After you've invested time and money in a dental crown, you may find it hard to believe that a toothache could develop---especially if you had no discomfort before placement of the restoration. But this is a common dental condition, and a toothache in a tooth with a crown does not indicate poor dental treatment.
Anatomy
A tooth is composed of a crown and root or roots. The crown is visible above the gum tissue. The roots are beneath the crown and submerged in bone. Lying on the inside of both of these is soft tissue known as the dental pulp, which is composed of blood vessels, nerve fibers and connective tissue. Removing tooth decay from the crown of a tooth and placing a filling helps protect the pulp from inflammation and infection.
Procedure
When extensive decay destroys a large amount of tooth structure, a dental crown procedure becomes necessary. This procedure involves reducing the tooth approximately 2 mm in depth. An impression or mold of the prepared tooth duplicates the remaining tooth structure, and a dental laboratory uses the mold to fabricate a porcelain or metal restoration known as a dental crown. An acrylic temporary crown placed on the tooth protects it in the interim. After production of the restoration, a dental cement seals the porcelain or metal crown over the prepared tooth.
Inflammation
Reducing the outer surface of the tooth for the crown produces inflammation of the dental pulp. Frictional heat and bacteria entering the pulp through the freshly cut dentin surface produce this inflammatory reaction. A poorly fitting temporary crown that permits salivary bacteria to enter the pulp can also cause pulpal inflammation.
Symptoms
Inflammation of the dental pulp is known as pulpitis. A reversible pulpitis produces a mild toothache or sensitivity that resolves in a few days. An irreversible pulpitis, however, causes intense sensitivity to hot and cold that lingers and possibly initiates a throbbing toothache. Pain when biting frequently occurs. With irreversible pulpitis, there's no chance of the pulp returning to its normal and healthy state. A diseased pulp ultimately necroses, or dies, and produces an abscessed tooth. When this happens, the surrounding bone becomes infected.
Solution
Root canal treatment is the only way to save a tooth in this condition, according to the American Association of Endodontists. A toothache in the tooth with a crown does not mean losing the crown. The dentist makes a small opening through the center of the crown. Small endodontic instruments placed through this opening remove the diseased pulp from inside the roots. A root canal filling then seals the roots from further infection. Placing a filling in the opening through the crown completes the procedure.
Warning
Pain from other body parts can feel like a toothache, as the University of Maryland Medical Center points out. The ear, eye, sinus or even another tooth can refer pain to a healthy tooth. A heart attack can also cause pain in the jaw and teeth, highlighting the need for immediate medical attention once pain starts in a tooth.
