A dental crown is a custom-made, tooth-shaped cap placed over a damaged tooth to restore its shape, size, strength, and appearance. It acts as a protective shield, encasing the entire visible portion of the tooth above the gum line. While the procedure is routine and highly successful, the persistence of pain or the development of new, severe symptoms indicates an underlying issue requiring professional investigation. Exploring the potential sources of this ongoing pain is the first step toward finding a resolution for the discomfort.
Expected Short-Term Sensitivity
Preparing a tooth for a crown involves removing enamel and dentin using high-speed instruments. This mechanical action and heat can temporarily inflame the dental pulp, the soft tissue containing the nerve and blood vessels. This temporary inflammation, known as reversible pulpitis, causes heightened sensitivity to temperature changes, especially cold liquids or air. Patients feel mild, transient aches that should diminish significantly within a few days to two weeks as the pulp recovers from the preparation trauma.
Mild soreness of the gums is also expected immediately following the crown cementation appointment. This irritation is usually a consequence of the temporary crown or the retraction cord used during the impression process. This localized soreness typically resolves completely as the tissue heals, often within the first week. If sensitivity or discomfort does not steadily decrease within this timeframe, the cause is likely more complex than simple post-operative inflammation.
Pain Caused by the Crown’s Fit
One of the most common causes of lingering pain is a mechanical problem known as a “high bite.” If the crown is slightly taller than the natural tooth, it makes premature contact when chewing or biting down. This undue force compresses the periodontal ligament, the tissue that anchors the tooth to the jawbone, causing pain and pressure that irritates the nerve. The primary symptom is sharp discomfort when the patient exerts pressure, such as biting down on firm food.
Another structural issue occurs if the crown’s margin does not form a perfect seal where it meets the tooth at the gum line. A poorly fitting margin traps food debris and harbors bacteria, leading to localized gum inflammation. This also increases the risk of microleakage, allowing oral fluids and bacteria to penetrate the underlying tooth structure. Fortunately, mechanical issues like a high spot on the biting surface are often the easiest to resolve, typically requiring only a simple adjustment.
Deep-Seated Nerve and Decay Problems
Irreversible Pulpitis and Abscess
Spontaneous, throbbing pain that wakes a person from sleep often signifies a serious biological issue involving the dental pulp. This intense, persistent pain is symptomatic of irreversible pulpitis, meaning the nerve tissue is irreparably damaged or infected. A telltale sign is a prolonged pain response to heat, lasting 30 seconds or more after the stimulus is removed. If the nerve dies, pain may temporarily subside, but it returns intensely as an infection develops at the root tip, forming an an abscess.
Recurrent Decay
Recurrent decay occurs if existing decay was not fully removed before crown placement, or if a faulty crown margin allows new decay to form. Bacteria penetrate the dentin beneath the restoration and progress toward the pulp chamber. Since the decay is hidden by the crown, it can advance silently until it reaches the nerve, triggering severe pain that requires immediate endodontic intervention.
Cracked Tooth Syndrome
A highly painful cause is a crack in the tooth or root structure beneath the crown. The crack may originate during preparation, from a high-impact bite, or from cementation stress. When biting down, the tooth segments separate slightly, causing fluid movement within the microscopic dentinal tubules that signals the nerve. This results in a sharp, shooting pain typically associated with releasing the bite or chewing at a specific angle.
Identifying Warning Signs and Next Steps
Persistent discomfort that fails to resolve after two to three weeks, or pain that intensifies rather than diminishes, is a clear indication that a professional evaluation is necessary. The presence of specific symptoms should prompt an immediate call to the dental office, as they signal an escalating infection requiring urgent care.
The most concerning warning signs include:
- Visible swelling in the face, jaw, or neck, which suggests the infection has spread beyond the tooth’s immediate area.
- A fever, especially when combined with pain, indicating a systemic bacterial infection.
- Severe, unrelenting throbbing pain that is not adequately managed by over-the-counter pain relievers.
- The presence of a foul taste or drainage (pus) around the crowned tooth.
Delaying treatment for these severe symptoms can allow the infection to progress and potentially cause more widespread health complications.