6-01: Tooth Subluxation

Introduction

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.)

Clinical Summary

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.

Management and Disposition

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.

Good oral hygiene should be maintained by using chlorhexidine 0.12% topically twice a day for a week.

Pearls

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

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