You've just had a dental crown placed and now your tooth requires root canal treatment?
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Complications with a dental crown: The tooth now hurts.
Here's a scenario that as a dentist I've struggled with explaining to patients. No doubt every dentist has.
A patient comes in with a broken tooth or one that has extensive decay. The tooth clearly shows need for repair but otherwise is asymptomatic (hasn't caused any pain). I tell the patient that their tooth needs to have a dental crown made for it. The work is scheduled and begun.
[Thanks to Animated-Teeth.com for granting me permission to use their graphics. Their website has a section on it about dental crowns, including when they should be placed and how they are made.]
During those days and weeks after the initial crowning work has been performed (or even those first few days or weeks after the whole crowning process has been completed) the situation changes. Now the patient does experience symptoms with their tooth. Possibly it throbs without rhyme or reason or else it is tender when they try to chew with it. The patient now returns to my office so I can evaluate these new events.
Sometimes there are very simple fixes for a tooth like this, if one is even required at all. But in other instances it may very well be that the only determination that can be made is that tooth needs root canal treatment. So what went wrong? How does a tooth go from being just fine to now being painful and needing root canal treatment, just because a dental crown has been placed?
[If you need more information, Animated-Teeth. com has a section on their website that describes what root canal treatment is and what takes place when you have endodontic therapy.]
Well, in these circumstances there certainly does seem to be some correlation between the time frame when the crowning procedure was begun and the tooth pain began. But is it simple cause and effect? Was there something about the crowning process that was done wrong? In most cases no. Here's why.
A tooth's nerve is easier to damage than you might expect.
The nerve tissue found in a tooth lies in a precarious locality, it is housed inside a hard object (the tooth). When a tooth's nerve receives insult (such as trauma from blow to the tooth, tooth fracture, the presence of a large amount of decay, or trauma from a dental procedure such as drilling out decay or trimming a tooth for a dental crown) it's natural response is to swell (just like trauma associated with twisting an ankle will make it swell). The problem with this swelling event is as follows.
Since the nerve tissue is encapsulated inside the tooth, as it swells it has no room in which to expand. As a result the swelling action (inflammation) creates a significant amount of compressive force upon the nerve tissue. The net effect of this event is that the nerve tissue's blood vessels become compressed, thus restricting their flow. This means that the vital duties that the circulation system serves (providing oxygen and nutrients, removal of excess fluids) are inhibited. The very items that are needed so the tooth can rebound and heal are stifled. Since the opposite of what is needed occurs, there is a significant risk that the nerve tissue will die.
What happened with our dental crown placement?
So, with our situation involving the new dental crown, what has caused the tooth's nerve tissue to become compromised and symptomatic now? Well, it actually could be that events that occurred during the crowning procedure did traumatize the tooth (the production of heat, friction, vibration or the advancement of bacteria toward the nerve) to the extent that they triggered the cascade of events that resulted in nerve damage. But is this what has happened in our situation here with the dental crown? Probably not.
The more likely scenario lies with the following. When a tooth undergoes a traumatic episode such as any one of those described above, the result can be a nerve that has been seriously compromised but not damaged enough to die. This nerve tissue is compromised in the sense that it is now no longer resilient enough to rebound readily from insult. In this state the nerve tissue may go ahead and die immediately (or linger and die) or else it may take one or more traumatic events (either major or minor in nature) to finally push the health of the nerve tissue over the edge. No one could ever know or predict.So, in the case of our new crown, yes the trauma from the process associated with making the crown has no doubt been enough to advance the deterioration of the nerve (hence the appearance of symptoms). But no, the trauma was not likely excessive and would not have created a problem for a tooth that was in good health. Most likely a significant traumatic event had happened to the tooth at a previous, even distant, time (hence the need for the dental crown in the first place). The act of placing the crown was simply that last traumatic straw that triggered what would have eventually happened anyway. (This exact same type of scenario can take place with new fillings, bridgework placement, teeth that are put under stress because a new partial denture places pressure on them, orthodontic treatment, or even just repeated teeth clenching and grinding. Trauma is trauma.)Articles from Dentistry-Explained: A blog about dentistry.
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Comments
i had a irraigation cleaning the crown swelled an is sentive now
Patty,
I don't have an answer for you. You need to contact your dentist for observation and treatment.
A crown is a hard object, it can't swell. The same goes with a tooth, it can't swell or change size (although it could slightly change in position due to swelling in the tissue around it).
I would have to assume that your reference to swelling means that the tissue around the crowned tooth has swollen.
This event would be consistent with a tooth state that required special cleaning (a tooth that has gum disease issues).
As an alternative explanation, possibly there was previously undiagnosed infection inside the tooth (in it's nerve space).
Either way, a vigorous cleaning could trigger a state where an inactive infection becomes acute and produces tissue swelling.
Whatever has transpired, you need to let your dentist look at things and make a treatment recommendation.
Thnaks for the great info. Exactly what I needed. Perfectly explained.
I am still in pain from a crown done 2 weeks ago, but at least now I understand why.
THANKS SO MUCH
Lia, you should make sure you are in contact with your dentist. Let them examine you and make a treatment recommendation if it is needed. A stitch in time always saves nine when it comes to dentistry.
dear dr, i am very afraid to visit the dentist! :( my molar has lost 1/3 of its teeth, and now, the nerve tissue has shown (i can see a swell coming out from the place where the 1/3 rotten tooth fell off). what can i do?? when food hits the swell, it really hurts!! :(
There simply is no alternative to visiting the dentist and seeking treatment. If you are afraid of treatment then make an appointment just for a consultation regarding your matter. If you're inclined, also let them examine all of your teeth so to see what other teeth need attention (so they get fixed before reaching the same state as your problem tooth).
Then discuss with the dentist about the possibility of using a sedative drug that you could take before your appointment when the dental work is actually performed. This way you will be less apprehensive about having the work performed.
By the way, Mimi, it is unlikely that the sensitive tissue that you are looking at is acutally the tooth's nerve. It is more likely that it is gum tissue that has grown into area where parts of the tooth are missing. If so, there is some chance that your tooth is in slightly better condition than you anticipate.
Hello! I had a crown put on my upper first molar 2 weeks ago because of "excessive decay" I suppose because I had numerous fillings on this same tooth over the past years. My dentist decided a crown was the best option. I had been having some pain on and off over the past year in this area, but nothing too bad. After having the crown put on, it is severely sensitive to hot and cold liquids/foods and it's also causing pain when chewing hard foods. I've followed up twice with my dentist already. Once was to remove excess cement and to fix my bite and the second time was today where my bite was adjusted again and some type of metal fixture was used between the teeth to smooth out the crown I think. I explained to the dentist that the pain also comes when I am flossing, but not when I get to the gum line. The pain comes when I get half way up the tooth. He said he doesn't have any definitive answers for me right now because he didn't see anything on the x-ray. He did prescribe me some antibiotics, as he said I should have been on these when I had the crown done, but for some reason I wasn't. He said I might have to be referred to an endodontist for a possible root canal if my symptoms don't improve.
My main concern is that why wasn't a root canal done in the first place? You've provided some great information, but it seems as though if a tooth has been through numerous fillings and there is more decay, then it seems to me that it might be somewhat obvious that a crown would be the "last straw" to cause the final nerve damage. Also, what's the probability of preserving the new crown during a root canal? It seems as though if I have to have a root canal, then I would have to have a completely new crown as well? Any other suggestions/comments would be much appreciated as well.
Thanks for the help!
Possibly in hindsight, since you had previously been having some discomfort with the tooth, your dentist might have suggested root canal treatment before your crown was made. Many (or most) dentists won't however. There is a significant cost associated with root canal treatment (which really might not have been needed). And just as you have experienced complications with your crown, root canal treatment doesn't always go predictably. Your dentist was just trying to be conservative.
The discomfort you have had since the crown has been placed could be related to the crown's "bite." If the crown is too thick, when you bite down the crowned tooth it will receive more pressure than it should. This can aggravate the tooth. This is why your dentist adjusted the bite on your crown. They are hoping that by doing so your tooth will settle down. If not then root canal treatment will probably be the only solution.
Your symptom with the floss is strange. I'm sure it happens, it's just that no dentist is going to be able to come up with a diagnosis regarding its cause. Since the dentist saw nothing obvious with the x-ray to indicate a nerve problem, yet you are having significant problems, they placed you on antibiotics in case it is an infection that just hasn't developed enough to give clear signs and symptoms so that a definitive diagnosis can be made.
You'll have to discuss the need for a new crown with both the endodontist and your dentist. If the crown can't be removed for the root canal work, a hole will have to be drilled through it so the tooth's nerve space can be accessed. This hole can be filled with a filling but (in theory at least) doing so doesn't seal the tooth off from the oral environment as well as a pristine crown.
All and all, even though your are no doubt having an unpleasant experience, it seems your dentist is pretty much doing everything by the book and doing the best they can for you under the circumstances.
3 wks ago I had temporary crown placed on my lower molar to treat a "large crack", which went well. Then last week, my dentist put a permanent crown. First day it was fine, I had a steak dinner, it almost felt like the food got stuck there, but nothing on flossing. Bite felt fine, normal. Next day fine, then 3. day, some minor pressure with biting. Yesterday and today it HURTS ! Intense dull pain and pressure even on a gentle tap with a finger. Unable to chew on that side at all.
I had no pain to start with, just minor sensitivity with chewing , now I can't chew at all, I am in pain and popping Motrin like candies.
Is there a possibility that a food particle somehow got under the crown ? Why was it fine for the first 2 days ? Can the bite be off and manifest now ? Can he just remove the crown and put another one there, or is it cemented for good ?
thanks
Peter, You need to be in touch with your dentist so they can provide you with attention.It is conceivable that what you have noticed is related to the "bite" being off on the crown (the timing you state is compatible with that). However, since you state that the "bite" initially felt normal, the chances that it is this are lessened somewhat. Your symptoms are also compatible with the nerve degeneration scenario as described in this hub. And finally, possibly there is some sort of food impaction problem associated with the crown that has triggered some gum tissue inflammation.No, food can't get underneath a crown. A crown is cemented onto a tooth. The cement fills the space (micro-gap) between the crown and tooth.If it is the "bite," then the dentist will simply buff on the crown (so to thin it) until your "bite" is right. Crowns can be difficult to remove, so they will trim the crown right there in your mouth (with anesthetic if needed). Anti-inflammatory analgesics (you mentioned motrin) can help to settle down teeth that have become irritated due to an incorrect "bite." The solution, however, is for the dentist to adjust the crown.If your dentist diagnoses it as a nerve problem, they will go ahead and start root canal treatment so to get you out of pain and possibly also place you on an antibiotic (penicillin is common for those who are not allergic).If the dentist can't come up with a definitive diagnosis they will take the "shotgun" approach. They will adjust the tooth's bite, place the patient on antibiotics, and prescribe or recommend analgesics that can keep the patient comfortable until that point in time when a definitive diagnosis can be made.It all starts with contacting your dentist. Best of luck on this matter.
I have had 3 rootcanals prior to what is happenening so let me just say that i know what teh pain feels like when i need one. With that said, I went into the dentist with pain after my crown was placed. They tried to get it off but it was being stubborn and i was in terrible pain. He numbed me and it was still too excruciating to take off. He assumed i needed a rootcanal. Good assumption. So i went to the endo that day and he xrayed it and said that i need to go on antibiotics to bring down inflammation. I did, went back in a few days, he shot me up i dont know how many times, more than 6 and he then tested me by poking. He asked me if i felt it and i said yes so he shot me up more, again , he poked me and i still felt it a little to moderate. He said that i shouldnt be feeling anything at all with how much he numbed me. He said he coudlnt numb me anymore and i need to go on a stronger antibiotic. I am not on this antibiotic. There is another antibiotic that got me very sick that ic ant take but that i know works well on this type of inflammation. He opted for astronger amoxicillin. The pain is not letting up, it is throbbing and i feel it in my jjaw and ear. I obviously need a root canal. I am due to leave teh country on June 25th and it is now June 12. :( My first time and i cant get rid of this pain to get the root canal. I've never had this much of a problem kncking out infection in a tooth. Coudl it be that the crown is really aggrivating it since it was impossibel to get off ? I desperately need help.
Sorry, typo. I am NOW on the antibiotic and feel no relief.
Aliza,
I don't have any advice to give you. You state that you went to see the "endo." I assume that means endodontist. If so, you should be in as capable hands as is possible. If you continue to have problems, I would stay in touch with them and continue to let them know you are having problems.
The crown not comming off should only have to do with physics (the shape of the tooth, the fit of the crown, the cement). Crowns are supposed to stay on, so really it's doing its job. Possibly the dentist couldn't get the crown off because they couldn't apply enough pressure to it because doing so hurt you too much. Bottom line however, root canal treatment can be performed through a hole drilled in a crown if that's what is in the patient's best treatment interest and is needed.
Antibiotics don't work immediately. They must be absorbed by your body and distributed. It can take 24 - 72 hours to build up a theraputic blood level that can begin to kill the bacteria, depending on the antibiotic. That is why pain relievers are prescribed concurrently with antibiotics. That is why swelling may get worse even though a patient has already started taking an antibiotic.
Best of luck. Like I said, stay in touch with your endodontist. Let them know what is going on.
i hav taken root cana treatmentn crown is put 2 days back to the same tooth. when crown was palced i dint hav any discomfort but now i feel little high n mild pain when i eat n when i clench my teeth.. so i wnted to know whether that crown should remove n plaace it again of same size or can they trim it in mouth itself?
You need to let your dentist examine you.
It could be as simple as the crown is too "high," meaning when it was recemented it wasn't placed fully onto the tooth. If this is the case the dentist could trim the crown slightly so the crown is returned to its proper dimensions. Appoint with your dentist so they can make a determination.
Hi there, I recently had a new crown put on one of my back molars. This tooth had a crown on it that was about 6-7 years old, so my current dentist recommeded that I have it replaced. The new crown was permanently put on my molar about 3 weeks ago. I then started to develop extreme pain with cold and hot liquids and called the dentist but wasn't able to be seen for 3 days due to availability. In that time, the pain worsened to the point that it hurt when I pushed on the tooth. Today I finally went in to the dentist. However, since it hurt only when pushing the tooth from the bottom (no pain from the side, no pain when I floss) and the x-rays showed no infection, my dentist simply adjusted the "bite' explaining that it could be too high. He has told me that if the pain doesn't get any better that I should return. I was feeling a lot better following my appointment, the pressure, the throbbing was gone. However, now that it has been several hours, there is a dull pain. The tooth is still very sore to touch. Will this subside? Guess I am wondering how long should I wait for it to "improve?" Thanks for your help.
I recently had my front tooth crowned and experienced something very similar to chillibean. the front tooth experiences sensitivity to hot and cold, and when i push the tooth from the front, there would be a mild pain. I have been to the dentist today and he filed down my lower tooth for a better bite, which has helped in the pressure against the tooth, and he believes it will improve the pain on the crown now that theres less pressure against it. he then added some sort of coating around the crown, to seal in the tooth, which when he tested the coating, felt great, no sensitivity. he then asked me to not eat or drink for half an hour, but i've been tonguing away at the crown which left a strange taste in my mouth and I'm not sure if i've inadvertantly removed this veneer and am interested in what the dentist actually tried to do. would you be able to clarify what was the process of coating the tooth and whether i should have left it alone when i came out of the dentist?
my front teeth is broking mounths ago; wen i visited dentist the doctor says you must be your teeth be repair he said i shot or block your teeth nerve decond take medicine than repair
he is right or wrong ?
Nb my english is not well sorry
thanks doctor
I went through the most extreme pain but 2 weeks after getting a crown. The pain traveling up into my head and the whole side of my face was extremely swollen. A specialist told me I needed a root canal before crown, but my dentist told me he couldn't see an infection from the x-ray and to just get the crown. I have been searching for answers for this and a Dr sent me this great book called Root Canal Cover-Up written by George E. Meinig D.D.S but states how root canals damage your health because there is like 3 miles of tubules in the hard part of your teeth that still harbor infection and affects illness in the whole body. I I have been ill and there has been studies done of how a root canal tooth was placed in a rabbit and it got the same disease (everything from asthma to cancer) that the patient had (every time) while the patient ended up being cleared of their illness after the tooth was removed! I am still having swelling after a month and I am getting my tooth pulled! Look up the focal infection theory and get this book if you ever had root canal, a crown, or even thinking of getting it done!!
all dentissts are fucking asshole scums of the earth, ther drilling and shit, causes root canals to be needed.....never go to the bastards, unless u reallyhave pain/ which is a cavity...!!!
never do any work on a teeth unless u actually have pain!!! scums u will burn in hell u pices of shits
Well, I feel almost the same way as malik about dentists. However, I think they mean well. I had a root canal done and five years later an endodontist did a retreatment. Guess what? The tooth still was in pain months later. I changed my diet and got rid of the fluoride toothpaste and my pain and sensitivity went away. Study out all your options before drilling.
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