Problems with teeth that have permanent or temporary dental crowns. -
This page outlines some of the different types of problems that tend to occur with teeth that have dental crowns, either permanent or temporary.
A) Common problems associated with permanent crowns:
- Tooth pain - Ache, throbbing, pain when biting.
- Sensitivity - Thermal (hot/cold), sensitivity to air.
- "Bite" issues - Irregular bite, tenderness when biting.
- What to do if a permanent crown comes off or you swallow it.
B) Common problems associated with temporary crowns:
- Gum tissue pain or sensitivity.
- Abnormal bite.
- Sensitivity to hot, cold or air.
- Tooth pain or sensitivity following the crowning procedure.
- What to do if your temporary crown comes off.
- Temporary crown dos, don'ts and precautions.
If you notice problems, you need to let your dentist know.
This page describes many complications that take place with teeth that have temporary and permanent crowns, and we hope you find it helpful. But bottom line, if you're having problems with a crowned tooth the right solution is always to contact your dentist so they can evaluate your situation and provide the treatment you require in a timely fashion.
Dentists study for years and spend small fortunes for equipment so they can diagnose and address the issues we discuss on this page. Clearly just reading from a website is no substitute, nor will you be able to provide treatment for yourself. The problems discussed on this page require attention from your dentist.
A) Permanent dental crowns: Common problems, pains, sensitivities.
1) Problems that cause tooth pain.
a) Tooth nerve problems (endodontic complications).
Degenerative changes occurring within a crowned tooth's nerve space can cause it to start hurting. These events might be set off by the crowning process (although aspects of the problem likely existed before, see below), or at the other extreme, take years to progress far enough to cause noticeable symptoms.
[There is a general relationship between crowned teeth and their ultimate need for root canal treatment (the usual solution for this problem), we discuss it here.]
Signs and symptoms - Teeth experiencing an endodontic problem might:
- Show signs of slight tenderness (like in response to biting pressure). Or, at the other extreme, cause severe pain that lasts for hours on end.
- The discomfort might be triggered by a stimulus, such as biting down or hot foods and beverages. Once set off, the pain may linger (as opposed to quickly fading after the stimulus has been removed). In other cases, the pain may occur spontaneously.
- When the duration of the pain is extended, it frequently has a throbbing, sometimes radiating, nature.
Treatment - There are so many variations on the possible signs and symptoms of endodontic problems that it can even be difficult for a dentist to make this diagnosis. But in situations where the patient's condition has been determined to involve irreversible complications with the tooth's nerve, root canal treatment is the required solution.
Why problems with crowned teeth may arise unexpectedly.
Crowns aren't placed on pristine teeth. They're generally only required after a tooth has experience some type of catastrophic event, such as fracture, tooth decay or a lost filling.
These same events can have a detrimental effect on other aspects of the tooth, like its nerve. It may, however, take time for these problems to develop. And for this reason, a tooth that previously seemed just fine, either before the crowning process was begun or even many years after, may suddenly begin to hurt.
That means, while the timing of the symptoms may seem suspicious, the fact that they've cropped up is most likely just an indication that all was not well with the tooth initially, before its crown was placed. Unfortunately, at that time the full extent of its problem could not be definitively identified.
b) Cracked teeth.
In response to functioning under heavy loads or receiving trauma, the root of a crowned tooth may crack.
Crowns generally create a splinting effect that helps to hold teeth together. But cracks that form in a tooth's root can lie beyond where its stabilizing forces are effective. If so, when pressure is applied to the tooth the two split halves move independently, thus causing discomfort.
Signs and symptoms - Cracked teeth characteristically cause sharp pain in response to pressure (like biting down).
2) "Bite" issues that can cause pain.
a) Incorrect bite on a new crown.
Your dentist will evaluate the way your new crown bites against its opposing teeth before they cement it into place. Even so, you may discover (especially after your numbness has worn off) that its shape is still not exactly right.
You may find that your crowned tooth touches first when you bring your teeth together (it's too "high"). Or maybe as you slide your teeth from side to side, you can feel some aspect of the crown that's too prominent.
Initially what's noticed may only be an annoyance. But this situation tends to traumatize the tooth or teeth involved and as a result they may begin to hurt. If left unattended long enough, the pain may become severe.
- If treated early, this type of problem is an easy fix for your dentist. They simply need to buff your crown down, so its shape is more in harmony with your bite.
- Don't expect this type of problem to just take care of itself because it won't. In fact, if this condition is not remedied in a timely fashion it can lead to serious consequences, such as severe pain and a need for root canal treatment. (We discuss why more thoroughly below.)
b) Bite issues with existing crowns.
It's possible for teeth that were crowned some time ago, even those that have always seemed just fine, to develop some type of painful bite-related issue.
a) Tooth infections.
Pus formation associated with an infection inside a crowned tooth may cause it to extrude slightly out of its socket (the level of the tooth rises in comparison to its neighboring teeth). As a result, on closing the tooth will always touches first.
- Teeth that have this problem typically hurt when you bite down. The degree of pain can range from just slight to severe.
- There might be evidence of swelling in the tissues that surround the tooth.
Treatment - The solution is to resolve the infection by way of performing root canal treatment.
b) Pain related to tooth grinding.
It may be that the "bite" of a crown is close enough to perfect that all is well most of the time. But during times when the person bruxes their teeth (clenches and grinds, especially for extended periods of time) that the imperfections of the crown direct excessive pressure to the tooth. The result is inflammation of its nerve tissue and ultimately sensitivity or pain.
This condition is very similar to when a crown is too "high."
- The dentist will buff the chewing surface of the crown down so its more in harmony with the person's bite.
- If this condition isn't remedied in a timely fashion it can lead to serious consequences, such as severe pain and a need for root canal treatment. (We explain more thoroughly below.)
The pain comes from sensitive tooth surfaces at the edge of the crown.
3) Crowned teeth that are sensitive to hot and cold.
After a dental crown has been cemented into place, a person may notice that their tooth is sensitive to:
- Hot and cold foods and beverages. Dentists refer to this as "thermal" sensitivity.
- Air may cause a similar sensation (like when breathing through your mouth).
- The location of the sensitivity is usually right at the edge of the crown, by the gum line.
- The pain is triggered by the stimulus but then disappears. It's typically just mild to moderate in intensity. It's usually always about the same, it doesn't worsen.
It's possible for this condition to crop up with older (existing) crowns too.
The common cause of this problem is exposed tooth dentin. [On the upper part of a tooth, this is the layer that lies underneath its enamel (which may have been ground away during the crowning process). With roots, it's the surface layer of the tooth.]
- In the case of a new crown, this is a sign that it doesn't cover over the tooth quite as far as it ideally might (although possibly on a scale so small it can't readily be visualized). But it doesn't necessarily mean that the crown is poorly made or is deficient.
- With existing crowns, it's usually gum recession that has caused the dentin to become exposed.
When the underlying problem is dentin sensitivity, it's often easy to fix.
- The cure might be as simple as using toothpaste that's marketed as a treatment for "sensitive teeth" (the active ingredient in these products is usually potassium nitrate).
- Or the dentist may apply a solution to the tooth that helps to protect (and therefore desensitize) the exposed dentin.
B) Temporary crowns: Common problems, pains, sensitivities.
Teeth with temporary crowns can experience most all of the same types of problems as those fitted with permanent ones.
But unlike our discussion above, this section focuses on issues more likely to be associated with the immediate effects of the crowning procedure, or related to the short-term, disposable nature the temporary crown itself.
Stay in touch with your dentist.
Of course, in all cases, if you experience any type of problem you should feel free to report it to your dentist so they can make an evaluation of your situation. This is their obligation as your treatment provider.
1) Gum tissue pain.
The edge of most crowns ends right at or below the gum line. And it's easy for the tissue in this area to get roughed up during the crown-making process (either when your tooth is trimmed or during the impression taking process).
That means any tenderness you feel at the edge of your temporary crown is unlikely related to it, as opposed to the irritated gum tissue itself.
2) Problems with your temporary crown's bite.
After the numbness of your procedure has worn off, you may notice problems with the "bite" of the temporary crown that's been placed. For example:
- When you close your teeth together, it may seem too tall (as in it touches first as you bring your teeth together, possibly keeping you from closing all of the way).
- The "bite" may seem OK when you initially close. But as you slide your teeth left, right or forward, the shape of the temporary deflects your normal jaw movements.
- Dentist typically phrase this condition as the crown is too "high."
- Initially, the tooth may not hurt much at all. But as time goes by, it may become more and more sensitive, or even outright painful.
The cause of the problem.
The fundamental problem is simply that the shape of the temporary isn't quite right. And having this complication is not all that uncommon.
The dentist's inability to get the "bite" right usually stems from either:
- Confusion that the patient has with following their instructions about what type of jaw movements to make during testing.
- Or their inability to create the needed movements due to the feeling of numbness they are experiencing.
The pain itself is a sign of inflammation of the tooth's nerve. This is its response to the constant trauma it receives due to having a heavy bite on it. (See reversible and irreversible inflammation section below.)
If tended to early enough, this is a simple problem to fix. Your dentist just needs to buff down the surface of your temporary with their drill, so it's more in harmony with your bite. (Doing so should just take a few moments.) If you've had discomfort, your tooth will usually return to normal in just a few days.
- Not correcting this problem early on can result in serious consequences. The extra pressure that's directed to the tooth each and every time you close creates trauma. If allowed to persist long enough, the trauma can aggravate the tooth's nerve, resulting in sensitivity or pain.
- As a worst case scenario, the cumulative nerve trauma may be severe enough that root canal treatment is ultimately needed.
- It's common for a dentist to recommend the use of an over-the-counter NSAID medication (non-steroidal anti-inflammatory drug) such as Ibuprofen, Motrin or aspirin.
The idea is that it helps to prevent/minimize the amount of nerve tissue inflammation that takes place, thus lowering the level of pain/sensitivity that's experienced. The use of an NSAID can also assist the nerve tissue in making a healthy recovery from the episode.
3) Teeth that have increased thermal sensitivity.
Teeth fitted with a temporary crown sometimes exhibit sensitivity to:
- Hot and cold foods and beverages. (Dentists refer to this as thermal sensitivity.)
- Air, like when you breath through your mouth.
A temporary crown may have a relatively imprecise fit.
The cause of the problem.
It's the nature of temporaries that they typically fit over their tooth less precisely or fully than the permanent crown that will follow. These are, after all, just disposable items made as quickly and cheaply as possible.
At a level that may be too small for your dentist to inspect, a temporary crown may fall short of fully covering over its entire tooth preparation (see illustration). As a result, dentin (a sensitive tooth tissue that lies under enamel and makes up the bulk of roots) may be exposed.
If so, hot or cold stimuli or the affects of air may irritate it, resulting in the sensitivity that you feel.
It makes sense to let your dentist know what you are experiencing. They can then evaluate your symptoms and determine what type of attention is needed.
C) Tooth pain following the crowning procedure.
It's possible that after being trimmed for a dental crown, your tooth may cause some discomfort. If so, you should let your dentist know so they can evaluate your symptoms.
The cause of the problem.
In most cases, the discomfort is due to inflammation of the tooth's nerve tissue (a "pulpitis") that's been triggered by the trauma of the crowning procedure. The issue of concern being, how extensive this reaction will be and how it will affect your tooth.
a) Reversible pulpitis - The hope is that the inflammation is just transient and reversible, meaning it will resolve and the nerve tissue will return to normal. And in most cases this is the outcome that can be expected.
To aid with this process, and control the level of pain you feel, your dentist may recommend that you take an over-the-counter NSAID medication (non-steroidal anti-inflammatory drug) such as Ibuprofen, Motrin or aspirin.
b) Irreversible pulpitis - This is the situation where the tooth nerve has been "pushed over the edge." The trauma and resulting inflammation have created a situation from which the nerve tissue cannot/will not recover. If so, the ultimate outcome will be one where the tooth requires root canal therapy.
Since the range of outcomes between these two conditions is so great, it always makes sense to be in touch with your dentist, sooner rather than later.
- Following simple steps that they recommend, such as taking an anti-inflammatory drug (NSAID) early on, may help to prevent a status of irreversible pulpitis from developing.
- Once having been alerted, they can help to monitor your condition, manage your symptoms and provide prompt attention if your status worsens.
D) What should you do if your permanent or temporary dental crown comes off?
We now discuss this topic on these pages:
E) Temporary dental crowns - Precautions you should take.
What kind of service should you expect from your temporary?
Generally speaking, properly executed provisional crowns rarely fail. Loss or fracture is usually associated with deficiencies involving either the tooth's preparation (shape) or the temporary's construction (Schwass 2013). [page references]
It would be our conjecture that due to the throw-away nature of these restorations, taking shortcuts when making them is relatively commonplace. The good news being that your permanent crown is unlikely to suffer from these same deficiencies.
A temporary dental crown is usually cemented using "temporary" cement, so it can be removed easily at that appointment when your permanent one is placed.
And since this kind of cement is not as strong as others, your dentist will probably recommend that you take the following precautions. (Ask them if there are any other steps that they feel are important for you to take too.)
1) Favor the side of your mouth that has the temporary.
There's no need to look for trouble, so give your temporary crown some consideration when eating. As much as possible, shift the bulk of your chewing activities to other areas.
2) Keep sticky foods away.
Anything sticky (caramel, chewing gum, etc...) has the potential to grab onto your temporary crown and pull it off.
3) Avoid hard foods.
Exceptionally hard foods, such as raw vegetables (carrots), can break or dislodge a temporary crown.
4) Be careful when you floss.
A tooth with a temporary can usually be flossed in normal fashion, with the following consideration.
When finished, it may be best to remove the floss by way of letting loose of one end of it and then pulling it out to the side. Pulling the floss back up and out in normal fashion might snag the edge of the crown and pull it off.
Full menu for topic Dental Crowns -
- Dental crown ("cap") basics - What are they? When is one needed?
- Applications / Advantages -
- The steps of the dental crown procedure.
- Common problems and complications.
- How to sell old crowns.
- Assorted FYI facts about dental crowns.