Difference between revisions of "Dental fracture"

(Crown Root/Root fracture- not a common dental injury)
 
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==Background==
 
==Background==
  
==DDX==
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*[[Dental Problems]]
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==Clinical Features==
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[[File:PMC3514946 CCD-3-194-g001.png|thumb|Ellis class III fracture on tooth 9]]
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*Localized tooth fracture
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*History of oral trauma
 +
 
 +
==Differential Diagnosis==
 +
{{Template:Dental Problems DDX}}
 +
 
 +
==Evaluation==
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*Clinical diagnosis
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*Consider obtaining panorex to evaluate for associated bone fracture
  
 
==Management==
 
==Management==
#Enamel (Ellis Class I)
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===Enamel ('''Ellis Class I''')===
##Routine f/u only; nothing to do
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*Routine follow up only; nothing to do
#Enamel + dentin (yellowish) (Ellis Class II)
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*May consider filing down sharp edges with an emery board for comfort
##Pts experience sensitivity to hot/cold stimuli and air passing over tooth during breathing
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##Cover exposed dentin to decrease pulpal contamination
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===Enamel + dentin (yellowish) ('''Ellis Class II''')===
###Place dental cement over fracture site
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*Patients experience sensitivity to hot/cold stimuli and air passing over tooth during breathing
###Next day f/u
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*Cover exposed dentin with calcium hydroxide to decrease pulpal contamination
#Enamel + dentin + pulp (reddish) (Ellis Class III)
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**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.
##On wiping fractured surface with gauze, blood is easily seen
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*** 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>
##Immediate referral (dental emergency)
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*Next day follow up
##If no dentist is available:
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###Cover exposed pulp with calcium hydroxide base
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===Enamel + dentin + pulp (reddish) ('''Ellis Class III''')===
###Cover this and the remaining exposed dentin with dental cement
+
*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)===
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*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==
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*Discharge with dental follow-up
  
 
==See Also==
 
==See Also==
*[[Dental Problems]]
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*[[Dental problems]]
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==External Links==
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*[https://coreem.net/core/dental-trauma/ Core EM Dental Trauma Page]
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==Video==
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{{#widget:YouTube|id=GBCMn-xovHU}}
  
== Source ==
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==References==
*ER Atlas
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<references/>
*Tintinalli
 
*UpToDate
 
  
 
[[Category:ENT]]
 
[[Category:ENT]]
 +
[[category:Trauma]]

Latest revision as of 06:00, 10 December 2019

Background

Clinical Features

Ellis class III fracture on tooth 9
  • Localized tooth fracture
  • History of oral trauma

Differential Diagnosis

Dentoalveolar Injuries

Odontogenic Infections

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.
      • Dermabond can be used if no other materials are available [1][2]
  • 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

See Also

External Links

Video

References