Background

Different types of injuries that affect the teeth include avulsion, teeth displacement or fractures. These injuries are more common to cause displacement of the primary teeth rather than the actual fractures. Among all the primary teeth, there are likely to be displaced, mandibular and maxilla incisors predominately. 

Epidemiology

Displacement of teeth is the common primary dentition injury. In Sweden, 7% of all physical injuries involve the oral cavity, with 9% in 0-19 years old. Iver 50% of child abuse cases involve the neck and head region. The average age of injury is variable with falls and sport activities in youth and motor vehicle collisions and assaults in teenaged years. 

Anatomy

Pathophysiology

A common cause of a directed force large enough to disrupt the attachment between the affected tooth and the periodontal ligament present on the alveoli/walls of the socket. Displacement may be intrusions into alveolar socket, extrusions outside of alveolar socket or subluxation with the severing of the apical neurovascular bundle. All these forces may lead to formation of apical abscess and pulp necrosis. 

Etiology

Tooth displacement can be caused by: 

1. Altercations- 17% 
2. Motorcycle accidents- 10.4% 
3. Ice hockey- 2.3% 
4. Motor vehicle collisions- 10.8% 
5. Contact sports- 15.9% 
6. Unknown reasons- 17% 

Genetics

Prognostic Factors

Tooth injury is not acutely dangerous but can harm the airway due to fracture and maxillofacial injuries. Morbidity in terms of caries could be split between primary and permanent teeth in view of individual variation in susceptibility to the disease. Half luxated teeth get necrotic within a period of three years. These mal occlusions may undergo failure to change in colour, abscess, failure to eruption, lost space in dental arch, ankylosis, abnormal root development and injury to permanent teeth. 

Clinical History

Spontaneous or continuous pain in the injured teeth may signify an injury to the supporting bone, periodontal ligament or pulp. 

Lateral displacement 

Tooth displacement can be firm or mobile but lingually or facially displaced. Axial displacement, intrusion injury, and extrusion injury can cause misaligned teeth, pain, or mobility with pain having the worst prognosis. 

Physical Examination

• Inspection: The diagnosis of tooth fractures involves examination of soft tissue surrounding the area for ecchymosis, discolouration, retained foreign bodies and lacerations. Radiographs helps to find tooth fragments in the lip. In fractured crowns of teeth, radiographic screening and manual palpitation will identify the foreign body. The soft tissues should not be removed from the tooth or scrapped before reimplantation. It can result in chronic infection or fibrosis if embedded tooth fragments are present. 
• Palpation: Examine whether the tooth or entire segment is movable. Patient can be asked to bite to suspected area. 
• Sensitivity and percussion: This test should be carried out using a tongue blade to assess general sensitivity. Note the sensitivity of air, cold, and heat. 

Age group

Associated comorbidity

1. Infection 
2. Tooth loss 
3. Cosmetic deformity 

Associated activity

Acuity of presentation

Differential Diagnoses

Fractured tooth (Dental) 

Avulsed tooth (Dental) 

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

• Emergency department care: Adequate therapy for managing pain should be advised along with tetanus vaccination. Regular monitoring and follow-up care is suggested. 
• Consultations: An oral maxillofacial or dental surgeon should be consulted for treatment. 
• Surgical care: A study was carried out on the comparison of the periodontal outcomes of PDCs (palatally displaced canines) exposed using an open or closed surgical methods. There is a periodontal impact while unilateral PDC exposure and alignment is done, but such disturbance is minor and not likely to be relevant clinically in the short term. 

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

modification-of-the-environment

To effectively manage a displaced tooth, follow these steps: 

1. Protect the surrounding soft tissue by not removing or scraping it. 
2. Maintain a sterile environment to prevent infection using sterile gloves, instruments and saline solution. 
3. Gently reposition the tooth to its original position, avoiding further trauma. 
4. Apply a flexible splint to stabilize the tooth, allowing periodontal ligament fibers to reattach and heal properly. 
5. Use radiographs to assess the position of the tooth and check for fractures or embedded fragments. 

Use of antibiotics

• Penicillin VK: It inhibits the biosynthesis of mucopeptides in the cell wall and is effective in case of active multiplication. 
• Amoxicillin: It is known to interfere with the cell wall mucopeptide in the active multiplication which results in bactericidal activity. 
• Erythromycin: It is used as an alternative treatment in patients who are allergic to penicillin. This acts by inhibiting protein synthesis that is RNA-dependent by stimulating the breakdown of peptidyl tRNA which inhibits the growth of bacteria. As the drug may cause irriation of the gastrointestinal tract, it is advised to take it with milk or food. 

Use of analgesics

• Acetaminophen and oxycodone: It is employed in relieving moderate to intense pain. It is indicated in treating patients who are sensitive to aspirin. 
• Acetaminophen and hydrocodone bitartrate: The combination of these drugs in used to relieve mild to medial pain. 

use-of-phases-of-management-in-treating-displaced-tooth

It is important to reiterate that there are some quite critical stages involved in the management of a displaced tooth for the best possible recovery and prognosis. These phases include initial assessment and stabilization, immediate treatment, post-treatment care, regular checkups, radiographic monitoring, and finally long-term management. 

The initial assessment involves evaluating the injury, pain management, radiographic examination, and immediate treatment. Post-treatment care includes antibiotics, anti-inflammatory medication, and oral hygiene. Regular check-ups monitor healing and vitality tests. Long-term management includes assessing treatment success, managing complications, and considering orthodontics. The final evaluation concludes treatment, ensuring the best possible outcome. 

Medication

Future Trends

Media Gallary

References

Tooth Luxation: Symptoms, Causes and Treatment (clevelandclinic.org)