A Crown or Filling Came Out: What to Do Next
It usually happens at the worst possible moment — mid-meal, or first thing in the morning when you bite into toast and something feels off. You run your tongue over the spot and find a rough edge where a crown or a filling used to be. Sometimes the crown is sitting in your hand, perfectly intact. Sometimes you swallowed it without noticing.
This is one of the more common calls we get, and I want to walk you through what it means, what to do in the first few hours, and how quickly you need to be seen. For most people this is not a true emergency. It is also not something to leave alone for a few months.
Why it came loose
A crown is cemented over the tooth underneath it, so when one comes off, the cement or the tooth has usually given way first. Often the cement has slowly broken down over years. Just as often, decay has formed at the margin — the line where the crown meets your tooth — and eaten away the solid tooth the cement was holding onto. Fillings come out for similar reasons: the bond wears, the filling flexes under years of chewing, or decay undermines it from the edge.
Caramel or taffy often gets the blame, and it may be what finally dislodged things, but it is rarely the underlying reason.
What to do in the first hour
Save the crown if you have it. Rinse it, dry it, and put it somewhere safe like a small container or a zip bag. If both the crown and the tooth underneath are sound, it can often be cemented back on.
Look at what came out. If the crown has a chunk of tooth or a metal post inside it, that is useful for me to know before you come in.
Keep the area clean. Brush gently over the exposed tooth and rinse with warm salt water, especially after eating.
Chew on the other side until you are seen.
Call us, even if nothing hurts. Describing what happened helps us decide how soon to bring you in.
If you swallowed the crown, that is usually harmless and it will pass on its own. Let us know, though, because we will plan on making a new one.
What not to do
Do not use superglue or any household adhesive. These are not made for the mouth, they can ruin a crown that could otherwise have been reused, and they make cleaning up the tooth much harder.
Do not press the crown back on and leave it there uncemented. It can come loose while you sleep or eat, and a loose crown can be swallowed or, rarely, inhaled.
Do not wait weeks and hope. An uncovered tooth can decay quickly, and the teeth around it drift once the shape is gone, so a crown that fit perfectly this month may not seat properly two months from now.
Pharmacies do sell temporary dental cement, and used as directed for a few days it can hold a crown in place and keep the tooth covered. Think of it as a stopgap to get you comfortable until your appointment, not a repair.
Should I expect pain?
Often the tooth is sensitive rather than painful — cold water, sweet things, and even a breath of cold air can make it twinge, because the surface that was under the crown is softer and more porous than enamel. A desensitizing toothpaste can take the edge off. If the tooth has had a root canal, you may feel nothing at all. What is worth telling us about is sharp pain when you bite down, or a dull ache that will not settle.
When it cannot wait
Call us the same day, or seek urgent care if we are closed, if you notice:
Swelling in the gum, cheek, or jaw
Fever, or a bad taste or discharge around the tooth
Pain that wakes you at night or does not respond to over-the-counter pain relief
A sharp edge cutting your tongue or cheek
Bleeding that does not stop
What happens at the visit
I will look at the tooth and the crown, and usually take an x-ray to see what is going on underneath. If the tooth is solid and the crown is undamaged, cleaning both and recementing it is often all that is needed, and that is a short appointment. If there is decay under the crown, I will clear that out first and rebuild the tooth, and depending on how much is left, the old crown may or may not still fit. When too little tooth remains to hold a crown, we will talk through the options for that tooth honestly, including what each one involves.
A filling that falls out is usually replaced the same way. If the cavity has grown large, or the tooth has cracked around it, I may suggest something that covers more of the tooth, like an onlay or a crown, because a big filling in a weak tooth tends not to last.
This is general information rather than a diagnosis — your tooth may need something different, and I would need to look at it to say.
If a crown or filling has come out, call and let us know. We would rather see you for a quick recement than for something bigger a few months later.
Hashimi Dental, 3701 Market St. Suite E, Riverside, CA 92501
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