The Missing Piece of Tooth Was Inside His Lip

Quick answer: After any injury that breaks a tooth, every missing fragment must be accounted for. Pieces routinely end up buried in the lip, where they cause infection and permanent scarring if left. If a fragment cannot be found at the scene, the injured tissue needs x-raying.

The call

Motzei Shabbat in Nofei Aviv. Yehuda, 12, had been running in the stairwell of his building and had gone down hard onto the edge of a step. His upper front tooth was chipped, his lower lip was cut and swollen, and nobody could find the missing piece of tooth.

They had looked on the stairs. It was not there.

What we found

Upper left central incisor with a fracture through enamel and dentine, taking the corner. No pulp exposure. The tooth was firm and responded normally.

The lower lip was the problem. It was swollen out of proportion to the size of the cut, with a 12mm laceration on the inner surface and a firm lump palpable within the tissue beneath it.

We took a soft tissue x-ray — the same sensor used for teeth, placed against the lip with the exposure reduced. Two radio-opaque fragments were clearly visible inside the lip, one about 4mm and one smaller.

This is far more common than people expect. The mechanism is simple: the lip is between the teeth and the impacting surface. The tooth fractures and the fragment is driven straight into the soft tissue behind it.

Left in place, the consequences are predictable. The tissue becomes chronically infected or forms a persistent lump. Grit and debris embedded alongside produce a permanent blue-grey traumatic tattoo, which is very difficult to remove afterwards. Occasionally an abscess forms weeks later and nobody connects it to the original injury.

The rule that follows from all this is simple: after a facial injury with a broken tooth, count the pieces. Every fragment must be found, either at the scene or on an x-ray.

What we did

The lip first. Local anaesthetic, the wound gently explored through the existing laceration, and both fragments removed with fine forceps. Then thorough irrigation with saline under pressure — grit was present, and washing it out properly is what prevents tattooing. Three dissolving sutures.

Then the tooth. We covered the exposed dentine and rebuilt the corner in layered composite, matching the translucency at the edge.

Tetanus status checked. Antibiotics, justified here by a contaminated soft tissue wound.

We also confirmed he had no head injury symptoms and that his bite was normal, which rules out a jaw fracture.

The outcome

The lip healed with a barely visible scar. No tattooing, because the wound was irrigated properly. The tooth stayed vital at the one-year review and the composite has needed one polish.

Had the fragments been left, he would most likely have had a firm lump in his lip for the rest of his life, and quite possibly a grey mark alongside it.

What to do if this happens to you

1. Look for every missing piece of tooth. Search the scene properly.
2. If a piece cannot be found, say so at the clinic. Ask specifically for a soft tissue x-ray of the lip.
3. Keep any fragments you do find in milk — sometimes they can be bonded back on.
4. Do not probe the wound yourself.
5. Have the lip irrigated properly, not just closed. Debris left underneath is what tattoos.
6. Check tetanus status for any dirty wound.

Facial injury with a broken tooth? Ramat Beit Shemesh Urgent Dental Care checks the soft tissue, not just the tooth. 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.