Loose or broken crown or bridge? Here is what to do

As a dentist at Tandarts West in Rotterdam West, I see it almost every week: someone comes in with a crown that is loose or a broken crown in a napkin. Almost always my first sentence is reassuring. A loose crown or a bridge with a loose tooth is usually easy to repair, and often even with the crown you already had. What you do in the first few hours does determine how many options remain. That is why you will read here, step by step, what is wise to do.

What does it mean when your crown comes loose or breaks off?

A crown is a cap that sits over a damaged or treated tooth, usually fixed in place with dental cement. A bridge is a row of connected crowns that fills a gap where a tooth is missing. Both are firmly attached, but not forever. When a crown comes loose, it is rarely the crown itself that is at fault.

The most common causes are: cement that lets go after years, a new cavity (decay) under the edge of the crown, tooth grinding that overloads the connection, or simply biting hard on something unexpected such as an olive stone or a crusty piece of bread. With a bridge, one of the supporting teeth can weaken, causing the whole construction to come loose.

It is important to know: a crown that is loose but still on the tooth is different from a crown that is off or broken. If it is still loosely attached, chew on the other side and make an appointment quickly. If it is completely off, keep it safe. With a truly broken crown, where a piece of ceramic has chipped off but the rest is still attached, the dentist assesses whether repair or replacement is needed.

A loose crown is rarely the end of the crown. In the vast majority of cases, the same crown can simply go back on.

First aid: what you can do yourself and what to avoid

What you can do yourself

• Keep the crown or bridge part. Rinse it briefly with lukewarm water and place it dry in a small box or bag. Bring it to your appointment.
• Keep the tooth clean. Keep brushing gently, including the exposed tooth stump, and rinse with lukewarm water or a salt solution after eating.
• Chew on the other side. Load the tooth without a crown as little as possible.
• Soften a sharp edge. If a broken edge feels sharp against your tongue, you may temporarily cover it with dental protective wax or sugar-free chewing gum until you are with us.
• Call the same day. The sooner you make an appointment, the greater the chance the tooth underneath stays intact.

What you should really avoid

• No superglue or other glue. It is toxic, damages the tooth stump and often makes neat refitting by the dentist impossible.
• Do not file or trim it yourself. Tampering with a sharp edge or with the crown itself causes more damage.
• Do not chew hard on the tooth to push the crown back. You can damage the tooth stump or the neighbouring tooth.
• Do not throw the crown away. Even a crown you no longer like is still valuable information for us and often reusable.

Is it an emergency and when should you call immediately?

Most people are startled and immediately think of an emergency, but a loose or broken crown usually is not. As a rule, you can wait for a regular appointment within a day or two, as long as you spare the tooth. Still, there are situations in which you should call right away.

Call our emergency dentist immediately or, outside opening hours, the on-duty emergency service in the following cases:

• Severe, throbbing pain that does not subside with a normal painkiller.
• A swollen cheek, gum or fever, which may indicate an infection.
• A sharp edge that cuts your tongue or cheek and keeps irritating it.
• A crown or bridge part you have swallowed and where you feel short of breath or have to cough.
• A front tooth where the cosmetic discomfort gets in your way, for example for work.

In doubt? Feel free to call 010 846 6539. Together on the phone we assess how quickly you need to be seen. For patients in Rotterdam West, for example in Delfshaven, there is usually room soon. If you are in the middle of a toothache situation, we of course act faster.

How the dentist refits or replaces

When you are in the chair at Tandarts West Rotterdam, it starts with looking and feeling. I check the crown or bridge itself, the tooth stump underneath and the gum. We often take a small X-ray to see whether there is decay or a fracture under the crown.

Refitting an existing crown

If the crown is intact and the tooth is healthy, I thoroughly clean both the inside of the crown and the tooth stump, remove the old cement and fit the crown again. Then I secure the crown with fresh dental cement and check that your bite feels right. This is a short, usually painless treatment.

Repair or replacement

If there is decay under the crown, the tooth stump is weakened or the crown is cracked, refitting is not a good solution. Sometimes a build-up or a root canal treatment is needed first before a new crown can be placed. Only when the foundation is healthy do we take an impression or scan for a new crown or bridge. Whatever is needed, you always hear beforehand what we do and why. Read more on our page about crowns and bridges.

Can the same crown go back or do you need a new one?

This is the question everyone asks, and the honest answer is: it depends on the crown and the tooth underneath. As a rule of thumb, we always first look at whether your own crown can be kept, because that is faster, cheaper and less demanding.

The same crown can usually go back if:

• the crown is in one piece and not cracked;
• the tooth stump underneath is healthy and strong enough;
• there is no decay or infection under the crown;
• the crown still fits your gum and bite well.

A new crown or bridge is needed if:

• the crown is broken, cracked or deformed;
• there is a new cavity under the edge;
• the tooth stump has broken off or is too affected;
• with a bridge, one of the supporting teeth is no longer reliable.

How to prevent it happening again

A crown or bridge lasts on average ten to fifteen years, sometimes longer. With a few habits you extend that lifespan and prevent ending up with a loose crown again.

• Brush and clean well around the edge. Decay develops exactly where crown and tooth meet. Use interdental brushes or floss daily.
• Come in for check-ups. At a periodic check-up we spot loosening and early decay, often before the crown truly comes off.
• Do you grind at night? Ask about a night guard. Overloading is a common reason crowns and bridges come loose.
• Be careful with hard food. Ice cubes, nuts and hard crusts are notorious.

Finally: being startled by a loose or broken crown is completely normal, but it is rarely a disaster. Keep the crown, stay away from the glue and call us. At Tandarts West Rotterdam we quickly get you back on track, preferably with the crown you already had.