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4.14 Dental Trauma (fracture, subluxation and displacement)


Presentation

After a direct blow to the mouth the patient may have a portion of a tooth broken off, or a tooth may be loosened to a variable degree. Ellis class I dental fractures involve only enamel, and are problems only if they leave a sharp edge, which can be filed down. Ellis class II fractures expose yellow dentin, which is sensitive, can become infected, and should be covered. Ellis class III fractures expose pulp, which bleeds and hurts. A tooth that is either impacted inwards or partially avulsed outwards can be recognized because its occlusal surface is out of alignment compared to adjacent teeth. There is also usually some heorrhage at the gingival margin. If several teeth move together, suspect a fracture of the alveolar ridge.

What to do:

What not to do:

Discussion

Exposure of dentin leads to variable sequelae depending upon the age of the patient. Because it is composed of microtubules, dentin can serve as a conduit for pathogenic microorganisms. In children, the exposed dentin in an Ellis class II fracture lies nearer the neurovascular pulp and is more likely to lead to a pulp infection. Therefore, in patients less than 12 years old, this injury requires a dressing such as Dycal. Mix a drop of resin and catalyst over the fracture and cover with dry foil. When in doubt, consult a dentist. In older patients with Ellis class II fractures however, analgesics, avoidance of hot or cold foods and follow up with a dentist in 24 hours is quite adequate. If Coe-Pack or wire are not available to stabilize loose teeth, use soft wax spread over palatal and labial surfaces and neighboring teeth as a temporary splint.

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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