Summertime brings us all sorts of playground, sports and even graduation party injuries. Injuries to the teeth, though not usually life threatening, can often make us uncomfortable. Next time you approach a patient with a dental injury, remember the Ellis system of classification system for a tooth fracture.

Ellis 1: injury of the crown into enamel only

  • On exam: nontender, no color change, maybe rough edges
  • Treat: file down sharp edges prn (w emery board), recommend follow up with a dentist for cosmetic treatment

Ellis 2: injury of enamel and dentin

  • On exam:  tender, may see dentin appears as yellow layer
  • Treat: goal to cover exposed dentin, can use calcium hydroxide composition, an adhesive barrier called Stomahesive, Dermabond has also worked if no other adhesive available. Pain medication prn, follow up with dentist in 24 hours

Ellis 3: injury of enamel, dentin and pulp

  • On exam: tender, color change, pink or red, possible visible blood
  • Treat: emergent dental referral, cover exposed dentin/pulp with the same as listed above, initiate abx – PCN or clindamycin

Thanks to Dr. Kevin Hu for post inspiration.


  • Tintinalli, Judith E., et al., eds. Tintinalli’s emergency medicine: a comprehensive study guide. New York: McGraw-Hill Education, 2016.