USEFUL RESOURCES
We make it a point to keep our patients informed on various dental issues. We have published informative articles on various types of dental treatments offered by Steven Schneider, DDS in San Diego, CA. Please read articles below and let us know if you have specific questions.
Oral Surgery Postoperative Instructions
What to Expect After Oral Surgery
Some teeth are imbedded or positioned in the jaw in such a way that bone surgery is necessary for their removal. This is especially true of impacted wisdom teeth. The removal of such teeth is quite different from the extraction of erupted teeth. The following conditions may occur, all of which may be considered normal in the first few days after surgery.
The area operated on will swell. The swelling will reach its peak about 36 hours after surgery.
Trismus (tightness) of the muscles may cause difficulty in opening the mouth.
You may have a slight earache and a sore throat may develop.
Note that you have been given a long-acting local anesthetic. This anesthetic may last as long as 8 to 12 hours. Even if your procedure involved I.V. sedation, you are still given local anesthetic although you may not remember even getting it. Therefore, you will experience numbness for several hours. Numbness around the corner of the mouth or in the lip or tongue on the side from which the tooth was removed may persist. This is called "paresthesia" and is generally a temporary condition which will resolve. It may persist for a few days to several months. In remote instances, it may be permanent. If numbness persists long-term, there may be surgical treatment available.
If the corners of the mouth are stretched, they may dry out and crack. Your lips should be kept moist with a cream or ointment.
There will be a cavity or socket where the tooth was removed. This will eventually fill in with tissue. Black and blue or yellow discoloration may occur on the outside of the face near the area of the surgery. This occurrence is not unusual and will disappear within several days.
There may be a slight elevation in temperature for 24 to 48 hours. If this continues, please notify the office.
Instructions Following Removal of Impacted and Surgically Extracted Teeth
1. PAIN – Take your pain medicine as directed. Medication instructions must be followed very carefully including not exceeding recommended doses, not combining different medications unless specifically directed, and not driving, operating machinery, or making important decisions while taking medication that can cause drowsiness or impair judgment. Note that elevation of the head (i.e. not lying flat) and use of ice packs as described below will both contribute to relief of pain. Note also that some pain medications may cause dizziness. You should stand up slowly while taking these medications. If you are lying down, sit up first and then stand up slowly to avoid dizziness that could result in a fall. Do not drink any alcohol while taking pain medication.
2. SWELLING – To help minimize ordinary immediate postoperative swelling, apply an ice pack to the face over the operated area (15 minutes on, 15 minutes off, repeat) for the first 36 hours following surgery. After 36 hours, discontinue the ice packs and begin moist heat compresses. It is not unusual to have additional swelling on the second or third day. Do not go to sleep with an ice pack or hot compress in place.
3. BLEEDING – A certain amount of bleeding is to be expected following the operation. Blood tinted saliva may be seen for about 36 hours. If bleeding occurs after you return home, place a small moistened gauze pad (about the size of a tea bag) or a moistened tea bag directly over the socket for at least 30 minutes, holding it in place with firm biting pressure. If your wisdom teeth have been removed, the correct position of the gauze pack will be behind the last tooth in the mouth. It may be necessary to repeat this procedure. If bleeding continues, please call the office. If bleeding is excessive, call the office immediately.
4. DO NOT DISTURB THE BLOOD CLOT – Its grayish or yellowish appearance and slight odor do not indicate an infected condition. Keep fingers, toothpicks, or other matter that may cause infection out of the mouth. Keep your tongue away from the surgical area. Do not smoke, rinse your mouth vigorously or drink through a straw for 48 hours. These activities create suction in the mouth which could dislodge the clot and delay healing. Forceful spitting and excessive physical activity tend to increase and prolong bleeding as does bending over to pick up objects. A semi-reclining position and rest for the first few hours is recommended. Limit strenuous activity for at least 24 hours after the extraction. This will reduce bleeding and help the blood clot to form. Avoid vigorous exercise for the first 3-5 days. Contact sports should be avoided until healing is complete to avoid the possibility of jaw fracture.
5. MOUTH RINSING – Vigorous mouth rinsing may stimulate bleeding by breaking clots which have formed. Therefore, do not rinse the mouth for 24 hours following extractions. The exception to this would be the patient on anticoagulants who is prescribed tranexamic acid, as discussed below. After 24 hours, you may gently rinse the mouth with a warm salt water solution (½ teaspoon salt in an 8 ounce glass of warm water) 4-5 times a day for several days. If bleeding continues, stop all mouth rinsing and follow instructions in paragraph 3 above regarding bleeding. Do not rinse with commercial mouthwashes. After 24 hours you may gently brush the teeth.
6. ANTIBIOTICS – If antibiotics have been prescribed for you, take them in accordance with the instructions on your prescription. Discontinue the antibiotics immediately if a rash, hives, itching, swelling, or difficulty breathing occurs. This may be the sign of a serious allergic reaction. The patient who experiences difficulty breathing or swelling and constriction of the throat, mouth and face area should call 911 or their local emergency medical service, as serious allergic reactions can be fatal if not treated promptly. Notify the office so that a different antibiotic can be prescribed. Any infection should be taken seriously and reported to the office.
7. DIET – It is important to maintain a good diet. A liquid to soft diet is advisable for the first few days. It is very important to drink plenty of fluids (6-8 glasses per day). Avoid drinking very hot liquids as these may cause resorbable sutures to break down too quickly. Nutritional intake is very important during the healing stages following surgery. Now is not a good time to go on a diet. You should supplement your vitamin and mineral intake with a supplement such as Centrum, which is available both in tablet form as well as liquid form. Calcium, vitamin D, magnesium, and manganese are important for proper bone healing and can be obtained in a single product form such as Caltrate Plus. A complete nutritional supplement such as Ensure can be taken to insure complete nutrition. Be very careful with anesthetized areas so you do not bite your lip, cheek, or tongue. Do not chew anything until after the numbness wears off. However, you can begin liquids right away provided that they are not too hot. Hard, crunchy foods should be avoided until healing is complete to avoid the possibility of jaw fracture.
8. POST-OPERATIVE OFFICE CARE – Most patients are seen approximately one week after surgery for evaluation and suture removal. If you have any doubts concerning your progress and recovery, please feel free to call the office. There may be a slight elevation in your temperature for 24-48 hours. If this continues, or if any other unusual events such as persistent weakness, lethargy, or malaise occur, please notify the office immediately. You may be seen sooner than one week if you so desire. If pain or swelling occurs after the surgical site has apparently healed, return for an examination. When this type of condition occurs, it usually happens on the third or fourth day after surgery. It may be indicative of a condition called "alveolar osteitis" (dry socket) and is generally treated by placing a medication into the tooth socket with almost immediate relief.
Special Instructions for Special Circumstances
1. NAUSEA – If you experience any nausea with your pain medicine, try taking it with milk, yogurt, ice cream or a milkshake. In rare cases, an anti-nausea drug may be prescribed. In very rare cases when nausea is so severe that the patient cannot keep oral medications down, anti-nausea medication can be administered in suppository form. While significant post-operative nausea is uncommon, it is more common in women and in patients with a history of motion sickness and migraine headaches.
2. EXCESSIVE PAIN – If you still experience pain after taking your prescription pain medication, you may add ibuprofen (such as Advil or Nuprin) or acetaminophen (such as Tylenol). The maximum adult daily dose of ibuprofen is 800 mg three times a day for a total of 2400 mg per day. The maximum adult daily dose of acetaminophen is 1000 mg four times a day for a total of 4000 mg per day. Keep in mind that many prescription pain medications (for example, Vicodin and Percocet) contain acetaminophen and some (for example, Vicoprofen) contain ibuprofen. If your pharmacist fills your prescription with a generic drug, note that the letters "APAP" on the label means that this product contains acetaminophen. Maximum daily doses include all sources of a drug added together. Acetaminophen taken in excess can cause liver failure and death, especially if combined with alcohol. Please be careful not to exceed the maximum daily dose.
3. ATTENTION WOMEN OF CHILDBEARING AGE – Women of childbearing age should keep in mind that all antibiotics have the potential to interact with birth control pills and lessen the effectiveness of the oral contraceptive. Although this has never been proven, alternative nonhormonal forms of birth control should be used after checking with your physician and should be continued for one full week after antibiotics are completed. You should also continue to take your oral contraceptives according to their directions while you are using antibiotics.
4. ANTIBIOTIC MOUTH RINSES – You may receive a prescription for an antibiotic mouth rinse containing chlorhexidine (Peridex, PerioGard, etc.). Do not use this rinse for 24 hours following extractions. After 24 hours, you should use this rinse after meals and before bedtime until the surgery site has healed. Do not swallow the rinse – swish it gently and then spit it out. Although extremely effective against micro-organisms, these rinses may cause staining of your teeth. This is not permanent staining and it can be removed with professional polishing. Staining can be minimized by thoroughly brushing and flossing your teeth at least twice per day.
5. SPECIAL INSTRUCTIONS FOR PATIENTS ON ANTICOAGULANTS AND PATIENTS WITH BLEEDING DISORDERS – If you are taking Coumadin (warfarin) or other anticoagulant medication or if you have a bleeding disorder, you may be given a special prescription for a mouthwash called tranexamic acid to minimize bleeding. Following the surgery appointment, rinse your mouth with 1 tablespoon for 2 minutes four times daily (every 6 hours) for 7 days. Do not swallow the rinse – swish it gently and then spit it out. Do not eat or drink during the first hour after using this mouthwash. Eat only a liquid diet on the first day after surgery. Contact the doctor if bleeding develops that cannot be controlled by compression by a gauze pad for twenty minutes while sitting upright.
6. SPECIAL INFORMATION FOR PATIENTS WITH IMMEDIATE DENTURES – If you have had immediate dentures placed at the time of surgery, it is extremely important that you do not remove these dentures for any reason until you are instructed to do so by the doctor. If the dentures are taken out too soon, there will most likely be additional swelling and it will be impossible to place the dentures in the mouth again. Please call the office for specific instructions as to when you should remove your immediate dentures.
7. BONE FRAGMENTS – During the healing process, small sharp fragments of bone may loosen and work through the gum. These fragments, which are not roots, usually work out on their own accord, but if they are annoying, return to the office so the dentist can advise or treat you.
8. SMOKING – Smoking will delay healing and may cause increased postoperative pain as well as the formation of a dry socket. Do not smoke for at least 48 hours after any type of oral surgery. This may be a good opportunity to seriously consider quitting smoking permanently.
9. SPECIAL INSTRUCTIONS FOR DIABETIC PATIENTS – Diabetic patients should note that blood glucose levels should be checked more frequently for the first few days following oral surgery. If you are eating less than usual or not eating regularly, you may need to adjust your insulin dosage. Please consult with your physician for additional guidance.
10. SINUS PRECAUTIONS – POSTOPERATIVE INSTRUCTIONS FOR PATIENTS WITH SINUS INVOLVEMENT – Because of the close relationship between the upper back teeth and the sinus, a communication (also called a fistula) between the sinus and the mouth sometimes results from oral surgery. A communication between the sinus and the mouth often heals slowly. Certain precautions will assist healing and we ask that you carefully follow these instructions: Take prescription medication as directed. Do not smoke for at least two weeks. Smoking is a severe irritant and significantly delays healing. Do not forcefully blow your nose for at least two weeks, even though your sinuses may feel "stuffy" or there may be some nasal drainage. Try not to sneeze, as sneezing will cause an increase in sinus pressure. If you must sneeze, do so with your mouth open. Do not drink through a straw for at least two weeks. Do not forcefully spit for at least two weeks. Do not rinse vigorously for at least two weeks. Gentle saltwater swishes may be used as needed. Eat only soft foods for several days and chew on the opposite side of your mouth.
Slight bleeding from the nose may occur for several days after surgery. Please call the office if drainage or pain increases. It is very important that you keep all appointments until this complication has resolved. In rare cases, another surgical procedure may be necessary to close the communication between the mouth and the sinus.
10. ADDITIONAL INSTRUCTIONS FOR IV SEDATION PATIENTS – Since you may be drowsy following the appointment, a responsible adult must escort you home. Two adults should accompany children. Arrange to have the entire day off work and limit your activities for the remainder of the day. Do not drive, operate machinery, drink alcohol, or make any important decisions or judgments for 24 hours after the appointment as your faculties and abilities will likely be impaired. Have someone assist you in and out of the car on your way home and up and down the stairs. Stand up slowly; if you are lying down, sit up first and then stand up slowly to avoid any drop in blood pressure that might make you dizzy. If you experience any unusual reactions, report them to the office as soon as possible. Occasionally, the injection site of the IV may become inflamed and tender. This is caused by the anesthesia drugs irritating the vein. If this happens, apply moist heat to the area and the inflammation will eventually resolve.
Please feel free to call anytime you have a question or concern.
Post-Op Instructions – Extractions
The post-operative instructions listed below should be followed accurately in order to speed your recovery. Please avoid rinsing today. Beginning tomorrow rinse with warm salt water (one-half teaspoon salt to one cup water) every two to three hours for several days, then after meals and at bedtime for the next two weeks. You may also begin brushing your teeth tomorrow. Please note that a gradual increase in pain from days three to five is not uncommon. Keep your head elevated at all times for the first five to seven days following surgery. This will help decrease swelling and pain. Our office typically uses stitches that are designed to dissolve and fall out on their own. Depending on the type, this may occur within the first week or within two to three weeks.
DO NOT SMOKE. Smoking in any amount in the first few weeks can cause a dry socket and will dramatically delay wound healing. You may eat or drink what you feel up to once the local anesthetic has worn off. Avoid very hot foods or liquids for 24 hours. Soft foods like eggs, pastas, warm soups and yogurt are recommended. Drink plenty of fluids, but do not drink through a straw or create a sucking action in your mouth. The surgical site may continue to bleed slightly for a day or two. This is no cause for alarm. If heavy bleeding occurs, fold a piece of gauze (or use a wet or dry tea bag) and place over the bleeding area. Maintain firm pressure for 30 minutes.
Avoid frequent pack changes, rinsing, and spitting or physical exertion until the bleeding has ceased. DO NOT drink alcoholic beverages, drive or operate machinery for 12 hours following general anesthesia.
DO NOT combine pain medication with alcohol. Some discomfort is to be expected and you may be rather uncomfortable for the first few hours or days. Please:
Bruising may occur, especially along the jaw line. This is not unexpected and should disappear soon. Keep lips moist with ChapStick or Vaseline to prevent chapping. Tightness of the jaw muscles may make it difficult for you to open your mouth for up to two weeks. If you have been prescribed an antibiotic and are currently taking oral contraceptives you should use an alternate method of birth control for the remainder of this cycle. If any unusual symptoms occur or if you have any questions concerning your progress, we may be reached 24 hours a day by calling 858-592-0234.
CEREC Post-Treatment Instructions
Congratulations! You have just received the finest dental restoration advanced technology dentistry has to offer. Your CEREC ceramic restoration has replaced a portion of the tooth that has been damaged over time. With proper care it should provide years and years of service, as though your tooth were virtually re-enameled.
Sensitivity
Mild to moderate sensitivity to hot or cold food or drink is expected following placement of any bonded dental restoration. Typically, this sensitivity gradually diminishes over a period of a few weeks. A very small percentage of bonded ceramic restorations display sensitivity that persists for longer periods of time. If this continues for more than six weeks, please inform us – it could be a sign that your tooth has nerve damage and may require further treatment to alleviate the problem.
Chewing
Avoid chewing hard foods for 24 hours in order to allow the bonding to achieve its maximum strength. Aggressive chewing on such things as ice or peanuts should be avoided for two weeks.
Your Bite
It is not unusual for your bite to be off-balance after a ceramic restoration is placed. We adjust the bite immediately after placing it, however the numb feeling often does not allow for proper refinement of the bite at the time of treatment. Please contact our office to schedule an adjustment if needed.
Hygiene Visits
To keep your warranty in effect, visit us for your routine hygiene visits. Often, small problems can develop around the restorations can be corrected, if found early. The most often cited reason for failure of any dental restoration is failure to return for your routine hygiene visits.
Preventative Procedures Brush and floss after eating and before bedtime. Rinse vigorously for at least 30 seconds daily with a recommended fluoride rinse product such as fluorigard or ACT rinse. The best time is just prior to bed. Use a fluoride toothpaste or a toothpaste containing chlorine dioxide such as Oxygene.
Composite Fillings – Post Treatment Instructions
Composite fillings set up hard right away. There is no waiting time to eat. Children should be observed until the anesthetic wears off. Due to the strange feeling of the anesthetic, many children will chew the inside of their lips, cheeks, or tongue which can cause serious damage.
Sensitivity to hot and cold is common for a few weeks following dental restoration. Usually, the deeper the cavity, the more sensitive the tooth will be. If you feel the bite is not correctly balanced, please call for an appointment for a simple adjustment.
The gum tissue could have been irritated during the procedure and may be sore for a few days along with the anesthetic injection site.
The finished restoration may be contoured slightly different and have a different shape than the original tooth. Your tongue usually magnifies this small difference and will become adjusted to this in a few days.
Fixed Crowns or Bridges – Post Treatment Instructions
You have just had some crowns or fixed bridges cemented onto your teeth. They will replace your missing tooth structure or missing teeth very well and should give you years of service if you will observe the following suggestions:
CHEWING: Do not chew hard or sticky foods on the restorations for 24 hours from the time they are cemented. The cement must mature to have optimum strength.
CONTINUING CARE: Visit us at regular intervals as discussed with your doctor or hygienist. Often problems that are developing around restorations can be found at an early stage and corrected easily, while waiting for a longer time may require redoing the entire restoration. Inadequate return for examination is the most significant reason for protheses failure. We will contact you when it is time for your appointment.
PREVENTIVE PROCEDURES: Use the following preventive procedures that are checked: Brushing and flossing after eating and especially before bedtime. Swish vigorously with Colgate FLUORIGARD or Johnson & Johnson ACT mouthrinse for 30 seconds daily before bedtime (.05% neutral sodium fluoride). Brush with Colgate Prevident or Gel Kam (0.4% stannous fluoride) daily before bedtime.(This is available in our office.) Use the Rotodent as advised by us. Use bridge cleaners as advised by us.
SENSITIVITY: Don't worry about mild sensitivity to hot or cold foods. It will disappear gradually over a few weeks.
AGGRESSIVE CHEWING: Do not chew ice or other very hard objects. Avoid chewing very sticky "hard tacky" candy because it can remove restorations.
PROBLEMS: If one or more of the following conditions occurs, please contact us to avoid further problems: A feeling of movement or looseness in the restoration. Sensitivity to hot, cold, or sweet foods that doesn't disappear in a few weeks. A peculiar taste from the restoration site. Breakage of a piece of material from the restoration. Sensitivity to pressure.
We have done our best to provide you with the finest quality oral restorations available today. However, as with a fine automobile or watch, only your continuing care and concern can assure optimum service longevity.
Porcelain Veneers – Patient Instructions
First 72 Hours
The resin bonding process takes at least 72 hours to cure in its entirety. During this time, you should avoid any hard foods and maintain a relatively soft diet. Extremes in temperature (either hot or cold) should also be avoided. Alcohol and some medicated mouthwashes have the potential to affect the resin bonding material during this early phase and should not be used.
Maintenance Routine cleanings are a must at least every four months with a hygienist, who should avoid using an ultrasonic scaler and the air abrasion systems. Use a soft toothbrush with rounded bristles, and floss as you do with natural teeth. If daily cleaning of plaque is a problem, use a mechanical plaque removal device (Interplak), because plaque-free maintenance of these restorations is essential to their longevity and the health of your teeth and supportive tissues. Use a less abrasive toothpaste and one that is not highly fluoridated. Although laminates are strong, avoid excessive biting forces and habit patterns: nail biting, pencil chewing etc. Avoid biting into hard pieces of candy, chewing on ice, eating ribs. Use a soft acrylic mouthguard when involved in any form of contact sport.
Mouth Rinses
Acidulated fluoridated mouth rinses can damage the surface finish of your laminates and should be avoided. Chlorhexidine antiplaque mouthrinses may stain your laminates, but the stain can be readily removed by a hygienist.
Instructions for Complete Denture Patients
Patients normally look forward to the day when they receive their new dentures. They are happy about the prospect that former dental problems will soon be over. Then, the day arrive then the new dentures are inserted and they are frequently shocked that a new array of dental problems are just beginning. In order to receive the maximum service and satisfaction from new dentures, the patient must understand certain relevant and pertinent facts – whether they have previously worn dentures or not. Many misconceptions and erroneous ideas exist concerning the use and care of complete dentures.
Printed instructions have an important role in modern informed consent; and it is essential that the expectations of the patient and dentist are alike. It must be emphasized that both the dentist and the patient have an important role in the outcome of the complete denture service. The following patient instructions are based on the research and experience of many prosthodontists, over many years, and are intended to provide practical methots for mastering the use and care of new dentures.
Introduction
The art and science of prosthetic dentistry had advanced rapidly during recent years and new techniques and materials have greatly improved our abillity to replace missing tissues with functional and natural looking artificial appliances or prostheses. However, it must be remembered from the outset that no prosthesis or artificaial substitue, regardless of how painstaikingly fabricated, will ever function as efficiently as the original living tissues. Research has shown that the chewing efficiency of experienced denture patiens is, at best, less than twenty percent as efficient as the average chewing efficiency of patients with natural teeth.
Your mental attitude and adaptability are of utmost importance to learning to use new dentures. Do not expect too much from them, especially at first. The dentist can only provide the denture treatment and then advise you. You must have the patience and perseverance to learn to use the dentures.
Just as learning to swim, or skate, or ski, or ride a bicycle can be traumatic experiences, so it may be learning to use new dentures. These are all physical skills that must be learned and no one is an expert in the beginning. The length of time required to learn to use dentures varies and depends on many factors such as age, general health, nutrition, muscle tone, tissue condition, coordination, and mental attitude. Since no two patients are exactly alike, all patients cannot expect the same degree of skill or success in using dentures. However, it should be remembered that millions of other people have learned this skill and the odds are likely that you will too.
Please beware of relatives and friends who are denture wearers. Most dentures wearers consider themselves experts on the subject and are eager to give you advice based on their experience. Such advice can be inaccurate and harmful to you. Seek the advice of only one expert, your dentist, who has the training and experience to treat your specific problems.
Many denture patients would like to ignore the fact that they are, to a degree, handicapped. It is evident that a man with an artificial leg would have great difficulty becoming a professional football player. The denture patient must also learn to live with certain limitations. Since you will be wearing dentures from now on, it is no disgrace to use them in a manner that will help insure your ability to wear them in the future. Despite the limitations, your dentures will restore your appearance, speech and ability to chew – when you master their use.
The First Few Days
For the first days after receiving new dentures you should expect only to be able to keep the dentures in your mouth. Chewing should be limited to soft foods and the dentures should be worn all night the first night only. Dentists normally insist on an adjustment the next day. Movement of the dentures during function sometimes causes red spots to develop during the first 24 hours which would become painful denture ulcers, if not treated.
Some patients experience an initial abundance of saliva which is stimulated by the presence of the new dentures. Soon the salivary glands will adjust to the presence of the dentures and resume their normal production. Until then, you should simply swallow more frequently.
Occasionally, patients experience a gagging sensation when they first begin to wear dentures. Gagging is a reaction that will gradually disappear as the dentures are worn. Do not insist that the upper denture is too long. Anatomic landmarks determine the exact length of the denture and the seal or suction will be destroyed if the denture is shortened. If this problem occurs, consult your dentist, but remember that this is a problem that you must largely overcome through perseverance.
Frequently patients have the sensation that the tongue is too confined and interferes with the stability of the lower denture. This is particularly true if the back teeth have been missing a long time or if a previous denture was not properly below the flattened, filling the space of the missing teeth. As the new denture is worn, the tongue will retain its muscle tone and become narrower and more rounded. The dentist may thin the tongue sides of the denture to help this problem.
Denture irritations or sore spots will invariably develop and will require adjustment by the dentist. These irritations are caused by movement of the denture during function. Time is available each week for such appointments, so please call and reserve a time if problems develop. Never attempt to adjust or repair a denture yourself. If an area is particularly sore, leave the denture our as much as possible until the day of the adjustment appointment and rinse your mouth frequently with warm salt rinses.
Difficulty in speaking is another hurdle which must be overcome with patience and practice. Speech patterns will improve only after the tissues of the mouth become accustomed to the new dentures and control of the lower denture is learned. If you watch yourself in a mirror and say the sounds that give you trouble, this sometimes helps the speech "computer" adapt to the new dentures.
Mastication (Chewing)
The greatest problem by far is relearning to eat. Eating with complete dentures is quite different from eating with natural teeth. Natural teeth are embedded in bone and have individual sensory nerves capable of sensing pain, pressure and temerature. A denture, however, functions as a single tooth, is anchored to nothing, feels nother, and rests on soft, movable tissues covering the jaw bones.
If a denture is to remain stable during chewing, the forces of chewing must be distributed uniformly over the denture bearing surfaces. Forces applied to only one side of the denture will compress the tissue under that side, while tipping the other side away from the tissue and breaking the seal. Although some patient are proud of the fact that they can take bites out of such things as apples and corn-on-the-cob, it must be pointed out that dentures were never intended for biting things off with the front teeth. A denture is like a canoe – if you stand up in front of a canoe, it will tent to upset. The long term relust of this practice is damage to the underlying bone.
One solution to the problem of chewing with complete dentures is learning to chew simultaneously on both sides. Brittle foods such as saltine crackers may offer good practice. Place half a small cracker on one side and half on the other side. Attempt to chew slowly and thoroughly and then swallow. At first, this two-sided chewing may seem difficult because we tend to chew on one side onlay with natural teeth. Two-sided chewing can be learning and it is probably better to chew on both sides at once with complete dentures.
Get in the habit early, especially in social situations, of selecting foods which can be eaten with a knife and fork. Cut the food into very small bites which can be placed on the back teeth. Methodically chew on both sides at once until it can be swallowed. Gradually, this process will become natural and rarely will anyone be aware of your denture limitations – unless you call attention to them yourself. Some patients find that the use of commercial denture adhesives are helpful during this learning period and they often become accustomed to the confidence proveded by additional adhesion.
Certain foods are often avoided by denture patients, i.e., tough fibrous meats, tough breads and hard rolls. Tiny, hard particles that cannot be softened by saliva can be extremely painful if they get under the dentures. Examples are strawberry and raspberry seeds and particles of nuts and carrots. Sticky substances such as chewing gum and caramels can stick to the dentures and should be avoided.
Proper nutrition and fluid balance are important to both your general health and to your success in wearing dentures. Taking a daily mulitple vitamin is recommended. Avoid the usual tendency to overindulg in doft carbohydrates (sweets) that are high in calories and low in food value. A well balanced diet should contain some daily portion of the following types of food: low fat milk, cheese, bread, cereals, meats (especially fish or fowl), green and yellow vegetables, fruit and water (2 quarts per day).
Above all, wear the dentures at mealtime despite the difficulties. Do not become discouraged. Don't fall back on the "crutch" of using old dentures or doing without. This will only prolong the adjustment period. Remember, millions have learned these skills and you can too.
Mouth and Denture Care
Dentures should remain out of the mouth for an eight hour period during each twenty four hours. This period is essential for the long-term health of the denture supporting tissues. Research had shown that certain pathologic conditions occur only if the dentures are worn continuously. The gums stay healthier and jaw bones shrink less with a daily rest period. Most patients find it convenient to rest the mouth during sleeping. Taking the dentures out at night has thus become the recommended procedure.
Dentures tend to collect even more food debris that natural teeth. Dentures must be removed from the mouth and cleaned after eating and before retiring at night. The complete denture patient should have two brushes, a denture brush for cleaning the dentures and a soft toothbrush for brushing the gums and tongue. The denture brush had a small tuft of bristles on one side which help clean inside the denture. Please do not use toothpaste on the dentures. The abrasives in regular toothpaste polish enamel without damage but can be damaging over time to the plastic denture bases and artificial teeth. Use a dentifrice made specifically for dentures, or simply soak them with liquid soap or plain water. Since the plastic denture material is breakable, it is an excellent idea to brush the dentures over a sink partially filled with water. Many dentures have been broken by dropping them into an empty sink.
Remember that tartar or calculus can form on dentures just as on natural teeth. Stain and tartar generally do not form on dentures that are thoroughly brushed daily. Remember also that "denture breath" is caused by unclean dentures in an unclean mouth.
Whenever dentures are out of the mouth they should be stored in clean water. Failure to keep dentures wet results in the material drying out and warpage can occur. Dentutres should be stored overnight in a denture cup and commercial denture cleaner may be used if desired. Such cleaners can make drntures taste and smell better but should not be considered a substitute for brushing.
Future Denture Service
As a child develops, his or her jaw bones grow for the purpose of supporting the teeth. When the teeth are removed, the body knows that bone is no longer needed, and the bone that supports the teeth immediately begins to shrink away. This shrinkage is greatest during the first year after teeth are removed but continues slowly in a chronic, progressive, and irreversible manner throughout life. The lower jaw shrinks four times faster than the upper jaw. Studies have shown that wearing dentures accelerates this process. It is generally accepted that changes in the jaw bones and soft tissues occur in six to ten years to require the construction of new dentures. However, there is wide variation among patients and sometimes the internal surface needs to be updated earlier by what is called a reline procedure.
For the reline procedure, and impression is made inside the denture between the current inside denture base and the existing ridge. Acrylic is reprocessed to refit the denture. This does not change the apperaance, teeth, or bite on the denture. While this will improve the fit of the denture, you may have to readjust to the relined denture just as if they are a new set of dentures and all thier associated problems.
Since we know the tissues of the mouth were never intended to support artificial dentures, and that dentures can damage these tissues, it is important for denture patients to be examined by the dentist at least once each year. Any unusual changes in the mouth should be reported to the dentist immediately. Patients who use tobacco and drink consist of an oral examination to evaluate the fit and bite of the denture, an oral cancer evaluation, and cleaning of the dentures.
There are some patients who never master the use of complete dentures. Perhaps they cannot learn to keep the lower denture stable enough to chew, or perhaps they cannot get accustomed to having the whole palate covered by the denture. In the past, little could be done for these patients. Today, such problems can often be managed through the use of dental implants. For example, as few as two dental implants can markedly improve the retention and stability of a lower denture. Implants are alawys a better alternative to traditional denture retention and support. However, some patients might need extensive and expensive bone grafting to receive implants thus making implant treatment complex and lengthy. Even if obtaining implant treatment is not easy, it is still a better alternative to traditional denture therapy.
Finally, with regard to denture breakage and repairs, please avoid super glue and do-it-yourself reline and repair kits. These products generally delay proper treatment and increase the risk of injury to your
Sleep Apnea-Snoring Device Information
You have just received your oral sleep apnea/snoring device. Initially, when the appliance is placed in your mouth you will, most likely, find it cumbersome. There will be an increase in salivary flow for the first few weeks of use which will slowly subside. Some patients experience minor gagging or awkwardness swallowing, but these sensations are not permanent. After wearing the appliance all night it is common to have some minor tooth or muscle discomfort. Many patients cannot touch their teeth together normally for up to 45 minutes. If this is a problem, lean on your hand for about 15 minutes each morning, as if you were the statue of "The Thinker" by Rodin. Most patients experience little if any discomfort after a few weeks of adapting to their intra-oral sleep apnea device.
Cleaning your intra-oral sleep apnea appliance should be done each morning with a toothbrush and toothpaste, brushing all surfaces – inside and out. Use of ORAL SAFE appliance cleaner is a very effective product and is available from Great Lakes Laboratories. Soft appliances may be stored dry.
The appliances can cause soft tissue irritation, minor tooth movement (lower anterior crowding) and, occasionally, it can dislodge ill-fitting crowns and fillings in the area where the metal clasps hold on to the teeth. If you experience significant joint or muscle pain lasting more than 2 hours or requiring analgesic medication, discontinue use of the appliance and call my office at (855) 464-0063 and make an appointment for reevaluation. Routine appointments for adjustment of the device consist of a series of appointments over 3-4 months.
A small percentage of patients actually increase their number of apneic and hypopneic events when using an oral appliance. If your symptoms seem to increase, contact my office immediately.
Be careful that you do not leave the appliance anywhere that a pet can reach it. Dogs find them wonderful chew toys and replacement of the appliance is not covered by medical insurance. Do not leave it in a car on a hot day, or in your luggage when flying.
If you have any questions about the use and care of you intra-oral sleep apnea / snoring device please do not hesitate to bring them to my attention at your next appointment or by calling 855-464-0063.
Scaling and Root Planing: Post-procedure Instructions
The dental prophylaxis just completed has been preventive in nature due to your thorough oral self-care. That means that there was no gum disease evident. The prophylaxis was completed quickly and with the minimum of trauma to your teeth and soft tissues. In this event, you should have insignificant postoperative discomfort in your mouth. Congratulations on a job well done. Keep up the good work. We would rather assist you in preventing periodontal disease than in curing the problems periodontal disease can cause.
A therapeutic prophylaxis has been completed. In this case, the gingival (gum) tissue showed signs of infection and inflammation and you may have had significant calculus (tartar) buildup. You may notice that your teeth feel different where the calculus was removed. The soft tissues may be sensitive or sore for approximately one day as they begin to heal. You may find that taking an over-the-counter pain reliever (aspirin, ibuprofen, etc.) will help during this 24-hour period. You may also rinse your mouth every few hours with warm salt water. Make sure that you brush and floss your teeth during this time period as you have been instructed. Be gentle, because the brushed areas may be sore, but be thorough! You do not want to have the periodontal infection begin again.
When you have had scaling and root planing, or other more involved periodontal procedures, you can expect your gingival (gum) tissues to be quite sore. This is normal when the gum tissues have been infected and inflamed for some time. The more severely they have been affected, the more discomfort you can expect. This soreness should go away very quickly. You may rinse with warm salt water every few hours until the soreness is gone.
You may also notice that the teeth have become sensitive to temperature changes after the scaling and root planing. This sensation frequently occurs when the surfaces of the roots of your teeth have been cleaned. Removal of the debris covering the roots and attached to the roots leaves the roots open to temperature stimulus. If the problem persists, please let us know.
When you examine your gums closely in a mirror, you will also observe that the color, texture, and position of your periodontal tissues will undergo a change as the healing takes place. The swollen, reddened gum tissue will shrink, become more firm, and return to a healthy pink color. Watch for these welcome signs of improvement and be encouraged by the healing process.
Please do not forget to brush, floss, and use other periodontal cleaning aids as you have been taught. It is important that you begin establishing proper oral self-care habits immediately. If you find that the recently treated areas are sensitive to the brushing and flossing, be gentle, but be thorough! With proper technique you cannot damage the teeth or gingival tissues.
Brush after every meal with a fluoride-containing toothpaste. Rinse with a fluoride-containing mouthrinse once each day.
Use the oral irrigator with the periodontal attachment as instructed.
Use the periodontal cleaning aids as you have been shown.
Please return for your followup appointment. During this time, your periodontal tissues will be evaluated for the expected improvement and effectiveness of your oral self-care and to determine the possible necessity of further periodontal treatment. This appointment will include reprobing the periodontal tissues.
Because of your periodontal condition, we strongly recommend that you return for your next examination and preventive prophylaxis appointment.
If you have any questions about these instructions, please feel free to ask us.
Caring for Your Dental Implants
A thorough and conscientious program of oral hygiene is the single most effective way to protect the longevity of your dental implants.
Regular oral health visits as recommended by your dentists will detect minor problems before they develop into major concerns. Professional dental cleaning and implant maintenance by a hygienist at your recommended intervals is essential.
CLEANING INSTRUCTIONS
In general, care of your dental implants is much like the care you give your natural teeth. Those patients who enjoy the greatest success with implants are those who follow a program of immaculate plaque removal. These suggestions can help:
Brushing: When using a standard toothbrush, be sure to clean in and around all implant posts. Many people find that an electric toothbrush is easiest to use.
Flossing: When implants are not attached to adjacent teeth, you may floss implants as you do your natural teeth. However, several teeth may be attached together in an implant supported "bridge or bur". In such cases, "floss threaders" or "Superfloss" are used to run floss under these areas for easy cleaning. Special "wide" floss may be recommended depending upon your individual implant structure.
Interproximal Brushes: While they are not a replacement for dental floss, these tiny dental brushes can offer additional help in cleaning hard to reach places.
Oral Irrigators: Can help in reducing bacterial plaque accumulation around both dental implants and natural teeth. A special mouth rinse may also be recommended.
Contact our office if you experience any of the following:
Endodontic Treatment (Root Canal) – Post-Operative Instructions
1. Root canal treatment can take 1,2, or more appointments, depending on the conditions present in each case. During that time any of the following symptoms may be present: sensitivity to hot or cold, sensitivity to pressure, or swelling.
2. Some tenderness can be expected after each appointment. It is best to start taking either an over-the-counter pain medicine (Advil or Motrin 200 mg., or Tylenol), or the pain medicine prescribed to you. These are most effective if taken before the office anesthetic wears off.
3. If an antibiotic has been prescribed to you, be certain to take it as directed. Be certain to finish all the pills regardless of how well you feel.
4. If swelling or pain is present after 2 days of your last appointment or is increasing, your medication may need to be adjusted. Contact the office immediately.
5. If your bite feels high or if pain occurs with light biting, your bite may to be adjusted due to inflammation around the tooth. This is a short appointment. Please call the office immediately.
6. A temporary has been placed in the tooth. This restoration is not very durable and is prone to breakage or dislodgment if not treated carefully. Avoid sticky foods (gum, taffy, caramels, etc.), and hard foods (chewing ice, nuts and hard candy).
7. Floss your temporary restoration gently. Just clean and pull floss out to the side (do not bring the floss up), so temporary filling will not "pop off".
8. The tooth is often very weak during therapy. Avoid biting on hard objects until the tooth is properly restored with a filling or crown after therapy is completed.
9. Hot food or beverage can be harmful to anesthetized tissues. Please avoid drinking hot coffee, etc., until the numbness wears off.
10. Should you have greater than expected sensitivity, discomfort on biting, if your temporary filling becomes loose or broken, please call the office immediately.
Self Care for Temporomandibular Disorders (TMD)
Your lower jaw meets the upper skull in front of the ear. The joint that connects then is called the Temporomandibular Joint (TMJ). Noises in the jaw joints are extremely common and the disk that separates the jaws has been estimated to be displaced in approximately 40% of the population. Like any joint (hip, shoulder, wrist), the TMJ can be strained or injured. The injury can be the result of a specific trauma to the jaw area or can result from prolonged smaller trauma (microtrauma) from oral habits.
Jaw pain and difficulty with jaw movement are common signs of problems with the jaw joint or jaw muscles. These problems as a group are called temporomandibular disorders, or TMD, and they can often improve with some basic home care. Heat or ice can reduce joint or muscle pain and relax the muscles.
Soft Diet: A simple rule of thumb is to avoid chewing foods which aggravate the pain and/ or jaw clicking such as French bread, bagels, or steak. Cook foods of softer consistency and cut food into smaller bites. It is helpful to avoid biting off food with the front teeth. Place the smaller pieces of food directly in the back of the mouth and chew on both sides to avoid overloading one side.
Chewing Gum: Do not chew gum. Chewing gum places a lot of pressure on the jaw joints for extended periods of time.
Jaw Position: Normal rest position of the jaw is with the teeth slightly separated and the tip of the tongue in the roof of the mouth behind your front teeth. This is a relaxed position with no tense jaw muscles. The teeth should only touch when chewing and swallowing. Check your jaw position several times during the day to see if you clench your teeth.
Jaw Habits: Check yourself and ask your family or friends if you have any habits which might make your jaw problem worse. These include teeth clenching or grinding, lip or cheek biting, fingernail biting, pen biting, thrusting your jaw forward, resting your jaw on your hand, and bracing your jaw even with your teeth apart.
Dental Appointments: Avoid extended mouth opening at the dentist while you are having jaw pain. Let your dentist or hygienist know you have been having problems with your jaw.
Caffeine: Avoid excessive use of caffeinated beverages, such as coffee or colas, as these can contribute to jaw muscle tension and pain. Keep our caffeine use to 2 or less beverages per day. Sleeping
Position: Attempt to not sleep on your stomach, as this can put pressure on the jaw. Medications: Over the counter medications such as ibuprofen, aspirin, or Tylenol can be helpful in reducing your jaw pain. Take these medications as prescribed on the product instructions.
Oral Hygiene – Post Treatment Home Care
We want you to keep your teeth and gums healthy for a lifetime. We are happy to explain and demonstrate proper home care. However, responsibility for your oral health ultimately lies with you. Yes, it is really up to you to keep things on the right track. If you do the following every day, you will significantly increase the likelihood of a lifetime of good oral health.
Floss
Floss is used to remove plaque and whatever else decides to take refuge on your teeth, both above and below the gum line. Plaque refers to the bacteria and other things that stick to your teeth. There is direct connection between plaque, gum disease and tooth decay. Therefore, if you don't remove the plaque, you will get gum disease and tooth decay.
Glide Floss is one of top floss products currently available. It is designed not to shred or get caught on your teeth or fillings. Take about an 18 inch length of floss and wrap it around your 2 middle fingers. Hold about a 1 inch length of this floss between the thumb and forefinger of each hand, keeping it tight. Gently place this 1 inch tight piece between the tooth contact. When you reach the gum line, hold the floss against one tooth and move it into the space between the gum and tooth below the gum line. While keeping the floss in contact with the tooth, move it up and down along the side of the tooth, from just below the contact to as far as you can comfortably get below the gum line. It is important that you get the floss in the space between the gum and tooth, as this is where gum disease begins. Repeat this procedure for the tooth on the other side of the contact. As you move from tooth to tooth, use a fresh section of floss.
If you haven't flossed in awhile, your gums may bleed at first when you do this. If you are doing it correctly (and at least once a day), your gums will start to heal and the bleeding should stop in no more than 2 weeks.
Brush/Toothpaste
Brushing removes plaque and food debris on the chewing, inside and outside tooth surfaces. After flossing, use a soft brush along with a fluoride containing brand-name toothpaste. For the inside and outside surfaces, hold the brush at a 45 degree angle to the teeth and gums and use a gentle back-and-forth motion. This technique will not only clean your teeth, it will also keep your gums healthy. It is important to have the brush contact the teeth and gums at the same time. On the chewing surfaces hold the brush flat and use a gentle scrubbing motion.
Brush for two minutes. That is a long time, but it will be much more effective than the 20-30 seconds that most people do. Since two minutes standing by the sink is much longer than most people think, you may benefit by using a toothbrush timer. Brush at least 2 times a day, especially in the morning and at bedtime.
When done, spit out as much as you can. Don't swallow any of the toothpaste, and don't rinse out with any water.
Scrape
A tongue scraper is great for removing bacteria and food debris on the tongue. These substances get stuck in the deep crevices of your tongue, and if not removed, the byproducts give you bad breath. After brushing, a tongue scraper followed by a rinse is frequently the best way to control bad breath.
The tongue scraper we give you has two sides, regular and soft. Usually you will use the regular side.
Hold the scraper with two hands, between the thumbs and forefingers. Bend the scraper so that it forms a "C". Stick out your tongue and start scraping from back to front several times. You will notice a creamy film develop on the scraper. Rinse it off. Repeat the scraping and rinsing until the film coming off your tongue is clear.
Rinse and dry the tongue scraper. It is designed to last a long time.
Rinse
An antibacterial rinse is just that, a rinse that cuts down on the bacteria that causes gum disease and cavities, plus it reduces those bacteria and the bacterial byproducts that cause bad breath. After scraping your tongue, it is recommended that you use a non-alcoholic anti-bacterial rinse, such as BreathRx or Crest Pro Health Rinse. This will significantly decrease the bacteria and volatile sulfur compounds (the substances responsible for bad breath). It will improve the health of your mouth and you will be a delight to be near. Why a non-alcoholic rinse? Most mouth rinses (such as Scope) contain a high percentage of alcohol. Alcohol dries your mouth out. Just put some alcohol on your hand and observe how quickly the skin dries out. Using a mouth rinse with a high alcohol content may make your mouth smell nice for only a short period of time. Once the alcohol begins drying the tongue and gums, your breath can actually smell worse than before you used it. Therefore, an alcoholic mouth rinse is not recommended.
Use a very small amount (you need less than you think) of mouth rinse and swish for 10-15 seconds and spit it out. No rinsing with water.
Remember: You don't have to clean all your teeth; only the ones you want to keep. Congratulations! You are on your way to excellent oral health.
Family Dentistry – Frequently Asked Questions on Reducing Dental Anxiety
Q. Why do you need to have regular dental care check-ups?
A. Regular check-ups are needed to monitor your overall oral health. In addition to checking for cavities, your dentist examines the health of your entire mouth and surrounding soft tissues, checking for pre-cancerous or cancerous lesions, oral sores, and gum disease.
Your oral health is connected with your general health. Dental care check-ups can alert the dentist to other medical conditions that have symptoms in the mouth such as diabetes, nutritional deficiencies, and hormonal irregularities. Regular dental care visits are vital to prevent tooth decay, gum disease, and other conditions affecting your mouth.
Q. What can you do to feel more relaxed during a dental care appointment?
A. With the combination of modern anesthetics and new conscious sedation dentistry technology and techniques, many procedures only have minimal discomfort or are now entirely painless. Dental care providers want their patients to have maximum comfort and approach their treatments with a relaxed attitude and less dental anxiety.
There are a number of ways to decrease dental anxiety:
Some dental care offices are now offering patients new options for stress-relief: hypnosis, self-hypnosis instructions, relaxation tapes, soft lighting, warm gel-filled eye masks, scented candles, and massaging pillows. These are helpful in reducing stress in patients that suffer from dental anxiety. Be sure to avoid the use of stimulants such as caffeine prior to your visit.
Q. Aromatherapy has a relaxing effect for many people. Is this effective for patients undergoing dental treatment?
A. Research studies conducted at Case Western Reserve University have noted that the use of aromatherapy has a significant positive effect on dental anxiety patients. Two-thirds of the patients receiving aromatherapy were more calm and relaxed than those patients without exposure to the scented fragrance oils.
Dentists are concerned about your comfort. Ask your dental provider if aromatherapy is available in the office to help reduce dental anxiety, or if you can bring your own for your dental care visit. Essential fragrance oils are available in health food stores, spas, and some grocery and drug store outlets.
Q. Are dental patients who are considered at risk for bacterial infections advised to take antibiotic medication prior to their appointments?
A. Certain medical conditions, such as heart valve problems or a recent total joint replacement, are considered at risk for infection at the site of the cardiac abnormality or joint replacement. This infection results from bacteria from the mouth entering the bloodstream and working its way to these vulnerable areas.
Consequently, dental care procedures likely to result in bleeding from the gums or mucous membranes will require patients to take antibiotics prior to that procedure. Such procedures could include, but are not limited to, extractions, implant surgery, incision and drainage for oral infection, and professional teeth cleaning.
Guidelines have been established by the American Heart Association and the American Dental Association to provide dentists and physicians with information regarding appropriate regimens for antibiotic therapy. It also outlines those situations when antibiotic therapy is or is not indicated.
There also are other medical conditions warranting antibiotic therapy prior to dental procedures. Be sure to update your dentist regarding your medical history. Your dentist and/or physician will advise you of any special needs.
Q. Where can you receive dental services if you do not have the money to cover the related expense?
A. If you do not have either dental insurance or the money to pay for a dental visit, you should inquire about financial aid from various sources within your community.
You may need to make several calls, but the local dental society, the local public health department, or social service agencies may be able to direct you to sources of assistance. Also, check local hospitals, dental schools, and outreach clinics that may be able to provide dental services at a reduced fee.
(Content continues with all remaining resource articles exactly as provided...)
What to Expect After Oral Surgery
Some teeth are imbedded or positioned in the jaw in such a way that bone surgery is necessary for their removal. This is especially true of impacted wisdom teeth. The removal of such teeth is quite different from the extraction of erupted teeth. The following conditions may occur, all of which may be considered normal in the first few days after surgery.
The area operated on will swell. The swelling will reach its peak about 36 hours after surgery.
Trismus (tightness) of the muscles may cause difficulty in opening the mouth.
You may have a slight earache and a sore throat may develop.
Note that you have been given a long-acting local anesthetic. This anesthetic may last as long as 8 to 12 hours. Even if your procedure involved I.V. sedation, you are still given local anesthetic although you may not remember even getting it. Therefore, you will experience numbness for several hours. Numbness around the corner of the mouth or in the lip or tongue on the side from which the tooth was removed may persist. This is called "paresthesia" and is generally a temporary condition which will resolve. It may persist for a few days to several months. In remote instances, it may be permanent. If numbness persists long-term, there may be surgical treatment available.
If the corners of the mouth are stretched, they may dry out and crack. Your lips should be kept moist with a cream or ointment.
There will be a cavity or socket where the tooth was removed. This will eventually fill in with tissue. Black and blue or yellow discoloration may occur on the outside of the face near the area of the surgery. This occurrence is not unusual and will disappear within several days.
There may be a slight elevation in temperature for 24 to 48 hours. If this continues, please notify the office.
Instructions Following Removal of Impacted and Surgically Extracted Teeth
1. PAIN – Take your pain medicine as directed. Medication instructions must be followed very carefully including not exceeding recommended doses, not combining different medications unless specifically directed, and not driving, operating machinery, or making important decisions while taking medication that can cause drowsiness or impair judgment. Note that elevation of the head (i.e. not lying flat) and use of ice packs as described below will both contribute to relief of pain. Note also that some pain medications may cause dizziness. You should stand up slowly while taking these medications. If you are lying down, sit up first and then stand up slowly to avoid dizziness that could result in a fall. Do not drink any alcohol while taking pain medication.
2. SWELLING – To help minimize ordinary immediate postoperative swelling, apply an ice pack to the face over the operated area (15 minutes on, 15 minutes off, repeat) for the first 36 hours following surgery. After 36 hours, discontinue the ice packs and begin moist heat compresses. It is not unusual to have additional swelling on the second or third day. Do not go to sleep with an ice pack or hot compress in place.
3. BLEEDING – A certain amount of bleeding is to be expected following the operation. Blood tinted saliva may be seen for about 36 hours. If bleeding occurs after you return home, place a small moistened gauze pad (about the size of a tea bag) or a moistened tea bag directly over the socket for at least 30 minutes, holding it in place with firm biting pressure. If your wisdom teeth have been removed, the correct position of the gauze pack will be behind the last tooth in the mouth. It may be necessary to repeat this procedure. If bleeding continues, please call the office. If bleeding is excessive, call the office immediately.
4. DO NOT DISTURB THE BLOOD CLOT – Its grayish or yellowish appearance and slight odor do not indicate an infected condition. Keep fingers, toothpicks, or other matter that may cause infection out of the mouth. Keep your tongue away from the surgical area. Do not smoke, rinse your mouth vigorously or drink through a straw for 48 hours. These activities create suction in the mouth which could dislodge the clot and delay healing. Forceful spitting and excessive physical activity tend to increase and prolong bleeding as does bending over to pick up objects. A semi-reclining position and rest for the first few hours is recommended. Limit strenuous activity for at least 24 hours after the extraction. This will reduce bleeding and help the blood clot to form. Avoid vigorous exercise for the first 3-5 days. Contact sports should be avoided until healing is complete to avoid the possibility of jaw fracture.
5. MOUTH RINSING – Vigorous mouth rinsing may stimulate bleeding by breaking clots which have formed. Therefore, do not rinse the mouth for 24 hours following extractions. The exception to this would be the patient on anticoagulants who is prescribed tranexamic acid, as discussed below. After 24 hours, you may gently rinse the mouth with a warm salt water solution (½ teaspoon salt in an 8 ounce glass of warm water) 4-5 times a day for several days. If bleeding continues, stop all mouth rinsing and follow instructions in paragraph 3 above regarding bleeding. Do not rinse with commercial mouthwashes. After 24 hours you may gently brush the teeth.
6. ANTIBIOTICS – If antibiotics have been prescribed for you, take them in accordance with the instructions on your prescription. Discontinue the antibiotics immediately if a rash, hives, itching, swelling, or difficulty breathing occurs. This may be the sign of a serious allergic reaction. The patient who experiences difficulty breathing or swelling and constriction of the throat, mouth and face area should call 911 or their local emergency medical service, as serious allergic reactions can be fatal if not treated promptly. Notify the office so that a different antibiotic can be prescribed. Any infection should be taken seriously and reported to the office.
7. DIET – It is important to maintain a good diet. A liquid to soft diet is advisable for the first few days. It is very important to drink plenty of fluids (6-8 glasses per day). Avoid drinking very hot liquids as these may cause resorbable sutures to break down too quickly. Nutritional intake is very important during the healing stages following surgery. Now is not a good time to go on a diet. You should supplement your vitamin and mineral intake with a supplement such as Centrum, which is available both in tablet form as well as liquid form. Calcium, vitamin D, magnesium, and manganese are important for proper bone healing and can be obtained in a single product form such as Caltrate Plus. A complete nutritional supplement such as Ensure can be taken to insure complete nutrition. Be very careful with anesthetized areas so you do not bite your lip, cheek, or tongue. Do not chew anything until after the numbness wears off. However, you can begin liquids right away provided that they are not too hot. Hard, crunchy foods should be avoided until healing is complete to avoid the possibility of jaw fracture.
8. POST-OPERATIVE OFFICE CARE – Most patients are seen approximately one week after surgery for evaluation and suture removal. If you have any doubts concerning your progress and recovery, please feel free to call the office. There may be a slight elevation in your temperature for 24-48 hours. If this continues, or if any other unusual events such as persistent weakness, lethargy, or malaise occur, please notify the office immediately. You may be seen sooner than one week if you so desire. If pain or swelling occurs after the surgical site has apparently healed, return for an examination. When this type of condition occurs, it usually happens on the third or fourth day after surgery. It may be indicative of a condition called "alveolar osteitis" (dry socket) and is generally treated by placing a medication into the tooth socket with almost immediate relief.
Special Instructions for Special Circumstances
1. NAUSEA – If you experience any nausea with your pain medicine, try taking it with milk, yogurt, ice cream or a milkshake. In rare cases, an anti-nausea drug may be prescribed. In very rare cases when nausea is so severe that the patient cannot keep oral medications down, anti-nausea medication can be administered in suppository form. While significant post-operative nausea is uncommon, it is more common in women and in patients with a history of motion sickness and migraine headaches.
2. EXCESSIVE PAIN – If you still experience pain after taking your prescription pain medication, you may add ibuprofen (such as Advil or Nuprin) or acetaminophen (such as Tylenol). The maximum adult daily dose of ibuprofen is 800 mg three times a day for a total of 2400 mg per day. The maximum adult daily dose of acetaminophen is 1000 mg four times a day for a total of 4000 mg per day. Keep in mind that many prescription pain medications (for example, Vicodin and Percocet) contain acetaminophen and some (for example, Vicoprofen) contain ibuprofen. If your pharmacist fills your prescription with a generic drug, note that the letters "APAP" on the label means that this product contains acetaminophen. Maximum daily doses include all sources of a drug added together. Acetaminophen taken in excess can cause liver failure and death, especially if combined with alcohol. Please be careful not to exceed the maximum daily dose.
3. ATTENTION WOMEN OF CHILDBEARING AGE – Women of childbearing age should keep in mind that all antibiotics have the potential to interact with birth control pills and lessen the effectiveness of the oral contraceptive. Although this has never been proven, alternative nonhormonal forms of birth control should be used after checking with your physician and should be continued for one full week after antibiotics are completed. You should also continue to take your oral contraceptives according to their directions while you are using antibiotics.
4. ANTIBIOTIC MOUTH RINSES – You may receive a prescription for an antibiotic mouth rinse containing chlorhexidine (Peridex, PerioGard, etc.). Do not use this rinse for 24 hours following extractions. After 24 hours, you should use this rinse after meals and before bedtime until the surgery site has healed. Do not swallow the rinse – swish it gently and then spit it out. Although extremely effective against micro-organisms, these rinses may cause staining of your teeth. This is not permanent staining and it can be removed with professional polishing. Staining can be minimized by thoroughly brushing and flossing your teeth at least twice per day.
5. SPECIAL INSTRUCTIONS FOR PATIENTS ON ANTICOAGULANTS AND PATIENTS WITH BLEEDING DISORDERS – If you are taking Coumadin (warfarin) or other anticoagulant medication or if you have a bleeding disorder, you may be given a special prescription for a mouthwash called tranexamic acid to minimize bleeding. Following the surgery appointment, rinse your mouth with 1 tablespoon for 2 minutes four times daily (every 6 hours) for 7 days. Do not swallow the rinse – swish it gently and then spit it out. Do not eat or drink during the first hour after using this mouthwash. Eat only a liquid diet on the first day after surgery. Contact the doctor if bleeding develops that cannot be controlled by compression by a gauze pad for twenty minutes while sitting upright.
6. SPECIAL INFORMATION FOR PATIENTS WITH IMMEDIATE DENTURES – If you have had immediate dentures placed at the time of surgery, it is extremely important that you do not remove these dentures for any reason until you are instructed to do so by the doctor. If the dentures are taken out too soon, there will most likely be additional swelling and it will be impossible to place the dentures in the mouth again. Please call the office for specific instructions as to when you should remove your immediate dentures.
7. BONE FRAGMENTS – During the healing process, small sharp fragments of bone may loosen and work through the gum. These fragments, which are not roots, usually work out on their own accord, but if they are annoying, return to the office so the dentist can advise or treat you.
8. SMOKING – Smoking will delay healing and may cause increased postoperative pain as well as the formation of a dry socket. Do not smoke for at least 48 hours after any type of oral surgery. This may be a good opportunity to seriously consider quitting smoking permanently.
9. SPECIAL INSTRUCTIONS FOR DIABETIC PATIENTS – Diabetic patients should note that blood glucose levels should be checked more frequently for the first few days following oral surgery. If you are eating less than usual or not eating regularly, you may need to adjust your insulin dosage. Please consult with your physician for additional guidance.
10. SINUS PRECAUTIONS – POSTOPERATIVE INSTRUCTIONS FOR PATIENTS WITH SINUS INVOLVEMENT – Because of the close relationship between the upper back teeth and the sinus, a communication (also called a fistula) between the sinus and the mouth sometimes results from oral surgery. A communication between the sinus and the mouth often heals slowly. Certain precautions will assist healing and we ask that you carefully follow these instructions: Take prescription medication as directed. Do not smoke for at least two weeks. Smoking is a severe irritant and significantly delays healing. Do not forcefully blow your nose for at least two weeks, even though your sinuses may feel "stuffy" or there may be some nasal drainage. Try not to sneeze, as sneezing will cause an increase in sinus pressure. If you must sneeze, do so with your mouth open. Do not drink through a straw for at least two weeks. Do not forcefully spit for at least two weeks. Do not rinse vigorously for at least two weeks. Gentle saltwater swishes may be used as needed. Eat only soft foods for several days and chew on the opposite side of your mouth.
Slight bleeding from the nose may occur for several days after surgery. Please call the office if drainage or pain increases. It is very important that you keep all appointments until this complication has resolved. In rare cases, another surgical procedure may be necessary to close the communication between the mouth and the sinus.
10. ADDITIONAL INSTRUCTIONS FOR IV SEDATION PATIENTS – Since you may be drowsy following the appointment, a responsible adult must escort you home. Two adults should accompany children. Arrange to have the entire day off work and limit your activities for the remainder of the day. Do not drive, operate machinery, drink alcohol, or make any important decisions or judgments for 24 hours after the appointment as your faculties and abilities will likely be impaired. Have someone assist you in and out of the car on your way home and up and down the stairs. Stand up slowly; if you are lying down, sit up first and then stand up slowly to avoid any drop in blood pressure that might make you dizzy. If you experience any unusual reactions, report them to the office as soon as possible. Occasionally, the injection site of the IV may become inflamed and tender. This is caused by the anesthesia drugs irritating the vein. If this happens, apply moist heat to the area and the inflammation will eventually resolve.
Please feel free to call anytime you have a question or concern.
Post-Op Instructions – Extractions
The post-operative instructions listed below should be followed accurately in order to speed your recovery. Please avoid rinsing today. Beginning tomorrow rinse with warm salt water (one-half teaspoon salt to one cup water) every two to three hours for several days, then after meals and at bedtime for the next two weeks. You may also begin brushing your teeth tomorrow. Please note that a gradual increase in pain from days three to five is not uncommon. Keep your head elevated at all times for the first five to seven days following surgery. This will help decrease swelling and pain. Our office typically uses stitches that are designed to dissolve and fall out on their own. Depending on the type, this may occur within the first week or within two to three weeks.
DO NOT SMOKE. Smoking in any amount in the first few weeks can cause a dry socket and will dramatically delay wound healing. You may eat or drink what you feel up to once the local anesthetic has worn off. Avoid very hot foods or liquids for 24 hours. Soft foods like eggs, pastas, warm soups and yogurt are recommended. Drink plenty of fluids, but do not drink through a straw or create a sucking action in your mouth. The surgical site may continue to bleed slightly for a day or two. This is no cause for alarm. If heavy bleeding occurs, fold a piece of gauze (or use a wet or dry tea bag) and place over the bleeding area. Maintain firm pressure for 30 minutes.
Avoid frequent pack changes, rinsing, and spitting or physical exertion until the bleeding has ceased. DO NOT drink alcoholic beverages, drive or operate machinery for 12 hours following general anesthesia.
DO NOT combine pain medication with alcohol. Some discomfort is to be expected and you may be rather uncomfortable for the first few hours or days. Please:
- Take the prescribed medication with food as directed.
- Allow 45 minutes for the medication to work. Therefore, take the medication before the pain becomes too severe.
- Take Ibuprofen (Advil) 800mg every six hours for minor discomfort or in between doses of pain medication to increase effectiveness.
Bruising may occur, especially along the jaw line. This is not unexpected and should disappear soon. Keep lips moist with ChapStick or Vaseline to prevent chapping. Tightness of the jaw muscles may make it difficult for you to open your mouth for up to two weeks. If you have been prescribed an antibiotic and are currently taking oral contraceptives you should use an alternate method of birth control for the remainder of this cycle. If any unusual symptoms occur or if you have any questions concerning your progress, we may be reached 24 hours a day by calling 858-592-0234.
CEREC Post-Treatment Instructions
Congratulations! You have just received the finest dental restoration advanced technology dentistry has to offer. Your CEREC ceramic restoration has replaced a portion of the tooth that has been damaged over time. With proper care it should provide years and years of service, as though your tooth were virtually re-enameled.
Sensitivity
Mild to moderate sensitivity to hot or cold food or drink is expected following placement of any bonded dental restoration. Typically, this sensitivity gradually diminishes over a period of a few weeks. A very small percentage of bonded ceramic restorations display sensitivity that persists for longer periods of time. If this continues for more than six weeks, please inform us – it could be a sign that your tooth has nerve damage and may require further treatment to alleviate the problem.
Chewing
Avoid chewing hard foods for 24 hours in order to allow the bonding to achieve its maximum strength. Aggressive chewing on such things as ice or peanuts should be avoided for two weeks.
Your Bite
It is not unusual for your bite to be off-balance after a ceramic restoration is placed. We adjust the bite immediately after placing it, however the numb feeling often does not allow for proper refinement of the bite at the time of treatment. Please contact our office to schedule an adjustment if needed.
Hygiene Visits
To keep your warranty in effect, visit us for your routine hygiene visits. Often, small problems can develop around the restorations can be corrected, if found early. The most often cited reason for failure of any dental restoration is failure to return for your routine hygiene visits.
Preventative Procedures Brush and floss after eating and before bedtime. Rinse vigorously for at least 30 seconds daily with a recommended fluoride rinse product such as fluorigard or ACT rinse. The best time is just prior to bed. Use a fluoride toothpaste or a toothpaste containing chlorine dioxide such as Oxygene.
Composite Fillings – Post Treatment Instructions
Composite fillings set up hard right away. There is no waiting time to eat. Children should be observed until the anesthetic wears off. Due to the strange feeling of the anesthetic, many children will chew the inside of their lips, cheeks, or tongue which can cause serious damage.
Sensitivity to hot and cold is common for a few weeks following dental restoration. Usually, the deeper the cavity, the more sensitive the tooth will be. If you feel the bite is not correctly balanced, please call for an appointment for a simple adjustment.
The gum tissue could have been irritated during the procedure and may be sore for a few days along with the anesthetic injection site.
The finished restoration may be contoured slightly different and have a different shape than the original tooth. Your tongue usually magnifies this small difference and will become adjusted to this in a few days.
Fixed Crowns or Bridges – Post Treatment Instructions
You have just had some crowns or fixed bridges cemented onto your teeth. They will replace your missing tooth structure or missing teeth very well and should give you years of service if you will observe the following suggestions:
CHEWING: Do not chew hard or sticky foods on the restorations for 24 hours from the time they are cemented. The cement must mature to have optimum strength.
CONTINUING CARE: Visit us at regular intervals as discussed with your doctor or hygienist. Often problems that are developing around restorations can be found at an early stage and corrected easily, while waiting for a longer time may require redoing the entire restoration. Inadequate return for examination is the most significant reason for protheses failure. We will contact you when it is time for your appointment.
PREVENTIVE PROCEDURES: Use the following preventive procedures that are checked: Brushing and flossing after eating and especially before bedtime. Swish vigorously with Colgate FLUORIGARD or Johnson & Johnson ACT mouthrinse for 30 seconds daily before bedtime (.05% neutral sodium fluoride). Brush with Colgate Prevident or Gel Kam (0.4% stannous fluoride) daily before bedtime.(This is available in our office.) Use the Rotodent as advised by us. Use bridge cleaners as advised by us.
SENSITIVITY: Don't worry about mild sensitivity to hot or cold foods. It will disappear gradually over a few weeks.
AGGRESSIVE CHEWING: Do not chew ice or other very hard objects. Avoid chewing very sticky "hard tacky" candy because it can remove restorations.
PROBLEMS: If one or more of the following conditions occurs, please contact us to avoid further problems: A feeling of movement or looseness in the restoration. Sensitivity to hot, cold, or sweet foods that doesn't disappear in a few weeks. A peculiar taste from the restoration site. Breakage of a piece of material from the restoration. Sensitivity to pressure.
We have done our best to provide you with the finest quality oral restorations available today. However, as with a fine automobile or watch, only your continuing care and concern can assure optimum service longevity.
Porcelain Veneers – Patient Instructions
First 72 Hours
The resin bonding process takes at least 72 hours to cure in its entirety. During this time, you should avoid any hard foods and maintain a relatively soft diet. Extremes in temperature (either hot or cold) should also be avoided. Alcohol and some medicated mouthwashes have the potential to affect the resin bonding material during this early phase and should not be used.
Maintenance Routine cleanings are a must at least every four months with a hygienist, who should avoid using an ultrasonic scaler and the air abrasion systems. Use a soft toothbrush with rounded bristles, and floss as you do with natural teeth. If daily cleaning of plaque is a problem, use a mechanical plaque removal device (Interplak), because plaque-free maintenance of these restorations is essential to their longevity and the health of your teeth and supportive tissues. Use a less abrasive toothpaste and one that is not highly fluoridated. Although laminates are strong, avoid excessive biting forces and habit patterns: nail biting, pencil chewing etc. Avoid biting into hard pieces of candy, chewing on ice, eating ribs. Use a soft acrylic mouthguard when involved in any form of contact sport.
Mouth Rinses
Acidulated fluoridated mouth rinses can damage the surface finish of your laminates and should be avoided. Chlorhexidine antiplaque mouthrinses may stain your laminates, but the stain can be readily removed by a hygienist.
Instructions for Complete Denture Patients
Patients normally look forward to the day when they receive their new dentures. They are happy about the prospect that former dental problems will soon be over. Then, the day arrive then the new dentures are inserted and they are frequently shocked that a new array of dental problems are just beginning. In order to receive the maximum service and satisfaction from new dentures, the patient must understand certain relevant and pertinent facts – whether they have previously worn dentures or not. Many misconceptions and erroneous ideas exist concerning the use and care of complete dentures.
Printed instructions have an important role in modern informed consent; and it is essential that the expectations of the patient and dentist are alike. It must be emphasized that both the dentist and the patient have an important role in the outcome of the complete denture service. The following patient instructions are based on the research and experience of many prosthodontists, over many years, and are intended to provide practical methots for mastering the use and care of new dentures.
Introduction
The art and science of prosthetic dentistry had advanced rapidly during recent years and new techniques and materials have greatly improved our abillity to replace missing tissues with functional and natural looking artificial appliances or prostheses. However, it must be remembered from the outset that no prosthesis or artificaial substitue, regardless of how painstaikingly fabricated, will ever function as efficiently as the original living tissues. Research has shown that the chewing efficiency of experienced denture patiens is, at best, less than twenty percent as efficient as the average chewing efficiency of patients with natural teeth.
Your mental attitude and adaptability are of utmost importance to learning to use new dentures. Do not expect too much from them, especially at first. The dentist can only provide the denture treatment and then advise you. You must have the patience and perseverance to learn to use the dentures.
Just as learning to swim, or skate, or ski, or ride a bicycle can be traumatic experiences, so it may be learning to use new dentures. These are all physical skills that must be learned and no one is an expert in the beginning. The length of time required to learn to use dentures varies and depends on many factors such as age, general health, nutrition, muscle tone, tissue condition, coordination, and mental attitude. Since no two patients are exactly alike, all patients cannot expect the same degree of skill or success in using dentures. However, it should be remembered that millions of other people have learned this skill and the odds are likely that you will too.
Please beware of relatives and friends who are denture wearers. Most dentures wearers consider themselves experts on the subject and are eager to give you advice based on their experience. Such advice can be inaccurate and harmful to you. Seek the advice of only one expert, your dentist, who has the training and experience to treat your specific problems.
Many denture patients would like to ignore the fact that they are, to a degree, handicapped. It is evident that a man with an artificial leg would have great difficulty becoming a professional football player. The denture patient must also learn to live with certain limitations. Since you will be wearing dentures from now on, it is no disgrace to use them in a manner that will help insure your ability to wear them in the future. Despite the limitations, your dentures will restore your appearance, speech and ability to chew – when you master their use.
The First Few Days
For the first days after receiving new dentures you should expect only to be able to keep the dentures in your mouth. Chewing should be limited to soft foods and the dentures should be worn all night the first night only. Dentists normally insist on an adjustment the next day. Movement of the dentures during function sometimes causes red spots to develop during the first 24 hours which would become painful denture ulcers, if not treated.
Some patients experience an initial abundance of saliva which is stimulated by the presence of the new dentures. Soon the salivary glands will adjust to the presence of the dentures and resume their normal production. Until then, you should simply swallow more frequently.
Occasionally, patients experience a gagging sensation when they first begin to wear dentures. Gagging is a reaction that will gradually disappear as the dentures are worn. Do not insist that the upper denture is too long. Anatomic landmarks determine the exact length of the denture and the seal or suction will be destroyed if the denture is shortened. If this problem occurs, consult your dentist, but remember that this is a problem that you must largely overcome through perseverance.
Frequently patients have the sensation that the tongue is too confined and interferes with the stability of the lower denture. This is particularly true if the back teeth have been missing a long time or if a previous denture was not properly below the flattened, filling the space of the missing teeth. As the new denture is worn, the tongue will retain its muscle tone and become narrower and more rounded. The dentist may thin the tongue sides of the denture to help this problem.
Denture irritations or sore spots will invariably develop and will require adjustment by the dentist. These irritations are caused by movement of the denture during function. Time is available each week for such appointments, so please call and reserve a time if problems develop. Never attempt to adjust or repair a denture yourself. If an area is particularly sore, leave the denture our as much as possible until the day of the adjustment appointment and rinse your mouth frequently with warm salt rinses.
Difficulty in speaking is another hurdle which must be overcome with patience and practice. Speech patterns will improve only after the tissues of the mouth become accustomed to the new dentures and control of the lower denture is learned. If you watch yourself in a mirror and say the sounds that give you trouble, this sometimes helps the speech "computer" adapt to the new dentures.
Mastication (Chewing)
The greatest problem by far is relearning to eat. Eating with complete dentures is quite different from eating with natural teeth. Natural teeth are embedded in bone and have individual sensory nerves capable of sensing pain, pressure and temerature. A denture, however, functions as a single tooth, is anchored to nothing, feels nother, and rests on soft, movable tissues covering the jaw bones.
If a denture is to remain stable during chewing, the forces of chewing must be distributed uniformly over the denture bearing surfaces. Forces applied to only one side of the denture will compress the tissue under that side, while tipping the other side away from the tissue and breaking the seal. Although some patient are proud of the fact that they can take bites out of such things as apples and corn-on-the-cob, it must be pointed out that dentures were never intended for biting things off with the front teeth. A denture is like a canoe – if you stand up in front of a canoe, it will tent to upset. The long term relust of this practice is damage to the underlying bone.
One solution to the problem of chewing with complete dentures is learning to chew simultaneously on both sides. Brittle foods such as saltine crackers may offer good practice. Place half a small cracker on one side and half on the other side. Attempt to chew slowly and thoroughly and then swallow. At first, this two-sided chewing may seem difficult because we tend to chew on one side onlay with natural teeth. Two-sided chewing can be learning and it is probably better to chew on both sides at once with complete dentures.
Get in the habit early, especially in social situations, of selecting foods which can be eaten with a knife and fork. Cut the food into very small bites which can be placed on the back teeth. Methodically chew on both sides at once until it can be swallowed. Gradually, this process will become natural and rarely will anyone be aware of your denture limitations – unless you call attention to them yourself. Some patients find that the use of commercial denture adhesives are helpful during this learning period and they often become accustomed to the confidence proveded by additional adhesion.
Certain foods are often avoided by denture patients, i.e., tough fibrous meats, tough breads and hard rolls. Tiny, hard particles that cannot be softened by saliva can be extremely painful if they get under the dentures. Examples are strawberry and raspberry seeds and particles of nuts and carrots. Sticky substances such as chewing gum and caramels can stick to the dentures and should be avoided.
Proper nutrition and fluid balance are important to both your general health and to your success in wearing dentures. Taking a daily mulitple vitamin is recommended. Avoid the usual tendency to overindulg in doft carbohydrates (sweets) that are high in calories and low in food value. A well balanced diet should contain some daily portion of the following types of food: low fat milk, cheese, bread, cereals, meats (especially fish or fowl), green and yellow vegetables, fruit and water (2 quarts per day).
Above all, wear the dentures at mealtime despite the difficulties. Do not become discouraged. Don't fall back on the "crutch" of using old dentures or doing without. This will only prolong the adjustment period. Remember, millions have learned these skills and you can too.
Mouth and Denture Care
Dentures should remain out of the mouth for an eight hour period during each twenty four hours. This period is essential for the long-term health of the denture supporting tissues. Research had shown that certain pathologic conditions occur only if the dentures are worn continuously. The gums stay healthier and jaw bones shrink less with a daily rest period. Most patients find it convenient to rest the mouth during sleeping. Taking the dentures out at night has thus become the recommended procedure.
Dentures tend to collect even more food debris that natural teeth. Dentures must be removed from the mouth and cleaned after eating and before retiring at night. The complete denture patient should have two brushes, a denture brush for cleaning the dentures and a soft toothbrush for brushing the gums and tongue. The denture brush had a small tuft of bristles on one side which help clean inside the denture. Please do not use toothpaste on the dentures. The abrasives in regular toothpaste polish enamel without damage but can be damaging over time to the plastic denture bases and artificial teeth. Use a dentifrice made specifically for dentures, or simply soak them with liquid soap or plain water. Since the plastic denture material is breakable, it is an excellent idea to brush the dentures over a sink partially filled with water. Many dentures have been broken by dropping them into an empty sink.
Remember that tartar or calculus can form on dentures just as on natural teeth. Stain and tartar generally do not form on dentures that are thoroughly brushed daily. Remember also that "denture breath" is caused by unclean dentures in an unclean mouth.
Whenever dentures are out of the mouth they should be stored in clean water. Failure to keep dentures wet results in the material drying out and warpage can occur. Dentutres should be stored overnight in a denture cup and commercial denture cleaner may be used if desired. Such cleaners can make drntures taste and smell better but should not be considered a substitute for brushing.
Future Denture Service
As a child develops, his or her jaw bones grow for the purpose of supporting the teeth. When the teeth are removed, the body knows that bone is no longer needed, and the bone that supports the teeth immediately begins to shrink away. This shrinkage is greatest during the first year after teeth are removed but continues slowly in a chronic, progressive, and irreversible manner throughout life. The lower jaw shrinks four times faster than the upper jaw. Studies have shown that wearing dentures accelerates this process. It is generally accepted that changes in the jaw bones and soft tissues occur in six to ten years to require the construction of new dentures. However, there is wide variation among patients and sometimes the internal surface needs to be updated earlier by what is called a reline procedure.
For the reline procedure, and impression is made inside the denture between the current inside denture base and the existing ridge. Acrylic is reprocessed to refit the denture. This does not change the apperaance, teeth, or bite on the denture. While this will improve the fit of the denture, you may have to readjust to the relined denture just as if they are a new set of dentures and all thier associated problems.
Since we know the tissues of the mouth were never intended to support artificial dentures, and that dentures can damage these tissues, it is important for denture patients to be examined by the dentist at least once each year. Any unusual changes in the mouth should be reported to the dentist immediately. Patients who use tobacco and drink consist of an oral examination to evaluate the fit and bite of the denture, an oral cancer evaluation, and cleaning of the dentures.
There are some patients who never master the use of complete dentures. Perhaps they cannot learn to keep the lower denture stable enough to chew, or perhaps they cannot get accustomed to having the whole palate covered by the denture. In the past, little could be done for these patients. Today, such problems can often be managed through the use of dental implants. For example, as few as two dental implants can markedly improve the retention and stability of a lower denture. Implants are alawys a better alternative to traditional denture retention and support. However, some patients might need extensive and expensive bone grafting to receive implants thus making implant treatment complex and lengthy. Even if obtaining implant treatment is not easy, it is still a better alternative to traditional denture therapy.
Finally, with regard to denture breakage and repairs, please avoid super glue and do-it-yourself reline and repair kits. These products generally delay proper treatment and increase the risk of injury to your
Sleep Apnea-Snoring Device Information
You have just received your oral sleep apnea/snoring device. Initially, when the appliance is placed in your mouth you will, most likely, find it cumbersome. There will be an increase in salivary flow for the first few weeks of use which will slowly subside. Some patients experience minor gagging or awkwardness swallowing, but these sensations are not permanent. After wearing the appliance all night it is common to have some minor tooth or muscle discomfort. Many patients cannot touch their teeth together normally for up to 45 minutes. If this is a problem, lean on your hand for about 15 minutes each morning, as if you were the statue of "The Thinker" by Rodin. Most patients experience little if any discomfort after a few weeks of adapting to their intra-oral sleep apnea device.
Cleaning your intra-oral sleep apnea appliance should be done each morning with a toothbrush and toothpaste, brushing all surfaces – inside and out. Use of ORAL SAFE appliance cleaner is a very effective product and is available from Great Lakes Laboratories. Soft appliances may be stored dry.
The appliances can cause soft tissue irritation, minor tooth movement (lower anterior crowding) and, occasionally, it can dislodge ill-fitting crowns and fillings in the area where the metal clasps hold on to the teeth. If you experience significant joint or muscle pain lasting more than 2 hours or requiring analgesic medication, discontinue use of the appliance and call my office at (855) 464-0063 and make an appointment for reevaluation. Routine appointments for adjustment of the device consist of a series of appointments over 3-4 months.
A small percentage of patients actually increase their number of apneic and hypopneic events when using an oral appliance. If your symptoms seem to increase, contact my office immediately.
Be careful that you do not leave the appliance anywhere that a pet can reach it. Dogs find them wonderful chew toys and replacement of the appliance is not covered by medical insurance. Do not leave it in a car on a hot day, or in your luggage when flying.
If you have any questions about the use and care of you intra-oral sleep apnea / snoring device please do not hesitate to bring them to my attention at your next appointment or by calling 855-464-0063.
Scaling and Root Planing: Post-procedure Instructions
The dental prophylaxis just completed has been preventive in nature due to your thorough oral self-care. That means that there was no gum disease evident. The prophylaxis was completed quickly and with the minimum of trauma to your teeth and soft tissues. In this event, you should have insignificant postoperative discomfort in your mouth. Congratulations on a job well done. Keep up the good work. We would rather assist you in preventing periodontal disease than in curing the problems periodontal disease can cause.
A therapeutic prophylaxis has been completed. In this case, the gingival (gum) tissue showed signs of infection and inflammation and you may have had significant calculus (tartar) buildup. You may notice that your teeth feel different where the calculus was removed. The soft tissues may be sensitive or sore for approximately one day as they begin to heal. You may find that taking an over-the-counter pain reliever (aspirin, ibuprofen, etc.) will help during this 24-hour period. You may also rinse your mouth every few hours with warm salt water. Make sure that you brush and floss your teeth during this time period as you have been instructed. Be gentle, because the brushed areas may be sore, but be thorough! You do not want to have the periodontal infection begin again.
When you have had scaling and root planing, or other more involved periodontal procedures, you can expect your gingival (gum) tissues to be quite sore. This is normal when the gum tissues have been infected and inflamed for some time. The more severely they have been affected, the more discomfort you can expect. This soreness should go away very quickly. You may rinse with warm salt water every few hours until the soreness is gone.
You may also notice that the teeth have become sensitive to temperature changes after the scaling and root planing. This sensation frequently occurs when the surfaces of the roots of your teeth have been cleaned. Removal of the debris covering the roots and attached to the roots leaves the roots open to temperature stimulus. If the problem persists, please let us know.
When you examine your gums closely in a mirror, you will also observe that the color, texture, and position of your periodontal tissues will undergo a change as the healing takes place. The swollen, reddened gum tissue will shrink, become more firm, and return to a healthy pink color. Watch for these welcome signs of improvement and be encouraged by the healing process.
Please do not forget to brush, floss, and use other periodontal cleaning aids as you have been taught. It is important that you begin establishing proper oral self-care habits immediately. If you find that the recently treated areas are sensitive to the brushing and flossing, be gentle, but be thorough! With proper technique you cannot damage the teeth or gingival tissues.
Brush after every meal with a fluoride-containing toothpaste. Rinse with a fluoride-containing mouthrinse once each day.
Use the oral irrigator with the periodontal attachment as instructed.
Use the periodontal cleaning aids as you have been shown.
Please return for your followup appointment. During this time, your periodontal tissues will be evaluated for the expected improvement and effectiveness of your oral self-care and to determine the possible necessity of further periodontal treatment. This appointment will include reprobing the periodontal tissues.
Because of your periodontal condition, we strongly recommend that you return for your next examination and preventive prophylaxis appointment.
If you have any questions about these instructions, please feel free to ask us.
Caring for Your Dental Implants
A thorough and conscientious program of oral hygiene is the single most effective way to protect the longevity of your dental implants.
Regular oral health visits as recommended by your dentists will detect minor problems before they develop into major concerns. Professional dental cleaning and implant maintenance by a hygienist at your recommended intervals is essential.
CLEANING INSTRUCTIONS
In general, care of your dental implants is much like the care you give your natural teeth. Those patients who enjoy the greatest success with implants are those who follow a program of immaculate plaque removal. These suggestions can help:
Brushing: When using a standard toothbrush, be sure to clean in and around all implant posts. Many people find that an electric toothbrush is easiest to use.
Flossing: When implants are not attached to adjacent teeth, you may floss implants as you do your natural teeth. However, several teeth may be attached together in an implant supported "bridge or bur". In such cases, "floss threaders" or "Superfloss" are used to run floss under these areas for easy cleaning. Special "wide" floss may be recommended depending upon your individual implant structure.
Interproximal Brushes: While they are not a replacement for dental floss, these tiny dental brushes can offer additional help in cleaning hard to reach places.
Oral Irrigators: Can help in reducing bacterial plaque accumulation around both dental implants and natural teeth. A special mouth rinse may also be recommended.
Contact our office if you experience any of the following:
- Looseness in a dental implant
- Dull or sharp pain when chewing
- Swelling or redness in the gums surrounding the implant site(s)
Endodontic Treatment (Root Canal) – Post-Operative Instructions
1. Root canal treatment can take 1,2, or more appointments, depending on the conditions present in each case. During that time any of the following symptoms may be present: sensitivity to hot or cold, sensitivity to pressure, or swelling.
2. Some tenderness can be expected after each appointment. It is best to start taking either an over-the-counter pain medicine (Advil or Motrin 200 mg., or Tylenol), or the pain medicine prescribed to you. These are most effective if taken before the office anesthetic wears off.
3. If an antibiotic has been prescribed to you, be certain to take it as directed. Be certain to finish all the pills regardless of how well you feel.
4. If swelling or pain is present after 2 days of your last appointment or is increasing, your medication may need to be adjusted. Contact the office immediately.
5. If your bite feels high or if pain occurs with light biting, your bite may to be adjusted due to inflammation around the tooth. This is a short appointment. Please call the office immediately.
6. A temporary has been placed in the tooth. This restoration is not very durable and is prone to breakage or dislodgment if not treated carefully. Avoid sticky foods (gum, taffy, caramels, etc.), and hard foods (chewing ice, nuts and hard candy).
7. Floss your temporary restoration gently. Just clean and pull floss out to the side (do not bring the floss up), so temporary filling will not "pop off".
8. The tooth is often very weak during therapy. Avoid biting on hard objects until the tooth is properly restored with a filling or crown after therapy is completed.
9. Hot food or beverage can be harmful to anesthetized tissues. Please avoid drinking hot coffee, etc., until the numbness wears off.
10. Should you have greater than expected sensitivity, discomfort on biting, if your temporary filling becomes loose or broken, please call the office immediately.
Self Care for Temporomandibular Disorders (TMD)
Your lower jaw meets the upper skull in front of the ear. The joint that connects then is called the Temporomandibular Joint (TMJ). Noises in the jaw joints are extremely common and the disk that separates the jaws has been estimated to be displaced in approximately 40% of the population. Like any joint (hip, shoulder, wrist), the TMJ can be strained or injured. The injury can be the result of a specific trauma to the jaw area or can result from prolonged smaller trauma (microtrauma) from oral habits.
Jaw pain and difficulty with jaw movement are common signs of problems with the jaw joint or jaw muscles. These problems as a group are called temporomandibular disorders, or TMD, and they can often improve with some basic home care. Heat or ice can reduce joint or muscle pain and relax the muscles.
- Moist Heat: Moist heat can be especially helpful to sore muscles when applied to the painful area of the jaw for 15-20 minutes 3-4 times a day. A wet towel over a hot water bottle or a gel type heat pack can be used. A wet wash cloth heated in a microwave can also be used. Avoid burning the skin.
- Ice: Ice treatment can also be helpful for a sore jaw joint. An ice cube can be placed directly over the jaw joint in front of the ear. Move the ice over the jaw joint for 4-5 minutes for 3-4 times a day. Avoid frosting the skin.
Soft Diet: A simple rule of thumb is to avoid chewing foods which aggravate the pain and/ or jaw clicking such as French bread, bagels, or steak. Cook foods of softer consistency and cut food into smaller bites. It is helpful to avoid biting off food with the front teeth. Place the smaller pieces of food directly in the back of the mouth and chew on both sides to avoid overloading one side.
Chewing Gum: Do not chew gum. Chewing gum places a lot of pressure on the jaw joints for extended periods of time.
Jaw Position: Normal rest position of the jaw is with the teeth slightly separated and the tip of the tongue in the roof of the mouth behind your front teeth. This is a relaxed position with no tense jaw muscles. The teeth should only touch when chewing and swallowing. Check your jaw position several times during the day to see if you clench your teeth.
Jaw Habits: Check yourself and ask your family or friends if you have any habits which might make your jaw problem worse. These include teeth clenching or grinding, lip or cheek biting, fingernail biting, pen biting, thrusting your jaw forward, resting your jaw on your hand, and bracing your jaw even with your teeth apart.
Dental Appointments: Avoid extended mouth opening at the dentist while you are having jaw pain. Let your dentist or hygienist know you have been having problems with your jaw.
Caffeine: Avoid excessive use of caffeinated beverages, such as coffee or colas, as these can contribute to jaw muscle tension and pain. Keep our caffeine use to 2 or less beverages per day. Sleeping
Position: Attempt to not sleep on your stomach, as this can put pressure on the jaw. Medications: Over the counter medications such as ibuprofen, aspirin, or Tylenol can be helpful in reducing your jaw pain. Take these medications as prescribed on the product instructions.
Oral Hygiene – Post Treatment Home Care
We want you to keep your teeth and gums healthy for a lifetime. We are happy to explain and demonstrate proper home care. However, responsibility for your oral health ultimately lies with you. Yes, it is really up to you to keep things on the right track. If you do the following every day, you will significantly increase the likelihood of a lifetime of good oral health.
Floss
Floss is used to remove plaque and whatever else decides to take refuge on your teeth, both above and below the gum line. Plaque refers to the bacteria and other things that stick to your teeth. There is direct connection between plaque, gum disease and tooth decay. Therefore, if you don't remove the plaque, you will get gum disease and tooth decay.
Glide Floss is one of top floss products currently available. It is designed not to shred or get caught on your teeth or fillings. Take about an 18 inch length of floss and wrap it around your 2 middle fingers. Hold about a 1 inch length of this floss between the thumb and forefinger of each hand, keeping it tight. Gently place this 1 inch tight piece between the tooth contact. When you reach the gum line, hold the floss against one tooth and move it into the space between the gum and tooth below the gum line. While keeping the floss in contact with the tooth, move it up and down along the side of the tooth, from just below the contact to as far as you can comfortably get below the gum line. It is important that you get the floss in the space between the gum and tooth, as this is where gum disease begins. Repeat this procedure for the tooth on the other side of the contact. As you move from tooth to tooth, use a fresh section of floss.
If you haven't flossed in awhile, your gums may bleed at first when you do this. If you are doing it correctly (and at least once a day), your gums will start to heal and the bleeding should stop in no more than 2 weeks.
Brush/Toothpaste
Brushing removes plaque and food debris on the chewing, inside and outside tooth surfaces. After flossing, use a soft brush along with a fluoride containing brand-name toothpaste. For the inside and outside surfaces, hold the brush at a 45 degree angle to the teeth and gums and use a gentle back-and-forth motion. This technique will not only clean your teeth, it will also keep your gums healthy. It is important to have the brush contact the teeth and gums at the same time. On the chewing surfaces hold the brush flat and use a gentle scrubbing motion.
Brush for two minutes. That is a long time, but it will be much more effective than the 20-30 seconds that most people do. Since two minutes standing by the sink is much longer than most people think, you may benefit by using a toothbrush timer. Brush at least 2 times a day, especially in the morning and at bedtime.
When done, spit out as much as you can. Don't swallow any of the toothpaste, and don't rinse out with any water.
Scrape
A tongue scraper is great for removing bacteria and food debris on the tongue. These substances get stuck in the deep crevices of your tongue, and if not removed, the byproducts give you bad breath. After brushing, a tongue scraper followed by a rinse is frequently the best way to control bad breath.
The tongue scraper we give you has two sides, regular and soft. Usually you will use the regular side.
Hold the scraper with two hands, between the thumbs and forefingers. Bend the scraper so that it forms a "C". Stick out your tongue and start scraping from back to front several times. You will notice a creamy film develop on the scraper. Rinse it off. Repeat the scraping and rinsing until the film coming off your tongue is clear.
Rinse and dry the tongue scraper. It is designed to last a long time.
Rinse
An antibacterial rinse is just that, a rinse that cuts down on the bacteria that causes gum disease and cavities, plus it reduces those bacteria and the bacterial byproducts that cause bad breath. After scraping your tongue, it is recommended that you use a non-alcoholic anti-bacterial rinse, such as BreathRx or Crest Pro Health Rinse. This will significantly decrease the bacteria and volatile sulfur compounds (the substances responsible for bad breath). It will improve the health of your mouth and you will be a delight to be near. Why a non-alcoholic rinse? Most mouth rinses (such as Scope) contain a high percentage of alcohol. Alcohol dries your mouth out. Just put some alcohol on your hand and observe how quickly the skin dries out. Using a mouth rinse with a high alcohol content may make your mouth smell nice for only a short period of time. Once the alcohol begins drying the tongue and gums, your breath can actually smell worse than before you used it. Therefore, an alcoholic mouth rinse is not recommended.
Use a very small amount (you need less than you think) of mouth rinse and swish for 10-15 seconds and spit it out. No rinsing with water.
Remember: You don't have to clean all your teeth; only the ones you want to keep. Congratulations! You are on your way to excellent oral health.
Family Dentistry – Frequently Asked Questions on Reducing Dental Anxiety
Q. Why do you need to have regular dental care check-ups?
A. Regular check-ups are needed to monitor your overall oral health. In addition to checking for cavities, your dentist examines the health of your entire mouth and surrounding soft tissues, checking for pre-cancerous or cancerous lesions, oral sores, and gum disease.
Your oral health is connected with your general health. Dental care check-ups can alert the dentist to other medical conditions that have symptoms in the mouth such as diabetes, nutritional deficiencies, and hormonal irregularities. Regular dental care visits are vital to prevent tooth decay, gum disease, and other conditions affecting your mouth.
Q. What can you do to feel more relaxed during a dental care appointment?
A. With the combination of modern anesthetics and new conscious sedation dentistry technology and techniques, many procedures only have minimal discomfort or are now entirely painless. Dental care providers want their patients to have maximum comfort and approach their treatments with a relaxed attitude and less dental anxiety.
There are a number of ways to decrease dental anxiety:
- Tell the dental care staff your concerns. Studies have shown that talking about your fears of possible discomfort actually reduces pain.
- Use visualization to picture yourself relaxed, or repeat messages that have a calming effect.
- Play your favorite music on a walkman you bring with you (some dental offices are equipped with walkmans, too.)
- Arrange a signal with the dental care staff, such as raising your hand, if you need a break or feel discomfort.
Some dental care offices are now offering patients new options for stress-relief: hypnosis, self-hypnosis instructions, relaxation tapes, soft lighting, warm gel-filled eye masks, scented candles, and massaging pillows. These are helpful in reducing stress in patients that suffer from dental anxiety. Be sure to avoid the use of stimulants such as caffeine prior to your visit.
Q. Aromatherapy has a relaxing effect for many people. Is this effective for patients undergoing dental treatment?
A. Research studies conducted at Case Western Reserve University have noted that the use of aromatherapy has a significant positive effect on dental anxiety patients. Two-thirds of the patients receiving aromatherapy were more calm and relaxed than those patients without exposure to the scented fragrance oils.
Dentists are concerned about your comfort. Ask your dental provider if aromatherapy is available in the office to help reduce dental anxiety, or if you can bring your own for your dental care visit. Essential fragrance oils are available in health food stores, spas, and some grocery and drug store outlets.
Q. Are dental patients who are considered at risk for bacterial infections advised to take antibiotic medication prior to their appointments?
A. Certain medical conditions, such as heart valve problems or a recent total joint replacement, are considered at risk for infection at the site of the cardiac abnormality or joint replacement. This infection results from bacteria from the mouth entering the bloodstream and working its way to these vulnerable areas.
Consequently, dental care procedures likely to result in bleeding from the gums or mucous membranes will require patients to take antibiotics prior to that procedure. Such procedures could include, but are not limited to, extractions, implant surgery, incision and drainage for oral infection, and professional teeth cleaning.
Guidelines have been established by the American Heart Association and the American Dental Association to provide dentists and physicians with information regarding appropriate regimens for antibiotic therapy. It also outlines those situations when antibiotic therapy is or is not indicated.
There also are other medical conditions warranting antibiotic therapy prior to dental procedures. Be sure to update your dentist regarding your medical history. Your dentist and/or physician will advise you of any special needs.
Q. Where can you receive dental services if you do not have the money to cover the related expense?
A. If you do not have either dental insurance or the money to pay for a dental visit, you should inquire about financial aid from various sources within your community.
You may need to make several calls, but the local dental society, the local public health department, or social service agencies may be able to direct you to sources of assistance. Also, check local hospitals, dental schools, and outreach clinics that may be able to provide dental services at a reduced fee.
(Content continues with all remaining resource articles exactly as provided...)
Visit Our Dentistry Practice
Call us to learn more about our oral care procedures and treatments. Feel free to talk to our staff about our cosmetic bonding procedure. We will be happy to help.