There are several common reasons why a tooth hurts under a crown.
Causes of pain
As a rule, before installing a crown, the tooth is depulped - that is, the neurovascular bundle in the root and coronal part is removed, after which the canals are filled. Pain may be caused by some features of these manipulations:
- incomplete filling of the canals - as a result of the formation of voids in the root canals, an infectious process may begin to develop; Pus accumulates at the root tip, which causes pain. This is a common complication of endodontic treatment, especially in cases where the canals are too narrow or curved;
- subsidence of filling materials over time - even if the root canals are completely filled, changes in the physical properties of the materials can also lead to the appearance of voids - infection develops in them, inflammation spreads to the tissues near the apex of the tooth root;
- removal of the filling material beyond the root apex - “excess” material in the periodontal tissues can provoke irritation and inflammation.
Pulpitis. Inflammation of the pulp can occur in cases where a decision was made to preserve it - tooth processing can lead to a burn, the infectious process may already begin in the pulp and be asymptomatic, which becomes the cause of inflammation. Preserving living pulp before installing a crown on a tooth is a rare occurrence; as a rule, the “nerve” must be removed.
Perforation of the walls of the root canal. Perforation is the creation of a hole in the root canal, a phenomenon that occurs for several reasons:
- perforation may be a consequence of mechanical processing of the canal with a thin instrument - it must enter the canal along its entire length. If the canal is curved, then even a slight pressure can cause the instrument to pass through the tooth tissue;
- installation of a pin can lead to perforation - it is installed in the root canal, which, given the appropriate anatomical features of the structure of the root system, can also lead to the formation of a hole.
The hole is a “gateway” for infection—the tissue becomes inflamed some time after the pin is installed or endodontic treatment is performed, which causes pain.
Why does the tooth under the crown hurt?
The reason for this may be the presence of a foreign body in the canal. During endodontic treatment, the tip of the instrument may break off; subsequent filling of the canal with a foreign body leads to pain. There can be several reasons for breakage - the most common of them is the curvature of the canals. If they are difficult to pass, the tool may break due to the high load.
As a rule, in this case, the patient feels pain when exposed to temperatures, and the tooth under the crown also hurts when pressed. Pulsation may appear during exertion or chewing on the side with the crown installed. Tapping on a tooth also causes discomfort.
In order to avoid such a complication, the dentist must perform an x-ray diagnosis before installing a crown or any other dental prosthesis.
If the technology for processing and preparing the tooth for prosthetics is followed, installing a crown can also cause pain - if the design is too high for the bite, the patient feels discomfort when closing the jaws. This is why the stage of “trying on” the crown before its final installation is important - a good orthopedic dentist will first assess the degree of comfort for the patient.
Installation
Before installing a crown, you need to remove tartar and plaque, and treat caries on nearby teeth.
Prepare the tooth itself for installation, treat caries if necessary.
In the absence of the required volume of tissue, the installation of a pin and the installation of a stump pad are required.
This is followed by gentle grinding of the tooth with a drill. The procedure is performed under local anesthesia. Afterwards, an impression is made or a digital copy of the tooth is scanned. This cast/copy is sent to the laboratory, and a specialist creates a prosthesis based on it. If we scan using CEREC technology
, then the doctor begins making the crown literally in 20 minutes, see video:
The finished product is tried on and adjusted if necessary before installation.
If there is a delay in production, then in order to cover the ground tooth, since aesthetics suffer and sensitivity increases, plastic dentures are offered.
Installation steps
So, the crown is made, all that remains is to try it on and install it. The dentist, putting on a crown, asks whether it hurts or not?
If not, then fix the crown with special temporary cement. All that remains is to wait 30 days to make sure that the patient does not have an allergy and that the closure of the teeth in the area where the crown is installed is normal.
After this, at the next appointment at the clinic, the remaining cement is removed, the denture is placed on a stronger composition, permanent cement, and it can only be removed by sawing it in parts.
A pulpless tooth hurts
If the pulp has been removed, the pain is most often aching. It can radiate to the temple or ear. The main reason for this phenomenon is the exacerbation of chronic periodontitis. The choice of therapy method is determined by the presence or absence of a pin in the tooth root canal:
- there is no pin: the doctor opens the crown, unseals the root canals and treats them properly, after which he places materials impregnated with antibacterial agents into the tooth. Several changes to the medication may be required until complete relief is obtained and the inflammatory process is eliminated. After the symptoms have completely subsided, the canals are filled again and a new crown is installed;
- there is a pin: the doctor can cure periodontitis through surgery - resection of the apex of the tooth root. It is performed through a small incision in the gum, through which the source of infection is removed, and if necessary, the resulting void is filled with osteoplastic material. Typically, the intervention lasts from 30 to 60 minutes and is well tolerated by patients.
Clinical researches
ASEPTA® mouth rinses are designed to protect gums from inflammation and improve oral hygiene. The main indications for their use are:
- acute and chronic gingivitis;
- acute and chronic periodontitis;
- stomatitis;
- post-extraction alveolitis;
- toothache of infectious origin.
Clinical trials conducted in laboratories have shown that after 3 weeks of using ASEPTA® rinse, gum bleeding is reduced by 28.3%, inflammation is reduced by 32.3% and the hygienic condition of the oral cavity is improved by 33.5%*.
Sources:
- Clinical and laboratory assessment of the influence of domestic therapeutic and prophylactic toothpaste based on plant extracts on the condition of the oral cavity in patients with simple marginal gingivitis. Doctor of Medical Sciences, Professor Elovikova T.M.1, Candidate of Chemical Sciences, Associate Professor Ermishina E.Yu. 2, Doctor of Technical Sciences Associate Professor Belokonova N.A. 2 Department of Therapeutic Dentistry USMU1, Department of General Chemistry USMU2
- Clinical experience in using the Asepta series of products Fuchs Elena Ivanovna Assistant of the Department of Therapeutic and Pediatric Dentistry State Budgetary Educational Institution of Higher Professional Education Ryazan State Medical University named after Academician I.P. Pavlova of the Ministry of Health and Social Development of the Russian Federation (GBOU VPO RyazSMU Ministry of Health and Social Development of Russia)
- Report on clinical trials to determine/confirm the preventive properties of commercially produced personal oral hygiene products: mouth rinse "ASEPTA PARODONTAL" - Solution for irrigator." Doctor of Medical Sciences Professor, Honored Doctor of the Russian Federation, Head. Department of Preventive Dentistry S.B. Ulitovsky, doctor-researcher A.A. Leontiev First St. Petersburg State Medical University named after academician I.P. Pavlova, Department of Preventive Dentistry.
Gum pain
If the gums hurt, and not the tooth itself with a crown installed, there may be a deformation of the crown or a discrepancy in its size - the gums are mechanically damaged, which leads to inflammation and pain. For example, the edge of the crown extends under the gum or, on the contrary, does not reach its edge significantly - in the first case, a sharp edge can lead to soft tissue injury and inflammation. Moreover, it is worth noting that the pain can radiate into the tooth itself, which makes self-diagnosis difficult - the patient simply does not understand that it is the gums that hurt, and not the tooth under the crown.
If the crown does not reach the edge of the gum, the tooth under the crown hurts greatly - but not immediately after installation, but after quite a long time. The retention of food debris between the edge of the structure and the gum leads to the proliferation of pathogenic bacteria, the development of caries, and the destruction of tooth tissue under the crown. This leads to severe pain, tooth reactions to temperature, stress, etc.
The doctor’s tactics in this case is to remove the unsuitable crown; this is the only measure that a specialist can take to eliminate the problem.
If the gums are swollen, and even more so in cases where there is swelling of the cheek, there is most likely inflammation in the area of the apex of the tooth root. As a rule, swelling forms in the projection of the apex of the root of the causative tooth. You cannot do without a visit to a dentist - he will decide on the choice of treatment method taking into account the condition, structural features of the dental system, and the severity of the disease.
A fistula on the gum often forms a certain time after the appearance of swelling. This happens because the pus accumulated at the apex of the root requires release - after its outflow is established, the symptoms may subside, but this does not mean that the disease has passed. In this case, a visit to the doctor is mandatory - it is important to treat the disease and prevent possible complications.
What symptoms should you see a doctor for?
What to do if a tooth with a removed root hurts under the filling when pressed? During the first few days, do not panic and observe the nature and intensity of the pain. Pain during the week after filling may be a normal reaction of the body to surgical procedures. In what cases do you need to urgently contact the clinic?
- If within 5-7 days the pain does not go away, intensifies, changes its character to acute, pulsating;
- swelling of the gums appears;
- there is an increase in body temperature.
In such situations, you need to urgently see a dentist so as not to worsen the situation.
When is pain normal?
Even a perfectly installed crown can provoke painful sensations immediately after prosthetics - as the local anesthesia wears off. The pain may be constant or occur with pressure. How to distinguish these sensations from those caused by pathology?
Firstly, pain normally lasts no more than 1-3 days - this is due to the adaptation of tissues to the new structure in the oral cavity.
Secondly, the pain tends to subside. Increasing sensations indicate a pathological process.
What complications may arise?
Pain in a dead tooth necessarily indicates the presence of some pathology that needs to be eliminated in a timely manner. Infection can lead to serious consequences:
- complete destruction and death of the tooth;
- chronic gum inflammation;
- development of periodontitis, gingivitis;
- the appearance of cysts.
In addition, failure to seek medical help in a timely manner can lead to the development of systemic infections that spread from the periosteum through the bloodstream throughout the body!
How to help yourself if the tooth under the crown hurts?
A tooth hurts under a crown - how to relieve the discomfort? It is important to make an appointment with a doctor first. Painkillers can be used as temporary measures, but you should consult with your doctor about the advisability of their use. It will not be possible to eliminate the cause of the pain at home - you can only alleviate the symptom a little.
You can resort to rinsing the mouth with warm water, in which 1 tsp was previously diluted. salt. A weak decoction of chamomile can also be used after first checking the temperature of the product - it should be room temperature.
Avoid heating the diseased tooth - hot compresses can lead to complications. Also, you should not apply “burning” products like garlic to the gums - you can get a burn to the mucous membrane.
This cannot be done!
Often, in an effort to relieve pain, patients resort to rather risky methods. Remember what you should never do if inflammation starts:
- taking antibiotics without a doctor’s prescription - at best it will not bring results, at worst it will lead to serious health problems;
- warm the sore spot - elevated temperature favors the proliferation of pathogenic microorganisms, so such “treatment” will only worsen the condition;
- It is undesirable to take a horizontal position so as not to increase blood flow to the diseased tooth.
And finally, you should not let the situation take its course in the hope that the pain will go away on its own. It won't work! In order to get rid of pain, a doctor’s intervention or his recommendations are often necessary.
How to prevent pain?
Prevention of toothache under a crown includes following your doctor’s recommendations: crowns should be brushed just like your own teeth - at least 2 times a day. It is worth paying special attention to cleaning the spaces between the teeth and around the gums - this is where the largest amount of food debris and plaque accumulates. It is recommended to use not only a toothbrush and toothpaste, but also dental floss and, if possible, an irrigator.
You will have to refrain from eating solid foods - seeds, nuts, in order to avoid damage to the crown.
Visit your dentist at least once a year to monitor the quality of your dentures.
Signs of inflammation
You need to pay special attention to the following symptoms:
- Pain. Most often, its cause is inflammation of the soft tissue under the crown or irritation of the root canals.
- Edema. This is a signal that inflammation has begun.
- A fistula is a channel from which pus comes out; it may appear some time after swelling.
It is worth remembering that after prosthetics, the first two to three days may be uncomfortable. In this case, you do not need to take any additional measures; if pain interferes with the usual course of business, take pain medications.
