Tooth Pain Under a Crown or Bridge

Symptoms That Should Be Taken Seriously

Pain when pressing or biting.

This could be a sign of a purulent inflammation. The pain can intensify and then subside. Over time, the inflammation may become chronic, with rare and brief pains.

Fistula under the crown

An opening forms in the mucous membrane, allowing pus to flow from the root canal into the oral cavity. As the pus drains, the pain may decrease, but the risk of blood and lymph infection increases.

The mucous membrane under the crown has swollen, an abscess has formed.

The emergence of swelling with intense pain is a sign of root inflammation. At the onset of the disease, an inconspicuous thickening appears. However, neglecting treatment can cause the swelling to spread to the entire cheek, increasing pain.

Sinusitis

Sinusitis worsens due to an infection in the sinus cavities, leading to difficulty in draining pus. It occurs due to not fully healed upper molars.

Cyst Under the Crown

Gum inflammation causes a cyst under the crown. It is accompanied by redness, swelling, and pain. Initially, a granuloma forms, which then turns into a pus-filled cyst. A cyst can lead to serious complications, including infection of the entire body.

Reasons for Tooth Pain Under a Prosthesis

• Secondary tooth decay. Secondary caries can develop if not all infected tissues were removed before crown placement, leading to recurrent caries.
• Poor root canal filling. If the root canal is not properly sealed, harmful bacteria accumulate in the cavities. These bacteria cause inflammation and pain when pressing on the crown.
• Instrument fragment remaining in the root canal. A fragment of an instrument left in the root canal causes tooth inflammation and painful gums. This is more common when working with curved canals and can be a result of repeatedly using the same instrument.
• Thermic burn to neurovascular bundle. A thermal burn of the vascular-nerve bundle usually occurs due to insufficient cooling during grinding. This can lead to pulp inflammation, causing pain in the short-term (4-6 weeks) or long-term (10-12 months) period after dental prosthetics.
• A crown of incorrect shape can cause issues. An incorrect shape of the crown can lead to issues. The crown may not fit tightly on the supporting tooth, allowing food particles to enter microscopic gaps, causing inflammation. Additionally, it can injure the oral mucosa during chewing.
• A hole in the wall of the tooth root can occur. This can be the result of the dentist during the instrumental expansion of the canal or when inserting a pin.

If The Tooth Under a Crown or Bridge Starts to Hurt - What Should You Do?

If a tooth under a crown or bridge starts hurting, you should immediately make an appointment with a dentist to get a diagnosis and determine the cause.

How can you relieve pain under a crown while waiting for a dentist appointment?

Rinsing your mouth with an antiseptic or a chamomile and sage decoction can help reduce inflammation. A pain reliever, such as Ketanov or Nurofen, can alleviate severe pain.

Tooth Pain – What Happens If You Leave It Alone?

The inflammation spreads to the bone, causing its atrophy. The tooth can become loose and fall out.

Treatment for Pain Under a Crown

Abscess

An inflammation at the tooth root with pus causes pain. If the inflammation is old, a cyst may form, visible on an X-ray.

Nerve Not Removed

Secondary caries reaching the pulp causes pain. The crown needs to be removed to treat the various tissues.

Crown on a Post

When removing the crown, the dentist must be careful to avoid root fracture or perforation when extracting the post.

How is treatment conducted?

• With the removal of the crown. In cases of secondary caries, a cyst on the root, or acute periodontitis, the crown is removed for treatment, and then a new prosthesis is made and fixed.
• Without removing the crown. A hole is drilled in the crown to provide access for treatments, such as root canal therapy.

When is it necessary to remove the crown?

• When a cyst or abscess is present at the root of the tooth.
• In cases of acute periodontitis and deep caries.
• In case of an allergy to the crown material.

Here are some cases when it's necessary to remove the dental prosthesis:

• If the prosthesis is held on a post, its removal can be difficult. In some cases, this may lead to the removal of the tooth, root fracture, or perforation.
• If the cause of inflammation is poorly filled root canals, they need to be re-treated. This process requires high professional skill and diligence from the dentist. Sometimes dentists suggest removing the tooth and placing a bridge or implant, which increases the cost of treatment.
• Even if the dentist decides to remove the filling and treat the canals, a long-term inflammation treatment is required. This can take 1-3 months with regular dental visits. Only after anti-inflammatory therapy can a high-quality canal filling be done and a new crown placed.

Is it always necessary to remove dental prosthesis for tooth treatment?

No. Sometimes an apicoectomy or root-end resection is enough if the inflammation affects only the upper part of the root canal. The surgeon drills a hole in the bone to remove the infected parts of the root and pus. The operation is performed under local or general anesthesia.

Preventive Measures

To prevent problems after crowning a treated tooth, follow these recommendations: