A dental crown, often described as a cap, is a restorative treatment placed over a damaged or weakened tooth to restore its shape, strength, and appearance. While crowns are a routine and successful procedure, pain or discomfort afterward is a frequent concern. This symptom can range from a minor, temporary annoyance to an indication of a more serious underlying issue. Understanding the nature and origin of the pain is the first step toward finding relief and preserving the health of the crowned tooth.
Temporary Sensitivity Following Placement
Preparing a tooth for a crown involves removing a significant amount of the outer enamel layer, which can cause immediate, short-term discomfort. This preparation can induce temporary inflammation of the dental pulp, the soft tissue containing the nerves and blood vessels inside the tooth. This inflammation is a natural response to the physical trauma of the procedure and usually subsides as the tissue heals.
This initial discomfort often manifests as heightened sensitivity to hot or cold temperatures, known as thermal hypersensitivity. The porous dentin layer, which connects to the pulp, becomes more exposed during preparation, allowing external stimuli to reach the nerve easily. This sensitivity resolves spontaneously within a few days to several weeks as the pulp recovers. If the sensitivity is mild and steadily decreases, it is considered a normal part of the healing process.
Internal Issues Affecting the Nerve
Deep, throbbing, or persistent pain, especially if it wakes a person from sleep, often points to a problem with the nerve tissue (pulp) beneath the crown. A common internal cause is secondary decay (caries) developing at the margin where the crown meets the natural tooth structure. If the crown’s cement seal fails, oral bacteria can infiltrate the gap and dissolve the underlying tooth material.
As decay progresses deeper, it causes pulpitis, which is inflammation of the nerve tissue. This inflammation is reversible if caught early, but extensive bacterial invasion leads to irreversible and chronic pulpitis. Pressure buildup within the rigid pulp chamber causes severe, spontaneous pain that is difficult to manage with over-the-counter medication. The previous trauma of the crown preparation, combined with the decay, also stresses the pulp, making it more susceptible to irreversible damage.
The most severe internal issue occurs when untreated infection causes the nerve tissue to die, leading to a dental abscess. An abscess is a pocket of pus that forms at the root tip as the body attempts to contain the bacterial infection spreading into the jawbone. This condition causes extreme, localized pain, swelling in the gum tissue, and sometimes a bad taste if the abscess drains. This failure of the biological structure frequently necessitates root canal therapy to clear the infection and save the tooth.
External and Mechanical Fit Problems
Crown pain can originate from the physical interaction of the crown with opposing teeth and surrounding soft tissues, rather than the internal nerve. A frequent mechanical issue is a crown that is slightly too tall, known as a “high spot” or occlusal interference. This height difference causes the crowned tooth to hit the opposing tooth prematurely during biting, placing excessive force on the periodontal ligament.
The resulting pain often feels like soreness or a bruise, particularly when biting down or chewing, and may cause the tooth to feel loose or tender. This mechanical overload is common immediately following placement and requires a simple adjustment to shave down the high spot. If left uncorrected, the constant trauma can lead to inflammation of the periodontal ligament, known as traumatic periodontitis, which persists until the bite is corrected.
Problems with the crown’s margins—the edges where the restoration meets the natural tooth—can also cause discomfort. A poorly contoured or rough margin can chronically irritate the gum tissue, leading to localized gingivitis and soreness. If the margin is open, it represents a mechanical failure of the seal, allowing plaque to accumulate and potentially causing gum inflammation and bone loss. Furthermore, a fractured crown or hairline cracks in the porcelain expose the underlying tooth structure to temperature changes and pressure. These structural failures result in sharp, fleeting pain, distinct from the deep throbbing of internal nerve issues.
Knowing When to Call the Dentist
While minor, temporary sensitivity following crown placement can often be managed at home, certain symptoms require immediate professional attention. Pain that is severe, constant, or occurs spontaneously without stimulus requires urgent evaluation, as this often indicates irreversible nerve damage or active infection. Pain that does not respond to over-the-counter medication or increases over several days should prompt a call to the dental office.
Visible signs of an advancing problem include swelling of the face or gums, a small pimple-like bump on the gum line, or a fever. These symptoms suggest an abscess that requires immediate drainage and antibiotic therapy to prevent the infection from spreading. If the crown feels loose, fractured, or completely falls off, immediate attention is required to protect the underlying tooth structure. If pain occurs only when biting after a recent placement, the issue may be a simple bite adjustment, but only a dentist can definitively diagnose and correct the problem.