Dental Trauma or Infection Clinical Pathway — Emergency Department

Fractures of Primary and Permanent Teeth

Fractures of both primary and permanent dentition cause sensitivity to the injured tooth, and if there
is pulp involvement can result in infection if neglected

Injury	Clinical Signs	Management	Follow-Up
Uncomplicated Crown Fracture Enamel fracture (Ellis I)	Fracture of outer enamel layer of tooth Associated with: Slight sensitivity to temperature change $Ellis fracture, enamel. Example 1$	No need for emergent treatment	Personal dentist or Penn Dental Medicine
Uncomplicated Crown Fracture Enamel-dentin fracture (Ellis II)	Fracture of enamel with exposure of dentin Associated with: Moderate sensitivity to temperature change $Ellis fracture example 2$	No need for emergent treatment if asymptomatic Consult Dental Symptomatic Composite bandage needed If unable to assess if nerve/pulp is exposed, add an image to Epic chart via Haiku for Dental review	Personal dentist or Penn Dental Medicine
Complicated Crown Fracture Enamel-dentin-pulp (Ellis III)	Fracture of tooth with exposure of the pulp/nerve Associated with: Bleeding from the tooth “Blushing” of pulp tissue through thin layer of dentin Moderate-to-severe sensitivity to stimulation $Ellis fracture example 3$	Consult Dental Primary tooth: complicated fracture may require extraction Permanent tooth: direct pulp cap and composite bandage Antibiotics No need for antibiotics Analgesia NSAIDs/acetaminophen	Personal dentist or Penn Dental Medicine for further pulp treatment/root canal

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

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