History
Different physical and clinical findings present depending on where the tooth is fractured. Note the fracture's extent and the patient's age. The Ellis classification has been designed for evident fractures.
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Ellis I fractures involve only the enamel; these injuries may show minor chipping with rough edges.
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Ellis II fractures involve enamel and dentin; patients may complain of pain to touch and sensitivity to air. A pale yellow exposure of the dentinal processes, which communicates directly with the pulp, can occur. Patients younger than 12 years have immature teeth with much less dentin spanning the space between the pulp and enamel. The chance of infection and damage to the pulp in this age group is much greater because of larger pulp size and shorter dentin distance the infection has to traverse. [6]
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Ellis III fractures involve enamel, dentin, and pulp; patients complain of pain with manipulation, air, and temperature. Pinkish or reddish markings around surrounding dentin or blood in the center of the tooth from the exposed pulp may present.
Root fractures are clinically difficult to diagnose; patients may notice abnormal mobility and sensitivity to percussion of the tooth.
Dentoalveolar fractures may cause patients to complain of malocclusion and mobility with findings of a mobile group of teeth.
Physical Examination
Inspection
Evaluate surrounding soft tissue area for laceration, discoloration, ecchymosis, and embedded foreign bodies (eg, chipped teeth).
Evaluate teeth for fractures, chips, and other deformities. Embedded tooth fragments may lead to chronic infection or fibrosis.
Palpation
Evaluate if the tooth is mobile or if an entire segment is mobile.
If possible, have the patient bite down to further localize suspect area.
Percussion and sensitivity
Percuss with tongue blade to evaluate sensitivity.
Assess sensitivity to air and hot and cold solutions.
Percussion is necessary when an impact trauma with no fractures or displacement is involved. In apparently undamaged teeth, the neurovascular bundle that enters through the apical canal may have been damaged. The resulting damage can lead to pulp degeneration. These teeth are often sensitive to percussion.
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Cross section of an Ellis III dental fracture.
