Tooth Fractures

1
(No Transcript)
2
Tooth Fractures
3
Anatomy of Tooth
Cementum - the layer of hard bone-like tissue
covering the root of the tooth. Cemento-enamel
junction - the line where the enamel and cementum
meet. Dentin - the hard yellow tissue underlying
the enamel and cementum, making up the main bulk
of the tooth. Enamel - the hard, white outer
layer of the tooth. Gingiva - the gum tissue
surrounding the tooth. Ligament - the connective
tissue that surrounds the tooth and connects it
to bone. Nerves - relay signals such as pain to
and from your brain. Pulp - located in the center
of the tooth, it contains the arteries, veins and
nerves. Root canal - canal in the root of the
tooth where the nerves and blood vessels travel
through
4
Numbering
1. 3rd Molar (wisdom tooth)2. 2nd Molar (12-yr
molar)3. 1st Molar (6-yr molar)4. 2nd Bicuspid
(2nd premolar)5. 1st Bicuspid (1st premolar)6.
Cuspid (canine/eye tooth)7. Lateral incisor8.
Central incisor9. Central incisor10. Lateral
incisor11. Cuspid (canine/eye tooth)12. 1st
Bicuspid (1st premolar)13. 2nd Bicuspid (2nd
premolar)14. 1st Molar (6-yr molar)15. 2nd
Molar (12-yr molar)16. 3rd Molar (wisdom
tooth)17. 3rd Molar (wisdom tooth)18. 2nd Molar
(12-yr molar)19. 1st Molar (6-yr molar)20. 2nd
Bicuspid (2nd premolar)21. 1st Bicuspid (1st
premolar)22. Cuspid (canine/eye tooth)23.
Lateral incisor24. Central incisor25. Central
incisor26. Lateral incisor27. Cuspid
(canine/eye tooth)28. 1st Bicuspid (1st
premolar)29. 2nd Bicuspid (2nd premolar)30. 1st
Molar (6-yr molar)31. 2nd Molar (12-yr
molar)32. 3rd Molar (wisdom tooth)
primary teeth are designated by upper case
letters A through T, with A being the patient's
upper right second primary molar and T being the
lower right second primary molar.
5
Classification

• Ellis I enamel only
• White, chalky appearance
• Ellis II enamel dentin
• Dentin is pink /or yellow
• Hot/cold sensitivity
• More serious in childrenlt12 yrs old (less dentin)
• Ellis III to the pulp
• Exposed blood
• Severe pain 2/2 exposed nerve
• Risk for abscess formation

6
Ellis Type II
7
Evaluation

• PE
• Evaluate surrounding soft tissue area for
  laceration, discoloration, ecchymosis and
  embedded foreign bodies (eg, chipped
  teeth?chronic infexn, fibrosis).
• Evaluate if tooth is mobile or if an entire
  segment is mobile (have pt bite down on tongue
  blade)
• Percuss with tongue blade to evaluate
  sensitivity.
• XR
• Panorex evaluate for mandibular/maxillary fx,
  foreign body, displacement

8
Treatment

• Ellis Ismooth rough cornes with dental drill or
  emery board
• Immediate dentral referral w/I 24 hr when soft
  tissue injury caused by sharp pieces of tooth
• Ellis IICover exposed dentin with a layer of
  zinc oxide or calcium hydroxide paste (Dycal).
• Cover tooth with a small piece of dental or
  aluminum foil. Exposure to humidity increases the
  rate at which the Dycal will set.
• In patients younger than 12 years, coverage is
  especially important to prevent infection.
• Refer to denist within 24 hours
• Ellis IIISame as type II BUT urgent Dental
  Refferal
• Risk for Abscess formation
• Abx pcn, amoxacillin

9

• Ellis II III
• Advise pts to not eat food to lessen chances of
  loosing adhesive dressing
• Root Fx
• Early reduction, immob, spliting
• Coe-Pak (stabilizin compund)
• Dental referral w/I 24 hours
• Complications
• Tooth loss
• Cosmetic Deformity
• Infection

10
Medical/Legal Pitfalls

• Failure to provide tetanus prophylaxis
• Failure to rule out aspiration of tooth chips if
  unable to recover the tooth in the field
• Failure to properly examine surrounding
  traumatized tissue for tooth chips
• Failure to recognize domestic and/or child abuse
• Failure to evaluate fully the temporomandibular
  joint, maxilla, mandible, and occlusion
• Failure to evaluate associated head and neck
  injuries
• Failure to recognize possible airway compromise
• Failure to warn patient that any trauma to teeth
  can disrupt the neurovascular supply and lead to
  long-term pulp necrosis or root resorption