Dislocation of a tooth

A dislocation of the tooth is a traumatically occurring damage to the ligamentous apparatus of the teeth, which causes the reposition of a particular tooth in its well and the damage to the periodontal tissue that occurs when a lateral or vertically directed action of the traumatic force occurs. The traumatizing factor can be an incredible set of provocateurs - they act like a stroke( in case of falling, for example), and very little - when eating( biting hard for the consistency of food).

Dislocation of the tooth often happens on the frontal teeth of the maxillary row, much less often we encounter a dislocation of the tooth of the mandibular. Approximately with the same frequency, this pathology occurs both in adults and in very young ones. It should be noted that the dislocation of the tooth in a child differs in categories - a dislocation of a milk tooth or a permanent tooth, as in the treatment of the latter, a variant of its extraction and re-implantation( which is extremely psychologically traumatic for children), while the abnormal process of the milk tooth, evenWhen it is removed does not require further dental surgical manipulation.

Depending on the level of damage, the dislocation of the tooth is subdivided into subspecies: complete, inconclusive or incomplete and nested.

The main manifestations of pathology are unbearable severe pain, changing the position of the injured tooth relative to the rest of the teeth with its pathological, painful and inconvenient mobility. Also, in cases of moderate severity and more severe, it is possible to attach complications in the form of an inflammatory periodontal reaction and necroticisation of the pulp. In the incomplete case of a dislocation, the tooth itself can be inserted into its place by the manual dentist, in case of pathology the beaten dislocation of the tooth - perhaps even self-healing to its former place in the series, with the full version of the trauma - removal, followed by its introduction into the well with which it waswithdrawal was carried out.

What is a tooth dislocation?

A dislocation of a baby tooth or a dislocation of a permanent replaced tooth is, first of all, a tooth reposition in its well under the influence of unfavorable factors. With a healthy state of the peridontal tissues, an incredibly strong traumatic factor is required for tooth dislocation. However, in the presence of resorptive kostonotkannyh violations of the jaw, dislocation can happen even with the slightest impact on the tooth itself and accompany it will damage the integrity of the gums around.

Dislocation of the tooth can act as an independent pathology, isolated from the rest of the teeth, and be combined with a fracture of the tooth root, alveolar process or the entire jawbone.

Among the dislocations, the following types are classified:

• Bruising is traumatization of the tooth and its ligament fixation apparatus, without the presence of a reposition of the habitual location of the tooth. The most remarkable clinical manifestation is a significantly increased sensitivity to percussion. Although there is no apparent shift, but there is little mobility.

• Incomplete dislocation of the tooth is characterized by the fact that it has a tooth reposition relative to the habitual position. If there is a change in the normal position of the tooth in the hole, then this is a partial dislocation.

• The full version of the injury is actually the complete loss of the tooth from the socket.

Pathogenically traumatic dental lesions are most likely to cause obliteration and the inability to carry out any further adequate blood flow of the main blood-bearing pulpal vessels, the apical region of which is located. Later there is a hemorrhage with capillary dilatation in the pulp. After the stasis already occurred in the capillaries, their degeneration sets in, with seepage through the injured capillary wall of the erythrocyte mass. Due to the lack of pulpary collaterals, minor inflammatory processes are formed, as a reaction to damage and possibly the development of a partial or absolute pulpal infarction. With insufficient blood flow or lack of it at all, pulp in neglected condition can be months or even years. With transiently formed contamination of the bloodstream by bacteria, microbial pathogens penetrate through the small vessels of the root apex into the infarct pulpal tissues and settle in it. Bacterial-associated infection, which is formed as a consequence of pathological mechanisms, may be the initial clinical manifestation of necrotizing the pulp.

Sometimes the process of infarction is not total, and yet several capillaries are still viable and continue to function, they represent single blood-transducing vessels to individual zones of pulp, and some neural-fiber elements remain viable. There is a blockage of the infarctionally dying tissue of the temperature-mechanical receptors, preventing painful stimuli obtained from enamel and dentin. That, in turn, indicates the possibility of reversibility of pathopresises within a couple of weeks.

Existing statistical data indicate that combined pathology significantly increases the chance of developing pulpal necrosis. Crown fractures without the presence of an existing bruise or pathologically diagnosed mobility cause necrosis in 4% of cases, but with fractures with bruises the frequency reaches over 30%.

Incomplete dislocation of the tooth is diagnosed with a weighty displacement, that is, more than 4-5 mm from the hole, it is with this option that a fracture of the appendix can be attached. If several teeth are damaged at once( during an automobile accident, falling from a height), they can be so prone to displacement that their normal posture will be absolutely impossible, and in this case it is possible to help only by performing a reposition so that all teeth that are opposable to the toothacheIt's teeth-antagonists).

In case of a variant pathology, a dislocated dislocation of the tooth, with a minimally determined shear, self-healing often occurs - the tooth is self-inserted, but with a strong bias, medical intervention is necessary.

The most unpleasant consequences of dislocation of teeth are:

- necrosis, occurs in 51% of all diagnosed cases, and with intrusive - 96%;

- dystrophic calcification obliteration of the pulp - 20-25% of all cases;

- root resorption, second only to extrusion repositions;

- loss of bone attachment.

Causes of dislocation of the tooth

The following provocators are the causative factors of tooth dislocation:

- The leading place is given to the force that was applied to the dental crown, that is, the cause is directly impact, or in other words, the trauma that can occur at such events:, Car accident, impact in the jaw area, etc. More often in such incidents it happens that the centrally growing teeth and canines, both maxillary and mandibular, can be damaged.

- Foreign body of hard or hard consistency in human food that is chewed( this option is often noted in the presence of weakened periodontal tissues, existing dental cracks).

- Bad habits or neglect in relation to your own teeth: opening the lids of the bottles with jaws, cracking the shell of nuts, etc.

- Unprofessional, inaccurate or incorrect extraction of teeth, or at all their self-isolation. But, the important point is that the dislocation itself happens to the nearby tooth. Often this extraction of the incisors is affected.

Symptoms and signs of dislocation of the tooth

Symptom complex differs in different subspecies of dislocation of the tooth:

• Full dislocation of the tooth can be characterized as complete loss of it from its positional notch hole. Most patients experience pain and emotional-stress shock. There may be severe bleeding or the formation of a blood clot.

When dental examination of the oral cavity can be seen that the tooth is absent and in its place already formed either bleeding wound, or in the place of excavation freshly formed thrombus. Often there are accompanying injuries of soft tissue edging lip and puffiness.

• Incomplete dislocation of the tooth is only a displacement of a part of the root, which is always accompanied by damage to the periodontal fibers. Patients may present the following complaints: pain symptoms, pathological uncomfortable mobility, a sense of change in the place of tooth jaw row, pulled out a tooth, and aching pain, which tends to be aggravated by chewing act. Sometimes food intake is completely impossible and so painful that the patient does not want to eat at all, although he can be very hungry. When examined, the tooth is easily moved and sharply percussion and palpation painful. The gums are swollen and bloody, there are tears and bleeds. With the rupture of the annular ligament and peridontal tissues, lesions in the alveolar wall, pathological bleeding pockets are present. When the crown is displaced, the root of the tooth is displaced vestibularly, and when it moves in the side of the occlusal-compressing plane, it protrudes above the prescribed level.

• impacted dislocation of the tooth is characterized by screwing the tooth in the jaw bone( this phenomenon is called intrusion), this leads to significant pathological kostnotkannym resorptive mechanisms. This form of dislocation is very serious, since the tooth can be wound into the sinus of the upper jaw or completely into the nasal cavity.

Among the complaints, you can also select the following symptoms: a shortening of the tooth relative to the remaining teeth or tooth is not visible side by side, a little percussion is painful, pain when biting food, little bleeding and pain in the gums surrounding the pressure-sensitive.

Diagnostics tooth dislocation

diagnostic complex determination of tooth dislocation is very simple and consists of a dental examination oral carrying percussion in bruised tooth assess the status of nearby and countervailing teeth defining gum condition and bleeding, the possible additional pathological changes and mobilities of traumatically damagedTooth. It is also very important for the patient to have an early diagnosis, that is, it is necessary to determine in time the presence of complications of dislocation( fractures of adjacent incisors, damage to the vasculature or the presence of tissue necrosis and bone resorptive mechanisms).

Also in the diagnosis include the collection of anamnesis and patient complaints.

addition is conducted to assess in what a state at the time of applying for help is the jaw( the presence of ulceration of bone structures), adjacent spaced teeth, innervation damage invisible when viewed from the changes and clarify the complexity of pathological dislocation, X-ray study, which is called ortopantomogramma.

Treatment of tooth dislocation

First of all, you need to decide on the appropriateness of tooth preservation. The main criterion is the state of the bone-knotted elements of the root of the tooth. If it is at least half the length of the root, it is rational to keep the tooth. If the outline, then installs the tooth in its place under the influence of anesthesia and then eliminate his ability to move, the method of splinting and appoint "food rest", without forgetting to treat the pulp with the arising deviations.

In the case of pulp necrosis, pulp is extruded and the canal is sealed, while in the absence of pathology it is left untouched. For the definition of the pulpal state, its reaction is measured by using sensitivity on the electric current( the norm is 2-3 μA).But, it is important to know that in the first 3-5 days from the injury, a functional self-healing decrease in sensitivity is possible, then it is necessary to repeat the study in dynamics. But, if there is no response to current from 100 μA, then this is an indicator of the necrosis that has already occurred.

In case of trauma, it is also possible to thrust the dental root into the jaw, with the necessarily accompanied break of the neuromuscular bundle. Then the tooth is fixed and immediately removed pathological necrotic pulp as soon as possible, so as not to bring to the state of decomposition and coloring in the black and gray color of the crown.

If the tooth falls outside the clinic and gets dirty, clean it with clean water without using detergents and brushes, so as not to damage it. You can use containers with wet biocompatible media or containers with milk during transportation. In extreme cases, to transfer the tooth directly in the mouth: behind the cheek, under the tongue. Since contact with tap water, there is a possibility of its further inability to reimplant.

If self-healing has occurred, then after removing the tires, it is necessary to install crowns on the sprained and adjacent healthy teeth.

A nested version of the pathology is prone to self-healing, but nevertheless it is important to monitor the dentist in order to prevent complications.

In general, treatment, regardless of configuration, implies a huge complex of medical and dental manipulations, in order to restore the old functionality.

Treatment of incomplete dislocation of the tooth is performed according to the following criteria:

1).Reposition. The tooth moves into its anatomical recess and is fixed to adjacent on either side or gypsum material, tires( wire, plastic, metal) filling artificial implant-option( the fixing time is about ten days).Immobilization with retention is carried out in the following ways:

- Ligature binding( simple, continuous eight, according to Baronov, Obvezzru, Frigofu).It is shown in the presence of steadily standing teeth( from two to three specimens on both sides).The disadvantage is the impossibility of a temporary bite and the inability to fix it rigidly.

- The tire-brace is shown in a constant bite, but it is traumatic, the process itself is very time-consuming and limited in use.

- Plastic kappa, which is created directly in the mouth.

- Plastic wire nadubno-naresnevye tires, they are convenient for any bite and do not need to connect adjacent teeth. Produced in laboratories from impressions of the model of a specific jaw.

- Composite material variants, fixing wire arcs or other tires.

Immobilization should last from four weeks, while it is important to strictly maintain oral hygiene, in addition to not acquire inflammatory reactions and do not damage the enamel of the shin teeth.

2).Gentle diet. To prevent further displacements and solid food ingestion in the diseased tooth and causing pain.

3).Examination by a doctor after a month and a half, when the tires will be removed and find out how the blood supply and innervation sensitivity are preserved. At the same time, a control radiography is performed in order to see how correctly the repositioning took place and whether there are any complications.

The treatment for the complete dislocation of the tooth consists in the re-implantation. A well fixation is also carried out, which is carried out with the help of special dental structures. But, before installation, the well is thoroughly cleaned from blood deposits and extraneous impurities using antimicrobial and analgesics. Subdivide this manipulation into several consecutive stages:

1).Dental trepanation, pulpary extirpation and canal for sealing.

2).Replantation is a return to one's own recess. Differences are one-stage( at a time the tooth is prepared for insertion back, sealed, re-implanted with splints) and delayed( the tooth is washed, immersed in saline with an antibacterial drug and placed in a cold room for a while, and after a certain time, the manipulations listed in point 1).

3).Fixing for a month with a kappa or a smooth staple.

4).Mechanically relaxed diet table.

5).X-ray control is performed.

In a month and a half from the operation performed, the following outcomes are possible:

1. Syndhesmosis - engraftment through the peridonally-primary tension. This is the most advantageous option.

2. Synostosis - engraftment as a bone fusion of the root and wall of the recess-hole. This is the least favorable outcome.

3. Periodontal-fibrous-ossic joint variant - fusion of the root and walls of the alveoli.