To better explain the causes of tooth pain under a crown, we must first understand who gets one and why.
A crown is a kind of cap that is placed on the tooth, covering and protecting its tissues. It is applied in three cases:
• If the crown of the natural tooth is more than half damaged and cannot be repaired by a filling or other restoration;
• To improve the aesthetics of the tooth - to correct the shape of the tooth, to hide visual defects;
• For restorations with a bridge. In this case, crowns are placed on the supporting teeth.
A crowns can only be placed on a tooth with an intact root. If the upper part of the tooth is severely damaged and the decay has reached the pulp cavity, the tooth is repaired and the root canals are filled in before the crown is placed.
For bridges, the supporting teeth are covered with dental crowns even if they are not decayed. If the tooth is relatively healthy and the dentin and pulp are intact, crowns can be placed without pulping.
The specialists at our clinic do not recommend bridges to patients, but offer other types of restorations, as long as the supporting teeth are healthy. In order to place a crown, the doctor must grind the tooth, i.e. completely remove the enamel. Without a natural protective layer, even a crowned tooth becomes vulnerable and gradually decays. A dental bridge should only be placed on teeth that have "nothing left to lose".
Modern dental crowns are made from :
• Metal. Metal crowns are considered outdated due to their lack of aesthetics, but they are still used because they are the least expensive option;
• Metal-Ceramic. A relatively economical and durable option, but due to the metal base, it is difficult to achieve a "healthy" whiteness of the artificial tooth;
• Ceramic. Ceramic crowns are more aesthetically pleasing than metal-ceramic crowns, but their strength is lower, so they are usually placed only on front teeth;
• Porcelain. A variety of porcelain crowns. Porcelain crowns are indistinguishable from natural teeth, because the optical properties of the material are similar to those of tooth enamel. They are also mounted on the front teeth ;
• Zirconia. Made from zirconium dioxide, with a ceramic coating. Durable, aesthetic, but relatively expensive crowns.
Zirconia crowns can be used on any tooth.
This material, contrary to popular belief, does not cause toothache, but it may be the answer to the question: why is the gum painful after placing a crown? Inflammation of the mucous membranes and gums can be caused by an allergic reaction to the metal of the metal crown. Patients with ceramic and zirconia restorations do not experience such problems.
Toothaches can be caused by a number of reasons, most of which are related to improper pretion of the tooth for the crown. The most common cause is an error in filling the root canal after a pulp removal.
Inflammation under the crown can be caused by:
• Failure to fill the root canal. If the root canal is not filled to the top, the empty space is quickly invaded by pathogenic microflora. Its products cause inflammation.
• Poor quality filling (root canal filling). If the doctor, in his haste or inexperience, does not fill the root canals properly, they can be invaded by bacteria, which can eventually cause inflammation. Pain in the crown can occur months or years later.
• Perforation of the root canal wall. The most common situation is when the doctor mechanically widens the root canal with a rasp. For example, in a curved or bent root canal. The practitioner must have a lot of experience to be able to fill these root canals correctly without drilling the wall. The dentist may also damage the wall when inserting the post. If the hole is closed immediately with a special material, there will be no complications. But if the doctor simply fills the root canal without closing the "gap", problems can occur. The filling material is not fully biocompatible with the periodontium, the connective tissue that surrounds the root. If it escapes from the root canal through the hole it has created, the periodontium becomes inflamed. A cyst or granuloma can be a complication of the inflammatory process.
• A broken instrument in the root canal cavity. Unfortunately, this is not uncommon. A broken instrument can be caused by poor technique and is the fault of the doctor. Or due to a physiological condition of the root. For example, if it is very curved and difficult to pass. In this case, it is not the fault of the specialist. The main problem in these situations is that it is often impossible to remove the chip from the root canal. But regardless of why a foreign body is in the root canal, it can cause inflammation, even if the root canal is sealed.
• Pulp burn. This occurs when a crown is placed on a living (non-pulped) tooth. During treatment, the specialist must strictly follow the protocol. In particular, use water cooling and do not let the tissue overheat. If the dentist does not follow the protocol or is in a hurry, the dentin will overheat from the friction of the bur and "burn" the neurovascular bundle underneath it. As a result, the pulp becomes inflamed, the tooth reacts to heat and cold, and acute pain can occasionally occur, which can develop into a stabbing pain.
• Improper placement of the crown. For example, the crown does not fit properly, there is a gap between the crown and the tooth. Another possibility is that the acetabulum of the crown is too low, which presses on the gum and causes inflammation. The patient may feel pain under the crown when pressure is applied.
Root inflammation can occur without symptoms for a long time. However, at some point, the patient feels pain when pressing or chewing on the tooth. Over time, other signs of inflammation may appear:
• Gum swelling;
If you have a toothache, you need to see a doctor, preferably an experienced doctor with good references. Putting off a visit thinking that "it will go away by itself" is not a good idea. The inflammation will only get worse. If you don't know where to go for pain in Moscow, come to our clinic, the phone number for an appointment is at the top of this page.
Acute pain occurs when the inflammatory process is very advanced and a lot of pus has accumulated in the root area. Analgesics or non-steroidal painkillers can provide temporary relief. They are available in pharmacies without a prescription. However, it is important to remember that these medications do not cure or eliminate the inflammation, so you should see a doctor as soon as possible.
Treating dentures is difficult and expensive. Inflammation can only be relieved by removing the cause. To do this, the root canals must be unsealed, an anti-inflammatory treatment must be performed, which may last 2-3 months, and then the root canals must be re-sealed.
The fear that the crown might fall of and cause an infection in such case is usually baseless, so the patients should not fear it.
The patient not only has to undergo several unpleasant procedures, but also has to pay for a new prosthesis, because in most cases the crown has to be removed. Sometimes the dentist is able to fill in the root canals without removing the denture. A hole is drilled in the crown, which is filled with a filling after treatment. However, this is not always possible.
Not all professionals will agree to retreat the tooth under the crown. It is time consuming and there is no 100% guarantee that retreatment will save the tooth. In such situations, many doctors immediately refer the patient for an extraction. The specialists at our clinic take on the most difficult cases and do everything they can to save the patient's teeth.
If the inflammation is due to an undercutting of the root canal, but treatment by conservative methods is impossible, the doctor may suggest the patient to solve the problem surgically - by performing a resection (excision) of the root apex. In this case, the unsealed area where a granuloma or cyst is located is removed through an incision in the gum. The operation is performed under local anesthesia and takes 30 to 60 minutes.
The doctor determines the treatment method individually for each situation, depending on the cause and stage of the inflammation. Unfortunately, there are situations when it is really impossible to save a tooth and the only option is its extraction and subsequent placement of a prosthesis.
No matter what the "experts" on the Internet say, there is no effective folk remedy for toothache. Especially if its cause is an inflammation of the root tip. If you have a toothache, do not treat yourself, do not aggravate the situation - consult a dentist.