Inflammation under the tooth crown

introduction

If a tooth has been completely destroyed due to caries, the dental crown is the method of choice as a denture. Sudden onset of pain below this definitive denture can cause persistent malaise, the symptoms, therapy and prognosis of which are explained below.

Symptoms of inflammation under the tooth crown

If an inflammation forms under a crowned tooth, this is a very unpleasant undertaking for the person concerned. The following symptoms occur more frequently:

• Pressure sensitivity: The inflammation of the vessels in the tooth chamber creates gases that want to escape. Since the crown prevents any escape, very strong pressure is created on the crowned tooth. The gums around the tooth can also be tender and painful if you just touch them.
• Swelling: The inflammation tries to spread downwards, as there is no way upwards. This can also infect the bone and soft tissue below the tooth root and cause slight swelling. The swelling ensures that the tooth is slightly higher and that every bite causes discomfort. Chewing on the affected side is usually unbearable, so that the affected person moves to the other side. Biting and chewing causes pain that feels pressing and stabbing, some patients describe it as "lightning bolts shooting into the tooth."
• Redness: The gums around the tooth are often red, swollen and warm to the touch. It can be seen that cold foods and drinks provide relief while warm foods tend to exacerbate the symptoms.
• Abscess formation: If not treated, apical periodontitis, an inflammation below the tip of the root, can occur. This can lead to an abscess, a bacteria-filled accumulation of pus.
• Fistula duct: Another form of apical periodontitis is a fistula duct in which the inflammation forms a thin duct either in the oral cavity or outside the oral cavity, through which the pus can permanently drain. This variant is more favorable for the patient, since there is no feeling of pressure, but the permanently secreted pus can result in an unpleasant smell and a bad taste sensation.

To learn more, also read our article: Toothache under the tooth crown - causes and therapy.

Pain right after insertion

Unpleasant sensations can occur immediately after the insertion of a crown, but this is completely normal. The chewing sensation can feel different and unusual, but you get used to it after a certain amount of time. The new crown can also feel a little too "high", which should subside again during the acclimatization period.

But if you have this feeling all the time and you are not sure whether the other teeth are still clenching correctly, it may have been designed too high and a visit to the dentist is advisable.

Temporary temperature sensitivity that lasts a few seconds is also not unusual, only worrying if it does not get better over time and the pain lasts longer.

Course of pain with inflammation under the tooth crown

Initially, the inflammation will not be noticeable until it continues to spread. Slight pain follows, especially when eating hot or cold dishes. As the duration progresses, it increases more and more, can also express itself in a pulsating manner and turn into permanent pain.

The pain can be increased especially when biting, as the crown is stressed. The tooth is sensitive to knocking.

As soon as the first signs appear, it is advisable to seek expert advice in order to be able to start treatment as early as possible.

Treating inflammation

If tooth decay has been diagnosed under a tooth crown, the tooth root is inflamed, or excessive wear has occurred on the tooth crown, it is removed again in most cases.

Detecting tooth decay under a crown is not that easy. The dentist tests the edge of the crown for the caries to avoid the Secondary caries to discover or get an X-ray. Evaluating these turns out to be difficult because the metal crown can overlay the recording. The subsequent removal of the crown requires precise work, since the existing tooth stump, the gums and the bone must not be damaged. The removal depends on the type of attachment.

If the crown is already very loose, it can possibly be removed by simply turning it, but if it is more tightly seated, special instruments such as e.g. a dedicated grinding tool and expanding pliers.

After removal, the stump is assessed by the dentist and the necessary treatment is carried out. This can be the removal of the caries or a root canal treatment. Depending on the situation, the previously removed crown is reinserted or a new one is made. In such cases, the removal of the crown is covered by the health insurance company, insofar as it makes clinical sense.

Why is the crown reamed if the inflammation is localized underneath?

If there is inflammation under the crown, the tooth needs to be reamed to remove all of the inflammatory tissue so that the inflammation is prevented from spreading. If the crown is temporarily attached, it can be removed and does not have to be pierced. The root canal treatment is carried out on the affected tooth and the crown is reattached after completion.

However, if the crown is definitely cemented, it may not be possible to loosen or loosen it and the tooth has to be treated by the crown. In this case, a hole is drilled through the crown and the root canal treatment is carried out, after which the resulting hole is then filled with plastic. The crown can still be used, but aesthetically it is an unsightly solution.

When do you need antibiotics?

The use of an antibiotic is at the discretion of the practitioner, since antibiotics require a prescription. In the majority of cases, an antibiotic is used for inflammation under the crown, if the inflammation has a tendency to spread and there is a risk that the pathogen cells could enter the bloodstream.
If bacteria from the abscess get into the bloodstream, a systemic infection occurs that affects the entire body, known as sepsis. Since sepsis is life-threatening, attempts are made to use the antibiotic alongside dental treatment to eliminate the bacteria from the body more quickly. The antibiotic is given in addition to a relief incision of an abscess or a reaming of the affected tooth to remove the bacteria. The bacteria are contained and destroyed much faster than if only surgical or dental treatment is carried out.

Which antibiotic is best?

Aminopenicillins are the antibiotic subgroup of choice for inflammation of the oral cavity and especially teeth. These include, for example Ampicillin or Amoxicillinwhich have been scientifically proven to be the most effective because they are bactericidal, which means that the bacteria are destroyed directly. In addition, aminopenicillins can also be used in pregnant women, since they pose the lowest risk to the unborn child.

For patients with penicillin allergy is considered an alternative antibiotic Clavulanic acid or Clindamycinwhich, however, are not as effective as the aminopenicillins.

In general, it applies to all antibiotics that the prescribed intake must be adhered to. The antibiotic must be taken for a certain number of days, usually 4-5, so that no bacteria survive that can get used to the antibiotic and develop the dreaded resistances.

How does inflammation develop under the crown?

Inflammation under a crown is usually caused by the penetration of bacteria. Of course, the question arises as to how the bacteria can get under the crown, because after all it is usually made of metal.
The biggest weak point is the marginal fit, i.e. the transition from the denture to the tooth stump. It can usually not be seen with the naked eye because this gap only needs to be a few micrometers. Bacteria like to accumulate there, come into contact with the tooth stump and spread further under the crown. The result is tooth decay and inflammation that is painful, invisible, and can lead to the loss of the crown. In addition, an inflamed tooth root can of course also be the cause of pain.

Illustration of inflammation under the tooth crown

Inflammation under the tooth crown

1. Crowns, dentures
2. Tooth stump (tooth enamel) -
   Enameluma
3. Dentin (= dentine) -
   Dentinum
4. Area of ​​the crown margin
   Transition from dentures to
   Tooth stump (here correct occlusion)
5. Gums -
   Gingiva
6. Alveolar bone
   (tooth-bearing part of the
   Jawbone) -
   Pars alveolaris
   (Alveolar process)
7. Opening of the tooth root tip -
   Foramen apicale dentis
8. Bacteria accumulation
9. Inflamed gums -
   Gingivitis
   in the picture below left
   correct occlusion - closure
   Possible causes of inflammation:
   A - crown margin -
   too short, protruding
   B - crown margin -
   too long
   C - crown margin -
   stands out from tooth
   D - crown margin -
   too bulged
   (overcontoured)
   Types of tooth crown:
   a - metal - ceramic - crown
   b - all ceramic, plastic - crown
   c - gold, titanium crown

You can find an overview of all Dr-Gumpert images at: medical illustrations

How can you prevent inflammation under a crown?

Good oral hygiene must always be observed, regardless of whether you have dentures in your mouth or not, because this reduces the risk of developing tooth decay. If a tooth has been fitted with a crown, it is advisable to brush your teeth and tongue at least twice a day, but preferably after each meal.

Mouth rinses and dental floss should be used as support, as they can be used to reach the rather fine crown edge area and remove the bacteria that have settled there. Marginal caries can thus be avoided.

Also read our articles: Correct tooth brushing and optimal oral hygiene.

Reasons for a crown restoration

In addition to the most common reason, namely carious destruction of the tooth, where a new filling no longer makes sense for static reasons, there are other indications for a crown.

• Is missing e.g. a tooth, this gap must be closed by a bridge. To fix the bridge, the teeth that delimit the gap are crowned as they serve as an anchor to which the pontic, which closes the gap, is attached.
• A crown is also indicated for developmental disorders of the tooth structure, discoloration or to correct positional anomalies.
• In many cases the crown is also crowned if the tooth has been treated with a root canal, as it is less elastic than a living tooth. Thus, the risk of fracture is greater and the tooth is given a crown to ensure stability.
• A crown must be tailored to the individual situation of the tooth being treated. Many people crunch during the night, due to stress, emotional distress, or issues with the TMJ, whatever Abrasions leads to the teeth. If these are very pronounced, a crown can also be attached. The crunch must also be treated at the same time, otherwise the new crown will be overloaded.
• In addition to the factors just mentioned, a tooth can also be crowned if the static and dynamic occlusion, i.e. the correct interlocking when clenching and moving the teeth, is no longer given. Since this can cause long-term serious disturbances, the correct occlusion in statics and dynamics must be restored with a crown.
• Aesthetics naturally play an important role here, because a beautiful and healthy smile are important features of attractiveness that can also be reasons for a crown and must be taken into account during treatment. They are also classified in this category phonetics and the chewing function.
• Lastly, traumatic tooth damage or multiple large-area fillings should be mentioned, which are indications for such a restoration.

Manufacture and insertion of a crown

In principle, every tooth can be crowned. It only has to be anchored sufficiently firmly in the jawbone, the root and root tips have to be healthy and the gums have to be in good condition. Whether a tooth can be crowned is sufficiently examined beforehand.

The patient is now spoiled for choice as to which type of crown to choose. The decisive factors are, of course, the services that are covered by the health insurance, the aesthetics, the area where the crown should be used, what you want to pay for yourself and what you consider appropriate.

The basic supply is a fully cast crown that is completely cast from metal. Without veneering, this is usually used in the posterior region, as the metallic element is less visible there.

As an alternative, a crown can also be made that is completely made of ceramic and, thanks to its good aesthetic properties, can also be used in the anterior region. It is usually difficult to distinguish good all-ceramics from a natural tooth.

There is also the option of casting a metal crown and then veneering it with ceramic to improve the appearance.

The best result is discussed in detail with the patient and the individual tooth color is determined. Then the tooth is prepared for the respective crown. This means that it is ground with various grinding tools so that a crown can be inserted. The ground tooth is like a miniature version of the previous tooth. After an impression has been taken, the dental technician then makes the crown in the laboratory and uses it in the next step.

The crown must have a good marginal fit, must not be too high, must have good contact with the neighboring teeth, sit properly on the stump, be properly processed in terms of material and enable good static and dynamic occlusion. The accuracy of fit at the edge of the crown, i.e. the transition between the artificial crown and the tooth, is particularly important because an inaccurate fit can quickly lead to inflammation of the gums and caries under the crown, which causes pain. If all of this is ensured, the crown is definitely incorporated (attached).

You can find more general information on the subject of dental crowns in our main article: Dental crown.

Risks of a crown restoration

In most cases it seems unrealistic that a crown will last a lifetime. Inflammation can spread underneath or other complications can lead to premature loss.

If the gums become inflamed and the inflammation may spread to the bone, the rate of loss is high. Reasons for this can be an existing gum disease or new bacterial accumulations, among other things due to poor oral hygiene.

Plaque builds up on the crown and irritates the surrounding gums. If the tooth has had a root canal treatment, a possible loss of the crown is very likely, as such teeth generally have a reduced life expectancy.

Severe grinding or clenching of the teeth can also lead to premature loss.

Of course, it is also possible that the dentist or dental technician did not work properly enough and that there is a loss due to inaccuracies of fit and the associated caries.

Summary

Pain under a crown is usually a sign that something is wrong with the definitive denture and that it needs to be replaced.

Marginal tooth decay is the most common cause of this problem. This spreads quickly and causes an uncomfortable throbbing pain that should be seen by a dentist as soon as possible so that the pain can be relieved quickly.