A dental crown, or cap, is a custom-made covering that encases the entire visible portion of a tooth. Its purpose is to restore the tooth’s original shape, size, strength, and appearance, typically placed when a tooth is extensively damaged or weakened. While crowns are generally successful, discomfort or pain in a crowned tooth can occur. This article explores common reasons why a capped tooth might hurt and what steps can address the issue.
Pain After Crown Placement
Discomfort can arise soon after a dental crown is placed. Temporary sensitivity is common as the tooth and surrounding tissues react to the dental work. This sensitivity to temperature changes usually diminishes within days or weeks as the tooth recovers. The crown preparation process can sometimes irritate the tooth’s nerve.
Another frequent cause of pain after crown placement relates to the bite. If the new crown is slightly higher than adjacent teeth, it creates an uneven pressure point during biting or chewing. This imbalance can lead to soreness in the tooth and jaw muscles due to excessive force. A simple adjustment to the crown’s biting surface by a dentist can resolve this issue, restoring proper occlusion.
An improper crown fit can also contribute to discomfort. If the crown does not seat perfectly, it can leave tiny gaps at the margin where it meets the tooth structure. This allows food particles and bacteria to accumulate, irritating the gum tissue around the crown and leading to inflammation or sensitivity. An improperly sealed crown may also permit external stimuli to reach the tooth, causing ongoing sensitivity.
Deeper Dental Problems
Pain in a crowned tooth can also stem from underlying dental problems that develop over time. New decay forming underneath the crown is a common issue. Decay can initiate at the crown’s margin if plaque and bacteria accumulate, progressing inward to affect the underlying tooth structure. This decay can eventually reach the tooth’s inner pulp, causing pain and requiring further treatment.
Gum disease can affect a crowned tooth just like any natural tooth. Inflammation and infection of the gum tissue surrounding the crown can lead to soreness, bleeding, and even bone loss. While the crown itself does not cause gum disease, its contour or fit might make proper cleaning difficult, potentially contributing to plaque buildup and the progression of gum issues.
A cracked tooth structure beneath the crown is another potential source of pain. The natural tooth material under the crown can develop cracks, especially if the tooth was already weakened or subjected to significant biting forces. These cracks can extend into the tooth’s inner layers, causing sharp pain upon chewing or sensitivity to temperature changes. Diagnosing these cracks can be challenging, as the crown covers the affected area.
Pulpitis, inflammation or infection of the tooth’s inner pulp, can also cause severe pain. This condition often results from deep decay that has reached the pulp, trauma, or repeated dental procedures that have stressed the nerve. If pulpitis is irreversible, the pulp tissue may die, leading to persistent throbbing pain and potentially requiring root canal treatment to remove the infected tissue and save the tooth.
In some cases, a dental abscess may form, a pocket of pus caused by a bacterial infection. An abscess can result from untreated pulpitis or advanced gum disease and often presents with constant, throbbing pain, swelling in the face or gums, and sometimes a fever. This condition requires prompt professional intervention to drain the infection and prevent further complications. Occasionally, pain felt in a crowned tooth might be referred pain, originating from an adjacent tooth, a sinus infection, or issues with the temporomandibular joint (TMJ).
When to Seek Professional Care
Seek professional dental care if you experience persistent or worsening pain in a crowned tooth. Pain that does not subside or intensifies over time warrants an immediate dental examination, indicating an underlying issue that requires attention.
Other warning signs include swelling, redness, or tenderness around the affected tooth or gum tissue. These indicate inflammation or a developing infection, requiring prompt diagnosis and treatment. A fever accompanying dental pain suggests a spreading infection that needs urgent medical and dental evaluation.
Pain triggered by chewing or biting down suggests a problem with the tooth’s structure or bite alignment. Lingering sensitivity to hot or cold temperatures indicates inflammation or damage to the tooth’s internal nerve. Visible damage to the crown itself, such as a chip, crack, or if it feels loose, also requires professional assessment.
Understanding Dental Diagnosis and Treatment
When visiting the dentist for a painful crowned tooth, the diagnostic process begins with a thorough clinical examination. The dentist will visually inspect the crown and surrounding gum tissue, and may gently probe the area to check for tenderness or inflammation. This assessment helps identify issues with the crown’s fit or gum health.
Dental X-rays allow the dentist to view the underlying tooth structure, root, and surrounding bone. X-rays can reveal hidden decay beneath the crown, signs of infection at the root tip, or issues with the crown’s margin not visible during a surface examination. A bite test may also be performed to identify any high spots on the crown causing excessive pressure.
Vitality testing may be conducted to assess the tooth’s nerve health, involving a cold stimulus to gauge its response and determine if the pulp is inflamed or non-vital. Treatment approaches depend on the underlying cause of the pain. If the crown is too high, a simple bite adjustment can alleviate discomfort.
If the crown is loose or ill-fitting, it may need re-cementing or replacement to ensure a proper seal and fit. For gum disease, deep cleaning procedures like scaling and root planing may be necessary to remove plaque and tartar buildup. If pulpitis or an infection is diagnosed, root canal therapy is often performed to remove infected tissue and save the tooth. In severe cases where the tooth is extensively damaged or infected, extraction may be the only viable option. Accurate diagnosis determines the course of treatment for effective pain resolution and dental health.