If you're experiencing pain in a tooth that previously had a root canal, you may have a vertical root fracture.
Vertical root fractures start near the top of the tooth — called the crown — and run all the way to the end of the tooth root underneath the gum. These fractures are the third most common reason for extraction of a tooth that has been treated with a root canal, according to a review in the Journal of Conservative Dentistry (JCD).
Why Do Vertical Root Fractures Happen?
These fractures are most common in teeth that have been treated with a root canal, meaning the nerves inside the tooth have been removed and replaced with a dental material. The JCD review notes several factors that increase the risk of fracture in these teeth:
- If there are narrow roots inside the tooth, which are common anatomical features in certain teeth, including premolars, the tooth may be more prone to fractures.
- Sometimes, teeth become stiffer and dehydrated once the nerves are removed, which makes them more brittle.
- Root canal treatment may sometimes weaken the internal tooth structure.
- Some methods of filling the root canal can cause wedging forces and stresses in the tooth, which can lead to internal cracks.
- In heavily eroded teeth, dentists sometimes have to place a post inside the root to help hold in a crown. These can cause internal stresses that may lead to fractures.
Symptoms of a Vertical Root Fracture
Symptoms of fractures can vary, making this one of the most difficult conditions to diagnose in dentistry, according to the JCD review. However, signs that you may have a vertical root fracture include:
- Mild pain
- Spontaneous pain when eating
- Tooth mobility issues
- A draining sinus tract appearing next to the tooth that looks like a boil or ulcer, which is often a sign that there is an infection beneath the tooth
- A pocket between the gum and the tooth, near the fracture, where the gum essentially detaches from the tooth
A dental professional or specialist (usually an endodontist) may be able to diagnose a fracture during a root canal procedure if they are able to see a crack. If the fracture occurs after the procedure, they might need to take X-rays, which may show the fractured root characteristically shaped like the letter J, or the specialist may also use a diagnostic method known as transillumination, where they shine a light through your tooth to detect any fracture lines.
How Are Vertical Root Fractures Treated?
Unfortunately, the JCD review notes that, in most cases, the best treatment for a vertical root fracture is removal of the tooth. It's important to have this procedure as soon as a fracture is diagnosed, as chronic infection can eat away at the bone around the tooth, which may be needed in the future to support a dental implant. In some cases, the use of cements may strengthen the tooth and unite the fractured pieces, as the JCD review describes.
To avoid dealing with the fallout of a vertical root fracture, here are some preventative steps you can take to protect your teeth:
- As these fractures occur mostly in teeth treated with a root canal, avoid this treatment if possible. This means scheduling regular dental examinations so your dentist can detect problems early and help you prevent cavities from forming in the first place.
- If you need root canal treatment, ask your endodontist about the root canal filling technique that they will use and discuss how to reduce your risk of a fracture, such as avoiding post placement.
If your symptoms match those outlined above and you're worried that you may have this type of fracture, talk with your dentist. They will help you determine the cause of your symptoms and give you the proper treatment to keep your teeth healthy and functioning.