A 16-year-old girl was struck in the mouth with a baseball. She complains of mild nasal tenderness and a sore tooth. Her left central incisor is chipped and blood is visible at the site. You must:
Place a calcium hydroxide dressing on the tooth and advise the patient to see a dentist within 24 hours.
+Administer a regional anesthetic block, smooth off the rough edge, and refer to the dentist for elective treatment.
+Apply oil of cloves for analgesia, administer antibiotics, and refer to a dentist within 24 hours.
+Arrange immediate dental referral.
+Debride the protruding pulpal tissue after dental nerve block, then cover with foil and refer to a dentist.
Management of dental fractures is determined by the Ellis classification. An Ellis class I fracture only involves the enamel. The patient should be referred to a dentist for elective cosmetic treatment. An Ellis class II fracture exposes the dentin. The patient will typically note extreme temperature sensitivity. If the patient is younger than 12 years or if the fracture involves a large portion of the tooth, a calcium hydroxide dressing covered with gauze or foil is applied and the patient is referred to a dentist within 24 hours. Older patients do not require the dressing but should see a dentist within the same time frame. An Ellis class III fracture exposes the pulp and therefore bleeds. This fracture is a dental emergency and requires immediate dental referral. If a dentist is not immediately available, moist cotton can be placed over the exposed pulp and covered with a piece of dry foil. Never debride the pulp. In cases of extreme pain a dental nerve block may be helpful. Topical analgesics should not be used, since they may cause additional damage or promote sterile abscess formation.