Lost a filling or crown while travelling

A crown coming off is startling and rarely painful. A filling dropping out is usually noticed as a sudden sharp edge or a rush of cold. Neither is an emergency in the way a spreading infection is — but both leave the tooth underneath exposed, and that is a clock.

If a crown has come off

Keep it. Rinse it, dry it, and put it somewhere safe — a small container, not a tissue that gets thrown away. If the crown is intact and the tooth underneath is sound, re-cementing it is a short, inexpensive appointment. Losing the crown turns that into a new one.

Do not glue it back. Not with superglue, not with anything from a pharmacy shelf that is not specifically dental temporary cement. Household adhesives are toxic, they fill the fitting surface irreversibly, and a crown glued on crooked either cannot be removed or has to be cut off. This is the single most common way a re-cementing appointment becomes a remake.

Temporary dental cement from a pharmacy is acceptable for a day or two if you are somewhere with no dentist. It is designed to be removed. Clean the crown first, use a small amount, seat it fully, and bite down to check it is not high.

Protect the tooth underneath. It has been prepared — reduced on all sides — so it is smaller, sensitive and vulnerable. Chew on the other side. Avoid very cold drinks.

Why crowns come off

Worth knowing, because it changes what happens next:

• Cement failure. The crown is fine, the tooth is fine, the cement gave out. Re-cemented, done.
• Decay underneath. The tooth has softened at the margin and the crown no longer has anything to grip. Needs the decay removed and usually a new crown.
• The core has fractured. The build-up inside the crown has broken. Needs rebuilding, sometimes root canal treatment first.
• The tooth broke. Sometimes the crown comes off with a piece of tooth still inside it. That is the one where the plan changes most.

Only an examination distinguishes them, and if the crown comes off cleanly with nothing inside it, you are probably in the first group — the good one.

If a filling has come out

Less can be done at home, and there is less to keep. The cavity left behind is open and will collect food and bacteria.

• Rinse with warm salt water after eating.
• Keep brushing it gently — a cavity left dirty deteriorates fastest.
• Sugar-free gum or temporary filling material from a pharmacy can cover a sharp edge for a day or two.
• Avoid very sweet, very cold and very hot things.
• Get it seen. A replacement filling is quick and inexpensive; the same tooth two weeks later with decay into the pulp is root canal treatment and a crown.

Why not just wait until you get home?

Because the arithmetic is bad. An exposed prepared tooth or an open cavity deteriorates quickly, especially on holiday when the diet and the routine both change. A re-cement or a replacement filling in Patong is a short appointment. The same problem three weeks later is often a different, larger treatment — the exact opposite of the saving people think they are making.

There is also the flight. An open cavity with air in it is the classic setup for pressure pain in the cabin — see flying after dental treatment.

What to bring

• The crown itself, if you have it.
• Any dental records or the name of the material, if you happen to have them.
• The date it came off and whether it hurt at the time — painless usually means cement failure, painful more often means something underneath.

We are open Monday to Saturday, 10:00 to 20:00. Bring the crown in a container, not in your pocket.