A crown coming off is one of the least painful dental emergencies and one of the most commonly mishandled. It usually happens with something sticky, often at the worst possible time, and because there is rarely any pain people put it in a drawer and get on with the week.
That drawer is where a lot of recementable crowns go to die. Here is what to do instead.
Tonight, in order
Find it and keep it. Rinse it under water, dry it, and put it somewhere you will not lose it. A small container, not a tissue on the kitchen bench, because tissues get thrown out. If you swallowed it, that is generally not dangerous, but ring us and mention it.
Clean the tooth gently. Brush the exposed tooth carefully. It may be sensitive. There is often old cement left on it, which is fine, do not attempt to chisel it off.
Cover it if you can. Temporary dental cement from the chemist is designed exactly for this. Dry the tooth, put a small amount inside the crown, seat it, bite gently, and clean off what squeezes out. If you do not have any, leave it out rather than forcing it.
Do not use superglue. The most important line on this page. Covered properly below.
Keep off that side, avoid sticky and hard food, and stay off temperature extremes. Exposed dentine reacts to cold.
Ring us. (02) 6672 1980. This is rarely a same-day emergency, but it is a this-week problem, not a next-month one.
Why not superglue
People reach for it because it seems obviously right. A crown is a hard thing that needs sticking to another hard thing.
Two problems. Cyanoacrylate is not formulated for prolonged contact with oral tissue, and it can irritate the gum and the pulp. More practically, it sets as a thin rigid film that we cannot remove from the fitting surface of the crown without damaging it. Dental cements are chosen so they can be cleaned off and the crown reseated accurately. Superglue leaves a contaminated surface, an inaccurate fit, and a crown that no longer sits where it was made to sit.
We see a handful of these a year, and the outcome is usually a new crown at full cost instead of a fifteen-minute recement. If you have already done it, bring the crown in anyway and let us look rather than assuming the worst.
What temporary cement actually does
It is genuinely useful and it is worth being clear about its limits.
It does two things well: it keeps the tooth covered so it is less sensitive and less likely to chip, and it stops the neighbouring teeth drifting into the space. Teeth move faster than people expect. A tooth left uncovered for several weeks can allow enough movement that the original crown no longer seats properly, which is a frustrating way to lose a crown that was otherwise perfect.
It does not do two things: it is not strong enough to chew on normally, and it does not seal the tooth against bacteria for long. So use it, and still book the appointment.
Why it came off, which is the real question
The crown is the obvious casualty. The tooth underneath is the actual issue.
The cement seal aged out. Cements do not last forever, and after ten or fifteen years a seal can simply fail. The tooth underneath is sound. This is the straightforward one, and it is a recement.
Decay developed underneath. The margin where crown meets tooth is the vulnerable point. Decay creeping under that margin gradually removes the structure the crown was gripping, until one day the crown lifts off with a toffee. The crown is fine. The tooth has a hole in it. Recementing without treating that decay just traps the problem.
The tooth fractured. Sometimes a piece of the tooth comes away inside the crown. If you look into the crown and see something solid that is not cement, that is usually tooth.
Only one of those three is fixed by putting the crown back. That is why we check the tooth rather than just handing you a recemented crown, and why an examination and often an X-ray are part of the appointment even when the crown looks perfect.
Lost fillings
Same principles, slightly different specifics.
A filling that falls out leaves a cavity with rough walls that traps food and is difficult to clean. The tooth is usually sensitive because the dentine is exposed. Temporary filling material from the chemist works for a few days.
Fillings usually fall out because decay has developed around or underneath them, or because the remaining tooth wall has flexed and fractured. Either way, the replacement is generally larger than the original, which is the underlying pattern with dental work: each round removes a bit more tooth. That is not a reason for despair, it is a reason not to leave the gap for six months.
If a large old filling has come out of a back tooth and the remaining walls look thin, we may recommend a crown rather than another filling, because a big filling in a hollow tooth tends to split the tooth eventually.
What the appointment looks like
Short, usually. An examination of the tooth and the crown, a check for decay at the margin, often an X-ray to see under the crown and around the root, and a test of whether the nerve is still healthy.
If the tooth is sound, we clean the fitting surface and the tooth, and recement. If there is decay, we remove it first and then decide whether the existing crown still fits, which it often does. If the tooth has fractured, we talk through options honestly, which may include root canal treatment and a new crown, or removal if too little tooth remains.
You get an itemised quote before anything starts.
Getting seen
We are open Monday to Friday, 8:00am to 5:00pm, at Level 1, Tweed Arcade, 2 Queen Street in Murwillumbah. Ring (02) 6672 1980 and bring the crown with you.
You do not need to be an existing patient. We look after people from Uki, Pottsville, Kingscliff and across the Tweed Valley, including visitors whose crown chose the holiday to come off.
For other dental emergencies and what to do first, see our emergency dentistry page.
Frequently asked questions
Can a crown that fell off be put back on? +
Often yes, if the crown is undamaged and the tooth underneath is sound. Keep it, clean it gently, and bring it in. Whether it can be recemented depends on why it came off in the first place, which is what we check.
Is temporary dental cement from the chemist safe to use? +
For a night or a weekend, yes, and it is better than leaving the tooth exposed. It is a holding measure. It is not strong enough to chew on properly and it will not seal the tooth against bacteria for long.
Should I superglue my crown back on? +
No. Household superglue is not safe in the mouth, and it fills the fitting surface with a material we cannot remove cleanly. That frequently turns a straightforward recementing into a new crown.
It does not hurt. Can I just leave it? +
Leaving it is what turns a small problem into a large one. An unprotected tooth chips, drifts and decays, and the exposed inner layer of the tooth is far softer than enamel. Most crowns that cannot be refitted were left too long, not damaged in the fall.
Why did my crown come off? +
Usually one of three reasons: the cement seal finally failed after years, decay has developed underneath and destroyed what the crown was holding onto, or the tooth underneath has fractured. Only the first is a simple recement, which is why the tooth needs checking rather than just the crown.