Excerpt from Dental, Fractured Tooth

Synonyms, Key Words, and Related Terms: tooth fracture, broken tooth, traumatized maxillary teeth, postnormal occlusion, overjet, short upper lip, incompetent lip, mouth breathing, maxillofacial injuries, maxillofacial fractures, Ellis classification, Ellis I fractures, Ellis II fractures, Ellis III fractures, chipped tooth, chipped teeth, root fractures, dentoalveolar fractures, malocclusion, dental displacement, maxillary fractures, mandibular fractures, Panorex, zinc oxide, calcium hydroxide paste, Dycal, bone wax, Ethicon, gutta-percha filling, partial pulpotomy, tetanus prophylaxis

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Background: Dental fractures are commonly seen with other oral injuries. Early recognition and management can improve tooth survival and functionality. Approximately 82% of traumatized teeth are maxillary teeth. Fractures to the maxillary teeth are distributed among the central incisors (64%), lateral incisors (15%), and canines (3%).

Pathophysiology: The typical cause is severe force to the teeth sufficient to disrupt the enamel and/or dentin of a tooth. In a study of 1610 children, predisposing factors included postnormal occlusion, an overjet exceeding 4 mm, a short upper lip, an incompetent lip, and mouth breathing.

Frequency:

In the US: More than 50% of physical trauma in child abuse occurs in the head and neck region.

Internationally: In a study conducted in Sweden, approximately 7% of all physical injuries involved the oral cavity. In patients aged 0-19 years, 9% of injuries involved the oral cavity. During the Korean War, 3000 maxillofacial injuries occurred.

Mortality/Morbidity: Trauma to the teeth is not life threatening; however, associated maxillofacial injuries and fractures can compromise the airway. Morbidity to the teeth may be individualized to primary and permanent teeth. Fractures are more common in permanent teeth; primary teeth usually become displaced.

Primary teeth - Failure to continue eruption, color changes, infection, abscess, loss of space in the dental arch, ankylosis, injury to the permanent teeth, abnormal exfoliation

Permanent teeth - Color changes, infection, abscess, loss of space in the dental arch, ankylosis, resorption of root structure, abnormal root development

Sex: Male-to-female ratio is 2-3:1.

Age: Average age of injury is variable. In youths, falls and sporting activities account for the majority of injuries. In later teenaged years, motor vehicle collisions (MVCs) account for the majority of injuries.