It is common to experience discomfort or pain in a crowned tooth when biting down. This sensation can range from mild sensitivity to sharp, persistent pain, and it often indicates an underlying issue that requires attention. While a dental crown is designed to protect a damaged tooth, the tooth underneath remains alive and susceptible to various problems.
Immediate Causes of Pain
Pain in a crowned tooth when biting down can stem from common issues that arise shortly after crown placement. One frequent cause is a “high bite” or occlusal discrepancy. If the crown is slightly too tall or improperly positioned, it can receive excessive pressure when you bite, leading to discomfort. This uneven contact can make the tooth sensitive, and the pain typically occurs when the teeth come together.
Temporary sensitivity can also occur as the tooth adjusts to the new crown. Crown preparation alters tooth structure, exposing dentin channels and causing temporary sensitivity to pressure and temperature. This sensitivity usually subsides within a few days to a couple of weeks as the tooth heals.
Gum irritation around the crowned tooth is another immediate cause of pain. The crown’s margin, where it meets the gum, can cause inflammation if the fit is imperfect or placement caused minor trauma. This irritation leads to redness, swelling, and discomfort when pressure is applied. Food particles can also become lodged around the crown, causing similar pain.
Deeper Dental Problems
Pain in a crowned tooth when biting down can also signal more significant, underlying dental issues. Tooth decay beneath the crown is a common concern. Even with a crown, new or residual decay can develop at the border where the crown meets the natural tooth structure, affecting the underlying dentin and potentially reaching the pulp (nerve). This decay can cause persistent pain and sensitivity, especially when biting or consuming certain foods.
Cracked tooth syndrome involves a fracture in the natural tooth structure underneath the crown, or sometimes even in the crown itself. These cracks can be difficult to detect but often cause sharp pain when biting down, particularly when releasing the biting pressure. The pain may also be triggered by temperature changes.
Pulpitis, inflammation or infection of the tooth’s nerve (pulp), can also cause pain when biting. This condition results from deep decay, crown placement trauma, or bacteria leaking from old fillings. Symptoms include throbbing pain, prolonged sensitivity to hot or cold, and pain when chewing.
Periodontal disease, an infection affecting the gums and supporting bone, can cause pain in a crowned tooth. Progression of gum disease weakens surrounding tissues and bone, leading to discomfort when pressure is applied. Symptoms include swollen or bleeding gums, and sometimes a foul taste.
Bruxism, the habitual grinding or clenching of teeth, places excessive force on all teeth, including crowned ones. This sustained pressure can lead to pain, sensitivity, and even damage to the crowned tooth or the crown itself. The pain associated with bruxism may be more noticeable upon waking or after periods of stress.
When to Seek Dental Care
It is important to recognize when pain in a crowned tooth warrants a visit to the dentist. Persistent or worsening pain that does not subside with over-the-counter pain relievers indicates a need for professional evaluation. Sharp pain when biting down or when releasing pressure often suggests a cracked tooth or a bite alignment issue.
Lingering sensitivity to hot or cold temperatures, especially if it persists for more than a few weeks after crown placement, can be a sign of deeper nerve irritation or infection. Swelling or redness around the crowned tooth, accompanied by pain, may indicate a gum infection or an abscess.
Fever or general malaise accompanying tooth pain suggest a spreading infection and require immediate dental attention. Visible damage to the crown, such as a chip or crack, or a loose crown, also warrants a dental visit. Pain disrupting sleep or daily activities should be evaluated by a dentist.
Diagnostic and Treatment Approaches
When you visit the dentist for pain in a crowned tooth, a thorough dental examination is the first step. The dentist will visually inspect the crown and surrounding tissues, gently probe the gums, and tap on the tooth to assess sensitivity and pinpoint the exact location of the discomfort.
X-rays are commonly used to identify issues not visible during a clinical examination. These images can reveal hidden decay beneath the crown, problems with the tooth’s root, or signs of infection in the bone. The dentist will also check your bite to determine if the crown is too high or misaligned, which can be adjusted by carefully reshaping the crown’s biting surface.
Pulp vitality testing may be performed to assess the health of the tooth’s nerve. This often involves using a cold stimulus or an electric pulp tester to gauge the nerve’s response. The results, interpreted alongside other clinical findings, help determine if the nerve is inflamed or infected.
Treatment options vary by diagnosis. If the bite is high, a simple crown adjustment can alleviate pain. For decay under the crown, it may need removal to clean the decay and place a new filling or crown.
If the tooth’s nerve is infected or severely inflamed, a root canal may be necessary to save the tooth. For periodontal disease, deep cleaning or other gum treatments are recommended. In severe cases, where the tooth is extensively damaged or infected, extraction may be the only option, followed by tooth replacement discussion.