Difference between revisions of "Dental fracture"
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**Cover exposed dentin with calcium hydroxide to decrease pulpal contamination | **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. | ***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 | **Next day follow up | ||
*Enamel + dentin + pulp (reddish) ('''Ellis Class III''') | *Enamel + dentin + pulp (reddish) ('''Ellis Class III''') | ||
Revision as of 20:15, 16 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
- 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