Management of Loose Teeth Following Motor Vehicle Accident
For loose teeth after MVA, immediately assess the type of luxation injury and reposition the tooth with gentle digital pressure for minor displacement or refer urgently for dental splinting if significantly mobile, while monitoring for pulpal necrosis and ensuring the occlusion is not compromised. 1
Initial Assessment and Classification
Loose teeth from trauma represent luxation injuries that require classification to guide management:
- Concussion: Tooth is tender but not mobile and requires no immediate treatment, only observation for future pulpal necrosis 1
- Subluxation: Tooth has increased mobility without displacement and requires no immediate treatment, only monitoring for pulpal necrosis 1
- Extrusive luxation: Tooth is partially displaced out of socket and appears elongated 1
- Lateral luxation: Tooth is displaced in a direction other than axially (sideways) 1
- Intrusive luxation: Tooth is pushed into the alveolar bone 1
Immediate Management by Luxation Type
Extrusive Luxation (Tooth Pulled Outward)
- For minor extrusion: Apply gentle digital pressure to reposition the tooth back into the socket 1
- For excessive extrusion: Refer immediately to dentist for repositioning with dental forceps and placement of flexible splint for 2 weeks 1
- The dentist will determine need for pulp therapy based on root maturity 1
Lateral Luxation (Sideways Displacement)
- Reposition the tooth to its original position regardless of displacement amount 1
- For minor displacement: Use gentle digital apical pressure to reposition 1
- For significant displacement: Immediate dental referral required for repositioning with dental forceps 1
- Critical step: Verify the tooth position does not interfere with occlusion by having patient say "cheese" or letter "e" to visualize that posterior molars can fully interdigitate 1
- Permanent teeth require stabilization with flexible splint for 4 weeks 1
Intrusive Luxation (Tooth Pushed Into Bone)
- Mild intrusion: Tooth will typically re-erupt gradually on its own; observe for several weeks 1
- If no re-eruption visible after a few weeks, orthodontic or surgical repositioning is necessary 1
- Early dental involvement is critical to supervise repositioning 1
- Severe intrusion may not be clinically visible and requires intraoral radiography to assess tooth position within alveolus 1
Critical Occlusion Assessment
A common pitfall is failing to verify proper occlusion after repositioning, which can lead to malocclusion and inability to masticate properly:
- Ensure posterior teeth (molars) can fully interdigitate 1
- Ask patient to demonstrate bite closure 1
- If bite cannot close properly, urgent repositioning is required 1
Special Considerations for MVA Patients
If Patient is Intubated
- Obtain chest radiograph immediately if teeth are unaccounted for or patient has breathing difficulties to rule out aspiration into tracheobronchial tree 2
- Perform intraoral radiography if available to confirm tooth location or rule out intrusion 2
- Remove severely mobile tooth fragments that cannot be stabilized as they pose continued aspiration hazard 2
- Arrange dental consultation once patient is stabilized for definitive management 2
Antibiotic Considerations
- Antibiotics are not routinely indicated for uncomplicated dental trauma 2
- Consider antibiotic coverage only if there is concern for contamination from oral flora 2
Follow-Up and Monitoring
All luxated permanent teeth require monitoring for:
- Pulpal necrosis (most important complication) 1
- Periodontal pathology 1
- Signs of infection: gingival swelling, increased mobility, parulis 1
Primary vs. Permanent Teeth Distinction
This management applies to permanent teeth only. Primary teeth that are significantly luxated should generally not be repositioned to avoid damage to underlying permanent tooth germs 1. The American Academy of Pediatrics guidelines emphasize this critical distinction to prevent long-term developmental complications 1.