A Beam Came Down While He Was Building the Sukkah

Quick answer: After a blow to the face, the most useful question is whether your bite feels normal. A bite that has changed — teeth meeting in a different place, or not meeting at all on one side — is the single strongest sign of a broken jaw, and it means hospital rather than a dental appointment.

The call

Erev Sukkot, mid-afternoon, in Nachala U'Menucha. Avraham, 47, was up a ladder fixing the schach when a beam shifted and caught him across the lower jaw on its way down.

He phoned about a chipped tooth. In the first thirty seconds of the call he also mentioned, in passing, that his teeth "were not meeting properly". That changed the conversation entirely.

What we found

He came in immediately and we examined him properly before touching the tooth.

Findings that mattered: - His bite was demonstrably wrong. The back teeth on the right met before anything else, and there was a gap between the front teeth when he closed — an anterior open bite that had not been there in the morning. - Tenderness over the angle of the jaw on the left, with a step palpable along the lower border. - Numbness of the lower lip and chin on the left side. - Bruising in the floor of the mouth, under the tongue. - Mouth opening reduced and deviating to the left.

Findings that were secondary: a chipped upper premolar and a bruised lip.

Any one of those first five findings warrants investigation. Together they are close to diagnostic of a mandibular fracture.

The bite change is the most useful sign a patient can report, because the jaw is a bone with teeth attached: if it breaks, the segments shift and the teeth no longer meet where they did. It is more reliable than pain, more reliable than swelling, and something anyone can check on themselves in ten seconds.

Bruising under the tongue — sublingual ecchymosis — is another strong indicator, and it is often missed because nobody looks there.

Lip numbness pointed to the fracture line crossing the nerve canal, which also told us roughly where the break was.

What we did

Nothing to the tooth. We took a panoramic x-ray, which showed a fracture through the left angle of the mandible, and we phoned the maxillofacial unit at Hadassah Ein Kerem directly.

He went straight there, with the x-ray and a written summary, and with clear instructions: nothing to eat, since he might need a general anaesthetic.

He had the fracture plated the following day and was discharged after two nights, on a soft diet for six weeks.

We repaired the chipped premolar three weeks later, once he could open comfortably. That was always the least important part.

The outcome

The fracture healed well. The lip numbness recovered gradually over about four months, which is typical. His bite returned to normal, and we checked it against his pre-injury records.

What to do if this happens to you

1. Bite your teeth together gently. If they meet differently from normal, go to hospital.
2. Check for numbness of the lip, chin or tongue.
3. Look under the tongue for bruising.
4. Support the jaw with a hand or a bandage while travelling, and do not eat or drink in case surgery is needed.
5. Go to a hospital emergency department, not a dental clinic, if any of these are present.
6. Deal with the chipped tooth afterwards. It is not the priority, however much it bothers you.

Blow to the jaw and your bite feels wrong? That is a hospital visit. For everything after that, Ramat Beit Shemesh Urgent Dental Care is here: 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.