Broken or Knocked-out Teeth (cont.)
Exams and Tests
If there is no other trauma, the doctor or dentist will take a history of events leading up to the injury. A focused examination of the face, neck, mouth, and the teeth follows. The doctor or dentist will look for damage to the jaw, salivary ducts, and nerves, as well as to account for all missing teeth.
- For a single tooth injury, a plain dental x-ray will be taken, although most hospitals do not offer this type of film. A panoramic x-ray may also be taken to detect dental injuries. This image is taken as the device sweeps around the jaw in an arc and permits a thorough structural evaluation of the teeth, jaw, and soft tissue structures. It is typically found in most oral surgeons’ offices, as well as in some dental offices and some Emergency Departments.
- If a tooth is missing and is suspected to have been swallowed, a neck or chest x-ray may be taken to try to find it. The tooth may end up in the throat, lung, or stomach.
- The Ellis classification is a way to grade or describe tooth fractures. The higher the number, the more serious the fracture.
- An Ellis I fracture solely involves the enamel. This is the proverbial "chipped tooth." It is usually painless and more a cosmetic problem than anything else.
- An Ellis II fracture extends through the enamel and stops at the dentin. Usually the tooth is sensitive to cold.
- In an Ellis III fracture, the injury extends through all 3 layers, exposing the pulp. Typically you will have extreme pain, often accompanied with mild bleeding from the tooth itself.
Joseph J Sachter, MD, FACEP
Scott H Plantz, MD, FAAEM
Francisco Talavera, PharmD, PhD
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