Tooth Luxation: Symptoms, Types, Causes and Treatment

Tooth luxation, a form of traumatic dental injury (TDI), can have a profound impact on oral health, aesthetics, and function. Whether you’re a parent, a patient, or a dental professional, understanding the symptoms, types, causes, and treatments of tooth luxation is crucial for timely and effective management. This comprehensive guide presents an evidence-based overview of tooth luxation, drawing on the latest research and clinical guidelines to help you navigate this important dental topic.

Symptoms of Tooth Luxation

Tooth luxation injuries can be distressing, both physically and emotionally. Recognizing the symptoms early is key for seeking prompt dental care and minimizing complications. Symptoms may vary depending on the type and severity of the luxation, but certain clinical signs are consistently observed.

Symptom	Description	Severity	Sources
Mobility	Increased tooth movement	Mild-Severe	2 4 8
Displacement	Tooth appears out of alignment	Mild-Severe	2 3 4
Pain/Tenderness	Sensitivity to touch or biting	Mild-Moderate	2 4 8
Bleeding	From gums around the affected tooth	Mild-Moderate	3 4 7
Color Change	Tooth darkens or becomes reddish	Moderate-Severe	4 5
Swelling	Localized gum or facial swelling	Mild-Moderate	4 5

Table 1: Key Symptoms of Tooth Luxation

Understanding Symptoms

Tooth luxation is typically characterized by abnormal tooth movement and changes in position. Here’s a closer look at what to watch for:

Mobility and Displacement

• Mobility: The affected tooth may feel loose or wobbly. In subluxation and lateral luxation, mobility is often pronounced 2 4 8.
• Displacement: Teeth may appear pushed outwards, inwards, or sideways from their normal position. This is especially notable in extrusive, lateral, or intrusive luxation 2 3 4.

Pain, Tenderness, and Bleeding

• Pain/Tenderness: Patients often report discomfort when biting or touching the tooth. The pain may be mild in cases like concussion or more severe in lateral or extrusive luxations 2 4 8.
• Bleeding: The gums surrounding the affected tooth may bleed, sometimes accompanied by swelling. Bleeding tends to be more evident in severe luxation injuries or when the periodontal ligament is significantly damaged 3 4 7.

Color Change and Swelling

• Color Change: Over time, the tooth may darken (indicating pulp damage or necrosis), or develop a reddish hue due to internal bleeding 4 5.
• Swelling: Swelling of the gums or, in some cases, the surrounding facial tissues may occur as part of the inflammatory response 4 5.

Other Observations

• In children, luxation injuries can affect primary (baby) teeth, potentially causing additional symptoms such as anxiety or aversion to eating 5 6.
• In some cases, symptoms may be subtle, especially with concussion or subluxation, underlining the importance of dental evaluation after trauma 2 8.

Types of Tooth Luxation

Tooth luxation encompasses a spectrum of injuries defined by the direction and extent of tooth displacement within its socket. A clear understanding of the types helps guide accurate diagnosis and management.

Type	Description	Frequency (Permanent Teeth)	Sources
Concussion	No displacement, tender to touch	Common	1 2 8
Subluxation	Increased mobility, no displacement	Common	1 2 8
Extrusive	Partial axial displacement outward	Less common	2 3 10
Lateral	Displacement sideways, socket fracture	Moderate	1 2 4 8
Intrusive	Tooth pushed into socket	Less common, severe	2 3 9
Avulsion	Complete displacement from socket	Rare, most severe	2 4 7

Table 2: Types of Tooth Luxation

Overview of Luxation Types

Tooth luxation is broadly classified by the movement of the tooth and involvement of surrounding tissues:

Concussion and Subluxation

• Concussion: The tooth is tender to touch or percussion but remains in its normal position. There is no abnormal mobility, and the periodontal ligament is bruised but not displaced 1 2 8.
• Subluxation: The tooth displays increased mobility but is not displaced. Bleeding from the gingival sulcus may be present, indicating injury to the periodontal ligament 1 2 8.

Extrusive, Lateral, and Intrusive Luxation

• Extrusive Luxation: The tooth is partially displaced out of its socket along the axis, appearing elongated. Mobility increases, and immediate repositioning is often required 2 3 10.
• Lateral Luxation: The tooth is displaced sideways, usually with a fracture of the socket wall. The tooth may feel immobile due to being locked in the new position 1 2 4 8.
• Intrusive Luxation: The tooth is pushed deeper into the alveolar bone, often causing severe damage to the periodontal ligament, alveolar bone, and pulp 2 3 9.

Avulsion

• Avulsion: The tooth is completely dislodged from its socket. This is the most severe form of luxation and requires urgent action to attempt replantation and save the tooth 2 4 7.

Age and Dentition Considerations

• Children: Luxation injuries are more common in primary teeth, with lateral and intrusive luxations posing additional risks to the developing permanent tooth bud 5 6.
• Adults: Lateral luxations and crown fractures increase in frequency with age, and the risk of pulp necrosis is higher in teeth with mature roots 1 4.

Causes of Tooth Luxation

Luxation injuries result from traumatic forces that displace the tooth within or out of its socket. Understanding these causes can help with prevention and risk assessment.

Cause	Typical Scenario	Risk Group	Sources
Falls	Accidental, sports, home	Children	4 5 6
Sports Injuries	Contact sports, bicycling	Adolescents, adults	4 5 7
Traffic Accidents	Vehicle collisions	All ages	4 7
Assaults	Physical altercations	Adolescents, adults	4 7
Domestic Accidents	Play, running, household hazards	Children	3 5

Table 3: Common Causes of Tooth Luxation

Mechanisms and Risk Factors

Tooth luxation typically occurs when a sudden impact transmits force to the teeth, exceeding the supporting structures’ ability to absorb it:

Accidental Falls

• Falls while playing, running, or walking are the leading cause of luxation injuries, especially in young children. The risk is greatest during early childhood when motor coordination is still developing 5 6.
• Domestic accidents—such as falls from furniture or playground equipment—are also common in this age group 3 5.

Sports and Traffic Accidents

• Sports injuries—notably from contact sports and bicycling—are a major cause in adolescents and adults. The use of protective gear can reduce this risk 4 5 7.
• Traffic accidents (including pedestrian and vehicular collisions) can result in high-impact injuries and multiple dental luxations 4 7.

Assaults and Other Traumas

• Physical assaults are a significant cause among adolescents and adults, often leading to complex luxation and combination injuries 4 7.
• Other causes: Unusual circumstances, such as industrial accidents or recreational mishaps, can also result in dental luxation.

Additional Risk Factors

• Developmental stage of teeth: Immature teeth with incomplete root formation may respond differently to trauma compared to mature teeth 2 4.
• Oral habits and malocclusion: Protruding teeth (overjet) and certain oral habits may predispose individuals to luxation injuries 4.

Treatment of Tooth Luxation

Timely and appropriate management of tooth luxation is vital to optimize healing, preserve tooth vitality, and prevent long-term complications. Treatment varies according to the type and severity of the injury, as well as the age and dental development of the patient.

Luxation Type	Immediate Action	Long-term Care	Sources
Concussion	Observation, hygiene	Monitoring, soft diet	2 8
Subluxation	Observation, splint (if needed)	Monitoring, hygiene	2 8 11
Extrusive	Reposition, splint	Monitor pulp, splint removal	3 10 11
Lateral	Reposition, splint	Monitor root, pulp	2 4 8 11
Intrusive	Allow re-eruption/orthodontic/surgical reposition	Monitor, endodontic care if needed	2 9 11
Avulsion	Replant (if possible), splint	Monitor, root canal as indicated	2 4 7 8

Table 4: Treatment Approaches for Tooth Luxation

General Principles

Successful management of tooth luxation hinges on rapid assessment, proper repositioning (if indicated), stabilization, and ongoing follow-up:

Immediate Management

• Concussion/Subluxation: Treatment is generally conservative. Gentle oral hygiene, a soft diet, and close observation are recommended. Splinting may be considered if mobility interferes with function or comfort 2 8 11.
• Extrusive/Lateral Luxation: The tooth should be gently repositioned into its original location as soon as possible. Stabilization with a flexible splint for 2–4 weeks is standard; longer durations may be needed for severe injuries 3 10 11.
• Intrusive Luxation: Management depends on the developmental stage of the tooth. Options include allowing spontaneous re-eruption (especially in children), orthodontic repositioning, or surgical repositioning. More severe cases often require endodontic intervention to address pulp necrosis and root resorption 2 9 11.
• Avulsion: Immediate replantation is critical. If replantation is not possible at the scene, the tooth should be stored in a suitable medium (e.g., milk, saline) and transported to a dental clinic urgently. Splinting and root canal therapy are usually required 2 4 7 8.

Special Considerations for Primary Teeth

• In primary dentition, the risk to the developing permanent tooth bud guides management. Conservative treatments are preferred to minimize trauma, and extraction may be indicated if the primary tooth poses a risk to the underlying permanent tooth 5 6.

Follow-up and Complications

Ongoing monitoring is essential, as complications like pulp necrosis, pulp canal obliteration, and root resorption are common following tooth luxation 4 5 11.

• Pulp necrosis: Can occur in any luxation injury, particularly in teeth with mature roots 1 4 5.
• Root resorption: Risks increase with the severity of injury and delay in management 4 9 10.
• Long-term sequelae: Discoloration, enamel hypoplasia, and tooth loss may develop, especially if the injury affects the permanent tooth germ in children 5 6.

Orthodontic and Surgical Interventions

• Orthodontic repositioning is mainly used for intrusive luxations and, less commonly, for extrusive and lateral luxations 9 10 11.
• Surgical interventions may be necessary for teeth that are severely displaced or when repositioning cannot be achieved non-surgically 9 10.

International Guidelines

• The International Association of Dental Traumatology (IADT) provides evidence-based protocols for the diagnosis, treatment, and follow-up of tooth luxation injuries. Their guidelines emphasize individualized care, considering patient age, root development, and specific injury characteristics 2 7 8.

Conclusion

Tooth luxation is a complex dental trauma requiring timely recognition and appropriate management to achieve the best possible outcomes. Here’s a quick summary of the main points:

• Symptoms: Range from mobility and displacement to pain, bleeding, and color change. Early detection is crucial 1 2 4 8.
• Types: Include concussion, subluxation, extrusive, lateral, intrusive luxation, and avulsion—each requiring a distinct approach 1 2 3 4 8.
• Causes: Most commonly accidental falls, sports injuries, and traffic accidents, with children being especially vulnerable 4 5 6.
• Treatment: Depends on luxation type, severity, and patient age. Prompt repositioning, stabilization, and follow-up can prevent many complications. Adherence to expert guidelines is recommended for optimal care 2 4 7 8 9 10 11.

Understanding tooth luxation empowers patients and clinicians to act swiftly, minimizing damage and optimizing oral health after trauma.