Tooth Luxation

Tooth luxation is displacement of a tooth within its socket with damage to the periodontal ligament, from a trauma force. This article covers the injuries with little or sideways displacement: concussion, subluxation and lateral luxation. Axial displacement forms (partial removal and deeper insertion) are separate injuries with their own treatment.

Concussion is an injury to the supporting structures with no mobility or displacement. Subluxation is abnormal loosening with no displacement. Lateral luxation is displacement in a direction other than axial, with fracture of the socket wall and locking of the tooth. Together they make up the majority of luxation injuries.

Pathophysiology. Impact force stretches or tears the periodontal ligament fibres and, depending on severity, the apical blood vessels. Concussion causes oedema and bleeding in the ligament.

Lateral luxation drives the root against the socket wall, fracturing it, and the apex is displaced in the opposite direction, which locks the tooth. Pulp necrosis follows in a proportion of teeth, particularly mature teeth and lateral luxation.

Concussion: tender to percussion with no mobility and no bleeding. Subluxation: tender, with increased mobility and bleeding from the gingival sulcus, with no displacement. Lateral luxation: crown displaced palatally or labially, a high metallic percussion note, immobility from locking, and bleeding from the gingiva, with malocclusion.

Check other tooth, alveolar and facial injuries, soft tissue wounds, and tetanus status.

Airway concern, head injury, other fractures and contaminated wounds need urgent assessment.

• Clinical examination: displacement, mobility, percussion note, occlusion and bleeding.
• Periapical radiographs from several angles and an occlusal view. Cone beam CT for lateral luxation and when alveolar fracture or root fracture is suspected.
• Pulp sensibility tests at baseline (unreliable early) and at follow up.
• Tetanus status.

Differential diagnosis.

• Extrusive and intrusive luxation
• Root fracture with a mobile or displaced coronal segment
• Alveolar fracture
• Avulsion
• Crown fracture with sensitivity
• Periodontal mobility from other causes

• Concussion: no active treatment. Soft diet for 1 to 2 weeks, with monitoring of pulp status.
• Subluxation: flexible splint for 2 weeks only if the tooth is painful on biting, with soft diet. Monitor.
• Lateral luxation: under local anaesthesia, free the tooth from its locked position by finger pressure and reposition it into the socket with the socket wall, check the occlusion, and stabilise with a flexible splint for 4 weeks. Suture gingival tears.
• Pulp: immature teeth are monitored for revascularisation. Mature teeth with necrosis, and lateral luxation in mature teeth, need root canal treatment, with calcium hydroxide dressing for 1 to 4 weeks and a root filling.
• Primary teeth: concussion and subluxation need observation and soft diet. Lateral luxation with minimal displacement and no occlusal interference is observed, and a tooth displaced towards the permanent germ or interfering with occlusion is extracted.
• Antibiotics: not routinely needed. For contaminated wounds or other injuries, doxycycline 100 mg orally twice daily for 7 days in patients aged 12 years and over, avoided in pregnancy, breastfeeding and renal impairment, or amoxicillin 500 mg orally three times daily for 5 to 7 days (reduce to 500 mg every 12 hours at eGFR 10 to 30). Children under 12: amoxicillin 125 mg three times daily at 1 to 11 months, 250 mg at 1 to 4 years and 500 mg at 5 to 11 years.
• Tetanus toxoid 0.5 mL intramuscularly if vaccination is incomplete or the last dose was over 10 years ago, with tetanus immunoglobulin 250 IU intramuscularly (500 IU after 24 hours or heavy contamination) when status is unknown or incomplete.
• Chlorhexidine 0.12% mouthwash 10 mL twice daily for 1 week, soft diet, careful brushing, and no contact sport.
• Analgesia: paracetamol 1 g every 6 hours (maximum 4 g daily) with ibuprofen 400 mg every 8 hours with food. Children use paracetamol 15 mg/kg every 4 to 6 hours (maximum 75 mg/kg daily) and ibuprofen 5 to 10 mg/kg every 6 to 8 hours.

Monitoring. Review at 2 weeks, 4 weeks, 6 to 8 weeks, 6 months, 1 year, and yearly for 5 years, with radiographs and sensibility tests. Watch for pulp necrosis, canal obliteration, inflammatory resorption and ankylosis.

Referral and escalation. Refer to a dental trauma service or oral and maxillofacial surgery for lateral luxation, alveolar fracture or multiple injuries. Urgent referral for head injury, airway concern or contamination.