A dental crown is a fixed cap designed to completely cover a damaged tooth, restoring its shape, size, and strength. Crowns are bonded onto the tooth structure with specialized dental cement. Although durable, crowns occasionally come loose and fall out. This is not usually a severe emergency, but it requires prompt action to protect the underlying tooth and determine if the crown can be salvaged.
Immediate Steps After the Crown Falls Off
First, safely retrieve the crown and handle it gently. Rinse the crown gently with lukewarm water to remove debris or saliva from the interior surface. Avoid scrubbing or using harsh chemicals, as this could damage the crown and prevent reattachment.
The exposed tooth will likely be sensitive because it was filed down. For temporary relief, you can use over-the-counter dental cement or petroleum jelly to carefully seat the crown back onto the tooth, but only if it slides easily into place. If it does not fit, store it in a secure container until your appointment.
Contacting your dentist immediately is important. The exposed tooth is vulnerable to decay and fracture, and most dental offices reserve time for urgent matters. Until your appointment, avoid chewing on the affected side and stick to a soft diet.
Criteria for Successful Reattachment
Successful reattachment depends on the dental professional examining three primary factors.
Condition of the Underlying Tooth
The condition of the underlying tooth structure is the primary consideration. If new decay has formed where the crown meets the tooth, or if a fracture has occurred, the existing crown cannot be cemented back into place. If significant decay is present, it must be removed. This often changes the tooth’s shape and necessitates a new crown to ensure a precise fit.
Integrity of the Crown
The physical integrity of the crown itself must be assessed. It must be completely intact without cracks, chips, or warping. A crown that is structurally compromised or has a damaged internal surface will not bond correctly and can lead to failure after re-cementation.
Cause of Failure
The third factor involves diagnosing the original cause of the failure. If the dental cement simply washed out over time, reattachment is usually successful. If the crown fell off due to bite misalignment or insufficient remaining tooth structure, re-cementing the old crown may only be a temporary fix. The underlying issue must be addressed before a permanent restoration is placed.
Professional Treatment Options
If the dentist determines the existing crown and underlying tooth are in good condition, the standard procedure is to reattach the original restoration. This involves thoroughly cleaning the inside of the crown and the surface of the prepared tooth to remove old cement and contaminants. Once clean and dry, a professional-grade dental cement is applied to the interior of the crown.
The crown is carefully seated back onto the tooth, and the patient bites down gently to ensure proper positioning. Excess cement that oozes out is meticulously removed before it sets, which prevents gum irritation. This re-cementation is a permanent solution if the original cause was simple cement failure.
If the crown is damaged or the tooth requires additional repair, a replacement crown is necessary. The dentist will remove any decay and rebuild the tooth structure, often using a core build-up, to create a stable foundation. An impression of the prepared tooth is then taken and sent to a lab for fabrication of a custom-fitted permanent crown. The patient wears a temporary crown to protect the tooth while the new prosthetic is being made, a process that typically takes about two weeks.