A 24-year-old man sustains a tooth fracture; the fragment is unavailable. In addition to referral to a dentist, what is the most appropriate immediate management?

A 24-year-old man sustains a tooth fracture; the fragment is unavailable. In addition to referral to a dentist, what is the most appropriate immediate management?

• A. Apply topical calcium hydroxide paste
• B. Place temporary crown on the tooth
• C. Administer IV antibiotics
• D. Observe and return if pain

Answer: (A)

When a tooth is fractured and the fragment can’t be reattached, the immediate goal is to protect the exposed dentin and pulp from infection and further irritation while arranging definitive dental care. Applying topical calcium hydroxide paste achieves this by creating an alkaline, antibacterial environment and by encouraging the formation of reparative dentin, which helps seal and protect the pulp and preserve vitality until a dentist can restore the tooth. This is more urgent than simply covering the tooth with a temporary crown, which requires a suitable fragment or preparation and doesn’t directly address pulp protection. Administering IV antibiotics isn’t routinely needed unless there are signs of infection or systemic involvement, and waiting to see if pain develops delays necessary protective measures.

When a tooth is fractured and the fragment can’t be reattached, the immediate goal is to protect the exposed dentin and pulp from infection and further irritation while arranging definitive dental care. Applying topical calcium hydroxide paste achieves this by creating an alkaline, antibacterial environment and by encouraging the formation of reparative dentin, which helps seal and protect the pulp and preserve vitality until a dentist can restore the tooth. This is more urgent than simply covering the tooth with a temporary crown, which requires a suitable fragment or preparation and doesn’t directly address pulp protection. Administering IV antibiotics isn’t routinely needed unless there are signs of infection or systemic involvement, and waiting to see if pain develops delays necessary protective measures.