Pain in or under your crown can occur from day one when it was put in, or many years after the crown was placed. The pain can be transient or it can be continuous. Source: https://medium.com/what-is-gingivitis-dr-muzzafar-zaman/pain-in-my-crown-11930c9ac8dc

1. Pain In My Crown
Pain in or under your crown can occur from day one when it was put in,
or many years after the crown was placed. The pain can be transient or it
can be continuous. It may occur without any reason or it may be set off
in response to a particular stimulus such as hot, cold or chewing. Pain
under a crown is quite common so we will explore reasons and solutions
if you notice this problem. All crowns can cause pain for example, a gold
crown, a porcelain fused to metal crown, a Zirconia crown and so on.
Pain in or under your new crown.
When your dentist has just placed a new crown over your tooth and the
tooth is vital i.e the nerve is still alive, this can cause pain. Often, a
crown is placed on a tooth which has had a root filling so on these
teeth, there should be no sensation whatsoever because the nerve has

2. been already removed.
It is common to find that a new crown takes some time to fully settle
down. Hopefully and usually, any initial pain or sensitivity is not severe
and does not last for more than a day or so. This is simply because the
dentine of the tooth has been exposed during the process of crown
cementation. In addition, the permanent cement can initially cause the
underlying dentine to respond causing pain. If you avoid eating on this
side initially with also taking some painkillers such as paracetamol or
ibuprofen or similar, this will help you until the pain or sensitivity
naturally subsides. Once your new crown is pain free, you can start
eating on it as normal and it will just feel like a normal tooth.

3. What if this initial pain does not go away or is getting worse? The best
advice here is to take painkillers and book an emergency appointment
specifically with the dentist who did the treatment. A very common
cause of pain under a crown is an incorrect bite causing a premature
occlusal contact. Usually, a new crown will feel odd to chew or bite on
for a few days but it will gradually feel comfortable and inconspicuous
again unless the bite is incorrect in which case you will need to see your
dentist.

4. Your dentist will reassess your bite using articulating paper. Articulating
paper makes coloured marks on your teeth which the dentist uses as a
guide to adjust the bite. If the bite on the crown is high, the dentist will
adjust the bite using a polishing burr in the dental handpiece. This is
easily done without the need to administer a local anaesthetic first.
Ideally it is best not to adjust a crown in the first place but if it has to be
carried out, ask your dentist to make it as smooth as possible where it
has been trimmed back so your tongue does not keep rubbing over any
rough areas left behind after the adjustments. If the bite is very
incorrect, it can be necessary to remake the crown from scratch again.
Another way to readjust the bite is to sometimes polish the opposing
tooth that the crown bites on. Once again, a mild adjustment is
acceptable but anything more will require a new crown to be made again
from scratch.
In rare cases, when a new crown just does not settle down it can even
develop into a raging continuous toothache leading to an abscess and
swelling. If this happens, your dentist will need to carry out further
treatment such as a root canal or even an extraction.

5. Pain once the crown has been in for a while
You may have had a crown placed months or years ago and you have
never had any problems with it whatsoever, until now that is. At first,
you probably ignore it in the hope it disappears but every time you bite
on it, it hurts. Eventually the pain gets worse.
The most common cause for a crown causing pain is when decay has
developed inside your own tooth under the crown. It’s very important to
have your crown checked by your dentist immediately. Decay under a
crown can be very bad news because once it has spread to a certain
depth, the tooth has to be extracted. It’s also worth bearing in mind that
early decay under a crown is not easily identified by visual examination
or by radiographs. Once the caries has spread deep into the pulp, it can
cause the formation of a periapical abscess. A periapical abscess is
identified on a periapical radiograph of the tooth. Sometimes it is still
possible to save the tooth by first of all removing the crown away from
the underlying tooth. Next, all decay is cleaned out and a root canal is
started. Once the root canal has been completed with a good apical and
coronal seal, the tooth is built back up as a pinned core or a post core.
Finally a new crown is made using the appropriate material such as
gold, porcelain or zirconia.
If it is not possible to save the tooth, the options available to restore the
gap are an implant, a bridge or a denture.

6. REFERENCES
International Journal of Applied Basic Medical Research. 2015 Sep-Dec;
5(3): 164–168.
Cracked tooth syndrome: Overview of literature
Shamimul Hasan, Kuldeep Singh, and Naseer Salati
Associations of Types of Pain with Crack-Level, Tooth-Level and Patient-Level
Characteristics in Posterior Teeth with Visible Cracks: Findings from the
National Dental Practice-Based Research Network.
Hilton TJ1, Funkhouser E2, Ferracane JL3, Gordan VV4, Huff KD5,
Barna J6, Mungia R7, Marker T8, Gilbert GH9; National Dental PBRN
Collaborative Group.
European Journal of Dentistry . 2015 Apr-Jun;9(2):293–303.
Cracked tooth diagnosis and treatment:
An alternative paradigm.
Mamoun JS, Napoletano D.
British Dental Journal 2010 May 22;208(10):459–63. doi:
10.1038/sj.bdj.2010.449.
Cracked tooth syndrome. Part 1:
aetiology and diagnosis.
Banerji S, Mehta SB, Millar BJ.
JOURNAL OF DENTAL RESEARCH
Global Burden of Untreated Caries

7. A Systematic Review
N.J. Kassebaum12
N.J. Kassebaum
1Institute for Health Metrics and Evaluation, University of Washington,
Seattle, WA, USA2Department of Anesthesiology and Pain Medicine,
University of Washington and Seattle Children’s Hospital, Seattle, WA,
USA
3Division of Population and Patient Health, King’s College London
Dental Institute, London, UK
M. Dahiya4
Tagged in Dentistry, Dr Muzzafar Zaman
By Dr Muzzafar Zaman on February 16, 2018.
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Exported from Medium on May 11, 2018.