02 January 2018
ask the dentist
Patient's Concern
“I recently had a root canal performed on tooth #19. I had a temporary crown made for it which went well. I had a permanent crown placed on it which was too wide and surpassed the margin of my gums. The dentist took new molds and prepared a second permanent crown. 3 weeks ago I had the permanent crown placed with temporary cement. For a week, it was fine and pain-free. Last week I began to have massive pain in my jaw, mouth area, and temples.
I saw the dentist again this Monday the 29th. The dentist said the crown was too high, and fixed it and adjusted it. Now it is Thursday the 31st, and I still have pain chewing on the crown, as well as pain into my jaw. Is this pain a bruising/muscular issue? How long does it approximately take for the crown to become comfortable and painless? Do I need a new permanent crown? ”
Dr. Cochran's Response
I empathize with your discomfort. Having tooth pain for over a month can really dampen one's quality of life. Is this pain a bruising/muscular issue? Your pain could be due to one of two causes: 1. Force, 2. Bacteria. Force from chewing, or from grinding/clenching at night, can cause a very painful bruise around a tooth, if that tooth is taking more force than any other tooth. Crowns are often a little high after being cemented onto teeth, and need to be adjusted to fit into your individual bite pattern. Until that crown fits well, you may continue to experience significant discomfort. Bacteria dissolve away tooth until they kill the nerve inside tooth, and then bacteria may travel from inside the tooth into your jaw creating an infection in your jaw.
A root canal performed by a dentist cleans out the inside of the tooth and seals it from bacteria so your body can fight the infection and heal. You can liken the healing process to removing a splinter from an infected finger so the finger can heal. That infected area of the jaw below a tooth can be sore up to a year after a root canal is performed. One more reason your tooth may be hurting is that root canals are only 80-90% successful within the first 5 years. There are many reasons for this. For instance, the tooth could have a microscopic fracture that is not visible in the mouth or on an x-ray. If the root canal is not successful, an infection will persist and cause pain as the infection grows and puts pressure on the surrounding tissues.
How long does it approximately take for the crown to become comfortable and painless? If the post-root canal pain is gone, the crown itself is comfortable as soon as your crown fits into your bite correctly. Do I need a new permanent crown? If you're having pain from the root canal procedure, no you don't need a new crown. If the crown isn't fitting correctly into your bite, you likely need the height of the crown to be adjusted, not a new crown. This is very complex subject with many possible answers.
Credit- Dr. Cochran's original response on Dental Optimizer.