Fremitus tooth mobility vibration upon closing. The patient’s chief complaint was that the upper right central incisor tooth (#8) was very loose and she did not want it extracted. 1) The upper right central incisor tooth (#8) has extruded – grown out of the gum – and moved labially toward the lip creating a diastema – a tooth gap space as seen in the pictures. 2) The x-ray shows severe bone loss – gum disease. The black dotted line shows the location for a potential root resection extraction if necessary. Scaling was performed after the dental splint was glued with dental bonding material. The patient will return in three months to reevaluate periodontal healing and the potential need for the root resection. 3) Palatal view of the splint between teeth #’s 7 – 9. 4) Post-op view. Same day. Notice the diastema tooth gap space was closed with teeth bonding to hide the wire splint and the incisal edge of #8 was reduced by drilling it shorter.

Fremitus is occlusal bite trauma that occurs when closing in centric relation. Tooth vibration can be felt on the tooth with an index finger when the mouth is opened and then closed. These pictures show the treatment of a periodontally involved – gum disease – upper left central incisor tooth #9. 1) & 2) Pre operative picture and xray. Note the angular bony defect in the radiograph. The patient reported that the tooth was getting longer and that he never previously had the tooth gap space between his two front teeth. 3) Palatal photo of the teeth splint placed between teeth #’s 8 & 9. 4) Post-operative image one hour later. Tooth bonding placed between the teeth to close the gap tooth space also hides the palatal wire splint. The incisal edge of #9 was shortened and the occlusion bite was checked and adjusted for fremitus. Scaling and root planing was next performed and the patient was placed on a three-month periodontal reevaluation with the periodontist.

Occluso-periodontal combined bite gum problems and Fremitus – tooth mobility vibration upon closing.. This 40 year old patient’s chief complaint was her front teeth are moving and she now has a tooth gap space. Fremitus upon teeth closing was noted only on tooth #8. Notice her deep bite, which can exacerbate this potential problem. Consider either lower anterior orthodontic intrusion with teeth braces or incisal adjustment – sculpting. Next, periodontal root planing and then probably gum surgery in the upper anterior. Following gum healing consider either upper orthodontic movement to bring these teeth back, or dental bonding with a palatal splint, after incisal adjustment of tooth #8.

Fremitus is a palpable pathologic occlusion bite typically found on one upper front tooth when a patient closes their teeth. This tooth vibration is considered an occlusal trauma. This patient presented with her upper left central incisor tooth flared labially – towards the lip. 1) Front view photo. 2) Side view photo. 3) Occlusal view. 4) X-ray radiograph. The patient, who was in her twenties, was informed by the periodontist about the severe periodontal gum condition and that the prognosis for this tooth was guarded at best. She was informed that a thorough check-up was indicated. Orthodontics teeth braces is contra-indicated here because of the severe periodontal gum problem. If the patient accepts treatment on a tooth with a guarded prognosis, then it could include: scaling and root planing, open gum flap debridement if necessary, root canal therapy and dental crown with pink gum for aesthetics and possibly a teeth splint. Treatment, otherwise, could include just scaling and root planing and incisal adjustment – sculpting. I personally would not rush to extract this tooth though the patient needs to be aware of this possibility.