Updated: Apr 17
Just because you put a crown on your tooth, it does not make it immune to future dental problems. It can have issues just like any other teeth in your mouth. In fact, one of the most common symptoms that patients experience with crowns is pain when they bite down.
It may seem straightforward to you since it literally has one sign and symptom but it is far more complicated than that. There are actually quite a few conditions which may cause you to feel pain, sensitivity, or pressure when biting down with your crown.
A virtual consultation will never be able to pinpoint the exact cause because it is that complex. Nonetheless, we will do our best to at least inform you of what to potentially expect for when you go in for your dental consultation.
Possible causes for pain in your tooth with a crown when biting down:
The bite is high or uneven
If you just had the crown placed on your tooth not too long ago, the pain from biting down could be from a high bite. In other words, the occlusion is high or uneven. What that means is when you bite down, you could be hitting the crown tooth harder than all of your other teeth.
If that is the case, it is not unusual for you to feel some pain or sensitivity whenever you try to chew on it. Since that tooth is taking the brunt of the force, it would become traumatized after a few days.
This situation is the most common when you just had the new crown done a week or two ago. When you were getting the crown glued in, you were most likely numb so you probably couldn't really feel if all of your teeth were touching evenly or not. It was probably not until after the numbness wore away and when you start to chew with it that you noticed the pain.
How to fix a high bite for your crown
If the biting pain is coming from a crown with a high bite, the solution for it is quite simple. You just need to return to your dentist for a follow up appointment and have them adjust the bite.
Basically what your dentist will do is mark your teeth with colored paper (articulating paper) and it will reveal the uneven spots when you bite down. Then all they will have to do is grind down the high spots, the spots that were marked with the paper. After the polishing it off you should be good to go! The appointment should take no more than 10 minutes total.
Just be aware that the tooth may still be a little tender for the next 2-3 days since its been bruised. Thus, you may want to avoid chewing on that side for just a short while until it heals. Once it heals you can eat like you normally do.
Soreness from newly placed crown
If the bite doesn't feel high or off, the tooth could very well just be sore from the crown procedure. There was a lot of manipulation and drilling around that tooth during the procedure.
Essentially your dentist had to work on that tooth for at least 45-60 minutes straight. It would be unusual for the tooth to not feel a little sore or tender. We're actually quite surprised when patients don't complain about it at all the next day!
Here is a picture of what teeth look like with the crowns on and with them off. As you can see, the teeth were shaved down quite a bit for the procedure. I mean, how could you not feel something afterwards right?
What to do about the soreness
If there is nothing wrong with the tooth aside from soreness from the procedure, it should resolve on its own. It may take a few days but it'll go away with you doing anything.
However, you can increase the healing speed if you take extra care of that crown. Here are some tips that you can use if you want to recover faster.
Chew more on the opposite side.
Avoid very hard or crunchy foods for the next few days.
If it feels mildly inflamed, you can take an anti-inflammatory like ibuprofen.
There really isn't too much that you need to do for this, just give it a week or so and see if it goes away. If it doesn't go away then you may want to return to your dentist because something else could be going on instead.
Tooth fracture underneath the crown
If your crown hurts to bite on but your dentist can't find anything else that is wrong with it, the tooth underneath could be fractured. What we mean is that the crown itself is intact but the tooth structure underneath it could be cracked.
What makes it difficult for your dentist to diagnose is that if you have a crown on, you won't be able to see it at all. The crown literally covers the whole thing and prevents you from seeing the crack.
The only way your dentist can verify if it is truly cracked or not is if they remove the crown. Although removing the crown can make it unusable afterwards so you'll probably need a new one.
Alternatively they can also take a CBCT scan which is a 3D x-ray to see if it is potentially fractured. Regular x-rays only show it in two dimensions so it doesn't give as much information.
Treatment for a fractured crown tooth
If the tooth is truly fractured, it would unfortunately need to be extracted. There is no dental treatment in the world that can mend a tooth which has split in half. The only proper treatment for it would be to have the entire tooth removed along with the crown.
In order to replace the tooth to be extracted, your options would be a dental implant or a bridge. The implant is more conservative because it does not require you to drill into the adjacent teeth. The bridge does require you to crown both of the teeth adjacent to the missing one so that makes it less conservative.
The crown is fractured
If you're feeling pain when biting down it could mean that your crown is fractured. When we say the crown is cracked, we mean that the tooth underneath of it is still intact. Only the porcelain restoration was damaged.
Instead of chipping off a large piece of the crown, sometimes you can also create a hole through the chewing surface.
We had this happen to our patient. He had a hole through the top of the crown and would feel pain every time he ate. Food kept getting jammed inside of the hole on the top of the crown so when he bit down it would hurt.
How to fix a fractured crown
For a fractured crown, the treatment for it would be to simply replace it with a new one. Once you have a brand new one that is intact and protecting the tooth underneath of it, that chewing pain should subside.
You would basically repeat the crown procedure all over again like the first time in order to have it replaced. You can also refer to it as a redo procedure.
Teeth grinding habit at night
If you're a habitual teeth grinder when you sleep, that could very well put a lot of stress on not only your crown but your entire dentition. That back and forth grinding motion will knock your teeth against one another all night long. It wouldn't be unusual for your teeth to feel sore when you wake up in the morning.
However, you should be aware that this only applies to you IF your crown AND the rest of your teeth are sore in the morning. If it happens to be JUST your crown that feels painful then its most likely not due to grinding.
What to do about the teeth grinding
If you grind your teeth you should ask your dentist to make you a night guard. This is an acrylic mouth guard that you wear at night which protects your teeth. It won't stop you from grinding but it'll at least protect your teeth from being damaged.
You would literally just grind through the night guard instead of grinding on your teeth. What we're implying is that the mouth guard won't last forever because you will eventually wear through it. It means that you'll need to have it replaced every few years.
Irreversible pulpitis - Nerve could be dying
The crown tooth could be in pain when you bite down because the nerve could be dying. Maybe the cavity that necessitated the crown was too big or close to the nerve. It may not have been bothering you when you were getting the procedure done but after you glued in the crown it just started hurting.
When the nerve is unhealthy like this, we call it irreversible pulpitis. It means irreversible inflammation of the tooth nerve. It will keep acting up and bothering you until you finally decide to get it treated. It will certainly hurt if you try to chew on the crown when the nerve is inflamed.
How to treat a dying nerve
The only way to treat an unhealthy nerve is by getting a root canal. This is a procedure that only your dentist can do so don't even bother trying home remedies on this one!
The treatment involves your dentist drilling through the crown in order to get to the nerve. Then they will remove the nerve from the tooth. Once they are done, they'll fill the nerve canals back in with a filling material.
Since your dentist had to drill through the crown to do this procedure, there is a good chance you may need the crown replaced. It offers better structural integrity if the crown is in one piece rather than have a hole through the top of it.
There are some situations where your tooth already has a crown AND a root canal on it but it still hurts when you chew. If this sounds like your condition, it could be that the root canal got re-infected and an abscess could be forming at the tip of the root.
Yes, it is possible because having a root canal and a crown on a tooth does not make it immune to future infections. These teeth can become abscessed just like any other tooth in your mouth.
Here is a picture of a tooth with a crown that has an abscess. One of the tell tale signs of the infection is if it has a gum boil or pimple on the gums. If you see a pimple like that, you should try to see a dentist as soon as possible. That biting pain you're feeling on the crown is definitely not from a high bite or soreness. This means that the tooth got reinfected with another abscess!
How to get rid of a tooth abscess in a crowned tooth
If the tooth had a root canal already and it still became abscessed, you may need to have the root canal redone. When you have to redo it, the procedure is called a root canal retreatment.
One of the most common causes for having to redo it is because if your tooth had extra nerves in there but it happened to have been missed. What we mean is that most molar teeth have three nerves but there are situations where it can have more than that!
The x-rays above show how many nerves each root canal had. Each white line represents one canal or one nerve.
The point that we're trying to make is that if you did the root canal and you placed a crown over the tooth but some of the nerves were missed, it could be the cause of that abscess returning. If the crown is just infected, it wouldn't be unusual for it to hurt when you bite down with it.
Aside from the crown tooth itself getting abscessed, the gums surrounding it can also become infected. In this situation it is actually the gums around the crown which is abscessed.
This could happen if you happen to get food or something lodged into the gums. If you can't get it out, it will slowly swell up more and more until it looks like the picture above.
If that happens to you, your crown would certainly feel tender when you bite down on it. In fact, that entire area would probably feel painful.
How to treat a gum abscess on a crowned tooth
If you have abscessed gums around your crown, the only way to make it go away is by draining it. You would definitely need to see a dentist for this because it would be quite difficult for you to do this at home. There is also the fact that you probably want to be numb for the procedure!
Here is what to expect:
Administer local anesthesia
Pop the abscess and drain it
Squeeze out all of the pus and purulence.
Deep clean the affected teeth.
Flush it all out with an antibiotic solution.
You will most likely leave the dentist with some antibiotics and the antibiotic mouth rinse to use. You should notice an improvement after 24 hours if you get this treated. That biting pain should subside after a few days once the gums fully heal.
Related content: In case you were curious about how to drain a gum abscess at home, we do have an article on it.
If you're having pain in your tooth with a crown when you biting down, it definitely means that something is wrong. It is not as simple as it may seem because there could be many possibilities for why it could be hurting.
Some of the causes could be a quick fix while others are much more extensive or invasive. If it happens to be some sort of infection or abscess, you're going to need at least a couple of dental appointments! However, it could also be something easy to fix like a high bite.
The best thing to do is to schedule a consultation with your dentist so that they can diagnose the problem. It is better to get it taken care of sooner rather than later!
If you are near the Long Island City area of NYC, our office does offer dental crown services if you are in need of one. If you're far away, you may have to find someone else that is closer to you.