Dental fracture

Clinical Features

Coronal incisor fractures and with extrusive luxation (partial avulsion) of the upper right central incisor.

• Localized tooth fracture
• History of oral trauma

Differential Diagnosis

Dentoalveolar Injuries

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

Odontogenic Infections

• Acute alveolar osteitis (dry socket)
• Acute necrotizing ulcerative gingivitis (trench mouth)
• Dental abscess
  • Periapical abscess
  • Periodontal abscess
• Ludwig's angina
• Pulpitis (dental caries)
• Pericoronitis
• Peritonsillar abscess (PTA)
• Retropharyngeal abscess
• Vincent's angina - tonsillitis and pharyngitis

Other

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

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.
  • 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

• Dental problems

Video

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References

Core EM Dental Trauma Page