Dental subluxation

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]

Dental subluxation
SpecialtyDentistry

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 socket1. 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/or sulcus as it has been slightly mobilised yet remains undisplaced. To begin with, 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; something which the patient may not actually have noticed or complained of. If there is any suspicion of a root fracture, it is recommended to take an occlusal exposure radiograph to allow for a definitive diagnosis. Taking radiographs is useful as they can be referred to in case of any future complications.

Management

When a patient presents to the dentist following any form of dental trauma, a full and thorough clinical assessment should be carried 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 our head injury or inhalation of particles. Questions to obtain this information include:

·     Did the patient lose consciousness?[5]

·     Were there any witnesses?

·     Has the patient had any nausea or vomiting since the incident?

·     Is there any loss of memory?

·     Can all particles be accounted for

·     Is the patient experiencing any change in vision?[6]

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, it is then important to undertake a full trauma, dental and medical history. 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:

·     Cleaning cuts with saline solution and removal of foreign bodies

·     Palpation of the entire facial skeleton to rule out fractures

·     Assessment for abnormalities in mandibular opening

·     Checking for bruising[4]

Intra-oral examination includes checking for:

·     Bruising

·     Blood clots

·     Cuts/ lacerations

·     Tooth mobility

·     Fractured teeth

·     Changes to occlusion[4]

Primary teeth

Following subluxation of a primary tooth there is no active treatment required. The patient should be 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 commonest 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.

gollark: What's the difference between the AR and NDAR?
gollark: DOWN WITH SICKNESS!
gollark: I wonder what happened to the hatcheries. This is weird.
gollark: *hatchling* soon though I forgot about it until now.
gollark: I've not really gotten any PMs about it, which makes it a bit more odd (are they just looking at it for no reason?) but you know.

See also

References
  1. Paediatric dentistry. Welbury, Richard., Duggal, Monty S., Hosey, Marie Thérèse. (4th ed.). Oxford: Oxford University Press. 2012. ISBN 9780199574919. OCLC 792747085.CS1 maint: others (link)
  2. "The treatment of traumatic dental injuries" (PDF). American Association of Endodontics. 2014. Retrieved 2 November 2018.
  3. "Dental Trauma Guide" (PDF). 2018.
  4. Clinical problem solving in dentistry. Odell, E. W. (3rd ed.). Edinburgh: Churchill Livingstone. 2010. ISBN 9780443067846. OCLC 427608817.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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