Tooth Fracture Question
 

I had posted a few weeks ago with questions about a root canal and pain that I was experiencing after having it. I had a bite adjustment and antibiotics and the tooth still was hurting (tooth is still sore when tapped on and aches). So I was sent to an Oral Surgeon who thinks I have a fracture in the tooth (in the root). They want me to have it extracted and get an implant. I am very nervous because this is my front tooth and the fracture doesn't show in the x-ray. There is a infection showing on the x-ray, so I have to stay on antibiotics until the tooth is pulled.

So my first question is has anyone had an experience with a fracture in the root of their tooth or dental implant in their front tooth?

Also, the past couple of days the other front tooth (the one right next to the root canaled tooth) has started to ache. Can you feel pain in other teeth if one of your teeth has an infection and/or has a fracture in the root?

Has anyone ever wore a flipper before while waiting to get your dental implant? Are they really uncomfortable?

Thanks in advance. Just trying to make the best decision for me. I know once you pull a tooth you can't get it back. :(

Hi Alex,

I have not personally had this type of dental treatment. However, I have worked with 100's of patients who have. So I can offer you my thoughts from that perspective....

The 4 upper front teeth are susceptible to fracture because that bone is more fragile (thinner) than it is in other places in the mouth. Any tooth that has a root fracture is not salvagable, not even temporarily with a root canal procedure. There is no way to patch up, close up or correct the fracture. It's not like other bones in the body that if not displaced will generally heal on their own. The fact that you continue to have radiographic pathology (infection) and pain indicates the tooth is probably fractured. Root fractures are hard to detect on a typical xray but if the xray is angled differently sometimes that can pick it up. Other times it is not seen until the tooth is removed.

The antibiotic is only subsiding the symptoms temporarily. So that is only a very brief course of treatment and it is best to have the tooth removed while taking the antibiotics. The other tooth could be hurting for any number of reasons. Some of them could be...... that tooth may also be injured from whatever it was that caused this tooth to be fractured..... the infection from this tooth could have spread to that other tooth..... or there is pressure in the surrounding bone from the bacteria in the fractured tooth which would cause additional pain/tenderness in the surrounding teeth. An xray should be able to diagnose the health of the other tooth.

The dental appliance referred to as a flipper is generally quite small and holds only that one missing tooth. Yes, it can be a bit challenging to wear and to eat with. But the purpose of the flipper is to prevent the other teeth from moving into that space and to give the patient a natural looking smile during the healing phase. This appliance may also be adjusted to wear during the healing phase of the dental implant.

It is ideal to have the infected tooth removed as soon as possible to prevent the spread of infection. The idea is to maintain as much healthy bone as possible for the placement and integration of the dental implant.

I know this is scary and the thought of this happening in the front of your mouth is bearly unthinkable! Every patient I have worked with who has had this done feels exactly the same way. However without any doubt, the patients that experience the least post operative discomfort from the extraction and end up with the best overall outcome of the implant and implant crown are those who have had the least infection.

Have you had impressions made for the flipper yet?

Bryanna

Thank you so much for the info. I don't know anyone that has had a fractured root in their tooth or had an implant so this is very scary for me.

I am having the impression made for the flipper this week by my dentist. But was told it can take a week or two for the flipper to come back. And then the Oral Surgeon will pull the tooth. The Oral Surgeon wanted to wait to pull my tooth so I don't have to walk around with a missing front tooth. Which I agreed. So I won't be having the tooth pulled for at least two weeks. Which I am a little concerned about waiting another two weeks to have it pulled even though I will be on antibiotics.

I also think I have to have a bone graft. Does that hurt or feel weird? They are not putting the implant in the day of the extraction, so I guess they would do the bone graft at the extraction appointment?

Again, thank you for your reply. It was very helpful.

Hi Alex,

The sooner the tooth is removed the better, but 2 weeks may be ok. You will have to monitor your symptoms and if the pain increases or you get a swelling then you may have to get it out sooner.

When the extraction is done, the bone will be evaluated and the bone graft may be placed at that time. If there is too much infection, the graft will be done at a separate surgery date a few weeks later. Either way, the bone grafting is not uncomfortable and you won't even know it's there. Depending on what type of grafting material is used, sometimes tiny pieces fall out as the area is healing which is very normal and nothing to worry about. Alot of graft material is used to fill up the surgical socket so losing some is no big deal.

This is definitely a difficult thing to deal with....... but you really will be ok. The flipper will be annoying at times, but it will give you a pleasant smile and you will learn to work with it very quickly. Fractured teeth are very common and typically people don't know they have one until the tooth shows signs of infection. Often the fracture is not visible until the tooth is removed.... sometimes the dentist tells the patient and other times he doesn't.

Hang in there...... everything will work out ok!

Bryanna

Well I wanted to post an update. :) I had my tooth extracted (#8) on Thursday morning. Everything went very well and it is healing great. I go in about 2 1/2 months to have my dental implant put in.

My flipper looks very natural, but feels so tight against my other front tooth. It was kind of hard to get the flipper (tooth part) in the extraction site this morning. Which it was not that tight against the other front tooth the first evening I wore it. And it definitely pinches my gum. So it is not very comfortable right now. But I haven't worn it that much (only a few hours each day since the extraction). But will be wearing all day from here out. Will the tight feeling against the other tooth go away? I don't want to mess that tooth up.

I know I will probably have to call my dentist next week for an adjustment. But was wondering what is normal with a flipper.

Thanks so much!

Hi Alex,

Well that's a relief!! So glad to hear the extraction went well!

The reason the flipper is tight against the other teeth is because there is some swelling there from the surgery. Did you put the flippper in immediately after the surgery and wear it for 24 hours or did you wait? It is meant to be worn the first 24 hours (not removed at all) to prevent the area from swelling. Did your dentist tell you that? Was it too uncomfortable to wear?

It is not a good idea to wear the flipper if it feels that tight and is putting pressure on your other teeth. I know this is not what you want to hear but the pressure can cause trauma to the nerves of those teeth and they can die. The best scenerio is to leave the flipper out until the swelling subsides and the flipper is no longer causing any pressure or to see your dentist asap, have him adjust it slightly to alleviate that pressure.

Keep us posted....
Bryanna

Well the flipper being tight next to the other front tooth is a lot better. But the flipper still feels like it is pinching the gum. So it is looking like I need an adjustment on it.

But right under my nose has become very sore (above the tooth that was extracted). I don't remember it being sore before. Could this be from wearing the flipper or just the healing of the extraction site? Also it throbs when I wear the flipper. Is that from healing or it being tight? I just had the surgery Thursday so I don't know what is normal.

Oh and I didn't wear the flipper straight for the first 24 hours. They told me to wear it that afternoon. So I didn't put it in until about 7 hours after the extraction and wore it for a few hours. And now I am wearing it more. But after wearing it for 3-4 hours I have to take it out because it gets so uncomfortable. And then I put it back in a few hours later.

The extraction site looks really good and I am on antibiotic. I know I probably need to give it more time, but patience is not one of my gifts. :)

Thanks!

Hi Alex,

If the flipper is less tight against the teeth, then some of the inflammation has gone down. However, the soreness under your nose above the extraction site and the throbbing indicates that the flipper is too snug up against the surgical area. This will impede the healing process, so it is wise not to wear the flipper until you can get it adjusted by your dentist.

After the adjustment that throbbing should go away and the soreness will slowly subside.

Bryanna

Alex,
Crazy but i am going through almost the exact same situation and I stumbled upon your post while I was searching for info! I'm 27 and I had a root canal 5 yrs ago.. I recently found out the root of my front tooth (number 9 i think) is fractured and it has to be extracted! I am losing my mind over this, and seriously have thoughts of just avoiding it and seeing what happens.
I recently had to get a flipper made and it is currently sitting at my dentist's office because I am too afraid to go and pick it up. I am scheduled to have the extraction next monday. I also will have to have a bone graft, which I am pretty sure delays this process even more. Do you mind answering a few questions for me?
-How are you doing with the flipper? Does it look different or no one can tell?
-Do you have a lisp when you speak? I am so nervous for this especially because I am a teacher.
-Do you have to take it out when you eat? I really don't think I will be able to do this.
-Were you really freaked out to see yourself without a front tooth?
-Does it hurt?
-Can you still make out with people? haha sounds ridiculous, but i wonder this.

Ok i have about a million more questions but I'll start with those haha. I am going to my dentist tomorrow and i do plan to ask some, but I always feel like they think it's no big deal when personally I feel devastated! I also seem to take much longer to heal than they say when it comes to these types of procedures.

Any help you (or anyone) could give me would be so great. Thank you in advance!!

Hi mo,

I am in the dental field so I can offer you my thoughts from that perspective since I have not personally had this dental issue myself. I know hundreds+ of people who have undergone this procedure and dentally speaking it's pretty straight forward in patients who otherwise have healthy mouths. I know this is a very scary thing to be dealing with and your concerns are all valid. But try to keep in mind that with each completed step, you will feel much relief. At the onset it would be very helpful for you emotionally to understand that this realy is the best/healthiest option to take care of your dental problem and you will get through this ok.

If your dentist has not already told you..... a very important thing to understand is that the fractured part of the tooth is open when normally it is sealed closed. Bacteria has already begun to build up there and infection is imminent. Unless you've had a traumatic injury recently to that tooth, chances are the tooth had been fractured without you even knowing it. It is not uncommon for root canaled teeth to fracture either during the root canal procedure or anytime thereafter. Because most root fractures are not easily picked up on an xray, they are often undiagnosed until infection or other pathology is seen on an xray. So to take a wait and see approach will only contribute to further problems and deterioration in the bone would make the oral surgery as well as the permanent restoration more complex. Because the jawbone is so vascular, the bacteria will also spread to the adjacent teeth if it is not removed.

Putting bone graft material in the socket of an upper front tooth is very common because the bone in that area is much thinner than the rest of the mouth. However, there has to be some amount of healthy bone around the surgical socket to place the bone graft in. So again, it is best to have this tooth removed before the condition progresses.

Everyone's experience with wearing the flipper is a little different. You will find that you have to be careful of how you eat because it is not meant to be used like a normal tooth. Biting into an apple, sandwich or hamburger, anything like that will cause it to come out and/or break. We suggest patients cut up their food, and avoid using the front teeth to chew with. If you are careful and mindful of wearing it, you will be surprised at how functional it can be. As far as it being lose..... in the beginning it may feel tight, then lose as the mouth heals. You may need a few adjustments on the flipper at your dentist office and sometimes patients use a slight dab of denture adhesive to keep it in. The flipper is designed to fit into your smile and usually it is esthetically pleasing to anyone looking at you. As for kissing... depends on what is comfortable for you and your partner. It may not even be noticed or you may prefer to take it out........ depends on the date I guess ;)

For many people, initially it is alarming to see yourself without a front tooth. But my patients tell me that concern goes away alot quicker than they thought it would because they are so relieved to have that bad tooth out.

I hope this information is helpful to you..... if you don't hear back from Alex on this thread.. make a new post entry directly to her and then make a reference to this thread.

Keep in touch and let us know how you're doing ~'.'~

Bryanna




QUOTE=mo27;635161]Alex,
Crazy but i am going through almost the exact same situation and I stumbled upon your post while I was searching for info! I'm 27 and I had a root canal 5 yrs ago.. I recently found out the root of my front tooth (number 9 i think) is fractured and it has to be extracted! I am losing my mind over this, and seriously have thoughts of just avoiding it and seeing what happens.
I recently had to get a flipper made and it is currently sitting at my dentist's office because I am too afraid to go and pick it up. I am scheduled to have the extraction next monday. I also will have to have a bone graft, which I am pretty sure delays this process even more. Do you mind answering a few questions for me?
-How are you doing with the flipper? Does it look different or no one can tell?
-Do you have a lisp when you speak? I am so nervous for this especially because I am a teacher.
-Do you have to take it out when you eat? I really don't think I will be able to do this.
-Were you really freaked out to see yourself without a front tooth?
-Does it hurt?
-Can you still make out with people? haha sounds ridiculous, but i wonder this.

Ok i have about a million more questions but I'll start with those haha. I am going to my dentist tomorrow and i do plan to ask some, but I always feel like they think it's no big deal when personally I feel devastated! I also seem to take much longer to heal than they say when it comes to these types of procedures.

Any help you (or anyone) could give me would be so great. Thank you in advance!![/QUOTE]

Hi Mo,

I am sorry your tooth is fractured and your having to deal with this. It has been almost two weeks since my front tooth was extracted. I was so nervous about having my tooth extracted. Like you I am fairly young, so I understand how you feel.

The flipper that I got looks very natural. No one can tell I am wearing a flipper. The first few days wearing it was uncomfortable and hurt a little only because it was too tight and because the gum was healing. But my dentist adjusted the flipper and as the gum heals the more comfortable it feels.

I personally can't eat with it. It is uncomfortable for me. My bottom teeth hit the plastic part that is on the roof of my mouth and makes it hard to chew. But my dentist said you can eat with them. He said it takes some getting used to. So I am hoping over time I can eat with it in. I can drink liquids of course fine with it in and even eat like yogurt or applesauce, but I have not mastered chewing with it in my mouth.

I do not have a lisp with my flipper at all. I sound completely normal.

Seeing myself without a front tooth for the first time was hard, but I actually got over it pretty fast. I am just happy that the tooth is not causing me pain anymore.

I was devastated when I learned I had to have my tooth extracted too. I almost cried in the dentist chair the day I got the flipper made. And the day before the extraction actually thought about canceling the appointment. But I didn't. I know it is hard, but looking back on it I am glad I went though with it. I don't have to worry about it anymore. I am not in pain anymore. Plus even the extraction itself wasn't that bad.

Are you getting a dental implant? I am getting a dental implant in a few months.

Hopefully I was of some help. Bryanna on this site is really awesome. She always has wonderful info and has helped me a lot when I have posted.

I wish you the best of luck. Keep us posted on how everything goes.

Thank you both so much for your responses! You both made me feel better. I went to pick up the "flipper" today. It's basically what I pictured, it looks like a retainer kinda thing. Hopefully I don't have trouble talking or eating with it. It does make me hopeful to know that your experience hasn't been too bad. The eating thing does sort of concern me but I guess I can't worry until I see what happens. I will definitely let you both know in a week or so how it goes. Alex, I am getting an implant, but they weren't able to tell me how long I will have the flipper until the tooth comes out and they see what's going on. How long do you have to wear your flipper for? Did you have a bone graft too? If so how was it?
The weirdest part about this for me is the fact that my tooth never once hurt me. My root canaled tooth appeared to be getting longer, falling almost so I asked my dentist about it. It never hurt or felt lose. He noticed a gray area on the xray and had me to go to an oral surgeon. After many mistakes and a pointless apicoectomy I found out the root was fractured. Now after that my tooth is bothering me a bit but I think that's because I made the mistake of even letting them do the apico before exploring what it was. Live and learn I guess! And now my tooth is starting to look a different color and all that, so I am sure in the end I will like my new tooth better.
One more question for you.. How long did it take you to recover after getting the extraction and flipper? I guess I just want to mentally prepare myself for how many days I will need after.
Thank you both again so much, you are very helpful! I'm glad I found this site.
Maureen :)

Hi Mo,

It sounds like we probably have the same type of flipper. Mine is like a retainer thing that fits on the roof of my mouth with a fake tooth on it that fits in the place of the extraction site.

Don't worry about the eating thing. You might do just fine eating with the flipper.

I did not have to have a bone graft. I thought I was going to have one, but the oral surgeon said since I am having my dental implant done in about 2 1/2 to 3 months I didn't need one. But if I was going to wait longer to get my dental implant then I would have to get a bone graft. I guess bone grafts vary from person to person. I'm assuming he saw in my x-ray that I have enough bone to put my dental implant it. Not sure how that all works.

The first day of the extraction I rested and took it easy at home. I did take something all day for the pain because that is what I was instructed to do for the first day. But was never in a lot of pain. The next day I didn't feel much pain at all. I don't think I even took anything for pain until bed that evening. After that it was just sore and achy like it was healing. Sometimes it had a dull throb. But it was not that painful for me. Wearing the flipper at first was uncomfortable because it was too tight and because the gum was healing. But the dentist adjusted the flipper and as the gum heals the flipper feels better.

I will be wearing my flipper until the dental implant process is complete. So I am thinking for 6 to 9 more months. Not quite sure. I am sure hoping I will be finished with all this by the end of the year.


It took a while for my tooth to be diagnosed as having a root fracture. I had a root canal at the beginning of the year and that only made the tooth worse. And the fracture wasn't showing up on the x-ray. So it was a long road to finally not have to worry about this tooth anymore. I remember the days leading up to the extraction were stressful for me, but everything worked out. And I know everything will work out for you too.

Keep us posted! :)

Hi mo,

I feel so bad that you have gone through so much with this tooth. Your dental problem is very common and just so you know.... everything you have written indicates an infection. The sooner you get this tooth out the better!

Your situation is a bit different than Alex in that you had the apicoectomy which in itself causes a void in the bone above the tooth. The dentist will not know the extent of the void until he removes the tooth. Again, this condition is always seen when a apico has been done.

The down time after the extraction varies from person to person. It would be a good idea to plan on a few restful days after the extraction and prepare a nutritious, soft food diet ahead of time. One that you can easily put together without too much thought. Unless your dentist instructs you otherwise, it is also important to wear the flipper for the first 24 hours after the extraction and then the next day take it out to clean it, give your mouth a rest and then wear it for several more hours the second day. By the third day you may need to see your dentist for an adjustment. Wearing the flipper at the onset does a few things. One, it acts as a bandade and protection over the extraction site. Second, it prevents the gum tissue from swelling alot. Third, the shape of the tooth on the flipper acts like a template along the gum as the surgical site is healing. So it's advantageous to wear the flipper as much as possible in the beginning and also throughout the healing process because it can actually help shape the level of gum tissue so the permanent restoration will look more natural.

I know this is scary and you'd rather do anything other than this..... but you realy will be fine. Please try not to worry and please keep in touch here!

Bryanna

Bryanna,
Thanks so much! I know.. looking back, i have no idea why the dentist decided to do the apico knowing that it actually goes through more bone. I'm so disappointed that I made the decision to even do it, but if the dentist is telling me that is the best plan then how was I supposed to know? That's why I get very anxious about all this because I never know if Im making the right decision. I should've just had them go in and explore, which was what one of my other dentist had suggested originally. Oh well.
I am going in for the procedure today :( I am really nervous, but I know it's better to get it done sooner than later. I don't ever want to take the flipper out because Im so nervous of seeing myself without a tooth! Ahh. I'll be sure to get back to you of how it goes. I'm sure I will have many more questions.
Thanks so much again you have both made me feel much better about this!
Mo

Hi mo,

Please do let us know how you are doing ~'.'~

Bryanna

Hii,
Ok so i basically had the weirdest experience yesterday. I didn't get my tooth out after all this!! The doctor who was doing my implant is not the same doctor who i originally went to for my partial apico. I changed doctors because I moved and heard good things about another doctor. Basically, he wanted to go in an check to make sure there was a root fracture instead of taking the other dr's word for it.. Turns out he didnt see a fracture! I dont get how this is possible, but instead of taking the tooth out he ended up doing an apico and bone graft. Have u ever heard of such a thing?? I was shocked. He said there could still be a chance it's a hidden fracture but he couldnt see taking my tooth out if he didnt see it. So weird. Im scared to get my hopes up bc im skeptical this wont work and ill still have to do it. But for now im happy to have my tooth. He has me on antibiotics for a week and i have to go back in 3 weeks. We will see i guess. What a nightmare!

Hi mo,

Well........ I imagine you feel some relief because you still have your tooth. However, I'm sorry to hear that things didn't go as planned because you geared yourself up to have the tooth removed which really would have solved the problem.

Unfortunately, most fractures in a tooth cannot be seen clinically because they form internally within the tooth and can therefore only be found once the tooth is extracted and evaluated. If the fracture is large enough to cause a splintering of the tooth, then it can be seen on an xray and sometimes clinically as well. Generally a dentist will diagnose a fractured tooth based on the patients symptoms and radiographic history.

Unfortunately, I have seen many patients who have undergone apicos, even multiple apicos on one tooth. Basically they are done as a heroic effort to "retain", not cure, a diseased tooth. Most often they are done on patients who have not accepted the idea of losing their tooth yet.

Mo, the truth of the matter is that your tooth is not healthy. Irrelevant of what is done to it or the bone surrounding it, the tooth is not healthy. Because the procedure has already been done, I'm not going to go into anymore detail about that here because it would just upset you.

It is wise to have an xray of that area twice a year at your dental cleaning appointments to monitor any changes in that area of the bone .... or sooner if you develop any swelling, pimple on the gum, redness or pus coming from that area.

I hope you are not too uncomfortable and wish you the best of possible outcomes!!

Bryanna

Bryanna,
Thanks for responding! I know. I cant help but wonder if i am delaying the inevitable, but I wasn't left with much choice I guess. Everything seems to be so conflicting from one dr. to the next and it makes it almost impossible to know what the "right" decision is for someone who has very minimal knowledge about dentistry u know? Especially when I'm sitting in the chair!
I guess they are hoping that maybe my tooth isn't actually fractured and that this will help heal the tooth? I don't know. I wouldn't go through another apico in the future. I'm sure if this doesnt "work" they are still going to tell me to have the tooth removed. I have to go back in 3 wks to see how this went. Thanks for your help. I definitely am unsure of this situation, but we will see. Ill keep u posted!

Hi Mo,

It is so true that when most people are in the dental chair, they're scared to some degreee, don't know what questions to ask, and feel helpless about making the right decision. So naturally they put their trust in the dentist who should be honest enough to make the right choice for that patient. It is so unfair that a person should feel like they have no choice but to go along.

Based on all that you have posted here, the recommendation to have the tooth extracted was probably the best treatment option because the bone could have been cleaned up and possibly regrowth of bone could have been achieved with a bone grafting procedure which would increase the success of placing an implant in the future.

Let me give you a clearer visual of what has happened...

Root canaled tooth= non vital, necrotic, diseased, fractured(?).

Some irreplaceable bone loss caused by the long standing disease process from all of the above.

Apico= additional bone loss, additional irritation and inflammation to the bone, procedure does not stabilize or positively alter the necrotic, diseased condition of the tooth.

Bone grafting= positive regrowth of bone when placed in healthy bone.... little to no solid regrowth of bone when placed in diseased bone.

These are the things that your dentist(s) should have discussed with you. I didn't post them here until now because I assumed you were having the tooth removed.

This is an unsettling situation to say the least and you have not been informed properly. Please don't feel like you are alone in this or that you did anything wrong. This situation occurs too frequently unfortunately. I urge you to monitor this tooth radiographically twice a year because this tooth and the surrounding bone is not healthy and it will show radiographic pathology before it gives you symptoms.

I'm sorry to bring you this crappy news....... I wish I could make it better. Please keep in touch.......

Bryanna