Difference between revisions of "Dental fracture"
(→Management) |
(→Crown Root/Root fracture- not a common dental injury) |
||
| (11 intermediate revisions by 5 users not shown) | |||
| Line 3: | Line 3: | ||
==Clinical Features== | ==Clinical Features== | ||
| + | [[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 | ||
| Line 14: | Line 15: | ||
==Management== | ==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 | + | **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 33: | Line 42: | ||
==See Also== | ==See Also== | ||
*[[Dental problems]] | *[[Dental problems]] | ||
| + | |||
| + | ==External Links== | ||
| + | *[https://coreem.net/core/dental-trauma/ Core EM Dental Trauma Page] | ||
==Video== | ==Video== | ||
| Line 41: | Line 53: | ||
[[Category:ENT]] | [[Category:ENT]] | ||
| + | [[category:Trauma]] | ||
Latest revision as of 06:00, 10 December 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.
Disposition
- Discharge with dental follow-up
See Also
External Links
Video