Concussion and subluxation

These injuries represent minor injuries to the periodontal ligament and pulp caused by an acute impact

A concussed tooth is TTP due to oedema and haemorrhage in the periodontal ligament. Vitality if often maintained but electric pulp tests and ethyl chloride may be negative at first. This is because pulp sensibility tests only assess the response of the nerve, not the blood supply.

A subluxed tooth is TTP and also abnormally loose, due to rupture of periodontal ligament fibres. The tooth has been moved within the socket but is still in it's original position.

Treatment of concussion and subluxation:

1. Occlusal relief and soft diet

2. Immobilisation of the injured teeth is often not required (occasionally provided for patient comfort)

3. Chlorhexidine 0.2% mouthwash, twice daily

4. Follow up at 1 and 2 months post-trauma, vitality testing, radiographic assessment

5. Prognosis—minimal risk of pulp necrosis