Why does a temporary crown often bring pain?

As your tooth becomes severely damaged to the point that it can no longer support a filling, your dentist may suggest a crown to restore and protect it.

However, this does not come without a cost. Often, the pain comes right after you receive your temporary crown.

Find out in this article whether your pain is normal or not, the possible complications, and how to manage them while waiting for your permanent crown.

What happens to the tooth that will receive a temporary crown?

Before placing a crown, your dentist must first trim the tooth so that the crown can fit.

But before we go any further, we need to know that our teeth are covered with two hard layers: enamel and dentin.



Enamel is the outermost layer and hardest tissue of our body, while dentin is softer and lies beneath it. After the tooth preparation, only a layer of dentin remains, which separates the nerves from the outside environment.

The problem is that dentin is not an impermeable tissue and does not protect the tooth sufficiently as enamel does. It is composed of numerous canals called dentinal tubules, which represent an easy entrance for bacteria to the pulp. There are approximately 18,000 and 21,000 tubules per mm2 of dentin (1).

A tooth with exposed dentin is therefore more sensitive and can cause sensitivity to hot and cold foods, hence the need for a well-fitting temporary crown. A crown that doesn't completely cover the tooth can let saliva and bacteria leak through the dentin. The outcome? Pain that gets worse with meals or when having a hot or cold drink.

In addition, the pulp, which contains our teeth's nerves and blood vessels, can be slightly irritated during the procedure. This is because it can feel the pressure of the instruments used. In response, the pulp triggers a temporary inflammation, which explains the pain you feel right after the numbness wears off (2).

When is pain from a temporary crown normal?

After placing a temporary crown, some pain or discomfort should not be a cause for concern. If your tooth is alive (without root canal treatment), you should expect some nerve inflammation following the procedure. This is usually a short-lived reaction that gradually subsides and resolves on its own in a few days.

Note that the pain should be moderate and should not persist after the stimulus is removed. Otherwise, if the pain is intense, constant, and extends to other areas of the jaw, you should talk to your dentist as it may be an infection.

Your gums may also feel a little sore after the procedure. This is because your dentist may have accidentally injured your gums. You should know that this is temporary and that your gums will soon return to their normal state.

Additionally, you should give time to your mouth to adapt to your new crown. It can take up to two weeks for your jaws to align and for your bite to feel right. Therefore, discomfort in your mouth or pain when chewing your food is perfectly normal.

The most common problems associated with a temporary crown:

The main purpose of a temporary crown is to protect the tooth from external irritation and to restore its appearance until the permanent crown is ready.

However, in some situations, the temporary crown can be associated with several problems that can cause you abnormal pain and discomfort. These include:

1. Cavities:

When placing a temporary crown, the dentist makes sure that there are no gaps near the gum line where bacteria and food debris can enter. If this happens, tooth decay can occur under the crown, which, if left untreated, can lead to infection.

This can also occur if the dentist has not completely removed the decay before cementing the crown. In this case, the lesion can quickly spread and reach the tooth nerve.

How it looks like?

If a cavity has developed, you may notice a black discoloration around the crown and near the gum line. Your tooth will also be more sensitive, especially to cold and sour foods.

Treatment:

Your dentist will first remove the crown and clean your tooth. Then, he will put the crown back in place.
If the decay is too deep or if your dentist suspects that the nerve is infected, he may perform a root canal.

2. Infection:

Although dental crowns have a high survival rate, an infection can occur. This is most likely to happen if your tooth has been damaged too much by decay, your oral hygiene is poor, or the crown is not fitted properly. This is why a dental crown often comes with a root canal.

According to an article published in The Journal of Prosthetic Dentistry, of the 823 crowns studied, 27 required root canal therapy (3%).

Be aware that even a tooth with a root canal can still become infected. If decay occurs, it can damage tooth structures and allow bacteria to penetrate deep into the tissue.

The symptoms to look for:

Symptoms to look for in a dental infection include:

• Redness around the crown
• Intense pain radiating to the jaws
• Heat sensation
• Pus discharge around the crown
• Bad breath or unpleasant taste in the mouth
• Gum boil
• A feeling that the tooth is long

Treatment:

If the tooth becomes infected, a root canal is required. If already done, your dentist may do it a second time. In extreme cases where the tooth is too damaged, an extraction may be necessary.

3. The crown doesn't fit correctly:

If there are problems with the shape and size of your crown, you may experience pain and discomfort, especially during meals.

For instance, when the tooth sits higher, it will be overloaded by receiving more chewing force than usual.

On the other hand, if the spaces between the teeth are not properly restored, food could accumulate in those areas and irritate your gums.

Symptoms to look for:

• Your temporary crown is loose or comes off the tooth;
• Sensitivity and discomfort when chewing;
• Your bite doesn’t feel right;
• Accumulation of food debris between your teeth;
• The spaces between the teeth are too wide or too tight.

Treatment:

If you think your crown is poorly shaped, talk to your dentist. He will adjust the height and size of your crown so that it lines up with your other teeth. This way, the chewing forces can be distributed evenly.

4. Extreme sensitivity to hot or cold foods:

When this happens, it usually means that the crown does not cover the entire tooth. There is still some exposed dentin that reacts to cold, hot, or acidic foods with a brief, sharp pain.

Treatment:

Treatment consists of reshaping the crown by adding more material over the missing areas. The goal is to cover all exposed dentin to stop sensitivity.

Other potential causes of your temporary crown pain:

Other causes of pain in your temporary crowned tooth can include:

1. Receding gums:

When the gums pull away from your teeth, they expose the roots to the oral environment. Because the roots are more sensitive, you may start to feel pain when you eat cold, hot, or acidic foods.

2. Sore gums:

Pain or inflammation of the gums surrounding the tooth after the procedure is normal if it lasts a few days. However, if it lasts longer than expected, visit your dentist to rule out any possible infection.

3. Bruxism:

If you have a habit of grinding or clenching your teeth, this is probably the cause of the toothache you are experiencing. The forces triggered by bruxism will overload the tooth, causing irritation and inflammation of the dental tissue.

4. Cracked tooth:

Tooth fracture can also be a potential cause of your pain. After trimming the tooth, it becomes more fragile as it has lost some of its supporting structure. It's even worse if it has had a root canal. This makes the roots weaker and more likely to break.

The risk is higher if you put excessive force on the tooth, such as by biting on something hard.

In its early stage, it can be challenging to spot. However, it usually starts with pain on pressure or when you chew on the tooth. You may also notice a tiny line when you take a closer look at the tooth. When you go to your dentist, he may have to remove the crown to better assess your tooth.

When should you talk to your dentist?

The pain after crown placement is usually temporary. It should gradually subside within the first week. This is the case when the pain is isolated to the tooth and doesn't spread to the jaw or face. The pain should also stop as the stimulus is removed.

However, some symptoms may indicate that something is wrong. You should talk to your dentist if you experience any of the following:

1. Severe toothache: If you experience intense, stabbing tooth pain, especially if it is spontaneous, it is important to see your dentist as soon as possible. It could be an infection that needs to be treated rapidly to save the tooth.


2. Bleeding or swollen gums: If your gums are bleeding or swollen, it may be a sign of gum disease or, more seriously, an abscess. Your dentist can help you determine the cause and recommend the appropriate treatment.


3. Your crown is loose: If you notice that your crown is loose or not firmly attached to the tooth, talk to your dentist to adjust it.


4. Sensitivity to hot or cold: If your tooth is sensitive to hot or cold foods or drinks, your crown may not completely cover the tooth. This could also be a sign of decay or gum recession. Your dentist will help you identify the real cause and recommend the appropriate treatment.

How to manage the pain from a temporary crown at home?

Here are some tips that can help relieve your discomfort and pain after crown placement:

• Over-the-counter pain relievers: Taking over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help reduce pain.


• A mouthguard: If you clench or grind your teeth, wearing a mouthguard can help relieve the pressure on your teeth. This can also prevent other dental conditions, such as tooth wear and gum disease.


• Saltwater rinse: Rinsing your mouth with warm salt water can help to reduce inflammation and promote healing. Dissolve a teaspoon of salt in a cup of warm water and rinse your mouth with the solution for 30 seconds to one minute, then spit it out.


• Baking soda rinse: Baking soda rinse can help to offset acidity in your mouth, reduce inflammation, and soothe pain and discomfort around your crown.


• Avoid hard or sticky foods: To prevent further pain and discomfort, avoid hard or sticky foods that may dislodge the temporary crown or exacerbate the pain. Stick to soft foods and liquids until the pain subsides.


• Apply a cold compress: Applying a cold compress to the affected area can help to reduce swelling and relieve pain. Wrap a bag of ice or a cold pack in a towel and apply it to the cheek near the affected tooth for 10 to 15 minutes at a time.