Auto and Medical Insurance Letter Concerning Dental Injury

Dr. Name
Office address
City, State ZIP
(or preferably print on letterhead)


re: Patient Name (dob 9-14-96)

To Whom It May Concern:

On October 10th, 1997, John Doe had an accident while skateboarding.  He took a fall, hitting his maxillary anterior teeth.  Both central incisors (teeth #8 and 9) were fractured obliquely into the dentin.  The right central incisor was slightly extruded; the fracture was in close to the pulp.

Both teeth were restored on 10/13/97 with large 4-surface composites.  No further treatment is planned in the near future. 

Both teeth will likely need crowns in the future, after his jaws and dentition are fully developed.  Also, there is a strong possibility that one or both teeth will need root canal therapy in the future if they abscess (this could occur many years after the initial trauma).  I have also seen cases where a tooth needs to be extracted a number of years after the trauma, necessitating replacement with a bridge or implant.

Please call if you have any further questions.



Dr. _____