Root Fracture
Adult Teeth and Dental Trauma
In this section, we will cover:
- What is a root fracture?
- What should I do after the injury?
- Will I need treatment?
- What can I do to help the area heal at home?
- Will I need any follow up appointments?
- What should I look out for?
- What are the long term complications?
What is a root fracture?
This is an injury in which the root of the tooth has fractured below the gum. You will not be able to see the fracture but the broken part of the tooth may be wobbly or displaced from its original position.
This type of injury can look similar to a lateral luxation injury.
What should I do after the injury?
It can be very distressing if you/your child has suffered trauma to the teeth. The first thing to do is not panic.
Dental trauma is very common and there are a few steps you can follow to get the best outcome after the injury.
You should:
- Take a second to collect yourself and check you/your child hasn't blacked out.
If you/your child has hit their head and you think they may have lost consciousness (even for a few seconds) or they feel nauseous or dizzy, you should get this checked out by your doctor or local A&E department to rule out a concussion (head injury). - Call your dentist as soon as possible so they can arrange to check the teeth and provide any necessary treatment.
- Pick up any broken fragments of the tooth if you can find them. You should take these to your dentist's appointment so they can check the fragment hasn't been accidentally swallowed and no tooth fragments are in any cuts in the soft tissues.
- If there are any cuts in or around the mouth, clean them with warm salty water. If there is any bleeding, dampen a clean handkerchief in salt water and press it firmly on the bleeding area.
- If the injury happened in a place thought to be unclean, and there has been a cut to the skin/lip/gum, you should check all tetanus vaccinations are up to date with your GP. You may need a tetanus booster vaccination.
Will I need treatment?
Your dentist will take some xrays of the teeth to check for any other injuries and to compare any future xrays against.
If there was a broken fragment of tooth lost and there is a cut in the soft tissue (e.g. lip), your dentist will take an xray of this area to make sure the missing fragment is not in the soft tissue.
If the tooth can be saved, the loose fragment needs to be repositioned/stabilised by your dentist. The steps are:
- Local anaesthetic to make the procedure more comfortable
- If the loose fragment has been displaced, your dentist will reposition it as close to the original position as possible. They will take another xray to confirm the tooth is in the correct position
- A splint (flexible metal wire) is placed on the injured tooth and the teeth either side of it for 4 weeks to hold the tooth in place. If the root has fractured close to the gumline, the splint may be left on for up to 4 months
If the tooth has fractured above the bone level and is only being held in by the gum, the broken part of the tooth should be removed. The options for treatment are:
- The root which remains in the bone can be root canal treated and the tooth can then be restored with a post/crown
- The root can be extracted (either a dental extraction or a surgical extraction if the root is far below the gum) and replaced with a denture, bridge or implant
If there are any deep cuts on the gum/lip/tongue which your dentist thinks will not heal by themselves, they will place a few stitches to help them heal. You may need to be seen in an A&E department with a specialist team of "oral and maxillofacial surgeons" for this.
If you/your child are unable to tolerate treatment under local anaesthetic, they will be able to offer the treatment under sedation and/or general anaesthetic in hospital. If you think your child will need a general anaesthetic for treatment, they will need to be fasted for 8 hours prior to the procedure.
What can I do to help the area heal at home?
To help the area heal at home, you should:
- Brush the teeth after every meal with a soft toothbrush
- Gently brush the injured area to prevent build up of plaque
- Carry out salt water or alcohol-free chlorhexidine mouthwash (corsodyl) twice a day.
For a young child who isn't able to use a mouthwash, use a cotton swab/handkerchief moistened in salt water or alcohol-free chlorhexidine mouthwash (Corsodyl) to clean the gum twice a day - Have a soft diet
- Take medicine to help manage any discomfort (ibuprofen or paracetamol)
- Avoid contact sports
- Don't smoke
Will I need any follow up appointments?
Your dentist will want to see you/your child again for a clinical examination and xray after:
- 4 weeks (to remove splint)
- 6-8 weeks
- 4 months (to remove splint for fractures close to the gumline)
- 6 months
- 1 year
- yearly for 5 years
X-rays are taken to assess how the root of the tooth is developing and to identify any complications with healing.
What should I look out for?
The long term consequences of dental trauma are unpredictable. You should monitor your/your child's teeth for any signs of infection.
Favourable outcome
- No pain
- Normal colour of the tooth
- Tooth not wobbly or only slightly wobbly
- Tooth in correct position
- Good quality, aesthetic restoration (if restored with post/crown)
Unfavourable outcome
- Pain
- Abscess on the gum
- Permanent grey discolouration of the tooth, along with one of the above signs/symptoms
- Tooth excessively wobbly
- Tooth out of position/longer than before injury
- Loss of restoration (if restored with post/crown)
What are the long term complications?
The long term consequences of dental trauma are unpredictable. You should monitor your/your child's teeth for any signs of infection (see "unfavourable outcome" above).
Possible complications include:
1) Nerve damage
- A) Nerve dies causing pain and infection.
The tooth may look grey/brown and be tender to bite on. This can be managed with root canal treatment. Where there has been a root fracture, the infection usually occurs at the fracture line so only the broken fragment of the tooth needs to be treated. The tip of the root which has broken can usually be left untreated without causing any further problems.
Once the tooth has been treated, it can be whitened to improve the appearance. You can find about more about tooth whitening here. - B) Root canal constricts as more dentine is formed (find out more about tooth anatomy here).
This is called "pulp canal obliteration". The tooth may look more yellow or brown but you won't have any pain from the tooth. This doesn't need any treatment unless the nerve dies. If the nerve dies, you may need to see a specialist endodontist for root canal treatment. If you are unhappy with the colour of the tooth, you can consider a course of tooth whitening. - C) Tooth starts to "dissolve" from the inside out.
This is called "internal inflammatory resorption". The tooth may have a pink-ish tinge to it. In most cases, you won't have any pain from the tooth unless the resorption has extended to the outer surface of the root. If detected very early, this condition can usually be managed with root canal treatment. Sometimes, the tooth will have to be removed (see dental extraction).
2) Failure of restoration (for tooth restored with a post/crown)
- Restoration falls off
A new post/crown will need to be placed if the tooth is still restorable. If not, the root can be:
A) Sealed with a restoration and the gap replaced with an overdenture or bridge.. This can be a good option if you are considering an implant in the future as the root maintains the bone.
B) Extracted and replaced with a denture/bridge/implant