Lost crown or broken tooth?

Signs you need the ER first.

• Difficulty breathing or swallowing.
• Uncontrolled bleeding.
• Severe facial swelling, especially near the eye or extending down the neck.
• Trauma involving more than just teeth (jaw, head, or loss of consciousness).

Those situations are for the emergency department or 911, not for a dental office. Once the immediate risk is addressed, the follow-up dental work happens after.

For a lost crown.

A crown that comes off is rarely an emergency, but it is worth handling promptly so the underlying tooth is not left exposed for weeks.

1. Save the crown. Rinse it and put it somewhere you will not lose it. In most cases the same crown can be recemented.
2. Do not force it back on yourself. Trying to seat a crown at home can shift it into the wrong position and can damage the underlying tooth.
3. Call the office to schedule. Recementation is usually a short visit.
4. Chew on the other side until the crown is back in place. The underlying tooth is more fragile without the crown covering it.

See the Dental Crowns page for more on crown work.

For a broken tooth.

A broken tooth is a spectrum. A small chip that is not painful is different from a large fracture that hurts to breathe on.

1. If there is a broken piece, save it in a small container. Sometimes it can be bonded back.
2. Rinse gently with warm water.
3. If there is bleeding from the gum, apply light pressure with clean gauze.
4. Cold sensitivity is common. Chew on the other side.
5. Call the office. A visual exam decides whether the repair is a filling, a crown, or something else.

See the Restorative Dentistry page for more on repair options.

For a knocked-out permanent tooth.

The ADA guidance for a knocked-out permanent tooth is time-sensitive.

1. Pick the tooth up by the crown, not the root.
2. If it is dirty, rinse gently with water. Do not scrub.
3. If possible, place the tooth back in its socket and hold it in place with light finger pressure or by biting on clean gauze.
4. If it cannot be placed back, keep it in milk or in saliva (in the cheek or in a container). Do not use tap water for storage.
5. Call the dentist immediately. Time is the critical variable for saving the tooth.

This applies to permanent teeth. Do not attempt to reinsert a baby tooth; it can damage the developing permanent tooth beneath. Call the office or a pediatric dentist for guidance.

For swelling.

Facial swelling is the situation that most often needs to be seen promptly. Small, contained swelling around a specific tooth can usually be triaged by phone. Larger swelling, especially with warmth, redness, or fever, needs same-day attention.

Swelling that extends past the jawline, involves the eye area, or affects breathing or swallowing is an emergency department situation, not a dental office one.

Between now and being seen, cool compresses on the outside of the face can help. Warm compresses can make the situation worse and are not recommended without a dentist's guidance.

What to say when you call.

The front desk asks a small set of questions to triage:

• What happened, and when.
• Whether there is pain, and how severe (a scale of 1 to 10 helps).
• Whether there is swelling, and where.
• Whether you have taken anything for it, and whether it helped.
• Any medical conditions or medications that matter.

That short conversation decides whether you should come in that day, whether you need the emergency department, or whether the situation can safely wait for the next available appointment.