A dental crown is a custom-made cap designed to cover a damaged or weakened tooth, restoring its shape, size, and strength. It acts as a protective shield for the remaining natural tooth structure. When a crown detaches, it exposes the underlying, prepared tooth. This requires prompt attention to prevent further damage or discomfort.
Immediate Steps to Take
The moment your crown comes loose or falls out, retrieve it safely to avoid swallowing or aspirating it. Gently rinse the crown with warm water to clean off debris, but avoid scrubbing or using harsh chemicals, which could damage the restoration. Inspect the crown for damage, then place it in a clean, sealed container or a small plastic baggie for safekeeping. Contact your dental office right away, explaining that the crown has detached. Even if you are not experiencing pain, the underlying tooth is vulnerable to decay, sensitivity, and fracture, making a prompt emergency appointment necessary.
Temporary Management of the Exposed Tooth
While waiting for your dental appointment, managing the exposed tooth is critical to minimize sensitivity and protect the tooth surface. The prepared tooth underneath the crown often has exposed dentin, which can lead to heightened sensitivity to air, pressure, and temperature extremes. You should immediately begin to avoid chewing on the side of your mouth where the crown is missing and stick to a soft-food diet.
You can manage any pain or discomfort with an over-the-counter anti-inflammatory medication, such as ibuprofen, following the dosage instructions carefully. To protect the exposed tooth structure, you can purchase temporary dental cement kits from most pharmacies. These kits contain a material specifically designed to temporarily secure the crown back onto the tooth or to fill and cover the exposed area.
If you are using the temporary cement to re-secure the crown, gently clean the inside of the crown, apply a very small amount of the cement, and carefully seat the crown back onto the tooth. The crown must only be placed if it slides on easily and you can bite down completely without feeling pressure or misalignment. Alternatively, if the crown is lost or damaged, you can mold soft dental wax or orthodontic wax over the exposed, sharp edges of the prepared tooth. This temporary covering provides a physical barrier, reducing sensitivity and preventing the tooth from irritating the soft tissues of your cheek or tongue until you can receive professional care.
Why Crowns Fail and Professional Solutions
Crowns detach for a few common reasons, with the most frequent being the failure of the dental cement used to bond the restoration to the tooth. Over time, the cement can degrade due to constant exposure to oral fluids, chewing forces, and wear, weakening the physical bond. Another common cause is the development of new tooth decay beneath the margin of the crown, which compromises the fit and structural integrity of the underlying tooth.
Trauma, such as biting down on a very hard object, or chronic habits like teeth grinding (bruxism) can also exert excessive force that fractures the cement seal or the crown itself. The original crown may also have had an improper initial fit, or there may be insufficient remaining tooth structure to create a strong, lasting bond.
Once you see your dentist, the professional solution will depend on an assessment of both the crown and the underlying tooth. The dentist will first clean all old cement residue from the crown and the tooth surface, then examine the tooth for new decay or fractures. If the original crown is intact and the tooth structure is healthy, the dentist can often simply re-cement the existing crown using a new, stronger dental adhesive. If significant decay is found, a new filling or even a root canal may be necessary before a new crown can be fabricated. If the crown is cracked or the tooth structure is irreparably damaged, a new impression will be taken to create a replacement crown to ensure proper fit and long-term stability.