Dental subluxation

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Dental subluxation
Specialty Dentistry

Dental subluxation is a traumatic injury to the periodontal tissue [1] in which the tooth has increased mobility (i.e., is loosened) but has not been displaced from its tooth socket. [1]

Contents

Cause

High impact force during trauma causes damage to the periodontium and results swelling and bleeding from the gingival sulcus. Trauma also causes rupture of some periodontal fibres and this leads to loosening of the tooth. However, the force is not strong enough to cause displacement of the tooth from its socket. Sometimes, the trauma might cause pulpal damage and there is a minimal risk of pulpal necrosis, thus follow-up is essential. [1] [2]

Diagnosis

A tooth that has been subluxated shows symptoms of being tender to percussion (tapped using the end of the mirror) and tender to palpate around the area and sulcus (as it has been slightly mobilised yet remains undisplaced). Any sensitivity testing of the pulp may provide a negative response, in which case it is important to continue monitoring until a pulpal response is received. [3]

Radiographically, there are no unusual features to note in a subluxated tooth. However, it is important to focus on the full image and scan for any other areas which may have also been affected. If there is any suspicion of a root fracture, it is recommended to take an occlusal exposure radiograph to allow for a definitive diagnosis. Radiographs can be referred to in case of any future complications.

Management

Following any form of dental trauma, a full and thorough clinical assessment is carried out to exclude more serious injuries that may require urgent management. [4]

The first stage of the clinical assessment is to take a complete history to rule out head injury or inhalation of particles. Questions to obtain this information include:

If there is any doubt of head injury or aspiration, the patient should attend the nearest accident and emergency service prior to receiving dental treatment. [7]

Having ruled out serious injuries, a full trauma, dental and medical history is undertaken. This will include understanding if the patient is currently having symptoms, has a history of dental trauma, and their tetanus status. [8]

Following a complete history, a clinical examination is then undertaken.

Extra-oral examination includes:

Intra-oral examination includes checking for:

Primary teeth

Following subluxation of a primary tooth, there is no active treatment required. The patient is advised to keep the area as clean as possible by swabbing with 0.12% chlorohexidine twice daily. Clinical follow up will be carried out at 1 week and 6–8 weeks after injury. Follow up radiographs are not required unless complications occur. [3]

Secondary teeth

Management is similar to primary teeth. No active treatment is usually required; however, a flexible splint may be placed for up to 2 weeks if the patient is experiencing extreme discomfort. Follow up to check for complications is more frequent. Radiographical and clinical exam should be carried out at 2 weeks, 4 weeks, 6–8 weeks, 6 months and 1 year. [3]

Epidemiology

Dental trauma is a major global health issue and it affects 17.5% of children and adolescents. [9] It is most commonly seen in school children. Dental subluxation is one of the most common traumatic injuries in primary dentition. Maxillary central incisors are the most commonly affected teeth. [10] [11] Some studies have proposed that the resilience nature of periodontium favours dislocation than fracture of the tooth itself. [12] However, the exact prevalence is difficult to be assessed because dental subluxations are often asymptomatic or only mildly symptomatic, and even overlooked by caregivers when treating more serious dental traumas in adjacent teeth.

See also

Related Research Articles

A subluxation is an incomplete or partial dislocation of a joint or organ. According to the World Health Organization, a subluxation is a "significant structural displacement" and is therefore visible on static imaging studies, such as X-rays. Unlike real subluxations, the pseudoscientific concept of a chiropractic "vertebral subluxation" may or may not be visible on x-rays.

<span class="mw-page-title-main">Bridge (dentistry)</span> Dental restoration for missing teeth

A bridge is a fixed dental restoration used to replace one or more missing teeth by joining an artificial tooth definitively to adjacent teeth or dental implants.

<span class="mw-page-title-main">Toothache</span> Medical condition of the teeth

Toothache, also known as dental pain or tooth pain, is pain in the teeth or their supporting structures, caused by dental diseases or pain referred to the teeth by non-dental diseases. When severe it may impact sleep, eating, and other daily activities.

<span class="mw-page-title-main">Periodontal fiber</span> Group of specialized connective tissue fibers

The periodontal ligament, commonly abbreviated as the PDL, is a group of specialized connective tissue fibers that essentially attach a tooth to the alveolar bone within which it sits. It inserts into root cementum on one side and onto alveolar bone on the other.

<span class="mw-page-title-main">Dentinogenesis imperfecta</span> Medical condition

Dentinogenesis imperfecta (DI) is a genetic disorder of tooth development. It is inherited in an autosomal dominant pattern, as a result of mutations on chromosome 4q21, in the dentine sialophosphoprotein gene (DSPP). It is one of the most frequently occurring autosomal dominant features in humans. Dentinogenesis imperfecta affects an estimated 1 in 6,000-8,000 people.

A dental emergency is an issue involving the teeth and supporting tissues that are of high importance to be treated by the relevant professional. Dental emergencies do not always involve pain, although this is a common signal that something needs to be looked at. Pain can originate from the tooth, surrounding tissues or can have the sensation of originating in the teeth but be caused by an independent source. Depending on the type of pain experienced an experienced clinician can determine the likely cause and can treat the issue as each tissue type gives different messages in a dental emergency.

<span class="mw-page-title-main">Veterinary dentistry</span> Branch of veterinary medicine

Veterinary dentistry is the field of dentistry applied to the care of animals. It is the art and science of prevention, diagnosis, and treatment of conditions, diseases, and disorders of the oral cavity, the maxillofacial region, and its associated structures as it relates to animals.

Dilaceration is a developmental disturbance in shape of teeth. It refers to an angulation, or a sharp bend or curve, in the root or crown of a formed tooth. This disturbance is more likely to affect the maxillary incisors and occurs in permanent dentition. Although this may seem more of an aesthetics issue, an impacted maxillary incisor will cause issues related to occlusion, phonetics, mastication, and psychology on young patients.

Dens invaginatus (DI), also known as tooth within a tooth, is a rare dental malformation where there is an infolding of enamel into dentine. The prevalence of condition is 0.3 - 10%, affecting more males than females. The condition is presented in two forms, coronal and radicular, with the coronal form being more common.

Dens evaginatus is a rare odontogenic developmental anomaly that is found in teeth where the outer surface appears to form an extra bump or cusp.

<span class="mw-page-title-main">Gingival sulcus</span> Space between tooth and gums

The gingival sulcus is an area of potential space between a tooth and the surrounding gingival tissue and is lined by sulcular epithelium. The depth of the sulcus is bounded by two entities: apically by the gingival fibers of the connective tissue attachment and coronally by the free gingival margin. A healthy sulcular depth is three millimeters or less, which is readily self-cleansable with a properly used toothbrush or the supplemental use of other oral hygiene aids.

<span class="mw-page-title-main">Pulpotomy</span>

Pulpotomy is a minimally invasive procedure performed in children on a primary tooth with extensive caries but without evidence of root pathology. The minimally invasive endodontic techniques of vital pulp therapy (VPT) are based on improved understanding of the capacity of pulp (nerve) tissues to heal and regenerate plus the availability of advanced endodontic materials. During the caries removal, this results in a carious or mechanical pulp exposure (bleeding) from the cavity. During pulpotomy, the inflamed/diseased pulp tissue is removed from the coronal pulp chamber of the tooth leaving healthy pulp tissue which is dressed with a long-term clinically successful medicament that maintains the survival of the pulp and promotes repair. There are various types of medicament placed above the vital pulp such as Buckley's Solution of formocresol, ferric sulfate, calcium hydroxide or mineral trioxide aggregate (MTA). MTA is a more recent material used for pulpotomies with a high rate of success, better than formocresol or ferric sulfate. It is also recommended to be the preferred pulpotomy agent in the future. After the coronal pulp chamber is filled, the tooth is restored with a filling material that seals the tooth from microleakage, such as a stainless steel crown which is the most effective long-term restoration. However, if there is sufficient remaining supporting tooth structure, other filling materials such as amalgam or composite resin can provide a functional alternative when the primary tooth has a life span of two years or less. The medium- to long-term treatment outcomes of pulpotomy in symptomatic permanent teeth with caries, especially in young people, indicate that pulpotomy can be a potential alternative to root canal therapy (RCT).

Pulp necrosis is a clinical diagnostic category indicating the death of cells and tissues in the pulp chamber of a tooth with or without bacterial invasion. It is often the result of many cases of dental trauma, caries and irreversible pulpitis.

<span class="mw-page-title-main">Dental trauma</span> Medical condition

Dental trauma refers to trauma (injury) to the teeth and/or periodontium, and nearby soft tissues such as the lips, tongue, etc. The study of dental trauma is called dental traumatology.

<span class="mw-page-title-main">Panoramic radiograph</span> Type of X-ray

A panoramic radiograph is a panoramic scanning dental X-ray of the upper and lower jaw. It shows a two-dimensional view of a half-circle from ear to ear. Panoramic radiography is a form of focal plane tomography; thus, images of multiple planes are taken to make up the composite panoramic image, where the maxilla and mandible are in the focal trough and the structures that are superficial and deep to the trough are blurred.

<span class="mw-page-title-main">Dental avulsion</span> Medical condition

Dental avulsion is the complete displacement of a tooth from its socket in alveolar bone owing to trauma. Normally, a tooth is connected to the socket by the periodontal ligament. When a tooth is knocked out, the ligament is torn.

<span class="mw-page-title-main">Orofacial pain</span> Medical condition

Orofacial pain is a general term covering any pain which is felt in the mouth, jaws and the face. Orofacial pain is a common symptom, and there are many causes.

<span class="mw-page-title-main">Tricho–dento–osseous syndrome</span> Medical condition

Tricho–dento–osseous syndrome (TDO) is a rare, systemic, autosomal dominant genetic disorder that causes defects in hair, teeth, and bones respectively. This disease is present at birth. TDO has been shown to occur in areas of close geographic proximity and within families; most recent documented cases are in Virginia, Tennessee, and North Carolina. The cause of this disease is a mutation in the DLX3 gene, which controls hair follicle differentiation and induction of bone formation. All patients with TDO have two co-existing conditions called enamel hypoplasia and taurodontism in which the abnormal growth patterns of the teeth result in severe external and internal defects. The hair defects are characterized as being rough, course, with profuse shedding. Hair is curly and kinky at infancy but later straightens. Dental defects are characterized by dark-yellow/brownish colored teeth, thin and/or possibly pitted enamel, that is malformed. The teeth can also look normal in color, but also have a physical impression of extreme fragility and thinness in appearance. Additionally, severe underbites where the top and bottom teeth fail to correctly align may be present; it is common for the affected individual to have a larger, more pronounced lower jaw and longer bones. The physical deformities that TDO causes become more noticeable with age, and emotional support for the family as well as the affected individual is frequently recommended. Adequate treatment for TDO is a team based approach, mostly involving physical therapists, dentists, and oromaxillofacial surgeons. Genetic counseling is also recommended.

<span class="mw-page-title-main">Tooth mobility</span> Medical condition

Tooth mobility is the horizontal or vertical displacement of a tooth beyond its normal physiological boundaries around the gingival area, i.e. the medical term for a loose tooth.

Root fracture of the tooth is a dentine cementum fracture involving the pulp.

References

  1. 1 2 3 Paediatric dentistry. Welbury, Richard., Duggal, Monty S., Hosey, Marie Thérèse. (4th ed.). Oxford: Oxford University Press. 2012. ISBN   9780199574919. OCLC   792747085.{{cite book}}: CS1 maint: others (link)
  2. ↑ "The treatment of traumatic dental injuries" (PDF). American Association of Endodontics. 2014. Retrieved 2 November 2018.
  3. 1 2 3 "Dental Trauma Guide" (PDF). 2018.
  4. 1 2 3 Clinical problem solving in dentistry. Odell, E. W. (3rd ed.). Edinburgh: Churchill Livingstone. 2010. ISBN   9780443067846. OCLC   427608817.{{cite book}}: CS1 maint: others (link)
  5. ↑ "clinical-examination". www.dentalcare.com. Retrieved 2018-11-12.
  6. ↑ Society, Canadian Paediatric. "Sport-related concussion: Evaluation and management | Canadian Paediatric Society". www.cps.ca. Retrieved 2018-11-12.
  7. ↑ Lecky F, Russell W, Fuller G, McClelland G, Pennington E, Goodacre S, Han K, Curran A, Holliman D, Freeman J, Chapman N, Stevenson M, Byers S, Mason S, Potter H, Coats T, Mackway-Jones K, Peters M, Shewan J, Strong M (January 2016). "The Head Injury Transportation Straight to Neurosurgery (HITS-NS) randomised trial: a feasibility study". Health Technology Assessment . 20 (1): 1–198. doi:10.3310/hta20010. PMC   4780924 . PMID   26753808.
  8. ↑ "Oral Injury as a Source of Tetanus Inoculation - Oral Health Group". Oral Health Group. Retrieved 2018-11-12.
  9. ↑ Azami-Aghdash S, Ebadifard Azar F, Pournaghi Azar F, Rezapour A, Moradi-Joo M, Moosavi A, Ghertasi Oskouei S (2015). "Prevalence, etiology, and types of dental trauma in children and adolescents: systematic review and meta-analysis". Medical Journal of the Islamic Republic of Iran. 29 (4): 234. PMC   4715389 . PMID   26793672.
  10. ↑ Sulieman AG, Awooda EM (2018). "Prevalence of Anterior Dental Trauma and Its Associated Factors among Preschool Children Aged 3-5 Years in Khartoum City, Sudan". International Journal of Dentistry. 2018: 2135381. doi: 10.1155/2018/2135381 . PMC   5994279 . PMID   29977294.
  11. ↑ Zadik Y, Levin L (February 2009). "Oral and facial trauma among paratroopers in the Israel Defense Forces". Dental Traumatology. 25 (1): 100–2. doi:10.1111/j.1600-9657.2008.00719.x. PMID   19208020.
  12. ↑ Lam R (March 2016). "Epidemiology and outcomes of traumatic dental injuries: a review of the literature". Australian Dental Journal. 61 (Suppl 1): 4–20. doi: 10.1111/adj.12395 . PMID   26923445.
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