A permanent dental crown is a custom-fitted cap placed over a damaged or weakened tooth to restore its shape, size, strength, and appearance. While a crown is designed to protect the tooth, it is not uncommon to experience some sensitivity as the underlying tissues adjust. However, sharp, noticeable pain that occurs specifically when you bite down or chew signals a mechanical or biological issue requiring professional evaluation. This pressure-related discomfort is generally not normal temporary sensitivity, and it clearly indicates the crowned tooth needs attention from a dentist.
Understanding Pain Triggers Under the Crown
The experience of pain when chewing is linked to the mechanical force applied to the tooth and its supporting structures. One frequent mechanical cause is occlusal trauma, or a “high spot” on the crown. This occurs when the crown is slightly taller than surrounding teeth, causing it to bear excessive force when biting down. This uneven pressure irritates the periodontal ligament, the tissue holding the tooth in its socket, leading to localized soreness and pain upon contact.
Another biological cause is inflammation of the dental pulp, known as pulpitis, which can be triggered by the crown preparation process. Shaping the tooth can irritate the nerve within the pulp chamber, especially if the original decay was deep. When this nerve tissue becomes inflamed, chewing pressure exacerbates the condition, leading to discomfort. If inflammation becomes irreversible, the pulp may die, potentially leading to an abscess that makes the tooth feel elevated when biting down.
Pain upon biting can also signal recurrent decay or microleakage at the crown’s margin. If the seal between the crown and the natural tooth is compromised, bacteria can penetrate and form a new cavity on the remaining tooth structure. As decay progresses closer to the nerve, the tooth becomes highly sensitive to the mechanical pressure of chewing.
A sharp pain upon biting may also indicate cracked tooth syndrome, where a fracture line exists in the underlying natural tooth. When pressure is applied during chewing, the crack edges momentarily separate, stimulating the pulp and causing a sharp, fleeting pain. This type of fracture can be difficult to detect, as it may not be visible on standard X-rays and requires specific diagnostic tests.
Differentiating Immediate Concerns and Normal Sensitivity
Patients should distinguish between expected post-procedure sensitivity and symptoms signaling a serious problem. Normal sensitivity involves a transient, sharp twinge when the tooth is exposed to extreme temperatures, such as hot or cold items. This mild discomfort results from the nerve adjusting after the dental work and should gradually fade within a few days to a couple of weeks. Sensitivity that lasts only during chewing and disappears immediately upon release often indicates a mechanical issue like a high spot or minor crack.
Symptoms demanding immediate dental contact include pain that lingers long after chewing pressure is released, or a constant, throbbing ache that wakes you up at night. Lingering or worsening pain suggests severe pulp inflammation or a developing infection. Signs of infection, such as swelling of the gums or face, a fever, or a persistent bad taste in the mouth, require urgent attention.
While awaiting an appointment, temporary measures can manage discomfort and prevent further irritation. Strictly avoid chewing on the side of the mouth where the crowned tooth is located. Over-the-counter anti-inflammatory medications, such as ibuprofen, can provide temporary relief by reducing nerve inflammation. However, these measures only treat the symptom and not the underlying cause of the pain.
Clinical Solutions for Crown Pain
Professional treatment for crown pain is determined by accurately diagnosing the underlying cause. If the pain is due to a high spot, the solution is occlusal correction or bite adjustment. The dentist uses articulating paper to mark the high points of the crown, then polishes the material to restore proper alignment with opposing teeth. This eliminates excessive pressure and provides immediate relief.
If the diagnosis points to irreversible pulpitis or an infection, the tooth will likely require root canal therapy. This procedure involves making an access opening through the crown to remove the inflamed or infected nerve tissue from the pulp chamber. After the canals are cleaned, disinfected, and filled, the access hole in the crown is sealed with a permanent filling.
In cases of recurrent decay, a poorly fitting crown, or an extensive fracture, the restoration may need replacement. While localized decay might allow for margin repair, a new crown is often necessary to ensure a bacteria-proof seal. A crown with a significant fracture or poor fit must be remade to eliminate microleakage and restore structural integrity.