Dentistry/Crown pain

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Question
Hello,
Two weeks ago I got a crown on my #30 tooth after getting a root canal.  I did not chew food on my crown until three days ago and since then I have been in pain.  It is a deep gnawing pain. All I ate was a turkey burger and a slice of cake.  I had no issues until I chewed food on my crown.

History:. My tooth was cracked, I got a root canal and a crown.
Any suggestions why I am having pain?

Thank you,
Lynnsie

Answer
Lynnsie,
Thank you for your question. As I always state without a complete, thorough clinical and radiographic exam, it is impossible to precisely recommend a diagnosis and treatment plan.
Your concerns are actually not an unusual situation.
When a root canal is completed,the bone and periodontal tissues surrounding the roots have been irritated. This unfortunately goes with the procedure. It may take anywhere from 6 months to 2 years for all the tissue and bone to heal completely. The time frame for healing is dependent on the amount of the initial damage, the patients medical situation, their immune system and the actual result of the treatment. If there is extensive bone damage, or if the patient for example is a diabetic, these can influence healing and length of repair.
If a tooth has had micro cracks  internally into the pulp or root canal chamber, this can result is potentially further more serious fractures. Usually these are able to be seen
prior to or during root canal treatment. If there was a vertical root fracture you will lose the tooth. From your history it sounds like your fracture was only a portion of the original tooth crown. If that was the case, after the root canal and tooth build up for a new crown, the prognosis is very good.
As far as your,subsequent pain on chewing, this is not an infrequent problem. Almost  all the time it just requires the new crowns bite to be adjusted. Once that is done, the pain is eliminated. Depending on the amount of bone damage at the end of the roots this will determine the length of time to heal. Thus if there is minimal damage full chewing could resume almost immediately.However if there was extensive damage, healing will take longer.
If you are biting high or hitting prematurely on a high spot on the new crown, this will act like a hammmer and traumatize the periodontal tissues,and bone surrounding the tooth. Sometimes the body responds to this by building up fluid at the end of the root(s) in the surrounding periodontal ligament ( sling around the roots).This causes inflammation and can push the tooth up in the va a socket and causes you to hit on  (occclude or bite)the tooth more vigorously. This can cause severe pain.
The solution is return to the dentist who placed the crown, have the bite adjusted, be prescribed  anti-inflammatory medication, and possibly an antibiotic. Once the bite is adjusted, the hammering on the tooth will no longer occur. Since the crown bite (occlusion) has been adjusted the pain will resolve. Most patients have instant relief and within a few days,or weeks,can carefully bite and chew normally.Good luck with your bite adjustment and I hope this resolves your problem.  

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robert block

Expertise

I would prefer to answer questions related in my specialty of Endodontics( ROOT CANAL THERAPY) I am a Board Certified Endodontist with a special interest in advanced surgical endodontic procedures. I know root canals create a lot of apprehension in patients, and they usually have many questions about the procedure. I can address patient concerns either before or after their root canal treatment. I also have re-treated numerous patients who have had previous endodontic treatment. As a result of these clinical failures,and the increase in the use of dental implants, its important patients understand the alternatives of therapy. There are often many components to treatment that interrelate the disciplines of endodontics, periodontics and restorative dentistry.Patients frequently question the importance of considering all facets in a clinical regimen. Hopefully, I would be able to educate and contribute some information from the endodontic perspective.

Experience

Diplomate American Board of Endodontics, 35 years plus private practice experience. Formerly Professor and Chairman, Department of Endodontics at US dental school. Editorial journal reviewer for the endodontic section of The Journal of American Dental Association. Serve as a reviewer on several editorial boards.

Organizations
American Association of Endodontists, College of Diplomates, American Board of Endodontics

Publications
Over 150 publications, abstracts, case reports, chapters in textbooks. J. Dental Research, J. of Endodontics, J. of Oral Surgery Oral Medicine Oral Pathology,The NEXTDDS J.For example: The Single File Approach for Predictable Endodontic Canal Instrumentation:The Wave One, THE NEXTDDS J. 4-2:13-17 Fall 2014 Non Surgical Management of an Endodontic Failure Utilizing Contemporary Technology, www.THENEXTDDS 5-1:60-63 Spring 2015 Are You Still Using Formocresol? An Update, Tn. Dent. J. 89-4:14-19 Fall 2009 Management of Endodontic Failures, Oral Surg.vol.66:711-Dec.1988

Education/Credentials
BA. DePauw University, DDS. University of Michigan, MS. Medical College of Virginia, Virginia Commonwealth University, Gen. Practice Resident, University of Connecticut, Endodontic Resident Medical College of Virginia, Virginia Commonwealth University

Awards and Honors
Numerous Awards and Honors, Edward P. Hatton Award( Int. Assoc. of Dental Research), Endodontic Memorial Research Award ( American Association of Endodontics) Outstanding Endodontic Department Teaching Award (given by dental students)Fellow American Academy of Dental Science

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