Tooth Pain Under a Crown Comes and Goes: Why It Happens and What to Do

Tooth pain under a crown that comes and goes usually has a cause beneath the crown that needs a dentist’s attention. It may be a crack, inflammation or infection of the nerve, decay or grinding. If the pain lasts more than two days, see a dentist to find the cause and discuss treatment.¹

A dental crown covers the visible outside of a tooth. It protects the remaining tooth structure, but it does not remove the living tissue inside. The pulp, which contains the nerve and blood supply, remains beneath the crown unless the tooth has had root canal treatment.

This distinction matters. A crown can look perfectly intact while something underneath it is causing discomfort. The pain may appear during chewing, after eating something hot or cold, or without an obvious trigger.

The most common possibilities include:

The diagram shows why this matters. Enamel forms the hard outer layer, dentine lies beneath it, and the pulp sits at the centre. The nerve is inside this pulp. Problems affecting these inner structures can cause pain even when the crown itself appears undamaged.

A crown therefore cannot rule out a dental problem. The dentist needs to examine the tooth and establish what is happening underneath it.

Pain when biting down on a crowned tooth is a reason to arrange a dental examination. The discomfort may be intermittent, particularly if the tooth is affected by a crack.¹

One important sign is pain when you release your bite rather than when you first press down.

The American Association of Endodontists describes this as a characteristic symptom of a cracked tooth. The pain can be unpredictable. You might feel it while chewing one day, then experience little discomfort the next. It can also be difficult to identify exactly which tooth is responsible.²

Do not assume that the crown simply needs time to settle, particularly if the pain keeps returning.

Your dentist can examine the tooth and assess whether a crack or another underlying problem is responsible.

Yes. A tooth can lose its living pulp after a crown has been fitted, even if it was alive when the treatment was completed.

A systematic review and meta-analysis published in BMC Oral Health in 2023 examined 37 studies involving teeth that had received crowns or similar indirect restorations. It estimated that approximately 5 in every 100 teeth with living pulp subsequently developed pulp necrosis, meaning the pulp lost its vitality. Around 3.6 in every 100 developed infection around the root tip.³

The researchers also identified factors associated with a greater likelihood of these complications:

• The tooth had decay or fillings before the restoration.
• The restored tooth was a front tooth.
• The tooth spent a prolonged period with a temporary restoration.
• The follow-up period was longer, particularly beyond 10 years.

It is important to interpret these figures carefully. The certainty of the evidence was rated low, so they should not be treated as precise predictions for an individual patient.

Most crowned teeth do not develop pulp necrosis. If the nerve does become damaged or dies, a dentist can assess the tooth and discuss treatment options.

The important point is that a crown does not guarantee that the nerve underneath will remain healthy indefinitely.

Yes. Decay can still develop in a tooth that has a crown.

The crown covers the tooth, but the underlying tooth structure remains susceptible to dental problems. Toothache is one of the symptoms associated with tooth decay, according to the NHS.¹

If you notice pain, sensitivity or discomfort around a crowned tooth, the dentist will need to check the crown and the tooth beneath it.

They may examine the edge of the crown to look for signs of decay and take an X-ray to assess the tooth.

Do not rely on the appearance of the crown alone. A crown that looks unchanged does not necessarily mean the tooth underneath is healthy.

An infection beneath a crown can cause an intense toothache. However, the symptoms are not always limited to the tooth itself.

According to the NHS, signs of a dental abscess can include:

• Intense toothache.
• A bad taste in your mouth.
• Swelling around the affected area.
• A high temperature.⁴

A dental abscess needs urgent treatment.

Contact a dentist or NHS 111 if you suspect an abscess. Do not wait for the symptoms to become more severe.

There are also situations that require emergency medical attention. Call 999 or go to A&E if you have difficulty breathing, speaking or swallowing, or if you have significant swelling or a swollen eye.⁴

These symptoms need to be taken seriously, but not every painful crowned tooth means you have an abscess. An examination is needed to establish the cause.

Getting a dental crown involves preparing the tooth and fitting the restoration. If the tooth needs root canal treatment, the NHS explains that this procedure is carried out under local anaesthetic.⁵

A temporary crown may be fitted while the permanent crown is being made. It protects the prepared tooth during this stage of treatment.⁶

Some patients notice discomfort around the time of crown treatment. However, there is no single pain duration that can be described as normal for every patient. The important thing is to pay attention to the pattern and severity of the symptoms.

Go back to your dentist if:

• The pain lasts longer than two days.
• The pain keeps returning.
• You cannot bite comfortably on the crowned tooth.

The NHS recommends seeing a dentist when toothache lasts more than two days. Pain when biting is also a reason to seek dental attention.¹

A new crown should not be assumed to be the cause of every symptom. The dentist needs to check the tooth itself.

There are different types of dental crowns, and the choice depends on the clinical situation. If you want to understand the available options, DentSpa’s guide to different types and uses of dental crowns explains the subject further.

Treatment depends on what the dentist finds. There is no single solution for every painful crowned tooth.

If your crowned tooth is hurting, arrange a dental appointment rather than relying on home treatment. There are, however, a few things you can do to manage the discomfort while waiting.

The NHS recommends the following measures for toothache:¹

• Take painkillers such as ibuprofen or paracetamol, if suitable for you, following the packet instructions.
• Consider a pain-relieving gel designed for use in the mouth.
• Rinse your mouth with warm salt water. This is suitable for adults.
• Choose soft foods that require less chewing.
• Avoid chewing on the side with the painful crown.
• Avoid very hot, cold or sweet foods and drinks if they trigger discomfort.

These measures may help you feel more comfortable, but they do not establish or treat the underlying cause.

If you want more practical advice while arranging an appointment, read DentSpa’s guide to toothache relief in the UK.

If you have swelling, a high temperature or symptoms suggesting an abscess, seek urgent dental advice rather than relying on self-care.

If your crowned tooth is hurting now, the first step is to have it examined by your own dentist or an urgent dental service. You should not delay an assessment to travel abroad.

DentSpa is relevant if you are planning a new crown or considering root canal treatment after receiving a diagnosis.

Located in Şişli, Istanbul, DentSpa provides crown and root canal treatment for international patients. Root canal procedures are carried out by endodontic specialists, including Dr Ahmet Çetinkaya, who has 10 years of experience.

You can read about Dr Ahmet Çetinkaya and his professional background.

1. NHS, Toothache. https://www.nhs.uk/symptoms/toothache/
2. American Association of Endodontists, Cracked Teeth. https://www.aae.org/patients/dental-symptoms/cracked-teeth/
3. Al-Manei KK, Alzaidi S, Almalki G, et al. (2023), Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a systematic review and meta-analysis. BMC Oral Health. https://doi.org/10.1186/s12903-023-02826-1
4. NHS, Dental Abscess. https://www.nhs.uk/conditions/dental-abscess/
5. NHS, Root Canal Treatment. https://www.nhs.uk/tests-and-treatments/root-canal-treatment/
6. Oral Health Foundation, Crowns. https://www.dentalhealth.org/crowns