Posted on: 19 January 2023
A dental crown becomes the new outer layer of a damaged tooth. The natural tooth structure is sealed under an airtight and watertight dental restoration. But the natural tooth is still there, and it contains dynamic living tissue—which is the pulp, or nerve, at the centre of the tooth. When this pulp becomes inflamed or even infected, the tooth is going to feel uncomfortable. What can cause toothache beneath the security of a dental crown?
A Crown on a Crown
It's a little confusing, but the visible part of a tooth is called a crown. The porcelain dental shell that was fitted over the tooth is also called a crown. So your dental restoration was essentially a crown on a crown. This crown was customised for your tooth and was designed to encompass the entire tooth down to its gingival margin—where the base of the tooth meets your gums.
This gingival margin should maintain a fixed position relative to the tooth. But this isn't assured. Gum recession is when your gingival tissues are lost—due to inadequate oral hygiene or overenthusiastic oral hygiene (brushing too hard). This loss is only fractional, but it exposes the tooth's cementum. This is a hard, protective layer that covers the tooth's root. It's weaker than enamel, which is the outer layer of a tooth's natural crown. It's also not as strong as a porcelain dental crown. This creates an opportunity for destructive bacteria to enter the tooth's root beneath the crown.
Beneath the Restoration
Toothache in a tooth covered by a crown may not originate in its root either. If the crown was cracked or damaged or has become loose, its seal on the tooth has been broken. Contaminants can work their way beneath the restoration, and the tooth can decay. This decay is invisible, as the porcelain crown can look intact, giving the tooth the outward illusion of health. However bacterial contaminants made contact with the tooth, your dentist will need to investigate.
It's probable that your dentist will remove the crown to have a thorough look at the tooth beneath it. When decay is evident in the tooth's natural crown, it can be filled. If the existing crown still fits the underlying outline of the tooth after these repairs, it will be re-cemented. If not, a new crown will be needed. For infections that originated in the tooth's root, a root canal (removal of the infected pulp) may be the only way forward, after which the tooth's porcelain crown will be put back into place.
Because a crown can hide visual warning signs of decay, it's really important that a toothache underneath a dental crown is promptly investigated.
Contact your dentist for more information about toothaches.Share