An Elbow at the Basketball Court Broke Two Teeth

Quick answer: After a blow to the mouth, the broken tooth is rarely the whole story. Teeth that look intact but feel loose, or that hurt when you bite, have been injured too, and they need splinting and monitoring even though nothing is visibly missing.

The call

A Thursday night pick-up game at the court in RBS Gimmel. Eli, 24, went up for a rebound and took an elbow square across the mouth. His friends drove him straight over; he arrived holding a tissue to his lip with two obvious fractures and a great deal of blood, most of it from the lip rather than the teeth.

What we found

Once we had cleaned him up, the picture was clearer than it first looked:

• Upper right central incisor — fracture through enamel and dentine, no pulp exposure, but tender to touch.
• Upper left central incisor — smaller enamel chip, and grade II mobility. It moved when pressed and it had been pushed slightly back.
• Upper left lateral incisor — nothing visible at all, but painful to tap.

That third tooth is the one that gets missed. A blow hard enough to break two teeth transmits force through the whole segment. Teeth that are merely bruised — concussed, in the technical language — do not look injured on the night, and can lose their nerve months later without warning.

The x-rays showed no root fractures and no jaw fracture. The lip needed cleaning but not suturing.

What we did

That night: we repositioned the displaced left central by hand under anaesthetic and splinted the four upper front teeth together with a flexible wire bonded across them. Flexible is the key word — a rigid splint holding a luxated tooth completely still promotes root resorption. We want slight physiological movement.

We covered the exposed dentine on the right central with a bonded dressing, prescribed a soft diet, chlorhexidine rinse and painkillers, and left the definitive cosmetic work for later.

Two weeks later the splint came off. Six weeks after that, once the gum contours had settled, we built up both central incisors in layered composite.

The outcome

At three months everything tested vital. At nine months the left central incisor stopped responding to cold and had darkened by about half a shade — the delayed nerve death we had warned him about. It had a root canal and internal whitening, and it now matches.

The lateral incisor, the one with no visible damage, is still healthy at three years. Both were possible; that is why we followed them.

Eli now wears a custom mouthguard for basketball. His brother, who plays in the same game, bought one the same week.

What to do if this happens to you

1. Control the bleeding first with firm pressure on the lip or gum for ten minutes.
2. Do not push a displaced tooth back yourself unless it is grossly out of position and you cannot get help quickly.
3. Be seen the same night if teeth are loose or displaced. Repositioning is far easier in the first hours.
4. Mention every tooth that feels odd, including ones that look fine.
5. Soft diet for two weeks, and keep the area meticulously clean.
6. Commit to the follow-ups. One year minimum. Delayed nerve death is common and silent.

Sports injury to the teeth in RBS or Beit Shemesh? Ramat Beit Shemesh Urgent Dental Care sees dental trauma the same day. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh.

Based on real cases treated at the clinic. Names have been changed.