The Crown Came Off in a Toffee

Quick answer: A crown that comes off is not usually painful, but it is time-sensitive. The tooth underneath is unprotected and can shift within days, after which the crown no longer fits. Keep the crown, do not superglue it, and be seen within a day or two.

The call

Sunday evening in RBS Alef. Devorah, 58, had been eating a toffee from a mishloach manot basket that had been sitting in a cupboard since Purim, and felt something come away. She spat out a gold crown, entirely intact.

No pain. Her question on the phone was whether it could wait until her check-up in six weeks.

What we found

Upper right first molar, crowned about twelve years earlier and root treated before that. What remained was a prepared tooth stump with an old post and core, clean, with no decay visible and no tenderness.

The crown itself was undamaged, with a thin layer of old cement inside it.

Three things make this urgent despite the absence of pain.

Teeth move. Left uncovered, the neighbouring teeth drift towards the gap and the opposing tooth over-erupts into it. Within one to two weeks a crown that fitted perfectly may no longer seat. Then you are paying for a new crown instead of a recementation.

The exposed stump is vulnerable. The prepared surface is dentine, not enamel — softer, and it collects plaque quickly. Decay at the margin is what causes a large proportion of crown failures.

Sensitivity. In a tooth with a live nerve, an exposed prepared stump is exquisitely sensitive to cold and air. Hers was root treated, so she felt nothing, which is exactly why she was inclined to leave it.

Why crowns come off. Usually one of three reasons: the cement has simply failed after a decade or more; decay has developed under the margin, so the crown is being held by less tooth than before; or the preparation was short or over-tapered and never had much to grip. Sticky food is the trigger, not the cause.

That distinction determines the treatment. A crown that comes off with clean, sound tooth underneath can usually be recemented and will last years. A crown that comes off with decay underneath needs the decay treated and often a new crown.

What we did

Saw her the next morning. Cleaned the old cement out of the crown carefully — leaving it in place means the crown sits high and comes off again. Cleaned the tooth stump, checked all round the margin for decay, and confirmed the fit was still accurate.

Recemented it with a modern resin-modified glass ionomer, checked the bite in every direction, and removed excess cement from around the gum. Twenty minutes.

We also warned her about the actual cause: not the toffee, but twelve-year-old cement. Her other crowns are now checked yearly with a specific look at the margins.

What to do if this happens to you

1. Keep the crown. Rinse it, put it somewhere safe, and bring it. Losing it is the difference between recementing and remaking.
2. Do not use superglue. It is toxic to the pulp, sets in the wrong position, and often ruins the crown for reuse.
3. A pharmacy temporary cement kit is fine overnight, if the crown seats easily by hand.
4. Keep the stump clean and brush it gently.
5. Avoid chewing on it, and avoid anything sticky.
6. Be seen within a day or two, even without pain. This is a matter of days, not weeks.

Crown come off? Bring it to Ramat Beit Shemesh Urgent Dental Care within a day or two: 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh.

Based on real cases treated at the clinic. Names have been changed.