Emergency Department Care

Provide adequate pain management and tetanus vaccination, and ensure proper follow-up care.

Ellis I fracture: Smooth rough corners with a dental drill or an emery board.
- Treatment of fractures contained solely within the enamel alone requires no urgent care. The tooth can be repaired cosmetically at the convenience of the patient
Ellis II fracture: Cover exposed dentin with a layer of zinc oxide or calcium hydroxide paste (Dycal).
- Dycal requires the tooth to be absolutely dry for adherence. Cover the 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.
Ellis III fracture: Cover exposed dentin with a layer of zinc oxide or calcium hydroxide. Bleeding and moisture with this type of fracture usually makes it more difficult for these materials to adhere to the tooth. Cover with dental foil and expediently refer the patient to a dentist.
Root and dentoalveolar fractures require splinting by a dentist for several weeks.
Bone wax (Ethicon), which is a combination of beeswax and isopropyl palmitate, is not recommended for open dental fractures because it can cause inflammatory reactions of the surrounding soft tissues (eg, pulp).

Consultations

Consult a dental or oral maxillofacial surgeon.

Depending on the extent of the fracture, the dentist may do perform a root canal with calcium hydroxide followed by a gutta-percha filling or a partial pulpotomy.

Medication

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Media Gallery

Cross section of an Ellis III dental fracture.

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Author

Lynnus F Peng, MD Assistant Clinical Professor, Department of Anesthesia, University of California at Irvine; Chairman of Anesthesia, Department of Surgery, St Jude Medical Center at Fullerton

Lynnus F Peng, MD is a member of the following medical societies: Alpha Omega Alpha, American Society of Anesthesiologists

Disclosure: Nothing to disclose.

Coauthor(s)

Caleb Cheng University of California at San Diego

Disclosure: Nothing to disclose.

Amin Antoine Kazzi, MD Professor of Clinical Emergency Medicine, Department of Emergency Medicine, American University of Beirut, Lebanon

Amin Antoine Kazzi, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Willard Peng, DDS, MS Keck School of Medicine of the University of Southern California

Willard Peng, DDS, MS is a member of the following medical societies: American Dental Association, California Dental Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Anil P Punjabi, MD, DDS Clinical Associate Professor, Department of Oral and Maxillofacial Surgery, Loma Linda University School of Dentistry; Clinical Associate Professor, Department of Plastic Surgery, Loma Linda University School of Medicine; Chairman, Department of Plastic, Maxillofacial and Reconstructive Surgery, Vice Chairman, Department of Surgery, Redlands Community Hospital; Medical Director, Terracina Surgical Arts

Anil P Punjabi, MD, DDS is a member of the following medical societies: American Cleft Palate-Craniofacial Association, American Medical Association, American Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Additional Contributors

Michael Glick, DMD Dean, University of Buffalo School of Dental Medicine

Michael Glick, DMD is a member of the following medical societies: American Academy of Oral Medicine, American Dental Association

Disclosure: Nothing to disclose.

Acknowledgements

Mark W Fourre, MD Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine; Program Director, Department of Emergency Medicine, Maine Medical Center

Disclosure: Nothing to disclose.

Fractured Tooth Treatment & Management

Emergency Department Care

Consultations

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