Dental fracture: Difference between revisions
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==Background== | ==Background== | ||
{{Dental numbers}} | |||
==Clinical Features== | ==Clinical Features== | ||
[[File:PMC3514946 CCD-3-194-g001.png|thumb|Ellis class III fracture on tooth | [[File:PMC3514946 CCD-3-194-g001.png|thumb|Ellis class III fracture on tooth 9]] | ||
*Localized tooth fracture | *Localized tooth fracture | ||
*History of oral trauma | *History of oral trauma | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{ | {{Dental Problems DDX}} | ||
==Evaluation== | ==Evaluation== | ||
| Line 15: | Line 15: | ||
==Management== | ==Management== | ||
[[File:Enamel.png|thumb|Diagram of the tooth displaying the enamel, dentin, and pulp]] | |||
===Enamel ('''Ellis Class I''')=== | |||
*Routine follow up only; nothing to do | |||
*May consider filing down sharp edges with an emery board for comfort | |||
===Enamel + dentin (yellowish) ('''Ellis Class II''')=== | |||
*Patients experience sensitivity to hot/cold stimuli and air passing over tooth during breathing | |||
**Next day follow up | *Cover exposed dentin with calcium hydroxide to decrease pulpal contamination | ||
**Greater than 2 mm of dentin offers more protection to pulp, can be covered with dental cement only. If dentin is less than 0.5 mm then cover with calcium hydroxide and dental cement over it. | |||
*** Dermabond can be used if no other materials are available <ref>[https://www.annemergmed.com/article/S0196-0644(05)02149-9/abstract Hile, et al Use of 2-Octyl Cyanoacrylate for the Repair of a Fractured Molar Tooth. Annals of Emergency Medicine May 2006Volume 47, Issue 5, Pages 424–426]</ref><ref>[https://emedicine.medscape.com/article/82755-overview#a7 Medscape Fracture Teeth by Thomas et. al. ]</ref> | |||
*Next day follow up | |||
===Enamel + dentin + pulp (reddish) ('''Ellis Class III''')=== | |||
*On wiping fractured surface with gauze, blood is easily seen | |||
*Immediate dental referral (dental emergency) - should be seen within 24 hours | |||
*If not able to be seen immediately, cover exposed pulp with calcium hydroxide and dental cement. | |||
*Discharge with [[penicillin]] or [[clindamycin]] as they have [[pulpitis]] by definition | |||
===Crown Root/Root fracture (not a common dental injury)=== | |||
*Treatment for both is reduction, stabilization if fracture segment is stable and outpatient follow with dentist in 24-48 hours. | |||
**If fracture segment unstable/very mobile may need to extract to prevent aspiration. | |||
*Crown Root fracture does not always involve pulp vs root fractures almost always involves pulp. | |||
==Disposition== | ==Disposition== | ||
| Line 38: | Line 43: | ||
==See Also== | ==See Also== | ||
*[[Dental problems]] | *[[Dental problems]] | ||
*[[In-Training Exam Review]] | |||
== | ==External Links== | ||
*[https://coreem.net/core/dental-trauma/ Core EM Dental Trauma Page] | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:ENT]] | [[Category:ENT]] | ||
[[category:Trauma]] | [[category:Trauma]] | ||
Latest revision as of 19:46, 17 April 2024
Background
Dental Numbering
- Adult (permanent) teeth identified by numbers
- From the midline to the back of the mouth on each side, there is a central incisor, a lateral incisor, a canine, two premolars (bicuspids), and three molars
- Children (non-permanent) teeth identified by letters
- Common landmarks:
- 1: Right upper wisdom
- 8 & 9: Upper incisors
- 16: Left upper wisdom
- 17: Left lower wisdom
- 24 & 25: Lower incisors
- 32: Right lower wisdom
Clinical Features
- Localized tooth fracture
- History of oral trauma
Differential Diagnosis
Dentoalveolar Injuries
Odontogenic Infections
- Acute alveolar osteitis (dry socket)
- Acute necrotizing ulcerative gingivitis (trench mouth)
- Dental abscess
- Periapical abscess
- Periodontal abscess
- Ludwig's angina
- Pulpitis (dental caries)
- Pericoronitis
- Peritonsillar abscess (PTA)
- Retropharyngeal abscess
- Vincent's angina - tonsillitis and pharyngitis
Other
Evaluation
- Clinical diagnosis
- Consider obtaining panorex to evaluate for associated bone fracture
Management
Enamel (Ellis Class I)
- Routine follow up only; nothing to do
- May consider filing down sharp edges with an emery board for comfort
Enamel + dentin (yellowish) (Ellis Class II)
- Patients experience sensitivity to hot/cold stimuli and air passing over tooth during breathing
- Cover exposed dentin with calcium hydroxide to decrease pulpal contamination
- Next day follow up
Enamel + dentin + pulp (reddish) (Ellis Class III)
- On wiping fractured surface with gauze, blood is easily seen
- Immediate dental referral (dental emergency) - should be seen within 24 hours
- If not able to be seen immediately, cover exposed pulp with calcium hydroxide and dental cement.
- Discharge with penicillin or clindamycin as they have pulpitis by definition
Crown Root/Root fracture (not a common dental injury)
- Treatment for both is reduction, stabilization if fracture segment is stable and outpatient follow with dentist in 24-48 hours.
- If fracture segment unstable/very mobile may need to extract to prevent aspiration.
- Crown Root fracture does not always involve pulp vs root fractures almost always involves pulp.
Disposition
- Discharge with dental follow-up