Key points in brief
- Mild pain when biting in the first days after a crown is fitted is normal. It usually eases day by day and lessens noticeably within a week.
- Pain that does not ease, or that comes back with every bite, usually has one of four causes. These are a crown that is too high, an irritated nerve in the tooth, inflammation around the tooth, or a crack.
- If the pain has not eased after a week, or the crown feels too high, go back to your dentist within a few days. Lowering the crown usually takes a few minutes, but it does not always get rid of the pain.
- Swelling, a fever, or severe throbbing pain that wakes you at night or does not go away with painkillers is a reason to see a dentist the same day.
- Even if root canal treatment is needed, the crown can usually stay: the dentist treats the tooth through a small opening in the crown.
What is normal in the first days after a crown is fitted?
In the first days after a crown is fitted, mild tenderness that lessens from day to day is normal. If a tooth hurts when you bite after a new filling, the causes can be similar to those after a crown.
Grinding the tooth down for a crown can irritate the nerve in the tooth, that is the pulp - the living tissue with nerves and blood vessels inside the tooth. This is why a tooth with a living nerve may react to cold and to biting down harder for a few days. This sensitivity can be strongest in the first 24 hours and usually eases noticeably within a week.
For 2–3 days the gum at the edge of the crown may be tender and bleed slightly when you brush. Pain that does not lessen or gets worse, on the other hand, is a cause for concern. So is pain that comes with every bite, comes on by itself without eating, or wakes you at night. The same applies to a feeling that the crown is “higher” than the neighbouring teeth.
A few observations during everyday meals will help you judge whether the pain is easing. Pay attention to:
- whether it is better, the same or worse from one day to the next
- whether the pain comes at the moment you bite down, or only when you release the pressure
- whether it hurts with every bite, or only on something hard and in one spot on the tooth
- whether, when you gently close your mouth without food, the crown touches the teeth opposite before the rest of your teeth do
- whether the tooth reacts to cold or to heat, and whether the pain goes away at once or lasts after you put the drink down
- whether the tooth hurts on its own or wakes you at night
- whether the gum around the crown is swollen, red or bleeds when you brush
Do not test the tooth by biting on hard things on purpose. If the tooth is cracked, such a test may make the crack deeper. Mention what you have noticed at the start of the appointment, because the test the dentist starts with often depends on them. Also say whether the tooth already hurt under the temporary crown, whether the temporary crown often came off, and how long it was before the permanent crown was fitted.
Four causes of pain when biting after a crown
When a tooth hurts after a crown is fitted, it is usually for one of four reasons. The first is a crown that is too high. People often notice it only in the evening or the next day. When fitting dental crowns, the dentist checks the bite, but while your mouth is numb from the anaesthetic, it is hard to feel which teeth touch first.
| Cause | When and how it usually hurts | What usually helps |
|---|---|---|
| A crown that is too high | From the moment the anaesthetic wears off, with every bite. The crown feels higher than the neighbouring teeth, and the pain does not ease. | A bite adjustment: the dentist grinds and polishes the spot that touches too early. |
| An irritated nerve in the tooth | In the first days, sensitivity to cold and sometimes to pressure, easing day by day. What is worrying is pain that comes on by itself, wakes you at night, lasts a long time after something cold or is set off by heat. | Usually time. If the inflammation of the nerve does not settle or the nerve dies, root canal treatment. |
| Inflammation around the tooth: at the gum or at the root tip | The gum at the edge of the crown stays tender and red for longer than a few days. Later, even years later: pain when biting, a feeling that the tooth is “raised”, sometimes swelling. | Removing leftover cement and caring for the gum. For inflammation at the root tip, root canal treatment. |
| A cracked tooth | A short, sharp pain when biting on one spot, often at the moment you release the pressure. Sometimes it was already there before the crown. | Depends on how far the crack reaches. A crown often stabilises the tooth. A crack that reaches the root is sometimes the reason the tooth has to be removed. |
At the gum, the source of pain is sometimes leftover cement - a hard lump left under the gum after the crown was cemented in place. A crown that does not touch the neighbouring tooth has a similar effect. Food then gets pushed between the teeth and presses on the gum.
The causes can overlap. A crown that is too high overloads the tooth with every bite. Over time, it may therefore also irritate the nerve in the tooth and the tissues that hold the root in the bone. When a crown is placed on a cracked tooth, it covers the cusps, that is the raised points on the chewing surface. This helps protect the tooth from cracking further, but it does not always get rid of the pain straight away.
A tooth that had root canal treatment before the crown was fitted does not react to cold, because it no longer has a living nerve. In such a tooth, pain under the crown when biting more likely points to a crown that is too high, inflammation at the root tip or a crack in the root.
How the dentist finds out what is causing tooth pain under a crown
The dentist first asks about what you have noticed: when the pain started, what sets it off and whether it is easing. Then they check your bite with bite paper, a thin sheet of coloured paper that you bite on and then slide your teeth across from side to side.
The dentist first asks about what you have noticed: when the pain started, what sets it off and whether it is easing. Then they check your bite with bite paper, a thin sheet of coloured paper that you bite on and then slide your teeth across from side to side.
The dentist checks the nerve in the tooth with cold. Through a crown, this test gives an accurate result somewhat less often than on a tooth without a crown. The dentist therefore reads it together with your symptoms and the tapping test.
An X-ray can show changes at the root tip, although on the image metal and zirconia hide the inside of the tooth under the crown. A crack in a tooth with a living nerve rarely shows up on an X-ray - in roughly two cases in 100. A normal X-ray therefore does not rule out a crack. Tomography, a 3D X-ray scan, does not show cracks reliably either.
It is not always possible to find the cause at the first appointment. The dentist then starts with the simplest step and looks at the tooth again after a few days. If the bite paper has shown a spot where the teeth touch too early, that step is usually a bite adjustment.
When a bite adjustment is enough, and when other treatment is needed
An adjustment is usually enough when the only cause is a crown that is too high. It generally takes a few minutes and does not need an anaesthetic.
If the pain has not lessened for a week after the adjustment, the cause is probably something else. The dentist then looks for that cause instead of grinding the crown again, because repeated grinding makes it thinner and weaker. The dentist may suggest a new crown if the one you have does not fit tightly against the tooth, or if it would have to be ground down too much.
Root canal treatment is needed when the inflammation of the nerve does not settle or the nerve is dying. Sensitivity that is easing usually only needs watching. Pain that comes on by itself, wakes you at night or lasts a long time after something cold may mean that the inflammation of the pulp, known as pulpitis, will not settle on its own. In the vast majority of teeth, the nerve under a crown stays healthy for many years, but in a few teeth in 100 it dies, sometimes only years later. This happens more often after a long time under a temporary crown.
The dentist usually treats the canals through a small opening in the crown and then closes it with a filling. The crown can usually stay in place. Over the years, however, some of these crowns need the filling in the opening repaired, need to be cemented back on, or need to be replaced. If the tooth hurts when you bite, the dentist may slightly lower its biting surface during treatment. It is not known whether this noticeably reduces pain after the procedure.
A cracked tooth under a crown can often be saved, sometimes after root canal treatment. A crown after root canal treatment reduces the risk of the tooth fracturing, but when a tooth with such a crown starts to hurt when you bite, the root needs to be checked.
In people who clench or grind their teeth at night, a tooth with a newly fitted crown is sometimes most tender in the morning. The dentist may then suggest a night guard.
What not to do on your own
Until your appointment, a few things may make matters worse or make it harder to find the cause:
- do not grind or file the crown yourself
- do not stick the crown back with glue from home if it comes loose
- do not bite hard things on the side of the painful tooth
- do not apply warm compresses if swelling has appeared
- do not take an antibiotic unless a dentist or doctor has prescribed it
- do not put off your appointment for weeks, waiting for the tooth to “get used to it”
If the crown is loose or has come out, make an appointment within a few days. Keep a crown that has come out in a dry container and bring it with you. Over-the-counter painkillers ease the pain, but they do not remove its cause.
When should you go back to the dentist after a crown is fitted?
Go back to your dentist within a few days if the crown feels higher than the neighbouring teeth, or if the pain when biting after the crown was fitted comes with every bite, gets worse or has not eased after a week. The same time frame applies to pain that comes on by itself without eating, lasts a long time after something cold, or starts after something warm. It also applies to new pain under a crown that has caused no trouble for years.
If you have swelling, a fever, or severe throbbing pain that wakes you at night or does not go away with painkillers, see a dentist the same day, including at an out-of-hours emergency dental service. If the swelling is getting bigger or makes it hard to open your mouth, swallow or breathe, call 112 immediately or go to a hospital emergency department.
Consult your case with an expert and get your treatment plan
Frequently asked questions
Can a crown that is too high be ground down?
Yes, most often it is enough to gently grind down the spot that touches too early and polish it carefully. Polishing matters, because rough porcelain or zirconia can wear down the teeth opposite. The material of the crown has a limited thickness, however. If a lot of material would have to be ground away to make it fit, the dentist may suggest a new crown, because a crown that is too thin cracks more easily.
Can a crown crack because of a bad bite?
A crown can crack because of a bad bite, although this is rare. Strong, repeated pressure increases the risk of the porcelain chipping, especially when it covers a metal or zirconia framework. Crowns made from a single block of material rarely crack in the first years, including in people who grind their teeth. Over the years, however, grinding may increase the risk that the crown will need replacing, which is why the dentist may recommend a night guard.
When does pain when biting need urgent attention?
Pain is urgent when it comes with swelling of the gum or face, a fever, pus around the tooth, or severe throbbing pain that wakes you at night or does not go away with painkillers. In that case, see a dentist the same day, including at an out-of-hours emergency dental service. If the swelling is getting bigger or makes it hard to open your mouth, swallow or breathe, call 112 immediately or go to a hospital emergency department.
Can I take painkillers before my appointment?
Yes, you can take over-the-counter painkillers as directed on the leaflet, without going over the dose. If you are pregnant, have a long-term illness or take other medicines, especially medicines that affect blood clotting, ask a pharmacist which painkiller to choose. A painkiller does not remove the cause of the pain, so do not put off your appointment because of it. Tell the dentist the name of the medicine and when you took the last dose, because it may also dull the pain during the examination.
Can I see a different dentist about pain after a new crown?
Yes. Any dentist can check the bite, the nerve in the tooth and the gum around the crown. Bring the most recent X-ray of that tooth if you have one, and say when the crown was fitted and what material it is made of. This helps the dentist read the X-ray and judge how much material can be ground away during an adjustment.
How many days after a bite adjustment should the pain go away?
If the pain when biting after the crown was fitted came from the crown being too high, it usually eases noticeably within a few days of the adjustment. Tenderness in the tissues that hold the tooth in the bone may last a few days longer. If the pain gets worse, or has not lessened after a week, tell your dentist, because the cause is probably something else.
What happens in the first week after root canal treatment through a crown?
For a few days after root canal treatment through a crown, the tooth may be tender when you bite, but it usually gets better from day to day. If the treatment is done in two stages, the opening is closed with a temporary filling until the next appointment, so do not bite hard things on that side in the meantime.
Read more:
- Dental crowns Warsaw
- A cracked tooth — when it can be saved and when it must be removed
- Pulpitis - reversible or irreversible. Why this distinction decides the fate of the tooth
- A crown on a tooth after root canal treatment - when it is necessary
- A fractured tooth root: when root canal treatment can no longer help
Content and liability disclaimer
This article is informational and educational in nature and does not constitute medical advice, a diagnosis or a therapeutic recommendation — it does not replace a consultation with a specialist. If you are experiencing symptoms, have doubts or are facing a decision about treatment, consult a dentist. The methods described and the data cited are general in nature. The results of scientific studies relate to populations, not to an individual patient. The course and outcome of therapy depend on the individual clinical situation and may vary between patients. No information contained in this article constitutes a guarantee of result. The content has been prepared with due care, based on publicly available medical knowledge and the scientific publications indicated in the Sources section. We do not advise taking or refraining from any health-related action solely on the basis of the content of this article, without prior consultation with a doctor.
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