Problems (pain, sensitivity) associated with permanent and temporary dental crowns. -

Types of discomfort explained - Toothache, throbbing, sensitivity (to hot and cold, air, biting pressure), gum irritation. | Causes. | Treatments. | Precautions to take with temporary crowns.

This page outlines some of the different types of pain related problems that tend to occur with teeth that have dental crowns, either permanent or temporary.

A) Common problems and causes of dental crown pain:

  1. Tooth pain - Ache, throbbing, pain when biting.
  2. Sensitivity - Thermal (hot/cold), sensitivity to air.
  3. "Bite" issues - Irregular bite, tenderness when biting.
  4. What to do if a permanent crown comes off or you swallow it.

B) Common problems and causes of temporary crown pain:

If you notice problems, you need to let your dentist know.

This page describes some of the more common complications associated with temporary and permanent crowns that typically involve some level of discomfort.

And while we hope you do find the contents of this page helpful in understanding what's possibly taking place with your tooth, bottom line, if you're having problems of any sort, 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.

There is no substitute.

Dentists study for years in school and spend small fortunes for equipment so they can diagnose and address the issues we discuss on this page. Just reading content on a website is no substitute, nor in most cases will you be able to provide adequate treatment on your own. The types of problems and complications discussed on this page typically require attention from your dentist.


A) Common problems, pains, sensitivities associated with teeth that have permanent dental crowns.

(The assumption with our discussion here is that the crowned tooth has no obvious extraneous issues, such as tooth decay, or the tooth itself has no issues with gum disease. Instead, the status of the crowned tooth is one where it would seem to be good order but instead painful symptoms exist.)

1) Endodontic complications (nerve problems) with crowned teeth.

The nerve inside a tooth (its "pulp") is living tissue. And in cases where it's been repeatedly or severely traumatized, either currently or historically, it may begin to degenerate (die).

Dentists refer to this situation/process as irreversible pulpitis (irreversible nerve tissue inflammation). And as this condition progresses, symptoms frequently develop, including pain.

Signs and symptoms.

The types of discomfort associated with a tooth that has irreversible pulpitis can be quite varied.

  • The level of pain can range from just slight tenderness, or transient discomfort, all of the way up to a severe toothache that lasts for hours on end.
  • The discomfort may be triggered by a stimulus, such as the pressure of biting down, or hot foods and beverages. Once set off, the pain often lingers (as opposed to quickly fading after the stimulus has been removed).

    In other cases, the pain may occur spontaneously (on its own, unprovoked).

  • The pain frequently has a throbbing, sometimes radiating, nature.

Due to these variations, the patient's dentist will need to evaluate the additional symptoms (non-pain related) associated with the tooth before being able to conclusively arrive at this diagnosis.

As far as the timing of this complication, there are no hard and fast rules.

  • Symptoms may first be noticed during the time frame of the crowning procedure (such as following the tooth's preparation appointment, while its temporary crown is worn, or shortly following the placement of its permanent crown).
  • With other cases, the degenerative nature of the pulpitis may take days, weeks, months or possibly even years before it's progressed to a point where it causes noticeable symptoms.
Treatment.

In the case where it's determined that the tooth's nerve has received a level of insult from which it can't recover (irreversible pulpitis), root canal treatment is the required solution.

Why would nerve problems just crop up with a crowned tooth?

Crowns aren't usually placed on pristine teeth. Instead, they're usually used to rebuild or strengthen those that have already experience some type of catastrophic event, such as fracture, tooth decay or a lost filling.

These same events can have a detrimental/traumatizing effect on the tooth's pulp tissue (be a cause of irreversible pulpitis). It may, however, take time for the symptoms associated with the nerve's problems to show up. And for that reason, a tooth that previously seemed just fine, either before its crowning process was begun or even many years after its crown was placed, may suddenly begin to hurt.

This link discusses the relationship between teeth that have been crowned and their possible need for root canal treatment at a later date in greater detail.

2) Pain associated with crowned teeth that have failed root canal treatment.

Despite a dentist's best efforts, some root canal cases will fail. And in many cases, one of the signals that a tooth's has is transient pain or a toothache. (Other signs and symptoms of failed root canal treatment.)

Treatment.

In most cases, the tooth can be retreated. However, if the dentist doesn't feel that the procedure's chances for success are good, they may instead recommend extraction and replacement.


3) Pain associated with crowned teeth that have cracks.

Crowns generally create a splinting effect that helps to hold teeth together. But it's possible for a crack to develop, or a existing crack to continue to grow in size, in the tooth's root beyond where its stabilizing forces are effective. If so:

  • When pressure is applied to the tooth, the two split halves may move independently, thus causing pain.
  • The crack may harbor bacteria. Or it may provide a pathway for them to enter the tooth's root canal system, thus compromising its nerve tissue (cause irreversible pulpitis).

Signs and symptoms - In regard to discomfort, cracked teeth characteristically give a sharp, painful response to pressure changes (like when biting down, or letting biting pressure off a tooth).

Treatment - This is a problem for which there often is no solution or repair. If so, the tooth will need to be extracted.


4) Problems with a crown's "bite" that can cause pain.

a) "Bite" issues with a new crown.

While your dentist will evaluate the way your new crown bites against the teeth it opposes, you may discover (especially after your numbness has worn off) that its shape still isn't quite right.

As examples:

  • You may find that it touches prematurely (first) when you bring your teeth together (referred to as being "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.
Pain related symptoms.
  • Initially you may just notice slight tenderness with either the crowned tooth or the teeth that bite against it.
  • If the situation is allowed to persist, it will further traumatize the nerves of the teeth involved. If left unattended long enough, any of the teeth affected may become severely traumatized and cause severe pain.
Treatment.
  • If treated early on, 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. After that's been accomplished, the tooth's condition (reversible pulpitis) should settle down.
  • 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 (irreversible pulpitis).

    As a result, the tooth may cause severe pain and ultimately require root canal treatment. (We discuss this subject more thoroughly below.)

b) Painful "bite" issues associated 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.

1) Crowned tooth 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 periods when the person bruxes (clenches and grinds their teeth), especially for extended periods of time, the prominent aspects of the crown direct excessive pressure to the tooth.

If so, the consequences will be inflammation of its nerve tissue (pulpitis), and ultimately some level of sensitivity or pain.

Treatment.

This condition is very similar to the discussion above about when a crown is too "high."

  • In routine cases, the dentist will buff the chewing surface of the crown down so it's in harmony with the person's bite. The tooth's sensitivity should then settle down (reversible pulpitis).
  • If this condition isn't remedied in a timely fashion it can lead to serious consequences (irreversible pulpitis), which can cause severe pain and the need for root canal treatment. (We explain more about this scenario below.)
2) Tooth infections.

Pus produced by an active infection inside a crowned tooth may force its way into the ligament space that lies between it and its surrounding bone. This can cause the tooth to extrude out of its socket slightly (the level of the tooth rises higher than its neighboring teeth). As a result, on closing the tooth will always touch first.

  • Teeth that have this problem typically hurt when you bite down. The amount of pain can range from just slight to severe.
  • Other aspects of the tooth's infection may cause pain too. (Related: Signs of needing root canal.)

Treatment - The solution is to resolve the infection by way of performing root canal therapy.

Graphic stating that thermal sensitivity may come from tooth surfaces at the crown's edge.

Crown thermal sensitivity may come from sensitive tooth surfaces at its edge.

5) Crowned teeth that have sensitivity to hot, cold or air.

a) Routine cases.

It's possible that after its dental crown has been cemented into place, a person will notice that their tooth is sensitive to:

  • Hot and cold foods and beverages. ("Thermal" sensitivity.)
  • Air. (Like when breathing in and out 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 hot, cold or air stimulus but then disappears. It's typically just mild to moderate in intensity. What's felt is always about the same. It doesn't worsen.

It's possible for this condition to crop up with older (existing) crowns too.

Exposed tooth dentin can explain thermal pain.

Animation showing the dentin portions of a tooth.

Yellow = The dentin portions of a tooth.

Routine causes of this type of sensitivity.

Usually the cause of this type of problem is exposed tooth dentin. This is the hard tooth tissue that lies under enamel (see animation). It characteristically displays the above mentioned sensitivities.

The exposed dentin may exist because the enamel layer that originally lay over it was trimmed away when the tooth was shaped for its crown. Or else the exposed surface of the tooth is its root (a portion of the tooth that has no enamel covering).

  • In the case of a new dental crown, the sensitivity may be a sign that the restoration doesn't cover over the tooth quite as fully as it ideally might.

    (The band of exposed dentin surrounding the edge of the crown may be so minute that the discrepancy can't even be visualized. Note: Having this problem doesn't necessarily mean that the crown is poorly made or deficient.)

  • With existing crowns, developing sensitivity is frequently due to gum recession.

    (As the tooth's gum tissue recedes, potentially sensitive root surfaces become exposed. Even very minor amounts of recession can result in sensitivity.)

Treatment.

When the underlying problem is dentin sensitivity, the fix is often easy.

  • 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 treat the exposed dentin with a "desensitizing" application. Examples include tooth varnish or else fluoride.

b) More serious conditions.

A crowned tooth whose nerve tissue is inflamed (reversible or irreversible pulpitis) may respond painfully to hot and/or cold stimuli. Crowned teeth in need of root canal treatment might too. We've discussed these conditions and their treatments above on this page.


B) Common problems, pains, sensitivities associated with temporary dental crowns.

Teeth that currently have a temporary (interim) crown placed on them can experience most all of the same types of pain-related problems as those discussed above with permanent ones.

So instead of rehashing those situations and conditions, this section focuses more so on causes of discomfort that tend to be side effects of the crowning procedure, or pains or sensitivities related to the short-term, disposable nature the temporary crown itself.

Stay in touch with your dentist.

Of course, in all cases when experiencing any type of problem you should report it to your dentist so they can make an evaluation of your situation. This is their obligation to you 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 along the edge of your temporary crown is less likely related to it, as opposed to the adjacent irritated gum tissue.

Treatment.

In most cases, you can expect that this type of discomfort will resolve on it's own after a few days. Rinsing with warm salt water, up to three times a day, can help to speed up healing.

2) Pain and tenderness associated with a temporary crown's "bite."

After the numbness of your procedure has worn off, you may notice that something is amiss with the "bite" of your temporary crown. 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).

    (In dentist terminology, the temporary crown is referred to as being "too high.")

  • 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.
  • Initially, the tooth may not hurt very much at all. But as time goes by, it may become more and more sensitive, or be outright painful.
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The cause of the problem.

The fundamental problem is simply that the shape of the temporary crown 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.
  • The patient's inability to create the needed movements due to the feeling of numbness they are experiencing.

The pain itself is due to inflammation of the tooth's nerve (pulpitis) caused by the constant trauma it receives due to the tooth having a heavy bite on it.

Treatment.

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. (The condition involved being reversible pulpitis.)

  • 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, pain or toothache.
  • As a worst case scenario, the cumulative nerve trauma may be severe enough that root canal treatment is ultimately needed (irreversible pulpitis).
  • 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:

  • Air. (Like when you breathe through your mouth.)
  • Hot and cold foods and beverages. (Dentists refer to this as thermal sensitivity.)
Graphic showing that the imprecise fit of a temporary crown may explain its thermal sensitivity.

A temporary crown may have a fairly imprecise fit, thus explaining its thermal sensitivity.

a) A possible simple cause of the sensitivity.

By nature, temporary crowns 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 minute level, possibly even too small to be readily visible, 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 air may irritate it, resulting in the sensitivity that you feel.

Treatment.

After an evaluation of your situation, your dentist will determine what level of attention is required. They may decide that your temporary crown needs additional work, or even replacement. Or that the application of a liquid coating (tooth varnish) over the exposed dentin will control the problem. If what's noticed is just minor, it may not be treated.

b) More serious conditions.

A crowned tooth whose nerve tissue is inflamed (reversible or irreversible pulpitis) may respond painfully to hot and/or cold stimuli, possibly even air. Crowned teeth in need of root canal treatment might too. We've discussed these conditions above on this page.


C) Tooth pain following the crowning procedure.

It's possible that following your appointment when your tooth was trimmed/shaped for its dental crown, it will start to cause discomfort.

With this scenario, it may be that your tooth currently has a temporary crown on it. Or in the case of single-visit protocol, your tooth's permanent crown may have already been cemented.

Possible causes of this type of sensitivity.

In most cases, the discomfort is due to inflammation of the tooth's nerve tissue (a "pulpitis") that's been triggered by trauma created during the crowning procedure.

The issue of concern being, how extensive the tooth's reaction will be, and how it will ultimately affect its health and outlook.

a) Reversible pulpitis - This is the case where the resulting inflammation is just transient and reversible, meaning it will ultimately resolve and the tooth's nerve tissue will return to a normal, healthy state. And in most cases after a tooth has been trimmed for a crown, this is the outcome that can be expected.

To assist the tooth's nerve in settling down and recovering, and to help to minimize the amount of pain you feel as it does, your dentist may recommend that you take an over-the-counter NSAID medication (non-steroidal anti-inflammatory drug) such as Ibuprofen, Motrin or aspirin.

The medication is typically taken over the few days it takes for the tooth to gradually return to normal. Doing so can be an important step in helping your tooth to recover, and therefore prevent the added complications (time, expense, toothache) that dealing with irreversible pulpitis typically presents.

b) Irreversible pulpitis - This is the situation where the trauma associated with trimming the tooth for its crown has pushed the tooth's nerve "over the edge."

The resulting inflammation has created a situation from which the nerve tissue cannot/will not recover. With this scenario, the ultimate outcome will be one where the tooth will require root canal therapy.

Treatment.

Since the range of outcomes between these two conditions is so great, if you notice pain or discomfort you need to be in touch with your dentist, and 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, your dentist can monitor your condition, help to manage your symptoms and provide prompt attention if your status worsens.

(This link discusses the relationship between the crowning procedure and the possible need for root canal treatment as a result in greater detail.)


What should you do if your permanent or temporary dental crown comes off?

We now discuss this topic on these pages:


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.

Temporary cement.

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.

 

Last revision/review: 9/5/2018 - Extensive revision. Content added.


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