Lost/Swallowed Crown(Emergency )

• Clinical Definition: Accidental removal of a tooth cap resulting in its loss or ingestion.

• Signs of an Emergency: Exposed sharp edges on the margin of a tooth; acute temperature sensitivity of a tooth to cold/hot temperatures; or symptoms of gastrointestinal distress after swallowing.

• Options for Recovery: Re-cementation (direct); provisional cap; replacement crown using modern ceramic materials available (CAD/CAM).

• Tactile (by Mouth) Changes: Sharp, rough edges from your tongue as opposed to a smooth tooth; a sensation similar to sandpaper on the teeth.

• Visual Presentation: Yellowish dentine core, exposed after a crown fell off; dark metal post visible in the mirror.

• Discomfort / Pain: Severe thermal hypersensitivity (hot/cold) and localized discomfort while chewing, immediately after a crown falls off.

• Signs of Serious Symptoms: Throbbing, unrelenting pain that is indicative of an acute pulpitis or nerve inflammation.

• Gastrointestinal Distress: Abdominal pain; inability to swallow food; soreness/throat irritation due to the metal or ceramic cap traveling into your stomach instead of being swallowed.

• Traumatic Injury to Soft Tissue: Lacerations on the inside of your cheek or your tongue, resulting from the sharp edges of the remaining tooth.

• Adhesive Failure: Caused by a breakdown in the base layer of a dental adhesive system from prolonged contact with enzymes present within saliva.

• Mechanical Trauma: Can occur when an individual bites into something hard while playing a sport and/or chewing hard foods.

• Secondary Decay: Occurs underneath the margin of a crown, allowing bacteria to develop and weaken the anchor tooth.

• Consumption Habits: High frequency of consuming sticky and strong foods like banana halva or unniyappam; these foods have an extreme tensile force against the cement used for crowning teeth.

• Anatomical Limitations: The amount of remaining tooth structure (clinical crown height); this determines how much mechanical retention is available.

• Para-Functional Habits: Bruxing (grinding teeth) provides excessive lateral forces against the bonding agent.

• Step 1: Rinse your mouth gently with warm saltwater and wash your hands to remove debris from the injury site.

• Step 2: Using a finger or a clean cotton swab, look for bleeding in the gum tissue while examining the area around your front teeth under good light conditions with a mirror.

• Step 3: Do not use toothpicks or sharp objects that could create micro-fractures on the fragile dentin when trying to probe into an exposed tooth stump.

• Clinical Evaluation: A visual and tactile evaluation by a dentist to determine if there are defects in the soft tissues as well as the marginal integrity of the tooth using a dental explorer.

• Radiographs (X-Rays): Periapical X-rays to exclude fractured roots, possible hidden decay, and/or periapical pathology.

• Thermal or Electrical Pulp Tests: To test if the nerve within the tooth is vital/healthy.

• Grade 1 (Superficial): An intact tooth crown falls clean from tooth structure damage. Simple recementation is acceptable.

• Grade 2 (Moderate): The crown has fallen off with some slight chipping of the build-up beneath. Core rebuild will be needed.

• Grade 3 (Severe): Fracture of subgingival tooth portion and/or significant loss of tooth structure that cannot support restorative options; extraction or post & core buildup may be necessary.

• Recementation: If the inner margin of the crown remains unaffected, then the crown can simply be cleaned and bonded back onto the tooth.

• Temporary Restoration: A protective acrylic cap is placed on top of the tooth until a long-term replacement is created.

• CAD/CAM Digital Crowns (Chair-side scan, mill crowns at the same time as scan): In one appointment, an optical chair-side scan is performed, and then a high-strength zirconium crown is milled using a computerized milling machine.

• Temporary Cementation/Coverage: Provisional fixes can cost anywhere from Rs. 500 to Rs. 1,500 as per your requirement.

• Permanent Ceramic/Zirconia Crown: The permanent crowns can be made of ceramic/zirconia, depending on the clinic tier and the material warranty in urban/semi-urban centers of Kerala. It will depend upon the type of material used. Cost is approximately between Rs. 5,000 to Rs. 15,000.

Most government health schemes and private dental insurance plans do pay for structural restorative treatments that are a result of an acute injury; however, all elective cosmetic replacement costs remain out of pocket (OOP).

• General Dentist: Ideal for routine recementation and temporary protective coverage.

• Prosthodontist: Specialized expert needed for complex full-mouth rehabilitations and precision crown design.

• Endodontist: If there is irreversible nerve damage due to exposure, then endodontic therapy would need to be done prior to recapping.

• Urgent (2 to 4 Hours): Necessary if you experience any of the following: sharp pain, bleeding, or the tooth is located in an aesthetic area and affects your ability to perform basic functions (such as chewing).

• Elective Window (24 to 48 Hours): Acceptable only if there is no pain or sensitivity, and opposing teeth have not shifted into vacant space.

1. What should I do if I swallow my crown by accident? 

Do not worry; most swallowed crowns are able to pass normally throughout your body's digestive system within a short period of time (usually less than 3 days) and you will be fine.

2. Is it okay to use household super glue to stick my crown back onto my tooth?

No. Household adhesives have harmful chemicals in them which will destroy the tooth structure for good and potentially kill all of the gum tissues attached to the tooth.

3. How many hours am I allowed to go without a crown on my tooth before I need to get evaluated professionally?

You should obtain an evaluation from a professional as soon as possible (within 48 hours) so you don't allow your other teeth to shift out of place and so bacteria cannot infect your exposed pulp core.

• Acutely Inflamed Pulpitis: Inflammation occurs in the core (pulp) of a tooth as the result of thermal and bacterial irritation to the newly exposed surface of the tooth's core.

• Hyperplastic Gingivae: The excess growth of gingiva (gum tissue) over the fractured area where the tooth was previously broken, resulting from chronic localized irritation at this site.

• Traumatic Occlusion: Pain associated with misaligned (over-erupted) opposing teeth, which are occluding on the gap created by the lost crown.

• Build-Up of Core: Building up the foundation of the tooth using composite resin prior to fabricating a new crown for placement onto it.

• Endodontic Root Canal Therapy: Cleaning and sealing infected root canal systems if the exposed tooth pulp has died.

• Custom Night Guards: Fabricating custom-fitted protective devices to prevent additional damage to the crown and potentially causing its dislodgment while grinding during sleep.

The loss or ingestion of a dental crown represents an immediate mechanical failure and removes the first line of biological defense against infection of a susceptible tooth. The sooner clinically effective interventions occur within the first 24 hours after the failure, the less likely that bacterial invasion will have occurred to induce pulp necrosis and further structural compromise. Those patients who live in areas with many opportunities to consume sticky foods should be particularly aware of their oral hygiene habits and schedule regular evaluations every six months to verify that their margins remain intact and that there is no indication of adhesive failure.