The most common initial clinical symptom in a patient with a vertical root fracture (VRF) is sharp pain on biting or release of pressure.

- Vertical root fractures often cause a mechanical disruption of the root structure, leading to inflammation of the periodontal ligament and adjacent tissues.
- This results in localized sharp pain, especially on biting or when pressure is released from the affected tooth, due to the slight movement of fracture fragments.
- Unlike other dental pain, the discomfort from a VRF is typically brief and sharp rather than a continuous dull ache.
- Sensitivity to cold stimuli is less commonly the first sign because the fracture often compromises the root rather than the enamel or dentin directly.
- Localized gingival swelling may occur but is usually secondary and not the initial presenting symptom.

Understanding these clinical findings is crucial for the early diagnosis and management of vertical root fractures, which are often challenging to detect radiographically.

Reference: Ingle’s Endodontics, 7th Edition, Chapter 10: Root Fractures and Repair, Page 459