What do I do if a temporary filling comes out?

Two things, in this order: call your dentist for a prompt appointment, and keep the area scrupulously clean until you are seen. The lost filling should be replaced as soon as possible. Out of hours, emergency dentistry is the route in; the number is 13 13 96.

A temporary filling coming out is not usually an emergency, but it is not something to leave for a few months either. The tooth underneath is in an unfinished state, and it is exposed.

Why a temporary filling was placed

There are several reasons your dentist may have placed one:

• To settle a painful tooth. A sedative temporary dressing over a deep cavity gives an inflamed pulp a chance to calm down before a decision is made about a permanent restoration.
• To seal a tooth part-way through root canal treatment. Between appointments the canal system must be sealed off from saliva and bacteria; the temporary filling is what does that. Root canal treatment: who and what is involved? explains the stages.
• As an interim filling until a crown, an onlay, or a CEREC porcelain restoration can be made and fitted — though same-day CEREC restorations remove that waiting stage entirely.
• After emergency treatment, where a definitive restoration was not possible at the time.

Which of these applies matters, because it changes how urgent the replacement is. A temporary over a tooth mid-root-canal is more time-critical than one placed simply to hold a shape for two weeks.

Temporary fillings are meant to fail eventually

Temporary materials are deliberately weaker than permanent ones. They are designed to be removed easily and cleanly at the next appointment, without damaging the tooth or having to be drilled out. Zinc oxide eugenol and glass ionomer temporary cements are soft by design.

The consequence is that it is not unusual for a temporary filling to fall out, particularly if it is on a chewing surface, if the cavity is large, or if it has been in place longer than intended. Losing one does not mean anything went wrong. Permanent materials are a different matter — how long do dental fillings last? gives the figures for those.

What to do while you wait for the appointment

Keep the area clean. Food caught in the space where the filling used to be results in the accumulation of harmful bacteria, which leads to further dental problems. That means:

• Brush thoroughly, including the cavity itself — gently, but do clean it. People instinctively avoid the area, which is exactly the wrong response. Which toothbrushes do dentists recommend?
• Floss carefully. Pull the floss out sideways rather than snapping it back up, in case an edge catches — and see is flossing really that important?
• Rinse after eating — warm salty water is fine and is soothing if the tooth is tender

Protect the tooth.

• Chew on the other side.
• Avoid anything hard, sticky or chewy on that tooth. A tooth prepared for a crown or part-way through root canal treatment has had substantial structure removed and the remaining walls are thin. A tooth that fractures below the gumline may not be restorable at all — which turns a filling appointment into an extraction, and then a conversation about replacing the tooth. This is the real risk of leaving it. Why does a cracked tooth hurt so much? and chipped and cracked teeth cover that failure.
• Avoid very hot and very cold food and drink if the tooth is sensitive.

Managing sensitivity. Some sensitivity to cold, air or sweet is common once the temporary is gone, because the exposed dentine is no longer covered — what to do if you suffer from sensitive teeth covers the mechanism. Over-the-counter pain relief taken according to the packet is reasonable in the short term. A pharmacy temporary filling material can be used as a stopgap for a day or two if you cannot get in immediately — it is not a substitute for the appointment, and you should tell your dentist you have used it.

Do not place aspirin against the gum — it causes a chemical burn of the soft tissue rather than relieving pain. How to relieve toothache sets out what actually helps.

When it is more urgent

Contact your dentist the same day, and describe the symptoms, if you have:

• Severe or throbbing pain, or pain that keeps you awake — see tooth pain and ache and I have a toothache, what could be the cause?
• Swelling of the face, gum or jaw
• A bad taste or discharge, which can indicate infection — what is a tooth abscess?
• Fever alongside dental pain — can a dental abscess affect your general health?
• A tooth that has visibly broken or cracked at the same time — will a cracked tooth be treated?
• A temporary filling lost from a tooth part-way through root canal treatment — the seal is what is keeping bacteria out of the canal system, and losing it can mean the canals need to be re-cleaned. Everything you need to know about root canal treatment explains why that seal matters so much

Facial swelling that is spreading, or any difficulty breathing or swallowing, is a medical emergency — present to a hospital emergency department, not a dental appointment. Why are dental abscesses so painful? describes how quickly that can develop.

What happens if it is left

The common assumption is that a tooth with a hole in it will simply sit there. In practice, leaving an unsealed temporary cavity for months tends to produce one of these:

None of these is dramatic in the first week. All of them are a real risk over months.

What the research shows — specifically for root-treated teeth

A caveat before the figures, because it decides whether they apply to you. The published evidence below is about teeth that have had root canal treatment. It does not describe an ordinary temporary dressing placed over a shallow cavity for a fortnight, and it should not be read as though it did. But if your temporary is sealing a tooth that is part-way through, or has just finished, root canal treatment, this is the part worth reading.

The coronal restoration — the filling or crown that goes on the biting surface afterwards — is not cosmetic tidying-up. The review Success and failure of endodontic treatment: predictability, complications, challenges and maintenance, published on nature.com, lists its jobs as providing a coronal seal and preventing reinfection of the root canal space, restoring form, occlusal stability and interproximal contact points, restoring function, protecting residual tooth structure, ensuring the health of the periodontal tissues, and aesthetics. The same review reports that a systematic review comparing the coronal restoration against the quality of the root canal treatment itself concluded that coronal seal was as important as the quality of the endodontic treatment in terms of treatment success, and states that there is evidence of an increased failure rate of endodontic treatment with temporary restorations.

On timing, Tooth survival after endodontic treatment (Fransson, International Endodontic Journal, 2023) reports that root-filled teeth left with temporary restorations are at higher risk of microbial leakage and of unrestorable fractures. It cites one study in which the absence of a permanent restoration within 90 days of root canal treatment was the most significant factor associated with the tooth later being extracted, and another in which teeth receiving a crown more than four months after treatment were almost three times more likely to be extracted than teeth crowned within four months. The same review reports a meta-analysis in which teeth restored with a crown had 3.92 times the chance of survival of teeth that received no crown after root canal treatment.

The review's own conclusion is cautious, and so is this page: the results suggest a higher risk of extraction where the permanent restoration is delayed beyond about three months, but the review describes the evidence on the timing of the restoration as limited, and says further investigation is warranted.

Two things follow from it. A temporary filling lost from a root-treated tooth is a reason to ring today rather than next month. And the appointment to place the definitive restoration is not the skippable one — on this evidence it is a large part of what decides whether the root canal treatment holds. Everything you need to know about root canal treatment and how much does a dental crown cost in Melbourne? cover what that second appointment involves.

Common questions

How long was the temporary supposed to last?

There is no single number, and any page that gives you one is guessing. The intended life of a temporary filling is set by the reason it was placed, not by the material: a dressing to settle a tooth may be intended for a few weeks, a seal between root canal appointments for days, an interim filling awaiting a laboratory-made restoration for a fortnight or so.

What that means practically is that the useful question is not “how long do these last” but “what date should this be replaced by, and what happens if it comes out before then?” — asked at the appointment where it is placed, and written on your treatment plan. If it has already come out and you do not know the answer, say so when you ring; the practice has the note.

The one place the published evidence does give a timeframe is root-treated teeth, and it is set out in the section above: the absence of a permanent restoration within 90 days was the most significant factor associated with later extraction in one study, and teeth crowned more than four months after treatment were extracted at around three times the rate of those crowned within four months. Those are horizons for the definitive restoration, not a guarantee that a temporary will survive that long.

The tooth feels completely fine. Can I just leave it?

Not safely, and the absence of pain is a weaker signal here than almost anywhere else in dentistry.

If the tooth has been root treated, the nerve that would have told you something was wrong has been removed. The European Society of Endodontology defines a successful outcome as “the absence of symptoms and clinical signs of disease, such as mobility, sinus tract or probing defect, with no loss of function”, with an intact apical periodontal ligament space on a radiograph. Note what that list requires: clinical examination and an x-ray. Two of the three components of failure are invisible and painless from the outside, which is the whole reason review appointments exist.

If the tooth has not been root treated, the temporary was most likely placed over deep decay or a recently prepared surface. Decay progressing under an open cavity is painless until it reaches the pulp, and a thin wall cracking is painless until it breaks. In both cases the first symptom tends to arrive at the point where the cheap fix is no longer available.

So: fine is good news about today, not evidence about the tooth. Ring anyway.

Does a root-treated tooth always need a crown, or is that an upsell?

It is a fair question and the literature does not answer it with a flat yes — which is itself worth knowing, because it means the answer should be reasoned for your particular tooth rather than applied as a rule.

What the sources agree on is that cuspal coverage — a restoration that caps the biting cusps, which may be a crown or an onlay — matters where the tooth has lost its walls. The European Society of Endodontology position statement “recommend[s] that each case should be considered individually”, and states that “loss of proximal walls is a strong indication of the need for cuspal coverage.” The nature.com review reports that “studies have shown that cuspal coverage restorations significantly improved survival of the root-filled tooth”, and that “root-filled molars with a direct restoration demonstrated a significantly higher frequency of extraction over a period of ten years compared with those restored with an indirect restoration.”

Where the sources disagree is on how universal that is. The same body of literature contains a systematic review and meta-analysis evaluating direct composite resin against indirect restorations on endodontically treated teeth that demonstrated no differences in tooth survival — with the qualification, in the study that reported it, that crowns were always selected where cusp coverage was needed, so the comparison was between appropriately chosen treatments rather than between a good option and a bad one. That is the honest reading: the restoration should match how much tooth is left, and a tooth with intact walls and a small access cavity is not automatically a crown.

Two further points. If cuspal coverage is indicated, the guidance is that it “should be provided as soon as possible after completion of endodontic treatment, provided there are no signs and symptoms from the tooth” — so delay is the thing to avoid, not the crown. And an onlay is explicitly named as an appropriate option “where cuspal coverage is required”, which is less destructive of remaining tooth than a full crown. If a crown has been proposed, it is entirely reasonable to ask how much sound tooth structure remains, whether an onlay would do, and what the plan is if you defer. What types of dental crown are available?, second opinions and corrective dentistry.

I swallowed it. Should I be worried, and can I put it back?

Swallowing a small piece of temporary cement is not a cause for alarm in itself; it passes. If you inhaled rather than swallowed it, or you are coughing persistently afterwards, that is a medical matter and you should see a doctor, not a dentist.

Do not attempt to glue anything back in. Household adhesives are not intended for use in the mouth, they are difficult to remove from a prepared tooth surface, and they can make the eventual restoration harder to fit. If you have the piece and it is in one lump, bring it — occasionally it tells the clinician something about how it failed — but it will not be reused.

A pharmacy temporary filling material is the only reasonable stopgap, for a day or two at most, and only over a cavity you can see and clean. Pack it gently, bite together so it sits level, and tell the practice you have used it so the tooth is checked properly underneath rather than just refilled.

Will I be charged again to replace it?

That depends on why it came out and how the original course of treatment was quoted, and it is a question to put to the practice directly rather than assume either way. Practices differ, and so do the circumstances: a temporary lost in the first days of a multi-appointment course is a different conversation from one lost six months after you were due back.

What is reasonable to ask, and to ask before the appointment rather than at the desk afterwards: whether replacing the temporary attracts a fee, whether an emergency or after-hours attendance is charged differently, and whether the replacement changes the quoted cost of the definitive restoration still to come. Having the answer in writing is normal practice and worth requesting. Price guide and understanding your treatment set out how fees and treatment plans are presented here.

Related reading

• Why do I need a filling?
• Can you reverse tooth decay?
• Porcelain, amalgam or composite resin?
• Porcelain and composite fillings: the differences and costs
• Why do I bite my cheek after a filling?
• What does restorative dentistry mean?

Practical details

Specialist registration can be verified on the AHPRA register, or by calling 1300 419 495. Registered specialists at the practice are listed as such, alongside the full team.

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000 — getting here. Phone 13 13 96, contact us, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment.

Published 16 November 2018, by Dr Madeleine Hoopmann. General information only; it does not replace advice from your treating practitioner. The endodontic outcome figures quoted above are from the third-party publications named, not from us' own data.

Smile Solutions trades under ABN 28 193 514 103.