Tobias K. Boehm (December 30, 2025)
Checking for tooth mobility during a dental exam (Dr. Boehm)
You may have had a dentist or another member of the dental practice team check for loose teeth during a gum exam, using a method as shown above, which is the typical method shown in professional textbooks, such as Carranza (1). You may also have experienced this with dental professionals using their fingers, or other instruments to see if the teeth can be moved. Usually, the amount of tooth movement is graded and entered as a single letter, roman numeral, or number per tooth, as shown here:
Example of a paper-based periodontal chart recording a tooth mobility of “A” at tooth no. 7 and no. 8. (Dr. Boehm)
The way tooth mobility is recorded can differ between practices and the software that is used to record tooth mobility.
In this article, we describe the terms “tooth mobility” and how it is related to teeth being loose. We also will describe what tooth mobility means and how it may affect treatment decisions for gum disease.
What is measured here?
Measuring tooth mobility. A dental professional applies force on a tooth with the back end of a mirror handle (or something similar) and feels and observes if the tooth moves at all (Dr. Boehm)
Dental professionals measure with this technique how much “give” a tooth has in response to forces applied to it. A common way of grading tooth mobility is the Miller grading system, from Samuel C. Miller’s textbook of the 1940s (2). In the Miller tooth mobility grading system, tooth mobility is graded as such:
- “1”: any first distinguishable tooth movement
- “2”: any movement that allows the crown to move up to one millimeter from its normal position in any direction. Teeth cannot be rotated or pressed into the socket.
- “3”: any movement that is more than one millimeter in any direction. Any tooth that can be rotated or pressed into the socket
Usually, absence of tooth mobility is not recorded. Some dental practices may record absence of tooth mobility as “0” if needed for insurance documentation.
What does the tooth mobility grade mean?
Generally, teeth should not be loose at all, and there should not be tooth mobility. Any high level of tooth mobility (i.e. Miller Grade 2 and 3) suggests a significant problem with a tooth.
Tooth mobility increases the risk of tooth loss. In a recent review of studies, only 6% of teeth with no tooth mobility are lost after 10 years, whereas 12% of teeth with grade 1 mobility and 40% of teeth with grade 2 mobility are lost (3).
In my professional experience, tooth mobility cases generally fall into these four categories:
- Teeth with slender roots and minor tooth mobility (i.e. Miller Grade 1): Many individuals, especially petite women, have lower front teeth (“mandibular incisors”) that normally have a little bit of a “give” when enough force is applied, even though there is no disease or problems with the underlying bone. Tooth mobility in those cases usually has no further significance, and teeth can survive indefinitely with preventive care.
- Teeth with short roots and minor tooth mobility (i.e. Miller Grade 1): Some individuals have teeth that have very short roots because of development, or had teeth loose their roots during orthodontic treatment (i.e. “root resorption”). Tooth mobility will be there and cannot be improved, but as long as there is no gum disease causing bone loss (“periodontitis”), cavities (“caries”) or accidents, such teeth may survive for a long time with preventive care.
- Mild to moderately loose teeth (i.e. Miller Grade 1 and 2) affected by premature or interference contacts: Bite conditions that result in teeth touching prematurely during chewing or mouth movements can cause loosening of teeth from their tooth sockets. In the presence of gum disease, these teeth may loosen more over time as the gum disease destroys the remaining supporting bone. Often, these teeth can be saved with dental treatment that restores normal bite function and treats any underlying gum disease.
- Severely loose teeth (i.e. Miller Grade 3): These teeth usually have severe gum disease or dental abscesses, and may fall out shortly by themselves without any treatment. Usually, there is no dental treatment that can save those teeth, and dentists usually remove such teeth early during treatment. Because these teeth tend to be grossly infected, it is best to seek immediate dental care for severely loose teeth as leaving such teeth in place can result in severe infection or choking risk.
The key to saving loose teeth and preventing teeth from becoming looser is periodontal treatment. Even teeth with signficant tooth mobility can be maintained (although not used much) if there is no other underlying problem, as suggested by the before mentioned research (3).
How does tooth mobility affect my gum treatment?
Dentists use tooth mobility as one key factor in deciding whether to keep or remove teeth (4).
Generally, dentists will usually recommend removing a tooth with severe tooth mobility (i.e. Miller Grade 3). For other levels of tooth mobility, dentists will try to understand why a tooth has tooth mobility and recommend treatment or referral to address the underlying cause of tooth mobility.
When should I be concerned about a loose tooth?
Teeth should not be loose. If you have a loose tooth, get evaluated by a dentist.
In my experience, loose teeth in adults usually suggest severe gum disease and a risk of losing all remaining teeth.
Can dental implants have mobility?
No. Dental implants should never have any visible mobility and should never be loose. If a dental implant is loose, it means there is no more bone attachment, and the implant likely has failed.
If you feel that a dental implant is loose, have a dentist check the implant and whether the implant is loose, or just the connecting crown, bridge, or denture.
What conditions cause loose teeth or tooth mobility?
Loose teeth or tooth mobility are most commonly caused by:
- severe gum disease (“periodontitis”)
- severe dental infections and abscesses
- a damaging bite condition (“occlusal trauma”).
Much less commonly, tooth mobility can be caused by
- Immature teeth with incomplete root formation in children
- Teeth with slender roots
- Teeth with abnormally short roots (caused by genetics, childhood disease, injury or orthodontic treatment)
- Recent mouth injuries (i.e. falls, sports injuries)
- Severe tooth infections (i.e. dental abscess)
- Bone diseases (i.e. osteoporosis (5))
- As rare side effect of some cancers such as leukemia (6)
How should tooth mobility change during treatment?
Generally, dental treatment prevents tooth mobility from getting worse over time.
Gum disease treatment may help improve tooth mobility as it helps firm up supporting soft tissue and prevents further bone loss. It is possible that periodontal surgery may cause a temporary increase in tooth mobility as the gum tissue reattaches to the teeth.
When should tooth mobility be measured?
According to the American Academy of Periodontology, tooth mobility should be checked as part of a periodontal assessment, and this should be done at least once a year (7,8).
Why does tooth mobility develop?
Teeth are supported by a thin sheet of fibrous tissue (“periodontal ligament”) that binds the teeth to the surrounding jawbone (“alveolar bone”). In absence of disease and with normal bite forces, this allows a microscopic amount of tooth movement to line up teeth for best chewing function and prevent damage to teeth and bones.
Infecting bacteria and inflammation can destroy the supporting tissue. Once a substantial amount of tooth supporting tissue is lost, teeth develop tooth mobility because even normal or small amount of forces can overcome the resistance of the remaining supporting tissue.
Tooth mobility can also develop in response to repeated excessive force from premature bite contacts. Here, repeated injury causes the periodontal ligament to become wider and more flexible, allowing the tooth to move away from the premature contact. The tooth-supporting bone may also widen and move away from the tooth to allow a greater range of tooth movement.
About the author:
Tobias K. Boehm, DDS, PhD, MBA, PC, DABP, DICOI, FGDIA is the founder of The Dental Institute, executive director at The Defeating Epilepsy Foundation and a professor at Western University of Health Sciences where he teaches and practices a periodontal specialist.
References:
(1) Newman MG, Klokkevold PR, Elegovan S, Kapila Y. Newman and Carranza’s Clinical Periodontology and Implantology, 14th edition. (2023) Saunders, St. Louis. Missouri. https://shop.elsevier.com/books/newman-and-carranzas-clinical-periodontology-and-implantology/newman/978-0-323-87887-6
(2) Miller SC, Sorrin, S, Blass JL. Textbook of Periodontia (Oral Medicine), 2nd edition (1943). Blakiston Company, Philadelphia.
(3) Peditto M, Rupe C, Gambino G, Di Martino M, Barbato L, Cairo F, Oteri G, Cavalcanti R (2024). Influence of mobility on the long-term risk of tooth extraction/loss in periodontitis patients. A systemic review and meta-analysis. J Periodontal Research 2024 59(6):1047-1061.https://onlinelibrary.wiley.com/doi/10.1111/jre.13286?msockid=105b374f85bd65a700b022fa842f643f
(4) Avila G, Galindo-Moreno P, Soehren S, Misch CE, Morelli T, Wang HL. A novel decision-making process for tooth retention or extraction. J Periodontol. 2009 Mar;80(3):476-91. doi: 10.1902/jop.2009.080454. PMID: 19254132.https://deepblue.lib.umich.edu/items/86d4b03d-21fa-45a8-8d05-6207996cc064
(5) Singh A, Sharma RK, Tewari S, Narula SC. Correlation of tooth mobility with systemic bone mineral density and periodontal status in Indian women. J Oral Sci. 2012;54(2):177-82. doi: 10.2334/josnusd.54.177. PMID: 22790410. http://japanlinkcenter.org/DN/JST.JSTAGE/josnusd/54.177?lang=en&from=PubMed
(6) Hamdan AA, Bouchard P, Hamdan AI, Hassona Y. Chronic lymphocytic leukemia presenting as gingival swelling and tooth mobility. Spec Care Dentist. 2022 May;42(3):312-316. doi: 10.1111/scd.12679. Epub 2021 Nov 12. PMID: 34766641.
(7) Parameter on comprehensive periodontal examination. American Academy of Periodontology. J Periodontol. 2000 May;71(5 Suppl):847-8. doi: 10.1902/jop.2000.71.5-S.847. PMID: 10875687.
(8) American Academy of Periodontology on comprehensive periodontal evaluation. Comprehensive Periodontal Evaluation (CPE) – American Academy of Periodontology