Grinding on New Crown

[BlakeVic]

Hello, I'm 41 and have a significant bruxism issue. Two-and-a-half weeks ago I had a zirconia layered with porcelain crown placed on #19. Since then I have seen three dentists (including the doctor who did the work) because of pain. All three have agreed that the crown is seated properly, my bite is healthy and x-rays look good. The tooth has been examined (tapped) with no problems. And my night guard has been examined, determined to be in good condition. However, I still have sensitivity to cold on the inside of the crown. Moreover, there is a dull pain (sometimes sharp) when I chew. Also, I'm still having headaches, and in the evening/night my teeth ache - especially the crowned molar. Twice I've woke up in the morning with a strained trap muscle (left side - same as crown) that has limited my mobility for days at a time. I was told the head, neck and back pain is a result of grinding, but I never had head, neck or back pain prior to this crown. I hate to think headaches, neck and back pain are going to be a new normal. If my bite is okay could this be the result of grinding on the zirconia, porcelain material? I wanted a gold crown and was talked into the layered zirconia instead. I've considered having the current crown replaced but due to the chewing pain the dentists I've consulted believe the nerve is still fragile and want to give it more time to heal (or determine a root canal is needed). I'm in pain and it's affecting my day-to-day as well as my sleep. Any thoughts are appreciated. Thank you.

 

[Dr M]

Good day

Did your dentist only take normal x-rays or was a CBCT scan also taken?
Do you perhaps have any x-rays you could share?

 

[honestdoc]

What were you experiencing before you had the crown #19? Did you have headaches only after the crown was placed? You may need RCT #19 (symptomatic irreversible pulpitis) and TMJ consult (headaches).

 

[BlakeVic]

Good day

Did your dentist only take normal x-rays or was a CBCT scan also taken?
Do you perhaps have any x-rays you could share?

Hello Dr. M, thank you for taking time to reply.

I do not have CBCT scans, but I have attached available scans and photo.

The photo is my tooth prior to prep. You'll notice significant wear from grinding - which included a divot that ran front to back on the buccal side. The tooth had been symptomatic for a couple of years. During times that I was grinding harder than usual it would ache for a few days, week and then go away. However, this time the ache lasted for six weeks and eventually became sensitive to air (occasionally, breathing would cause a light but zinging sensation).

I was told the due to my history of grinding the tooth could not be filled (filling, inlay, onlay, bonded). It was explained the previous methods mentioned and/or further grinding could lead to fracture, and that a crown was my best option. In your opinion, does this present as a tooth that needed crowing?

Also included are scans showing my tooth before and after prep - as well as the tooth with the crown on it.

It has been one month since the crown was seated. The chewing sensitivity has improved but continues to be present. Sensitivity to hot is almost non-existent. However, sensitivity to cold persists.

The scans do not show it but the inside of my tooth was prepped on an angle. That is where the tooth is sensitive to cold. I am concerned that the prep damaged the nerve. The owner of the practice where the procedure was preformed advised it may take six months for the root to calm down. I did seek a third opinion and was told if the sensitivity continues beyond two or three months a root canal may be needed. My tooth had significant wear from grinding but did not shows signs or have a history of fracture, chipping, cavity, etc.

Is it common for this type of situation to result in needing root canal treatment? Would a need for root canal cause headaches?

The dentist believes that at 41 years old, after two-plus-decades of grinding (and never having headaches, neck and back pain) that in the 24 hours after the crown was placed my body developed new symptoms to grinding: headaches, neck and back pain. However, he does not think those symptoms are related to the crown or tooth. I'm struggling with that assessment. He has referred me to a TMJ specialist.

My night guard fits my top teeth. The crown is on my bottom. I was told it shouldn't cause an issue but I have stopped wearing it temporarily as to test if it's causing the headaches. I'm still in the process of trying to figure this out. Is it possible there's an issue with the guard?

Again, thank you for time. Your thoughts are welcomed and appreciated.

 

[BlakeVic]

What were you experiencing before you had the crown #19? Did you have headaches only after the crown was placed? You may need RCT #19 (symptomatic irreversible pulpitis) and TMJ consult (headaches).

Hello honestdoc, thank you for your feedback.

Please feel free to review my other reply with additional information.

I have attached available scans and photo.

You'll notice significant wear from grinding - which included a divot that ran front to back on the buccal side. The tooth had been symptomatic for a couple of years. During times that I was grinding harder than usual it would ache for a few days, week and then go away. However, this time the ache lasted for six weeks and eventually became sensitive to air (occasionally, breathing would cause a light but zinging sensation).

Also included are scans showing my tooth before and after prep - as well as the tooth with the crown on it.

It has been one month since the crown was seated. The chewing sensitivity has improved but continues to be present. Sensitivity to hot is almost non-existent. However, sensitivity to cold persists.

The scans do not show it but the inside of my tooth was prepped on an angle. That is where the tooth is sensitive to cold. I am concerned that the prep damaged the nerve. The owner of the practice where the procedure was preformed advised it may take six months for the root to calm down. I did seek a third opinion and was told if the sensitivity continues beyond two or three months a root canal may be needed. My tooth had significant wear from grinding but did not shows signs or have a history of fracture, chipping, cavity, etc.

Is it common for this type of situation to result in needing root canal treatment? Would a need for root canal cause headaches?

The dentist believes that at 41 years old, after two-plus-decades of grinding (and never having headaches, neck and back pain) that in the 24 hours after the crown was placed my body developed new symptoms to grinding: headaches, neck and back pain. However, he does not think those symptoms are related to the crown or tooth. I'm struggling with that assessment. He has referred me to a TMJ specialist.

My night guard fits my top teeth. The crown is on my bottom. I was told it shouldn't cause an issue but I have stopped wearing it temporarily as to test if it's causing the headaches. I'm still in the process of trying to figure this out. Is it possible there's an issue with the guard?

Again, thank you for time. Your thoughts are welcomed and appreciated.

Attachments​

 

[honestdoc]

In my opinion, the custom night guard is going to help 2 ways. According to the pioneer of TMJ studies, Dr. Jeffrey Okeson at the Univ of Kentucky, your teeth should only touch each other for about 20 minutes a day. When you're at rest, your teeth are about a quarter inch apart. When your teeth are clenched together, they will be subjected to tremendous stress and your muscles will be at tension. With the muscles in tension, you will get headaches.

How you know you need a root canal is if you have intense pain that can wake you at night and unbearable pain to temperatures. That would indicate the nerve is damaged. Another indication is if you have swelling which means your nerve had died and became infected. If you feel cold and it goes away within a few seconds, then the nerve is good.

The prep looked good. Unfortunately, any drilling causes trauma to the nerve and prepping for crowns require a lot of drilling. That means the nerve is most likely injured and inflamed. It is best not to overwhelm the nerve with too much cold to allow it to heal.

 

[BlakeVic]

Thank you for such a thoughtful reply, doc.

I'll continue to monitor the nerve and be patient with its healing.

It helps to hear that you think the prep looks good.

I'm hoping to stop the headaches that started after the crown was placed. I'll be taking my current custom guard to see the TMJ specialist at month's end.

Thanks again!