He Came Off His Scooter and the Nerve Was Showing

Quick answer: If a broken tooth shows a red or bleeding spot in the middle of the break, the nerve is exposed and it needs treating within hours, not days. Treated early, the nerve can usually be kept alive. Left overnight and beyond, the odds fall away quickly.

The call

Eight in the evening, a father in RBS Bet. His thirteen-year-old, Dovi, had gone over the handlebars of an electric scooter on the hill down towards the shul. Helmet on, hands out — but he caught the kerb with his mouth.

The father sent a photograph on WhatsApp, which is exactly the right instinct. Even on a phone screen I could see the pink dot at the centre of the fracture. We opened up that evening.

What we found

The upper left central incisor was fractured across the middle third, with roughly a two-millimetre exposure of pulp that was bleeding gently and was exquisitely tender to air. The neighbouring tooth had a chip through enamel only. The lower lip was split on the inside and there was gravel in it, which we cleaned and which needed a tetanus check.

The x-ray showed the root still had an open apex — the tip was not yet fully formed. This is the crucial detail in a thirteen-year-old. A tooth with an incomplete root badly needs its nerve, because the nerve is what lays down the rest of the root. Take it out now and you are left with a thin-walled, fracture-prone root for the rest of his life.

What we did

A partial pulpotomy. Under local anaesthetic and rubber dam, we removed two millimetres of the inflamed surface pulp with a sterile bur and clean water, controlled the bleeding, and sealed the remaining healthy pulp with a bioceramic material. Then we rebuilt the corner in composite.

This is not a heroic procedure. It is a well-established one with high success rates in young teeth, and the single biggest factor is how quickly it is done and how clean the field is kept. Sending him home with painkillers overnight and treating him in the morning would have measurably reduced the chance of keeping that nerve.

The chipped neighbour was smoothed and polished. The lip was irrigated and left to heal.

The outcome

We reviewed at three weeks, three months, six months and a year. The tooth stayed vital throughout, and on the twelve-month x-ray the root apex had continued to close normally. The composite has been refreshed once for colour.

Dovi will need a definitive restoration in his twenties once the gum position has settled. But the tooth is alive, the root is fully formed, and that changes his next fifty years.

What to do if this happens to you

1. Look at the break in good light. Any pink, red or bleeding point in the middle means the nerve is exposed.
2. Phone immediately, and send a photo. Do not wait for morning.
3. Find the fragment and keep it in milk. It can often be bonded back.
4. Do not scrub the tooth or apply antiseptic to the broken surface.
5. Cold compress the lip, and check whether a tetanus booster is due if the wound is dirty.
6. Check the other teeth and the jaw. Ask the child to bite together and say whether it feels normal.

Dental trauma in RBS Bet or anywhere in Beit Shemesh? Ramat Beit Shemesh Urgent Dental Care answers WhatsApp out of hours for injuries: https://wa.me/972559858845 · 055-985-8845 · Harav Kook 28/1, Beit Shemesh.

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