A tooth has started to move: is it still worth retaining?｜證據鏈

A tooth that starts to move does warrant timely periodontal assessment, but “mobile” and “not worth retaining” are not equivalent statements. The dentist needs to consider active inflammation, alveolar bone support, pocket depth, furcation involvement, tooth position, access for cleaning and occlusal loading together, first identifying which factors are manageable before discussing retention, temporary splinting or extraction. A meta-analysis of 20 longitudinal studies involving 15,422 patients with periodontitis had a mean follow-up of 12 years. The odds ratio for future tooth loss associated with mobility was 3.71, with a 95% confidence interval of 1.65–8.38. The cautious interpretation is not that “a mobile tooth cannot be saved”, but that mobility should intensify assessment and follow-up. In the same study, patients lost a mean of 0.12 teeth per person-year. This is an average across populations and cannot forecast the outcome of one tooth. Splinting must also be placed correctly. The available systematic review found very little long-term clinical evidence and, at a low level of evidence, found no demonstrated improvement in retention of mobile teeth with splinting. Splinting may address chewing discomfort or procedural needs, but cannot replace inflammation control, debridement, risk management and supportive periodontal care.