Dental fracture

Management

• Enamel (Ellis Class I)
• Enamel + dentin (yellowish) (Ellis Class II)
• Enamel + dentin + pulp (reddish) (Ellis Class III)

Differential Diagnosis

Dentoalveolar Injuries

• Dental fracture
• Dental subluxation
• Dental avulsion
• Bleeding dental socket

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

• Scurvy
• Gingival hyperplasia
  • Phenytoin
  • Cyclosporine
  • Nifedipine, Amlodipine
  • Leukemia

Management

1. Enamel (Ellis Class I)
   1. Routine f/u only; nothing to do
2. Enamel + dentin (yellowish) (Ellis Class II)
   1. Pts experience sensitivity to hot/cold stimuli and air passing over tooth during breathing
   2. Cover exposed dentin to decrease pulpal contamination
      1. Place dental cement over fracture site
      2. Next day f/u
3. Enamel + dentin + pulp (reddish) (Ellis Class III)
   1. On wiping fractured surface with gauze, blood is easily seen
   2. Immediate referral (dental emergency)
   3. If no dentist is available:
      1. Cover exposed pulp with calcium hydroxide base
      2. Cover this and the remaining exposed dentin with dental cement

See Also

• Dental Problems

Source

• ER Atlas
• Tintinalli
• UpToDate