A dental crown is a custom-made cap placed over a damaged tooth, serving to restore its original shape, size, and function. This restoration is often necessary for teeth that are severely decayed, cracked, worn down, or have undergone a root canal procedure. While the crown itself is an inert prosthetic, the underlying tooth and its sensitive nerve tissue remain. Understanding the difference between expected, temporary sensitivity and discomfort that signals a deeper issue is important for your oral health.
Expected Sensitivity After Placement
It is normal to experience some degree of mild discomfort immediately following the procedure. This temporary sensitivity usually arises from the physical trauma involved in preparing the tooth and the irritation of the surrounding gum tissue. The dentist must remove the outer tooth structure (enamel) for the crown to fit, which can temporarily inflame the tooth’s internal nerve (the pulp).
This initial discomfort often manifests as mild sensitivity to hot or cold temperatures or slight tenderness when chewing. This expected sensitivity should steadily improve, usually fading significantly within a few days and resolving completely within one to two weeks. If the sensitivity is mild and quickly subsides after the stimulus is removed, it is typically a sign that the tooth is simply healing and adjusting to the new restoration.
Underlying Reasons for Ongoing Discomfort
Pain that persists beyond the initial few weeks or begins long after placement indicates an underlying problem requiring professional intervention.
Bite Misalignment
One frequent cause is bite misalignment, where the crown is slightly too high. Even a minute difference in height can cause undue pressure on the crowned tooth when biting down, leading to sharp pain or a bruised feeling.
Nerve Inflammation (Pulpitis)
Another common issue is inflammation of the tooth nerve, called pulpitis. If the pain is mild and fleeting, it is reversible pulpitis, suggesting the nerve can recover once the irritant is removed. However, throbbing pain or sensitivity to cold that lingers for more than 30 seconds signals irreversible pulpitis. This means the nerve tissue is dying and requires a root canal. The trauma of preparing a tooth with deep decay can sometimes push the nerve past its point of recovery.
Decay and Irritation
New decay forming at the margin where the crown meets the tooth structure is a later cause of persistent pain. If the seal around the crown fails, bacteria can leak underneath, causing a cavity in the remaining natural tooth. Similarly, small remnants of the cement used to bond the crown can sometimes be left under the gum line. This residual cement acts as a chronic irritant, causing localized gum inflammation and discomfort.
When to Seek Urgent Dental Care
While mild, temporary sensitivity is normal, certain symptoms necessitate an immediate call to your dental provider:
- Severe, constant throbbing pain, especially if it wakes you up at night, suggesting a deep infection or irreversible nerve damage.
- Visible swelling in the face, cheek, or gums surrounding the crowned tooth.
- Swelling accompanied by a fever or a bad taste in the mouth, which can signal a developing dental abscess (a pocket of pus caused by infection).
- If the crown feels suddenly loose, wobbly, or falls off completely, leaving the underlying tooth vulnerable and requiring immediate protection.
Professional Treatment and Resolution
The resolution for ongoing crown pain depends on the underlying cause, which a dentist diagnoses using a clinical examination and X-rays. If the pain is due to a slightly uneven bite, the dentist performs an occlusal adjustment. This involves carefully grinding down the high spot on the crown until the bite pressure is distributed correctly.
For cases of reversible nerve inflammation, the dentist may recommend observation, desensitizing agents, or anti-inflammatory medication. If the nerve is irreversibly damaged, the definitive treatment is root canal therapy. This procedure removes the infected pulp tissue from the interior of the tooth, resolving the source of the pain while preserving the tooth structure.
If the issue is decay under the crown or a fractured crown, the restoration often needs replacement to properly treat the underlying tooth. The old crown is carefully removed, the decay is cleaned out, and a new, sealed crown is fabricated and bonded into place. Removal of residual cement is a simpler process involving scaling the area around the gum line to eliminate the irritant and allow the tissue to heal.