serious fracture than type 1. The patient experiences severe pain from thermal changes in the affected tooth.
TREATMENTSelect a plastic crown form, and trim it with scissors to adapt it to the fractured crown. Place two or three small holes in the incisal edge of the crown form with a sharp, clean needle or pin. Fill the crown form with a thin mix of calcium hydroxide or ZOE. Gently place the crown form over the fractured crown. Remove excess moisture from the crown form with gauze and cotton pellets. Tell the patient to eat a diet consisting of soft foods and to avoid extremely hot or cold foods and liquids and sticky foods.
Type IIIThis is a large fracture with much pulp exposure, such as when the entire crown of the tooth is broken off (fig. 2-21). The pain is severe and mastication of food is almost impossible.
TREATMENTPlace a crown over the affected tooth as explained in the treatment of type II fractures. It may be impossible to place a crown form over the fractured tooth because the pressure of the crown aginst the pulp tissue may cause pain. If this happens, place a splint rather than a crown form on the tooth.
Make the splint by preparing a large mixture of ZOE, and add cotton fibers from a cotton pellet for strength. Place the splint so that it covers the affected tooth and the teeth immediately adjacent to it. See figure 2-22. Place the mixture well up on the lingual and facial aspects of the gingival tissue. Gently compress the splint between your finger and thumb to lock it into the interproximal spaces. Trim the splint from the incisal edges of the teeth so the patients occlusion is normal.
Advise the patient to let the splint harden for several hours before attempting to eat (see food restrictions under type II). Refer the patient to a dentist as soon as possible.
Type IVThis is a fracture of the root, which may be further complicated by a fracture of the crown (fig. 2-21). The pain is severe, mastication is almost impossible, and there may be a great deal of tooth mobility. Radiographic diagnosis is often the only sure way to determine a type IV fracture. However, any mobile tooth with a very recent history of trauma should be treated as a type IV fracture.
TREATMENTPlace a splint in the same way as for a type III fracture.
Occasionally, a patient may report with a tooth that has been knocked out of socket. When this happens, immediately place the tooth in sterile saline, and send it along with the patient to a dentist. If a dentist is not available, attempt to replace the tooth in the socket and stabilize it. If there is no root or alveolar fracture, anterior teeth often slip back into the socket very easily.
A working knowledge of the dental records and forms used in the Navy is essential for you to correctly use and understand their purpose.