eMedicine Specialties > Emergency Medicine > Ear, Nose, & Throat

Dental, Displaced Tooth

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
Coauthor(s): A Antoine Kazzi, MD, Chief of Service, Department of Emergency Medicine, Medical Director of the Emergency Unit, American University of Beirut; Willard Peng, BA, BS, MS, Doctor of Dental Surgery Candidate, Department of Oral Medicine, University of Southern California
Contributor Information and Disclosures

Updated: Apr 7, 2008

Introduction

Background

Trauma to the teeth may result in fractures, avulsions, or displacements. Injury to primary teeth more often results in displacement of teeth rather than fractures. Maxillary and mandibular incisors are the most commonly displaced primary teeth.

Pathophysiology

A typical cause is a directed force sufficient to overcome the bond between the affected tooth and the periodontal ligament within the cradling alveolar socket. Displacement may be in the form of subluxation, intrusion into the alveolar socket, or extrusion from the socket with tearing of the apical neurovascular bundle. All these forces may lead to pulp necrosis and apical abscess formation.

Frequency

United States

Dental displacement is the most common injury to primary dentition.

International

A study conducted in Sweden showed that approximately 7% of all physical injuries involved the oral cavity. In patients aged 0-19 years, 9% of all injuries involved the oral cavity. More than 50% of physical trauma in child abuse cases occurs in the head and neck region. During the Korean War, 3000 maxillofacial injuries occurred.

Mortality/Morbidity

Trauma to the teeth is not life threatening; however, associated maxillofacial injuries and fractures can compromise the airway. Morbidity to the teeth may be individualized to primary and permanent teeth.

Almost half of teeth with luxation injuries become necrotic after 3 years.

  • Primary teeth - Failure to continue eruption, color changes, infection, abscess, loss of space in the dental arch, ankylosis, injury to the permanent teeth, abnormal exfoliation
  • Permanent teeth - Color changes, infection, abscess, loss of space in the dental arch, ankylosis, resorption of root structure, abnormal root development

Sex

Male-to-female ratio is 2-3:1.

Age

Average age of injury is variable. In youths, falls and sporting activities account for the majority of injuries. In the later teenaged years, motor vehicle collisions (MVCs) and assaults account for the majority of injuries.

Clinical

History

  • Lateral displacement: Tooth may be mobile or firm but is displaced facially or lingually.
  • Axial displacement
    • 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.
  • Constant or spontaneous pain in traumatized teeth may indicate injury to the pulp, periodontal ligament, or supporting bone.

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.
    • 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.
    • When checking displaced tooth, ensure that the soft tissue is not removed or scraped from the tooth prior to reimplanation
    • Evaluate teeth for fractures, chips, and other deformities. Embedded tooth fragments may lead to chronic infection or fibrosis.
  • Palpation
    • Evaluate if tooth is mobile or if an entire segment is mobile.
    • If possible, have patients bite down to further localize suspected area.
  • Percussion and sensitivity
    • Percuss tooth with tongue blade to evaluate sensitivity.
    • 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.

Causes

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

More on Dental, Displaced Tooth

Overview: Dental, Displaced Tooth
Differential Diagnoses & Workup: Dental, Displaced Tooth
Treatment & Medication: Dental, Displaced Tooth
Follow-up: Dental, Displaced Tooth
References
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References

  1. 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].

  2. Bakland LK, Andreasen JO. Examination of the dentally traumatized patient. J Calif Dent Assoc. Feb 1996;24(2):35-7, 40-4. [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. Gutmann JL, Gutmann MS. Cause, incidence, and prevention of trauma to teeth. Dent Clin North Am. Jan 1995;39(1):1-13. [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. Josell SD. Evaluation, diagnosis, and treatment of the traumatized patient. Dent Clin North Am. Jan 1995;39(1):15-24. [Medline].

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

  8. 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].

  9. 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].

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

  13. 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].

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Further Reading

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Keywords

teeth displaced, tooth displacement, tooth extrusion, tooth intrusion, tooth fracture, tooth avulsion, alveolar socket, subluxation, intrusion into the alveolar socket, extrusion from the alveolar socket, apical neurovascular bundle, pulp necrosis, apical abscess formation, maxillofacial injuries, maxillofacial fractures, luxation injuries, lateral tooth displacement, axial tooth displacement, chipped tooth, lateral displacement, axial extrusive displacement, Panorex, maxillary fractures, mandibular fractures, subluxation, dentoalveolar ankylosis, tetanus prophylaxis

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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, Chief of Service, Department of Emergency Medicine, Medical Director of the Emergency Unit, American University of Beirut
A Antoine Kazzi, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, California Medical Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Willard Peng, BA, BS, MS, Doctor of Dental Surgery Candidate, Department of Oral Medicine, University of Southern California
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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.

CME Editor

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, Program Director, Department of 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.

 
 
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