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Dental Trauma Scale Instrument background and recommended use. This classification system was proposed by Ellis et al in 1970.

(Ellis RG, Da ey !". The classification and treatment of in#$ries to the teeth of children (%th ed.& 'ear (oo) *edical +$blishers ,nc. -hica.o. 1970.& The instrument can be used for all teeth but is primarily used for anterior teeth, as this is the location of most dental trauma. How it is administered The instrument is administered clinically using visual inspection of the teeth. Crown Fractures. /ract$res of the crown of the tooth comprise abo$t one0third of dental in#$ries to the primary teeth and abo$t 7%1 of in#$ries to the permanent teeth.1 The simplest crown fract$re is a crown infraction res$ltin. in incomplete fract$re or crac)s of the enamel witho$t loss of the tooth str$ct$re. The crac)s appear as cra2e lines r$nnin. parallel with the enamel prisms and endin. at the enamel dentin #$nction. These cra2e lines may be either ertical or hori2ontal. -rown infraction may be the only isible si.n of in#$ry. 3o treatment is indicated for crown infraction. 4nfort$nately, this tra$ma is often associated with displacement in#$ries that are detectable only on dental radio.raphs.5 -lassification of -rown /ract$res Crown Fracture Involving Enamel Only (Ellis Class I). 6n Ellis class , fract$re in ol es only the enamel portion of the tooth. Crown Fracture Involving Dentin (Ellis Class II Fracture). -rown fract$res e7posin. dentin. These fract$res can be reco.ni2ed by the yellow to pin) color of the dentin. Crown Fracture Exposing the Pulp (Ellis Class III Fracture). Teeth that are fract$red in the middle third of the clinical crown often e7pose ital tiss$e of the tooth (i.e., the p$lp&. The fract$re site will ha e either a reddish tin.e or will show fran) blood. E7pos$re of the p$lp e ent$ally leads to p$lpal necrosis from bacterial infection if not treated. Root Fractures Root fract$res are less common than fract$res of the crown and occ$r in only 71 or fewer of dental in#$ries.1 Root fract$res may be f$rther di ided into hori2ontal or ertical. +rimary teeth or de elopin. permanent teeth $s$ally do not s$stain root fract$res beca$se of the short roots. ,f the root fract$re comm$nicates with the oral ca ity, infection occ$rs, healin. is impaired, and the tooth fra.ment m$st be remo ed. ,n many cases, the root can be sal a.ed and later placement of a post and crown will restore aesthetics. 8ori2ontal root fract$res $s$ally occ$r in the anterior teeth and are ca$sed by

direct tra$ma. 9ertical root fract$res $s$ally occ$r in the molars and may be ca$sed by teeth clenchin. or bein. str$c) with the #aw closed. Root fract$res often are not apparent on clinical e7amination and can be missed if appropriate radio.raphs are not obtained. ,n most cases, dental radio.raphs will demonstrate this fract$re. ,n hori2ontal root fract$res, the fract$re line may not be readily isible on normal radio.raphs. 6n.$lation of the 70ray beam may show the fract$re line. Rarely, the fract$re line may not be isible $ntil either hemorrha.e or .ran$lation tiss$e forms and displaces the coronal se.ment.11 The most important consideration in the s$ccess and healin. of hori2ontal root fract$res is the immediate red$ction of the fract$red se.ments and the immobili2ation of the coronal se.ment. The pro.nosis for complete healin. is e7cellent if hori2ontal root fract$res are dia.nosed and the se.ments are ri.idly splinted in place for 1001: wee)s. ,n order to achie e this res$lt, root fract$res m$st be dia.nosed before repair be.ins and the blood clot pre ents apposition of the se.ments. ,f the se.ments are immobili2ed in close pro7imation, healin. with calcified tiss$e will $s$ally occ$r. The p$lp and tooth $s$ally remain ital and there is often no need for root canal or other p$lpal treatment. ,f more than :;07: ho$rs ha e elapsed, it may be impossible to .et close opposition of the se.ments. This may precl$de bony healin.. "itho$t bony healin., the pro.nosis for permanent retention of the tooth .oes from e7cellent to poor and more comple7 dental treatment $nder a dentist<s s$per ision is mandatory. 9ertical root fract$res are more diffic$lt to detect and may not be fo$nd $ntil e7tensi e tooth destr$ction has occ$rred or the tooth is e7tracted. The patient may complain of pain on bitin. or release or of sensiti ity to hot or cold foods. 9ertical root fract$res ha e a worse pro.nosis than hori2ontal root fract$res, probably beca$se they are not dia.nosed as easily. E7traction of all or part of the tooth is often indicated. 6mp$tation of part of the root may be appropriate if the tooth has more than one root. ,f the patient de elops a p$lp infection, root canal therapy is re=$ired. Displace or !oosene "eeth *any desi.nations ha e been $sed in the literat$re to describe displacement of a tooth. 4nfort$nately, many of these terms are conf$sin.. Generally spea)in., howe er, the terms conc$ssion, displacement, and a $lsion are ade=$ate to describe all forms of tra$ma in ol in. in#$ry to the periodontal attachment that do not in ol e loosenin. or loss of the tooth from the soc)et.

Scale Scoring and Normative Values How it is scored/calculated/summarized The various categories represent tooth-specific descriptors (nominal level) of the condition of the tooth with respect to traumatic injury. Are there subscales (if so, how are those calculated): None

Scale validity (include references if available): None Scale reliability (include reference is available): None Normative statistics. (Has this been used in definable populations and what values are considered normal/abnormal): None


Is there trauma to the maxillary anterior teeth No


Yes Is there trauma to the maxillary anterior teeth No

Yes Class 1 Simple fracture of the crown not involving dentin Class 2 Extensive fracture of the crown involving dentin Class 3 - Extensive fracture of the crown involving dentin and pulp exposure Class 4 Teeth lost as result of trauma Class 5 Fracture of the root Class 6 Displacement of tooth (without fracture of crown or root) #se$ul re$erences 1. 6ndreasen >?, 6ndreasen /*. Textbook and Color Atlas of Traumatic Injuries to the Teeth. @rd ed. At. Bo$isC *osbyD 199;. :. /o$ntain A(, -amp >8. Tra$matic in#$ries. ,nC -ohen A, ($rns R-. Pathways of the Pulp. 5th ed. At. Bo$isC *osbyD 199;. @. Ranalli D3, ed. Aports dentistry. Dent -lin 3orth 6m 1991D@%C 50905:5. ;. Gibson DE, 9erono 66. Dentistry in the emer.ency department. J Emer !ed 19E7D%C@%0;;.

%. >ar inen A. ,oncisal o er#et and tra$matic in#$ries to $pper permanent incisorsC 6 retrospecti e st$dy. Acta "dontol #an 197ED@5C@%9. 5. 6ndreasen >?. Traumatic Injuries of the Teeth. :nd ed. +hiladelphiaC ".(. Aa$nders -oD 19E1. 7. - e) *, B$ndber. *. 8istolo.ical appearance of p$lps after e7pos$re by a crown fract$re, partial p$lpotomy, and clinical dia.nosis of healin.. J Endod 19E@D9CE. E. /$)s 6(, et al. +artial p$lpotomy as a treatment alternati e for e7posed p$lps in crown and fract$red permanent incisors. Endod $ent Traumatol 19E7D@C100. 9. 8eide A, !erer)es !. Delayed partial p$lpotomy in permanent incisors of mon)eys. Int Endod J 19E5D19C7E. 10. *edford 8*, -$rtis >". 6c$te care of se ere tooth fract$res. Ann Emer !ed 19E@D1:C@5;0@55. 11. Glic)man G3, G$tman >B. *ana.ement of tra$matic tooth in#$riesC 6n o er iew. $entistry 19E9D9C:;0:E. 1:. Roc) "+, Gr$ndy *-. The effect of l$7ation and s$bl$7ation $pon the pro.nosis of tra$mati2ed incisor teeth. J $ent 19E1D9C::;. 1@. Gibson DE, 9erono 66, Dentistry in the emer.ency department. J Emer !ed 19E5D%C@%0;;. 1;. >ohnston D, >$dd +. +rimary and permanent dental tra$maC Two case reports. "ntario $ent 19E9D55C:@0:%. 1%. 6ndreasen >?. B$7ation of permanent teeth d$e to tra$ma. 6 clinical and radio.raphic follow $p st$dy of 1E9 in#$red teeth. #can J $ent %es 1970D7EC:7@. 15. 6ndreasen >?, (or$m *, >acobsen 8B, et al. Replantation of ;00 tra$matically a $lsed permanent incisors. Endod $ent Tra$matol 199%. ,n press. 17. *edford 8*. 6c$te care of a $lsed teeth. Ann Emer !ed 19E:D11C%%90%51. 1E. 6ndreasen >?. Relationship between cell dama.e in the periodontal li.ament after replantation and s$bse=$ent de elopment of root resorptionC 6 time related st$dy in mon)eys. Acta "dontol #can 19E1D@9C1%. 19. (rin.h$rst -, 8err RD, 6lso$s >6. ?ral tra$ma in the emer.ency department. Am J Emer !ed 199@D11C;E50;90.

:0. 6ndersson B, (odin ,, Aorensen A. +ro.ression of root resorption followin. replantation of h$man teeth after e7tended e7tra oral stora.e. Endod $ent Traumatol 19E9D%C@E. :1. 6ndersson B. Dentoal eolar an)ylosis and associated root resorption in replanted teeth. E7perimental and clinical st$dies in mon)eys and man. #wed $ent J 19EED%5 (A$ppl&C1. ::. 6ndreasen >?, Achwar2 ?. The effect of saline stora.e before replantation $pon dry dama.e of the periodontal li.ament. Endod $ent Traumatol 19E5D:C57. :@. (lomlof B, et al. +eriodontal healin. of replanted mon)ey teeth pre ented from dryin.. Acta "dotol #cand 19E@D;1C11. :;. Trope *, /riedman A. +eriodontal healin. of replanted do. teeth stored in 9iaspan, mil), and 8an)<s balanced salt sol$tion. Endod $ent Traumatol 199:DEC1E@. :%. !rasner +R. Treatment of tooth a $lsion by n$rses. J Emer &urs 1990D15C:90@5. :5. (lomlof B, et al. Atora.e of e7perimentally a $lsed teeth in mil) prior to replantation. J $ent %es 19E@D5C91:. :7. Binds)o. A, (lomlof B. ,nfl$ence of osmolality and composition of some stora.e media on h$man periodontal li.ament cells. Acta "dotol #cand 19E:D;0C;@%. :E. 8ilt2 >, Trope *. 9itality of h$man lip fibroblasts in mil), 8an)<s balanced salt sol$tion, and 9iaspan stora.e media. Endod $ent Traumatol 1991D7C59. :9. Binds)o. A, (lomlof B, 8ammarstrom B. *itosis and microor.anisms in the periodontal membrane after stora.e in mil) or sali a. #cand J $ent %es 19E@D91C;5%. @0. !rasner +R. Treatment of tooth a $lsion in the emer.ency departmentC 6ppropriate stora.e and transport media. Am J Emer !ed 1990DEC@%10@%%. @1. *edford 8*. Temporary stabili2ation of a $lsed or l$7ated teeth. Ann Emer !ed 19E:D11C;900;9:. @:. Gibson DE, 9erono 66. Dentistry in the emer.ency department. J Emer !ed 19E7D%C@%.

Feature Overjet Technique Place probe perpendicular to the facial surface of the mandibular central incisor and measure the point where the maxillary incisor contacts the probe. First measure More than white band Yes Second measure If Yes is it greater than white plus black band If no is there a reverse overjet If yes is it more than the white band

Yes No


Yes No Yes No

Open Bite

Measure open bite at maximal point by placing the probe at the black band region along the facial/buccal surface

More than black band


No Displacement Measures the largest tooth displacement using the black band area of the probe. Use either the full black plus white portion for larger displacements. More than black band Yes If yes is it more than the white band Yes No

No Over Bite Visually determine if maxillary incisor covers completely the mandibular incisor. Also indicate if there is palatal trauma from deep overbites. Complete Yes If yes is there tissue damage Yes No

No Angles Class Class 1

Class 2

Class 3

PSR CODES Deepest probing depth in sextant Bleeding after completion of probing absent present absent present absent present

1 2 3 4 5 6

Less than 3.5 mm Less than 3.5 mm More than 3.5 mm but less than 5.5 mm More than 3.5 mm but less than 5.5 mm More than 5.5 mm More than 5.5 mm