This is the second article in our series about First Aid in Dental Emergencies. Last time we addressed how to manage a tooth that had been ‘avulsed,’ which is dental-speak for ‘completely knocked out.’ You can read that article here.
Here, we are going to consider the situation where a tooth has received a blow but has been dislodged or displaced within its socket, rather than completely knocked out. This type of injury is called a “luxation” injury, and these are classified according to the direction of dislodgement.
Types Of Displacement Injuries And How To Recognise Them
The types of luxation injuries include:
- Concussion (of the tooth, not the patient). This means that the tooth has sustained a blow but has not been noticeably displaced. This type of injury still requires dental attention as the nerve or root may have been damaged
- Subluxation- this means that the tooth hasn’t been displaced but has been loosened. It will need to be stabilised by the dentist as soon as possible.
- Extrusive luxation- the tooth will appear longer than normal, because it has been knocked vertically out of its socket. It will need to be repositioned and stabilised by the dentist.
- Lateral luxation- the tooth has been dislodged forwards, backwards or to the side. Usually the bony socket has been fractured in the injury. This tooth will need to be repositioned and stabilised.
- Intrusive luxation- the tooth will appear shorter than normal because it has been pushed down into the socket.
It’s important to note that a dislodged tooth may be quite loose or may still feel very firm.
Applying First Aid To The Dislodged Tooth
Above all else, remain calm and check the patient for other injuries. If they are dizzy or were rendered unconscious by the blow, a head injury must be considered. A head injury should always receive priority in terms of management.
The aim of first aid is to try to return the tooth to its original position as quickly as possible and to stabilise it in place. Use the nearby teeth to guide the tooth into the correct position, although sometimes the tooth won’t realign properly no matter what you do: this can be because there is something preventing the tooth from moving back into its socket (the fractured bony socket), or the tooth may not have been straight in the first place.
A tooth that has been pushed into its socket will often be very difficult to reposition. It’s OK if you are unable to do so: the dentist will manage this injury.
If several teeth are loose and seem to be moving together, it’s likely that the bone holding them in place has been fractured.
The repositioned tooth must be held in place on the trip to the emergency dentist, and this can either be done by finger pressure, biting on a clean gauze or handkerchief or using some aluminium foil to fashion a splint, much like one might use a stick and some bandages to stabilise a broken limb.
The injured person should be taken directly to a dentist for management: time is of the essence.
Download Our Dental First Aid Guide
We have developed a guide to the management of dental injuries that you are welcome to download and share with others. Why not laminate a copy and ask your child’s school, sports coach and other significant adults to keep it handy as part of their first aid kit.