Lost a Filling or Crown: What to Do Tonight

A filling or crown that has come out is usually uncomfortable rather than dangerous, so in most cases the practical answer for tonight is to keep the crown, keep the area clean, chew on the other side, and arrange to be seen promptly rather than in the middle of the night. The exceptions are set out further down, and they are worth reading.

Keeping the crown makes a real difference to what can be done with it, so it is worth mentioning on the phone.
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What should be done tonight?

Find the crown and keep it

If a crown has come off whole, it can often be recemented, provided the tooth underneath is sound and the crown itself is undamaged. Rinse it under cool water, dry it, and put it somewhere safe and dry, such as a small container or a resealable bag. Bring it to the appointment.

A crown left on a bedside table or wrapped in a tissue that ends up in a bin removes an option that costs nothing to preserve.

Do not attempt to glue it back

Household adhesives and superglue are not made for the mouth. They are not designed to be in contact with tissue, they set in a way that stops the crown seating properly, and once a crown is fixed in the wrong position with the wrong material it often cannot be salvaged. A crown that could have been recemented can become a crown that has to be remade.

Temporary dental cement sold in pharmacies is a different thing and is reasonable as a short-term measure, particularly over a weekend. It is not a repair. It holds the position and protects the tooth until an appointment, and it should not become the reason the appointment is postponed.

Chew on the other side

A tooth missing a filling or a crown has lost structure and is more likely to fracture under load. Keeping it out of the chewing rotation for a few days is a small inconvenience that prevents a larger problem.

Keep the area clean

Brush it as normal, gently. Food packing into an open cavity is uncomfortable and makes the tooth more sensitive. A warm salt-water rinse after meals, half a teaspoon of salt in a cup of warm water, helps keep the area clear.

Cover a sharp edge if there is one

Orthodontic wax from a pharmacy, pressed over a rough edge, will stop it rubbing the tongue or cheek. A piece of sugar-free chewing gum works as a stopgap if wax is not available. Both are temporary.

Pain relief if needed

Over-the-counter pain relief is reasonable. Follow the directions on the packet, and check with a pharmacist or doctor, particularly if other medication is being taken. Nothing should be placed against the gum itself: aspirin held against gum tissue causes a chemical burn, and the various remedies circulated online do more harm than good.

Why is the tooth suddenly sensitive?

Under the enamel is dentine, and dentine is not solid. It is threaded with microscopic tubules running from the outer surface towards the pulp, where the nerve sits. Those tubules are filled with fluid.

When a filling or crown comes out, dentine that was covered is now open to the mouth. Cold, air and sweet things cause the fluid in the tubules to move, and that movement is registered by the nerve as a sharp, short jolt.

That is why the sensitivity is often immediate and dramatic without meaning anything has gone badly wrong. There is more on the structure in what is inside a tooth and why it hurts, and on the sensation itself in sensitive teeth to cold and what it means.

Sensitivity that is manageable tonight still deserves an assessment this week rather than next month.
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Why did it come out?

Restorations rarely fail without a reason, and the reason changes what happens next. The common ones are:

• Decay underneath. New decay at the margin undermines the restoration until it loses its grip. This is a frequent finding, and it is why a crown that came off cleanly is not always a simple recementation.
• A fractured cusp. Part of the tooth around the filling has broken, taking the filling with it.
• Cement washout. The cement holding a crown has slowly dissolved or washed out at the margin over years, leaving the crown loose before it came off.
• Age and size. A large old restoration that has been repaired several times has less sound tooth left to hold it. Restorations have a working life rather than a permanent one, which is covered in what fillings cost and how long they last.
• Grinding and clenching. Heavy nocturnal forces fatigue restorations and the tooth around them, often without the person being aware of it.

Can it just be put back?

Sometimes, and that is the simplest of the possible outcomes. A sound tooth under an intact crown, with no decay at the margin, is often a straightforward recementation.

Where it is not possible, the reason is usually one of the following. There is decay under the crown that must be removed first, which changes the shape of the tooth so the old crown no longer fits. Too little tooth structure remains to retain a crown. The crown itself is distorted or fractured. Or the nerve has been affected and needs treating before anything is placed on top.

The options then are a new filling, a new crown, sometimes a build-up before a crown, and occasionally root canal treatment or extraction where the tooth has fractured deeply. Which of those applies is determined by examination and radiographs, not by how the tooth looks in a mirror.

What happens if it is left?

A gap in the arch is not a stable situation. Teeth move.

The teeth either side drift towards the space, and the tooth in the opposing jaw over-erupts into it. Once that has happened, restoring the original tooth becomes harder, because the space it needs has been partly closed by its neighbours.

At the same time, exposed dentine decays faster than enamel, and food packing into an open cavity accelerates it. A tooth that needed a filling can become a tooth that needs a crown, and a tooth that needed a crown can become a tooth that needs root canal treatment or removal. The delay does not hold the situation still.

When is it actually urgent?

Most lost restorations can wait until an appointment. These should not:

• Severe pain, or pain that arrives on its own without a trigger and keeps someone awake.
• Pain that lingers for minutes after something cold or hot has been removed.
• Any swelling of the gum, face or jaw.
• A sharp edge that is cutting the tongue or cheek.
• A visibly fractured tooth with a large piece missing.

Emergency appointments are generally in the afternoon, and every call from someone in pain is treated as urgent. The emergency page explains how that works. For overnight measures while waiting, toothache relief tonight is the practical companion to this article.

What does the repair cost?

A composite filling is $250 to $450. A crown is $1,500 to $1,800. Root canal treatment, if the nerve is involved, is $1,600 to $2,200.

Recementing an existing crown is a smaller item than any of these, and it is quoted once the tooth has been assessed, because whether it is possible is the thing being determined.

All of those figures assume no health-fund contribution. A fund may contribute, and what it contributes depends on the policy, so it is worth checking with the fund directly. A written quotation is provided before treatment begins, so the cost is known in advance rather than afterwards. There is more on the fillings page and the fees page.

Quick answers

Can the crown be worn in the meantime?

Pushing a crown back on and leaving it there without cement is risky, because it can be swallowed or inhaled while asleep. If it will not stay put with temporary dental cement, keep it in a container and bring it in.

Is a black or dark area under the crown decay?

It may be decay, old cement, stained dentine or the darkened core of a previously treated tooth. That is not something to decide from a photograph or a mirror. A radiograph and an examination answer it.

Does a lost filling always mean a bigger filling?

Not always, but frequently. Whatever caused the first one to fail usually needs removing, and the cavity is generally larger afterwards. Earlier assessment keeps the difference smaller.

Is this a silly reason to ring after hours?

No question is a bad question. A short conversation that establishes it can safely wait until the morning is a good use of a phone call.

Where to go from here

For the longer view on restorations and their working life, read what fillings cost and how long they last. For managing discomfort overnight, toothache relief tonight covers it. General information on tooth decay is available from healthdirect.

A crown brought in with the patient is often a crown that can go back on the tooth.
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Written and reviewed by Humzah Aly, Oral Health Therapist. This article is general information only and is not a substitute for personalised dental advice. Please see a dental practitioner to discuss what is right for you.