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INTRODUCTION

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Herpes Labialis. Note the extensive painful ulcerations on the patient’s upper lip and corners of the mouth. A prodromal period of fever, malaise, and cervical adenopathy may herald the onset of these painful ulcerations. (Photo contributor: R. Jason Thurman, MD.)

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The authors acknowledge Brent E. Gottesman, MD, Edwin D. Turner, MD, and Sara-Jo Gahm, MD, for portions of this chapter written for the previous editions of this book.

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TOOTH SUBLUXATION

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Clinical Summary

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Tooth subluxation, the loosening of a tooth in its alveolar socket, is most commonly secondary to trauma; however, infection and periodontal disease may also produce subluxation. Gingival lacerations and alveolar fractures are associated with dental subluxations. Gentle pressure to the teeth with a tongue blade or fingertip may produce movement, mild displacement, or blood along the crevice of the gingiva, all signs of subluxation. Dental impaction and alveolar ridge fracture should be considered and ruled out clinically or radiographically.

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Management and Disposition

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  1. Primary teeth: If the subluxated tooth is forced into close proximity to the underlying permanent tooth, follow-up for extraction is indicated. Otherwise, the patient should be instructed to follow a soft diet for 1 to 2 weeks, allowing the tooth to reimplant spontaneously.

  2. Permanent teeth: Unstable teeth should be temporarily immobilized using gauze packing, a figure-eight suture around the tooth and an adjacent tooth, aluminum foil, or a special periodontal dressing, and the patient referred for dental follow-up.

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Pearls

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  1. Any evidence of tooth mobility following trauma is a subluxation by definition.

  2. Always consider an associated underlying alveolar or occult root fracture.

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FIGURE 6.1

Tooth Subluxation. Note the presence of blood along the crevice of the gingival margin of both central incisors—an indication of subluxation following trauma. Mild displacement of the subluxated teeth is noted. (Photo contributor: James F. Steiner, DDS.)

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FIGURE 6.2

Tooth Subluxation. Tooth subluxations can be quite subtle, as in this case of a slightly subluxed tooth #9 missed on initial examination. A careful dental examination is essential in patients with oral trauma. (Photo contributor: Kevin J. Knoop, MD, MS.)

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TOOTH IMPACTION (INTRUSIVE LUXATION)

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Clinical Summary

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Impacted or intruded teeth result when a tooth is forced deeper into the alveolar socket or surrounding tissues as a result of trauma. The tooth appears shorter than its contralateral partner. An impacted tooth may be partially visible or completely hidden by the gingiva and buried in the alveolar process. Completely impacted teeth may erroneously be considered avulsed until a radiograph demonstrates the intruded position. ...

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