Dental fracture

Management

• Enamel (Ellis Class I)
• Enamel + dentin (yellowish) (Ellis Class II)
• Enamel + dentin + pulp (reddish) (Ellis Class III)

Differential Diagnosis

Dentoalveolar Injuries

• Dental fracture
• Dental subluxation
• Dental avulsion
• Bleeding dental socket

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

• Scurvy
• Gingival hyperplasia
  • Phenytoin
  • Cyclosporine
  • Nifedipine, Amlodipine
  • Leukemia

Management

1. Enamel (Ellis Class I)
   1. Routine follow up only; nothing to do
2. Enamel + dentin (yellowish) (Ellis Class II)
   1. Patients experience sensitivity to hot/cold stimuli and air passing over tooth during breathing
   2. Cover exposed dentin to decrease pulpal contamination
      1. Place dental cement over fracture site
      2. Next day follow up
3. Enamel + dentin + pulp (reddish) (Ellis Class III)
   1. On wiping fractured surface with gauze, blood is easily seen
   2. Immediate referral (dental emergency)
   3. If no dentist is available:
      1. Cover exposed pulp with calcium hydroxide base
      2. Cover this and the remaining exposed dentin with dental cement

See Also

• Dental Problems

References

• ER Atlas