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Root fracture

Summary

A root fracture is a traumatic injury to teeth where the root of the tooth has fracture either horizontally across the root or obliquely. The tooth is often loose the prognosis is affected by how far up the root the fracture has occurred

Features

  • Tooth may be loose or displaced
  • Tender to pressure
  • May be bleeding coming from the gum margin
  • Tooth may appear red or grey
  • Cold insensitive - often the tooth gives no response to cold as the nerve has ruptured in the trauma

Root fractures can occur in adult or baby teeth.

If the tooth fragment has moved then it needs to be repositioned as soon as possible by a dentist and stabilised with a splint (wire attached to adjacent teeth). This usually stays in place for at least 4 weeks depending on the position of the fracture.

A baby tooth that has a root fracture where the fragment has moved will need extraction.

If the nerve dies then the nerve will need to be removed and the pulp chamber filled as far as the fracture line.

Image by Noah Hickman

Home care advice

In general a root fracture needs to be treated as a dental emergency and a prompt dental visit is necessary. A tooth fragment that has been displaced generally should be repositioned as soon as possible back to its original position. This is likely to be extremely painful and best performed by a dentist under local anaesthetic.

In decidous/baby teeth root fractures if the tooth has not moved then not treatment is generally required unless it is infected. If the tooth has moved then it will need to be removed

To keep the area clean in the mean time

  • Soft diet and avoid biting on area
  • Brush the area as normal if possible
  • Use a chlorhexidine mouthwash (in children use by dabbing area with cotton wool socked in the mouthwash)
  • Attend a dentist as soon as possible
  • Over the counter pain relief - Paracetamol (or Paracetamol with Codeine) and NSAIDs
  • Topical gels may provide some pain relief

If there is pain/swelling in the gum overlying the root of the tooth or swelling in your face then contact a dentist to discuss treatment.

Any damage to the lips or gums should be cleaned with salty water or chlorhexidine mouthwash (on cotton wool if necessary)

PLEASE NOTE ANY FAST SPREADING SWELLING IN YOUR FACE OR NECK REQUIRES IMMEDIATE ATTENTION AS IT CAN BECOME A MEDICAL EMERGENCY

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Written by Andrew Bain BDS MJDF (RCS Eng)
May 5, 2020