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painful crown

I had my front teeth crowned 4 weeks ago. I had previously had caps on them for 20yrs as I broke my teeth when i was 8. However, in the last 5 days i am experiencing a horrible sensation in them, like there is severe pressure being put on them and intermittent throbbing of the teeth themselves..what can it be. I cannot concentrate on anything as am aware of them all the time. There is no infammation of the gums or loosening.
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Avatar_m_tn
If the crowned teeth are vital and there is no pulp pathology, going back to your restorative dentist to have occlusal adjustment is advised. If your dentist can not adjust the bite to a comfortable level, seeing an occlusionist or prosthodontist is advised.
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I have had problems for 8 months and occlusal is the most important thing to be aware of if you start having problems I found out.  I went and seen a prosthdontist as I was advised and the occlusal was the problem causing me the pain.   If you don't get it fixed as soon as possible you might end up like I did.  

I am still not out of pain yet but only have my new temporary crowns on now, the inferior ones had to be removed.

The temps have now started doing the same thing as my orginals I had on, which were too big.  

Prosthodontist is your best bet; it was for me, at least I found out what my problem was.
My original dentist told me nothing was wrong and the crown was fine when it was not.   I believed him and ended up going to a Prosthodontist for anwsers.  

I still have pain when I chew in my chin and jaw, clear up into my head and I keep getting headaches and feel dizzy now, my ear has kind of settled down.  

I'm sure after the right occlusion has been done my symptoms will hopefully stop.

If the prosthodontist can't get it right this time, I may end up needing to find an occlusionist.  I heard they have machines that can detect bites that are off and exactly where the teeth are hitting causing the pain.  

Good luck.


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Avatar_m_tn
Detection of occlusal interference really depends on cinician's skill, state-of-the-art machine or device is useless. The only tool I live on is articulating paper, without which, I can do nothing.
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Thanks for the advice again before I go spending more money.  If other dentists use articulating paper, why do they not see that the bite is off? A dentist must have to be pretty skilled to get the occlusion right and I know now that it does take time and effort to do this.

I have been trying to get relief for months with what has happened to me regarding my teeth 18 and 19 which have now had root canals done February 4th, 2009. When the bite feels right the crown feels too far down in my gum between 19/20 teeth where it has been feeling like there is a gap or space in the corner ever since Dr. Bertolin put my crowns on in June.

This is causing my chin and jaw to hurt especially when I chew, my chin hurts, jaw gets sore and I have headaches.  Right now I am experiencing numbness in my jaw and it feels tight.   I called the new dentist and told him I need these temp crowns taken off (which are connected to each other) that I cannot deal with this anymore and it feels like this one has fallen deeper down into the gums also by me eating.

As soon as the crown felt like it fell further into the gums March 20, 2009 my jaw started hurting and March 21st I am feeling numbness in my chin, jaw, and neck and headaches are occurring.

If he cannot get my bite right I do not know what to do from here. He wants to put the permanent crowns on the 26th but I am not symptom free from the original crown problems yet.   I asked him if he could put the permanent ones on with temporary cement to see how they work out first before cementing them permanently.    He stated he would have to have a pretty good reason not to cement the permanent crowns on permanently.  

After what I have experienced with one dentist back in June- paid 2560.00
and now having to pay 3488.00 to have them replaced I think this would be a good enough reason not to want to have them cemented permanently until my pain is gone.

I need more help than anyone could imagine with these teeth and what problems the original crowns have caused me.  I had no symptoms of pain at all in the molars before the crowns were put on back in June. It was all due to a large amalgam filling that kept expanding and contracting and made the tooth thin and break off after 25 years.

Why can't I just leave the crowns off for awhile until everything heals, isn't there something they can put over the tooth while the tissue or bruising heals if that is what it is causing my pain.

When the crown is sitting too far down in the corner between 19/20 teeth (this is where most of the irritation is), I feel numbness in my neck, chin and jaw and then it starts causing my ear to feel funny also.  When I eat it causes these feelings to be more intense and I get headaches.  

Thanks for all your help.  sorry so long.
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Avatar_n_tn
i  just got 2 caps on 18 and 19. When i got the temp caps they where also together. well my teeth and gums hurt for a few days after then i felt like i had neck/ head ach pain for the next 3 days along with the top of my mouth being sensitive my whole left face hurting and my ear started to hurt. I really began to feel ill. I went to the dent ans they said my gums where inflamed and infected. 2 days after starting antibiotics i felt tons better. i just got my permanent caps put on and i have no sensitivity or anything. they feel like real teeth. i would suggest not to eat on the side with the temp caps./ i know they say you can but the material theya re made out of isnt that  strong and they are super sensitive. My dentist put on my teeth somthing to help with sensitivity and the cement he used was suposed to help with the sensitivity. sorry i dont know hwat its called but tell you dent you want the cement that helps with sensitivity. good luck to you i hope you get your teeth fuxed. also try some antibiotics you caould have an infection.
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Avatar_m_tn
Provisional crown implies that the final crown is supposed to duplicate the provional crown, not just temporary. Provisional crown serves the purpose to froesee the final outcome. If rpovisional crown does'nt work well, you are taking chance . This is what I taught other dentists. We do'nt take chance in dentistry. We want everying in control and predictable, as much as we can.
Assuming you were my patient, The first thing I would do is check the integrity of teeth # 18, 19. Assuming clinically and radiographically there is no structural pathology identified. Remove provional crowns, place a piece of cotton roll between tooth#18 and opposing tooth, asking you to clench. If you can comfortable clench and no discomfort upon release , the tooth is sound.  On the other hand, if you do feel discomfort or soreness upon clenching and upon release,  there is something wrong with the tooth or other structure. It's obvious that the prepared tooth is out of occlusion, if clenching on cotton roll can not be tolerated, no matter what we work on the crown occlusion, there would be no chance of success.  The underlying cause of sound tooth , which can not tolerate cotton roll clenching , includes: root fracture, referral phenomenon of masivatory musculature, central nervous system dysfunction. Myofascial trigger points of masticatory muscle is commonly present. Management of trigger point may be required. Occasionally, systemic administration of tricyclic antidepressant (amitryptyline) may improve sensitivity of tooth on force loading( coton roll clenching). Most patients can clench cotton roll on prepared tooth without problem. However, once the provional crown is put on, soreness develops upon clenching cotton roll and/or upon release , this indicates there is occlusal interference. If you are not sure what I described, place a piece of cotton roll between each teeth, you definite will perceive the sensation. It's a common mistake that dentists place the articulating paper betsween teeth and ask thre patient to close jaw. It's common that dentists are perplexed that no occluding mark on the tooth, how come the patient still feels high, frequently , the dentist attributs to the patient's mind. Detection of occlusal interference requires bimanual manipulation and pateint's voluntary closure, and clenching, and head position in neutral, hyperextended, and hyperflexed. I can not tell your dentist how  to implment occlusal adjustment, you may need to request him to see the occlusal marks while you close your jaw , clench your jaw, head moving backward, head neutral, and head bending down. Good luck.
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thank you for taking the time to write all of this.  You are a super person as it is seen that you really care about patients.  Even the ones on your site. You are just like what they teach dentists in school. I have heard that they tell them to listen to their patients, they will tell you what is wrong.  I can see you do this even when you don't have to listen, you listen because you care.  

thanks again.
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Glad you found out it was.
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How long does it take for tissue and bruising to heal from occlusal trauma caused by a crown being too high? My teeth were in hyper occlusion and was evidenced by the use of shim stock and articulating paper.   Crowns have bee replaced.

I had my final restorations placed March 26th, 2009.  He permanently cemented number 18 which is a little sore, but 19 is still hurting me alot and has not healed yet.

I feel like there is a gap or space for some reason between 19/20 teeth.  March 28th I woke up with swelling of my gums and have been rising with salt water but it seems not to help, so I rinsed with Listerine and it seemed to take some of the swelling away.

There is still something causing the swelling and irritation of the gums. It is mostly number 19 (crown was has temporary cement). If I go back to the endodontist to see if more work is needed on the root canal, will he be able to perform the job without disrupting the crown build up and just take the perm crown with temp cement off without having to drill down into it?  I would think since it has temp cement that he would be able to just take it off if more work is needed on the root canal that was done back on February 4, 2009.

When the endodontist did the root canal, he stated the tooth or canal was bleeding pretty bad.  can this what happen to a tooth that has been in hyper occlusion or is it normal for this to happen?



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Avatar_m_tn
I believe a prosthodontist is comnpetent enough to deliver a crown with optimal margin and contour. Swelling of gum after crown delivery is rare. Swelling is a subjective symptom. You may need to see your prosthodontist to validate if there is true swelling present. In addition, root canal treatment perfomed by an endodontist is probably meeting the stantard of care. If there is no evidence of hard tissue pathology revealed by x-ray, redo root canal is probably of no avail.
trauma from occlusion may be evidenced by widened periodontal ligament from x-ray. If no further occlusal trauma imposing on tooth , it tends to heal up with weeks.
Tooth#18 occlusion needs to be adjusted optimally,otherwise tooth#19 would be very difficult to achieve optimal occlusion.
Removal of tooth#19 crown is advised. Leave tooth #19 out of occlusion for a week.If tooth #19 is still problematic, other sources of dental pain need to be investigated.
Occlusion certainly plays an important role in the pathogenesis of many mysterious pain, but not always the sole factor.  I believe your prosthodontist is competent enough to manage your occlusal problem. However, he may not know that head position  may yield different occlusal contacts. You may need to ask him to take a look of occlusal contacts while you maintain different head postures. The prosthodontist is able to tell whether the contacts are good or bad.
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Thanks for your response again.  

Yes, I have faith in this prosthodontist I am now seeing and the endodontist who did the root canals.  

You stated, "trauma from occlusion may be evidenced by widened periodontal ligament from x-ray. If no further occlusal trauma imposing on tooth , it tends to heal up with weeks."  

I mentioned something about ligaments to my prosthodontist, but ............. he seems to feel I should not have any pain now at all from the occlusal trauma and I still have pain from something.  It was still sore when he put the permanent ones on, this is why I had him put permanent #19 on with temporary cement.

Number 19 seems like it is trying to heal but for some reason cannot, now I feel a little pull in my chin and it feels sore for a minute, fades away, but then comes back again every once in awhile.

The temporary crown he put on the 16th of March replicated the original crown that was giving me problems in the first place. He stated that was all he had to go from at that point and time.  The process started all over again, he had to adjust it on the 24th of March and when he took it off, I stated, can you just leave it off?  

He stated no he could not just leave the temporary off because my teeth would move, so he adjusted it and I went back March 26th for permanent ones.  

March 26th, I think the prosthodontist made some sort of different/alternate or modification adjustment when putting on the perm crown with temporary cement because of my gums still hurting and in between 19/20 crevice still hurting.  

I was told that if I leave the crown off that my teeth will move and that the crown cannot be left off.   Can I leave it off without my teeth moving?  If I can, this is what I am going to have him do or someone do, I think this is the only way I am going to be able to resolve my problem with number 19 tooth or get it pulled, one or the other.

Thanks again.   Please let me know if I can leave the crown off, because if I can I am going to have it taken off for a week to see if all heals.

I know I may be a rare case, but there is something still wrong.  I just wonder if I will ever find out what the problem is before I end up going and having it pulled.

My other gums on 20,  21and 22 are being affected by this pain also for some reason.
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Avatar_m_tn
Certainly the tooth out of occlusion and interproximal contacts would shift, but not much in a week.The purpose of leaving the tooth out of occlusion is for diagnosis. If your symptoms perisst, we know occlusion of tooth #19 is not the source of problem, because a prepared tooth definitely is out of occlusion. In this scenario, no matter how we manage occlusion is of no avail. I personally consider cotton roll clenching test is the gold standard for any restoration, because a healthy tooth  definetly can tolerate cotton roll clenching without problem. I believe your gum is healthy, otherwise the prosthodontist would not proceed final restoration. Your gum problem is probably referred pain from muscle. It's written in the book.titled" myofascial pain and dysfunction, the trigger point manual", myofascial trigger point pathology can  provoke tooth thermal sensitivity, and chewing sensitivity. Clinically, I can observe the phenomenon written in the book.
Currently, I am working on a patient , whose condition is similar to yours. He has problem of crowned teeth #30 and 31. Tooth #31 can not clench cotton roll comfortably with and without provisionals. I ended up administrating amitryptyline( tricyclic antidepressant), After one week of drug therapy, he is improving. I will proceed final restoration until he can pass cotton roll clenching test.
Please keep in mind not all dental pains are odontogenic .
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I don't know what odontogenic is, I tried to look it up but found nothing.  

I am going to have it taken off regardless and leave it off for a week. I have no other choice, even if I have to go to another dentist.

occlusal  is still the problem I think. Last night I could not sleep with it. It is hurting the back on the lingual side now and is still sore between 19/20 gums and it is still creating space inbetween these teeth for some reason, causing my other gums to hurt.

It is getting to be a little bit ridiculous with not getting my occlusal right,  if my gums are still hurting from trauma how can the gums get better with something on them irritating them is my question to this dentist.  

I can feel it trying to heal, but the crown will not let it. If something is keeping it from trying to heal and go over to where it is suppose to be and forcing it another way, there is no way it can heal.   This is what feels like is happening.  

Oh that cotton test, I tried it, when I bit down it is a little sore still, but I can bite it.

He also used what I think they call an orange stick to adjust the bite. He had me bite down on it.

I'm making some progress but just not there yet.  It should be starting to feel like a normal tooth in my mouth, but it does not.

Thanks again for all your help.    Once the gums are heeled then a crown should be able to fit like a normal tooth, until then I will be going through tons of adjustments if my gums are not heeled right and still causing the occlusion to be off, with adjusting the crown and it still hurting nothing is going to be right.   It only makes sense.


How come no one else can understand this logic of thinking? I can and I am not a dentist.  I think I'll take my chances on the teeth moving but it has got to be left off to heal.
Thanks so much.  




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Avatar_m_tn
Odontogenic means tooth origin or tooth causing. Sorry I am not familiar with verbal English.
Leaving a prepared tooth uncrowned for a week or 2 is not going to make detectable shift clinically. I believe your prosthodontist and endodontist can diagnose gum problem, if there is periodontal pathology present, they are able to diagnose. It's not uncommon that patient may perceive gum hurting when there is occlusal interference. Once occlusal interference is eliminated, sensation of gum discomfort goes away immediately.
Cotton roll and wood stick work similarly. I personally feel wook stick may have more risk of causing crown or root fracture. The purpose is to impose as much as force or load on one specific tooth. As I said before, a healthy tooth can tolerate the stress definiely. If it can't, we must find out why., the most common cause is occlusal interference.
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I had him (Prosthdontist) look at it on Saturday 4th of February and he had a periodontist come in to look at my gums, they are fine. Periodontist states my gums are healthy.  The Periodontists stated that he thinks it will take up to 6-8 more weeks for the endodonic treatment to heal. The prosthdontist put a new temp crown on and sent the other final restoration back after he took a pick up impression of it. (like you said he might have to do).  It was too bulky on the lingual side.  I am learning so much about teeth it is scary.  Especially when your teeth are out of occlusion. Thanks so much for all your help.  You have given me so much information. I was so knowledge less about things and you have helped me so much it is unbelievable. I tried to make him leave it off but he would't.  That's ok I just think he doesn't want to take a chance on my teeth moving or something.   As long as he puts everything on with temp cement I guess I can live with that. It has been in occlusion for 9 months so it will probably take awhile for my gums to go back to normal from the occlusional trauma. I guess now the symtoms (symptoms) will have to be reversing themselves now that the crown is down where it should be. It is weird though, I keep getting these sensations in my other teeth and my chin hurts like a bruise and it still feels like I keep feeling a space or gap in between 19/20 teeth. As long as I am not in serious pain like I was before I am going to try to deal with it. I cannot thank you enough for helping me through this with all the information and support you have given me.  
Thank you.  

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It is definitely out of occlusion.  I go back May 6th to have the permanent one placed again.  Once occlusion in fixed I should not feel any discomfort I would not think.  

He states the gums are still healing from the hyper occlusion.  

I didn't think after I got temp crowns and then final restoration that i would still have to go through more problems. I thought the gums would have been healed by now, but they are not.  I just cannot understand what makes the other gums sore also beside number 19.

Number 20 and 21 gums are sore and irritated.  Is this normal for the other gums to be sore while going through healing from malocclusion?
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Avatar_m_tn
Gum sumptom caused by occlusal interference is generally limited to the new restored tooth ( crowned tooth), it does'nt radiate to other teeth. Assuming the gum is healthy, which is validated by periodontist, gum pain is throbbing quality, which may be triggered by cold or hot stimulus, affected gum follows nerve supply of inferior alveolar or lingual nerve, which means your gum problem is limited to lower left area, I tend to speculate a rare condition known as pretrigeminal neuralgia.which is not easily recognized by many clinicians. You ask your dentist about this entity, which may expain your current symptomatology. I believe your dentists are probably at their wits end to expain your current presentations. Please be acknowledged that most cinicians are frustrated too, when they see a patient like you. I believe your dentists are trying their best to help you out. Please do not blame your dentists.
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I tried to make this one short but..........
I am not blaming the dentist. Elmo is trying to help me. I am blaming Francis Bertolini the first dentist who did my crowns for leaving them in hyper occlusion and causing me all my problems from the beginning.  If he would have just listened to me in the first place when I told him that It was feeling high and bulky and fixed them or sent them back to the lab I wouldn't be in the state I am in today.

I could not stand number 19 crown on anymore so I took it off Friday night. My gums are feeling better now, except gums around crown 18 are still hurting which is cemented on permanently. This one will probably have to come off also.  It is too bulky feeling on the side.

Number 19 was to high, I am biting down on it causing it to irritate my gums again and it is pushing itself down further on the gums.  I can feel where it is too high. When it is down too far in the gums, the bite feels right.  When it feels right at the gum line, it is too high feeling.  Number 18 is too bulky on the side in back.

My other two teeth 20 and 21gums were also hurting. I was getting headaches and my jaw was sore. Now that I have taken 19 crown off, my headache is somewhat gone and my jaw is not as sore.  My gums around the other teeth also quit hurting now that the crown is off.

I am going to let him know that if he cannot get the lab to make smaller crowns that I may have to go without or do something else. He is going to hopefully be able to make smaller crowns for my teeth to fit my mouth somehow.  

The new denstist should be able to make crowns that fit somehow.  It is probably from the occlusal trauma I have endured which may be playing a big part in why my crowns are not fitting right one time, fitting right the next time, and then not fitting right again.  

I think if the gums heal properly like they should, then the crowns can be placed right. I am sure the gums play a big part with the crown fitting properly, if not for the most part.

I am also frustrated because no one can make small enough crowns to fit my mouth to where they can get the occlusal right.    The answer is smaller, less bulky crowns and I don't think there is any other explanation for it.  

Why can't labs make smaller crowns?  I've read if the impressions are taken right that the crowns should fit like your natural tooth did and you should not be able to feel the difference after a couple of days.  It states that crowns should replicate the natural tooth being restored. If the crown is larger than the natural tooth it will trap bacteria which can cause decay or periodontal gum disease.

Like you stated before, he will have to do a pick up impression for final restoration
which has already been made and sent back. If this one doesn’t work and still hurts my gums I am at a total loss of what I should do next. except for waitinh of the gums to heal.

I guess from reading some more on failures of crowns regarding trauma from when repeated or sustained forces have been applied from hyper occlusion, an impression prepared prior to full recovery will convey erroneous relationships of the tooth with its neighbors to the working model and eventually to the prosthesis.

I also have read about inflammatry enlargement- factors include physical irritation of the gingiva by improper restorative or orthdontic appliances.  I know it is the occlusal doing it.    I never had pain like this before on my teeth until crowns were placed.  not being able to get the occlusal right is aggravating me, so I know it is irritating the dentist.  

Thanks again.  
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Had #19 off since Friday night. My gum is starting to resurface finally. Just in 3 days, the part where the original dentist had the crown too far down in the corner between 19/20 is starting to come back. I cannot believe it.   If I would have had the crown removed along time ago it  probably would have been healed by now.

It feels like the the gums surrounding the other teeth 20, 21 also 22 are starting to heal now that the crown has been taken off.  

I'm going to give it 6-8 weeks to heal and see what happens from there.

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Avatar_m_tn
Leaving a prepared tooth uncrowned for more than 2 weeks is unwise. I did suggest removal of crown for  diagnosis, but only for a wek or 2. It appears that your gum symptom is related to Tooth#19 occlusion , position, or contour. You may need to request your prosthodontist to adjust occluion and contour of provisional or final restoration.
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I go back today, he is going to put another temp crown on it.  Will my gums heal with a crown on though?

thanks

I think this is going to be a long process for me to get these teeth back to normal again.   It is frustrating, but............. I guess in the long run my teeth will hopefully be ok from the trauma my teeth and gums went through because of the inferior crowns the first time.  
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Avatar_m_tn
Occlusal trauma generally does'nt  cause gum injury, instead, overcontoured crown is the culprit of gum imflammation. Optimally contoured crown , whether provisional or final, guides or promotes gum healing or growth. I believe a prosthodontist can deliver a perfectly contoured crown, no doubt in my mind. However, as I said before, it would be very difficult to achieve optimal occlusion of tooth #19, if occlusion of tooth#18 is not optimal.Detection of occlusal interference is critical.If a tooth can not comfortably clench on a cotton roll, I believe there must be occlusal interference present.A dentist's job is to find it, and eliminate it.
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I went Tuesday April 14, it was another dentist who saw me; a general dentist there. Prosthodontist on vacation.  He adjusted the crown I took off and stated he took it out of occlusion and put it back on.   He stated since the gold one was on permanently he would not touch it, I would have to wait to see Elmo on that one.  May 6th I go back.

The gold one #18 is hitting the inside of my jaw causing soreness there. It is out of occlusion I'm sure because it is making the gum around it sorer.  

The crowns are just too big and need to be made smaller. It is occlusal interference and I hope he can find it. I'm sure he can, given time.

They need to be made smaller for one thing so they are not so high and thinned out at the sides; the lingual side and buccal.  They are just too big.

Maybe after the gums heal some more he'll be able to adjust it better.

The only thing I can do is keep waiting for my gums to heal; they are still sore and irritated.

Like I said before the crowns are too big and no one seems to understand this.

I am sure this dentist will make it right for me, so it seems like he will work with me to get it right.  If not, I'll be going to another dentist again until someone gets it right.

A person really shouldn't have to go through all this, but......if I want to keep my teeth and not have them pulled or implants I guess this is the only answer.

I hope he will find the occlusal interference and eliminate it somehow.

I surely don't want to have a tooth pulled if I don't have to.

I am about ready to go to another dentist though to see maybe if they can get the occlusal right after the other permanent crown is placed back on 19.  
The provisional 19 is still not right.

He definitely has to do something with 18 again, because I can't keep letting it hit my
jaw like this.  

I think alot of the hyper occlusional trauma may have alot to do with it and he didn't have my original teeth to work from either.  

Thanks for all your help.

You do not know how much I appreciate all your help.  You went beyond the call of duty for me.  

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Avatar_m_tn
Out of occlusion means no occlusal contact while jaw closing. If a dentist can not detect occlusal interference in the beginning, he or she probably can not detect later on. It's really the skill, although the skill is easy to learn. The crown is probably not bulky. A bulky crown generally results from inadequate reduction of tooth, Which I do'nt think that can happen to a prosthodontist. I have developed my own technique to detect occlusal interference, which is modified from Dawson's technique. If you think my technique is helpful for your dentist, please send me private e-mail. I can elaborate on how to detect occlusal interference. Once you grasp the technique, you may be able to communicate with your dentist.
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