FRACTURED TEETH

Pain from fractured teeth usually results from exposed dentin, or irritation of the pulp tissue as a result of trauma. You may also observe lacerations of the gingiva, lips, and cheeks. Except in a few rare cases, the dental officer will treat all tooth fractures. If authorized, the Dental Technician's primary duty is to lessen the pain and, if possible, prevent further injury to the patient until the dentist arrives to provide more definitive emergency treatment. You must be able to recognize the four different types of tooth fractures as illustrated in figure 6-6.

Symptoms (Type I\Enamel Fracture)

A patient may complain of the following:

Rough or sharp area on a tooth

Pain when eating or drinking

Sensitivity to heat, cold, or air

Figure 6-6.\Types of tooth fractures.

Signs

Upon examination of a type I fracture, you may observe:

A slight chip or fracture of the tooth enamel layer only, or with possible minimal dentin involvement

No exposure of the dentin or pulp

Treatment

Perform the emergency treatment guidelines. The following is a typical treatment plan that a dental officer might authorize you to perform to treat a type I fracture:

^1. Smooth sharp edges of the chipped area with sandpaper strips or disk to eliminate irritation of the tongue and lips.

2. Carefully dry the chipped area with a cotton roll or pellets.

3. Apply small coats of cavity varnish over the chipped area with cotton forceps and cotton pellets.

4. Instruct and caution the patient not to consume hot or cold liquids and food. Extreme heat or cold may damage the tooth pulp.

Symptoms (Type II\Enamel/Dentin Fracture)

A patient with a type II tooth fracture may complain of the following:

Very rough or sharp edges

Severe pain from heat, cold, or air

Toothache

Signs

Upon examination of a type II fracture, you may observe the following:

Extensive fracture involving the enamel and dentin layers

No pulp exposure

Treatment

Perform emergency treatment guidelines. Except in rare cases, the dental officer will provide emergency treatment. If for some reason he does not treat the patient, the dental officer could authorize the assistant to cover the exposed dentin with a temporary type paste or place a temporary crown.

The procedures for covering a type II with zinc oxide and eugenol paste or other temporary paste are as follows:

1. Isolate area with cotton rolls.

2. Carefully dry the fractured tooth off with cotton rolls or 2 x 2 gauze. (Do not use direct air with the 3-way syringe.)

3. Coat all exposed dentin with a zinc oxide and eugenol paste or other temporary material, including light cured glass ionomer cement.

^4. Advise the patient that this is a temporary procedure to relieve pain and sensitivity. The coat of zinc oxide and eugenol may come off the fracture.

5. Instruct patient to eat a bland diet and avoid extremely hot and cold foods, liquids, or sticky foods, and not to chew on the fractured tooth.

Procedure for placing a temporary crown on a type II fracture:

^1. Select a plastic crown form. Trim the form with scissors to adapt it to the fractured crown. Ensure that the entire fracture will be covered.

2. Also ensure the incisal edge in not in occlusion with the opposing teeth, while fitting the plastic crown.

3. Place two or three small holes in the incisal edge of the crown form with a sharp explorer.

^4. Fill the crown form with a thin mix of calcium hydroxide or zinc oxide and eugenol.

5. Gently place the crown form over the fractured crown. You will see any excess material expressed from the holes of the incisal edge while placing the crown.

6. Remove any excess material from and around the crown with gauze and cotton pellets

7. Instruct the patient to eat a bland diet and avoid extremely hot and cold foods or liquids and sticky foods.

Symptoms (Type III\Enamel/Dentin Fracture With Pulp Exposure)

A patient with a type III tooth fracture may complain of the following:

Severe, throbbing pain

Very rough or sharp edges

Severe pain from heat, cold, or air

Inability to chew food

Signs

Upon examination of a type III fracture, you may observe:

Extensive fracture with the pulp exposed

Most or all of the crown is fractured off

Bleeding from crown fracture

Treatment

Perform emergency treatment guidelines. In almost all cases of a fracture this severe, the dental officer will treat the patient. Only in rare cases would the Dental Technician treat the patient. The following is a treatment plan that the dental officer might authorize to treat a type III fracture.

1. Place a crown form over the affected tooth. Refer back to this procedure under the treatment for type II fractures. At times, it may be impossible to place a crown form over a fractured tooth. The pressure of the crown form against the pulp tissue may cause the patient pain or there may not be enough tooth structure left for retention of the crown. If this occurs, a splint rather than a crown form is placed on the tooth as shown in figure 6-7.

2. To make the splint, prepare a large mixture of zinc oxide and eugenol as described in Dental Technician, NAVEDTRA 12573, chapter 4, "Restorative Dentistry." Add cotton fibers from a cotton pellet to the mixture for strength. The mixture should have a dough-like consistency for molding the splint.

3. Place the splint so it covers the affected tooth and the teeth immediately adjacent to it (fig. 6-7). Ensure that the mixture is placed well up on the lingual and facial aspects of the gingival tissue. Gently compress the splint between your finger and thumb to lock it into the interproximal spaces.

4. Trim the splint from the incisal edges of the teeth. Check the occlusion to see if the splint is interfering with the patient's bite.

5. Advise the patient to let the splint harden for several hours before attempting to eat. Tell the patient to return to sick call ASAP for more definitive care.

Symptoms (Type IV\Root Fracture)

A patient with a type IV tooth fracture may complain of the following:

Severe pain from heat, cold, air

Inability to eat anything without severe pain

A tooth that is moving or loose

Figure 6-7.\Properly placed splint.

Signs

Upon examination of a type IV fracture, the dental officer may direct you to take a radiograph of the tooth to determine if there is a fracture of the root. You may observe:

A fractured root (as seen in the patient's X-ray), which may be further complicated by a fracture of the crown

Tooth mobility

Other facial trauma associated with the accident

Treatment

Perform emergency treatment guidelines. Because of the severity, almost all cases of type IV fractures will be treated by the dental officer. Only in very rare cases, will the Dental Technician provide treatment. In such rare cases, the dental officer might authorize the DT to place a splint in the same way as for the type III fracture.