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Second Opinion – New but Bad Fitting And Painful Crown

Case Report:

This young lady had this crown placed within the last year and has had constant pain since placement. Went back to see her dentist several times for “adjustments” without relief. Finally, after loosing confidence in her dentist she sought a second opinion.

After a thorough exam it was determined that the crown did not fit well – it did not seal around the tooth. Having not resolved the bad fitting crown in time it is very likely that she now will also need a root canal treatment as the tooth is dying because of the poor fitting crown.

The kicker is that when we requested the existing x-rays from the dentist who made this crown it was clear on those old x-rays that the crown did not fit. This is very disappointing to me as we, as a profession, need to strive for excellence at all time. This problem could have most likely been avoided had the x-ray been read properly and the bad fitting crown replaced sooner. Now the patient needs a new crown, with more cost, as well as probably a root canal treatment and a core buildup, both not the most comfortable procedures at times and expensive!

If you have a problem with recent dentistry that is not resolving, seek out a second opinion. Don’t just have a root canal treatment performed without discovering the actual cause of the problem. In this case, if the patient would have followed the recommendations of her old dentist she would have gotten the root canal treatment they prescribed and not redone the crown. This would have been a fatal mistake as the bad fitting crown would continue to decay and cause even more significant loss of tooth structure!

Keep Smiling,

Dr. Chris

posted in Cosmetic Dentistry

32 thoughts on “Second Opinion – New but Bad Fitting And Painful Crown

  1. Nick Kulczycki

    Unless the decay was present at the time of the insertion, the crown was ill fitting but not necessarily caused by the crown itself. Unfortunately, the tooth preparation has a lot to do with the symptons of pain. Shoulder and beveled preparation used to be more in use in the past than the present. This type of preparation was and is the best uniformally to support the crown. Current preparations are either full shoulder, champfer or modified champfer. These type do not adequately support a crown because the stresses are at the occlusal point of the preparation. The only other problem might have been the crown was high to begin with.

  2. hahndds

    Thank you Nick for your feedback! It always is good to hear from a dental lab owner.
    Design of the tooth is critical. Too many dentists simply chop the poor tooth down to bits and then expect a lab technician to mask it all with a beautiful crown. That simply won’t do. The support of the crown comes from the design of the tooth below it.
    If more dental laboratories felt the way you did then we would have a significant increase in the quality of dental care. Most labs are afraid of telling the dentist that the design of their tooth prep is wrong and the impression poor – I guess there are too many other labs hungry to work have more work regardless of the quality.

    Keep smiling,

    Dr. Chris

  3. Patsy

    Please help. I’ve had 4 root canals. My first dentist was amazing but retired. This new dentist is terrible. I’ve had 3 root canals from them and my teeth look like marshmallows. You can also see metal near my gum lines where the crowns are and I have constant pain where my crowns are. I just recently got another crown and it doesn’t even look like the tooth that’s on the other side. I also am not able to floss cause there’s left over cement and I have calcification on my teeth. My front teeth- you can almost see through them because they’re mostly cement from a cavity in between my two front teeth and I also have 8 more cavities to be done. I am 24 and I have very bad teeth. I really wanted to go to college, but I’ve spent all I can afford on my teeth and it wasn’t even worth it. Can someone please help? I willing to travel for a second chance. I’m always in pain and I just want to have healthy and happy teeth. My teeth depress me.

  4. hahndds

    Dear Patsy,

    I am surprised that at your young age you have so many dental issues. I strongly believe the best anti-dentist medicine is exquisite home care and proper nutrition. I see too many people these days that live in an acid world (soda, sport drinks, flavored water, you name it)….not to say that this is you, but I would take a strong look at why this is happening to you! What in your world is causing this? Take a look at this blog post and read about the dental cycle:
    DENTAL CYCLE

    Now, if your dentist is not able to help you avoid these issues and you are unhappy with his/her work, go find another dentist, there are many out there that would love to help you.

    I always give free second opinions, so if that is what you need, let me know.

    Keep smiling,
    Dr. Chris

  5. freddie

    hi chris, thanks so much for helping everyone.

    my back molar was extracted and the one next to it had had a root canal for now 4 years. I desperately need a crown for it. I was gonna do it last year but another one of my tooth broke so I had to spend my money on that one! Now I bought this deal to get a porcelain crown for AUS$499. Since it’s a back tooth with root canal and only one “neighboor” I don’t think much can go wrong. What do you think? should I ask what metal it’s made of? What metal should I avoid?

    Thank’s again, dentistery is so important, expensive and confusing, we definitely need more website like this one.

    freddie

  6. hahndds

    Hello Freddie ๐Ÿ™‚

    First, let me answer your question – if you are going to chose a crown that is “metal” I would highly suggest you tell the dentist you want “high noble gold”, so either a full gold crown or a porcelain fused to gold crown with high noble gold as a substructure.
    But, for the “deal” price I don’t think this will be an option. Regardless, there are great porcelain crowns available now that most people prefer anyhow.
    It has been my experience that that most reliable type of porcelain crown has a zirconium core. These zirconium core crowns are cemented vs. bonded which is much easier and harder to mess up ๐Ÿ™‚
    The key is to make sure it is not a huge, poor fitting crown, and that is tough to find because the dentist needs to prepare the tooth right, which is easier with a root canal treated tooth, and then send it to a good lab. You should not have many problems because the tooth has no feeling/nerve, but the crown needs to fit right around the tissue.
    Lastly, It is a very important tooth specifically because there is no tooth in front of it! You need this tooth…consider a “bridge” to close the missing tooth gap or even better, and implant in the future. Ask your dentist about these options. Since I believe the cost of either right now is too much for your budget I would plan for an implant in the future.
    Lastly, make darn certain you figure out “why” your teeth are breaking!!! Is it diet? (soda, sugar, flavored water, et.) or is it function? (do your teeth work correctly?) or is it periodontal disease or old dentistry…you need to figure out why and treat that asap!

    I hope this helps ๐Ÿ™‚

    Keep smiling,
    Dr. Chris

  7. Nancy

    Dear Dr. Chris,
    I am so bummed I did not find your website before I had crown and bridge work. You are doing an excellent job answering questions and I wished I would have found your website sooner. I have always had excellent teeth and have been missing a molar since I was 18 when I didn’t have dental insurance. I am 52 years old and about 6 weeks ago I woke up with mild tooth ache. I went to dentist and he said I needed root canal to remove a root tip and recommended a crown & bridge.

    Over the last 6 weeks I have been to dentist nearly 6 times because the temp they place kept coming off. After multiple re-cements, my crown finally came in and the work was finished. I told the dentist and his technician that it feels too high as when I bite the new crown touches first and on my right side, those teeth do not feel like they are touching. They kept filing and using the bite paper and the dentist insisted that it is right height and he permanently fitted the crown/bridge. It has been two days and I still feel the left bite is higher than my right bite. I also cannot chew on the left side and there is some small sensitivity. This morning I went to dentist and his hygienist did a cleaning and she said everything is fine and I just have to get used to the new crown/bridge.

    I am concerned if the height is wrong, what are the implications further down the road? Can I live with it like this and not do anymore damage to my teeth? What about only chewing on my right (original molars) side? Is this wise to do?

    I am not in pain and the crown looks like my teeth, essentially my only complaint is when I bite down, the left side touch first and I donโ€™t feel the right side touching at all and I am having trouble chewing with new crown/bridge.
    Thanks for your time!

  8. hahndds

    Dear Nancy,

    Your bite needs to feel normal! Simple as that. There are many reasons why your bite could feel wrong, but regardless, it needs to be adjusted correctly or you will have significant future issues.
    The bite paper is not nearly as accurate as your “feeling”, and if you feel the bite is off, then it is off ๐Ÿ™‚
    This is exactly how patients end up with more and more problems down the line. The bite shifts, teeth fracture, joints become inflamed and on and on. Simply put, it has to fit and function correctly.
    IF you dentist is not able to do this correctly, then you need a new dentist. Look for someone that will listen to you and has the training to back up his/her talk. I would recommend an AACD Accredited dentist because they really worked hard to achieve a higher level of competency so they work hard to live up to that level of quality. Go to the AACD website and “find a dentist” near you.

    I hope this helps.
    Keep smiling,
    Dr. Chris

  9. Mayra Castro

    I had my bottom molar fillings replaced and i was in pain later that day just biting was excruciating , i called the dentist and he said to come in and they would put a medicated filling and see if the pain would go away. It didn’t and I ended up with a root canal, and a crown on it. When I try bitting on it i still feel a little pain, and my crown fell off today, I also feel pain on the molar next to the one that I got the root canal on. He replaced the filling on that tooth too does that mean I need a root canal on that other tooth. He also left my bite high on another tooth and now I have a toothache and a lump on top of my tooth it doesn’t hurt but makes my tooth feel sensitive to the touch. This is truly a nightmare!!!

  10. hahndds

    Dear Mayra,

    Sounds like you may need to get a second opinion…sorry. Why do I say that? Well, the last straw was when the filling was too high and you are working on killing another tooth because the bite is off. You should not have new crowns coming off like that and root canals don’t “just happen”, they are a last resort. Warranted I don’t know the entire situation, but you should have been informed that there may be a crack or that the need for a root canal treatment was possible…
    Let me know how it goes.
    Keep smiling,

    Dr. Chris

  11. Chryssoula

    Just a quick hello to say “where have you been for the past year and a half of my life?!!”
    I’ve been going around with my dentist about how my bite is completely off since he put my crown in. 1st he tried to blame the root canal work for my feeling anything on the crown, because as he said “you shouldn’t feel anything, the root is gone.”
    The fact is, the crown LOOKS way too big, bigger than any other tooth in my mouth, I haven’t been able to close my jaw completely for a year and a half and my speech is affected!
    My dentist worked on both sides of my mouth essentially at once. On the right, he filled a molar in my back and did not carve it to fit. The he went on to put the crown in on my left back molar thus making me move my jaw to the left ( to avoid the clump in my right tooth filling) to be able to close my mouth enough to bite down on the crown for placement.

    He’s refused to remove the crown he sayed if he can’t see my teeth marking on that silly old carbon paper he could not do anything. I can see where my teeth hit each other, yet I can’t put my mouth/jaw in that position for him to get a mark. I want the crown out and I feel like he’s just jacking me around until I give up.
    I just can’t believe that dentists like this exist!! He obviously does not THINK about the issue at hand he just looks at what he knows and what doesn’t fit and send his patients “down a garden path”
    Sorry for the rant but it’s been 1/2 of my life and I’ve been made to feel like I’m exaggerating, how many other patients will not be as insistent and will walk around with teeth breaking for “no apparent reason” because a dentist is too prideful to admit he made a mistake.

    Apparently I have a hyper-mobile jaw

  12. hahndds

    Dear Chryssoula,

    Sorry to hear about your issues…Here is my opinion.
    First, the mouth is an incredibly complex mechanism and anything we do as dentists usually has a pretty significant effect. In your case it sounds like your crown is a bit “big” which to me usually screams cheap lab, but I can not really comment on that as I have not seen it. Anyhow, if your bite feels different then it IS different. Simple as that. The crown may not be hitting at all and your bite can be different, and here is why: The tooth needed a root canal treatment, correct? Well, the tooth could have been hitting very hard and the tooth could have been killed for that reason, so the dentist takes the tooth and puts a crown on it. Then he removes all contact and says his carbon paper shows no marks, but your bite has dramatically changed since the tooth was hitting too heavy before. So, you need to look at the entire mouth function, not just one tooth!
    This equilibration of the mouth is essential to prevent further breakdown of your dentition…I hope your dentist has the experience to do this, if not, you need someone who does.

    Keep smiling,
    Dr. Chris

  13. Jean

    Hello,
    I am also having issues with my crown. About a year ago, my dentist said my tooth was cracking (had a big filling that last 30 years) and needed a crown. The crown was never comfortable that I was using my other side to chew. When I chew on the side where the crown is placed, there is a dull pain and after much chewing there is soreness in the area. I have gone for adjustments a couple of times, but it is still painful when I chew. The tooth doesn’t hurt when I don’t chew, but sometimes that area is sensitive to heat or cold. My dentist says I will need a root canal. Would that really fix the chewing issue? I guess at this point I lost my confidence in my dentist and am wondering if I should take more treatments per his suggestion.
    I am in mid 40s and had no issues with my teeth other than fillings done in my early teens. I have been getting my teeth checked/cleaned religiously every 6 months for last 20 years.
    Thank you in advance,
    Jean

  14. hahndds

    Dear Jean,

    The tooth should feel normal/natural after having a good crown placed. If the tooth was cracked due to the probably silver mercury filling (they crack teeth all the time) then it is possible that the crack extended down the side of the tooth to the root. A root canal treatment would not 100% of the time fix that.
    I would suggest a second opinion to check out the fit of the crown and the function asap.

    Keep Smiling,

    Dr. Chris

  15. Chryssoula

    Thanks so much for your reply. I had saved the site but then lost it so I hadn’t found it til now. While I’m here I thought I’d give you an update. Soon after I commented I finally stopped going to that dentist.
    The thing is with hyper-mobility syndrome is that my joints are very forgiving so that in the case of my crown, it’s too wide so I move my jaw over to accommodate. I’ve got new wear where my teeth have been hitting, I’m biting “end to end” as one endodontist put it, some have chipped (a tiny bit) and I know one of my bottom teeth cracked days after the placement of the crown. When I addressed these things he essentially ignored each observation of mine. Right down to my pointing out an area on my jaw with pain and his answer was “oh, yeah, there’s a muscle there.” He finally suggested I see a “tmj doctor”. I did not have a problem with my temporomandibular joint before. I kind of feel held hostage by this tooth. How do I achieve equilibration? Who should I go to? Do they shave off your natural teeth to fit things? Or will they be able to actually find the issue and fix it?
    Thanks again for taking the time to read and answer you blog. This time I’ll be notified of your response so this time it won’t be another year ๐Ÿ˜‰
    Chryssoula

  16. Chryssoula

    Sorry, it’s me again. What I had wanted to add as an update was that when I finally did make an apt. with a new dentist, they called me back and said given my story and the fact that the dentist refused to remove the crown, I should contact the Ca. Dental Assoc. and that they would be cancelling my apt. As it turns out it would have taken 6-8 months to go trough this process and it was just to get my $ back. Which isn’t necessarily what I’m after. I want my bite back ๐Ÿ™‚ not my $.
    I had read about it sounding like a bad lab job before as well. I was googling why I felt like I was buck-toothed now.
    I did some research and realized I probably needed a neuromuscular dentist. When I went in for the apt. the did a thorough job of imaging from every angel but never let me talk. The dentist came in with his plan to help me which involved over a year of wearing a night piece. That’s all fine IF that’s what I need. I don’t feel confident that I do.
    I feel as though if they would hear my side and maybe LISTEN to what I have to say about my Hypermobility syndrome things would make sense to them. I’m sure they don’t have much experience it since it is somewhat of am “invisible disease”. When I share the nuances of it and how it impacts me, they shrug it off as me being too sensitive or asking too much. And in the back of their mind they’re saying “That’s not how the human body works “lay” person but I know what’s going on so I’ll just continue doing things the way I do for ALL my patients…but you talk your little heart out if it makes you feel any better”
    I think that’s where my ego comment comes in. Doctors and dentists don’t know everything they are people too. You’d think collaboration would be a good thing with an illness they may never have dealt with.
    And lastly how can I get this crown out of my mouth??
    The cosmetic dentist wants to re-shape my jaw and the other dentist I tried to make the apt with doesn’t want to just take it out. I don’t want to go back to the org. dentist, as we got nowhere and I don’t think he wants to remake the crown. Too cheap to do so? IDK.
    What do you suggest?
    Sorry for hogging up your comments section but you seem to have intelligent opinions and to be thinking a person. So, thanks again;
    Chryssoula

  17. hahndds

    Dear Chryssoula,

    I am going to try to help you as best as I can from here ๐Ÿ™‚
    First of all, we are all always learning! Nobody knows it all. We learn mostly through experiences and the only I can do when something I try does not work is try to make it better (redo, etc.). That being said, your case is somewhat new to me. This is how I would approach it:
    1. You felt fine before the new crown. All issues arose after the crown. So, take the crown off, place a temporary crown made out of acrylic that can be adjust until you are comfortable again.
    2. There are many different types of dental philosophies…neuromuscular, Dawson, etc. They all work in their own way. I have my own that leans more towards the Dawson side ๐Ÿ™‚
    3. Over thinking problems can cause even more problems! Start with the simple solution presented in #1 above, you can always do more!

    I hope this helps,
    Dr. Chris

  18. Chryssoula

    ๐Ÿ˜€ Thanks a bunch!!
    That’s exactly what I’d like to do. I guess after being turned away from the 1st dentist who recommended the Dental assoc.and 2 subsequent neuromuscular who wouldn’t listen, I felt as though no dentist would shape &/or remove another dentists crown. Phew!! Good to know that’s not the case. Ah, back to a world that makes sense.
    If only my original dentist would have been so kind.;)
    Thanks again Dr. Chris;
    Chryssoula ๐Ÿ™‚

  19. Pamela

    Hello Dr Chris!
    Just wondering if you might have a suggestion. A few years ago I had a root canal and crown fitted to my upper left canine. It never felt “right” and looks nothing like the canine on the right. I mentioned it to the dentist and was told that the tooth was mad to look as it should (I was at a guard at night for teeth grinding, so the tooth had been ground down quite a bit due to grinding) not as it did when it was capped. The fact that I grind has loosened the crown to the point of falling out several times. Should the crown not have been fitted to the same size as the other side so that the grinding didn’t affect the fit? It is bothersome while eating, feels way to large for the space and just doesn’t feel right over all. I’ve had another crown fitted long before this one and never had this weird feeling of it not fitting properly. Now my insurance has changed and the dentist who did the work on the crown causing problems doesn’t accept my new insurance and won’t see me with out an outrageous office charge. As I mentioned it when it was first done I’m confused as to why this is still an issue an wasn’t fixed or if he was correct that should have been fitted as it should have be structured instead of how it actually was structured.

    Please help. I’d be less concerned by it’s right up front and falls out all the time exposing the metal post especially when I smile.

    Thank so much for any insite,
    Pamyla

  20. Rich

    Hi Dr Chris,
    So glad I found this website. I have all the exact issues described in your post.
    I had a band on a very slightly cracked tooth (probably amalgam filling causation) for about 3 years with no issues whatsoever. My dentist suggested I should get it crowned before the band came off at an awkward time. I didn’t think it was absolutely necessary but preventative restoration might be ok, as ‘the Dr knows best’.
    The temporary seal after preparation was too high and did not seem to keep the crack clamped tightly, so I was in sleep depriving agony for 2 weeks. They ground the temp down a bit and I was on antibiotics for another 2 just in caution to make it settle. It did a little.
    The crown was put on and it was too high so not only was it ground back to the metal, the dentist also ground my upper molars until the bite was ok. I was immediately concerned as none of this should have been required if it was a proper fit. Especially grinding down perfectly good teeth!
    I then discovered that the margins are still exposed and causes hot/cold sensitivity. The crown also seems to have not ‘clamped’ the crack sufficiently so there is also still pain on biting and chewing. What a disaster! It is now worse than when I had the band.
    I sought a 2nd opinion, and whilst he wouldn’t outright say I got bad work done, he did advise that I would need that crown off, may as well get root canal whilst it’s exposed just to be sure and then get a new crown.
    So now I am up for more than double the cost of the original crown.
    So the lesson is, make sure you see a quality, skilled dentist. I thought my original dentist was relatively competent, but it appears not so after all. She should have admitted within minutes of the crown fitment that it was wrong, too high and exposed margin but instead chose to try and fix bad workmanship with grinding down of good teeth! The exposed margin should have also been immediately obvious, it certainly is to me.
    Thanks, now I know what to do in future, as you note I will try to get it resolved sooner rather than later before I end up with a condemned tooth. Thousands more dollars it will cost, unfortunately.

  21. Dr. Chris

    Dear Rich, you have a sad but common story. Quality is key in Dentistry and none of us are perfect! If the crown does not fit, send it back! If it is adjust down to the metal (who uses metal these days anymore anyhow?) then that alone is reason to redo it. Also, why not adjust it to fit perfect BEFORE you cement it? All this points to a lack of experience and expertise and you just need a new dentist.
    Now telling a patient you may as well get a root canal is simply ridiculous. If there truly is a fracture then a root canal will not fix that. A good crown is the best option but constantly stressing out the tooth with bad fitting crowns that are hitting to heavy will simply kill the tooth and spread the crack resulting in the tooth being lost.
    I know quality dentistry is expensive, but think about it. A good crown costs about 2000 dollars. That is less than the cost of a bad crown plus a root canal which is bad for your health. Plus, imagine all the wasted lifetime and worry, pain and suffering and future issues you will have because of the “cheaper or insurance” crown. Is it really worth it?
    I know you will make good decisions in the future and I appreciate you sharing your story!

    Cheers,
    dr. Chris

  22. Rich

    Thanks Dr Chris,
    The cost is an annoyance indeed, but good dollars spent on quality workmanship is paramount, I agree. We only have one set, requiring best care and treatment for our modern, long lives.
    Thanks for your note on possibly unwarranted root canal, I had my doubts, I think my 2nd opinion dentist, after hearing my woes, just wants to make as possibly sure there are no ongoing issues.
    I will request just a new, quality crown and we’ll leave root canal for the worst case scenario. Fingers crossed.
    Interesting about the metal being outdated, I never knew.
    Much appreciated, you’re on my Xmas card list ! ๐Ÿ™‚
    Rich

  23. Dr. Chris

    Your welcome Rich :). If you need anything else like maybe a good dental lab recommendation, let me know!

  24. Toni Beahm

    I had all my front teeth crowned in 2011. Two teeth snapped at the gum line within the first 8 months. The dentist removed all caps, dent a FULL crown lengthening and put a dental splint on. After about 6 months , they took the splint off and put all new caps on. One cap/tooth was very wiggly. Dentist shrugged it off. Within 6 months, 2 caps/teeth broke again at the gum line. I have no money to have all the damage reared. The last set of caps were put on in 2013, and fell off in 2014. I asked them to please fix my teeth and they said no. I am devastated .

    Thanks,
    Toni

  25. donna santoriello

    hey , do not go cheap….I fell for a “sale” on crowns….got 4 at once…what was I thinking….does price make the only difference…dentist super nice and tried super hard by bad lab work and bad cement and pain….do not risk it people….but how do you know good work? price alone? How do you find a good dentist?

  26. Dr. Chris

    Dear Toni. There has to be a reason for the front teeth breaking that is being missed. Often the lack of back teeth support results in too much stress on the front teeth. Having worn down the back teeth too much also puts too much stress on the front teeth. The key is to understand that the front and back teeth work together and if one of the two components is not functioning correctly the other one fails. Secondly, almost every one of my patients wears a properly adjust hard night guard to distribute forces and manage function at night. This is something you need to look into as well.
    Please get a second opinion from a dentist that has advanced training such as the Pankey Institute, they will better understand your situation.
    Sincerely,
    Dr Chris

  27. Dr. Chris

    Hello Donna. You are right, quality dentistry costs more for everyone including the dentist. Most dentists mean well but may not have the necessary experience, training and labs to deliver too Dentistry. I am disappointed at what I see what several dental schools are considering “good” dentistry theses days. How can a young dentist aspire to deliver beautiful quality dentistry when their “gold standard” is so low? USC, my dental school, set the bar so high that I daily hear my instructors in my head making sure I do things right.
    Finding a good dentist is tough. I believe one of the best ways tondo this is to call a top quality dental lab and ask them who gives them quality work! For that reason I will soon write a dental blog on the labs I have used and trust and why they make me a better dentist ๐Ÿ™‚
    Keep smiling,
    Dr Chris

  28. Carmel Baronoff

    Problems after dental work new crowns lowering of jaw with 4 false teeth on bottom after 8 months still painful no pain before having work done

  29. Dr. Chris

    If the new crowns are still painful then you need to have this looked at. I can’t give much more information…sorry

  30. Cody

    This is exactly what my crown looked like yesterday after final cementing, I’vehad the image of the two voids (one on each side of the tooth) stuck in my head. Should I get a second opinion? The doctor looked directly at the x-ray with me and said it was OK…I should have opened my mouth then but didn’t.

  31. Dr. Chris

    Absolutely yes Cody. Don’t live with it and you are welcome to send me the x-ray plus your written HIPPA approval to check it out for my free second opinion ๐Ÿ™‚

  32. Dr. Chris

    Yes! Get a second opinion.

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