Dental fracture

Revision as of 14:05, 19 October 2019 by Rossdonaldson1 (talk | contribs) (Clinical Features)


Clinical Features

Coronal incisor fractures and with extrusive luxation (partial avulsion) of the upper right central incisor.
Ellis class III fracture on tooth 21
  • Localized tooth fracture
  • History of oral trauma

Differential Diagnosis

Dentoalveolar Injuries

Odontogenic Infections



  • Clinical diagnosis
  • Consider obtaining panorex to evaluate for associated bone fracture


  • 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.


  • Discharge with dental follow-up

See Also



Core EM Dental Trauma Page