A dental crown functions as a cap placed over a damaged tooth, restoring its shape, size, strength, and appearance. The preparation process often involves significant drilling and shaping, which can cause the underlying living tissue to react. It is common for patients to experience discomfort, particularly when chewing, after the permanent crown is cemented. Understanding the reasons behind this post-procedure pain is the first step toward finding relief and ensuring the long-term health of the tooth.
Expected Post-Procedure Sensitivity
Mild soreness or sensitivity is a normal response immediately following the crown procedure. The preparation of the tooth, which includes drilling and shaping, causes trauma to the inner pulp tissue. This temporary irritation is often referred to as reversible pulpitis, where the nerve is inflamed but expected to recover.
This initial sensitivity is frequently triggered by temperature changes, such as hot coffee or cold water, but the pain typically goes away within a few seconds. The discomfort should gradually decrease, usually resolving within a few days to two weeks as the pulp calms down. Managing this period often involves using over-the-counter anti-inflammatory medications and avoiding hard foods on the crowned tooth.
The discomfort during this time is generally mild to moderate, and distinct from sharp pain that occurs specifically when biting down. If the tooth was already compromised by deep decay or a crack, the preparation process can exacerbate the issue. However, in most cases, this temporary sensitivity is simply the tooth adjusting to the new restoration.
Common Mechanical Causes of Discomfort
The most frequent and fixable cause of pain when chewing is a mechanical problem related to the crown’s fit, often described as the crown feeling “high.” If the new crown is slightly taller than the surrounding teeth, it takes the brunt of the force during biting. This extra pressure is transmitted through the tooth to the periodontal ligament (PDL), the tissue that anchors the tooth to the jawbone.
The PDL is extremely sensitive to changes in force, and excessive pressure causes inflammation and pain when the mouth is closed. This issue, known as an occlusal discrepancy, makes the tooth feel tender or sore. A follow-up appointment allows the dentist to use articulating paper to identify the “high spot” and adjust the crown by polishing the surface until the bite is even. This adjustment often provides immediate relief and is a routine part of restorative dentistry.
The cement used to bond the crown can also be a source of discomfort. If excess cement is left behind near the gumline after the crown is seated, it irritates the gingival tissues. This retained cement causes inflammation, leading to redness, swelling, and tenderness in the gums, making chewing painful. The dentist must meticulously clean and remove all residual cement to ensure gum health is not compromised.
An ill-fitting crown margin, where the edge meets the natural tooth structure, can also create mechanical irritation. If the margin has an overhang or is too bulky, it can press against the gums or trap bacteria and food particles. This ongoing irritation leads to localized gum inflammation, which is painful when chewing or applying pressure near the crown’s base. Addressing these mechanical issues early is essential to prevent chronic inflammation.
When Pain Requires Immediate Professional Attention
While initial sensitivity is common, certain types of pain signal a more serious complication that requires immediate professional contact. If the pain is spontaneous, meaning it throbs or aches even when you are not chewing, it may indicate irreversible pulpitis. This condition suggests that the inflammation of the pulp tissue is too severe to heal on its own and the nerve is beginning to die.
Pain that disrupts sleep or cannot be managed effectively with over-the-counter pain relievers is another sign of a serious underlying issue. Irreversible pulpitis is characterized by sensitivity to cold that lingers for more than 30 seconds, or any sensitivity to heat. If the nerve tissue has progressed to this state, the tooth will likely require root canal therapy to remove the infected or dying pulp.
Symptoms extending beyond the tooth itself also warrant urgent professional attention. Swelling of the gum tissue around the crown, the cheek, or the face can indicate a spreading infection. A persistent bad taste or the presence of pus are also signs of an abscess, which is a pocket of infection at the tip of the tooth’s root. These complications can be accompanied by a fever and require prompt treatment, including antibiotics and possibly root canal therapy or extraction.
A sharp, shooting pain upon biting down that feels like the tooth is cracking may signal a tooth fracture underneath the crown. Underlying problems, such as recurrent decay or a cracked root, can cause pain when pressure is applied. If the pain persists intensely for more than two to three weeks without improvement, or if the crown feels loose, it is necessary to see the dentist to diagnose and address the issue.