What is VRF (vertical root fracture) and cracked tooth syndrome?

January 14, 2016

What is VRF (vertical root fracture) and cracked tooth syndrome?
This premolar has a VRF (vertical root fracture). In the mouth this appears as a bleeding fracture like going from the mesial to the distal surface of the tooth.

Cracked tooth syndrome refers to minuscule fractures or cracks within the tooth that are not visible even with the help of x-rays. The patient may complain of pain on biting, even though there are no obvious signs of fracture or decay in the initial stage. However, if left untreated it can lead to complete fracture, pulpal infection and eventually gum infection. It is normally observed in the premolars and the molars which bear the maximum load of chewing.



CTS (cracked tooth syndrome) exhibits a wide variety of symptoms with the main being pain on biting. However, it is distinct from the constant ache of a cavity. It is characterized by pain on biting hard food or by rebound pain when the pressure is released on the tooth. It is especially noticeable when there are hard nuts or seeds in otherwise soft food. Pain may also be felt on eating or drinking something cold or sugary but there may not be any pain on having something hot. Pain is also felt on grinding the teeth sideways or back and forth.



Diagnosis of cracked tooth syndrome is somewhat difficult as it is not visible on x-rays. The pain may not be felt always and therefore difficult to pinpoint. It may also resemble other diseases such as TMJDs, sinusitis, facial pain or ear pain. Timely diagnosis is important as a cracked tooth is essentially an incomplete fracture and may progress to complete fracture and infection. The dentist may use various techniques to get an accurate diagnosis. These include transillumination with magnification (light source placed directly on the tooth) or highlighting the crack with a contrasting background. Bite tests on tooth sleuth, cotton rolls or wood sticks are often used to reproduce the characteristic pain on biting. Dentists sometimes also use the tip of a sharp explorer to catch the crack.



Treatment depends on the extent of the problem. It may be superficial cracks in the enamel itself or may be deeper going to the pulp. A core build up with composite bonding or the use of a band around the affected tooth to reduce flexing is the simplest treatment. However, in cases where the cracks are in more than one cusp of the tooth, then a crown offers better stabilization.

In cases where it has led to infection in the pulp then the first step would be root canal treatment. In case it has led to gum infection then it may not be possible to save the tooth and it may have to be extracted. Great materials for sealing cracks are MTA and bioceramics. They provide good protection and minimum leakage and are preferred by the dentists.



Though cracks cannot be prevented altogether you can reduce its probability by taking some precautions. As far as possible avoid chewing ice or foreign objects like the end of pen or pencils. If you are prone to bruxing then wearing mouth guards on the advice of your dentist would be better.


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