Dental fracture

Background

Dental Numbering

Classic dental numbering.
  • Adult (permanent) teeth identified by numbers
    • From the midline to the back of the mouth on each side, there is a central incisor, a lateral incisor, a canine, two premolars (bicuspids), and three molars
  • Children (non-permanent) teeth identified by letters
  • Common landmarks:
    • 1: Right upper wisdom
    • 8 & 9: Upper incisors
    • 16: Left upper wisdom
    • 17: Left lower wisdom
    • 24 & 25: Lower incisors
    • 32: Right lower wisdom

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

Diagram of the tooth displaying the enamel, dentin, and pulp

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

References

  1. ↑ 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
  2. ↑ Medscape Fracture Teeth by Thomas et. al.
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