Pediatric Dentistry · patient case question
A different child fractures a tooth. The fracture involves enamel and dentine, is SUPRAGINGIVAL, and there is no pulp exposure. What is the Ellis classification?
Patient case: A Seven-Year-Old with Two Painful Primary Molars
Patient: 7-year-old female
Chief Complaint: “Both bottom back baby teeth on the left hurt when she eats.”
Background: First dental visit. No medical history. Cooperative but apprehensive — she will sit and open, but keeps asking what will happen next and needs frequent reassurance.
Medications: None
Vital Signs: BP 100/64 mmHg · HR 90 bpm · RR 20 · T 98.4°F
Findings: Deep occlusal caries in teeth #S and #T with pain on eating that stops when the food is removed. Both teeth are RESTORABLE with substantial remaining structure. No swelling, no sinus tract, no mobility. Radiographs show no furcation or periapical radiolucency and no pathological root resorption.
Show answer and explanation
Correct answer: C. Class II
- A. Ellis Class IV is a tooth that has become NON-VITAL after trauma, with or without loss of structure. Some sources also apply it to crown-root fractures extending subgingivally.
- B. Ellis Class I is an enamel-only fracture. It is asymptomatic and needs no more than smoothing of the sharp edge.
- C. CORRECT. ELLIS CLASS II is a fracture through enamel AND DENTINE without pulpal involvement. The exposed dentinal tubules make the tooth sensitive and provide a pathway for bacteria to the pulp, so it must be covered promptly — glass ionomer or bonded composite over the exposed dentine.
- D. Ellis Class III involves enamel, dentine AND PULP EXPOSURE. The pulp is visible as a red or bleeding pinpoint and needs pulp capping, partial pulpotomy or full pulp treatment depending on the exposure size and the time elapsed.
Note: The full Ellis scale: I enamel only; II enamel and dentine; III pulp exposed; IV non-vital tooth (or crown-root fracture extending below the gingiva); V avulsion; VI root fracture; VII luxation or displacement without fracture; VIII complete crown fracture with intact root.
Practice Pediatric Dentistry questions Pediatric Dentistry study notes