Tooth luxation is a traumatic injury to a tooth with its displacement and damage to periodontal tissue. Depending on the degree of damage, the dislocation may be incomplete, complete and embedded. It is manifested by severe pain, displacement of the tooth in the dentition and its pathological mobility. It may be accompanied by periodontal inflammation and pulp necrosis. In case of incomplete dislocation, the tooth can be set, in case of an impaled tooth, self–healing of the tooth in the dentition is possible, in case of complete dislocation, tooth extraction or its replantation (insertion into its former place).
ICD 10
S03.2 Dislocation of the tooth
Meaning
Tooth luxation is called its displacement in the hole due to the impact of a traumatic factor. A traumatic factor can be both a blow and biting off hard food.
Causes
In case of impact or fall with the presence of a traumatic force of a vertical or lateral nature, incisors and canines are most prone to dislocations. Careless or unprofessional extraction of molars is often accompanied by dislocation of neighboring teeth. If the periodontal tissues are weakened, there are cracks on the teeth, even eating hard food and small foreign bodies (bone fragments, small fruit bones) in the chewed food can lead to dislocation.
Bad habits – opening bottles with teeth, gnawing bones and kernels of nuts sooner or later end with tooth luxation. Dislocation can be isolated or with injury to the gums. Sometimes, with dislocation, there is a fracture of the root of the tooth, a fracture of the alveolar process. If the traumatic force is residual, then a fracture or dislocation of the jaw is possible.
Symptoms
The clinical picture depends on the type of dislocation. With incomplete dislocation, when the root is partially displaced from the alveoli, and the periodontal ligaments are torn, the tooth changes its position in the dentition. Since the tooth becomes mobile, there is a pain syndrome. Toothache increases during the act of chewing. Sometimes eating becomes difficult and so painful that the patient refuses to eat. Due to the mobility of the tooth, the gum is also injured, it becomes inflamed and bleeds. Since in the natural position, when the mouth is closed, the pressure of the adjacent and upper/lower teeth causes pain, the patient’s mouth is compensatorily half-open to reduce pain. On visual inspection, you can see the displacement of the tooth against the background of an even dentition.
With a complete tooth luxation, there is a complete loss of connection with the hole, as a result of which the tooth falls out. Some patients believe that treatment is inappropriate here, since tooth loss has already occurred, although with timely assistance, the tooth can be restored. Some patients experience pain and emotional shock. Severe bleeding from the hole is possible.
Embedded dislocations of the tooth are less common. With a dislocation, the traumatic force often affects several teeth. Therefore, a part of the dentition is hammered in. It is clinically manifested by a decrease in the height of the tooth standing, swelling and bleeding of the gum area and sharp pain, which increases during eating.
Diagnostics
Tooth luxation rarely goes unnoticed by the patient, because of the pronounced pain syndrome and the inability to eat, he independently seeks help from the dentist. And more often offers tooth extraction, although the subsequent implantation of the tooth is more painful, lengthy and expensive procedure.
To assess the condition of the jaw, adjacent teeth and innervation in the area of the damaged tooth, an X-ray examination is performed – an orthopantomogram. And only with significant destruction of bone tissue, for example, when it is crushed, tooth extraction is shown. In other cases, it is possible to restore it.
Treatment
In case of incomplete tooth luxation, the tooth is set into the hole and fixed to the adjacent teeth either with wire splints or by applying plaster. After a month and a half, the splints are removed, and the tooth usually completely retains blood supply and innervation. After removing the tire, a gentle mode is recommended with the exception of significant loads on the tooth. A control radiography, which is carried out after a few months, shows how successfully the tooth has taken its position. Also, according to the X-ray, it is possible to judge the presence or absence of complications, including inflammatory ones.
If several days have passed after the tooth luxation, then temporary canal filling can be used during endodontic treatment. Permanent filling is done in a few months. With a complete tooth luxation, the possibility of its recovery depends on the actions of the victim. If the tooth is in the mouth, it should be carefully returned to the hole and seek medical help. The less time the tooth spends outside the hole, the more chances it has to fully restore its functions.
If the tooth has fallen out of the mouth and has dirt, then it needs to be washed with clean water. The use of detergents and brushes is unacceptable. If it is impossible to return the tooth to the well, for example, with severe pain or emotional shock, it must be stored in a moist biocompatible environment. Such containers are sold in pharmacies, in their absence, you can put the tooth in a container with milk. In extreme cases, the tooth is transported directly in the mouth: behind the cheek or under the tongue. Transportation in tap water reduces the probability of replantation several times.
If the blood supply is not damaged, the doctor replants the tooth while preserving the pulp. But if there are ruptures and damage to the neurovascular bundle, then depulpation and filling of the channels are performed. The tooth returned to the hole is strengthened with splints and periodic radiographs are carried out to control its condition. If the tooth has not taken its position, then the splints are removed with subsequent extraction of the tooth. If the tooth has regained its position, then after removing the splints, it is recommended to install crowns on the damaged and adjacent teeth.
A dislocated tooth is most often self-healing, as the tooth tends to take its original position. Regular dental monitoring is recommended to prevent complications. There are many factors that influence a favorable outcome after a dislocation of a tooth. Of great importance is the nature of the damage, the time interval from the tooth injury to the start of treatment, the protective properties of the body, the quality of treatment and care of the tooth after injury.
Sometimes tooth rejection can begin several years after the injury, as the body can react to it as an alien object. After successful treatment of tooth luxation, it is necessary to visit the dentist for several years. Professional examination and measures to prevent tooth resorption will help to completely restore the surrounding tissues and damaged tooth. However, in some cases, after seemingly successful therapy of tooth luxation, it is necessary to resort to its extraction.