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Tooth fracture
From WikEM
Contents
Background
Clinical Features
- Localized tooth fracture
- History of oral trauma
Differential Diagnosis
Dentoalveolar Injuries
- Tooth fracture
- Tooth subluxation
- Tooth avulsion
- Bleeding dental socket
Odontogenic Infections
- Dental caries (pulpitis)
- Ludwig's angina
- Periapical abcess
- Periodontal abscess
- Peritonsillar Abscess (PTA)
- Retropharyngeal abscess
- Trench Mouth (Acute Necrotizing Ulcerative Gingivitis)
- Vincent's angina - tonsillitis and pharyngitis
- Acute alveolar osteitis
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
- 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
- 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
- Discharge with penicillin or clindamycin as they have pulpitis by definition
Disposition
- Discharge with dental follow-up
See Also
Video
References
Authors
Ross Donaldson, Michael Holtz, Tianjiang Ye, Neil Young, Claire
