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Dental Trauma, continued

7. Fracture
There are 5 basic types of tooth fracture:

  • Infraction: incomplete fracture (crack) of the enamel without loss of tooth structure.
  • Uncomplicated Crown fracture: an enamel fracture or an enamel-dentin fracture that does not involve the pulp.
  • Complicated Crown fracture: an enamel-dentin fracture with pulp exposure.
  • Crown/root fracture: an enamel, dentin, and cementum fracture with or without pulp exposure.
  • Root Fracture: a dentin and cementum fracture involving the pulp.

Uncomplicated Crown Fracture
This type of fracture is a crack of the enamel or dentin that does not involve the pulp. It may have a sharp edge. 

Recommended treatment:

  • Inspect injured lips, tongue, and gingiva to rule out presence of tooth fragments
  • Provide a soft diet, avoiding temperature extremes.
  • If a permanent tooth is injured, refer to a dentist for evaluation ASAP (within 12 to 24 hours).
  • Recommend long-term follow-up to evaluate for complications, which are uncommon.
Complicated Crown Fracture
Complicated crown fracture is an enamel-dentin fracture with pulp exposure.Site of a complicated crown fracture has a reddish tinge or will bleed. This type of fracture can cause extreme pain and may lead to pulpal necrosis, root resorption, or infection in exposed pulp. Refer to dentist as soon as possible (within 12 to 24 hours) for evaluation.
Dentin: A calcareous material similar to bone but harder and denser that composes the principal mass of a tooth; consists of a matrix containing minute parallel tubules which open into the pulp cavity and during life contain processes of the cells of the pulp.
Pulp: The highly vascular sensitive tissue occupying the central cavity of a tooth.

Crown/Root Fracture
Enamel, dentin, and cementum fracture with or without pulp exposure. Likely complications include root resorption and pulp necrosis. Refer to dentist as soon as possible (within 12 to 24 hours) for evaluation, where diagnosis will be made via radiograph.  Treatment consists of reduction and splinting or extraction.

Root Fracture
Excessive mobility of the tooth may indicate a root fracture. This type of fracture includes pulp exposure. Potential complications for a root fracture include resorption and pulp necrosis. Refer to a dentist ASAP (within 12-24 hours) for evaluation, where diagnosis is made radiographically. Treatment consists of reduction and splinting for permanent teeth or extraction, depending on the extent of the traumatic lesion.

 
 
The 4 types of tooth fracture can only be distinguished by radiographs.
 
Complications of tooth fractures include pulp death, root resorption, and infection.
     
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