Sinusitis

Impacted tooth dislocation in a child. Who came across it? Subluxation of primary teeth

Tooth dislocation is a collective term, an injury characterized by a violation of the integrity of the periodontal ligament and displacement of the tooth in space. According to how the displacement occurs, dislocations are classified: complete, incomplete, impacted. What are the causes and symptoms of various tooth dislocations in children and adults, is it possible to save a tooth, and how to provide first aid? What treatment do dentists offer, and what complications can you expect?

Table of contents:

Causes and risk factors for tooth dislocation

It is not difficult to assume that the cause of such injuries can be a wide variety. But, nevertheless, statistical patterns can be traced.

If we consider a group of adults, the most common causes are: road accidents, fights, sports and extreme hobbies. Moreover, these reasons prevail in one age group or another.

If we talk about children, the main reason is the uncontrollable desire to explore the world.

Please note

The British Dental Association analyzed all the causes that lead to injuries to the dental system in children and identified the most common: falls, careless handling of objects, and high-impact sports. Less commonly, children are injured by violence, both in the family and at school.

Regardless of age, a predisposing factor for the development of injuries is especially when it comes to protrusion of the incisors, when they are pushed forward and located at an angle. The risk of injury depends on this angle: the chances increase several times.

But no matter what causes the injury, you need to be able to act correctly and provide first aid, which will help save the tooth and return it to its place.

Incomplete tooth luxation

Incomplete luxation is a tooth injury characterized by displacement of the tooth relative to its center line. Visually, the tooth moves, extends to varying degrees beyond the boundaries of the dentition, and can rotate around its axis. Clinically, even incomplete tooth luxation is characterized by rupture of the periodontal tissues that hold the tooth in place. A rupture of the neurovascular bundle, the dental pulp, which is more often called the “nerve,” may occur.

When the pulp ruptures, after some time (from several days to several weeks), the tooth becomes pink. This coloration can be explained by the saturation of the dentinal tubules with blood. Since the enamel is translucent, the tooth does not appear red, but only pink.

Sometimes, especially if the tooth is rotated around its axis, the pulp retains its vitality and is not injured.

If we consider real patient requests, incomplete dislocation of teeth is often accompanied by other injuries: crowns or chips of enamel at various levels, which can complicate treatment and increase the number of consequences and long-term complications.

Symptoms of incomplete tooth luxation

The first symptoms of a tooth injury will be not only in the tooth, but also in the injured area. Swelling and hematoma quickly form, and localized bleeding may occur from the gums in the area of injury.

The pain does not go away for a long time, but its intensity gradually decreases. Characteristics of pain: acute, tearing, throbbing, obsessive, may intensify with the action of irritants: when pressing on a damaged tooth.

Due to the fact that most often injuries are formed within the anterior group of teeth, soft tissue injuries can occur - ruptures, bruises, hematomas.

Patients come to the appointment with significant swelling of the lip and gums in the area of the injury, and hematomas. When examining the oral cavity, the dentist may see different symptoms:

rotation of the crown around its axis;
tilt to one side.

When examining the gums, swelling, cyanosis, a forming hematoma, and rupture of soft tissue are noticeable. Palpation of the injured area brings pain and a lot of discomfort.

Necessary research

Incomplete dislocation is often accompanied by other types of injuries that also need to be diagnosed and treated. Therefore, visual research methods are mandatory.

Displacement of the tooth crown may be accompanied by a fracture of the crown or root at various levels. If the fracture line occurs behind the gums, the dentist may not notice it. Diagnosis is complicated, since the pain that appears is associated with the main injury, and not with a root fracture.

The basis of diagnostics is targeted . Using the image, the doctor can exclude or confirm a fracture, assess the condition of the root and periodontal tissues. Based on the data obtained, a treatment plan is drawn up.

Of particular importance is the study of children during the period of mixed dentition, when milk teeth are replaced by permanent ones. Injuries to primary teeth can cause damage to the buds of permanent teeth and their subsequent loss.

Depending on the clinical situation, dentists may prescribe additional tests.

First aid

First aid consists of irrigating soft tissue lacerations and thoroughly examining the oral cavity. If the injury was sustained by a child, parents can apply ice. These actions will help reduce pain and swelling. After which you need to immediately seek help from a dentist: the sooner the better!

After examination and research, the doctor develops treatment tactics in each specific case.

Treatment of incomplete tooth luxation

The list of therapeutic procedures depends on the specific clinical picture and associated problems. Treatment for incomplete dislocation involves repositioning the tooth, that is, returning it to its place.

Due to damage to periodontal tissue, the tooth may become mobile, which requires it to be fixed using splinting.

Please note

Which method of tooth fixation to choose will depend on the condition of the oral cavity and associated symptoms and complications. These can be isolated splints for several teeth or full splints for the entire jaw.

The splints are installed for a period of several weeks, this time is enough to restore periodontal tissue and fix the tooth in its place. But the treatment does not end there. Afterwards, even if the tooth pulp remains alive and the tooth is not affected by caries, it must be depulped.

Depulpation– removal of the dental pulp followed by... When depulping a tooth after an injury, dentists use a method that allows you to get rid of the pink tint.

After treatment and root canal filling, all patients are registered at the dispensary with regular visits to the doctor according to the schedule.

This treatment tactic is applicable only in the case of isolated incomplete dislocation, which is not accompanied by other complications. For concomitant injuries, treatment tactics are determined by the patient’s condition:

combined soft tissue injury: primary surgical treatment, suturing if necessary;
tooth crown fracture: tooth reposition, root filling and restoration of lost tissue;

root fracture: treatment tactics depend on the level and complexity of the fracture. For minor fractures, canal filling and conservative treatment methods can save the tooth. If the fracture is complex, the tooth must be removed.

Possible complications

Even with all the treatment, the risks of complications remain. The most common ones include:

inflammatory complications in the periodontium, up to the formation of cysts;
complications after a root fracture: growth of periodontal tissue into the fracture line, which is accompanied by pain and subsequent tooth extraction. The same complications threaten if you refuse to depulpate the tooth; the pulp penetrates along the fracture line, which threatens with inflammatory complications;
formation . This is a long-term complication that may appear even after several years;
the formation of a local form with loss of bone tissue, exposure of the neck of the tooth, increased sensitivity of the teeth, and tooth mobility.

To avoid all possible consequences, regular dental examinations and monitoring of periodontal tissue restoration and healing are recommended for all patients. Doctor's examinations 3-4 times a year and control images will allow you to notice complications in a timely manner and stop them.

Impacted tooth dislocation

Impacted dislocation is one of the types of complete dislocation, when an impact force acts on the crown of the tooth, which leads to the root being pushed deep into the jaw. This tooth displacement is accompanied by perforation of the alveoli and penetration of the root into the deep layers of bone tissue. Simply put, the tooth was driven inside.

With such dislocations, which vary in severity, the tooth pulp always ruptures, and not only periodontal tissue is damaged, but also bone tissue. These injuries determine the symptoms and possible complications.

Symptoms of impacted tooth dislocation

Statistics show that the most common causes of impacted dislocation are fights and sports injuries. Oddly enough, road accidents are the least likely cause of impacted dislocations. Such data applies to all age groups.

The first symptom of an impacted dislocation is acute, shooting pain. Patients literally feel the tooth sink deeper. Such a dislocation is accompanied by injuries to the face, lips, etc.

During a general examination of the patient, swelling of the injured area, abrasions, and hematomas are noted. In the oral cavity:

gum rupture;
swelling, hematoma;
the injured tooth is shorter than the others;
bruises.

Involved dislocation is often combined with other injuries: crown fracture, enamel chips to varying degrees, and less commonly, a root fracture occurs. These associated injuries make the symptoms more varied.

Necessary research

The dentist can make a diagnosis after a thorough examination of the mouth and teeth. But to determine the extent of treatment, as well as to exclude concomitant injuries, visual research methods are needed - radiography or CT.

CT is the most informative method, allowing the dentist to examine even small details of the fracture and assess the condition of the compact lamina and bone tissue. Based on the data obtained, doctors draw up a treatment plan.

First aid

Impacted tooth dislocation is a serious injury associated with head impacts. When assessing the patient's condition and the amount of first aid required, the severity of the injuries must be taken into account and the patient's condition must be assessed. Initially, doctors rule out a brain contusion.

Having excluded, they begin to treat soft tissue wounds - they need to be rinsed with running water and a sterile bandage applied. Afterwards, you should seek help from doctors: an emergency room, a maxillofacial surgery hospital, or a dental surgeon’s office.

The patient’s condition determines where exactly the treatment will take place: a clinic or a hospital.

Treatment of impacted tooth dislocation

The diet should consist of liquid and semi-liquid dishes that do not require biting or prolonged chewing. Chewing pressure on an injured tooth can cause complications. The diet should be varied and complete.

Dentists can “switch off” a tooth from the bite by “cutting down” a small area of enamel. Thus, the tooth will not come into contact with teeth, thereby reducing the risk of complications.

Fixation of an injured tooth can be done in several ways:

tying with a ligature in the shape of an infinity sign. Can only be used on permanent teeth and only if there are 2-3 firmly standing teeth nearby;
bus-bracket: tape or wire. The damaged tooth is “tied” with 2-3 adjacent ones on both sides. This method can only be used in adults or children with permanent dentition;
splint-guard – a temporary individual construction made of plastic, fixed to several adjacent teeth after repositioning the injured tooth;
dento-gingival splints. They can be used in children, even during the period of mixed dentition, and in adults, even if there is not a sufficient number of supporting teeth. Tire material: plastic;
wire arches and filling. Bonding stable adjacent teeth using a ligature and filling material.

Tires are installed for a period of several weeks. Afterwards, the tooth must be depulped, which is a prerequisite! The tooth pulp has died and it is only a matter of time before acute inflammation forms. After filling the canals, patients are prescribed a number of physical procedures and a schedule of preventive examinations

In the presence of concomitant injuries, treatment tactics may change and be supplemented:

fracture of the coronal part - depulpation occurs immediately, the dentist closes the sensitive dentinal tubules, and complete restoration occurs after removing the splints;
root fracture: the dentist individually decides on the feasibility and possibility of saving the tooth;
combined soft tissue injuries are treated immediately. For ruptures of the frenulum of the upper lip, surgical debridement and suturing are recommended.

Injury to the cancellous bone, as well as the compact lamina, requires close attention from dentists and regular preventive examinations, allowing timely detection of a number of complications. The visiting schedule depends on the patient's age.

Possible complications

The most serious complication that can appear after a long time is necrosis of bone tissue in the area of the injured tooth. In elderly patients with chronic heart and vascular diseases, the risk of bone tissue necrosis is increased several times.

In addition, pathogenic flora can penetrate the periodontal tissues through an open wound. Pushing tartar inside – into the tooth socket – is especially dangerous. Inflammation can manifest itself after a long time in the form of a localized form of periodontitis, even an aggressive course, and can also lead to the formation of dental cysts.

Taking into account all the risks and possible consequences, patients with chronic diseases of internal organs, an unsanitized oral cavity and significant dental plaque are recommended to take a course, as well as a number of procedures that will help restore bone tissue and avoid serious complications.

Please note

In 32% of cases, despite all the efforts of doctors and dentists, a tooth after an impacted dislocation has to be removed. Statistics show that these are usually patients with diabetes mellitus, heart and vascular diseases, as well as initial forms of dystrophic changes in the bone tissue of the alveolar process and the jaw itself.

Complete dislocation of teeth

Complete luxation or avulsion is the loss of a tooth as a result of an impact. Simply put, the tooth was knocked out, but the root and crown part remained intact. Statistics show that the most common cause of complete dislocation is direct blows to the face in fights, as well as road accidents.

Complete dislocation, in addition to complete tooth loss, is characterized by a number of concomitant injuries: rupture of periodontal tissue, fracture, fracture of the tooth alveolus, perforation of the bottom of the socket. These circumstances explain the impossibility of fixing the tooth without additional manipulations.

Contrary to popular belief, the loss of a tooth does not mean that it is irreversible - it can be restored in the bite. The main thing is to act quickly and correctly.

Symptoms of complete tooth dislocation

Due to the fact that a complete dislocation is never a localized injury, the first place among the symptoms comes from blows to the head: severe pain or disturbances in consciousness, nausea, vomiting, swelling and bleeding from both the oral cavity (socket of the extracted tooth) and other impact sites.

The pain is sharp, tearing, pulsating, spreading far beyond the boundaries of the lost tooth; neighboring ones can also be injured. At a dentist's appointment, patients may have a combination of different types of dislocations on different teeth or fractures of the crown of a part within varying limits.

On examination, an empty tooth socket, a clot formed in it, a violation of the integrity of the gum, swelling and the formation of a hematoma are noticeable.

Combined trauma makes symptoms more varied:

rupture, abrasions of the face and lips;
when the alveolar process is fractured, even visually, the fracture line is noticeable, its integrity is compromised, mobility and significant swelling are determined;
with jaw fractures, the patient cannot fully open his mouth, severe pain is typical, and simple dental tests suggest a diagnosis;
dislocation of the jaw and damage to the temporomandibular joint leaves no chance for full opening of the mouth and can cause severe facial asymmetry.

Necessary research

The list of studies is determined by the patient’s condition. Often, a dental examination is not the first thing, especially if the injury was caused by an accident.

During a visual examination, the dentist assesses the condition of the socket, the alveolar process of the jaw, and evaluates the function of opening and closing the mouth. It is necessary to examine 2-3 adjacent teeth for injuries and mobility.

Mandatory research methods include radiography, but the most informative will be CT or MRI.

Using the photographs, the dentist evaluates the condition of the periodontium and bone tissue of the alveolar process. In addition to targeted photographs, it is also necessary to take a photograph of the entire maxillofacial area. A careful study of the results obtained and the data of dental tests will allow you to make a correct and accurate diagnosis, as well as not to miss other injuries.

Based on the data obtained, a treatment plan is drawn up. Doctors are primarily concerned with treating a condition that may threaten the life or health of the patient.

First aid

After an injury, it is necessary to find the knocked out tooth and place it in a nutrient medium. The most acceptable nutrient media include:

own saliva. If the patient is old enough, the knocked out tooth can be placed behind the cheek. Such actions are feasible only if there is no risk of loss of consciousness or even impairment;
saline;
less acceptable nutrient media include water or milk. But they can be used as temporary ones until it becomes possible to move the tooth.

To carry out the reimplantation operation, that is, returning the tooth to its place, you must appear in the dentist’s office no later than 72 hours after the injury. But the sooner the better.

Tissue restoration and regeneration processes in the socket of a knocked out tooth are carried out quite quickly! To avoid complications, you need to get to the dentist as quickly as possible!

Having placed the tooth in a nutrient medium, you need to take care of the victim itself:

rinse the wounds of the face and lips with running water;
apply cold to the injured area;
If bleeding from the socket of an extracted tooth does not stop within a minute, you need to twist a gauze roll (sterile) and bite it. The pressure applied by the roller will help a blood clot form and stop bleeding.

If the bleeding does not stop, despite all the measures taken, you must immediately go to the nearest maxillofacial surgery hospital or call an ambulance.

How does reimplantation occur?

The reimplantation operation occurs in several stages and is performed on an outpatient basis. First, the dentist depulps the knocked-out tooth, fills the canals, and “cuts down” the root tip (resection).

This is followed by the stage of surgical treatment of the hole - removal of the formed clot, assessment of the condition of the alveoli, reimplantation of the knocked out tooth. It is recommended to suturing the edges of the gums to additionally fix the tooth in its place, as well as stop bleeding.

The final stage of reimplantation is the application of splints or ligatures to immobilize the tooth and distribute the chewing load.

Fixation of the tooth with retaining structures lasts 4-8 weeks. The exact timing is determined by the patient’s age and the presence of concomitant injuries.

Tooth engraftment can be carried out in several types, which can only be determined after 4-6 weeks:

primary intention is the most favorable option; periodontal tissues remain viable, which eliminates possible complications;
bone fusion is the most unfavorable option, characterized by complete death of periodontal tissue;
mixed.

The type of tooth engraftment determines the number of complications, treatment and fate of the reimplanted tooth.

When is a tooth impossible to restore?

There are a number of situations when it is impossible to restore a lost tooth . Contraindications to tooth replantation include:

violation of the integrity of the tooth: visible root cracks, or the absence of one of them;
anti-inflammatory drugs;
multivitamins and calcium supplements;
keratoplasty to restore soft tissues and heal the socket of a dislocated tooth.

Please note

Dentists also adjust the diet. It is recommended to exclude spicy, salty and sweet foods. All dishes should be of liquid or semi-liquid consistency, at room temperature.

During the recovery stages, a number of physiotherapy procedures are prescribed to allow damaged periodontal and bone tissue to recover.

Preventive examinations should be regular and carried out according to schedule: the next day after fixing the tooth, on the 3rd, 7th, 10th day. Afterwards, the schedule is determined individually.

The dentist not only visually examines the condition and healing of the tooth socket, but also evaluates the condition of periodontal and bone tissues by studying X-ray photographs.

Possible complications

One of the most common complications after tooth reimplantation surgery is tooth rejection, complete death of periodontal tissue, and loss of bone tissue. Therefore, the tooth must be removed.

Loss of a reimplanted tooth is recorded in 28% of cases. In 43% of patients, several years after surgery, the process of root resorption, that is, its resorption, is noted. Its resorption explains the formation of tooth mobility of varying degrees of severity.

It is also possible for an infection to enter the socket of a dislocated tooth, especially if patients have a number of chronic diseases and the functioning of the immune defense is reduced. Otherwise, complications after complete tooth dislocation are associated with concomitant injuries.

Alena Paretskaya, doctor, medical columnist

Tooth dislocation is one of the most common injuries of the maxillofacial apparatus. This term refers to the displacement of a tooth in the socket under mechanical influence. It can be displaced in both vertical and horizontal directions; the nature of the injury depends on the direction of the traumatic force. Most often, the frontal teeth of the upper jaw are subject to such damage, and a little less often the lower teeth of the same area.

Causes of dislocation

The most common cause of dislocation of the frontal incisors is blows to the face. This problem is mainly addressed to the doctor by athletes involved in martial arts, as well as parents with children who have received this injury. Dental injuries in children are not uncommon, no matter how hard parents try to protect their child from all adversity, they still happen, so if something happens, don’t wait, don’t think that everything will go away on its own, contact a specialist, otherwise, if you leave everything to chance, you can lead to complications from the injury.

How to determine a dislocation

Tooth luxation has 3 types:

Complete dislocation;
Incomplete;
Hammered.

Determining whether a tooth is dislocated is very simple; you need to examine the jaw. If you are dealing with an incomplete dislocation, then the tooth will be in its place, but slightly shifted to one side, and the chewing function will be impaired. Also, the incisor may wobble, and there is a sharp pain when chewing. Swelling or tearing of the gums are also clear signs of a luxation. Concomitant lip injuries are quite common.

Possible complications with incomplete dislocation:

Root shortening;
Expansion of the hole;
Stopping root growth;
Development of a root cyst.

When an impacted, dislocated incisor sinks into the gum, if you are faced with this disease, then most likely, in addition to the tooth itself, the tissues that hold it and the jaw tissues are injured.

With this type of injury, patients complain that the crown has either become smaller, that is, it comes out of the gum differently than usual - it is shorter, or, on the contrary, protrudes more. There are also particularly severe cases when the crown is not visible at all. During the examination, the doctor sees only the cutting part of the tooth. Bleeding and rupture of the gum mucosa also occur.

Complete dislocation of a tooth is characterized by the fact that the incisor falls out when injured; this is due to the fact that the tissue of the circular ligament ruptures due to a strong blow to the crown. Whatever tooth dislocation you or your child suffers, you need to seek help from a doctor as soon as possible. The fact is that even if the incisor falls out, but it is intact, that is, the crown and root are preserved, it can be restored to its place (replanted). The main thing is to save it and try to get an appointment within 40 minutes, maximum, an hour.

Bruise or subluxation

A bruise, or, as I also call it, a subluxation, is also a type of dental injury. With such damage, there is no significant mobility of the tooth; there is also no displacement; even if there is mobility, it still remains in its place. In this case, the ligament that surrounds the crown of the incisor and holds it in place is damaged. Because of this injury, children may complain of pain when chewing food. There is a slight swelling or bruise in the injured area, but there is usually no blood.

First aid and actions to help save a tooth

Since tooth dislocations in children occur more often than in adults, we will consider the whole process using their example. Immediately after an incident where a child may have suffered a dislocation of a tooth, inspect the mouth for bleeding, as this is the first sign of a complete and impacted dislocation. If you find an impacted dislocation, under no circumstances try to put pressure on the damaged area, as this will definitely not help. It is best to apply something cold through the cheek or lip for such an injury, this will help stop the bleeding. In the case of complete dislocation, it is necessary to apply a pressure bandage to the affected area. Take a sterile gauze swab, never cotton wool, and press it onto the area where the blood is flowing for 10-15 minutes.

It is also important to properly preserve the knocked-out incisor in case of complete dislocation. You need to take a clean cloth, moisten it with water and wrap it around the tooth. When you arrive for your appointment, the doctor will independently perform antibacterial treatment and perform recovery surgery.

Methods for treating incomplete dislocation

Treatment of incomplete dislocations is carried out in several ways:

After completing one of the fixation methods, the tooth is removed from occlusion, that is, it is filed down a little so that it does not participate in chewing. This is done to reduce the likelihood of repeated displacement into the wrong position if the fixation was not done well enough. Further, during the recovery process, the doctor monitors the vital activity of the pulp during periodic examinations.
If you went to the doctor late, and the tooth has already settled into its new position, you can restore its normal state using special orthopedic methods.

Treatment of complete dislocation

First of all, the doctor you contact will examine the hole, assess its integrity and determine priority tasks. For these purposes, an X-ray examination is carried out, which allows us to fully study the free space in the hole and how injured it is.

Indications for replantation depend on many criteria:

Age of the patient;
Which tooth was lost: baby or molar;
Hole condition;
How formed is the root;
Integrity of root and crown.

Replantation is the process of restoring a lost tooth to its socket. There are 2 ways to carry out this operation: delayed and immediate. In the first case, the dislocated incisor is examined for the possibility of restoration, washed, placed in saline solution, and temporarily stored in the refrigerator. After some time, it is cleaned, trepanned, sealed and the final stage of installation in place is carried out. In the second method, the tooth is immediately trepanned, the root canal is filled and surgery is performed.

The entire replantation process can be divided into several stages:

Tooth preparation;
Preparing his hole;
Replantation;
Treatment after surgery, monitoring the dynamics of engraftment.

Treatment of impacted dislocation

With such an injury, treatment is selected strictly individually, and be prepared for the fact that it will be complex and lengthy. First of all, the doctor, as usual, assesses the condition and degree of damage to the socket and bone tissue of the jaw. Most often, the specialist chooses a delay, that is, he waits to see how the tooth behaves; if it is a milk tooth, then spontaneous protrusion is most often observed. The child must be taken to an appointment every month.

The doctor monitors how the bone tissue is restored. If a baby tooth is dislocated, the molar rudiment is examined for damage; if advancement does not occur, the first one is simply removed. The fact is that extension is possible only if the cutter has been driven in no more than halfway. When treating molars, the doctor can offer 2 options: spontaneous gradual advancement or removal followed by replantation.

Why are injuries dangerous?

The main danger of dental trauma in children of this nature is not the loss of a baby tooth, God be with him, the root one will come out, but the fact is that the permanent one, in the event of such an injury, may not come out completely healthy. The reason is that the child already has the rudiments of molars from infancy, they simply make themselves felt only by the age of 5-6 years. They remain in the body of the jaw and begin to erupt with age, pushing out the milk teeth. During the period of preparation of the child’s body for the change of teeth, the milk roots begin to dissolve, thereby freeing up space for the growth of the primary “changers”.

The rudiments of molars, already by the age of six years, come close to the milk teeth, and if an impacted dislocation occurs, there is a high probability that the molar will be damaged. With complete dislocation, the rudiment is not injured, but there is a risk of enamel chipping.

Damage to the rudiments of molars is a serious matter and can result in the development of inflammatory processes. Inflammation can lead to ostiomelitis of the jaw - this is inflammation of the bone tissue. This disease requires complex surgical treatment, so protect your children from dislocations at an early, and not only, age. Sometimes, when baby teeth are dislocated, molars appear with minor injuries, but this is easy to treat, the main thing is to notice the defect in time. If a tooth dislocates, take your child to the doctor; it’s better to be safe.

Some authors identify the following types of dental trauma: bruises, subluxations and partial or complete dislocations. There is no consensus regarding the differences between these terms. Different authors use different definitions. Below, the terms contusion, incomplete dislocation and complete dislocation will be used, as they are adequate for clinical differentiation and treatment of traumatic injuries.

A bruise is damage to a tooth and its fixing apparatus without displacement of its position in the alveolus. The most noticeable clinical manifestation of a contusion is significantly increased sensitivity to percussion. Although no obvious displacement is observed, mobility may occur.

An incomplete luxation is an injury in which a tooth moves out of its position in the socket. If there is any change in the normal position of the tooth in the socket, the condition is considered partial luxation.

Complete luxation is the complete loss of a tooth from its socket.

Traumatic injury to the tooth most likely causes obstruction of the major pulp vessels at the apex. Subsequently, blood escapes with expansion of the pulp capillaries. After stagnation in the capillaries, their degeneration occurs with the release of red blood cells and pulp edema. Due to the lack of collaterals in the pulp, only a small inflammatory response to injury develops and partial or complete pulpal infarction may occur. With little or no blood flow, the pulp may remain in this state for many months or years. With transient bacteremia, microbes can penetrate through small vessels of the root apex into the infarcted pulp tissue and settle in it.

The infection that develops as a result may be the first clinical sign of pulp necrosis. Stanley noted that in some cases the heart attack is not total. Several vessels continue to function and transport fresh blood to the pulp areas. These areas will remain alive. If pulp tests are negative, but there is tender tissue in the pulp cavity and bleeding from deeper areas, the remaining blood flow is supporting some nerve fibers. It appears that infarcted tissue blocks thermomechanical receptors, thus preventing the passage of stimuli received through enamel and dentin.

This means that if trauma to the tooth and pulp is minimal, short-term pulp ischemia can cause the development of reversible superficial infarcts. This may explain the restoration of positive pulp reactions after a few weeks.

With minimal displacement of the tooth from the socket, it will be slightly mobile and sensitive to percussion and pressure when biting. Due to damage to the periodontal ligament, slight bleeding may occur from the dentogingival sulcus. X-ray may reveal thickening of the periodontal fissure. This tooth will probably not need splinting. If there is any doubt about the need for splinting, it should be performed.

There is evidence that the combination of mobility with other tooth damage significantly increases the incidence of pulp necrosis. Fractures of crowns without contusion or the occurrence of mobility cause pulp necrosis in 3% of cases. However, in fractures with bruises, the incidence of necrosis increases to 30% or more.

If there are obvious clinical or radiological signs of tooth displacement, they need to be repositioned and splinted. Small displacements are usually not treated with endodontic treatment, but in about half of these teeth the pulp eventually becomes necrotic and requires root canal treatment. Therefore, clinical observation should be continued to determine the condition of the pulp.

Incomplete dislocation with significant displacement

In case of severe damage, teeth are subject to significant displacement from their position in the socket (more than 5 mm). These injuries may be accompanied by fractures of the alveolar process. The diagnosis is obvious when the tooth is extruded from the socket or there is vestibulo-lingual displacement.

When several teeth are damaged, such as in a car accident, they can be so displaced that their normal position is completely disrupted. It is necessary to reposition these teeth in such a way that all antagonist teeth come together.

When a tooth is extruded (vertical displacement from the socket) in the apex area, a clear widening of the periodontal fissure will be determined radiologically. If the root is displaced mesially or distally, then the expansion of the space will be one-sided, on the side opposite to the displacement of the root. When the root moves in a vestibular or lingual direction, the expanded space may be hidden behind the root of the tooth in its new position.

When teeth are displaced, temperature and electrical pulp tests are unpredictable. The issue of reliability of pulp tests in dental trauma has been discussed, but in general it can be noted that the greater the displacement and mobility, the less likely the pulp is to remain viable.

Treatment for an impacted tooth dislocation can vary. With minimal displacement, the tooth often snaps into place on its own, especially if the root is not fully formed. If the tooth is severely displaced, it must be pulled back to its original position with forceps and splinted, or it must be placed orthodontically in its normal position. The least amount of complications such as root resorption and alveolar bone loss from impacted luxation occur when the tooth is moved to its normal position orthodontically over a period of 3 to 4 weeks.

Due to root resorption, ankylosis may occur. Recent studies have shown that in experimental animals exposed to intrusive forces, ankylosis is observed within 5-6 days. External orthodontic movement should begin immediately after the injury to place the tooth in the correct position before possible ankylosis occurs.

Another complication is pulp necrosis (observed in 96% of teeth with internal displacement). With pulp necrosis, the frequency of external root resorption increases. To prevent the onset of inflammatory resorption, when a fully formed tooth is displaced by intrusion, endodontic treatment must be performed within 2-3 weeks from the moment of damage. Therefore, in order for the root canal to be accessed, the tooth must be in place, which further justifies the rapid initiation of orthodontic treatment, rather than waiting for the spontaneous restoration of the tooth position, which can take several months. If internal displacement does not impair access to the pulp chamber, spontaneous restoration of the tooth position can be expected.

However, ankylosis may develop, preventing the tooth from returning to its normal position.

Complications of injuries with dislocation

The main complications of displaced injuries were described by Andreasen. These are:

pulp obliteration;

root resorption;

loss of attachment to the marginal bone.

Pulp necrosis during dislocations occurs in 52% of cases, and in intrusive dislocations in 96%. According to various sources, the frequency of pulp necrosis during extrusion dislocations is 64-98%. It is also more likely to occur in teeth with fully formed roots than in teeth with immature roots.

Dystrophic pulp calcification occurs in approximately 20-25% of cases. This is a response to moderate damage, such as minimal displacement. Dislocation with significant displacement will most likely lead to pulp necrosis. After trauma to teeth with incompletely formed roots, the likelihood of preservation of living pulp is higher, as is the likelihood of pulp obliteration. With intrusive dislocations, pulp necrosis often develops, so obliteration is uncharacteristic.

Pulp necrosis after pulp calcification develops in approximately 10% of injured teeth. Therefore, preventive extirpation of the pulp, performed after identifying its dystrophic calcification, is not justified. A successful outcome was noted in 80% of endodontically treated teeth with obliteration phenomena.

After intrusive displacement, root resorption is usually observed. This type of displacement is second in frequency of root resorption, after extrusion displacement. With intrusive displacement, pulp necrosis also often develops. It is believed to promote root resorption. Resorption is detected only 2 months after damage, but can appear several months later.

The more severe the tooth injury, the more significant the periodontal injury, especially in cases of damage with extrusion and intrusion displacements. Delayed tooth reduction also increases the risk of damage to the supporting periodontal tissues.

Endodontic treatment of teeth with luxation

The decision about endodontic treatment of a tooth with luxation is made taking into account the situation in each specific case. In this case, you should pay attention to several factors. When deciding whether to have a root canal, it is helpful to consider several factors. The main and decisive indicator is the diagnosis of pulp necrosis. It is based on sensitivity to percussion, noticeable change in tooth color, lack of pulp response to temperature and electrical tests, and radiographic findings. In cases of dental trauma, the response of the pulp to tests is a very unreliable indicator.

In permanent teeth with formed roots, when dislocated with strong displacement (more than 5 mm), pulp necrosis is most likely. Therefore, root canal treatment is indicated for them, since the incidence of root resorption in such cases is especially high. To prevent the onset of root resorption, the use of calcium hydroxide as a temporary root filling material is justified.

Teeth with minimal displacement require splinting and careful monitoring of the condition of the pulp with x-ray control after 1, 3, 6 and 12 months. If a periapical radiolucency or obvious inflammatory resorption appears on the image, then endodontic treatment should be started immediately. The presence of periapical clearing without inflammatory resorption in teeth with formed roots provides grounds for endodontic treatment with gutta-percha. Any signs of inflammatory root resorption will justify a temporary filling with calcium hydroxide to stop it.

A displaced tooth with an immature root has a favorable prognosis for pulp preservation. Keeping the pulp alive promotes normal root development. On the other hand, inflammatory root resorption in teeth with a developing root progresses more quickly. Therefore, these teeth require careful radiological observation. If pulp necrosis is diagnosed or there is obvious periapical radiolucency or root resorption, endodontic treatment should be started immediately. Until the apex closes and root resorption stops, the canal is filled with calcium hydroxide. Later it is removed and a permanent filling with gutta-percha is performed.

Luxation of primary teeth

In children, due to the elasticity of the alveolar bone and shorter roots, tooth dislocations are more common than crown or root fractures.

When diagnosing luxation of primary teeth, determining the angle of displacement is crucial, since the roots of temporary teeth are very close to the developing permanent teeth. A typical displacement injury results in lingual movement of the crown while the root moves labially, but the tooth remains intact. If the root of a primary tooth is displaced vestibularly, then the likelihood of damage to the underlying permanent tooth is less than if it is lingually displaced or intruded. In the last two cases, the likelihood of damage to a permanent tooth increases significantly.

It has been noted that hypoplasia of the enamel of permanent anterior teeth in approximately 10% of cases is a consequence of trauma to temporary teeth. Spots of enamel hypoplasia are white or yellow-brown. More serious damage, such as disruption of the development of crowns or roots of permanent teeth and sequestration of permanent tooth buds, are possible but unlikely.

Treatment of bruises and dislocations with minor displacement of primary teeth is limited to clinical observation and radiological control.

In cases of severe lateral displacement and intrusion, radiographic confirmation of the root position is necessary. The occlusal photograph performed for these purposes requires certain professional skills and can be useful in determining the position of the root.

There is an opinion that if the root of a temporary tooth is displaced vestibularly, the position of the tooth should be restored spontaneously. There appears to be no difference in complications between primary and permanent teeth if they are allowed to heal spontaneously. Moreover, when removing an injured temporary tooth, there is a possibility of damage to the permanent tooth. Restoration of the position of a displaced temporary tooth usually occurs after 1-6 months. If, during intrusion, the temporary tooth does not come back out after 2-3 months, then ankylosis has probably developed and needs to be removed. With the development of inflammation of the periapical tissues, a temporary tooth with internal displacement must also be removed.

If the root of a primary tooth is displaced lingually towards the developing permanent tooth, it must be removed. Root resorption in anterior primary teeth begins from the lingual surface. Vestibular bending of the remaining part of the root also occurs. Since in most injuries the blow is directed from the front, when the anterior primary teeth are dislocated, the crown moves lingually and the root vestibularly. Consequently, the frequency of displacement of anterior primary teeth towards developing permanent teeth is quite low.

Parents and children should be warned about the possibility of serious damage to a developing permanent tooth that can occur when a temporary tooth is inserted into it. The potential for insurance problems and litigation requires careful documentation of the injury until the permanent teeth erupt and are thoroughly examined for developmental problems.

There are conflicting opinions regarding the treatment of dislocations of primary teeth. One of them is that they should be removed. The opposite opinion, held by many experts, is that luxated primary teeth should be preserved.

This opinion is based on the fact that endodontic treatment of primary teeth can be successful. If the luxation of a primary tooth is partial rather than complete, the tooth usually has sufficient root length to reattach itself in the socket. Therefore, if it can be reduced and stabilized, it should be preserved, just as permanent teeth are preserved. In our experience, the vestibular bending of the root of a primary tooth makes it possible to return it to its original position, often even without splinting. If the tooth is mobile, then it is advisable to install a splint made of composite material with etching for 7-10 days.

When the root tip of a primary tooth is open, there is an opportunity for revascularization. Only when signs of pulp necrosis, such as persistent sensitivity to percussion, radiographic periapical radiolucency, or continued darkening of the tooth, should endodontic treatment be performed.

In primary teeth with intrusive displacement, which have been given the opportunity to move back, pulp necrosis occurs in approximately one third of cases. Diagnosis of pulp necrosis is based on increased sensitivity, periapical clearing and discoloration of the tooth. One study showed that 50% of gray discoloration of primary teeth is reversible. The gray color, due to obliteration of the pulp, subsequently turns into yellow. When diagnosing pulp necrosis, you need to be careful. Pulp necrosis in monkeys, which lasted for 6 weeks and was accompanied by periapical inflammation, did not cause damage to the developing permanent tooth. If necrosis of the pulp of a primary tooth is diagnosed, then in order to eliminate periapical inflammation, endodontic treatment should be immediately started according to the principles of pediatric dentistry.

It is believed that the greatest damage to a developing permanent tooth is caused by the initial impact of a primary tooth. Therefore, if a decision is made to preserve a temporary tooth with vestibular root displacement, then conventional endodontic treatment is justified to eliminate long-term periapical inflammation.

Dental trauma in children

Causes of dental injury

Types of injuries and symptoms

Treatment of various dental injuries in children

Dental trauma in children

For parents, dental injuries in children often become a “headache”. The frequency of injuries often depends on the gender of the child - for example, in boys, jaw injuries are observed one and a half to two times more often than in girls.

Dental trauma is deformation and disruption of the structure of the tooth and tissues as a result of mechanical influence.

Since dental trauma is closely related and directly affects the deformation of the jaws, not only dentists, but also traumatologists should deal with this issue. These specialists are also involved in diagnostic and preventive actions related to childhood dental injuries. Due to the particularly active lifestyle of a child, his teeth are often subject to serious damage such as bruises, fractures and dislocations of the root and crown.

According to statistics, acute dental trauma occurs in every 3-4 children as a result of a fall or blow to the face. As for the period, the increase in the number of injuries is mainly observed in winter, during games on slippery roads or playing traumatic sports (skiing, skating, boxing, etc.). If we distinguish between injuries according to circumstances, they can be domestic, road or sports. Despite the fact that acute injury, as a rule, is associated with severe pain, parents of young patients often come to the doctor after a long time, thereby complicating the diagnosis and, as a result, treatment of the problem.

The type of injury depends on the strength, location and direction of the impact. It is also important to take into account the child’s age and the health of his teeth. The front row of teeth in 30% of cases is prematurely destroyed and lost as a result of acute injuries. Temporary teeth often suffer from dislocations, fractures, and sometimes from crown fractures. Injury to permanent teeth is characterized by fractures of part of the crown, dislocations, bruises and crown fractures. Most often, children injure their baby teeth between the ages of 1 and 3, and permanent teeth between the ages of 8 and 9.

Causes of dental injury

As mentioned above, as a rule, acute injuries occur during falls, accidents, sports activities or fights. However, there is another type of injury - chronic. Dental trauma can become chronic if bad habits such as biting nails, pens and pencils, biting threads, etc. are not eradicated in time. It is these seemingly simple actions that can cause thinning of teeth, chipping and abrasion of enamel. By the way, violation of proper treatment by a dentist can also very well cause a dental injury (for example, dislocation due to careless removal of an adjacent tooth, deformation due to an unsuitable filling, etc.).

Chronic tooth injury

Types of injuries and symptoms

Based on the type of influencing factors, dental injuries can be chronic or acute. Also, the types of injuries depend on whether the child’s teeth are permanent or temporary. In addition to the already described types of injuries to which primary and permanent teeth are subject, there are also those combining two or more forms of injury (for example, dislocation and fracture of the root, fracture of the root and crown, etc.).

If a child complains of prolonged pain that intensifies even with minimal load on the tooth, then this may be a symptom of a bruise, at the site of which internal hemorrhage can be observed. Because of this, the crown of the tooth becomes pinkish in color. When a tooth is dislocated or fractured, in the first few hours the child experiences a painful reaction of the tooth to minimal load, which is very different from the reaction of neighboring teeth (to touching or biting food).

Children aged 1 to 2 years most often experience acute domestic trauma. During this period, the baby learns about the world, he is interested in everything, but the lack of understanding of the possible danger, together with the inattention of the parents, can lead to injury to his baby teeth.

Between 8 and 9 years of age, the most common form of dental trauma is injury from a fall or fight. At this stage, children begin to engage in active sports and make their first attempts to assert themselves through the use of force. Teachers and parents cannot always look after them.

Injury due to a fall

Up to 60% of injuries occur during autumn and winter. The most common injury is damage to the front teeth. Parents must know that even in the presence of the mildest and most harmless injuries, they should immediately take their child to see a specialist.

Dental bruise is mainly observed in children with baby teeth. With such damage, the child may experience pain when pressing on the tooth and when eating. Sometimes a diseased tooth may appear higher than the rest due to swelling of the surrounding tissues.

As for the treatment of bruises of permanent and primary teeth, rest for 3-4 weeks is important. During this period, you should eat soft food, and also follow the dentist’s advice regarding the use of plates or mouth guards. If, due to an injury, the tooth pulp dies after a certain time, the child needs to be explained in advance that he will undergo long-term treatment in the dentist’s chair, however, this does not mean that he needs to worry and be afraid.

It is with temporary teeth that in 58% of cases a child can get a tooth dislocated. If the dislocation is incomplete, then there may be complaints of pain when eating, displacement and periodic bleeding. In the event of such an injury, the dislocated tooth is put back into place under anesthesia and ensured immobility. This is done by applying a splint or “tying” the teeth together. After the procedure, you need to strictly adhere to the doctor’s recommendations for 4-6 weeks. In children aged 2.5 years, primary teeth have not yet fully formed roots, and if fixation is unsuccessful, they can be removed.

Complete tooth dislocation

With a strong impact, the tooth can be completely dislocated, which leads to loss of contact between the socket and the tooth. A tooth can fall out of it and hold on only thanks to soft tissues, and the hole fills with blood. Basically, this type of injury is characteristic of the anterior dentition. Such damage is treated by transplanting the diseased tooth into its original alveolus and using splinting. However, when it comes to baby teeth, as well as permanent teeth with damaged roots, then such a transplant is contraindicated and treatment can only be carried out under general anesthesia. Parents need to remember that it is possible to keep the pulp alive within 2 hours after injury. Before visiting the hospital, the knocked out tooth should be kept in water, saline, milk or a sterile cloth.

Impacted dislocation is a common type of damage to primary teeth (up to 22% of all cases). The tooth seems to sink deep into the bone tissue and disrupt the socket. It feels as if the tooth has become shorter or simply disappeared. In order not to harm the further growth of permanent teeth, the method of waiting for the moment when the diseased tooth erupts is often used; this can last for a year.

A tooth fracture means deformation of hard tissues, occurring in 68% of permanent teeth and 6.5% of milk teeth. Only a dentist can determine the degree of fracture, the possibility of preserving the life of the tooth, and also carry out restoration of the crown. This process occurs 6-8 weeks after injury. The vitality of the pulp is observed until the roots are fully formed. Sometimes it takes 2 to 3 years.

Fracture of the coronal part of the tooth

The rarest form of dental trauma is a root fracture. It can occur in the apical, middle or coronal third of the root, and this can only be determined using an x-ray. Older children are most susceptible to this injury.

Treatment of various dental injuries in children

Dental injuries in children can be treated for several days or weeks, or several years (2-3 years). The duration depends on the severity of the injury, the general health of the child and the treatment method. But, no matter how long this rather complex morally and physically process lasts, it will go through 3 stages.

The first stage is the child’s first visit to the doctor with the problem of tooth damage. At this stage, the doctor examines the patient and provides emergency care. If the child does not have a concussion, and the tooth injury has not spread to soft tissues and facial bones, then the patient should be treated by a dentist. He examines, makes a diagnosis, gives pain medication if necessary and prescribes analgesics. It is good if the patient sees a doctor immediately after an injury, which will allow him to quickly prescribe treatment and avoid possible complications that can even lead to tooth loss.
The second stage consists of collecting data about the patient and his illness, establishing the cause of the injury and the treatment itself until complete recovery under the supervision of a doctor.
At the third stage, the child undergoes further treatment on his own, restoring the capabilities of his teeth after injury, and also periodically visits a doctor for examination.

Price

Phenomena such as chipped and fractured teeth are not such a rare occurrence among active children who have begun to engage in any traumatic sport. It should be remembered that restoration of baby teeth with composite materials is carried out in many dental clinics, its cost starts from $16.

This differentiation of the treatment process for children with dental injuries helps to provide medical care promptly and effectively at each stage. Today, dental clinics offer their services even in very severe cases of dental trauma. If a tooth cannot be saved, you can always replace it with an artificial one, which has practically no different characteristics from the natural one.

Prevention of dental injury mainly depends on the child’s lifestyle, behavior, and compliance with the rules of safe sports activities.

Almost everyone has been a patient in a dental office at least once in their life. Most often, we turn to doctors when caries reaches such a stage that pain begins that cannot be tolerated. We visit dentists and, if necessary, carry out prosthetics or cosmetic oral care. But there are situations when patients come for an appointment because their teeth have been dislocated. What kind of pathology is this, for what reasons does it occur and can it be managed? We will try to answer these questions.

What is tooth luxation?

If a tooth deviates from its axis relative to the location of other teeth, then we can talk about such a pathology. During dislocation, damage to the ligamentous apparatus occurs, which leads to tooth displacement.

Most often, tooth dislocation is observed in the upper jaw, sometimes it can also occur in the lower jaw.

Provoking factors for dislocation

Many factors can be the cause of this injury. Dislocations and fractures of teeth in both children and adults can occur for the following reasons:

Types of dislocations

This injury can be of several types:

Incomplete tooth dislocation. It is characterized by a violation of the integrity of the periodontium and injury to the pulp. With such an injury, there is still a chance to return the tooth to its place. It does not fall out of the hole, it simply deviates from its axis.
Complete tooth dislocation. It happens most often in the upper jaw, when the tooth practically falls out of the alveolus. In case of a strong blow, in addition to such an injury, there may also be a fracture of the jaw or tooth.
Impacted tooth dislocation. This type of dislocation is considered the most dangerous, as multiple tissue damage is observed. As a result of a strong impact, the tooth is embedded deep into the hole. You will have to put in a lot of effort to get your beautiful smile back.

Dislocation can be observed as an independent injury, and can also be accompanied by a fracture of the crown or root, and in serious cases, a jaw fracture is diagnosed. Taking into account the type of injury, the doctor will take measures and choose treatment tactics.

Symptoms of dislocations

Different injuries differ from each other and in their manifestations. Incomplete tooth luxation usually shows the following symptoms:

If the dislocation is complete, then the signs will be as follows:

If there is an impacted tooth dislocation, then the symptoms are as follows:

Severe pain at the site of injury.
A slight bleeding appears from the socket of the damaged tooth.
The patient finds it difficult to clench his teeth.
Without any devices, it is clearly visible that the tooth has decreased in height and size.
There is no mobility at all, because the jaw bone firmly fixes the tooth. If you try to shake it, you won't feel any pain.
The gums become swollen.

This dislocation is especially dangerous for children with baby teeth, since, by penetrating deep into the jaw, the crown can injure the rudiments of permanent teeth. They then grow back damaged or may not appear at all.

The danger of tooth dislocation in children

Children are very mobile, so such injuries are far from uncommon for them. And if you consider that this can happen in early childhood when there are still baby teeth, then you shouldn’t be surprised at all.

If such an injury occurs, many parents believe that they urgently need to put the tooth in its place. But experienced dentists do not always agree with this, especially if the tooth is baby, and the dislocation does not interfere or harm the child.

Moms and dads should know that it is not recommended to correct such a defect on your own. You can make it even worse and cause severe pain to the baby. If it comes to a baby tooth, then even more so, because the gums already contain the rudiments of permanent teeth, which can cause irreparable harm.

It is better to visit a specialist and, with his help, decide how to help the child.

First aid after tooth dislocation

After receiving such an injury (it doesn’t matter whether it’s a child or an adult), you need to get into the dentist’s chair as quickly as possible, but the first steps are very important:

Eliminate bleeding if possible.
It is forbidden to press on the injury site or directly on the tooth. There is no need to try to put the tooth in its place on your own.
Apply something cold to the cheek on the side of the injured tooth.
If the dislocation is complete, then apply a tampon, but not cotton wool.
When applying a pressure bandage, it should not be kept in place for more than 15 minutes.

Some people believe that since such an injury has occurred, the tooth will have to be removed. But a competent specialist resorts to such a measure quite rarely, only in the presence of serious indications, which will be discussed below.

Treatment of dislocated teeth

If a tooth dislocation is diagnosed, treatment will depend on the type of injury, the age of the patient, and also, in the case of a child, the degree of damage and the formation of the permanent tooth in the gum. For a specialist, the first priority is to preserve the tooth, but this will depend on many factors and includes several mandatory measures:

Getting rid of incomplete dislocation

Treatment of incomplete tooth dislocation comes down to the following procedures:

Repositioning the tooth, that is, returning it to its place.
Fixation to prevent displacement.
Maintaining hygiene.

After the tooth is installed in its rightful place, it must be fixed. Various devices are used for this:

After fixation, such a structure usually remains in the oral cavity for about a month. The doctor will explain that during this period it is important to maintain oral hygiene to prevent infection.

Therapy for complete dislocation

If the injury has led to complete dislocation of the tooth, then the following treatment will be required:

Pulp removal and canal filling.
Tooth replantation.
Fixation.
Maintaining a gentle diet.

During the examination, the doctor carefully examines the tooth socket and evaluates its integrity. Whether replantation is possible or not depends on several factors:

Patient's age.
Conditions of the tooth.
The tooth is temporary or permanent.
The root is well formed or not.

After filling the canals, tooth replantation begins. It can be one-stage, when the tooth is immediately put in place and splinted. But there is delayed replantation, then the tooth is placed in a special solution and sent to the refrigerator. And after a few days they begin to return it to its place.

The replantation process consists of the following stages:

Tooth preparation.
Hole processing.
Tooth replantation and fixation.
Therapy after surgery.

After the tooth replantation procedure has been carried out, after about 1.5-2 months, engraftment is possible according to several scenarios:

Engraftment according to the type of primary intention. This type is the most favorable for the tooth and the patient, but it will depend on the viability of the periodontal tissue.
Engraftment according to the type of bone fusion. This is observed if the death of periodontal tissue has occurred; naturally, this is not a completely favorable result.
A mixed type of engraftment, periodontal-fibrous-osseous, may also be observed.

Typically, if tooth replantation after injury is carried out almost immediately, the root is minimally damaged and the tooth can be preserved for a long time. But if a lot of time has passed since the dislocation occurred, then, as a rule, replantation ends with gradual resorption of the root and its complete destruction.

Treating an impacted tooth dislocation

If an incomplete dislocation of a permanent tooth is, in principle, easy to treat, then dealing with an impacted tooth is quite difficult. Some experts prefer to wait a while, hoping that the tooth will spontaneously return to its place. But this, if possible, is only in the presence of milk teeth, when advancement occurs due to the ongoing formation of the root.

At a young age, if shallow impaction is observed, self-extension is also possible, but provided that root formation has not completed and there is a germinal zone. The first signs of this phenomenon can be observed no earlier than 2-6 weeks after the injury.

If there are signs of the development of an inflammatory process, then it is necessary to trepan the tooth and remove the pulp.

If an impacted dislocation has almost completely immersed the tooth crown into the gum, then self-extension is unlikely, just as in the presence of inflammation and foci of infection in the periapical tissues.

After an injury, the impacted tooth can be repositioned almost immediately or within 3 days. Crown trephination and pulp cleansing are carried out after the tooth is securely installed in the socket.

If the crown is not deeply embedded, then orthodontic appliances can be used to advance it. In case of deeply impacted teeth, it is necessary to resort to surgical techniques so that the device can then be applied. This manipulation must be carried out as soon as possible after the injury, since ankylosis develops on days 5-6.

You can go the other way: remove the impacted tooth, and then carry out replantation.

In some cases, the only solution is to remove the tooth

If a patient goes to the dentist with a dislocated tooth, the doctor decides to remove it if the following predisposing factors are present:

In any case, only a doctor will decide to remove a tooth after carefully studying the situation, determining the degree of complexity of the injury and the condition of the dental system.

Is it possible to prevent such an injury?

Of course, you cannot completely insure yourself against a dislocated tooth, because boys who prove their case in a fight cannot guarantee that they will not receive a strong blow to the jaw. But there are other measures you can take to reduce the risk of injury:

Be more careful when choosing the foods you eat.
Go to the store and buy a bottle opener, don't test your teeth.
It is also not necessary to crack nuts with your teeth; you can use available tools.
Personal oral hygiene has never harmed anyone, and its absence leads to weakening of bone formations. Plaque leads to the gradual destruction and weakening of tooth enamel.
Eat more fresh vegetables and fruits; they not only cleanse your teeth of plaque well, but also strengthen them.

Beautiful teeth are not only health, but also beauty. Damaged or crooked teeth make us feel self-conscious about our smile. To prevent this from happening, you must maintain oral hygiene and take care of your teeth. At first glance, it seems that they are so strong and nothing is scary for them, but it turns out that just opening the bottle can end in disaster. It is important to teach children from early childhood to take care of their teeth, then, as adults, they will not sit in line for hours at the dentist’s office. Protect your teeth from dislocation and let your smile shine!

Luxation of teeth

The connection of the tooth with the alveolar wall is a type of syndesmosis; disruption of this connection can be considered a dislocation. When dislocated, the teeth change their position and can move towards the tongue or palate, lips and cheeks. There are complete and incomplete dislocations. With complete dislocation, the ligamentous apparatus of the tooth root is completely torn. The tooth becomes sharply mobile and does not fall out of the socket only due to its connection with the gum. In case of incomplete dislocation, the tooth only partially loses its connection with the socket, becomes mobile and protrudes somewhat above the closure plane of the remaining teeth. Dislocations are often accompanied by damage to the wall of the socket.

A type of dislocation is the impacting of a tooth into the spongy substance of the alveolar process (“impacted dislocation”). This type of dislocation occurs less frequently and almost exclusively in the area of the upper jaw incisors with fully formed roots, occurring when struck in the direction of the length of the tooth axis. In this case, the tooth looks shorter than the neighboring ones, and sometimes is not visible at all, and its position in the jaw can only be clarified on an x-ray.

When a tooth is dislocated, the possibility of rupture of the neurovascular bundle cannot be ruled out, so it is necessary to periodically check the electrical excitability of the pulp. In the absence of electrical excitability, trepanation and treatment are performed.

The choice of treatment method for dislocated teeth depends on the degree of damage, general condition and age of the child. When providing assistance in early childhood, treatment methods should be especially gentle. In children under 3 years of age, if possible, teeth should be preserved if they are dislocated. In case of incomplete dislocation, the tooth is placed in the correct position and secured using a splint made of celluloid or quick-hardening plastic. The splint should cover, in addition to the damaged tooth, another 2-3 teeth on both sides of the damaged one. It is better if the splint covers the entire dentition. If the tooth is completely dislocated, the tooth is removed, since in children under 3 years of age the roots of the baby teeth have not yet formed. When impacting primary incisors, they should be left, since during the process of root formation, the impacted tooth can move out and become stronger.

Channel expansion

At the age of 3 to 5 years, when the roots of the primary incisors are already formed, wire splints, including a splint-arc made of steel wire with a diameter of 0.5 to 1 mm, can be used to fix dislocated teeth. Such springy arches make it possible not only to strengthen, but also to reduce teeth that are displaced in different directions. If the teeth of the upper jaw, displaced downward, need to be moved upward, and the teeth of the lower jaw, displaced upward, must be “settled”, in addition to strengthening the splint in the usual way, a special supporting bandage should be applied to the damaged teeth.

Impaction of primary incisors in children 3-5 years old poses a danger to the rudiments of permanent teeth, since the root of a displaced primary tooth can cause mechanical damage to the crown of a permanent tooth or contribute to the penetration of infection into this area. Therefore, deciduous incisors embedded in the alveoli should be removed in children of this age.

In children from 5 to 7 years old, the roots of baby teeth are in the stage of resorption, therefore, when these teeth are injured, complete dislocation is most often observed. To determine the degree of root resorption in case of dental trauma in children of this age, it is necessary to take x-rays. If the resorption of the roots of baby teeth is not yet complete, strengthening the teeth with a splint is necessary, since premature loss of baby teeth adversely affects the development of the jaws, and also negatively affects the development and position of permanent teeth. If the roots of baby teeth have already been resorbed, these teeth should be removed.

When permanent teeth are dislocated and impacted, it is recommended to move the teeth into the correct position and fix them with splints. Splints made of fast-hardening plastic are widely used for fixing dislocated teeth.

If permanent teeth are completely dislocated, they can be replanted. Replantation of primary teeth is not advisable.

Enlarged lymph nodes in a child's neck, treatment, what antibiotics, constipation in a breastfed child, causes and treatment

What is tooth luxation?

Most often, tooth dislocation is observed in the upper jaw, sometimes it can also occur in the lower jaw.

Provoking factors for dislocation

Many factors can be the cause of this injury. Dislocations in both children and adults can occur for the following reasons:

Types of dislocations

This injury can be of several types:

Incomplete tooth dislocation. It is characterized by a violation of the integrity of the periodontium and injury to the pulp. With such an injury, there is still a chance to return the tooth to its place. It does not fall out of the hole, it simply deviates from its axis.
Complete tooth dislocation. It happens most often in the upper jaw, when the tooth practically falls out of the alveolus. In addition to such an injury, there may also be a tooth.
Impacted tooth dislocation. This type of dislocation is considered the most dangerous, as multiple tissue damage is observed. As a result of a strong impact, the tooth is embedded deep into the hole. You will have to put in a lot of effort to get your beautiful smile back.

Symptoms of dislocations

Different injuries differ from each other and in their manifestations. Incomplete tooth luxation usually shows the following symptoms:

If the dislocation is complete, then the signs will be as follows:

If there is an impacted tooth dislocation, then the symptoms are as follows:

Severe pain at the site of injury.
A slight bleeding appears from the socket of the damaged tooth.
It's difficult for the patient
Without any devices, it is clearly visible that the tooth has decreased in height and size.
There is no mobility at all, because the jaw bone firmly fixes the tooth. If you try to shake it, you won't feel any pain.
The gums become swollen.

The danger of tooth dislocation in children

It is better to visit a specialist and, with his help, decide how to help the child.

First aid after tooth dislocation

After receiving such an injury (it doesn’t matter whether it’s a child or an adult), you need to get into the dentist’s chair as quickly as possible, but the first steps are very important:

Eliminate bleeding if possible.
It is forbidden to press on the injury site or directly on the tooth. There is no need to try to put the tooth in its place on your own.
Apply something cold to the cheek on the side of the injured tooth.
If the dislocation is complete, then apply a tampon, but not cotton wool.
When applying a pressure bandage, it should not be kept in place for more than 15 minutes.

Treatment of dislocated teeth

Getting rid of incomplete dislocation

Treatment of incomplete tooth dislocation comes down to the following procedures:

Repositioning the tooth, that is, returning it to its place.
Fixation to prevent displacement.
Maintaining hygiene.

After the tooth is installed in its rightful place, it must be fixed. Various devices are used for this:

After fixation, such a structure usually remains in the oral cavity for about a month. The doctor will explain that during this period it is important to maintain oral hygiene to prevent infection.

Therapy for complete dislocation

If the injury has led to complete dislocation of the tooth, then the following treatment will be required:

Pulp removal and canal filling.
Tooth replantation.
Fixation.
Maintaining a gentle diet.

During the examination, the doctor carefully examines the tooth socket and evaluates its integrity. Whether replantation is possible or not depends on several factors:

Patient's age.
Conditions of the tooth.
The tooth is temporary or permanent.
The root is well formed or not.

The replantation process consists of the following stages:

Tooth preparation.
Hole processing.
Tooth replantation and fixation.
Therapy after surgery.

After the tooth replantation procedure has been carried out, after about 1.5-2 months, engraftment is possible according to several scenarios:

Engraftment according to the type of primary intention. This type is the most favorable for the tooth and the patient, but it will depend on the viability of the periodontal tissue.
Engraftment according to the type of bone fusion. This is observed if the death of periodontal tissue has occurred; naturally, this is not a completely favorable result.
A mixed type of engraftment, periodontal-fibrous-osseous, may also be observed.

Treating an impacted tooth dislocation

If there are signs of the development of an inflammatory process, then it is necessary to trepan the tooth and remove the pulp.

After an injury, the impacted tooth can be repositioned almost immediately or within 3 days. Crown trephination and pulp cleansing are carried out after the tooth is securely installed in the socket.

You can go the other way: remove the impacted tooth, and then carry out replantation.

In some cases, the only solution is to remove the tooth

If a patient goes to the dentist with a dislocated tooth, the doctor decides to remove it if the following predisposing factors are present:

In any case, only a doctor will decide to remove a tooth after carefully studying the situation, determining the degree of complexity of the injury and the condition of the dental system.

Is it possible to prevent such an injury?

Be more careful when choosing the foods you eat.
Go to the store and buy a bottle opener, don't test your teeth.
It is also not necessary to crack nuts with your teeth; you can use available tools.
Personal oral hygiene has never harmed anyone, and its absence leads to weakening of bone formations. Plaque leads to the gradual destruction and weakening of tooth enamel.
Eat more fresh vegetables and fruits; they not only cleanse your teeth of plaque well, but also strengthen them.

Girls, I have a problem - two days ago my 2-year-old daughter fell from a stool, so much so that she hit her lip very hard.
She asked for cottage cheese, I went to the kitchen, warmed it up, began to put it on a plate - I didn’t look at her for 10 seconds, I heard a crash and roar...

I almost had a heart attack on the spot - my daughter fell and cut her lip, there was blood... I immediately called an ambulance to wash the child with cold water, in my delirium I prepared documents for the child and things if I needed to go to the hospital... The ambulance was there 5 minutes. The doctor looked at Nastya, it was good that her husband was at home, the two of them held their daughter while the doctor looked at her. He said that the lower lip was not cut very badly, there was no need for stitches, he anointed it with brilliant green and told me to just treat it with brilliant green and put cholisal and solcoseryl on the gum for swelling. They said that there seemed to be nothing serious, no concussions, and they left.

Already on the first day of treatment, my daughter began to be afraid of me, when I approached her with medicine, and screamed wildly with fear when I smeared greenery on her sponge. After that my hands even shook...

Now the wound has healed, it doesn’t look so scary, and my daughter allows herself to be looked at normally. And then I saw the top one. her right fang had become almost half its size, but it was not chipped, but seemed to have gone deeper. Previously, because of the swollen gums, this was not visible, and my daughter did not let me look at her mouth - she was spinning and screaming. I read it on the Internet - it looks like an impacted dislocated tooth...

I don’t know what to do now - go to the dentist straight away or wait until the wound on my lip goes away (about a week)? I smear the gums with cholisal and solcoseryl - against inflammation and swelling, the gums are practically not swollen anymore. I'm afraid that the tooth might cause problems for us - what if we go to the dentist and they remove it?

Girls, who had a similar case, tell me how to treat an impacted tooth dislocation and is it dangerous for the child? My daughter eats normally (I give her semi-liquid food, I’m afraid of damaging a tooth after an injury), there is no fever.