Luxation injuries involve the displacement of the tooth from its normal position. They most commonly involve one or more maxillary incisors and may also involve root or crown fractures. It is important for the doctor to have some knowledge of these types of injury, to be able to differentiate and identify the injury and therefore be able to make the correct decision as to the treatment available. These injuries are usually the result of a direct blow or a fall.
In many cases, and with proper treatment, healing occurs without any further complications, however the stage of root development and the presence of any crown fracture may determine the likelihood of pulp death. With all luxation injuries, the following complications may occur:
- darkening of the tooth as a result of pulpal death
- dental abscess following damage of the pulp tissues
- loss of bone in the surrounding areas
- root resorption
- loss of tooth
Early treatment by a team dentist can help reduce the occurrence of these complications. The goals of treatment are to facilitate healing of the supporting tissues, reduce the risk of pulp death and to eliminate occlusal problems.
- This can occur after a blow to the tooth, either directly or as a result of impact from the opposing jaw. the athlete will have pain when the tooth is touched, but without any visible loosening or change in the position of the tooth. As with all dental injuries, it is necessary to have a dental review and an X-Ray of the tooth. This should show the tooth sitting normally in the socket. In most cases, the athlete can return to play without a risk of further damage occurring. Complications are rare, but follow-up and monitoring of the tooth are recommended.
- This is normally an injury to the maxillary incisors that results in loosening of one or more teeth – but without any displacement. Return to play in these cases is a matter of judgement upon how loose the teeth are and whether, in the opinion of the doctor, they are in danger of falling out. In sports where mouthguards are routinely worn, there would be little danger in returning to play wearing a guard. A dental review is needed. Occasionally the dentist may splint the teeth for up to three weeks for comfort. A soft diet is also advisable for two to three weeks. Where haemorrhaging is reported around the neck of the teeth, a course of antibiotics is advised.
- Extrusive luxation
- In this situation, one or more teeth are partially displaced (extruded) out of the tooth socket. Generally, the affected tooth appears longer and tilted towards the palate. In all cases, it will be significantly loose as the periodontal ligament has been torn or ruptured and the neurovascular bundle at the tip has been severed.
The tooth should be gently pushed back up into its socket. This is generally relatively painless and can be done on the touchline. If the teeth are to be saved, it is important that the athlete does not return to the field of play but instead goes immediately to a dentist to have the teeth splinted. Antibiotics may be given to prevent the invasion of bacteria down the periodontal ligament. In children, the pulp will commonly revascularise and the tooth may remain vital. In adults, however, pulp death most commonly occurs.
- Lateral luxation
- Although called a lateral luxation, it may be either a lateral or anterior/posterior displacement of one or more teeth. These injuries generally also involve a fracture of the alveolar plate. Unlike other luxation injuries, the tooth remains solid in its socket as it is firmly attached to the bone. The displaced tooth is normally firmly wedged and is hard to reduce. Local anaesthetic is normally needed. A dentist will splint the tooth/teeth for a minimum of four weeks to allow the alveolar fracture to heal. Appropriate antibiotics should be given to prevent bacterial infection at the fracture site. Revascularisation of the pulp is unlikely and pulp death can be expected.
- Intrusive luxation/intrusion
- This involves the displacement of the tooth apically through the floor of the tooth socket – as a result, it may appear “short”. Intrusive injuries comprise of approximately 2% of all dental trauma and often have the most severe consequences. This always results in pulp death and often root surface resorption because of the severity of the damage to the neurovascular bundle and periodontal ligament. Spontaneous resorption of intruded teeth is unreliable and the tooth should be repositioned either orthodontically or surgically as soon as possible. Repositioning should be followed by splinting. If not identified and properly treated, the tooth may become ankylosed (fused) with the bone and impossible to move.
Dr Anthony Clough
Sport, Implant and Restorative Dentistry