Displaced Tooth Clinical Presentation

  • Author: Lynnus F Peng, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP   more...
 
Updated: Jan 10, 2011
 

History

Constant or spontaneous pain in traumatized teeth may indicate injury to the pulp, periodontal ligament, or supporting bone.[5]

Lateral displacement

Tooth may be mobile or firm but is displaced facially or lingually.[5]

Axial displacement [5]

  • Extrusion injury: Patient may complain of mobility or malaligned teeth.
  • Intrusion injury: Patient may complain of pain; patient has malalignment or no sense of mobility. This type of displacement has the worst prognosis.[9]
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Physical

Inspection

Evaluate surrounding soft tissue area for laceration, discoloration, ecchymosis, and embedded foreign bodies (eg, chipped teeth). Use of radiographs to locate tooth fragments inside the lip is appropriate.[6, 7, 8]

In cases of tooth crown fractures, checking the lip for possible tooth fragments is important. Manual palpitation and radiographic screening of the affected lip help with detection of any foreign objects.[6, 7]

When checking displaced tooth, ensure that the soft tissue is not removed or scraped from the tooth prior to reimplanation.[6]

Evaluate teeth for fractures, chips, and other deformities. Embedded tooth fragments may lead to chronic infection or fibrosis.[6]

Palpation

Evaluate if tooth is mobile or if an entire segment is mobile.[6]

If possible, have patients bite down to further localize suspected area.

Percussion and sensitivity

Percuss tooth with tongue blade to evaluate sensitivity.[6]

Sensitivity to thermal stimuli may help to indicate status of the pulp. Lingering pain to temperature indicates irreversible pulpitis. Short duration of pain (< 5 seconds) indicates better recovery potential for the pulp.

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Causes

  • Unknown (17%)
  • Altercations (17%)
  • Contact sports (15.9%)
  • Motor vehicle collisions (10.8%)
  • Motorcycle accidents (10.4%)
  • Ice hockey (2.3%)
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Contributor Information and Disclosures
Author

Lynnus F Peng, MD  Assistant Clinical Professor, Department of Anesthesia, University of California at Irvine; Chairman of Anesthesia, Department of Surgery, St Jude Medical Center at Fullerton

Lynnus F Peng, MD is a member of the following medical societies: Alpha Omega Alpha and American Society of Anesthesiologists

Disclosure: Nothing to disclose.

Coauthor(s)

A Antoine Kazzi, MD  Chair and Medical Director, Department of Emergency Medicine, American University of Beirut, Lebanon

A Antoine Kazzi, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Willard Peng, MS  Doctor of Dental Surgery Candidate, Department of Oral Medicine, University of Southern California

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael Glick, DMD  Professor and Acting Chair, Department of Diagnostic Sciences, New Jersey Dental School, University of Medicine and Dentistry of New Jersey

Michael Glick, DMD is a member of the following medical societies: American Academy of Oral Medicine and American Dental Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Mark W Fourre, MD  Program Director, Department of Emergency Medicine, Maine Medical Center; Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP  Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

  1. Gutmann JL, Gutmann MS. Cause, incidence, and prevention of trauma to teeth. Dent Clin North Am. Jan 1995;39(1):1-13. [Medline].

  2. Josell SD, Abrams RG. Traumatic injuries to the dentition and its supporting structures. Pediatr Clin North Am. Jun 1982;29(3):717-41. [Medline].

  3. Devlin DH. A historical review of dental and facial skeletal trauma. J Calif Dent Assoc. Feb 1996;24(2):29-34. [Medline].

  4. Majorana A, Bardellini E, Conti G, Keller E, Pasini S. Root resorption in dental trauma: 45 cases followed for 5 years. Dent Traumatol. Oct 2003;19(5):262-5. [Medline].

  5. Harwood-Nuss A, Linden C, Luten R, eds. Dental injuries. In: The Clinical Practice of Emergency Medicine. Philadelphia, Pa: Lippincott, Williams & Wilkins; 1996:418-421.

  6. Bakland LK, Andreasen JO. Examination of the dentally traumatized patient. J Calif Dent Assoc. Feb 1996;24(2):35-7, 40-4. [Medline].

  7. Josell SD. Evaluation, diagnosis, and treatment of the traumatized patient. Dent Clin North Am. Jan 1995;39(1):15-24. [Medline].

  8. Flores MT, Andersson L, Andreasen JO, Bakland LK, Malmgren B, Barnett F, et al. Guidelines for the management of traumatic dental injuries. I. Fractures and luxations of permanent teeth. Dent Traumatol. Apr 2007;23(2):66-71. [Medline].

  9. Al-Jundi SH. Type of treatment, prognosis, and estimation of time spent to manage dental trauma in late presentation cases at a dental teaching hospital: a longitudinal and retrospective study. Dent Traumatol. Feb 2004;20(1):1-5. [Medline].

  10. Robert JR, Hedges JR. Emergency dental procedures. In: Clinical Procedures in Emergency Medicine. Philadelphia, Pa: WB Saunders Co; 1991:1045-1064.

  11. Rosen P, Barkin R. Dental emergencies. Emergency Medicine Concepts and Clinical Practice. Vol 3. 3rd ed. St Louis, Mo: Mosby-Year Book; 1992:2381-2398.

  12. Krasner P, Rankow HJ. New philosophy for the treatment of avulsed teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. May 1995;79(5):616-23. [Medline].

  13. Trope M. Protocol for treating the avulsed tooth. J Calif Dent Assoc. Mar 1996;24(3):43-9. [Medline].

 
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