Tooth Subluxation

A 27 year old male was seen in the emergency department following a trauma and bleeding from the mouth. On examination he was found to have teeth subluxation due to the trauma.

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


Case Discussion: 
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: 
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.

Important Learning Points: 
1. Any evidence of tooth mobility following trauma is a subluxation by definition.
2. Always consider an associated underlying alveolar or occult root fracture.