You bite down and feel something give — a crunch, a hard fragment, a crown rolling loose. It’s alarming, but most of the time the tooth can be saved if you handle the next few hours correctly. Here’s what to do first, from a prosthodontist who rebuilds damaged teeth every day.
Step 1: Stay Calm and Assess
Rinse your mouth gently with warm water. Look at what happened: Is it a small chip, a large fracture, a crown that came off whole, or a filling that fell out? Note your pain level — sharp pain when biting, lingering sensitivity to temperature, or no pain at all. This information helps the dental team triage you correctly when you call.
If there’s bleeding, apply gentle pressure with clean gauze. If a fragment broke off, save any pieces in a small container — sometimes they can be bonded back.
Step 2: Protect the Tooth
An exposed tooth is vulnerable. Until you’re seen:
- Don’t chew on that side. Every bite on a cracked tooth risks driving the fracture deeper — and a fracture that reaches below the gumline can turn a savable tooth into an extraction.
- Cover sharp edges. Dental wax (from any pharmacy) or even sugar-free chewing gum pressed over a jagged edge protects your tongue and cheek.
- Keep it clean. Brush gently around the area and rinse after meals; trapped food in an open cavity accelerates decay.
- Manage pain with over-the-counter pain relievers as directed. A cold compress helps if there’s swelling.
What NOT to do: don’t try to file the tooth yourself, don’t use superglue on anything going in your mouth, and don’t ignore it because “it doesn’t hurt.” Painless fractures still worsen.
If Your Crown Came Off
Crowns usually come off whole. Here’s the protocol:
- Retrieve the crown and keep it — don’t throw it away.
- Look at the tooth underneath. If the underlying tooth structure is intact, the crown can often simply be re-cemented.
- As a temporary measure, you can slip the crown back on with a dab of temporary dental cement from a pharmacy. It won’t hold like the real cement, but it protects the tooth for a day or two.
- Never use household glue or superglue — they’re toxic and make proper re-cementation harder.
Call promptly even if there’s no pain. An uncrowned tooth can shift, decay, or fracture further within days.
If Your Filling Fell Out
A lost filling leaves a hole that traps food and exposes sensitive inner tooth layers:
- Don’t try to pack the hole with cotton or tissue — fibers get stuck and irritate the area.
- Temporary filling material from a pharmacy can seal the opening for a short time.
- Avoid extreme temperatures and sugary foods on that side.
- See a dentist soon — an open cavity invites new decay quickly.
If the filling was large, the tooth may now need a crown or onlay rather than another filling. That’s a common and predictable upgrade, not a catastrophe.
How a Prosthodontist Repairs the Damage
Once you’re in the chair, the repair depends on what remains:
- Small chips: Often fixed with composite bonding in a single visit.
- Moderate fractures: A crown or onlay rebuilds the tooth’s shape and protects it from further cracking.
- Large fractures with nerve exposure: Root canal treatment followed by a crown saves the tooth.
- Fracture below the gumline: Sometimes crown lengthening (reshaping the gum) can expose enough tooth to restore it; in other cases, extraction with an implant replacement is the more predictable long-term answer.
This is where a prosthodontist’s training matters most: the decision isn’t just “can we patch it?” but “what restoration gives this tooth the best 10–20 year outlook?” Dr. Nikpour evaluates the fracture, your bite forces on that tooth, and the remaining tooth structure before recommending anything.
Frequently Asked Questions
Can a broken tooth heal on its own?
No. Unlike bone, tooth enamel and dentin can’t regenerate. Small fractures don’t remineralize away — they need professional repair before they spread.
How soon do I need to be seen?
Ideally within a day or two for fractures and lost crowns, sooner if you have significant pain or swelling. The longer a cracked tooth goes unprotected, the worse the fracture tends to get.
Will I lose the tooth?
Most broken teeth are savable, especially when treated promptly. Extraction becomes likely only when the fracture extends deep below the gumline or the remaining structure can’t support a restoration.
Can my old crown just be glued back on?
Often, yes — if the crown is intact and the tooth underneath is sound, re-cementing is a quick visit. If the tooth has decayed or fractured underneath, a new crown may be needed.
Why do crowns and fillings come off?
Common reasons: new decay under the restoration, a bite that’s too heavy on that tooth (often from grinding), cement breakdown over many years, or trauma. The underlying cause matters — it guides what comes next.
Does a broken tooth always need a root canal?
No. Only if the fracture reaches the nerve or the nerve is irreversibly inflamed. Many fractured teeth are restored with crowns alone.
Dr. Leila Nikpour is a prosthodontist in Roseville with more than 15 years of dentistry experience. For a broken tooth, lost crown, or lost filling, call Expert Dental Group at (916) 888-1646 or visit 5070 Foothills Blvd, Suite 2, Roseville, CA 95747 (Mon–Fri 9–6, Sat 9–1).