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Pediatric Dentistry · patient case with 3 questions

Basketball injury in a mixed dentition

Patient: 7-year-old boy brought in by his father one hour after an accident.

Chief complaint: Broke his front teeth playing basketball.

History: Struck in the mouth by an elbow. No loss of consciousness, no vomiting, no headache. Immunizations reportedly up to date but the father is unsure about the last tetanus booster.

Findings: Bleeding from the gingival margin and a lacerated lower lip. Fractures of two permanent maxillary incisors involving enamel and dentin with no pulp exposure; both respond within normal limits. A primary maxillary central incisor is luxated and grade 3 mobile. Radiographs show the tooth close to exfoliation with the permanent successor nearly erupted.

Question 1

How are the fractures of the permanent incisors classified?

  1. Ellis Class II — enamel and dentin, no pulp exposure
  2. Ellis Class IV — traumatized tooth that has become non-vital
  3. Ellis Class III — enamel and dentin with pulp exposure
  4. Ellis Class I — enamel only
Show answer and explanation

Correct answer: A. Ellis Class II — enamel and dentin, no pulp exposure

  • A. CORRECT. Ellis Class II is an uncomplicated crown fracture through enamel AND dentin with the pulp not exposed. Exposed dentinal tubules mean sensitivity and a route for bacterial ingress, so the dentin must be sealed promptly.
  • B. Class IV describes a tooth that has lost vitality following trauma, with or without crown loss.
  • C. Class III involves a frank pulp exposure — a visible pink or bleeding point.
  • D. Class I is confined to enamel, typically an incisal chip with no dentin showing.

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Question 2

Beyond managing the teeth and the lip laceration, what additional step does this injury require?

  1. Verify his tetanus immunization status and refer for a booster if it is not current
  2. Arrange a head CT to exclude intracranial injury
  3. Prescribe a seven-day course of prophylactic amoxicillin
  4. Order a full blood count and coagulation screen
Show answer and explanation

Correct answer: A. Verify his tetanus immunization status and refer for a booster if it is not current

  • A. CORRECT. Any contaminated or soil-exposed wound raises tetanus risk. When the immunization history is uncertain or the last booster was more than five years ago for a dirty wound, refer for tetanus prophylaxis. Clean the wound thoroughly and check for embedded debris.
  • B. Imaging of the head is reserved for red flags — loss of consciousness, vomiting, amnesia, headache, or altered consciousness — none of which are present here.
  • C. Routine systemic antibiotics are not indicated for a simple intraoral laceration in a healthy child; thorough irrigation and debridement matter more.
  • D. Blood tests are not indicated — there is no history of a bleeding disorder and the bleeding described is ordinary soft tissue bleeding.

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Question 3

What is the MOST appropriate management of the luxated primary incisor?

  1. Reposition and splint it for four weeks
  2. Perform a pulpotomy and place a stainless steel crown
  3. Extract it
  4. Leave it and review in six months
Show answer and explanation

Correct answer: C. Extract it

  • A. Splinting a tooth with almost no remaining root support achieves nothing and risks damaging the erupting successor.
  • B. Pulp therapy is for a restorable primary tooth with years of service left, not one about to exfoliate.
  • C. CORRECT. A grade 3 mobile primary tooth at the point of exfoliation, with the successor nearly erupted, offers nothing worth preserving and carries a real aspiration risk. Extract it; the permanent tooth will erupt into the space.
  • D. Watchful waiting is reasonable for a mildly mobile primary tooth, not for one that is grade 3 mobile and loose in a child's mouth.

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