A vertical root fracture is one of the most complicated dental injuries we can experience. Root fractures almost always require immediate intervention, particularly if the crack is painful. But how do dentists handle these kinds of emergencies? Well, the simplest way to fix most fractures is by installing dental crowns — after eliminating the damaged areas, of course.
Before we get ahead of ourselves, let’s establish what we mean when we talk about vertical root fractures. If you’ve ever been to a dental clinic, you’ve probably seen what a tooth looks like including the section that’s hidden under the gums. When considering a root fracture specifically, we have to consider both the structure and the shape of the tooth.
For one, our teeth are layered. The hard coat on the surface is enamel, which protects the more porous substance underneath it — dentine. In the very center of the tooth, we have the pulpy core that contains nerves and blood vessels.
Next up, we need to understand the location of a vertical root fracture. Just imagine what a tooth looks like on its own. A large portion of it extends into the jaw, forming long roots. Some teeth — like premolars — have narrow roots that are more prone to cracking under pressure.
What’s more, these injuries can also occur as a result of structural damages to the tooth. After root canal treatments, teeth stop getting the nutrients they need and become more brittle. Once that happens, every bite could cause undetectable fissures on the root of a tooth. And unless the crack reaches the surface part of the tooth, a dentist wouldn’t be able to properly diagnose the injury at a glance.
How Do Dentists Diagnose Vertical Root Fractures?
As we have established, spotting a crack on the root of a tooth is almost impossible! So how do dentists approach the process of diagnosing and treating patients that come in with root fractures? Before we dive into that subject, let’s talk about the symptoms that usually accompany root fractures.
The Main Fractured Tooth Root Symptoms
When we have a crack in our tooth, it’s usually caused by trauma that damaged the surface of the enamel. Remember, that layer is crucial to keeping all sorts of bacteria from penetrating the tooth. If the enamel cracks, bacteria can easily work through the porous dentine and burrow into the pulpy core of the tooth.
Now, if the aforementioned crack appeared on the exposed part of the tooth, we would discover it pretty quickly. Any cold and sweet foods we consumed would exacerbate the nerve endings inside the tooth. The shooting pain we would feel would drive us to make an appointment at the nearest dental clinic sooner rather than later.
But when the crack is concealed and somewhat protected by the gums, people usually don’t experience pain due to cold or sweet foods. Instead, they may feel pain as they bite down on particularly hard foods.
Of course, if the patient’s gums have retracted because of an unrelated issue, bacteria could get into the tooth anyway. At that point, the pain would become more apparent. Moreover, the patient might start tasting something strange in the area. That would probably be the result of a draining boil, which is an indicator of an underlying infection.
If the gums aren’t flush against the tooth, a dentist might have an easier time seeing the vertical root fracture. But how can they be sure of their diagnosis?
Confirming the Diagnosis
If a dentist suspects that their patient has a fractured tooth root, there are several ways to go about confirming those suspicions. First, a dentist might try to get a reaction out of the patient by tapping on the tooth or wiggling it. If the patient experiences pain, it’s safe to say that the nerves inside the tooth are exposed somehow.
If the fissure wasn’t immediately visible, most dentists would perform a scan of the area. X-ray images can reveal the hairline fractures in the tooth, allowing the dentist to pinpoint the location of the injury. At that point, they might use a probe to make contact with the crack and determine how deep it goes. You can see what this looks like in practice at https://www.youtube.com/watch?v=F3P5sfXSj2Y — the video shows the process from start to finish.
All things considered, vertical root fractures are a fairly rare kind of injury. They represent between 2 and 5% of all tooth fractures. And since the site of the injury is so difficult to get to, the treatment plan for root fractures often requires complete tooth extraction. Of course, that’s something that may differ depending on the case — dentists usually discuss the treatment before proceeding.
If an extraction is necessary, a dentist might just administer a numbing agent and pull the tooth out. However, if the patient already has a dental crown or bridge over the affected root, they would need to remove or resect the restoration first. After clearing out the remnants of the tooth and thoroughly cleaning the cavity to ensure that any bacteria is eviscerated, the dentist would need to think about dental implants.
As a temporary measure, the dentist would install a partial denture on site. At that point, they would probably schedule the patient for a follow-up appointment in a few days. During the second appointment, the dentist would clean the cavity where the tooth used to be and install a dental implant.
In this case, they’d need to screw in a base or fixture going into the jaw bone. The fixture holds the abutment, which is then used as a base for the screw. Lastly, the dentist would top it all off with a tooth crown. By the end of the procedure, it should look like the original tooth is back in place.
What to Do If You Suspect You Have a Vertical Root Fracture
At this point, we know all about how dentists usually go about devising and implementing a treatment plan for root fractures. Now, let’s talk about how patients can make the job a bit easier. How can you prepare for a dentist’s appointment if you suspect that you have a vertical root fracture?
Well, first things first, you should schedule an appointment with your dentist. During the call, make sure they know what they’re getting involved with. Mention any symptoms you’ve noted, particularly if you only feel pain when biting down or you often have a strange taste in your mouth. Bacterial infections can also cause bad breath, so if someone has noted that before, mention it as a potential symptom.
Additionally, you could note any existing vulnerabilities in the tooth that’s causing you pain. If the dentist knows that you’ve had a root canal treatment in that tooth, they’ll be more likely to assume a vertical root fracture. After scheduling the appointment, ask the dentist if you should come with an X-ray scan. Or just assume that you should and get one anyway — it’s always a useful tool to have during dental procedures!