermillion JR. The simplified oral hygiene index. J Am Dent Assoc 1964;68:7-13.
George AK. Tooth mobility. SRM Univ J Dent Sci 2011;2:324-7.
Demetriou N, Tsami-Pandi A, Parashis A. Is it possible for periodontal patients to recognize periodontal disease. Stomatologia (Athenai) 1991;47:284-95.
Umoh AO, Azodo CC. Prevalence of gingivitis and periodontitis in an adult male population in Nigeria. Niger J Basic Clin Sci 2012;9:65-9. [Full text]
Demetriou N, Parashis A, Tsami-Pandi A. Relationship between age and clinical symptoms of periodontal disease. Stomatologia (Athenai) 1990;47:231-41.
Ehizele AO, Azodo CC, Ojehanon PI, Akhionbare O, Umoh AO, Adeghe HA, et al.
Prevalence of tobacco use among dental patients and their knowledge of its health effects. Niger J Clin Pract 2012;15:270-5. [Full text]
Brunsvold MA, Nair P, Oates TW Jr. Chief complaints of patients seeking treatment for periodontitis. J Am Dent Assoc 1999;130:359-64.
Abdulkareem AA, Mohammed AN. Chronic periodontitis chief complaints: Gender and age distribution; their correlation with plaque index and probing pocket depth. Mustansiria Dent J 2010;7;143-9.
[Table 1], [Table 2], [Table 3], [Table 4]