Pediatric patients (aged < 12 y) have a thinner layer of dentin to protect the pulp. As a result, Ellis II fractures are more likely to become infected and should be treated as Ellis III fractures in this patient population.
Update the patient’s tetanus vaccination, if necessary.
Instruct patients to eat only soft foods following all injuries (except an Ellis I fracture).
Always consider the possibility of abuse (eg, child, spousal, or elder abuse) when patients present with dental fractures.
Complete a physical examination of the bony structures of the face when indicated to ensure that a more serious injury (eg, Le Fort fracture) is not missed.
Examine all intraoral lacerations for tooth fragments, which can result in chronic infections. For information on the treatment of intraoral lacerations, see eMedicine articles Complex Laceration, Lip and Complex Laceration, Tongue.
Avoid topical anesthesia, as it can increase the risk of a sterile abscess and irritation.
Dental blocks are very useful for pain control.
If teeth or partial teeth are missing, obtain a radiograph of the chest to rule out pulmonary aspiration or a CT scan of the face to rule out intrusion into alveolar bone or gingiva.
All dental fractures (except for Ellis I) require dental follow-up within 24 hours
COMPLICATIONS include
Loss of tooth
Infection or abscess
Aspiration of partial or whole tooth
Cosmetic deformity
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