A dental crown is a custom-made cap placed over a damaged tooth to restore its shape, size, strength, and appearance. Pain when biting down on a crowned tooth is a common symptom signaling an underlying problem. This discomfort occurs because the crowned tooth is still alive, containing nerves and connected to the jawbone by a sensitive ligament. Any pain upon chewing suggests a mechanical or biological failure has occurred.
Mechanical Issues Related to the Crown Itself
Pain triggered by the pressure of chewing often points to an issue with the crown’s fit, known as occlusal interference. If the crown is cemented slightly “too high,” it makes premature contact with the opposing tooth when the jaw closes. This creates excessive pressure, leading to inflammation of the periodontal ligament that anchors the tooth in the jawbone. A simple adjustment to reshape the biting surface can often alleviate this pressure-induced pain.
Another common mechanical cause is a compromised seal or a loose crown. Over time, the dental cement holding the crown in place can weaken, allowing the crown to shift minutely when pressure is applied during biting. This slight movement causes friction and sensitivity in the underlying tooth structure. If the crown is cracked or chipped, biting forces concentrate on the damaged area, causing sharp, localized pain.
Biological Causes Below the Crown
Persistent or severe pain, sometimes throbbing, often originates within the underlying tooth structure. The natural tooth remains vulnerable to new or recurrent decay (caries), which typically forms at the margin where the crown meets the tooth structure. If bacteria infiltrate this area due to an imperfect seal, the cavity can grow undetected beneath the crown, eventually reaching the dental pulp. The tooth’s nerve (pulp) can also become irritated or inflamed (pulpitis), especially if the original decay was deep or the crown preparation traumatized the tissue.
A more serious internal issue is a periapical infection or abscess, which develops at the root tip. This results from a failed or untreated pulp issue, where bacteria have spread into the jawbone. The accumulation of pus and resulting pressure causes a throbbing ache that worsens upon biting down, as the tooth is pushed against the infection. A sharp, instantaneous pain when releasing biting pressure is characteristic of Cracked Tooth Syndrome, where a fracture line hidden by the crown flexes under pressure.
Discomfort may also be localized to the supporting tissue surrounding the tooth. Inflammation of the gums, such as gingivitis or periodontitis, can occur around the crown margin due to plaque buildup. This localized inflammation makes the gum tissue tender and sensitive, contributing to generalized pain when chewing. Gum recession around the crowned tooth exposes the root surface, which is highly sensitive to pressure and temperature.
Immediate At-Home Relief Measures
While waiting for a dental appointment, several temporary measures can help manage the discomfort. Over-the-counter pain relievers, such as non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or acetaminophen, can be taken as directed to reduce pain and inflammation.
Dietary adjustments are important to prevent further irritation. This involves avoiding chewing on the painful side and sticking to soft foods that require minimal biting force. A warm saltwater rinse can be used several times a day to soothe inflamed gum tissue around the crown. A solution of a half teaspoon of salt dissolved in lukewarm water acts as a mild antiseptic and helps reduce local swelling.
Professional Diagnosis and Treatment Paths
Any crown pain that persists beyond a few days, or is accompanied by swelling, fever, or a visible bump on the gums, warrants an immediate call to a dental professional. The dentist will begin the diagnostic process with a thorough clinical examination. Dental X-rays are used to visualize the structure beneath the crown, checking for recurrent decay, bone loss, or an infection at the root tip.
The patient’s bite is checked using thin, colored articulation paper, which reveals any “high spots” on the crown causing excessive pressure. If the diagnosis is a simple high spot, treatment involves a quick adjustment to reshape the crown’s surface. If the pain is due to a loose crown, the dentist may attempt to remove and re-cement it, assuming no new damage or decay has occurred.
More complex issues like deep decay, a cracked tooth, or irreversible nerve inflammation necessitate more extensive treatment. A severe infection or pulpitis typically requires root canal therapy to remove the infected tissue and save the tooth. If the underlying tooth is extensively damaged, the crown must be removed, the problem addressed, and a new crown fabricated.