Why does a tooth hurt under a crown

Often, after prosthetics with metal-ceramic crowns, patients experience pain underneath. Pain may appear almost immediately after the procedure, but there are also cases when the nerve endings respond several years after installation.

In any case, if the tooth under the crown hurts, you should take this problem seriously and do not put off seeing a doctor. If you do not act, the consequences will not be long in coming: if you are late with treatment, you will lose a tooth or develop serious gum disease.

Why does a tooth hurt under a crown?

Sometimes after prosthetics, not only the “living” tooth hurts, but also the “dead”, pulpless tooth in which the nerve was removed. This may be due to inflammation of the periodontal tissues, resulting from a variety of reasons. The specialists of the YuliStom clinic have more than once had to deal with mistakes made by dentists in some clinics when installing crowns. They examine the patient, find out why the tooth hurts under the crown and eliminate the identified pathology. The most common mistakes made by dentists and patients are described below.

Pulpitis, periodontitis, periostitis

Inflammation of the pulp (the soft tissue of the tooth cavity and root canals) is a consequence of its incomplete removal in the process of preparation for prosthetics. If the tooth cavity has been opened, the infection in the mouth gets into it, so in most cases, before prosthetics, the pulp is removed - depulpation. Poor performance of this procedure leads to the development of infection and the appearance of a focus of inflammation, accompanied by severe pain, since the pulp is penetrated by nerve endings. Inflammation can also begin when the root canals are incompletely filled: infection develops in the unfilled areas.

Inflammatory process in tooth tissues

If the process is not stopped, the inflammation will spread to the periodontium - the ligament that holds the tooth in the cell. The pain intensifies and becomes pulsating. With purulent inflammation, a fistula may appear - pus begins to make its way to the surface of the gum. When the infection progresses further, the jaw tissue is affected, first the periosteum (periostitis or flux), and then the bone (osteomyelitis). Inflammation of soft tissues leads to the development of abscesses and phlegmons.

Perforation of channel walls

Sometimes during the process of cleaning the root canals or when installing a pin into a preserved root, a perforation of the root canal occurs. The infection enters the canal and causes inflammation. Aching pain and bad breath appear. May be complicated by periodontitis.

Perforation of the canal walls

Foreign body in the root canal

When cleaning dental root canals, the tip of a dental instrument occasionally breaks off. It remains in the root canal, injures its walls and prevents complete filling. In this case, the tooth first hurts when biting, and then the inflammatory process occurs and periodontitis develops with severe throbbing pain.

Periodontitis

Periodontitis is an inflammation of the periodontal tissues. The installation of a crown is rarely the cause of its development. More often this is a consequence of ignoring contraindications to prosthetics. Before installing a crown, periodontitis is treated and prosthetics are performed in the absence of an inflammatory process.

Cysts, granulomas

Cyst on the root of a tooth

With long-term chronic periodontitis, against the background of improper filling of the root canals, a small nodule can form in the area of the root apex, enclosed in a thin capsule, inside which immature connective tissue cells—granulations—grow. This is a granuloma; it can be asymptomatic for a long time, gradually increasing in size and turning into a cyst - a formation covered with a dense capsule, filled inside with inflammatory fluid.

It is impossible to detect an independent cyst or granuloma. Most often, these formations can only be seen on an x-ray.

Inflammatory processes in the granuloma and cyst can periodically become inflamed due to hypothermia, stress and other external influences. This is accompanied by pain, swelling of the gums and increased body temperature, and in the absence of adequate treatment will lead to the development of even more severe complications.

Odontogenic sinusitis

Inflammation of the maxillary sinus due to dental pathology, including after installation of an artificial crown (odontogenic sinusitis) is a consequence of untreated caries of the upper jaw, complicated by periodontitis. Another cause of sinusitis may be a perforation of the wall of the maxillary sinus during the treatment of the teeth of the upper jaw and entry into the cavity of infection.

Root crack or fracture

Tooth root fracture

Aching pain when biting can occur when a tooth root is cracked or fractured. The root is injured when the instrument presses too hard on the walls of the root canals during cleaning or filling. A crack or fracture may not appear immediately, but after a significant load on the tooth. A root fragment during a fracture can injure the periodontal tissues, which is often accompanied by infection and the development of purulent-inflammatory processes.

Incorrect crown installation

If the installed crown does not adhere tightly to the natural dental tissues in the cervical area, then an infection gets under it, which leads to the development of secondary caries and inflammation of the periodontal tissues. This is a mistake made by the orthopedic dentist. Swelling causes compression of nerve endings and pain even with a pulpless tooth.

Large load on the tooth

This may be due to:

incorrect size of the prosthesis if it is higher than adjacent units; this is a consequence of an incorrectly taken impression or a defect in the installation of the structure;
the patient constantly chewing nuts, seeds and other hard foods.

Poor oral hygiene

With improper or irregular oral care, colonies of bacteria are deposited on natural and artificial crowns, the acidity of the oral cavity changes, which negatively affects the condition of the prosthesis and contributes to the development of inflammatory processes in the periodontal tissues, accompanied by toothache.

The process of installing a crown on an implant

The orthopedic system consists of three important elements: the crown, the abutment and the implant. Prosthetics looks like this:

Introduction of anesthesia. To ensure that the patient does not experience pain, local anesthesia is administered, taking into account individual characteristics and possible allergic reactions.
Mounting the abutment. At this stage, a titanium rod or a zirconium dioxide abutment is fixed.
Formation of the impression. In the dental laboratory, an impression is created based on the data obtained. Based on the clinical situation, an orthopedic product can be installed either immediately or after several months. You can learn about how implant crowns are made from the specialists of our clinic.
Installation of a dental crown. The orthopedic dentist fixes the finished version in the oral cavity.

The crown is fixed to the implant using both cement and screw methods. In the first case, fixation is carried out using a special cement mortar based on composite glue. Screw or transocclusal means installation using a screw. It is considered more reliable; if necessary, you can always remove the crown and unscrew the screw. Each method has its own mandatory indications, pros and cons.

The artificial tooth is fixed at various times after surgical implantation, it all depends on the clinical picture and technique. The timing of prosthetics and installation of crowns on implants on chewing teeth is planned by the doctor. Much depends on the condition of the bone tissue and the somatic condition of the patient. Late loading is considered the safest, when prosthetics take from 2 to 4 months.

What to do if a tooth hurts under a crown

Severe toothache sometimes appears at the wrong time: at work or at night. In this case, there is no way to immediately contact a dentist. What to do if a tooth hurts under a crown, how to remove it and is it possible to do this? You can relieve pain using medications with analgesic properties or folk remedies.

Remember that it is necessary to temporarily relieve pain, but this does not cancel a visit to the doctor. In addition, you need to remember the maximum daily dose of the drug taken - it is indicated in the instructions for it.

Medications

Medicines from the group of non-steroidal anti-inflammatory drugs (NSAIDs) are very helpful. If you do not have diseases of the gastrointestinal tract (especially ulcerative processes in the gastrointestinal tract), then you can use one of the following remedies:

Ketorol – 1 tablet 10 mg;
Diclofenac – 1 rectal suppository 100 mg;
Nurofen – 1 tablet 200 mg.

These agents suppress the action of biologically active substances that cause inflammation and pain, and also protect the gastrointestinal mucosa from any influences. They will relieve pain, but will cause an exacerbation of the ulcerative process in the gastrointestinal tract. Therefore, for people suffering from gastric ulcers, it is better to take nimesulide (trade name Nise) - 1 tablet of 100 mg. Nise belongs to the latest generation of NSAIDs and does not have a negative effect on the gastrointestinal tract.

Folk remedies

What to do when a tooth hurts under a crown, but you don’t have the necessary tablets at hand? It is worth turning to people's experience. Sometimes folk remedies help as well as drug therapy. Take:

a piece of salted (but not smoked!) lard and place it on the gum next to the sore spot; salted lard will draw out fluid, eliminate swelling and pain; the effect occurs within 10 – 15 minutes;
finely grate onion and garlic in equal volumes, mix the same amount of salt, place in a linen napkin and apply to the gum; will also quickly relieve pain, but will also destroy the infection;
a teaspoon of baking soda per glass of boiled water and rinse every 15 minutes; baking soda will remove inflammatory products and bacteria, clean the cavity inside the prosthesis (if it has a gap) and soothe the pain.

Read more about how to safely and effectively relieve toothache before visiting the dentist in our article.

What not to do

There are things that you should not do when a tooth hurts under a crown. This:

Any warming procedures will not soothe, but will increase pain, and will also significantly increase the risk of complications, since the cause of tooth pain under the crown can be a purulent-inflammatory process; when heated (compress, heating pad applied to the sore spot), the blood vessels dilate and pus can spread through them to other organs and systems;
Self-administration of antibiotics - they will not relieve pain, but can cause side effects; Only a doctor can prescribe antibiotics;
Lie without a pillow - the head should be elevated - this ensures the outflow of blood and reduces swelling;
Attempting to cure a tooth on your own - only a dentist can help.

Tolerate or not pain in a tooth with a crown

Preliminary treatment before prosthetics is always accompanied by trauma to the periodontal tissues. Therefore, after installation of the prosthesis, injured tissues may hurt for some time. But this is not an intense pain that gradually subsides. Depending on the sensitivity of the patient, it can last from 1 to 7 days.

The cause of tooth pain under the crown may be completely different - it is an inflammatory process or an incorrectly installed prosthesis. The pain will be of a completely different nature. The characteristics of pain allow the dentist to assume the presence of a particular pathology.

Pain when pressed or bitten

When a tooth under the crown hurts when you press (bite), you should pay attention to other symptoms, such as swelling of the gums, discharge of pus from under the crown, bad breath, and increased body temperature. But sometimes, apart from pain when biting, nothing else bothers the patient.

Possible reasons: most often the tooth under the crown hurts when pressed due to the inflammatory process in the area of the apex of the tooth root. An acute inflammatory process can be purulent in nature. In this case, pus may be released from under the crown (abscess at the root apex). With a long-term inflammatory process, a granuloma or cyst forms in this area. In the absence of signs of inflammation, pain when pressed indicates an incorrectly installed prosthesis. It may be slightly longer than adjacent natural crowns, which leads to increased stress and injury to the periodontal tissues.
What is the best way to relieve pain: any drug from the NSAID group will do - Ibuprofen, Diclofenac, Ketonal, etc. But this is not a way out, but simply temporary self-help. To fix the problem, you need to urgently contact your dentist.

Pain under the crown from hot

With a properly installed denture, the tissues should not react to hot food. The pain under the dental crown from hot heat is acute and does not go away immediately. If you do not see a doctor in time, then over time it will become longer and more exhausting.

Possible causes: pain under dental crowns from hot temperatures is a sign of pulpitis. It develops in a “living” tooth or in a pulpless tooth when the pulp is not completely removed.
What is the best way to relieve pain: the pain with pulpitis is very strong, it is not so easy to calm it down, you need to urgently run to the dentist. Before leaving home, you need to rinse your mouth with a 2% soda solution and take a Ketorol tablet - this is the most effective pain reliever from the NSAID group.

Tooth pain from hot food

Pain under temporary crown

A temporary prosthesis is installed during the production of a permanent one in order to protect the prepared tooth from injury. They are made from plastic or metal-plastic. Sometimes wearing a temporary prosthesis is accompanied by aching pain. Painful sensations may be accompanied by swelling and redness of the gums.

Possible reasons: temporary structures made from cheap materials do not always adhere tightly to natural dental tissues, so infection can get underneath them and secondary caries can develop. Acrylic dentures often cause allergies and have a toxic effect on tissue.
What is the best way to relieve pain: treat the oral cavity with an infusion of chamomile or calendula (a tablespoon of raw material per glass of boiling water), take any NSAID tablet and an antihistamine (Zodak, Erius, Claritin) and visit a doctor; the denture may have to be replaced.

The tooth under the crown hurts and the gums/cheek are swollen

First, a small convex formation appears above the installed structure. If left untreated, the swelling increases and spreads to the entire affected half of the face, accompanied by severe pain.

Possible reasons: if the tooth under the crown hurts and the cheek is swollen, this is a sign of periostitis (flux) - inflammation of the periosteum of the jaw bone. The reason is poor quality treatment before prosthetics.
What is the best way to relieve pain: rinse with any antiseptic, take NSAIDs and antihistamines, immediately consult a dentist.

A tooth without a nerve hurts under the crown

After installation of the prosthesis, pain may appear in the “dead” pulpless unit. If a tooth hurts, but the intensity of the pain gradually decreases, then there is no need to worry - this is normal. Sometimes the pain does not appear immediately, but after a while its intensity increases and takes on a pulsating character. Patients are often perplexed: why does the tooth under the crown hurt if its nerve has been removed?

Possible causes: moderate pain that appears immediately after prosthetics - this is usually the result of trauma to the periodontal tissues. They last for several days and go away on their own. A “dead” tooth hurts under the crown also when depulpation was performed poorly, when particles of pulp remained in the dental cavity or root canals, they became infected and pulpitis or periodontitis developed.
What is the best way to relieve pain: minor pain after prosthetics does not require pain relief. The mouth can be rinsed with a 2% soda solution or an infusion of herbs with antiseptic properties (sage, calendula). If there is severe, growing throbbing pain, you can temporarily remove it by taking a Diclofenac or Nise tablet and contact your dentist.

It's a dull pain

An exhausting, aching pain syndrome may appear immediately or some time after prosthetics.

Possible reasons: this is typical for various pathologies in the area of the apex of the tooth root - granulomas, cysts and abscesses. They are a consequence of defects in cleaning and filling of root canals. An acute or chronic inflammatory process develops, accompanied by aching, wave-like pain.
What is the best way to relieve pain: it is difficult to independently relieve tooth pain under the crown if it is intensely aching, but to alleviate the condition before visiting the dentist, you can take any medicine from the NSAID group.

Physiological reaction of the body to the installation of a dental implant

After the anesthesia wears off, the vast majority of patients experience pain in the area of the installed implant. Discomfort can be localized or diffuse, which is also considered normal. Don’t be alarmed if the pain after installing the implant radiates to the ear, throat, or head. All this is within normal limits when it lasts no more than 4–5 days and is well relieved with painkillers.

As a rule, the intensity of pain is insignificant if classical implantation is performed without combination with combined procedures. In this case, only about 5% complain of more severe pain.

If, within one day, not only implantation is performed, but also surgical procedures combined with it, this can increase postoperative pain. This happens, in particular, when a tooth is removed at once or plastic surgery of hard or soft tissues is performed at the same visit.

Mild pain after implantation is quickly eliminated with conventional non-steroidal anti-inflammatory drugs. When the syndrome is severe, the doctor prescribes stronger painkillers, which significantly alleviate the patient’s condition.

When you need to see a doctor urgently

Urgent medical attention is necessary if tooth pain under the crown is accompanied by the following symptoms:

sore, swollen, reddened gums are a sign of inflammation of the periodontal tissues; It is better not to start this process, it can spread, causing various complications;
increase in body temperature - a slight increase indicates the presence of an infectious-inflammatory process in the tissues; if a high fever appears, then most likely the process has acquired a purulent character; it is very dangerous;
facial asymmetry - may be a consequence of tissue swelling with severe inflammation of soft tissues after prosthetics; it also occurs with injury or inflammation of the facial nerve associated with various dental procedures; If not treated promptly, facial asymmetry related to the facial nerve can last a lifetime.

How long can you wear implants without crowns?

If we consider a two-stage implantation protocol, then you will have to walk without permanent crowns for six months. To restore the aesthetics and chewing function of the dental system, temporary plastic crowns are fixed 2-3 months after surgery.

Permanent crowns are installed only after successful osseointegration of the implant into the bone tissue. Temporary crowns should be worn not only for aesthetics, but also to prevent atrophy of the bone tissue of the jaw arch and destabilization of the titanium rod.

How to treat a tooth with a crown

When the nerve under the crown of a tooth hurts, treatment is carried out differently depending on the clinical situation and X-ray data. Today, treatment is increasingly carried out through a drilled hole in the prosthesis. But sometimes the crown should be removed and only then the necessary treatment should be carried out. Mandatory removal of the structure is required when:

rapidly developing deep caries, complicated by pulpitis and periodontitis;
incorrectly installed crown or its destruction;
allergies to prosthetic material;
abscess, cyst in the area of the apex of the tooth root.

After treatment, the orthopedic structure is reinstalled. This can be an old crown (if it is completely preserved) or a new one (if the tooth has acquired a different shape after treatment). After treatment, the hole in the crown is sealed with a light-curing filling material.

Removing a crown for tooth treatment

"Living" tooth

This is a unit with no pulp removed. Most often, it performs a supporting function in a bridge prosthesis. If for some reason secondary caries develops in it, the artificial structure is removed under local anesthesia or a hole is drilled in it. The tooth cavity is opened, the pulp is removed, the root canals are cleaned and a complete filling is performed. After this, a crown is installed or the hole made through which the treatment was performed is repaired.

With the nerve removed

A pulpless tooth does not have a nerve (pulp). Pain is associated with problems in the area of the tooth root. To determine the cause of the pain, x-rays are performed. Treatment can take place both with the crown removed and through a drilled hole. The root canals are cleaned, foreign bodies and excess cement are removed. Treat or remove abscesses, cysts, granulomas. Then re-prosthetics or restoration of the integrity of the crown is carried out using photo-curing materials.

How does the second stage of dental implantation proceed?

The second stage of dental implantation is marked by the installation of a gum former. The purpose of the implant system element is to create a beautiful contour of the gum line. With one-stage implantation, the former is installed immediately after implantation. The construction is removed at the second visit and replaced with a temporary crown on the abutment. With a traditional two-stage protocol, the former is installed only after 4-6 months, when the implant has successfully taken root. In this case, a second operation is performed, during which the gingival flap is excised, the plug is removed from the implant, the former is fixed, and the wound is sutured tightly.

Prevention

To avoid complications during prosthetics and associated pain, the patient should:

follow all doctor’s recommendations for caring for the oral cavity and dentures;
Carry out professional cleaning of all dental units twice a year;
do not try to crack nuts on the prosthetic side;
carefully choose a clinic for prosthetics; Experienced specialists in most cases manage to avoid complications when installing a variety of types of dentures; patients of the YuliStom clinic do not experience severe pain after prosthetics; The schedule of specialists can be found on our website.

Pain after implantation as a syndrome of developing inflammation

It is recommended to immediately consult a doctor if you experience pain after installation of the implant:

become stronger every day, accompanied by a feeling of fullness, twitching;
weaken for a short time only under the influence of powerful analgesics;
last more than 4–5 days after simple implantation and longer than two weeks when combined with other surgical procedures;
are combined with swelling that does not subside after seven days, fluid secretion from under the gums, and a rise in temperature above 37.0–37.5°C.

The listed symptoms may indicate the development of postoperative complications, the most common of which is peri-implantitis. This is an inflammation of the tissue surrounding the titanium rod installed in the jawbone. The main cause of this pathology is infection.