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Tooth Subluxation

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Clinical Summary

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Tooth subluxation refers to the loosening of a tooth in its alveolar socket. Traumatic oral injury is the most common etiology; however, infection and periodontal disease may also produce loosening of teeth. Gingival lacerations and alveolar fractures are commonly associated with dental subluxations. Subluxated teeth are diagnosed by applying gentle pressure to the teeth with a tongue blade or fingertip. Movement, mild displacement, or blood along the crevice of the gingiva are signs of subluxation. Dental impaction and alveolar ridge fracture should be considered and ruled out clinically and radiographically.

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Emergency Department Treatment and Disposition

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  1. Primary teeth: If the subluxated tooth is forced into close proximity to the underlying permanent tooth, extraction by a dentist or oral surgeon 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, aluminium foil, or a special periodontal dressing (Coe-Pak), and the patient should be referred for dental follow-up.

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Figure 6.1.
Graphic Jump Location

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.
Graphic Jump Location

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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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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The authors acknowledge 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 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. The apex of a completely impacted permanent central incisor may be driven through the alveolar bone into the floor of the nares, causing epistaxis. Associated injuries may include alveolar fractures, dental crown or root fractures, and oral mucosal or gingival lacerations. Dental pulp necrosis occurs in ...

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