History
Constant or spontaneous pain in traumatized teeth may indicate injury to the pulp, periodontal ligament, or supporting bone. [7]
Lateral displacement
Tooth may be mobile or firm but is displaced facially or lingually. [7]
Axial displacement [7]
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Extrusion injury: Patient may complain of mobility or malaligned teeth.
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Intrusion injury: Patient may complain of pain; patient has malalignment or no sense of mobility. This type of displacement has the worst prognosis. [8]
Physical Examination
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. [9, 10, 11]
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. [9, 10]
When checking displaced tooth, ensure that the soft tissue is not removed or scraped from the tooth prior to reimplanation. [9]
Evaluate teeth for fractures, chips, and other deformities. Embedded tooth fragments may lead to chronic infection or fibrosis. [9]
Palpation
Evaluate if tooth is mobile or if an entire segment is mobile. [9]
If possible, have patients bite down to further localize suspected area.
Percussion and sensitivity
Percuss tooth with a tongue blade to evaluate sensitivity. [9]
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.
