Dental crown fell off or came loose: what to do

Prefer not to wait for a reply? Book online now, no phone call needed: see the open times and pick yours, any time (booking page in Portuguese).

Did your dental crown fall off or is it coming loose? Here's what to do: keep the crown in a small clean container, rinse your mouth with warm water, check whether the tooth underneath is intact, don't use any kind of glue and avoid chewing on that side. Book an appointment within the next few days — or the same day if you're in severe pain, the tooth is broken or you can't eat.

In clinical practice, a crown (the "cap" that covers a natural tooth) usually comes off for one of three reasons: the cement holding it has aged, a cavity formed in the tooth underneath, or the tooth — often one with a root canal and a post — fractured. Finding out the cause is what determines whether the same crown can go back on or a new one is needed.

Dr. Cléo Salustiano (CRO-SP 170844), a dentist in Mooca, explains what to do in the first few hours, what to avoid, how long it's safe to wait and how each situation is handled at the dental office. If your restoration is an implant crown, see the specific article on an implant crown that fell off.

This article comes from Dr. Cléo Salustiano's dental office in Mooca, São Paulo (care in English, Portuguese and Spanish). See the root canal treatment page to learn how the treatment is done here and book your assessment.

Step by step

1. Recover and keep the crown. Rinse the crown with water and keep it in a small, clean, dry container. Don't throw it away or leave it loose in your pocket: if the crown and the tooth are both intact, it may be re-cemented.
2. Look at the tooth that's left. Rinse your mouth and take a look: is the tooth intact, shaped like a "stump"? Is it dark, soft or broken? Is there a piece of tooth inside the crown? These answers help the dentist and indicate how urgent it is.
3. Never use glue. Super glue, contact cement and similar products burn the tooth and gums, contaminate the crown and can prevent it from fitting again. If the crown can be reused, the dentist cements it with the right material.
4. Protect the tooth until your appointment. Avoid chewing on that side and avoid hard, sticky, very cold or very hot foods. If the tooth is sensitive, a temporary dental cement from the drugstore placed over it can help for a few days. Putting the crown back in "dry" to eat isn't safe: it can come loose and be swallowed.
5. Keep the area clean. Gently brush the exposed tooth. Plaque building up on a tooth without its crown quickly turns into a cavity — and a cavity underneath is exactly what makes a new crown necessary.
6. Book an assessment. Within the next few days if there's no pain. The same day if you're in severe pain, the tooth is broken or loose, the edge is cutting your tongue or you inhaled the crown while coughing (in that case, seek medical care).

Why did the crown come off, and what does that change?

Aged cement: over the years, the cement holding the crown loses its grip and the crown comes off whole, with the tooth underneath intact. This is the simplest scenario — in most of these cases, the same crown can be cleaned and re-cemented, as long as it still fits precisely.

A cavity under the crown: the crown protects the top of the tooth, but the area where it meets the tooth can collect plaque. The cavity softens the tooth structure, the crown loses its support and comes off. When this happens, putting the same crown back doesn't solve anything: the decay needs to be removed and the tooth rebuilt, which usually calls for a new crown.

A fractured tooth or post: teeth that have had root canal treatment are more fragile. If the crown came off with a piece of tooth or the post inside it, a fracture is suspected. Depending on where the tooth broke, it may be rebuilt, need root canal retreatment or, with root fractures, extraction.

Bite and teeth grinding: when bite forces fall unevenly on the crown, or when someone grinds their teeth, both the cement and the tooth take the strain. If the crown has come off more than once, adjusting the bite and wearing a night guard are part of the solution.

What changes the urgency: a crown that came off whole, with the tooth intact and no pain, can wait a few days. An exposed tooth with pain, a broken or loose tooth, a sharp edge or a front tooth that affects your daily life calls for faster care. And the wait should never be weeks: without its crown, the tooth is unprotected, can fracture, and the neighboring teeth can shift so the crown no longer fits.

How does the dentist fix a crown that fell off?

The first step is examining the tooth and the crown, with an X-ray when needed. The dentist checks for decay, whether the tooth is intact, whether the root canal (if there is one) is still sound and whether the crown still fits the tooth's margins precisely.

If the tooth is intact and the crown fits well, the crown is cleaned, the tooth is prepared and the crown is re-cemented. It's a relatively quick procedure, often done at the same appointment. The bite is checked at the end so forces are balanced again.

If there's decay or the tooth has lost structure, the decay is removed and the tooth is rebuilt — sometimes with a post, when there's a root canal — before a new crown is made. Until the permanent one is ready, a temporary crown protects the tooth.

If the tooth fractured, the approach depends on the fracture line. Fractures above the gumline usually allow for rebuilding; root fractures, especially vertical ones, generally lead to extraction and planning a replacement, such as an implant or a prosthesis.

With older root canals, the X-ray also shows whether there are signs of infection at the root. If there are, root canal retreatment comes before the new crown, so the cosmetic work isn't done on top of a problem.

No dentist can guarantee that a re-cemented crown won't come off again — what the assessment does is treat the cause (cement, decay, fracture or bite) so the problem doesn't happen again for the same reason.

‹

Why does a tooth need a crown after a root canal?

Implant crown fell out or came loose: what should you do?

Root-canal-treated tooth hurting: what could it be?

Aftercare following a root canal

›