Tooth is mobile 1 of 2 Subluxation of Permanent Teeth

Tooth is mobile 1 of 2 Subluxation of Permanent Teeth

Subluxation

Description	An injury to the supporting structures of teeth that results in increased tooth mobility and sulcular bleeding, but does NOT displace the tooth.
Visual signs	The tooth does not appear displaced, but sulcular bleeding is noted.
Percussion test	Tender to percussion.
Mobility test	Increased mobility of tooth.
Cold test and electric pulp test	A positive pulpal response will be noted in about 50% of cases. Pulp testing may yield a lack of pulpal response, indicating transient pulpal injury. The pulpal response should be monitored until a definitive diagnosis can be made (up to 6 months). Testing is important for assessing the risk of healing complications. A negative response at the initial examination indicates an increased risk of future pulp necrosis.
Radiographic findings	No radiographic abnormalities apparent.
Recommended radiographs	Occlusal and periapicals (straight and angled 20° to the mesial or distal aspect for posterior teeth). The radiographs are used when ruling out tooth displacement or root fracture.

Management

Typically, there is no need for treatment beyond pulpal evaluation. However, a flexible splint may worn for 2 weeks in cases of a tooth with class II mobility

• Clean the area with saline 
• Place a flexible splint for 2 weeks making sure that the splint is not next to the gingiva.

Patient Instructions

• Eat soft foods for 1 week.
• Brush teeth with a soft bristled toothbrush after each meal.
• Use a chlorhexidine (0.12 %) mouth rinse BID for 1 week.

Follow-up Care

• Splint removal, clinical, and radiographic examination at 2 weeks.
• Clinical and radiographic examination at 6-8 weeks and 1 year.

References

1. Andreasen FM, Andreasen JO. Concussion and subluxation. In: Andreasen JO, Andreasen FM, Andersson L, (eds.). Textbook and Color Atlas of Traumatic Injuries to the Teeth (4th ed.). Oxford, Blackwell 2007.
2. Andreasen FM, Vestergaard Pedersen B. Prognosis of luxated permanent teeth – the development of pulp necrosis. Endod Dent Traumatol 1985; 1: 207–220.
3. Andreasen JO, Andreasen FM, Bakland LK, Flores MT. Concussion. Traumatic Dental Injuries. A Manual. Oxford: Blackwell/Munksgaard Publishing Company. 2003.40-41.
4. Diangelis AJ, Andreasen JO, Ebeleseder KA, Kenny DJ, Trope M, Sigurdsson A, Andersson L, Bourguignon C, Flores MT, Hicks ML, Lenzi AR, Malmgren B, Moule AJ, Pohl Y, Tsukiboshi M.International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dent Traumatol 2012; 28: 66-71.
5. DiAngelis AJ, Andreasen JO, Ebeleseder KA, Kenny DJ, Trope M.International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dent Traumatol. 2012, 28:2-12
6. Moorrees CF, Fanning EA, Hunt EE. Age variation of formation stages for ten permanent teeth. J Dent Res 1963; 42: 1490-1502.

Subluxation

Description	An injury to the supporting structures of teeth that results in increased tooth mobility and sulcular bleeding, but does NOT displace the tooth.
Visual signs	The tooth does not appear displaced, but sulcular bleeding is noted.
Percussion test	Tender to percussion.
Mobility test	Increased mobility of tooth.
Cold test and electric pulp test	Pulp vitality testing is not considered to be reliable in primary teeth.
Radiographic findings	No radiographic abnormalities apparent.
Recommended radiographs	Occlusal radiographs are suggested in order to screen for displacement, root fracture, or interaction with the permanent succedaneous teeth below.

Management

No treatment needed.

Patient Instructions

• Eat soft foods for 1 week.
• Brush teeth with a soft bristled toothbrush after each meal.

Follow-up Care

• Clinical and radiographic examination at 1 week, 6-8 weeks, and 1 year.
• Guardians should be informed that children may not complain about pain although an infection may be present, so they should watch for signs of gingival swelling and to make an appointment swelling is noted.

References

1. Borum MK, Andreasen JO. Sequelae of trauma to primary maxillary incisors. I. Complications in the primary dentition. Endod Dent Traumatol 1998; 114: 31-44.
2. Flores MT. Traumatic injuries in the primary dentition. Review. Dent Traumatol 2002;18:287-298.
3. Malmgren B, Andreasen JO, Flores MT, Robertson A, DiAngelis AJ, Andersson L, Cavalleri G, Cohenca N, Day P, Hicks ML, Malmgren O, Moule AJ, Onetto J, Tsukiboshi M. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition. Dent Traumatol 2012; 28:174-82.