Dental Trauma

Author: Hans Rosenberg, MD
Updated: 4/15/2011

Dental Trauma


  • 32 teeth (each quadrant: 2 incisors, 1 canine, 2 premolars, 3 molars)
  • Numbering: 1 to 32 starting in R maxilla and ending in R mandible

Tooth Anatomy

  • Pulp: Central portion, neurovascular supply
  • Dentin: Surrounds pulp, majority of tooth
  • Enamel: White visible portion of tooth
  • Periodontium: Attachment apparatus (gingiva, periodontal ligament, alveolar bone)

General Approach to Dental Trauma


  • Assess risk of aspiration
  • If loose/displaced tooth, do not manipulate the tooth

Hemorrhage control:

  • Apply gauze and direct pressure

Avulsed tooth

  1. Handle by crown only to avoid damage of periodontal ligament.
  2. Gently rise tooth with saline, but do not wipe root and ligament.
  3. Replace tooth and ask patient to bite on gauze (if not at aspiration risk)
  4. If unable to place in transport medium: Hank's balance solution, saline, milk

Identify all fracture fragments:

  • May have been aspirated, lodged in mucosal tissue, intruded into alveolar bone

Consider radiographs: CXR and panorex


  • Complicated fractures/avulsions may require Td and antibiotics (penicillin V, clindamycin)

Procedural videos from


Ellis Class I

  • Through enamel
  • Pulp necrosis risk = 0-3%
  • Treatment: Smooth sharp edges with emery board if causing pain
  • F/U with dentist PRN

Ellis Class II

  • Through enamel and dentin (yellow/pink appearance)
  • Pulp necrosis risk = 1-7%
  • Painful and temperature sensitive
  • Treatment:
  • Cover tooth with CaOH (eg. Dycal®) after drying tooth with gauze
  • Soft food diet
  • F/U with dentist 24-48 hrs

Ellis Class III

  • Involving pulp (pink appearance, blood often visible)
  • Pulp necrosis risk = 10-30%
  • Severe pain, temperature sensitive
  • Treatment: Dental emergency - contact on call dentist (If not immediatelyavailable, same treatment as Ellis II except liquid diet)

Alveolar Fracture

  • Fx of underlying alveolar bone with tooth involvement
  • Associated with high impact trauma
  • Emergency Department goal: Diagnose and preserve tissue, repair mucosal tissue
  • Treatment: Dental emergency - contact on call dentist/oral surgeon


Tooth is complete displaced from periodontal ligament Treatment: Dental emergency - contact on call dentist If PRIMAY DENTITION, do not replace because of risk of ankylosis. F/U with dentist in 1-2 weeks. If ADULT DENTITION, "time is tooth" - Periodontal ligament necrosis in 60-90 minutes if not in transport medium, loss of viability

  • Suction socket with Frasier tip suction
  • Irrigate with saline
  • Implant tooth using firm pressure
  • Apply splint (eg. Coe-Pak): Apply as a bridge to teeth and gingiva


  • Benko, K. Acute Dental Emergencies in EM. EM Practice. 2003, 5(5) [Source]