Pediatric emergency medicine trisk 3242 3242
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FIGURE 105.2 A: Primary dentition lettering system, starting with letter A in the upper right
proceeding across to J in the upper left, then continuing with K in the lower left to T in the
lower right. B: Permanent dentition number system, starting with number 1 in the upper right
across to 16 in the upper left, then 17 in the lower left through 32 in the lower right. (Reprinted
with permission from Lippincott Williams & Wilkins’ Comprehensive Dental Assisting .
Philadelphia, PA: Lippincott Williams & Wilkins; 2011.)
A complicated tooth fracture involves not only the enamel and dentin but also
the pulpal tissue, which is evident by a red area within the fracture site ( e-Fig.
105.4 ). To best preserve the viability of that tooth, the exposed pulp should be
treated as soon as possible. Prognosis depends on the size of the exposure, the
time interval between the trauma and therapy, and the maturity of the involved
tooth. Teeth with root fractures may present with mobility and/or crown
displacement and can only be diagnosed with an intraoral dental radiograph.
Treatment involves reduction if the tooth segments are not aligned and splinting
the affected tooth to the noninjured adjacent teeth. Pulpal therapy often is
necessary if physiologic healing of the fragments does not occur.
