Tooth Luxation

Aka: Tooth Luxation, Luxated Teeth, Loose Tooth, Tooth Lateral Luxation, Tooth Extrusion, Tooth Intrusion, Tooth Subluxation, Tooth Concussion

1. See Also
   1. Tooth Avulsion
   2. Tooth Fracture
2. Types: Spectrum from slight to complete tooth loss
   1. Tooth Concussion
      1. Mild Trauma with no tooth mobility or Tooth Fracture
      2. Patient has tenderness on tooth percussion
      3. Treated with Analgesics, soft food and good Oral Hygiene
      4. Dental follow-up
   2. Tooth Subluxation
      1. Tooth loose with bleeding but without displacement
      2. Evaluate for movement on Occlusion
         1. If movement, apply a splint
         2. If no movement, treat in same way as a Tooth Concussion
   3. Tooth Intrusion (axial displacement)
      1. Tooth driven into socket with secondary periodontal ligament injury and crush of alveolar socket
      2. Do not reposition tooth
      3. Clean the Gingiva and tooth with sterile saline
      4. Dental evaluation is needed to determine next step
   4. Tooth Extrusion (apical displacement)
      1. Tooth dislocated from socket centrally
      2. Clean the Gingiva and tooth with sterile saline
      3. Reposition the tooth apically and apply Dental Splint in position
      4. Follow all measures of Tooth Concussion in addition to oral antibiotics (Penicillin VK)
      5. Dental follow-up
   5. Lateral Luxation
      1. Displaced tooth that may be accompanied by alveolar Fracture
      2. Clean the Gingiva and tooth with sterile saline
      3. Administer local anesthetic
      4. Physician holds the tooth and Cortical Bone between fingers and repositions as a whole
      5. Follow all measures of Tooth Concussion in addition to oral antibiotics (Penicillin VK)
      6. Dental follow-up
   6. Tooth Avulsion
      1. Complete tooth displacement from its socket
      2. Dental Emergency (see Tooth Avulsion for management)
3. Grading: Tooth Mobility
   1. Grade 1 Mobility
      1. Buccal or lingual tooth movement of 0.5 mm
   2. Grade 2 Mobility
      1. Buccal or lingual tooth movement of 1 mm
   3. Grade 3 Mobility
      1. Lateral movement and depressibility in socket in addition to buccal or lingual tooth movement
4. Management: General
   1. Repositioning and Splinting of affected tooth as described above
      1. See Dental Splint
   2. Dental referral
      1. Root canal may be indicated in some cases
   3. Analgesics, soft food and good Oral Hygiene
   4. Antibiotics for Dental Infection indicated for Tooth Extrusion and Lateral luxation
5. References
   1. Broderick and Deak (2015) Crit Dec Emerg Med 29(1): 2-8