Why does my tooth hurt after placing a crown?

Question

Hello doctor,

My back upper left molar had a cavity deep enough to warrant a crown last month. Since then, I have been back to the dentist twice to get adjustments on the crown, under the suspicion that its slight misfit with my bite was causing the dull-to-sharp pain I experience when I use that molar. Despite the adjustments, no improvements have been made. During both adjustments, the dentist asked me questions regarding the pain type, sensitivity, etc. (I would presume to determine if a root canal or something else is necessary) and nothing raised flags- No passive pain, no sensitivity to hot or cold air. I have pain from use only, but it is significant enough that I have not used the left side of my mouth to chew since that time.

Should I go to another dentist to get a second opinion? I feel strange repeatedly going back to basically say he or she must be wrong and that no improvements are being made. Any advice would be appreciated.

Answer 1

Hi,

Welcome to icliniq.com.

In your case, there are three possibilities. The first line of treatment is done by your dentist. After crown placement, slight misfit issues occur that need to be adjusted by trimming the occlusal or biting surface. It gets better soon after trimming or relieving pressure. Otherwise, it gives continuous pain only when biting.

So, by symptoms, you are having pain on chewing and your dentist has not trimmed it to your comfort level, I guess, or you might be having a very deep bite that porcelain surface space would not be available and it needs to be trimmed now, and the dentist is avoiding it as metal will get exposed and it will not look good aesthetically. 90 % of crown issues and pain are fine-tuned by trimming high spots.

Now the second line of treatment: If still pain persists and you feel the pressure inside the tooth, you experience pain at night or on lying down, or slight infection in the gums right above the crown of the tooth, then it is an indication of root canal treatment. As the cavity was already deep, it was filled, and then the tooth was trimmed down for crown preparation, so that it is vital and it becomes sensitive, and there are only 10 % chances that the pulp of the root might have been exposed or a silent infection of the cavity might have been triggered after deep cleaning.

So now, root canal treatment is to be done in such cases. Or before attempting a root canal, if antibiotics are given, then such infection subsides, and you might feel absolutely okay with this tooth during medications. After the course is over, you will start feeling pain again. And then it would be better to opt for a root canal.

The third line of treatment: If you do not have any root canal issues and still pain persists on chewing, then there is a 1 to 2% possibility of fracture of the tooth due to uneven biting pressure over the crown. In such a worst-case scenario, extraction is recommended; the root canal does not help. I hope this is not the case.

Hopefully, you have a better idea of treatment options in your case. If you have further queries, let me know. My advice is to go to another dentist and ask him to trim the crown as much as he can to make it comfortable, leaving aesthetics aside. If it does not work, do an antibiotic regime course it will work.

I hope this helps you.

Thank you.