A tooth can crack on any part of its surface. Obviously, you're more likely to notice a crack on the tooth's crown, which is its visible surface area (above the gum line). But sometimes a crack can begin beneath the gum line before slowly making its way upwards. A crack like this needs urgent, and often significant, intervention.
Vertical Root Fractures
A vertical root fracture starts at the very base (or root) of the tooth. It can be caused by an impact injury to your mouth, with your gums very likely having been injured too—and seemingly taking the worst of the impact. Tooth decay can also be a factor if the tooth's overall strength has been weakened. Because there's no visible signifier of the crack, you're often unaware of any injury.
Irritation and Infection
The crack exposes the tooth's root system, allowing contaminants (primarily oral bacteria) to enter the tooth. The tooth's nerve then becomes irritated and infected. This is uncomfortable at first, and will quickly become painful as the infection takes hold. In fact, escalating pain in the affected tooth can often be your first indication that something's wrong.
An Expanding Crack
As the tooth's nerve becomes inflamed, the crack is likely to extend in length as it works its way upwards. The tooth is still being exposed to bio-mechanical bite forces, causing the two segments on either side of the crack to press against each other, thereby making the crack expand. It will soon extend above the gum line and may become visible at this point. The tooth will eventually split. What can be done to save your smile?
Unfortunately, there's little that can be done for a vertical root fracture unless it's caught immediately after it occurs (and even then, saving the tooth isn't a certainty). Tooth removal might sound drastic, but the prompt extraction of the tooth and its inflamed nerve will save you from severe pain.
Prior to removing your tooth, your dentist can discuss your viable replacement options. The most practical options are likely to be a dental bridge or a dental implant. Although you can take as long as you need to make a decision, it's better to move quickly if you opt for a dental implant, allowing the implant to be placed while your jawbone and soft tissues are at their most receptive.
Unfortunately, a vertical root fracture can mean your tooth has come to the end of the road. Although tooth removal might be inevitable, your dentist has a number of options to replace it. For more information on tooth removal, contact a professional near you.