What Happens If Invisalign Isn't Working as Expected?

Two days after Maria's new crown went in, she still couldn't chew on that side of her mouth. Every bite sent a jolt straight up into her jaw, and by the third day she was eating soup for dinner and wondering if something had gone wrong. That's a frustrating position to be in, especially right after paying for a new crown. It's also one of the more common calls a dental office gets after a crown appointment: "It's fine until I bite down, then it hurts." The tricky part is that this single symptom can point to two very different problems, one a five-minute fix and one that needs real attention. A crown that hurts specifically when you bite down is usually caused by the crown sitting a fraction of a millimeter too high, a problem dentists call occlusal interference, and it's corrected in minutes by filing down the high spot. If the pain lingers after you release the bite, throbs on its own, or wakes you at night, it points instead toward an infection developing under or around the tooth. Quick Answer: Pain only while biting, gone the instant you stop, is almost always a bite adjustment issue. Pain that lingers, comes with swelling, or shows up as a small bump on the gum near the crown is a different problem and needs an exam within a day or two, not a wait-and-see approach. Key Takeaways Pain right when you bite is usually mechanical: a crown sitting slightly too high. Pain that lingers, throbs, or wakes you at night is more likely a sign of infection underneath the crown. A pimple-like bump on the gum near the crown is a fistula, meaning an infection is already draining somewhere. Left untreated, an infected tooth under a crown can develop into an abscess that spreads into the jaw. A same-day bite adjustment fixes most "hurts when I bite" complaints; an X-ray and cold test rule out infection. Waiting rarely makes this better, and it sometimes turns a simple fix into a root canal. If you're reading this with an ice pack against your jaw right now, the comparison section further down is the fastest place to find your answer. When "Hurts When I Bite" Means Something Different Maria's dentist ran through the same short list any dentist runs through when a patient reports pain tied specifically to pressure. That specificity matters. A tooth that aches constantly, whether you're biting or not, points toward the nerve. A tooth that only complains under load points toward something mechanical, at least at first. New crowns are especially prone to this because a crown is built from an impression taken before the final cement sets, and even a small miscalculation in height can leave one tooth absorbing more force than its neighbors every time you chew. The good news is that mechanical problems are the more common of the two, and they're also the easier fix. The less good news is that a crown placed over a tooth with hidden decay, a hairline crack, or a nerve already under stress can develop real trouble that happens to announce itself with the exact same complaint: it hurts when I bite. Telling the two apart from the outside is part of what an exam is for, but there are patterns worth knowing before you ever pick up the phone. Five Reasons a Crown Hurts Under Pressure 1. The Crown Is Sitting a Little Too High This is occlusal interference, and it's the single most common reason for post-crown biting pain. When a crown is cemented even slightly higher than the surrounding teeth, that tooth takes the first and hardest hit every time the jaw closes, long before the other teeth share the load. The tooth's ligament, the soft tissue anchoring it in the bone, reacts to that overload the same way a bruised toe reacts to a tight shoe: sore under pressure, quiet otherwise. Patients often describe it as a bite that "doesn't feel right," even before it hurts outright. A dentist checks this with a thin strip of colored articulating paper. You bite down, the paper marks the high spot, and a few passes with a polishing bur bring the crown back into line with the rest of your bite. 2. The Cement Has Started to Wash Out Crowns are cemented, not glued in the way most people picture. Over months or years, the thin cement layer under the crown can wear down at the margin, the edge where crown meets natural tooth. Once that seal is compromised, chewing forces flex the crown slightly against the tooth underneath, and bacteria gets a path in that wasn't there before. This tends to show up gradually rather than right after a new crown, and it's often accompanied by a faint bad taste or a crown that feels like it shifts slightly when you press on it with your tongue. 3. Decay Has Started Under the Margin A crown covers the visible part of a tooth, but it doesn't make that tooth immune to cavities. Decay can start at the margin and work its way inward without ever being visible from the outside. Because it's hidden under porcelain or ceramic, patients usually don't notice it until it's deep enough to cause sensitivity to pressure or temperature. This is one of the reasons dentists x-ray crowned teeth at routine checkups even when nothing looks wrong on the surface. Caught early, margin decay is a straightforward filling. Left alone, it can progress to the pulp and turn into the kind of infection this article keeps circling back to. 4. There's a Crack in the Tooth Underneath Teeth that needed a crown in the first place were often already compromised: a large filling, a root canal, or heavy wear from grinding. That history can leave a hairline crack in the tooth structure below the crown, one too fine to show up on a standard X-ray. Cracked tooth syndrome has a fairly specific fingerprint: sharp pain on release of a bite rather than during it, often triggered by chewing on one particular side. It's an uncomfortable diagnosis to land on because cracks like this don't always show themselves clearly, and confirming one sometimes takes a bite test with a small plastic stick pressed against individual cusps of the tooth. 5. An Infection Has Developed Inside or Below the Tooth This is the scenario worth taking seriously. If the nerve inside a crowned tooth becomes inflamed or dies, pressure while biting can aggravate a pocket of infection at the root tip. Unlike a simple high bite, an infection rarely stays quiet between meals. It tends to announce itself with throbbing that continues after you stop chewing, sensitivity to hot that lingers for a full minute or longer instead of fading in seconds, tenderness when you press on the gum near the root, and sometimes a small, soft bump on the gum that looks almost like a pimple. That bump is a fistula, and it means the body has already found a way to drain the infection on its own, which is not the same thing as the infection resolving on its own. A tooth can carry an infection like this for weeks with only mild symptoms before it flares. Telling the Two Apart Before You Call A short mental checklist helps here, even though nothing replaces an actual exam. Pain that starts the instant you bite and disappears the instant you stop usually means bite height. Pain that lingers for minutes, builds through the day, or wakes you at 2 a.m. usually means something is happening inside the tooth. Swelling anywhere along the gumline near the crown is never a bite issue; it's a sign of infection until proven otherwise. A faint, persistent bad taste on that side of your mouth, especially paired with tenderness, points toward a cement seal that's failed rather than a purely mechanical problem. And if you press gently on the gum above the tooth and it's noticeably more tender than the same spot on the other side of your mouth, that's worth mentioning specifically when you call, since it helps the front desk decide how quickly to get you in. If you've been quietly hoping this will just go away on its own, it's worth saying plainly: infections under a crown very rarely resolve without treatment. What Actually Happens at the Exam An exam for this specific complaint usually takes less time than patients expect. Dr. Drisdale starts with percussion testing, a gentle tap on the crowned tooth and its neighbors with the back of a mirror handle, comparing how each one responds. A tooth with an active infection at the root typically reacts noticeably more than the teeth around it. Cold testing follows, checking whether the nerve inside still responds normally, responds with lingering pain, or doesn't respond at all, each of which points toward a different diagnosis. Articulating paper checks bite height directly. A digital X-ray rounds out the exam, showing whether there's a dark shadow at the root tip, the classic sign of a periapical infection, or whether the bone and root look normal and the problem really is mechanical. Most patients walk in without knowing which of these applies to them and walk out with a clear answer within about twenty minutes. Treatment Depends Entirely on the Cause If it's a high bite, treatment is often finished in the same visit: a few minutes with a polishing bur and a recheck with the articulating paper. If the cement seal has failed, the crown may be removed, cleaned, and recemented, sometimes with a temporary crown in place while a new one is fabricated if the old one no longer fits well. Margin decay caught early usually means removing the crown, treating the decay like a standard filling, and placing a new crown, since porcelain crowns can't simply be patched. A confirmed infection changes the plan more significantly. That typically means root canal treatment to remove the infected pulp, followed by a new crown once the tooth has healed, since a tooth that's had a root canal is more brittle and needs that crown's protection going forward. In the rare case where the infection has caused too much bone loss to save the tooth, extraction and a replacement option, like an implant, gets discussed instead. What Waiting Does, in Plain Terms An infection under a crown doesn't stay contained forever. Left alone, it can spread from the root tip into the surrounding jawbone, and from there into the soft tissue of the face, which is how a manageable dental problem turns into an emergency room visit. That progression can take weeks or, in some cases, just days once it accelerates. It's also worth knowing that pain sometimes decreases temporarily as an infection progresses, not because it's healing, but because the nerve inside the tooth has died and stopped signaling. A quiet tooth is not the same thing as a healthy one. Protecting a New Crown Before Your Follow-Up If you're a few days out from a new crown and waiting on a follow-up appointment: chew on the opposite side of your mouth, skip anything hard, sticky, or icy on that tooth, and avoid extreme hot or cold if the tooth is sensitive. Over-the-counter pain relief can manage mild discomfort in the meantime, but it shouldn't be the plan for more than a day or two. If swelling, throbbing, or a fever shows up at any point, that's a same-day call, not a wait-and-see situation. Frequently Asked Questions (FAQs)

A dentist typically recommends a dental crown when a tooth has a large crack, extensive decay, a failing filling, or has undergone root canal treatment, since these situations weaken the tooth structure beyond what a filling can support. At Dentistry of Midland, Dr. John K. Drisdale, DMD, FAGD, examines the extent of damage, the tooth's remaining structure, and the patient's bite before recommending a crown over a smaller restoration. A dental crown is usually recommended when a tooth is too damaged, weakened, or decayed for a filling to hold up. Common signs include a visible crack, a large old filling that's failing, sharp sensitivity to hot or cold, a tooth that's finished root canal treatment, or a tooth that's simply worn down from years of grinding. Dr. John K. Drisdale, DMD, FAGD, evaluates each of these factors during an exam before recommending a crown, and this guide walks through what he's actually looking for. What a Dental Crown Actually Does A dental crown is a custom-made cap that fits over the entire visible portion of a tooth, restoring its shape, strength, and appearance. Unlike a filling, which repairs a specific damaged area, a crown covers the whole tooth above the gumline. That full coverage is what makes it the right choice when a tooth is too compromised for a smaller repair to hold up under normal biting and chewing forces. Crowns are typically made from porcelain, ceramic, zirconia, or a metal alloy, depending on the tooth's location and the patient's priorities around appearance versus durability. Front teeth often use all-ceramic or porcelain crowns for a natural look, while back molars sometimes use zirconia or metal for added strength under heavier bite pressure. Five Signs a Dentist Looks For Before Recommending a Crown 1. A Crack That Extends Below the Gumline or Into the Tooth's Structure Not every crack requires a crown. Small surface cracks, sometimes called craze lines, are cosmetic and don't need treatment. But a crack that runs deep into the tooth, especially one that reaches the pulp or extends below the gumline, threatens the tooth's structural integrity. Left alone, that kind of crack can spread with normal chewing pressure until the tooth fractures. 2. A Large, Aging Filling That's Starting to Fail Fillings don't last forever. Over years of biting and chewing, a large filling can develop small gaps at the edges where bacteria sneak in, or the surrounding tooth structure can weaken from supporting an oversized restoration. When a filling covers more than roughly half the tooth's surface, a crown is often the more durable long-term fix. 3. Sharp Sensitivity to Hot, Cold, or Pressure Sensitivity that's sharp, sudden, and tied to a specific tooth (rather than generalized sensitivity across many teeth) can indicate that decay or a crack has reached closer to the nerve. This is one of the more common reasons patients schedule an exam in the first place, and it's a signal worth taking seriously rather than waiting out. 4. A Tooth That's Completed Root Canal Treatment Root canal treatment removes the infected or damaged pulp from inside a tooth, but that process also leaves the tooth more brittle than it was before. A crown placed after root canal treatment protects the tooth from fracturing under normal use, which is why it's a standard recommendation rather than an optional upgrade in most cases. 5. Significant Wear From Grinding or Long-Term Bite Issues Patients who grind their teeth at night, a habit called bruxism, can wear down tooth enamel over years without realizing it's happening. By the time wear is visible or a tooth starts to feel different when biting down, a crown can restore both the shape and the protective function that's been gradually lost. Quick Answer: With proper care, a dental crown typically lasts between 5 and 15 years, and some last significantly longer. Lifespan depends on the crown material, daily oral hygiene, and habits like teeth grinding. Regular checkups let a dentist catch early signs of wear before a crown needs replacement. What the Crown Procedure Involves Getting a crown at Dentistry of Midland generally takes place over two appointments, though some cases may be completed sooner using same-day technology depending on the tooth and material chosen. The general steps include: Preparing the tooth. The damaged or decayed portion is removed, and the tooth is reshaped to create room for the crown to fit properly. Taking an impression. A digital scan or physical impression captures the exact shape needed for the custom crown. Placing a temporary crown. While the permanent crown is fabricated, a temporary one protects the tooth. Fitting the permanent crown. Once ready, the permanent crown is checked for fit and bite alignment, then cemented into place. Dr. Drisdale's use of advanced imaging and precise digital impressions helps ensure the final crown fits comfortably and blends naturally with surrounding teeth from the first fitting. When a Crown Isn't the Right Call Not every damaged tooth needs a crown, and a thorough exam is what separates a case that needs one from a case that doesn't. Minor chips, small cavities, and cosmetic imperfections are often better addressed with a filling, bonding, or a veneer, all of which are less invasive and preserve more of the natural tooth. Part of choosing the right dentist is trusting that the recommendation matches the actual damage, not defaulting to the most extensive (and most expensive) option. Why Experience and Credentials Matter for Crown Recommendations Deciding between a filling, an inlay, and a full crown requires judgment built on experience. Dr. John K. Drisdale, DMD, is a Fellow of the Academy of General Dentistry (FAGD), a credential that reflects extensive continuing education in restorative techniques, and a member of the American Academy of Cosmetic Dentistry (AACD). He was also named a 2024 Super Dentist for West Texas. That combination of restorative training and cosmetic expertise means a crown recommendation accounts for both the tooth's structural needs and how the final result will look and feel. Frequently Asked Questions (FAQs)