Dental subluxation

Background

Diagram of the tooth displaying the enamel, dentin, and pulp

Dental Numbering

Classic dental numbering.

• Adult (permanent) teeth identified by numbers
  • From the midline to the back of the mouth on each side, there is a central incisor, a lateral incisor, a canine, two premolars (bicuspids), and three molars
• Children (non-permanent) teeth identified by letters
• Common landmarks:
  • 1: Right upper wisdom
  • 8 & 9: Upper incisors
  • 16: Left upper wisdom
  • 17: Left lower wisdom
  • 24 & 25: Lower incisors
  • 32: Right lower wisdom

Clinical Features

Coronal incisor fractures and with extrusive luxation of the upper right central incisor.

• Tooth is mobile but is still in original anatomic position
• If multiple consecutive teeth are involved, rule out underlying alveolar ridge fracture or other mandible fracture

Differential Diagnosis

Dentoalveolar Injuries

• Dental fracture
• Dental subluxation
• Dental avulsion
• Bleeding dental socket

Odontogenic Infections

• Acute alveolar osteitis (dry socket)
• Acute necrotizing ulcerative gingivitis (trench mouth)
• Dental abscess
  • Periapical abscess
  • Periodontal abscess
• Ludwig's angina
• Pulpitis (dental caries)
• Pericoronitis
• Peritonsillar abscess (PTA)
• Retropharyngeal abscess
• Vincent's angina - tonsillitis and pharyngitis

Other

• Scurvy
• Gingival hyperplasia
  • Phenytoin
  • Cyclosporine
  • Nifedipine, Amlodipine
  • Leukemia

Evaluation

• Clinical diagnosis

Management

Extrusive Luxation

• (tooth is moved partially out of the socket)
• Reposition tooth
• Follow up within 24hr for stabilization
• Temporizing measure: Periodontal pack (e.g.-Coe-Pak) in which tooth is bonded to its two neighboring teeth on both sides
  • Mix the resin and catalyst paste and apply to completely dry teeth
  • May use nasal cannula with oxygen as a air/drying source
  • May place gauze rolls in mucobuccal fold to absorb saliva
  • Wet or lubricated goves will allow for easier handling
  • Apply splinting to the facial side of the teeth, spanning approximately 1-2 teeth in either direction
  • Avoid covering the occlusal (biting) surface

Lateral Luxation

• (tooth displaced in a direction other than inward or outward)
• More extensive injury than extrusive luxation
  • Associated with cracking or fracture of the surrounding alveolar bone
• Attempt repositioning of tooth
• Apply temporary splinting with periodontal dressing
• Follow up within 24hr for stabilization

Intrusive Luxation

• (tooth is forced inward into the socket)
• Most serious because of significant damage to alveolar socket and periodontal ligament
• Allow tooth to erupt on its own

Disposition

• Discharge with dental follow up

See Also

• Dental Problems