Lost or Fractured Restoration

A patient with a fractured restoration or a hole in his tooth may present complaining of tooth pain when eating.

Sometimes the patient presents with the restoration in hand or complaining of a "hole" in his tooth - - those situations are easy to recognize and treat.

Other times, the diagnosis is not as straightforward. You must be sure of your diagnosis, because fractured/lost restorations may be confused with other diagnoses, particularly dental caries, fractured tooth, and pulpitis (reversible and irreversible).

These patients typically complain of pain with sensitivity to hot, cold, sweets, and on biting.

Check to see if any part of an existing filling is missing. Feel carefully to determine if any section of the tooth is mobile.

As you examine the affected tooth, check for tooth-colored filling materials. These will appear more opaque if you transilluminate the tooth.

• If the patient's filling is lost, replace it with a zinc oxide and eugenol (IRM temporary) restoration.

• If the patient has a cracked restoration, do not leave any mobile pieces in the mouth.

• If the pieces which cannot be removed do not fill the tooth, place the patient on a soft diet and have him avoid the tooth.

• If there is partial or total loss of a filling, then mix and apply IRM restoration.

• If the filling is cracked with pieces intact, then remove the mobile pieces, mix and apply IRM restoration.

• If the pieces cannot be removed, then apply stomahesive, place the patient on a soft diet and have the patient avoid the tooth.

• If the pain is severe, give analgesics as need.

In all cases, you should refer the patient to a dental clinic as soon as possible.

From "Dental Emergencies" Volume 803673 DN
Naval School of Health Sciences, December, 1995

For additional information, read:

"Dental Emergencies" in the General Medical Officer Manual.

"Oral Diseases and Injuries" in the Hospital Corpsman 1 and C Manual.

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