Luxated Tooth: Types, Symptoms, and Recovery Factors

A luxated tooth occurs when trauma shifts it from its normal position without being completely knocked out. This dental injury varies in severity, affecting both children and adults, and often requires immediate attention to prevent long-term damage.

Recognizing and managing these injuries promptly is crucial for the best outcome. Understanding the different types of luxation, their symptoms, and recovery factors ensures effective treatment.

Types Of Injuries

Luxation injuries are classified based on the direction and extent of displacement, which helps determine treatment and prognosis. Each type has distinct characteristics that influence management.

Subluxation

Subluxation is a minor injury where the tooth remains in place but has increased mobility due to periodontal ligament damage. There is no displacement, and the pulp usually remains intact. Patients may experience tenderness when biting and mild bleeding from the gingival sulcus.

A study in Dental Traumatology (2021) found that subluxated teeth in permanent dentition often recover spontaneously if no additional trauma occurs. Treatment typically involves monitoring, and in some cases, stabilizing the tooth with a flexible splint for one to two weeks. Pain can be managed with NSAIDs. Regular follow-ups assess for complications like pulp necrosis, which may require endodontic intervention.

Extrusive

Extrusive luxation occurs when a tooth is partially displaced outward from its socket due to periodontal ligament and alveolar bone damage. The affected tooth may appear elongated, exhibit increased mobility, and feel tender. The pulp may remain vital, but the risk of necrosis rises with greater displacement.

A systematic review in the International Journal of Paediatric Dentistry (2022) highlighted the importance of prompt repositioning for better long-term outcomes. Treatment involves gently repositioning the tooth and stabilizing it with a flexible splint for two to three weeks. In younger patients, the periodontal ligament may reattach naturally, while adults require close monitoring for pulpal degeneration. If pulp vitality is lost, root canal therapy may be needed to prevent infection and tooth loss.

Lateral

Lateral luxation involves horizontal displacement, often causing alveolar bone fractures or compression. The tooth may be locked in an abnormal position, making repositioning difficult. Clinically, affected teeth may appear angled, show minimal mobility, and produce a metallic sound upon percussion due to bone entrapment.

A retrospective study in The Journal of Endodontics (2023) found that lateral luxation has a higher risk of pulpal necrosis, especially in mature permanent teeth. Treatment involves repositioning under local anesthesia and stabilizing with a splint for three to four weeks. Radiographic evaluation is necessary to check for root fractures or alveolar bone damage. If pulp vitality is lost, early endodontic treatment is recommended to prevent inflammatory root resorption.

Intrusive

Intrusive luxation is the most severe type, where the tooth is forced into the alveolar bone due to axial impact. This causes significant damage to the periodontal ligament, pulp, and surrounding bone. Affected teeth may appear shorter or embedded in the gum, with limited mobility and a high risk of ankylosis.

Guidelines from the American Association of Endodontists (2023) recommend treatment based on the degree of intrusion and root development. In immature teeth, spontaneous re-eruption may occur, while fully developed teeth often require orthodontic or surgical repositioning. Splinting for up to four weeks is typically necessary, followed by regular monitoring for pulp necrosis or root resorption. Studies indicate that up to 80% of intruded permanent teeth require root canal therapy due to compromised blood supply.

Identifiable Signs And Symptoms

A luxated tooth presents with various physical changes, depending on the severity and direction of displacement. The most noticeable sign is a change in position, which may include elongation, angulation, or partial embedding in the gum. Mobility varies; some teeth are loose, while others are firmly lodged due to bone entrapment. Patients often report that the tooth feels “out of place” or misaligned when biting.

Pain levels depend on the extent of periodontal ligament damage and pulp involvement. Subluxation may cause mild discomfort, while lateral or intrusive luxations can result in intense, throbbing pain. Pressure on the affected tooth typically worsens discomfort, leading patients to avoid chewing on that side. If the pulp is compromised, spontaneous pain may develop, indicating potential necrosis.

Soft tissue changes often accompany luxation, including gingival bleeding or bruising from ruptured capillaries. Swelling may occur, sometimes extending to adjacent gum areas, lips, or cheeks. Severe alveolar bone involvement can cause ecchymosis or hematomas.

Sensory changes provide further diagnostic clues. Affected teeth may have altered sensitivity to temperature extremes. A metallic or dull sound upon percussion suggests rigid fixation within the bone, common in lateral or intrusive luxations, while a high-pitched, hollow sound indicates increased mobility and compromised support.

Diagnostic Steps

Diagnosing a luxated tooth requires clinical evaluation and imaging to assess displacement and structural damage. The initial assessment includes patient history, focusing on the mechanism of injury, symptoms, and any prior dental trauma. Understanding the force and direction of impact helps predict the type of luxation and potential pulpal involvement.

A clinical examination follows, checking for visible displacement, abnormal angulation, or extrusion. Palpation of surrounding tissues can reveal tenderness, swelling, or hematomas, indicating alveolar bone involvement. Mobility testing helps determine periodontal ligament damage, with excessive looseness suggesting subluxation or extrusion, while a firm but misaligned tooth suggests lateral or intrusive luxation. Percussion testing provides further insights—high-pitched sounds indicate ankylosis or bone entrapment, while dull responses suggest compromised support.

Radiographic imaging confirms the diagnosis and identifies associated injuries. Periapical and occlusal radiographs assess root positioning, periodontal ligament space, and fractures. Cone-beam computed tomography (CBCT) offers detailed three-dimensional visualization, aiding in complex cases by evaluating root resorption, bone fractures, and proximity to critical structures like the maxillary sinus or inferior alveolar nerve.

Pulp vitality testing determines whether the pulp remains functional or has undergone necrosis. Cold testing, electric pulp testing, or laser Doppler flowmetry help assess vascular supply. Teeth with mild luxation may retain normal sensitivity, while those with severe displacement often show delayed or absent responses, indicating potential loss of blood supply. These findings guide treatment decisions, particularly regarding endodontic intervention.

Recovery Factors

The prognosis of a luxated tooth depends on factors like periodontal ligament damage, patient age, and treatment timing. The ligament plays a key role in stabilizing the tooth and facilitating reattachment. If largely intact, healing is more predictable, while extensive disruption increases the risk of complications like external root resorption or ankylosis. Younger patients, especially those with developing dentition, have better regenerative capacity and a greater likelihood of spontaneous healing compared to adults with fully formed roots.

Timely repositioning and stabilization significantly affect outcomes. Teeth realigned and splinted within hours of injury have a higher chance of retaining pulp vitality, whereas delayed treatment increases the risk of necrosis. Splinting duration also matters, with flexible splints preferred for two to four weeks, depending on displacement severity. Overly rigid fixation can contribute to ankylosis by restricting normal movement, highlighting the importance of precise stabilization techniques.