My implant was placed years ago and the area hurts now: what should the dentist check?

Why the implant itself is rarely the source

A natural tooth hurts because it has a nerve inside it. A dental implant does not. The titanium or ceramic post sits in bone, the abutment connects to it, and the crown on top is a piece of ceramic or metal. None of those parts can feel anything. So when the area around an implant placed years ago starts to ache, the pain is coming from living tissue: the gum and bone that hold the implant, a neighboring natural tooth, the sinus above an upper implant, or the muscles and joint that move the jaw.

That is useful to know, because it changes what the dentist is looking for. The question is not "is the implant failing?" but "which of the tissues around this implant is irritated, and why?" The sections below walk through the usual answers and the signs that go with each.

The usual sources, one by one

Inflamed gum around the implant (peri-implant mucositis)

The soft tissue around an implant can become inflamed by plaque in the same way gum around a natural tooth does. The gum looks red or puffy and bleeds when you brush, floss or when the dentist gently probes it, but the bone underneath has not been lost. This stage is usually reversible once the plaque is removed and daily cleaning around the implant improves. Left alone, it may progress to the next stage.

Inflammation that has started to cost bone (peri-implantitis)

When inflammation reaches the bone supporting the implant, bone is lost around the post. Signs may include bleeding or pus on probing, deeper measurements than at earlier visits, gum that has pulled back so more of the implant shows, swelling, a bad taste, and sometimes a dull ache. Peri-implantitis can progress faster than gum disease around natural teeth, which is one reason a change you notice is worth an appointment rather than a wait. In advanced cases the implant can loosen, but by then the problem has usually been present for some time.

Something mechanical: screw, crown or bite

The crown is attached to the implant with a screw, with cement or both. Screws can loosen, cement can lose its grip and ceramic can chip or crack. A crown that moves slightly when you press it, clicks when you chew, or suddenly feels higher or different in the bite points toward a mechanical cause. A bite that lands too hard on the implant crown, or heavy clenching and grinding, can load the implant and its parts beyond what they were designed for; grinding is associated with more mechanical complications of implant restorations and with aching jaw muscles. A loosened part lets food and bacteria collect in the gap, so a mechanical problem and gum inflammation often appear together.

Food packing under or beside the crown

Implant crowns are shaped to be cleanable, but gaps can open over the years as neighboring teeth shift or gum recedes. Food caught under the edge of the crown can press on the gum and cause a localized, sore, "something stuck" feeling that eases after cleaning and returns after meals; plaque left in the same gap can inflame the gum. On its own this is not an emergency, but it is a sign the area needs reshaping or a new cleaning approach.

A neighboring natural tooth

Because the implant itself has no nerve, pain that seems to come from it often belongs to the tooth beside it. A natural tooth that is sensitive to hot or cold and lingers afterward, that hurts sharply when you bite and especially when you release, or that aches on its own may have decay under an old filling or crown, a crack or an inflamed or infected nerve. Patients sometimes point to the implant because it is the "new" thing in that area. The guide on whether a tooth under a crown can still get a cavity explains why an older neighboring crown is a common culprit.

The sinus, jaw muscles or jaw joint

Upper back implants sit close to the maxillary sinus, and a sinus infection or congestion can make the whole upper jaw, including the implant area, feel pressured and tender. Tension or disorders of the jaw muscles and joint can send pain into the face and around the teeth, especially on waking or after long chewing. These causes usually come with other clues: a stuffy nose, a cold, jaw clicking, a tired or sore jaw, or pain that moves around rather than staying in one place.

What the examination checks

Finding the source is a matter of comparison. The dentist is comparing today with the records made when the crown was first fitted and with later check-ups.

• Gum around the implant. Does it bleed or release pus when gently probed? How deep are the measurements, and are they deeper than at previous visits? Has the gum margin receded?
• Bone level on an X-ray. The bone around the implant is compared with the baseline image taken after the crown was placed. Bone that has stayed where it was points away from peri-implantitis even if the gum is inflamed; bone that has dropped points toward it. If no baseline exists, the dentist works from standard thresholds and asks for your earlier records.
• Movement. Is the crown moving on the abutment, or is the implant itself moving in the bone? The first is usually a loose screw or cement; the second is far more serious and is checked carefully.
• The bite. Where do the teeth meet? Does the implant crown take the first or hardest contact? Are there wear marks that suggest grinding?
• The neighboring teeth. Each tooth near the implant is tested for sensitivity, cracks, decay and infection, and shown on the same X-ray.
• Sinus and jaw joint. For upper implants, the X-ray and your symptoms are checked for sinus involvement; for any implant, the jaw muscles and joint are examined if the pain pattern suggests them.

If you have X-rays from the office that placed the implant, or the name of the implant system, bring them or ask that office to send them. A baseline image is often the most useful comparison for an implant that has been in place for years.

What makes peri-implant disease more likely

Research reviewed at the 2017 World Workshop on periodontal and peri-implant conditions found strong evidence that three things raise the risk of peri-implantitis: a history of gum disease around natural teeth, difficulty keeping plaque off the implant, and not attending regular maintenance visits after the implant was placed. Smoking and diabetes are often discussed as risk factors as well; the 2017 review found the evidence for their specific link to peri-implantitis inconclusive, but smoking can affect healing and the long-term success of an implant, and diabetes can interfere with healing, so both are reasons to tell the dentist about them.

Maintenance visits are for exactly this problem. They let the hygienist and dentist clean where the brush does not reach, repeat the probing measurements, and compare the bone level before any change becomes a symptom. If several years have passed since an implant was checked, that history itself tells the dentist something.

What to do tonight and before the visit

• Pain relief. An over-the-counter pain reliever, taken as directed on the label, is reasonable while you arrange an appointment. Tell the office which one you used.
• Clean gently. Brush the implant crown and the gum around it softly and use floss or a small interdental brush if you normally do. Do not scrub a sore area or dig at the gum.
• Do not pick, tighten or glue anything. If the crown moves, leave it alone and keep it clean; never use household adhesive. If it comes out entirely, keep it in a clean container and bring it with you.
• Chew on the other side and avoid very hard or sticky foods on the sore area.
• Write down what you notice. When does it hurt: on biting, on release, with cold, at night, after meals? Is there bleeding, a taste, swelling or looseness? This record helps the dentist decide urgency, as explained in tooth pain tonight: what information helps your dentist decide urgency.

When this is an emergency instead

Most pain around an older implant can wait for an appointment within days. A few signs cannot. Difficulty breathing or swallowing, swelling of the face or neck that is spreading quickly, or fever together with facial swelling means a possible spreading infection. Call 911 or go to the nearest emergency department now, and do not use the online request form for this. Uncontrolled bleeding or a blow to the face that has shifted the implant or neighboring teeth also goes to emergency care first. The guide on facial swelling with tooth pain covers these signs in more detail.

Reaching the practice

Loul Dental Studio is open Monday through Thursday from 8:00 am to 5:00 pm, with select Fridays by appointment. During those hours you can call (805) 565-5111 and describe the pain, how long it has lasted and whether anything moves, bleeds or is swollen, and ask how soon you can be seen. You can also send an appointment request; a request is not a confirmed appointment, and the team follows up. Ask the office how an existing-implant patient with pain should contact them, and what to do if the pain begins outside office hours. The services page lists the practice's implant care, including computer-guided implant placement.

The next step

Pain around an implant that was placed years ago is a signal from the tissues around it, and most of the causes above are more manageable the earlier they are found. Book an examination, bring any earlier X-rays and implant records you can find, and use the checklist below to describe what you are noticing. An examination, not a symptom list, determines the cause.