What is a Subluxated Tooth?
A subluxation tooth injury happens when the tissues connecting your tooth to your jawbone get damaged, but the tooth itself doesn’t get knocked out or fully dislodged. Think of it like spraining your ankle – the ligaments are stretched, but the bone is still in place. This type of injury is considered a traumatic dental injury (TDI), and it specifically affects the periodontal ligament (PDL).
If you’ve subluxated a tooth, it might feel loose or tender when you tap on it. TDIs are fairly common, especially in kids and teenagers, so it’s important to know what to do.
Taking care of the soft tissues, like that periodontal ligament, is key to keeping your tooth healthy and working properly in the long run. If a subluxated tooth isn’t treated correctly or quickly enough, it can lead to problems like the tooth’s pulp dying, the tooth fusing to the bone (ankylosis), or the root of the tooth dissolving (root resorption).
In this article, we’ll go over what causes a tooth subluxation, how it’s diagnosed, and how it’s treated. We’ll also cover what to expect during follow-up care, potential complications, and how to prevent these injuries in the first place.
What causes a tooth subluxation?
Usually, tooth subluxation happens after some kind of trauma to your face or mouth. Falls, sports injuries, and car accidents are common causes. But sometimes, habits like bruxism (grinding your teeth) or clenching your jaw can also loosen your teeth over time.
Some people are more likely to experience a subluxation. For example, if you have an overjet (when your top teeth stick out too far) or your lips don’t fully cover your teeth, you have a higher risk of dental trauma. Playing contact sports without a mouthguard is another big risk factor.
Research suggests that around 25% of schoolchildren experience some kind of dental trauma. One study found that over half of primary school children in Hong Kong had experienced a tooth subluxation.
Clinical Evaluation and Diagnosis of Subluxation
Diagnosing a subluxed tooth requires a thorough evaluation by a dentist or endodontist, including a review of your medical history and a detailed examination.
History and Patient Interview
The dental professional will want to gather as much information as possible about the injury, including when it happened, how it happened, and how forceful the impact was. It’s also important for the dentist to know about your general medical history, any medications you’re taking, and your family’s dental and medical history.
The dentist will also ask you about the pain you’re experiencing, including where it hurts, how intense the pain is, and how long you’ve been experiencing it. They’ll also want to know if the tooth is sensitive to hot, cold, or pressure.
Clinical Examination
The dentist will visually inspect your mouth for signs of bleeding, swelling, or discoloration of the gums. They’ll also assess the position and alignment of the tooth.
They’ll gently feel the alveolar bone around the tooth to check for tenderness or any irregularities. They may also tap on the tooth to assess sensitivity.
Dentists use the Miller’s tooth mobility grading system to evaluate tooth mobility. A subluxed tooth typically has increased mobility.
Dental Pulp Testing
Pulp vitality assessment is key, since it’s important to know whether the pulp inside the tooth is still alive. Dentists use electric pulp testing (EPT), thermal testing, and pulse oximetry to assess pulp vitality, although false negatives are possible, especially in younger people whose teeth haven’t fully matured.
Thermal testing uses hot and cold stimuli to assess pulp response. EPT stimulates nerve fibers in the pulp. Pulse oximetry and laser Doppler flowmetry measure blood flow within the pulp.
Radiographic Evaluation of a Subluxed Tooth
If your dentist suspects you have a subluxed tooth, they will almost certainly order X-rays to check for damage. Radiographs of the tooth and the surrounding bone are critical for ruling out other, more serious problems, such as fractures. They also give the dentist a better look at the space around the tooth root and whether the tooth has shifted in its socket.
The dentist may use a few different types of imaging:
- Periapical radiographs: These provide a detailed view of the whole tooth and the bone immediately surrounding it.
- Occlusal radiographs: These can help visualize fractures and any displacement of the tooth.
- Cone beam computed tomography (CBCT): In complex cases, a CBCT scan may be necessary to provide a 3D view of the area.
Management and Treatment of Tooth Subluxation
When a tooth is subluxated, quick and appropriate treatment is important for the best possible outcome. Here’s an overview of how dentists typically handle this type of injury:
Initial Management
- Pain Control: The first step is to manage the pain. Your dentist will likely recommend pain relievers and suggest you stick to a soft diet to avoid putting extra pressure on the injured tooth.
- Occlusal Adjustment: Your dentist will check your bite to make sure the injured tooth isn’t hitting other teeth in a way that could make the injury worse. If needed, they’ll adjust your bite to eliminate any undue stress on the tooth.
Splinting
- Why Splint?: Splinting the tooth gives it stability and support, which helps the periodontal ligament (PDL) heal.
- Types of Splints: Flexible splints are usually best because they allow the tooth to move a little bit, which is important for preventing a complication called ankylosis (where the tooth fuses to the bone). Common types of splints include orthodontic wire splints, nylon line splints, and resin splints.
- How Long to Splint?: The splint usually stays in place for 1 to 2 weeks, depending on how bad the injury is and how well you’re healing.
Monitoring Pulp Vitality
- Why Follow-Up?: It’s important to check the tooth regularly to make sure the pulp (the soft tissue inside the tooth) is still healthy. You want to catch any signs of pulp necrosis (death of the pulp) or pulp canal obliteration (where the pulp canal gets blocked).
- Pulp Testing Schedule: Your dentist will likely test the pulp every 2 to 4 weeks at first, then every 3 to 6 months for the first year. After that, they’ll continue to check it once a year for at least 5 years.
Pulp and periodontal ligament healing after subluxation
When a tooth is subluxed, there can be changes to the pulp tissue inside the tooth as well as the periodontal ligament (PDL) that holds the tooth in place. Here’s what can happen:
Pulp tissue changes in luxation and avulsion
After a tooth injury, here are some of the ways the pulp can heal:
- Normal pulp healing. In some cases, the pulp heals and goes back to normal, with the tooth working just as it should.
- Pulp canal obliteration (PCO). Sometimes hard tissue builds up inside the pulp canal. PCO doesn’t always need to be treated, but it can make it harder to get to the pulp if you need a root canal later on.
- Pulp necrosis. Pulp necrosis happens when the pulp tissue dies because it’s not getting enough blood or because of an infection. If the pulp dies, the tooth may change color and won’t respond to testing. You might also see signs of problems around the tip of the root on an X-ray.
Periodontal ligament changes in luxation and avulsion
Here’s how the periodontal ligament might respond to a tooth injury:
- Normal PDL healing. Often, the PDL heals without any problems, and the tooth is stable and moves normally.
- Ankylosis. Sometimes, the tooth fuses to the bone, and the PDL disappears. This means the tooth won’t move like it should. Ankylosis can cause the tooth to look like it’s sinking into the gums and can be a problem, especially in kids who are still growing.
- External inflammatory resorption. This is when the tooth starts to break down because of inflammation in the PDL. It can happen because of trauma, infection, or too much pressure on the tooth.
Potential Complications and Management Strategies
A tooth subluxation can lead to some complications that require ongoing management. Here’s a look at some of those issues.
Pulp Necrosis
Pulp necrosis, or death of the pulp, is a possible complication. If this happens, here are some potential treatments:
- Endodontic treatment. Root canal therapy may be needed to remove infected tissue and prevent further problems.
- Apexification. When a tooth isn’t fully developed, a procedure called apexification can help create a barrier at the root tip before a root canal.
- Pulp regeneration and pulp revascularization. These newer techniques are designed to try to restore the pulp in a dead tooth.
Root Resorption
Root resorption involves the breakdown and loss of root structure. If your dentist sees signs of this, they may:
- Monitor and intervene. Your dentist will keep an eye on things with regular X-rays. If resorption is happening, they’ll try to find out why and may recommend endodontic treatment.
Ankylosis
Ankylosis is when the tooth root fuses to the bone. Here’s how that might be handled:
- Observation. If there aren’t any symptoms, your dentist may just watch and wait, especially in adults.
- Decoronation. This means removing the crown but leaving the root to help keep the bone volume in the area.
- Orthodontic extrusion. This technique can slowly move the tooth outward to improve how it looks and works.
- Tooth decoronation and dental implant.
How to prevent a subluxed tooth
The best way to handle a subluxed tooth is to prevent it from happening in the first place. Here are some strategies for keeping your teeth safe:
Mouthguards
If you play sports, invest in a custom-fitted mouthguard. These mouthguards have been shown to be very effective at preventing tooth injuries.
Helmets and Face Shields
If you participate in activities that carry a high risk of facial trauma, make sure to wear a helmet and/or a face shield.
Education and Awareness
Talk to your family, friends, and teammates about the importance of preventing dental injuries. The more people who are aware of the risks, the better!
Orthodontic Treatment
Sometimes, crooked or misaligned teeth are more susceptible to injury. Talk to your dentist about whether orthodontic treatment could protect your teeth.
In Conclusion
Tooth subluxation, where a tooth loosens after an injury, is a common type of traumatic dental injury (TDI). To keep your teeth healthy and avoid problems, it’s important to get a quick diagnosis and good care.
Your dentist will need to do a thorough exam, take X-rays, and test the tooth to see if the pulp inside is still alive. They’ll then come up with a treatment plan that’s right for you.
After treatment, regular checkups are a must. These visits allow your dentist to keep an eye on the tooth, make sure it’s healing well, and address any issues that might pop up.
Of course, the best approach is to prevent injuries in the first place. Mouthguards are a great idea, especially if you play sports. And learning about how to protect your teeth can make a big difference.
How well a subluxated tooth does in the long run depends on things like how bad the injury was, your age, and how well the treatment worked. But with the right care and follow-up, many subluxated teeth can stay healthy and strong for years to come.