A “silver cap” is the common term for a Stainless Steel Crown (SSC), a pre-formed metal covering used in pediatric dentistry to protect a primary tooth that has suffered extensive damage or decay. SSCs are necessary when a regular filling cannot adequately restore the tooth structure, often following pulp therapy or when decay covers multiple surfaces. The crown is cemented onto the tooth to seal it from bacteria and provide a durable surface until the tooth naturally falls out. When the cap comes off, it exposes the underlying, vulnerable tooth and requires prompt dental attention.
Immediate Steps After the Cap Comes Off
Your immediate priority is to locate the lost crown and ensure your child has not swallowed or aspirated it. If the child shows signs of difficulty breathing, persistent coughing, or choking, seek emergency medical care immediately.
If the cap is found, rinse it gently with warm water to remove debris, and store it safely in a clean container or sealed plastic bag.
The exposed tooth must be kept clean to prevent bacterial re-entry. Use gauze or a clean cotton ball to manage excess saliva, and instruct your child to avoid chewing on that side.
Since the exposed tooth may be sensitive to temperature or pressure, offer soft foods and lukewarm drinks until the cap is re-cemented. Contact your pediatric dentist to schedule an appointment.
Why the Exposed Tooth Needs Protection
The tooth underneath the SSC is highly susceptible to new damage and infection. Since most of the original enamel and dentin were removed during preparation, the remaining structure is thin and fragile.
Losing the cap immediately breaks the protective seal, allowing bacteria to reach the tooth’s innermost layer, the pulp. Once exposed, the tooth risks developing pulpitis (inflammation of the nerve tissue) or a painful abscess due to rapid bacterial re-entry.
The primary tooth also serves as a natural space maintainer, holding the correct position for the permanent tooth. If the cap is left off for an extended period, adjacent teeth may shift into the open space, making it harder for the permanent tooth to erupt correctly.
Getting the Cap Replaced or Repaired
Once at the dentist’s office, the professional will evaluate both the original cap and the exposed tooth structure. If the stainless steel crown is intact and undamaged, and the underlying tooth shows no new decay, the dentist will re-cement the original cap.
The tooth and the inside of the crown will be thoroughly cleaned and dried before the cement is applied to ensure a successful, tight seal.
If the cap is bent, cracked, or if new decay has formed, a complete replacement will be necessary. The dentist will select a new pre-formed SSC, adjust its fit, and cement it onto the tooth in a single appointment. The cementation process requires the child to bite down firmly to fully seat the crown and create the marginal seal.
Following the procedure, post-care is essential to help the new seal set properly. For the first 24 hours, avoid sticky or hard foods that could pull the crown off while the cement cures.
To minimize recurrence, encourage your child to limit chewy candies, caramels, and gum, as these are the most common culprits for dislodging SSCs. Regular check-ups allow the dentist to monitor the crown’s fit until the primary tooth naturally exfoliates.