Splinting a loose tooth: how a flexible splint lets it heal in place

A tooth is not fixed rigidly in the jaw. It hangs in its socket from thousands of tiny ligament fibres, which is why healthy teeth have a fraction of a millimetre of give. A blow to the face tears some of those fibres and the tooth becomes loose, sometimes pushed sideways or partly out of the socket. Torn ligament heals well, but only if the two surfaces stay still, in the same way a broken bone needs a cast. Every time the loose tooth moves against food or the opposite teeth, the healing fibres tear again.

A splint holds the injured tooth to its stable neighbours so the ligament can knit. The important word is flexible. Older rigid splints, thick wires or acrylic, worked too well: a tooth held completely rigid can fuse to the bone, a process called ankylosis, and later sink or be impossible to move. Modern splints allow a tiny amount of physiological movement, which is what the ligament needs to heal as ligament rather than bone. A splint is not a cure for a tooth loosened by gum disease, which needs a different approach described further down.

The first 24 hours. Soft food only, and nothing that requires biting with the front teeth: no apples, crusty bread or corn on the cob for the whole splinting period. Take paracetamol or ibuprofen as directed on the packet; the tooth will ache as the bruised ligament settles. No smoking, which starves the healing ligament of oxygen. Do not test the tooth with your tongue or fingers.

The following weeks. Keep the splint and the gum line spotlessly clean, because plaque collects around the composite blobs and inflamed gum heals badly. Brush gently with a soft brush after every meal and use a chlorhexidine mouthwash twice a day for the first week. Call us if the splint comes loose from any tooth, if the tooth changes colour to grey or pink, if a pimple appears on the gum above it, or if pain increases after the first few days rather than fading. Children who have splints should avoid contact sports until the splint is off and, ideally, wear a mouthguard afterwards.

A splint gives the ligament the best chance; it does not guarantee the tooth. A root fractured close to the gum usually cannot be kept, because the crown fragment has too little root to stand on. A tooth that was out of the mouth and dry for more than an hour before replanting will often fuse and be lost over the following years, even with a perfect splint. Teeth loosened by gum disease do not tighten up with a splint, and treating the gum disease comes first. And a baby tooth that has been loosened is generally left to settle or removed, never splinted, because a splint can damage the adult tooth developing beneath it.