Broken and displaced teeth: fractures and luxations
- Emergency
A broken tooth that shows pink or bleeds has an exposed nerve and needs a dentist today. Loose or pushed-in teeth also need prompt care.
What it is
Dental trauma includes fractures of the crown or root and luxation injuries, in which the tooth is loosened or displaced. Crown fractures are graded by the tissues involved: enamel only, enamel and dentine (a yellow layer, sensitive), or with pulp exposure (a pink or bleeding spot). Root fractures may show only as mobility of the crown. Luxations range from concussion (tender, not loose) and subluxation (loose, not displaced) to extrusion (partly out of the socket), lateral luxation (tilted, often locked in bone) and intrusion (pushed into the bone). Cracked tooth syndrome is a separate, non-traumatic problem with sharp pain on biting and release.
How to recognise it
- Enamel only: smooth and refer routinely.
- Dentine exposed: sensitivity; cover and see a dentist within a day.
- Pulp exposed: pink or bleeding point; see a dentist the same day.
- Displaced teeth should be repositioned and splinted early by a dentist.
- Intruded primary teeth often re-erupt on their own; the dentist checks the permanent tooth beneath.
What to do at once
- Exclude head and neck injuries and look for a mandible fracture (malocclusion, step, numb lip).
- Find all fragments; a missing fragment may be in the lip, swallowed or inhaled.
- Examine each tooth: fracture lines, colour of the exposed surface, mobility, displacement, bite.
- Palpate the lips for embedded fragments and radiograph soft tissue if suspected.
- Cover exposed dentine or pulp with a moist gauze, give analgesia, and refer to the dentist with the fragments stored in water or saline.
- Check tetanus status and document injuries, especially in children.
Costly mistakes
- A tooth that turns grey weeks after trauma may have a dead pulp and needs review.
- Lip lacerations after dental trauma can hide tooth fragments that cause infection.
- Injuries to primary teeth can damage the permanent successors.
Next step / Initial management
- Pulp exposure, displacement or mobility: refer to the dentist the same day.
- Dentine exposure: dentist within one day; enamel-only fractures: routine visit.
- Missing fragment: soft-tissue radiograph of the lip and chest radiograph if aspiration is possible.
- All traumatised teeth need dental follow-up over months to detect pulp necrosis.
Test yourself
Think of the answer, then tap the question to see it.
What does a pink or bleeding spot in a fractured crown mean?
Pulp exposure, which needs dental treatment the same day.
Where can a missing tooth fragment be after trauma?
Embedded in the lip, swallowed or inhaled into the airway.
What late change suggests the pulp of a traumatised tooth has died?
Grey discoloration of the crown weeks or months later.
Connections
Educational content; it does not replace assessment by a dentist or doctor and is not a clinical instruction. For facial or neck swelling with difficulty swallowing or breathing, a knocked-out tooth or bleeding that will not stop, go to an emergency department at once.
Sources: Tooth Fracture (StatPearls Publishing (NCBI Bookshelf), 2025); Trauma to the Primary Dentition (StatPearls Publishing (NCBI Bookshelf), 2023); Cracked Tooth Syndrome (StatPearls Publishing (NCBI Bookshelf), 2024); Dental Emergencies (StatPearls Publishing (NCBI Bookshelf), 2022).
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Representative model, for educational purposes only.