A temporary crown serves as a protective cap placed over a tooth that has been prepared for a permanent restoration, which can take a few weeks to fabricate in a dental laboratory. The temporary crown shields the underlying tooth structure, maintains the correct spacing, and restores function and appearance while the final crown is being made. These provisional restorations are held in place with a weak, temporary dental cement, intentionally designed to allow the dentist to remove the crown easily when the permanent one is ready. Because of this design, it is common for a temporary crown to become loose or dislodged before the scheduled appointment.
Immediate Steps and Temporary Solutions
If your temporary crown feels loose or has come off, remain calm and immediately contact your dental office to schedule an emergency re-cementation appointment. If the crown has fallen out, carefully retrieve it to prevent swallowing or aspiration, and gently rinse both the crown and the exposed tooth with warm water.
Before attempting any temporary fix, clean out any remnants of old, hardened cement from the inside of the crown, often using a toothpick or paperclip. Once cleaned and dried with a cotton swab or gauze, you can attempt to re-seat the crown using a small amount of over-the-counter temporary dental cement, available at most pharmacies. Alternatively, a tiny dab of petroleum jelly, denture adhesive, or regular toothpaste can act as a very short-term adhesive to hold the crown in place until you see the dentist.
When placing the crown back, ensure it is oriented correctly and gently bite down to fully seat it, checking that your bite feels normal and comfortable. You should avoid using any household glues, such as super glue, as these are toxic, can damage the tooth, and will prevent the dentist from properly fitting the permanent crown later. Until you can get to the dentist, strictly chew only on the opposite side of your mouth and avoid pulling floss straight up and out from between the teeth adjacent to the crown.
Understanding Why the Crown Came Loose
The primary reason a temporary crown loosens is the deliberate use of a weaker, non-permanent cement, such as those based on zinc oxide. This low bond strength is necessary so the provisional crown can be easily removed without damaging the prepared tooth when the final restoration is ready. This design means the crown is susceptible to dislodgement from normal forces.
Specific actions can prematurely compromise the temporary seal and pull the crown off the prepared tooth. Consuming sticky foods, like caramels, chewing gum, or taffy, poses a high risk because the adhesive forces can overcome the weak temporary cement. Biting into hard foods or chewing on the side of the temporary crown also places excessive force on the restoration. Incorrect flossing technique, where the floss is pulled up between the teeth rather than threaded out to the side, can also catch the edge of the crown and lift it off the tooth.
Addressing Potential Complications
Leaving the prepared tooth exposed by a loose or missing temporary crown can lead to immediate and long-term problems that affect the final treatment outcome. The most immediate consequence is intense sensitivity to temperature, air, and pressure, as the dentin layer of the prepared tooth is exposed. Applying a small piece of orthodontic wax over the exposed tooth can help shield it from irritants and reduce discomfort.
More concerning is the risk of dental drift. Without the temporary crown maintaining the precise space, adjacent teeth can drift inward, or the opposing tooth can super-erupt. Even slight movement, which can happen in as little as 24 to 48 hours, means the custom-made permanent crown may no longer fit when it arrives from the lab. Additionally, the exposed tooth is vulnerable to bacterial contamination and decay, which may necessitate further dental work, such as a root canal, before the permanent crown can be placed.
What the Dentist Will Do
When you arrive at the dental office, the procedure begins with a thorough clinical assessment of the prepared tooth and the temporary crown. The dentist will examine the underlying tooth structure for any signs of damage, decay, or fracture that may have contributed to the crown loosening.
The inner surface of the temporary crown and the prepared tooth structure will be meticulously cleaned to remove all traces of old cement, debris, or plaque. After cleaning, the temporary crown is carefully placed back onto the tooth to check the fit and ensure the bite remains correct. Once confirmed, a fresh application of temporary cement is placed inside the crown, which is then firmly seated back onto the tooth. The dentist will remove any excess cement that extrudes from the margins of the crown to prevent gum irritation. If the original temporary crown is damaged beyond repair, the dental team can usually fabricate a new provisional crown on the spot using materials like acrylic resins or bis-acrylic composite.