A dental implant is a sophisticated medical device designed to replace the root of a missing tooth, typically consisting of a titanium post that has fused directly with the jawbone in a process called osseointegration. This integration allows the implant to support a replacement tooth, or crown, functioning much like a natural tooth root. When pain occurs specifically during the action of chewing, it signals a problem that requires prompt professional attention. Since an implant lacks the shock-absorbing ligament found around a natural tooth, any discomfort under pressure indicates that the system is experiencing a strain that should not be ignored. Understanding the source of the pain is the first step toward preserving the implant and restoring comfortable function.
Problems with the Restoration or Bite Alignment
Pain localized to chewing often points toward a mechanical issue within the implant’s prosthetic components. This category includes issues related to the crown or the connecting hardware, which are directly involved in absorbing the forces of mastication.
Occlusal Trauma (Improper Bite)
One frequent cause is occlusal trauma, or an improperly aligned bite, where the crown contacts the opposing tooth too soon or too forcefully. This excessive load puts undue stress on the implant and the surrounding bone, which can cause discomfort that intensifies when biting down.
Loose or Damaged Components
Another common mechanical problem involves the components connecting the crown to the implant post. The abutment, which serves as the connector, is secured by a small screw that can occasionally loosen over time under constant chewing force. When this screw becomes loose, the restoration may shift or wobble slightly under pressure, resulting in a noticeable clicking sound or a dull ache when the patient chews. This movement, even if minor, can irritate the soft tissue and transfer detrimental forces directly to the integrated implant.
Alternatively, the porcelain or ceramic crown itself might be damaged, leading to sharp, localized pain. Although the implant post remains securely anchored in the bone, the restoration can crack or fracture, especially if the patient clenches their jaw or grinds their teeth. A fractured crown or a loose abutment requires the dentist to remove the restoration, check the integrity of the underlying hardware, and either tighten the components or replace the damaged prosthetic. Correcting these issues often involves a simple adjustment to the bite or the replacement of a worn-out part.
Inflammation and Infection Around the Implant
While mechanical issues cause pain under load, biological complications represent a more serious threat to the longevity of the implant. These complications arise from inflammation and infection of the gum and bone tissues surrounding the implant, a condition known collectively as peri-implant disease.
Peri-Implant Mucositis
The earliest stage of this disease is peri-implant mucositis, which is similar to gingivitis around a natural tooth. Peri-implant mucositis involves inflammation, redness, and swelling of the gum tissue immediately surrounding the implant, often accompanied by bleeding when the area is brushed or probed. This stage is typically reversible with improved oral hygiene and professional cleaning, as the inflammation is limited to the soft tissue and has not yet caused any bone loss. Pain from mucositis is often a generalized tenderness that may become more pronounced when chewing, due to the pressure irritating the inflamed gums.
Peri-Implantitis
If mucositis is not addressed, it can progress to peri-implantitis, a destructive inflammatory process that leads to the loss of the supporting jawbone. This advanced stage is characterized by the presence of pus or discharge, deepening gum pockets around the implant, and visible bone loss on dental X-rays. Pain from peri-implantitis is typically more chronic and throbbing, and the act of chewing can exacerbate this deep-seated discomfort by pressing on the compromised tissues and unstable implant. If the disease is severe enough to cause mobility in the implant post, the pain under load becomes acute and signifies a high risk of implant failure.
Nerve Impingement
A rare but serious biological cause of pain is nerve impingement, which usually occurs when the implant is placed too close to a major nerve, such as the inferior alveolar nerve in the lower jaw. While this often manifests immediately after surgery as sharp, shooting pain, numbness, or tingling, it can sometimes present later as chronic discomfort. The pressure exerted on the implant during chewing can temporarily compress the already irritated nerve, leading to an intense, sharp pain rather than the dull ache associated with inflammation.
When to Seek Professional Help
Any discomfort or pain when chewing on an implant should be reported to a dental professional immediately, as early intervention significantly improves the prognosis. Ignoring the pain, even if mild or intermittent, can allow a localized issue to progress into a serious complication, potentially leading to the loss of the implant. Taking over-the-counter pain medication may mask the underlying problem without resolving the cause, allowing the damage to continue unchecked.
You should seek urgent dental attention if you notice severe symptoms:
- Fever.
- Visible pus drainage from the gum line.
- Significant, rapidly increasing swelling around the implant.
- Any sensation that the implant or its crown feels loose or wobbly.
These symptoms may indicate an advanced stage of infection or mechanical failure.
During the professional evaluation, the dentist will perform specific diagnostic steps to determine the cause of the discomfort. This will include physically probing the tissue around the implant to measure pocket depths and check for bleeding, which helps distinguish between mucositis and peri-implantitis. They will also take digital X-rays to assess the level of bone support around the implant post, which is the definitive way to diagnose bone loss. The dentist will also use specialized instruments to check the tightness of the prosthetic components and evaluate the bite to see if occlusal forces are responsible. While waiting for your appointment, avoid chewing on the painful side and maintain meticulous hygiene around the area to prevent further irritation.