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Dentistry/Porcelain Crown Causing Jaw/Ear Pain

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Sorry for the long back story, I just want to make sure you have all of the information. I had work done on tooth 18 lower left. No root canal or post but the dentist didn't explain if he was repairing it from decay or putting in a filling. Whatever he did, he said I needed a crown. He made a temp and it fit perfectly against the tooth, nice and tight,  but the top of it felt a little high. He said it would go down a bit on its own. I believed him because it really only felt high a small bit.

The first day while it was still high, I started getting pain in my TMJ on the right side. I've never had any face or jaw pain before and it was so bad, chewing was excruciating. I discovered that pushing down firmly on the joint allowed me to chew without pain for some reason so I just did that every time I took a bite. The next day, the temp no longer felt high and there was no more TMJ pain. The temp felt like a regular tooth, I couldn't even tell I had dental work anymore, and I was able to eat normally.

I went back two weeks later to get the permanent crown. I told him what happened with the temp and my jaw and said I read about occlusion and all the problems you can get with your jaw, teeth, and face if crowns aren't fitted right and that if you experienced any issues, make sure the dentist checks the bite in all quadrants as he adjusts to be sure everything is lining up how it should be and he said not to worry because he'd make sure the bite it great.

He removed the temp and did some prepping then put on the crown. The crown wouldn't stay on/stick to my tooth. It was like it was too big to grip it or like there wasn't enough tooth. Even when he'd have me bite down on that foam thing to try to wedge it down with pressure, the second I released my bite, the crown fell right off again.

I have a lot of crowns and I've never had one that wasn't a nice tight fit on the tooth on its own so I told him I was concerned that the crown wasn't made right and a new impression needs to be taken so another one can be made, especially knowing that the temp fit fine and had no problem being a snug fit and he said no, the crown's fit is perfect.

He couldn't work on it because it wouldn't stay on and at one point, he grabbed my jaw so that his thumb was pushing down on the crown as hard as possible and his other four fingers were gripping my jaw/chin for leverage and tried to work on it that way and I asked him to stop because him clenching my face like that was uncomfortable and I didn't see how all of that would be necessary if the fit was right.

He had them take an xray and said to make sure I bite down as hard as possible on the crown to keep it on while they take it. Then he left at one point to consult with the head dentist but didn't say about what. I heard the head dentist in the other room asking what something is on the xray like he was confused at what he was seeing so they both came in. The head dentist looked in my mouth and said something like, "Oh, I see, it just looked weird on the xray".

But it sounded like he was talking about something other than the crown. He left and my dentist continued trying to get the crown to stay on. He put it on and told me to bite down I felt something crunch under it. I told him and he said nothing was there and I said there was, it was like the crown crumbled somehing between it and my tooth and he said maybe there was debris there or something but it's gone now.

Since he couldn't get the crown to stay on by itself, he said he was just going to cement it in and then worry about adjusting it afterward. I wasn't comfortable with that but he seemed adamant that the crown didn't need to be remade and that the fit was good. He cemented it and then asked how the bite felt. I told him it was way too high. Not a little high like the temp was but extremely high to the point where none of my teeth were touching at all except the crown.

He made two adjustments and it was still the same. I reminded him about my TMJ concerns and asked if he could please check all over my mouth with the paper, not just the crowned tooth. He did and confirmed that my other teeth weren't touching at all so when I bit down, the paper just slid right out with no resistance.

He adjusted again and the teeth were finally slightly grazing each other again but only on an edge, which was weird, and overall the crown was still too high and I could feel a high point specifically on it that was poking too hard at the top teeth and he said the bite was fine. I argued but he kept saying it was fine and the paper agreed with him and to let it go down after a few days and it would be fine.

I knew this time it wouldn't because it was so completely off but I didn't know what to do because he wouldn't adjust it any more so I left. This was a Friday. That night, I tried to eat fish chewing only on the right side to avoid the dental work and it was awful. Every time I bit down, the crown would smash up against the upper teeth and after it did that enough, the tooth started to get really sensitive like it was injuring the root.

I tried instead to chew on the left side so at least the tooth wouldn't bang but the crowned tooth didn't feel stable almost like the crown wasn't fully on and felt too sensitive and chewing on the high side made the teeth on the right side no longer connect at all when I bit down which seemed to be making my jaw muscles tired. I gave up on eating for the night.

The next mornig I tried to have eggs and it was the same problem. Tired muscles and unstable feeling crown on the right if I ate on the left, crown smashing and making the tooth and root tender if I ate on the right. The smashing happened so much, even sometimes when I was talkig, that by the end of the day, the tooth so sensitive to touch that I got a shooting pain if anything even grazed it and my jawbone underneath it was starting to hurt.

They're closed on the weekends and I had to go out of town that week so I called the following Monday when I came back and told my dentist what happened and that not eating I have to chew and being mindful of keeping my mouth open a little all the time to avoid the crown touching has helped but something is wrong with the fit of the crown and with the bite.

They made me another appointment for that Friday and when I came in, I told him I was concerned about damage to my jaw and that the root was dying and also voiced again that the crown didn't feel like it was on my tooth right, it felt like it was going up and down when I bit down on it. Again he said the fit is perfect and the bite looks fine and gave me all kinds of excuses for what else could be causing the problems, like maybe I have sensitive gums which I know I don't.

I kept asking and he finally tried to adjust the crown's bite again and it was much better but still not perfect and again he told me to come back because he wouldn't adjust anymore. At this point, not only am I having pain in the tooth and in the bone underneath it but now I'm starting to feel pain in my ear and a sensation that the tooth is clicking or something is moving.

I was already on antibiotics from my doctor to avoid infection so it wasn't that. The right side also started giving me pain but this time, not in the joint or in the muscles but in the teeth I think from me eating on the right side all the time.

I made a third appointment and it was the same deal as the first and second. No matter what I said, he kept swearing the crown is sitting fine on the tooth with a perfect fit and the bite is fine but then checked again and said there was a tiny bit he could adjust. He did but I don't think he's good at that because the bite was still high and he didn't see any more issues but come back if I did.

I decided not to go back to him and to look for a second dentist. In the meantime, the pain was still bad in the jaw bone, only right under that tooth, not in the rest of the bone on that side, and the ear still has a weird intermittent pain on the inside of it and eating on that side still feels "wrong". The crown doesn't feel like a tooth like the temp did. It feels like something sitting ON my tooth. The right side jaw muscles still get tired now.

I went on message boards trying to find someone who had a similiar problem and the closest one I found ended up going to a new dentist as well and their new one said the problem with what they were feeling aside from the bite being wrong was that there was no mechanical retention. I wasn't positive what it meant but they said when the crown is done right and the tooth is prepped well, the tightness of the fit against the tooth aids in the crown's attachment to the tooth and the cement supports it.

But when too much of the tooth is removed or the crown isn't made right, the crown has to depend solely on cement to keep it bonded to the tooth and that can cause problems.

They also said that if the dentists uses too much cement to compensate for that, the crown can sit up higher than it should on the tooth. All of that sounded a lot like what was happening with mine and why mine doesn't feel right on my tooth but I can't find any more info about it.

I finally made an appointment with a new dentist and they said that the crown is sealed all the way around and they don't see any spaces in the cement on the xray but I forgot to ask her about mechanical retention and whether or not it looked like there was too much cement that might explain why my crown feels raised up off the tooth and kind of squishy when I bite down.

I will ask when I follow up but for right then, she said the bite was clearly high and made an adjustment that made my bite feel almost perfect except still that the crown itself feels up too high on the tooth and the jaw and ear pain is still there and still bad to the point where even sleeping on that side of my face will cause it to flare up. The only thing that's gotten better is no more sensitivity and pain in the tooth itself.

Now that you have the back story, my question is what in your opinion could be going on with this crown that's causing me these problems with my jaw bone and ear on the left side and a sense of weakness in the upper jaw muscles and by the ear near the TMJ on the right side? Is it just that the bite it still off or is it possible that the crown itself really is sitting up too high? Also, what are the downsides of a lack of mechcanical retention?

I noticed that sometimes, when I close my mouth, all of my teeth are touching like they should be and other times, when I close it, the ones on the right are lifted up a bit again and I never had that before this crown so I'm worried my jaw is shifting around all the time now because of the crown. Any advice and ideas you can throw out about the possibilities would be so helpful and I'll have more knowledge to be aware of and know what more to ask the next time I'm able to see my new dentist again.

Thank you!

Answer
KJ -  It is pretty obvious that the dentist who fabricated the crown and had trouble seating it, along with this new dentist are not skilled at all.  The new one doesn't want to get involved with a mess.  That original dentist either took a bad impression, the crown that he tried to put in was another person's crown or the bite is thrown off from a poor seating and over cementation of the crown.  I know you are the one dealing with this and I feel bad for you.

Just so you know, when the bite is off, the symptoms you have endured are caused by spasms of the jaw muscles, which throw the bite off even more.  Your dentist obviously did not want to redo the bad crown.  

I don't know what to tell you, but the dentists you have been involved with do not sound very good.  Do yourself a favor and if any problems occur again see if you can make an appointment with a dentist who teaches at New Jersey College of Medicine and Dentistry in north Jersey or U of Pennsylvania Dental School if you live in south New Jersey.

I wish you well and hope it all resolves, but if not, get a good dentist.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA -University of Connecticut DMD - University of Pennsylvania School of Dental Medicine

Awards and Honors
National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude

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