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Emergency Medical Minute


Aug 24, 2020

Contributor: Peter Bakes, MD

Educational Pearls:

  • Dental fractures are described by the Ellis classifications, which are based on the involvement of layers of the teeth:
    • Ellis I: involvement of the enamel 
    • Ellis II: involvement of the enamel and dentin
    • Ellis III: involvement of the enamel, dentin, and pulp
  • While Ellis I injuries can be sent for dental follow up without intervention, Ellis II/III injuries require covering of the exposed dental layers, particularly because bacteria can more easily enter into the pulp
    • Calcium hydroxide (Dycal) is used to cover teeth until patients can get to a dentist.
  • Dental avulsions, or displacement of the tooth from the socket, are time sensitive. Every minute the tooth is not put back in place carries an increased risk of permanent loss. After the tooth is replanted, it requires fixation or bracing
  • Dental subluxations can also be secured or braced with dental follow up


Marte, D, and B Robinson. Dental Trauma. Core EM, 7 Oct. 2019,

Rosenberg H, Rosenberg H, Hickey M. Emergency management of a traumatic tooth avulsion. Ann Emerg Med. 2011;57(4):375-377. 

Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD