Difference between revisions of "Dental fracture"
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==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 | ||
Revision as of 17:54, 7 November 2019
Contents
Background
Clinical Features
- Localized tooth fracture
- History of oral trauma
Differential Diagnosis
Dentoalveolar Injuries
Odontogenic Infections
- Acute alveolar osteitis
- Acute necrotizing ulcerative gingivitis (trench mouth)
- Dental caries (pulpitis)
- Ludwig's angina
- Periapical abscess
- Pericoronitis
- Periodontal abscess
- 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
- 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.
- 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.
- Treatment for both is reduction, stabilization if fracture segment is stable and outpatient follow with dentist in 24-48 hours.
Disposition
- Discharge with dental follow-up
See Also
External Links
Video