A dental crown is a tooth-shaped cap placed over a damaged tooth to restore its size, shape, strength, and appearance. Experiencing pain, especially throbbing discomfort that intensifies at night, is a common issue. This nighttime pain signals an underlying problem with the tooth or the crown that requires professional attention. Understanding the source of the pain and why it worsens when lying down can help you seek appropriate care.
Structural Causes of Crown Pain
The pain often originates from the tooth structure beneath the crown, which contains nerves and blood vessels. One frequent cause is pulpitis, or inflammation of the dental pulp, the soft tissue inside the tooth’s core. Preparing the tooth for the crown or existing decay close to the nerve can lead to irritation. In reversible pulpitis, the pain is sharp and short-lived, triggered by hot or cold temperatures, and the nerve can recover once the irritant is removed.
More persistent, throbbing pain may indicate irreversible pulpitis, where the nerve tissue is dying and requires a root canal to resolve. Another common issue is secondary decay, a new cavity that forms at the margin where the crown meets the natural tooth structure. If the seal is compromised, bacteria can leak in and cause decay, leading to sensitivity and intermittent pain.
The crown itself can also be the source of discomfort if it does not fit correctly. A crown that is slightly too high creates a misaligned bite (occlusion issue), causing excessive force on the tooth. This constant pressure can lead to soreness in the tooth’s supporting ligaments and a generalized ache. Additionally, a microscopic fracture in the tooth beneath the crown can cause sharp, unpredictable pain, especially when chewing.
Why Pain Intensifies When Lying Down
The shift from an upright posture to a horizontal one at night is a primary reason dental pain feels worse. When you lie flat, increased blood flow to the head and neck region, known as hydrostatic pressure, raises the pressure inside the already inflamed dental pulp. This internal pressure intensifies the throbbing sensation, making a mild daytime ache feel severe and impossible to ignore at night.
The lack of distractions at night also means the brain is more focused on bodily sensations. During the day, activity draws attention away from the discomfort, but at night, the pain becomes the central focus.
Bruxism, or unconscious clenching and grinding of the teeth during sleep, is another factor that exacerbates crown pain. Stress and muscle tension during sleep can cause powerful, damaging forces on the crowned tooth and its surrounding structures. This mechanical overload can cause dull, aching pain in the tooth and jaw muscles upon waking.
Temporary Relief Measures and Next Steps
For immediate, temporary relief, focus on reducing inflammation and pressure until you can see a dentist. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are effective because they target both pain and the throbbing inflammation. Applying a cold compress to the outside of your cheek for 10 to 15 minutes can help numb the sensation and reduce localized swelling.
To counteract hydrostatic pressure, try sleeping with your head slightly elevated using an extra pillow. This positional adjustment encourages blood flow away from the head, which may lessen the pressure inside the tooth and reduce the intensity of the throbbing. Rinsing your mouth with warm salt water can also soothe irritated gums and reduce bacteria around the crown margin.
While these measures offer short-term comfort, they do not resolve the underlying dental issue. Schedule an appointment with your dentist immediately for a proper diagnosis, which may involve X-rays to check for decay, infection, or a fracture beneath the crown. Seek emergency dental attention if the pain is accompanied by severe facial swelling, fever, or difficulty swallowing, as these indicate a spreading infection or abscess.