The Temporary Crown Came Off on Friday Night

Quick answer: A temporary crown that comes off matters more than it looks. The prepared tooth underneath is sensitive, and — the important part — the neighbouring and opposing teeth start moving within days, which can mean the permanent crown no longer fits. Keep it, put it back if you can, and be seen as soon as possible.

The call

Motzei Shabbat, ten past eight. Yehudit, 51, from RBS Bet, had been prepared for a crown on the Thursday. Halfway through the Friday night meal her temporary came off in a piece of chicken.

She had spent the rest of Shabbat with a sensitive tooth and had avoided that whole side. She had kept the temporary in a tissue on the counter, which was exactly right.

What we found

Upper left first molar, prepared for a crown, with an exposed dentine surface all over. The gum around it was already slightly inflamed where it had lost its support.

She was uncomfortable but not in severe pain.

Three reasons a lost temporary is more than a nuisance:

Sensitivity. A prepared tooth with a living nerve has millions of open dentine tubules exposed straight to the mouth. Cold air, cold water and sweet things all reach the nerve directly.

Movement — the significant one. A temporary crown holds the space. Without it, the teeth on either side drift towards the gap and the opposing tooth drops down into it, sometimes within days. If the permanent crown was made from a scan taken before the movement, it may not seat. Then the tooth has to be reprepared and the crown remade, at cost and delay.

Gum contour. The temporary shapes the gum around the margin. Left uncovered, the gum grows over the edge of the preparation, bleeds when the crown is fitted, and makes an accurate cementation harder.

Why they come off is usually one of a few things: temporary cement is deliberately weak so the crown can be removed easily; sticky or chewy food pulls it; the preparation may be short and offer little retention; or the temporary was slightly high in the bite and was being knocked off with every chew.

Hers was the classic combination — chewy food and a slightly short preparation on a molar.

What we did

Saw her first thing Sunday. Cleaned the old cement from the inside of the temporary and from the tooth, checked the preparation was undamaged, and confirmed nothing had moved appreciably in 36 hours.

Recemented it, this time with a slightly firmer temporary cement, and adjusted the bite carefully, which is the step that most often prevents a repeat.

The permanent crown was fitted the following week and seated perfectly.

What to do if this happens to you

1. Keep the temporary. Rinse it and put it somewhere safe.
2. Try putting it back. Dry the tooth, seat the temporary by hand, and check it feels right when you bite. If it seats and stays, that is genuinely useful.
3. Use a pharmacy temporary cement kit if you have one, or a dab of toothpaste as a very short-term measure to hold it and reduce sensitivity.
4. Do not use superglue. It ruins the temporary, damages the tooth surface and can harm the nerve.
5. Avoid chewing on that side, and avoid anything sticky, chewy or very cold.
6. Phone as early as possible on the next working day. Days matter here.

Temporary crown come off over Shabbat? Message Ramat Beit Shemesh Urgent Dental Care on WhatsApp https://wa.me/972559858845 and we will see you Sunday. 055-985-8845 · Harav Kook 28/1, Beit Shemesh.

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