The presence of pain around a dental restoration, often called a “fake tooth,” can be confusing and concerning. This term generally refers to a dental crown, a fixed bridge, or the prosthetic crown attached to a dental implant. While these devices restore function, they do not make the area immune to biological or mechanical issues. Discomfort signals a problem that requires professional attention, and understanding the source of the pain is the first step toward finding relief.
Pain Originating from the Supporting Tooth or Implant
Discomfort often stems from the natural tooth structure underneath a crown or bridge, or from the bone and tissue holding an implant. A common issue is recurrent decay, or a cavity forming at the margin where the crown meets the natural tooth. Bacteria can seep into this junction, creating an infection that progresses until it reaches the tooth’s sensitive inner pulp, causing a persistent ache or sharp pain.
Even a tooth that previously received a root canal can develop pain years later due to reinfection. This occurs when bacteria re-enter the root canal system through a small crack or a failure of the initial seal. The infection then spreads into the surrounding jawbone, often resulting in pressure and tenderness when biting down.
For dental implants, a primary source of late-onset pain is peri-implantitis, an inflammatory disease similar to periodontitis. This condition involves a bacterial infection that causes inflammation of the gum tissue and progressive loss of the bone supporting the implant screw. Early signs include bleeding, redness, or pus around the implant.
Advanced stages of peri-implantitis can lead to bone deterioration and a feeling of looseness. Less commonly, pain arises from an implant placed too close to a nerve, causing shooting sensations, or from a failure of the implant to properly integrate with the bone (osseointegration).
Pain Caused by the Prosthetic’s Fit or Damage
Sometimes, the pain is strictly mechanical, caused by a physical issue with the restoration itself. A frequent cause is an uneven bite, known as occlusal trauma, where the prosthetic sits slightly “high.” This high spot concentrates excessive force when biting or chewing, leading to inflammation in the ligaments or bone. This translates to a dull ache or sensitivity to pressure, which a dentist can typically correct quickly by making a minor adjustment to the crown’s surface.
The physical integrity of the restoration is also a factor. A crack or fracture in the crown material can expose the underlying tooth to temperature changes and bacteria. These cracks can be microscopic, yet still allow irritants to reach the sensitive dentin or pulp, causing intermittent sharp pain.
If the margin—the edge where the crown meets the tooth—is poorly sealed or begins to leak, it creates a “marginal gap.” This gap traps food debris and plaque, which can lead to localized gum irritation. It also serves as an entry point for decay that slowly undermines the underlying tooth.
Pain Related to Gum Health and Surrounding Structures
Pain can also originate from the soft tissues immediately surrounding the fake tooth, particularly the gums. Gingivitis, the initial stage of gum disease, causes the gums around the restoration to become red, swollen, and prone to bleeding due to plaque accumulation. If the restoration’s shape contributes to poor hygiene, the resulting inflammation can be a persistent source of discomfort.
A specific localized issue is food impaction, which occurs when a space between the prosthetic and an adjacent tooth allows food particles to wedge deep into the gum tissue. This creates intense, acute pain and pressure that is instantly relieved when the debris is removed. The constant pressure and bacterial presence from trapped food can lead to localized gum breakdown and a higher risk of decay.
Pain may also be referred from structures outside the mouth, meaning the source of the problem is elsewhere but the sensation is felt in the teeth. For upper back teeth, inflammation in the maxillary sinuses (sinusitis) can cause a dull, generalized ache across multiple teeth. This occurs because the tooth roots lie close to the sinus floor, and the discomfort often intensifies when bending over due to changing sinus pressure.
Another source of referred pain is temporomandibular joint (TMJ) dysfunction or teeth clenching (bruxism). This creates muscle tension and joint inflammation that radiates pain to the teeth, mimicking a genuine toothache.
When Immediate Dental Care is Necessary
Certain symptoms around a fake tooth require prompt evaluation by a dental professional to prevent serious complications. Seek immediate care if you experience severe, throbbing pain that keeps you awake or is not relieved by over-the-counter medication. Another warning sign is the sudden appearance of facial swelling that extends toward the eye or neck, as this indicates a spreading infection or abscess.
The prosthetic crown or implant feeling loose, or the presence of a persistent bad taste or discharge of pus around the gumline, also warrants urgent attention. While waiting for an appointment, rinse with warm salt water to help soothe inflamed tissues and temporarily manage pain with an anti-inflammatory medication like ibuprofen. These measures are not a substitute for professional diagnosis and treatment, as only a dentist can use tools like X-rays to determine the precise underlying cause.