II. Definitions

  1. Tooth Fracture
    1. Broken Tooth affecting any portion of tooth (root or crown)

III. Symptoms

  1. Pain at affected tooth

IV. Types

  1. Root Fracture
    1. Difficult to diagnose without dental expertise and imaging
    2. Typically treated as Tooth Luxation
  2. Tooth splinter line or crack line
    1. Asymptomatic in most cases
    2. Amenable to cosmetic restoration
    3. Longterm risk of future affected tooth problems
  3. Crown Fracture
    1. Enamel Fracture (Ellis Type 1)
      1. Remaining tooth white or opaque
      2. Painless to air and water
      3. Amenable to cosmetic restoration
    2. Dentin extension (Ellis Type 2)
      1. Remaining tooth demonstrates brown or yellow coloration
      2. Sensitive to air and water, as well as hot and cold
      3. Apply Calcium hydroxide to the Fracture site
      4. Dental referral for permanent restoration
    3. Pulpal space extension (Ellis Type 3)
      1. Remaining tooth is pink, red or bleeding
      2. Rinse the tooth with saline to isolate the bleeding source (tooth vs Gingiva)
      3. Apply Calcium hydroxide to the Fracture site
      4. Treat with antibiotics (Penicillin VK) and NSAIDs
      5. Referral to dentist within 24 hours
        1. Root canal needed in some cases

V. Management: General

  1. Keep tooth fragments hydrated
  2. See a dentist as soon as possible (typically within 24 hours, especially Ellis Type 3 pulpal space extensions)

VI. Management: Tooth Fracture Dressing

  1. Dressing may reduce pain and reduce infection risk
    1. However, dressing may not prevent pulp necrosis or infection
  2. Technique
    1. Moisten exposed dentin and pulp, while keeping remaining tooth dry
      1. Apply a damp gauze to surface
    2. Mix together dental cement (e.g. Calcium hydroxide)
      1. Combine 1-2 mm each of catalyst and base on a mixing pad
      2. Mix for 15 seconds until consistent color
      3. Alternatives: Light-Cured Composites are typically used by dentists
    3. Apply a thin layer (0.5 mm thick) onto exposed dentin and pulp surface
    4. Keep the region dry for at least 60 seconds
      1. Lip and Tongue held away from surface
      2. Local gauze roll can absorb Saliva
    5. Confirm cement hardened
      1. Light pressure to cement should not leave an indent
  3. References
    1. Warrington (2022) Crit Dec Emerg Med 36(5): 15

VII. References

  1. Broderick and Deak (2015) Crit Dec Emerg Med 29(1): 2-8
  2. Claudius, Behar and Trahini in Herbert (2015) EM:Rap 15(5): 5-7

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