Does tooth verticar root fracture show a symptoms? Different Endo opinions. How to know if I need a Rct or not. Anyone experienced like this before?

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Hi,
I have been dealing with lower jaw pain under earlobe for past 3 months. I have ear pain, lower jaw pain with Swelling in the jaw. I have severe pain in the lower jaw. After a month, I started feeling pain on the side of the neck. It's mildly swollen too. I have some spots in the side of the neck and under the earlobe in the lower jaw. I have been to ENT and different dentists. No ear infection.

My dentist said it could be from a tooth crack or fracture on tooth#30 or upper wisdom tooth. I extracted the upper wisdom tooth 7 weeks back and no changes in my symptoms. I have pain on top side of the head above the ear. It hurts whenever I open the jaw and my jaw clicks or pops Everytime. My upper molars are so tight since may when all these started. It's still the same and no increase or decrease in the swelling. It's the same.

I went to an Endo based on my dentist referral and he tested. He said no fracture. And during the cold test, I felt more sensitivity on that tooth and felt soreness for 20 seconds after that.
I felt pain to bite on one spot on that tooth. So he said no RCT needed. I told him that pain in the lower jaw is so severe and throbbing when I lie down. So, he said if it's throbbing pain to lie down , I can do RCT and send me with a treatment plan.

Meanwhile, I saw an OMFS for a post op follow up and he said my issue might be TMJ issue and referred me to tmj specialist.

I have severe pain in the lower jaw under ear lobe and side of the neck. It hurts to touch under the ear and neck. It's so tender and sore. My PCP told me to try physical therapy if it's from tmjd and any muscular issue.

My dentist is very sure that my issue is from the tooth crack only. He said all the pain and swelling could be a referred pain from the tooth crack on #30. He talk to the referred Endo and he told me to so RCT with Endo and come back to him for a crown.

I never had RCT before and very nervous and panic about it. I am not against my dentist treatment plan or thoughts. I wanted to know if my jaw pain under earlobe and neck swelling and pain is from the tooth crack before proceeding with RCT. But no answer for that.

I did see a physical therapist based on my PCP suggestion. He did say that my symptoms looks like tmjd and needed some manual therapy treatment. But my PT wanted to make sure if there is no issue from the tooth before moving on with PT.
I went to another Endodontist today to check if any issue on my #30 tooth. This Endo has good Google reviews and was listening to me so patiently. He didn't take any new x-rays as I have all my x-rays and CBCT scan. He didn't see my cbct scan or didn't take one. He said the scan is not required.

He did bite test, cold test, fibre optic light test. I felt little soreness after the cold on that tooth. I also felt some pain to bite on one spot on that tooth. He said, no RCT needed now. Couldn't see any crack in the light. If it's a root fracture, we cannot see it. But other symptoms will show up. So, told me to check with TMJ specialist and ENT for the jaw and neck pain.

So, I have 2 different opinions regarding the root canal now. So, it's very confusing how to proceed further. Is it really a crack or I should hold on with RCT for now?
Any thoughts or inputs anyone? Please.

P.S: during my 2 Endo visits, both the Endo didn't take or see the cbct scan. They said it's really not necessary. But during my first dental visit, the dentist said that I have fracture by seeing the cbct. So it's very confusing why the Endo not seeing the cbct scan and they rely on cold test and bite test along with fibre optic light test.
 

honestdoc

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If you get a vertical fracture on a tooth or root, it may take a few weeks to manifest into gum attachment damage. The dentist will probe around your normal teeth with readings like 3 mm, 2 mm, 3 mm. If vertical root fracture happened about 4-6 weeks before, depending on how deep the fracture is, the readings will be like 3 mm, 7 mm, 3 mm. The 7 mm indicates gum attachment loss (damage). After a few months, the bone around the problem root or fracture will show damage on x-ray as black (radiolucent).
 

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If you get a vertical fracture on a tooth or root, it may take a few weeks to manifest into gum attachment damage. The dentist will probe around your normal teeth with readings like 3 mm, 2 mm, 3 mm. If vertical root fracture happened about 4-6 weeks before, depending on how deep the fracture is, the readings will be like 3 mm, 7 mm, 3 mm. The 7 mm indicates gum attachment loss (damage). After a few months, the bone around the problem root or fracture will show damage on x-ray as black (radiolucent).
Thank you doctor @honestdoc.
How do they do this probe? Like scratching over the gum area? I do remember that my new Endodontist did that yesterday. He said it will be very tender and painful before doing it. I felt so painful and tender. He scratched over the gum, but he didn't say anything like these values. He was checking all the tooth gum area. This was the first test he did.

It's been 3 months since this issue started. He didn't take any new x-rays though. Saw my old x-rays. If its a root fracture, it would atleast show up with a gum probe by now?

I did email my general dentist after the second Endo opinion. Endo have sent his report to my dentist as well. My dentist is not so friendly and good with anxious dental patients like me. He replied me that, what is your next step and getting multiple opinions can be very confusing.

So, he is not suggesting anything on my issue now. He just want me to decide my next plan and let him know about it. He actually want me to try the RCT and see if helps in my symptoms. He told me that when I talk to him last week.

I have very severe pain in the lower jaw under earlobe, side of the neck. It has a small lump on the side of the neck. It's very painful to touch the jaw area and neck. My PCP wants me to do a neck ultrasound to check if that lump is a cyst. I have mild swelling in the side of the neck for last 2 months and in the jaw for last 3.months.

I did ask the new Endodontist that a crack will cause these symptoms. She said certainly not. So, it's confusing if I am missing something or should try RCT and see if I have a root fracture or not since it's not visible on the xray or through diagnosis.
 

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