Dental Trauma : (Fracture, Subluxation, and Displacement)

Presentation

After a direct blow to the mouth, a portion of a patient’s tooth (most often one of the maxillary incisors) may be broken off, or a tooth may be loosened to a variable degree.

Ellis class I dental fractures ( Fig. 50.1 ) involve only the enamel and are problematic only if a sharp edge remains, which can be filed down with an emery board. These fractures are painless, do not bleed, and can be referred to a dentist for cosmetic repairs. Athletes with only this type of injury may return to play. Ellis class II fractures ( Fig. 50.2 ) expose yellow dentin, which is sensitive to temperature, percussion, and forced air. This type of fracture can become infected and may bleed slightly. Ellis class III fractures ( Fig. 50.3 ) expose pulp that is pink, typically bleed, and are usually painful. Ellis II and III fractures should be covered to help control pain and prevent pulp infection.

A tooth that is either impacted inward or partially avulsed outward is recognizable because its occlusal surface is out of alignment compared with adjacent teeth. There is also usually some hemorrhaging at the gingival margin. If several teeth move together, suspect a fracture of the alveolar ridge. Fig. 50.4 shows normal dental anatomy.