Subluxation
Adult Teeth and Dental Trauma
In this section, we will cover:
- What is a subluxation?
- What should I do after the injury?
- Will I need treatment?
- What can I do to help the area heal at home?
- Will I need any follow up appointments?
- What should I look out for?
- What are the long term complications?
What is a subluxation?
A subluxation is an injury to the structures supporting the tooth after which the tooth is:
- still in its original position
- slightly wobbly
- there may be bleeding around the gum
What should I do after the injury?
It can be very distressing if you or your child has suffered trauma to the teeth. The first thing to do is not panic.
Dental trauma is very common and there are a few steps you can follow to get the best outcome after the injury.
You should:
- Take a second to collect yourself and check you/your child hasn't blacked out.
If you/your child has hit their head and you think they may have lost consciousness (even for a few seconds) or they feel nauseous or dizzy, you should get this checked out by your doctor or local A&E department to rule out a concussion (head injury). - Call your dentist as soon as possible so they can arrange to check the teeth and provide any necessary treatment.
- If there are any cuts in or around the mouth, clean them with warm water. If there is any bleeding, dampen a clean handkerchief in water and press it firmly on the bleeding area.
- If the injury happened in a place thought to be unclean, and there has been a cut to the skin/lip/gum, you should check all tetanus vaccinations are up to date with your GP. You may need a tetanus booster vaccination.
Will I need treatment?
Your dentist will take an xray to check there are no other injuries to the teeth and to compare any future xrays against.
Teeth which have suffered from a subluxation usually do not need any immediate treatment but they will need to be monitored for signs of infection (see below). You should also follow the advice on how to help the area heal at home (see below).
If the tooth is very loose or tender, a splint (flexible metal wire) can be placed on the injured tooth and the teeth either side of it for 2 weeks to make it more comfortable for you (although the wire can be irritating itself!).
If there are any injuries to the soft tissue, you can see here for more information.
What can I do to help the area heal at home?
To help the area heal at home, you should:
- Brush the teeth after every meal with a soft toothbrush
- Gently brush the injured area to prevent build up of plaque
- Carry out salt water or alcohol-free chlorhexidine mouthwash (corsodyl) twice a day.
For a young child who isn't able to use a mouthwash, use a cotton swab/handkerchief moistened in salt water or alcohol-free chlorhexidine mouthwash (Corsodyl) to clean the gum twice a day - Have a soft diet
- Take medicine to help manage any discomfort (ibuprofen or paracetamol)
- Avoid contact sports
- Don't smoke
Will I need any follow up appointments?
Your dentist will want to see you/your child again for a clinical examination and xray after:
- 2 weeks (the splint will be removed at this appointment)
- 12 weeks
- 6 months
- 1 year
X-rays are taken to assess how the root of the tooth is developing and to identify any complications with healing.
What should I look out for?
The long term consequences of dental trauma are unpredictable. You should monitor your/your child's teeth for any signs of infection.
Favourable outcome
- No pain
- Normal colour of the tooth
- Temporary darkening of the tooth to red/grey/yellow
Unfavourable outcome
- Pain
- Abscess on the gum
- Increased mobility
- Permanent grey discolouration of the tooth, along with one of the above signs/symptoms
What are the long term complications?
The long term consequences of dental trauma are unpredictable. You should monitor your/your child's teeth for any signs of infection (see "unfavourable outcome" above).
Long term complications are rare in teeth which have a "subluxation" but may include:
1) Nerve damage
- A) Nerve dies causing pain and infection. The tooth may look grey/brown and be tender to bite on. This can be managed with root canal treatment. Once the tooth has been treated, it can be whitened to improve the appearance. You can find about more about tooth whitening here.
- B) Root canal constricts as more dentine is formed (find out more about tooth anatomy here). This is called "pulp canal obliteration". The tooth may look more yellow or brown. This doesn't need any treatment unless the nerve dies. If the nerve dies, you may need to see a specialist endodontist for root canal treatment. If you are unhappy with the colour of the tooth, you can consider a course of tooth whitening.
- C) Tooth starts to "dissolve" from the inside out. This is called "internal inflammatory resorption". The tooth may have a pink-ish tinge to it. This can usually be managed with root canal treatment if detected early. Sometimes, the tooth will have to be removed (see dental extraction).
2) Damage to outer surface of root
- Outer surface of the root starts to "dissolve" away due to infection. This is called "external inflammatory root resorption". Root canal treatment should be started immediately to try to stop it progressing. Your dentist may also choose to refer you to a specialist children's dentist (paediatric dentist) or root canal specialist (endodontist) to continue treatment.
3) Abnormal root development
- This is more relevant if the injured tooth has erupted in the last 3 years, as the root is still growing.
- If the nerve dies, the root stops growing. This means the tip of the root is left wide open. It can be managed with root canal treatment and a special material called "MTA", which is a bit like a cement. MTA is used to "plug" the hole at the tip of the root during root canal treatment. This is a treatment which is usually only carried out by a specialist children's dentist (paediatric dentist) or endodontist (root canal specialist).