Difference between revisions of "Dental fracture"

(Crown Root/Root fracture- not a common dental injury)
 
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==Clinical Features==
 
==Clinical Features==
[[File:PMC3514946 CCD-3-194-g001.png|thumb|Ellis class III fracture on tooth 21]]
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[[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
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==Management==
 
==Management==
*Enamel ('''Ellis Class I''')
+
===Enamel ('''Ellis Class I''')===
**Routine follow up only; nothing to do
+
*Routine follow up only; nothing to do
**May consider filing down sharp edges with an emery board for comfort
+
*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
+
===Enamel + dentin (yellowish) ('''Ellis Class II''')===
**Cover exposed dentin with calcium hydroxide to decrease pulpal contamination
+
*Patients experience sensitivity to hot/cold stimuli and air passing over tooth during breathing
***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.  
+
*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.  
*Enamel + dentin + pulp (reddish) ('''Ellis Class III''')
+
*** 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>
**On wiping fractured surface with gauze, blood is easily seen
+
*Next day follow up
**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.
+
===Enamel + dentin + pulp (reddish) ('''Ellis Class III''')===
**Discharge with [[penicillin]] or [[clindamycin]] as they have [[pulpitis]] by definition
+
*On wiping fractured surface with gauze, blood is easily seen
*Crown Root/Root fracture- not a common dental injury
+
*Immediate dental referral (dental emergency) - should be seen within 24 hours
**Treatment for both is reduction, stabilization if fracture segment is stable and outpatient follow with dentist in 24-48 hours.  
+
*If not able to be seen immediately, cover exposed pulp with calcium hydroxide and dental cement.
***If fracture segment unstable/very mobile may need to extract to prevent aspiration.  
+
*Discharge with [[penicillin]] or [[clindamycin]] as they have [[pulpitis]] by definition
**Crown Root fracture does not always involve pulp vs root fractures almost always involves pulp.
+
 
 +
===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==

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