The Crown Was Two Years Old and the Tooth Was Killing Him

Quick answer: A crowned tooth still has a living nerve inside it unless it has had a root canal. Crowns protect teeth from fracture; they do not make the nerve immune. When a crowned tooth starts throbbing, the root canal can almost always be done through the crown, leaving it in place.

The call

Aryeh, 50, from RBS Bet, was annoyed as much as he was in pain. He had paid for a crown two years earlier specifically so that the tooth would stop being a problem, and now it was waking him at night. His assumption — a reasonable one — was that the crown had been done badly.

What we found

The crown was, in fact, well made. The margins were sealed, the contacts were good, the x-ray showed no gap and no decay underneath.

What the x-ray did show was how deep the original cavity had been. The pulp chamber sat directly beneath where the decay had reached. That is the whole explanation, and it is worth understanding, because this happens to a meaningful minority of crowned teeth.

When a tooth needs a crown, it has usually been through a lot already: deep decay, a large old filling, perhaps a fracture, then the preparation itself, which removes structure and generates heat. Each of those insults the nerve. The pulp can absorb a good deal and carry on, but the injuries are cumulative, and sometimes it gives up a year or two later. Somewhere around one in ten heavily prepared teeth loses its nerve within a few years of crowning. It is not, by itself, evidence of poor work.

Testing confirmed it: no response to cold at all, tender to tapping, and a small dark area forming at one root tip. The nerve was dead and infected.

What we did

Root canal treatment through the crown. We made a small access opening through the biting surface of the porcelain, using a diamond bur under water and gentle pressure to avoid chipping, treated the canals normally under rubber dam, and then sealed the access with a bonded composite core and a well-polished restoration.

Removing and remaking the crown would have been the wrong instinct here. It costs the patient another crown, risks damaging a well-fitting margin, and gains nothing when the existing crown is sound.

We were careful about one thing: crowns on back teeth can hide the true anatomy, so we took a pre-operative x-ray from a second angle to locate the canals accurately before drilling through the porcelain.

The outcome

Pain gone after the first visit. The access was sealed at the second. Two years on the crown remains in place, the root tip has healed on the x-ray, and the tooth functions normally.

Aryeh's crown will likely last as long as it would have anyway. The access filling is small and well sealed.

What to do if this happens to you

1. Do not assume the crown was faulty. Most crowned teeth that need root canals do so because of the damage that led to the crown.
2. Note whether it hurts to bite or to temperature. Bite pain suggests infection past the root tip; temperature suggests the nerve is still alive but inflamed.
3. Be seen promptly. A dead nerve under a crown will abscess given time.
4. Ask whether the crown can stay. In most cases it can and should.
5. Keep the crown clean at the gum margin. Decay at the edge is the other reason crowned teeth fail.
6. Ask for the x-ray to be shown to you. It usually makes the situation obvious.

Crowned tooth hurting? Ramat Beit Shemesh Urgent Dental Care treats these without replacing sound crowns. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh.

Based on real cases treated at the clinic. Names have been changed.