A dental crown is essentially a cap cemented over a damaged tooth to restore its shape, strength, and appearance. Pain in a crowned tooth, especially when biting or chewing, indicates a functional problem related to pressure and the tooth’s underlying structure. When the crown and the natural tooth are healthy and properly aligned, they should function seamlessly without discomfort. Pain occurring under the mechanical load of chewing suggests an issue with either the crown’s fit or a biological problem originating from the tooth’s internal components or surrounding tissues.
Pain from Mechanical Fit Issues
Pain upon biting or chewing can often be traced back to problems with the crown’s physical structure or its interaction with the opposing teeth. The most common mechanical issue is a condition known as “high bite,” or high occlusion. This occurs when the crown is fractionally too tall, causing it to contact the opposing tooth before the surrounding natural teeth when the mouth closes. This premature contact generates excessive pressure on the ligament that holds the tooth in the jawbone, leading to soreness and pain that intensifies with chewing.
A simple adjustment by the dentist to reduce the crown’s height can quickly resolve this issue, often providing immediate relief. Another mechanical cause of pain is a failing crown margin, which can lead to looseness or cement failure. If the crown is not securely bonded to the underlying tooth, it may shift slightly under the strong forces of chewing. This movement can cause discomfort and also allow oral bacteria and food particles to seep into the gap.
Alternatively, the crown itself may have structural damage such as a crack or fracture. Although crowns are durable, they can be damaged by biting down on hard objects or through excessive clenching and grinding, known as bruxism. A fractured crown may expose the underlying tooth structure, leading to sensitivity and pain when pressure is applied. Pain from a loose or cracked crown often requires the restoration to be recemented or replaced entirely.
Pain from Underlying Tooth and Nerve Issues
When pain persists and is not solely related to the initial bite contact, it often points to a biological issue beneath the protective cap that is exacerbated by the pressure of chewing. One frequent cause is secondary decay, which is new tooth decay that forms at the margin of the crown or underneath it. If bacteria penetrate the seal between the crown and the natural tooth, decay can progress, irritating the dentin and pulp and causing pain when pressure is placed on the tooth. This type of decay is concerning because the crown can obscure its detection during routine visual exams.
The tooth’s internal soft tissue, called the pulp, can become inflamed or infected, a condition known as pulpitis. This inflammation of the nerve tissue can occur if the original tooth preparation was deep, if decay has reached the pulp chamber, or due to trauma from the crown procedure itself. Pain from chewing, especially a lingering ache, can be a sign of irreversible pulpitis, which indicates that the nerve is dying and often requires root canal therapy. Pressure from biting down on the crown compresses the inflamed tissue inside the tooth, resulting in sharp or throbbing pain.
A severe cause of pain under a crown is cracked tooth syndrome, where the underlying natural tooth develops a vertical fracture. When pressure is applied during chewing, the crack momentarily opens, causing a sharp, fleeting pain that disappears when the pressure is released. This condition is difficult to diagnose but is suggested by sudden, localized pain when biting certain foods. Discomfort may also originate from the surrounding gum tissue, known as periodontal issues, making the area sensitive to chewing forces.
Immediate Steps and Professional Diagnosis
If you experience pain in a crowned tooth when chewing, it is advisable to modify your diet immediately to soft foods and avoid chewing on the affected side to prevent further irritation or damage. Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help manage temporary discomfort and inflammation. Rinsing the mouth with warm salt water several times a day can also provide temporary relief by soothing inflamed gum tissues.
It is important to seek professional dental attention promptly if the pain is persistent, worsening, or accompanied by signs of acute infection like swelling, fever, or a constant throbbing ache. During a dental visit, the practitioner will use several diagnostic tools to determine the precise cause of the pain. Diagnostic procedures typically involve taking X-rays to check for issues like decay under the crown, bone loss around the root, or signs of infection.
The dentist will also use articulating paper, or bite paper, to assess the occlusion and identify any high spots on the crown that need adjustment. Temperature and percussion tests are performed to evaluate the vitality and health of the tooth’s nerve.
Depending on the diagnosis, treatment may range from a simple crown adjustment for a high bite to a replacement crown for structural failure. More involved procedures, such as root canal therapy, may be required for a compromised nerve or deep decay.