- Localized tooth fracture
- History of oral trauma
- Acute alveolar osteitis
- Acute necrotizing ulcerative gingivitis (trench mouth)
- Dental caries (pulpitis)
- Ludwig's angina
- Periapical abscess
- Periodontal abscess
- Peritonsillar abscess (PTA)
- Retropharyngeal abscess
- Vincent's angina - tonsillitis and pharyngitis
- 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
- 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