Lateral Luxation
Baby Teeth and Dental Trauma
In this section, we will cover:
- What is a lateral luxation?
- 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 lateral luxation?
A lateral luxation is an injury to the structures supporting the tooth in which the tooth:
- has been knocked forwards or backwards from its normal position
- is more wobbly than normal
- there may be bleeding around the gum
What should I do after the injury?
It can be very distressing if 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 your child hasn't blacked out.
If 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 salty water. If there is any bleeding, dampen a clean handkerchief in salt 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 when you first see them after the injury to make a diagnosis and as a baseline to compare future xrays against.
Not all teeth which have been diagnosed with a "lateral luxation" injury will need treatment. This decision will be based on whether the tooth is interfering with the bite.
If the tooth is not interfering with the bite, or there is only a slight interference, no immediate treatment is needed but the dentist will want to monitor the teeth. The tooth may reposition itself over the next 6 months.
If the tooth is interfering with the bite, there are two options:
- Remove the tooth (see dental extraction), or
- Gently reposition the tooth to its original position (or as close to it as possible) under local anaesthetic. If the tooth is loose, a splint (flexible metal wire) can be placed on the injured tooth and the teeth either side of it for 4 weeks to hold it in place
This treatment generally requires a high level of cooperation and is usually carried out by a dentist with experience in treating children and managing dental trauma. This will usually require an urgent referral by your dentist to the appropriate specialist service.
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
- 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
Will I need any follow up appointments?
Your dentist will want to see your child again for a clinical examination after:
- 1 week
- 6-8 weeks
- 6 months
- 1 year
If your dentist is concerned there may be long term complications, they will review the area every year until the adult tooth has erupted (come through the gum).
An x-ray is not usually needed at follow up visits unless your dentist is concerned about damage to the nerve/infection.
What should I look out for?
The long term consequences of dental trauma are unpredictable. You should monitor your child's teeth for any signs of infection.
Favourable outcome
Baby tooth:
- No pain
- Normal colour of the tooth
- Temporary darkening of the tooth to red/grey/yellow
- Tooth repositions itself to original position
- No disturbance with how the teeth bite together
Underlying adult tooth:
- Erupts at the expected time
- No discoloured patches on the crown when it erupts
Unfavourable outcome
Baby tooth:
- Pain
- Abscess on the gum
- Increased mobility (but this can be normal as the adult tooth starts to come through)
- Permanent grey discolouration of the tooth, along with one of the above signs/symptoms
- No improvement in the position of the tooth
- Disturbance with the way the teeth bite together
- Tooth is very firm in the jaw (this is called "ankylosis" which is where the bone fuses to, and replaces, the root of the tooth)
Underlying adult tooth:
- Doesn't erupt at expected time (usually 6-7 years old)
- Discoloured or thin enamel layer
What are the long term complications?
If the baby tooth becomes painful, infected or ankylosed (see "unfavourable outcome" above), it will need to be removed (see dental extraction). There will be a gap here until the adult tooth erupts at around 6-7 years old.
Treatment can be done under local anaesthetic, inhalation sedation or general anaesthetic depending on the age and cooperation of your child.
Complications with the underlying adult tooth are quite rare but can be seen in lateral luxation injuries:
- Adult tooth doesn't erupt
- Discoloured patches on enamel (hypomineralisation - find out more here LINK)
- Thin enamel (hypoplasia - find out more here LINK)
Adult tooth doesn't erupt
If the adult tooth hasn't erupted by 7 or 8 years old, your dentist will take a series of xrays to check where the tooth is and what the root looks like.
Depending on what the xrays show, your child may need one of the following surgical procedures:
- Expose and bond. (LINK)
Sometimes the tooth can be brought into the mouth through the gum. This involves a surgical procedure to uncover the tooth and braces to pull the tooth in line with the rest of the teeth. - Dental extraction.
If it is not possible to bring the tooth in line with the rest of the teeth, the tooth can be removed (see here). - Monitor the tooth without treatment.
The tooth can be left under the gum but it will need to be monitored with xrays to ensure it doesn't cause problems over time.
Discoloured patches
A knock to the baby tooth can disturb the development of the underlying adult tooth. This disrupts the formation of healthy enamel and causes discolouration.
Treatment options:
- microabrasion
- resin infiltration (for white spots)
- tooth whitening
- composite bonding
- dental veneer (more appropriate for adults)
Thin enamel
A knock to the baby tooth can disturb the development of the underlying adult tooth resulting in only a thin layer of enamel being formed.
Treatment options:
- composite bonding
- dental veneer (more appropriate for adults)