1

What is the anatomy of a tooth?

The crown is the visible portion of the tooth, which consists of three layers: The pulp (neurovascular supply of the tooth) is surrounded by dentin, which is covered by enamel. The root is the portion of the tooth that extends into the bone. It is covered by cementum, which adheres to the periodontal ligament.

2

How are teeth numbered? ( Fig. 4.1 )

Tooth identification using either name or American Dental Association numbering system; letters for deciduous teeth, numbers for permanent teeth.

From Mosby’s Guide to Physical Examination , 2006.

3

Describe the types of dental fractures.

Ellis type I is a fracture of the enamel only and does not require treatment. Ellis type II fractures to the dentin are most common, and the tooth is usually sensitive to changes in temperature. Ellis type III (blood exposure) fractures expose the pulp. Types II and III require placement of a protective covering, such as calcium hydroxide base, as a delay in treatment increases the likelihood of pulpal necrosis. Patients need urgent referral to a dentist. Root fractures will have mobility of the crown (with or without Ellis fractures); radiographs will confirm. Alveolar fractures will allow multiple teeth to move together with palpation ( Fig. 4.2 ).

Dental Tooth Fracture.

From Curtis, Emergency and Trauma Care for Nurses and Paramedics , 2011.

4

Describe and define the different types of dental trauma

See Table 4.1 .

5

What is the treatment for an avulsed tooth?

The best way to transport the tooth is in the patient’s tooth socket. Gently rinse (to remove debris) and replace it (only primary teeth should be reimplanted). Handle the tooth by the crown, as not to damage the periodontal ligament. It should be reimplanted within 2 hours, and stabilized with a dental dressing paste. If it cannot be reimplanted, use Hank salt-based solution or cold milk. The patient’s saliva is less ideal, and do not place the tooth in the mouth due to risk of aspiration.