A “fake tooth” generally refers to a fixed dental restoration such as a crown, which caps a natural tooth; a bridge, which replaces missing teeth by anchoring to adjacent teeth; or a dental implant, which replaces the tooth root entirely. When any of these prosthetics cause pain, it signals an underlying biological or mechanical issue requiring immediate professional evaluation. This discomfort alerts you to a problem, whether it is an infection, structural failure, or nerve irritation. Ignoring the pain can lead to serious complications, including the potential loss of the prosthetic or the supporting structure.
Pain Originating from the Underlying Tooth Structure
Pain under a crown or bridge often originates from the natural tooth structure beneath the cap. The most common cause is recurrent dental decay (caries), which occurs when bacteria penetrate the microscopic seal between the crown margin and the prepared tooth surface. This decay progresses inward, eventually reaching the pulp chamber, which houses the tooth’s nerve and blood vessels.
Another frequent source of discomfort is pulpitis, the inflammation of the dental pulp. This can be a delayed reaction to the initial trauma of tooth preparation, or it may be caused by new trauma or deep decay irritating the nerve tissue. Pulpitis may manifest as lingering sensitivity to hot or cold temperatures, or as a spontaneous, throbbing ache.
If a tooth under a crown has previously undergone a root canal, pain can indicate the failure of that treatment. Bacteria can persist or re-enter the root canal system, leading to an infection at the root tip, known as an apical abscess. This infection results in a localized pocket of pus and causes pain and swelling as pressure builds within the jawbone.
Structural and Mechanical Issues with the Prosthesis
Pain that occurs when chewing or biting down can often be traced back to a mechanical issue with the prosthetic device. One common structural problem is malocclusion, or a “high bite,” where the crown or bridge sits taller than the surrounding natural teeth. This excessive force concentrates pressure onto the underlying tooth or implant, leading to inflammation of the supporting ligament or bone and causing localized tenderness.
The cement securing a crown or bridge can wash out over time, leading to a loose fit. A crown that has lost its seal allows bacteria, fluids, and temperature changes to access the exposed dentin, causing sharp sensitivity and increasing the risk of recurrent decay. Even subtle loosening creates movement when chewing, which irritates the underlying tooth or soft tissue.
The restoration materials, such as porcelain or ceramic, can fracture or chip under biting forces or due to habits like teeth grinding. While a small chip may only cause rough edges, a deeper fracture compromises the crown’s integrity, allowing bacteria to enter or causing sharp pain if the break extends to the underlying tooth structure.
Inflammatory Reactions in Surrounding Gum and Bone Tissue
Inflammation in the soft tissues surrounding a prosthetic affects both natural teeth with crowns and dental implants. Around a crown, poor hygiene at the gum line can lead to gingivitis or periodontitis, characterized by redness, swelling, and bleeding. An ill-fitting crown margin that physically irritates the gum tissue can also create a chronic inflammatory response, making the area painful and sensitive to touch.
For dental implants, peri-implantitis is the most serious source of pain originating from the surrounding bone and gum. This is an infection caused by bacterial plaque accumulation on the implant surface, similar to periodontitis. The infection triggers a chronic inflammatory process that destroys the supporting jawbone around the implant.
As peri-implantitis progresses, it causes symptoms like persistent swelling, redness, bleeding, and sometimes the discharge of pus from the gum margin. This loss of bone support can eventually lead to implant mobility and failure, often accompanied by a dull ache or sharp pain when pressure is applied. Chronic teeth grinding (bruxism) can also place excessive mechanical stress on an implant, accelerating bone loss and contributing to inflammation even without plaque buildup.
Necessary Steps for Diagnosis and Treatment
Experiencing pain in a prosthetic tooth requires immediate consultation with a dental professional. The dentist will conduct a clinical examination, using a dental probe to check for gum pockets and tapping the tooth or implant to assess sensitivity. Diagnostic imaging, particularly a periapical X-ray, is essential to visualize the bone level around an implant or to detect decay, infection, or a failed root canal beneath a crown.
Once the cause is identified, treatment varies widely. If the pain is from a high spot, a simple bite adjustment may relieve the issue quickly. For recurrent decay under a crown, treatment may range from replacing the crown to performing a root canal if the nerve is involved.
In cases of infection or abscess, the dentist may prescribe an antibiotic course, followed by a root canal. For peri-implantitis, treatment involves a deep cleaning or surgical procedure to decontaminate the implant surface and potentially graft bone. While waiting for the appointment, over-the-counter pain relievers like ibuprofen can help manage discomfort by reducing inflammation, and a warm salt water rinse can soothe irritated gum tissue.