When we decide to cover teeth with ceramic crowns or bridges, it is assumed that the teeth are healthy or properly treated. In addition, these teeth should have healthy surrounding structures — bone and gums.
So why does it sometimes happen that a tooth starts to hurt right after cementation, or even several years later?
Pain can occur due to problems with the tooth itself or due to gum-related issues.
Tooth Pain
1. Pain after cementation
Mild pain after cementing a crown or bridge can last for several days. This is a natural reaction of the tooth and usually decreases over time, or in some patients does not appear at all. The problem arises when the pain does not subside for weeks or months after cementing a new crown or bridge. This may be the result of:
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physical or chemical trauma to the tooth,
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improper bite,
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or an already existing tooth pathology.
2. Pain several years later
If pain appears years later, it usually indicates tooth decay (caries) or nerve inflammation under the crown. This often occurs in patients whose gums have receded over time. In such cases, part of the tooth is no longer fully protected by the crown, becomes exposed, and thus vulnerable to bacteria. Bacteria then cause decay or nerve inflammation.
Gum Pain
1. Pain after cementation
This can be caused by the injection of anesthesia and usually disappears spontaneously after a few days. Gums may also become painful due to inadequate oral hygiene. In such cases, food particles remain trapped between the crown and gums, bacteria multiply, leading to gum inflammation and bleeding.
2. Pain several years later
As already mentioned, gum recession is often the cause. In the advanced stages of gum disease, periodontitis develops, leading to bone loss and the formation of so-called periodontal pockets. These pockets are filled with bacteria and can often cause severe, sudden pain, swelling, and a foul taste in the mouth.
(Example of gum recession around an old bridge: https://www.minthilldentistry.com/gum-recession)
What to Do When a Tooth Hurts Under a Crown?
When pain occurs in a tooth covered by a crown or bridge, you should see your dentist as soon as possible. The longer you wait, the lower the chance of saving that tooth.
To relieve symptoms temporarily, you can take an over-the-counter pain reliever. It is also important not to neglect oral hygiene even if the tooth is painful, as this helps remove bacteria from the mouth.
What Can a Dentist Do in These Situations?
Based on a clinical examination and X-ray analysis, the dentist will determine the appropriate treatment.
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If the gums are healthy and the pain originates from the tooth, it may be possible to treat the tooth through the crown.
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In other cases, when the gums do not fit well around the crown or bridge, the dentist may recommend removing the restoration, treating the tooth, and then making a new crown. (Once old crowns and bridges are removed, they cannot be reused and must be replaced with new ones.)
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If the pain is caused by gum inflammation, a detailed cleaning (periodontal treatment) is required. This procedure removes plaque, tartar, and bacteria responsible for the inflammation.
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If pain is due to an inflamed periodontal pocket (acute periodontal abscess), the pocket can be cleaned (curettage) as a temporary measure. However, in many cases gum recession is also present, and the restoration will eventually need to be replaced.
Infection at the Root Tip That Doesn’t Cause Pain
Sometimes, patients have a crown on a tooth where the nerve was previously removed, but an infection (lesion, abscess) develops at the root tip. This condition is often accompanied by a small bump on the gum (similar to a pimple) in the area of the root tip.
The problem can be resolved if the tooth has healthy gums and surrounding bone. In such cases, a surgical procedure is performed — only the diseased root tip is removed (apicoectomy), while the tooth itself remains in the jaw.
If you notice even mild pain, contact your dentist as soon as possible so that timely treatment can be performed. Delaying may cause the pain to worsen and eventually lead to tooth loss.
