Tooth pain after a crown: causes and what to do

What’s probably going on

A new crown is a big change for a tooth. The tooth was numbed, reshaped and covered, so some soreness afterward is expected. The question is whether it’s settling down or not.

The most common causes, roughly in order:

• Normal sensitivity while the tooth settles. If the tooth still has its nerve, MedlinePlus says it may be sensitive to heat or cold for a while. Cleveland Clinic says some sensitivity for a couple of weeks is normal. It should fade, not grow.
• A crown that sits a little too high. If the crown touches before your other teeth do, that tooth takes the force of every bite. This often shows up as pain when you chew or clench, or a bite that just feels off. MedlinePlus lists a bite that doesn’t feel right as a reason to call your dentist.
• An irritated or inflamed nerve. Deep decay, a large old filling or the crown work itself can leave the nerve inside the tooth inflamed. The American Association of Endodontists says pain that lingers after hot or cold often means the pulp is damaged, and a root canal may be needed to save the tooth. See tooth sensitive to cold.
• An infection at the root. Throbbing pain, swelling, a bad taste or a bump on the gum can mean an abscess. See tooth abscess.
• A loose crown or a new cavity. A crown can work loose, and the tooth underneath can still decay. Cleveland Clinic lists a loose crown and bad breath or a bad taste as reasons to call.
• Grinding or clenching. Night grinding can make a crowned tooth ache and can chip the crown. See jaw and tooth pain from grinding.

A useful rule of thumb from the AAE: a quick twinge that stops when the cold is gone is usually less worrying than pain that hangs on afterward.

What to do tonight

1. Give normal sensitivity some time. If it’s mild, only with cold or heat, and getting a little better each day, it’s usually settling.
2. Take an over-the-counter pain reliever as the label directs. For adults and teens 12 and up, an anti-inflammatory such as ibuprofen or naproxen, alone or with acetaminophen, is a usual first choice. Ask a pharmacist first if you take other medicines, are pregnant, or have stomach, kidney or bleeding problems.
3. Chew on the other side. Give the tooth a break, especially if biting is what hurts.
4. Avoid very hot, very cold and very sweet foods for a few days if they set it off.
5. Switch to a toothpaste for sensitive teeth if cold is the trigger. The ADA’s MouthHealthy site says these usually take several uses before sensitivity eases. A sensitivity toothpaste is an easy one to keep on hand.
6. Call your dentist if your bite feels off. A high crown doesn’t fix itself, and it’s the kind of problem worth mentioning early.

If the crown came off

Keep the crown, don’t use household glue on it, and call your dentist. Our guide to a lost filling or crown covers how to protect the tooth tonight.

What not to do

• Don’t put aspirin on the tooth or gum. It burns the tissue.
• Don’t chew ice, hard candy or sticky foods on the new crown, especially a temporary one.
• Don’t take leftover antibiotics. Only a dentist or doctor should decide whether you need them.
• Don’t wait out pain that keeps getting worse. Worsening pain is the sign to call.

How a dentist fixes it, and what it costs

The dentist will usually check your bite, look at the crown’s edges, and may take an X-ray.

• A high crown can often be reshaped in the chair until your teeth meet evenly. Cleveland Clinic describes the same fix for a new filling that throws off your bite.
• A loose crown can sometimes be cemented back on, if the crown and the tooth under it are still in good shape. Your dentist will check for decay first. CareCredit’s 2024 national survey puts the average cost of re-cementing a dislodged crown at $126.
• An inflamed or infected nerve usually needs a root canal. MedlinePlus notes a tooth under a crown may need one, or in some cases may need to be pulled. See pain after a root canal and root canal cost.
• Decay under the crown or a broken crown usually means a new crown. See crown cost.

If the crown is new, ask whether a follow-up adjustment is included in what you already paid. For bigger work, ask for a written estimate first. If you don’t have insurance, a dental savings plan (a discount membership, not insurance) can lower the price at participating dentists.

How to keep it from coming back

A crown protects the tooth, but the tooth underneath can still decay. MedlinePlus and Cleveland Clinic say most crowns last at least five years, often much longer, with good care.

• Brush twice a day with a fluoride toothpaste and floss once a day, paying attention to where the crown meets the gum.
• Keep up with checkups so a loose edge or new cavity is caught early.
• Skip ice, very hard nuts, popcorn kernels and very sticky candy.
• If you grind or clench, ask about a night guard. See custom vs over-the-counter night guards.