Pain & Sensitivity

Why does the tooth under a (zirconia) crown hurt?

Sensitivity in the first few weeks with a new crown is common and usually passes; pain that starts weeks later or keeps getting worse points to something different

It can be confusing when your tooth hurts after you have had a crown fitted: the treatment you had to fix a problem seems to have created a new one. On this page we explain the four possible sources of pain in a crowned tooth, which one passes within a few days, which one needs an examination, and why you cannot see what is happening under the crown.

Short answer

Pain in a crowned tooth can have several different causes. If the tooth was prepared close to its living tissue when the crown was made, temporary sensitivity in the first few weeks is normal. A crown left slightly too high in the bite causes constant pain when chewing, and it is easy to correct. Decay that creeps in unseen from the edge of the crown causes lasting, increasing pain if it reaches the inside of the tooth, and may need root canal treatment. An undetected crack in the tooth underneath can also cause pain when you bite or let go. An examination, a bite test and an X-ray tell them apart.

Sensitivity in the first few weeks: Normal, and usually eases on its own
Pain that starts or gets worse weeks later: Possible decay under the crown or a bite problem
The hidden risk: Decay under a crown cannot be seen, and sometimes shows up late on an X-ray too
Urgency: The same day for swelling, throbbing or pain that gets worse at night

Medically reviewed by Bilge Ilgın, Dentist · ImplantologyLast reviewed 2026-09-13

Four sources of pain in a crowned tooth

When a crown is made, the tooth is shaved down by a certain thickness on every surface so that zirconia or another material can sit on top of it. This preparation sometimes comes close to the living tissue in the middle of the tooth (the pulp: the tissue that carries the nerve and blood vessels). Because the preparation itself counts as trauma, the nerve can react temporarily; this is called reversible inflammation of the nerve (reversible pulpitis). Its sign is mild sensitivity brought on by heat, cold and chewing, and it eases on its own over a period of days to a few weeks.

This is the most common and most harmless cause of pain in a crowned tooth. What sets it apart is the timing: the pain starts straight after the crown is fitted, does not keep getting worse, and instead fades over the weeks. There is nothing to do in this situation; waiting is enough. If it carries on or gets worse instead of easing, one of the causes below may have come into play.

The second cause is a crown left slightly too high in the bite. If the crown is even a hair's breadth higher than its neighbours, every time your jaw closes that tooth touches first and takes the load on its own; the connective tissue underneath gets bruised and the tooth hurts when you chew. The sign is clear: the pain is only there when you chew, not when you rest, and it started straight after the crown was fitted. Correcting it takes a few minutes in the dentist's chair.

The third and most serious cause is hidden decay creeping in from the edge of the crown; this is called decay under the crown, or recurrent decay. Over time, the cement between the crown and the tooth can wear thin at the edges, and bacteria leaking in there work their way into the tooth. Because this decay is hidden under the crown, it cannot be seen; in the early stages it may not be spotted even on an X-ray. As it progresses, it causes a dull ache that becomes constant and gets worse at night, a reaction to heat that lasts a long time, or throbbing that comes on by itself. If it has reached this point, the decay has reached the nerve, and root canal treatment or sometimes extraction is needed.

The fourth cause is an undetected crack in the tooth under the crown. The crack may have been there before the crown, or the extensive preparation for the crown may have weakened the structure of the tooth. The signature is clear: the pain comes not while you bite but the moment you release your bite, and it is short and sharp. Even if the crown looks intact from the outside, it can hide a crack progressing in the tooth structure underneath; that is why cracks in crowned teeth are sometimes diagnosed later.

A less common and milder cause is the gum receding over time and exposing the root surface at the edge of the crown. There is no decay here; the exposed root surface is sensitive to cold, and this is not a problem with the nerve inside the tooth. The difference between these four causes often lies not in how severe the pain is, but in when it started and what triggers it.

Clenching or grinding your teeth at night (bruxism) is a separate factor that can set off several of these pictures at once. The force applied without your knowing during sleep can be much greater than the force used in chewing, and this load usually concentrates on a few teeth, especially crowned teeth that touch first in the bite. As a result, it can speed up both bite-related pain and, over time, a crack. If there is sensitivity in more than one crowned tooth at the same time, or it is more noticeable when you wake up in the morning, this possibility should come to mind; the solution is a night guard.

Excess cement left just under the gum when the crown is cemented in place can also cause similar pain; this is called residual cement. Here the problem is not inside the tooth but in the gum: the excess cement constantly irritates the gum and causes tenderness in the area that hurts with pressure and a light touch. What sets it apart from decay is that the pain comes not from the tooth itself but from the gum around it, and it usually comes with noticeable redness in that area; it clears up quickly once the excess cement is removed.

The most challenging thing about a crowned tooth is that you can no longer see inside it. With a tooth that has no crown, you might notice decay that has started, over time, by eye or by a change in colour; with a crowned tooth, this is not possible. That is why, with crowned teeth, carefully keeping track of when the pain comes on and what triggers it becomes a more telling clue than with an uncrowned tooth.

Which pain can wait, and which cannot

The distinction below is a general framework. The exact cause becomes clear with an examination, a bite test and, when needed, an X-ray.

The tooth can be saved

Mild sensitivity in the first week or two with a new crownSensitivity brought on by heat, cold and chewing that keeps easing is a normal part of the healing process.
A brief reaction only to hot and coldA reaction that passes within seconds shows temporary irritation, not lasting inflammation.
Discomfort that started straight after the crown and only comes when chewingThis points to a bite that is too high; an appointment within a few days will sort it out.
Mild pain that comes and goes, with no swellingThis can be assessed within days; it is not urgent, but it should not be ignored.

Saving it is unlikely to hold

Pain that started weeks later or is getting worseThis may show that decay under the crown is progressing; it needs an examination.
Throbbing pain that wakes you at nightThis points to inflammation that has reached the root tip; it does not get better on its own.
A reaction to heat that lasts for minutesUnlike brief irritation, this may show that the nerve has developed inflammation that is hard to reverse.
Swelling, a bad taste or discharge from the gumThis is a sign that things have gone beyond a mechanical problem; it needs to be assessed the same day.

How the cause is found

With a crowned tooth, diagnosis relies on more testing than with an uncrowned tooth, because you cannot see inside the tooth.

1
Taking the history
When the crown was fitted, when the pain started, what triggers it and how long it lasts; this information narrows down the cause considerably.
2
Bite test
You are asked to bite on different points of the tooth one at a time with a bite stick. Sharp pain when you let go points to a crack.
3
Vitality test
A cold test checks whether the tissue inside the tooth is alive; this shows how far the inflammation has progressed.
4
Bite check
Articulating paper is used to measure whether the crown has been left higher than its neighbours.
5
X-ray
A periapical X-ray can show decay at the edge of the crown and inflammation at the root tip; with early-stage decay the image may come out clear, and this does not rule out decay.
6
Partly examining the crown, if needed
Sometimes a definite diagnosis can only be made once the edge of the crown is opened up and looked at directly.

Treatment by cause

Treatment varies with the cause; the list starts with the least invasive.

Bite adjustment

The high surface is smoothed down and the load is spread evenly across the teeth. The procedure takes a few minutes and needs no anaesthetic.

Removing the crown and cleaning the tooth

With decay under a crown, the crown is taken off, the decay is cleaned out and the tooth is covered with a new crown.

Root canal treatment

If decay or a crack has reached the nerve, the tissue inside the tooth is cleaned out and the canal is filled; the crown may be kept or replaced.

Extraction and planning for the gap

If the crack has gone down into the root or not enough structure remains, the tooth is taken out; what the gap is filled with is a separate decision.

What happens if it is put off

We are not writing this to frighten you, but to show why waiting carries a different risk with a crowned tooth.

Decay moves into the tooth

Decay that would end with a simple clean-out if caught early grows, the longer it is left, towards root canal treatment and sometimes extraction.

Pain stopping is not healing

With inflammation at the root tip, the pain eases once the nerve inside the tooth has died completely; this is not relief but a sign that the disease has progressed.

If the bite is not corrected, both teeth are put under strain

A crown left too high can, over time, put strain not only on the tissue under it but also on the opposing tooth.

A crack deepens over time

An undetected crack can go a little further with every bite and turn into a root fracture under the crown.

The crown hides the problem from view

Decay that would be visible on an uncrowned tooth becomes a problem that is noticed late on a crowned tooth; that is why regular check-ups matter.

After treatment

The process depends on which treatment was carried out.

If the bite has been adjusted
The bruised connective tissue takes a few days to recover; the sensitivity eases noticeably during this time.
If the crown has been replaced
A temporary crown is worn while the laboratory work is done; this can take a few weeks.
If root canal treatment has been done
Mild tenderness when biting for a few days after the procedure is normal; healing in the bone takes months and is monitored with check-up X-rays.
If the tooth has been taken out
The area takes weeks to heal; during this time the decision is made about what to fill the gap with.

Message us right away if

Throbbing pain that keeps you awake at night. This may point to inflammation that will not get better on its own; do not wait.
Swelling or a bad taste. This may show that the infection has spread to the bone; call the same day.
A reaction to heat lasting for minutes. This points to something different from temporary irritation.
Sharp pain that keeps coming when you bite and let go. This may show that the crack is progressing; avoid biting hard things and book your appointment early.

What determines the cost

There are no figures on this page; behind the same symptom there may be an adjustment lasting a few minutes, or root canal treatment or an extraction. These are the items that determine it:

The cause of the pain: A bite adjustment, replacing a crown, root canal treatment and an extraction are procedures of completely different scope.
Whether the crown has to come off: If the decay is under the crown, replacing the crown is added to the plan as well.
Whether root canal treatment is needed: If decay or a crack has reached the nerve, this step is added to the treatment.
Planning for the gap if the tooth is lost: If extraction is needed, filling the gap with an implant, a bridge or a denture is a separate item.

Frequently asked questions

My new zirconia crown hurts. Is that normal?

Mild sensitivity brought on by heat, cold and chewing in the first week or two is normal; it comes from the living tissue of the tooth being irritated during preparation and usually eases on its own. If it is not easing, or is getting worse, you need an examination.

Can there be decay under a crown, and how would I know?

Yes, there can, and it cannot be seen from the outside. A bad taste, a slight smell, or pain that keeps getting worse and carries on at night should make you think of this possibility. A definite diagnosis is made with an X-ray and, if needed, by looking at the edge of the crown.

If my crowned tooth needs root canal treatment, does the crown have to come off?

Often, yes; the crown needs to be removed to reach the canal. In some cases, a small opening can be made through the crown and the treatment completed; the type of crown and where the decay is decide which is suitable.

My crowned tooth throbs with hot drinks. What does that mean?

A reaction that passes within seconds shows temporary irritation. Throbbing that lasts for minutes after the heat is removed, however, may show that the nerve is inflamed, and this does not get better on its own.

Why does pain start years after a crown?

The most common cause of pain that starts years later is the cement at the edge of the crown wearing thin over time and hidden decay starting from there. Sensitivity to cold from a root surface exposed by receding gums is another possibility; in this second case there is no decay.

If my crowned tooth is taken out, what goes in its place?

This depends on the size of the gap and the condition of the neighbouring teeth. For a single tooth, a bridge or an implant is discussed; if the neighbouring teeth are healthy, an implant offers a solution without touching them.

Does decay under a crown show up on an X-ray?

Advanced decay usually shows up, but in the early stages the X-ray may come out clear. A clear X-ray does not completely rule out decay under a crown; how the pain develops and the other tests complete the diagnosis.

Can I take painkillers and wait?

If the pain only comes when you chew, the tooth is quiet when you rest and there is no swelling, you can wait a few days. If the pain is throbbing, keeping you awake at night or comes with swelling, do not wait; this does not get better on its own.

I have a habit of clenching my teeth. Is that why my crowned tooth hurts?

It could be. Clenching at night concentrates a force much greater than chewing on a few teeth, especially the crowned teeth that touch first in the bite. This can speed up both bite-related pain and, over time, a crack; noticeable sensitivity in the morning should make you think of this possibility.

Several of my crowned teeth hurt at the same time. What does that mean?

Sensitivity that starts in several teeth at once, rather than in a single tooth, points less to decay in individual teeth and more to a shared force problem, such as an uneven bite or clenching at night. In this situation the crowns need to be assessed not one by one, but together with the bite as a whole.

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