Post Treatment Instructions

This therapy is designed to clean your oral tissues of bacterial toxins and debris. This will start the process toward gum and tissue healing. Our goal is to make your gums and supporting structures a stable foundation to complete your dental treatment and maintain your teeth.

Upon dismissal from our office – you may notice slight ‘oozing’ from the gums. This will decrease rapidly. Some sensitivity to certain foods may be expected following your appointment(s) including:

• Extreme hot and cold
• Spicy foods
• Acidic foods (e.g. citrus)

Over the next few days and weeks, as your teeth and gums become healthier, the gum tissue will actually shrink. More tooth may be exposed. Increased sensitivity can occur with these teeth – which is transient in nature. The best way to decrease this sensitivity is to keep the area as clean as possible by brushing, flossing and rinsing; as directed with fluoride containing products.

How Do I Take Care During Therapy?

Every person is different. Thus, all post operative instructions are customized for you by our dental team. However, basic rules do apply:

• Mouthwash that is Alcohol Free or Prescription rinses to begin 24 – 48 hours after therapy.
• Salt Water rinses (1 tsp. salt and 1 cup warm water) 3 times per day – for 30 to 60 seconds.
• Peroxide water rinses to assist with impacted debris (1/2 cup hydrogen peroxide 3% and 1/2 cup warm water).

Pain Medication?

In a vast majority of cases pain medication is not necessary. Should medications for sensitivity be needed over the counter anti-inflammatory formulations work very well. These include:

• Advil (Ibuprofen)
• Aleve (Naprosyn Sodium)

An excellent method to reduce sensitivity post operatively is to take one of these medications one hour before your next appointment. Please remember, the success of your deep cleaning therapy is a team effort. Your commitment to proper care is essential for success!

Removable partial or full dentures require proper denture care to keep them clean, free from stains and looking their best. For good denture care here are some tips:

• • • Handle dentures with great care. To avoid accidentally dropping them, stand over a folded towel or a full sink of water when handling dentures.
    • Remove and rinse dentures after eating. Run water over your dentures to remove food debris and other loose particles.
    • Clean your mouth after removing your dentures. Use a soft-bristled toothbrush on natural teeth and gauze or a soft toothbrush to clean your tongue and palate.
    • Brush your dentures at least daily. Gently scrub your dentures using a denture cleaner, mild soap or dishwashing liquid and a denture brush to remove food, plaque and other deposits. Avoid stiff-bristled brushes, strong cleaners like bleach and toothpaste, as these are too abrasive and can damage your dentures.
    • Handle your dentures carefully. Be sure you don’t bend or damage the plastic or the clasps when cleaning. Don’t ever place dentures in hot water as they can warp.
    • Soak dentures overnight. Most types of dentures need to remain moist to keep their shape. Place the dentures in water or a mild denture-soaking solution overnight. Don’t soak dentures with metal attachments in solutions that contain chlorine because it can tarnish the metal. Check with your dentist about properly storing your dentures overnight.
    • Rinse dentures before putting them back in your mouth, especially if using a denture-soaking solution.
    • Schedule regular dental checkups. We will advise you about how often to visit to have your dentures examined and professionally cleaned. We can help ensure a proper fit to prevent slippage and discomfort. See us promptly if your dentures become loose. Loose dentures can cause irritation, sores and infection.

Your anesthesia will wear off in approximately 1 to 3 hours after the procedure. It is very important not to chew on the numb side (to prevent biting tongue, lip, etc.) until the anesthesia wears off.

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, especially to cold, hot, or pressure is common for a few days to a couple weeks following a dental restoration. Usually, the deeper the cavity, the more sensitive the tooth will be. As long as your teeth or gums are continuing to feel better, basically not staying the same or getting worse, everything is fine. There is no need for concern.

Sensitivity is usually most noticeable the first 12 to 24 hours after the anesthetic wears on.

The gum tissue could have been irritated during the procedure and may be sore for a few days together with the anesthetic injection site.

The finished restoration may be contoured slightly different and have a different texture than the original tooth. Your tongue usually magnifies this small difference, but you will become accustomed to this in a few days.

Once the anesthesia has worn off and you feel as though any of the teeth we have worked on are hitting first, please give the office a call immediately. This imbalance with your bite may cause further discomfort and should be adjusted.

Please contact our office with any questions or problems.

What Are Fluoride Trays?

Fluoride trays are custom fitted plastic trays made by your dentist to be filled with prescription fluoride gel to help control decay and strengthening teeth structures.

Why Use Fluoride Trays?

Because of your high need to prevent or control dental decay, or reduce tooth sensitivity, it is recommended that you use fluoride daily. Documented research found that the use of these trays and fluoride will prevent new decay almost totally and will slow down currently present decay. Additionally, it will desensitize sensitive tooth root surfaces. However, you must be consistent in carrying out the treatment daily.

Who Should Use Fluoride Trays?

• Head and neck radiation patients are at a lifelong risk for tooth decay due to the reduction in their saliva.
• Patients with decreased salivary flow from medication, sjogren’s syndrome, or other causes.
• Patients with teeth sensitivity.
• Patients at high risk for caries.

Fluoride Trays Instructions:

• One application should be made before bed each night.
• Brush and floss your teeth thoroughly to remove plaque completely.
• Load each tray with about five to six drops of fluoride gel, spacing the drops equally. This is a medication requiring a prescription from your dentist, if you run out of the material, call us for a refill.
• Dry the mouth by swallowing several times.
• Place the fluoride tray(s) into your mouth seating them completely.
• Expectorate (spit out) the excess fluoride.
• Leave the trays and fluoride in your mouth for 10 minutes and do not swallow.
• Remove the trays, wash the trays out with water, and place them upside down in a convenient place to let them drain out and dry before the next use. Return to provided storage container.
• Do not eat, drink, brush, or rinse for 1 hr after use.

For the best results, fluoride varnish and gel should remain on your teeth for approximately 4-6 hours for the maximum effect.

After treatment it is recommended that you:

• Do not eat or drink liquids for 1 hours after treatment.
• Only eat soft foods and drink cool liquids for 4 hours after treatment.
• Do not brush or floss for 4 hours.
• Brush and floss after the recommended time to remove the varnish if it is unsightly to you but does not pose any danger to your dental health.

• Biting pressure on the denture will promote clotting and will decrease the healing time. Slight bleeding can last up to 2-3 days.
• Use an ice compress on affected side for 20 minutes on and 20 minutes off for the first 36 hours.
• Limit your diet to soft nurturing foods and plenty of fluids for the first week.
• Don’t take the denture out for the first 48 hrs but rinse your mouth with warm salt water before going to bed (1 tsp salt in 1 cup warm water).
• Starting on the third day carefully remove the denture twice a day and clean the denture with a toothbrush or denture cleanser. Rinse your mouth with warm salt water.
• Sleep with the denture in for one week unless otherwise instructed. Then take the denture out when sleeping.
• Due to the gum tissue shrinkage and bone remodeling that occurs within the first 6 months, you may go through periods of loose fitting denture. A temporary liner will be added as needed and denture adhesives can be used during this period.
• A more permanent reline or remake of the denture will be required after 6 months to adapt to the new tissue surface.
• You may experience sore spots caused by the denture being too long or from uneven pressure being applied to the healing gum tissues. We will adjust the denture as these problems occur.

Prescription Rinse:

Chlorhexidine, Periogard, or Peridex

• These products are prescription medications. Please keep safely out of the reach of children!
• Swish with 1/2 ounces or 1 tablespoon for 30 seconds and expectorate. Avoid rinsing with water for 30 minutes thereafter. We recommend morning following breakfast and just before bedtime. If a fluoride rinse is recommended, please use the fluoride at a different time of day, i.e. not in conjunction with Chlorhexidine, PerioGard or Peridex.
• Remember: Chlorhexidine, PerioGard or Peridex can cause some increased staining of teeth. Thus, adequate brushing and flossing is important. Also, some slight alteration in taste may occur. Therefore we recommend patients only use these rinses for the first week of every month if they maintain longtime use.

Over-the-Counter or OTC Mouthwash:

• Fluoride containing mouth rinses like ACT, Listerine Total Care Zero, Biotene, Crest Pro-Health Fluoride, and Rembrandt with Fluoride.
• Fluoride containing mouth rinses are an excellent non-prescription cavity or caries fighting rinse.
• Care should be taken with children. Excessive amounts are not meant for swallowing!
• Swish vigorously with 1/2 – 1 capful for at least 1 minute. Remove excess mouthrinse and do not rinse your mouth or drink for about 30 minutes. We recommend you rinse in this fashion twice per day.
• Mouthwash or mouth rinses with alcohol can cause burning and soft tissue damage in the mouth. If negative symptoms or experiences result from such rinses discontinue use.

Rinses can generally be classified into two categories:

• Cosmetic rinses are commercial over-the-counter (OTC) products that help remove oral debris before or after brushing, temporarily suppress bad breath, diminish bacteria in the mouth and refresh the mouth with a pleasant taste.
• Therapeutic rinses have the benefits of their cosmetic counterparts, but also contain an added active ingredient that helps protect against some oral diseases. Therapeutic rinses are regulated by the FDA and are voluntarily approved by the American Dental Association (ADA). We only recommend therapeutic rinses with fluoride!

Homemade Mouth Rinse:

Swish vigorously with 1 tablespoon for at least 1 minute and expectorate. Repeat as needed.

1. Saline: 1/2 tsp. salt + 1 cup of water or for a stronger solutions, 1 tsp. salt + 1/2 cup of water. This is helpful as an antiseptic and removing debris improving wound healing.
2. Sodium bicarbonate: 1/2 tsp. baking soda + 1 cup water. This is a mild abrasive that helps reduce the number of microorganisms in the mouth.
3. Hydrogen Peroxide rinse: 1/2 cup hydrogen peroxide 3% + 1/2 cup water. Helps to remove debris and cleanse the mouth.

Good oral hygiene is vital to orthodontic success, and it will also help to ensure that your smile lasts a lifetime. Get used to:

• Brushing your teeth (not just the brackets) after every meal with an electric toothbrush e.g. Sonicare.
• Flossing daily as directed.
• Massaging your gums gently with your toothbrush to keep them healthy.
• Avoiding foods that can damage your braces or get stuck in your teeth.

With braces, good oral hygiene is even more important than ever, because it’s easy for particles of food to get trapped in and around brackets and wires. This increases your chances of tooth decay and can cause bad breath.

If the brackets are white, bits of food will be easy to see. Not only that, but improper oral hygiene can cause the ligatures that hold the archwire onto your brackets to discolor and look bad.

If circumstances prevent you from brushing, it can be helpful to rinse your mouth with water after drinking soda or eating a sugary snack.

Before Leaving the Office

There are routine steps that we ask that you complete prior to leaving the office. Please make these steps a part of each office visit:

1. Using your finger and tongue, check that wire ends do not poke or abrade the cheek or tongue.
2. Make sure you understand what you are to do until your next appointment. This could include wearing headgear or elastics as instructed, adjusting an expander or following specific hygiene or diet instructions.
3. Make sure you have an adequate supply of dental wax, special cleaning aids, rubber bands, or other related materials you may need between appointments.
4. Always schedule your next appointment before leaving the office. Waiting 1-2 weeks after an appointment before scheduling your next office visit complicates the scheduling process, since appointments are usually programmed 4-6 weeks in advance. Postponing appointments is a common contributor to overtime treatment.

Food

Candy and foods that are sticky and chewy, or hard and crunchy, create the biggest problems for children and adults wearing braces or retainers. Therefore, in general do not eat:

• Anything hard
• Anything sticky
• No big mouthfuls
• No biting into anything hard

Specific Foods to Avoid:

• Sticky gum
• Taffy
• Hard candy
• Sticky candy (e.g. caramels, Sugar Daddies™, Starbursts™, caramelized apples, Sugar Babies™, licorice, toffee, Tootsie Rolls™, Now & Laters™)
• Popcorn
• Peanuts
• Ice
• Taco chips
• Whole apples and carrots (cut them into pieces first)
• Hard French bread crust and rolls
• Spareribs
• Corn-on-the-cob (cut the corn off the cob before eating)
• Bagels
• Pizza crusts
• Carrots (uncooked)
• Doritos™
• Pretzels

Plain chocolate candy is all right, as long as you brush afterwards.

Remember: Crunchy, chewy, sticky, gooey foods can damage your braces and lengthen treatment time. YOUR help and cooperation in following your doctor’s instructions about what to eat and how to keep your braces in good shape, leads to great results!

What to Do If There is an Emergency

We are always available to attend to any orthodontic emergency, should one ever occur. Our emergency number can be accessed on our after hours message by calling our main office number, (916) 626-4050 ext 1 after business hours, and on weekends.

Any severe or unusual pain, accidents, or trauma to the teeth or braces are considered orthodontic emergencies so please do not hesitate to call us if any of these occur.

Other less severe situations may be alleviated at home until they are seen the next business day, but if you have any doubts, please do not hesitate to call. Some of these may be a loose band or bracket, a poking wire, or a missing elastic or metal ties.

Emergencies can be taken care of at home temporarily. Here are some examples of what you can do:

• Poking Wire: If your cheeks, tongue or lips are sore from a sharp piece of your braces, place a small amount of soft dental wax that was given to you at your bracketing appointment and call us the next day. If you don’t have wax, a little piece of wet cotton will also help until we can see you.
• If the wax does not stay, you may try to push the poking wire with the end of a pencil eraser to tuck it behind the main arch wire and make it more comfortable for your lips and cheeks.
• Only do this for the softer, thinner wires that can be bent around; some thicker wires will not allow you to push them or bend them around.

Loose Band or Bracket

If anything feels loose or broken, keep any parts that detach from your braces and carefully put them in a zip-lock bag. Call us during business hours and bring your broken pieces to the repair appointment.

Missing Elastic or Metal Tie

If you notice any of your braces are missing the ties that hold the wire in place, if the wire is loose or anything feels different, please call us during business hours for an appointment.

Pain

After the placement of your braces, or after a wire adjustment, you may experience mild to moderate discomfort while chewing and biting. This discomfort will disappear in two to four days. Any over the counter pain medication that you take for a headache will help but we recommend Tylenol (acetaminophen). If pain is severe or does not disappear with your usual analgesics, please call immediately for an emergency appointment.

Lost Retainers

If you lose your retainers, please call us the next business day for an appointment to make you some new ones.

Important – Do Not Forget!

• If you are wearing a night brace, retainer or functional appliance, always bring it with you to each appointment.
• Broken appointment will prolong treatment.
• Cooperation in wearing elastics, night brace, and all removable appliances is most important to treatment success.

Your root canal treatment may take one or more visits to complete. During treatment, we will remove the diseased pulp (nerve), then clean, shape and fill the space where the pulp was (the nerve canal of the tooth; which is in the root). The filling material is specially designed for this purpose, to help prevent recontamination of the nerve chamber.

What to Expect During Treatment:

Because cleaning the root canals may cause inflammation of the tissue surrounding the tooth, you may experience some discomfort for a day or so. Some initial minor swelling may also occur. It is advisable to place an ice bag on the outside of the face that corresponds to the site of the tooth. Alternate 15 minutes on and 10 minutes off for at least two to three hours. If the swelling should linger more than a few days, or increases, call us!

Over-the-counter pain relievers usually assist with the discomfort. We will advise you as to which medicine to take. At times, a prescription pain medication will be suggested. If the discomfort continues for more than a few days, or if severe pain occurs, call us! Sometimes antibiotics will be prescribed to help control infection. It is very important that you take the medication as directed!

How To Take Care of Your Mouth:

• Between appointments, a temporary filling will be placed over the entry to the nerve space. Because temporary restorations may loosen, call us if there is significant loss of this filling.
• Avoid chewing or biting with excessive force directly on the treated tooth, until we complete the root canal.
• Do not ignore brushing and flossing this tooth; as comfort allows.
• Do not delay final permanent restorative treatment as this could make the root canal worthless.

Please Note:

Retreatment may occasionally be necessary. Even though the pulp of the tooth was removed, the tooth is still nourished from surrounding tissues. As with any living tissue, treatment is occasionally unsuccessful and retreatment or even tooth removal may be indicated.

Your bone graft is made up of many particles. You may find some small granules in your mouth during the first several days after surgery. Do not be alarmed by these; it is normal to have some of them come out of the graft and into your mouth. There are some things you can do to minimize the amount of particles that become dislodged and help promote an excellent graft result.

• Do not disturb or touch the wound.
• Do not apply pressure with your tongue or fingers to the grafted area, as the material is movable during the initial healing.
• Do not smoke for at least two weeks after surgery.
• Do not drink alcoholic beverages during the first week after surgery.
• Avoid chewing or creating pressure on the graft site.

Gentle rinsing should be started on the first postoperative day. Use a warm salt water rinse (1/2 a teaspoon of salt in a glass of warm water) at least 4 to 5 times a day. If Peridex (Chlorhexidine) oral rinse was prescribed, use it full strength beginning on the evening of surgery or the day after surgery.

Rinse a capful in the mouth for one minute then spit out twice a day after tooth brushing. Gentle tooth brushing with a soft bristle toothbrush and toothpaste and flossing should be started on the first postoperative day and continued at least twice a day. Please be very careful not to disturb the graft area. Remember, your mouth will heal faster and better if you maintain excellent oral hygiene.

The temporary appliance should be worn in public when necessary for cosmetic purposes only, and removed in the privacy of your own home.

The extraction site with socket preservation graft will be evaluated for implant placement approximately 4 months after the graft has been placed.

It is our desire that your recovery be as smooth and pleasant as possible. If you have questions about your progress please call the office.

Please review our Surgical Post-Operative Care Instructions for additional helpful information.

Because of the close relationship between upper back teeth and the sinus, an opening between the sinus and mouth sometimes results from surgery. That complication, which has occurred in your case, occasionally heals slowly and with difficulty. Certain precautions will assist healing and we ask that you faithfully follow these instructions:

• Take prescriptions as directed.
• Do not forcefully spit for several days.
• Do not smoke for several days.
• Do not use a straw for several days.
• Do not forcefully blow your nose for at least two weeks, even though your sinus may feel “stuffy” or there may be some nasal drainage.
• Try not to sneeze: it will cause undesired sinus pressure. If you must sneeze, keep your mouth open and do not plug your nose.
• Eat only soft foods for several days, always trying to chew on the opposite side of your mouth.
• Do not rinse vigorously for several days. Gentle salt-water swishes may be used.
• Slight bleeding from the nose is not uncommon for several days after surgery.

Please keep our office advised of any changes in your condition, especially if drainage or pain increases. It is important that you keep all future appointments until this complication has resolved.

Swelling Control:

Place an ice bag on the outside of the face that corresponds to the operative site. Alternate 15 minutes on and 10 minutes off for 12 hours.

Bleeding Control:

• Keep firm pressure with gauze over the surgical site – changing the gauze every hour, as it becomes soiled. Continue until bleeding has mostly ceased.
• No spitting or rinsing for at least 24 hours.
• Do not drink from a straw for 24 hours.
• Avoid smoking for at least 24 hours – and longer.
• If bleeding still persists, place a moist tea bag over the surgical site, and apply firm biting pressure.

Comfort Control:

• Take pain medication as prescribed.
• Relax! Physical activity will increase healing time.
• Follow recommended diet for at least the first 24 hours.

Food and Drink to Avoid:

• Hard & Crunchy Items
• Extremes in Temperatures & Spices
• Citrus, Carbonated or Alcoholic Beverages
• Items containing rice granules or similar size piece

Enjoy:

• Cold Treats: yogurt, popsicles, milkshakes (with a spoon)
• Soft Main Dishes: Meat Loaf, Mashed Potatoes, etc.

Hygiene control:

• Starting 24 hours after the surgery, begin salt & water or peroxide and water rinses four times per day for one to two weeks. (Saline rinse is 1/2 tsp. salt + 1 cup of water and hydrogen peroxide rinse is 1/2 cup hydrogen peroxide 3% + 1/2 cup water.)
• Light brushing around the surgical site should be started in the evening. Brush more vigorously each day as comfort allows.
• We ask that you follow the above instructions carefully. They will greatly assist you in having a smooth recovery from your dental surgical care.

Please do not hesitate to call us should there be any questions or excessive discomfort.

Here are some immediate care instructions while you wait for your final restoration.

Care:

A temporary tooth-colored restoration may be placed to protect the tooth (teeth) while your new restoration is being made. Avoid heavy chewing and sticky foods. If this temporary does dislodge before your next visit, call us! Please do not attempt to place restoration back into place with anything other than Vaseline. Superglue, for example, is not healthy in the oral environment. It also will greatly disturb the bonding process of your final cosmetic restoration!

Cleaning:

Brushing can be accomplished with a gentle motion on the sides of the tooth – flexing the soft bristles at the gum line. We may instruct you not to use dental floss, depending on the procedure. When flossing is recommended, place it gently between the teeth, clean the gum areas as usual, then release your inside finger and pull the floss through the space, toward the cheek. Do not draw the floss back between the two teeth. Rinsing with mouthwash twice a day is also recommended.

Congratulations!

You are on your way to receiving the most advanced, state-of-the-art cosmetic and structurally sound restorative dentistry available today. We are excited with what Heritage Oak Dental can do for you and your teeth, and are pleased that you are as committed to high quality dentistry, as we are. It’s our privilege to provide this service for you.

Please call us if you have any questions. We care and want you to be as comfortable as possible.

What To Do After Tooth Extraction

Control Bleeding:

• Bite firmly on the gauze pack over the surgical area for at least 1/2 hour; then discard it gently.
• Some blood will ooze from the area of surgery for several hours and it is normal.
• Do not spit, or suck through a straw, since it can cause dry socket or loss of the blood clot.
• When bleeding persists at home, place a gauze pad or cold wet tea bag over the area and bite firmly for 30 minutes.
• Avoid rubbing the area with your tongue.
• Keep your head elevated on several pillows or sit in a lounge chair for 12 hours.
• DO NOT SMOKE for at least 24 hours after surgery because this will cause bleeding, pain and interfere with healing. It is recommended to not smoke for 7 days after surgery, besides this might be a great opportunity for smoking cessation.

Rinsing

Do not rinse your mouth or brush your teeth for the first 6 hours after the surgical appointment. Then use warm salt water (1 teaspoon salt in 1 cup of warm water) after tooth-brushing and every 2 hours.

Bacterial Plaque Control

• Brush the teeth gently.
• Avoid the surgical site.

Rest

Get plenty of rest, at least 8 to 10 hours of sleep each night. Avoid strenuous exercise during the first 24 hours, and keep the mouth from excessive movement. Physical activity can cause bleeding, loss of the blood clot, and slow healing time.

Diet

• Use a liquid or soft diet high in protein.
• Drink a large volume of water and fruit juices.
• Do not drink through a straw because this may promote bleeding.
• Avoid hot food for the first 24 hours after surgery because this may promote bleeding.
• Eat a soft diet for the first 24 hours after tooth extraction.
• Avoid foods that require excessive chewing.
• You can resume a normal diet the day after tooth removal.

Pain and Discomfort

• Some discomfort is normal after surgery. It can be controlled by taking the pain medication your dentist has prescribed or recommended.
• Start taking your pain pills before the numbing medication has worn off.
• Take your pain pill with an 8 oz. glass of water and/or a small amount of food to prevent nausea.

Swelling and Ice-packs

• Swelling after surgery is a normal body reaction.
• Swelling reaches its maximum about 48 hours after surgery, and usually lasts 4-6 days.
• Applying ice packs over the area for the first 24 hours (no longer than 20 minutes at a time) helps control swelling and make you more comfortable.
• Heat is not used for swelling.

Bruising

• You may experience some mild bruising in the area of your surgery.
• This is a normal response in some persons and should not be cause for alarm.
• It will disappear in 7-14 days.

Sutures or Stitches

If stitches were placed in the area of your surgery, your dentist will tell you if and when they need to be removed (usually in about 1 week). Many times stitches are used which are self-dissolving (7-10 days) and do not require removal.

The removal of impacted wisdom teeth and surgical extraction of teeth is quite different from the extraction of erupted teeth. The following conditions may occur, all of which are considered normal:

The surgical area will swell.

• Swelling peaks on the 2nd or 3rd postoperative day.
• Trismus (stiffness) of the muscles may cause difficulty in opening your mouth for a period of days.
• You may have a slight earache.
• A sore throat may develop.
• Your other teeth may ache temporarily. This is referred pain and is a temporary condition.
• If the corners of the mouth are stretched out they may dry and crack. Your lips should be kept moist with cream or ointment.
• There will be a space where the tooth was removed. After 24 hours this area should be rinsed following meals with warm salt water until it is healed. This cavity will gradually fill in with new tissue.
• There may be a slight elevation of temperature for 24 to 48 hours. If temperature continues, notify us.
• It is not unusual to develop bruising in the area of an extraction.

Call your Dentist or a Hospital Emergency Room if:

• You experience discomfort you cannot control with your pain pills.
• You have bleeding that you cannot control by biting on gauze.
• You have increased swelling after the third day following surgery.
• You have a fever.
• You have any questions.

Keeping Infection Under Control After Tooth Extraction

The removal of teeth can allow germs in the mouth to enter the bloodstream and cause infections in other parts of your body. If you have difficulty fighting off infections you may need to take antibiotics after tooth extraction. This includes those who:

• Have had bacterial endocarditis, an infection of the lining of the heart.
• Were born with heart defects.
• Have damaged or artificial heart valves.
• Have artificial joints, such as a hip replacement.
• Have diabetes or another disease that causes an impaired immune system.
• Take steroids for other conditions, such as Crohn’s disease or asthma.
• Feel free to contact us if any doubt arises as to your progress and recovery.

What To Do After Tooth Extraction

Control Bleeding:

• Bite firmly on the gauze pack over the surgical area for at least 1/2 hour; then discard it gently.
• Some blood will ooze from the area of surgery for several hours and it is normal.
• Do not spit, or suck through a straw, since it can cause dry socket or loss of the blood clot.
• When bleeding persists at home, place a gauze pad or cold wet tea bag over the area and bite firmly for 30 minutes.
• Avoid rubbing the area with your tongue.
• Keep your head elevated on several pillows or sit in a lounge chair for 12 hours.
• DO NOT SMOKE for at least 24 hours after surgery because this will cause bleeding, pain and interfere with healing. It is recommended to not smoke for 7 days after surgery, besides this might be a great opportunity for smoking cessation.

 

Rinsing

Do not rinse your mouth or brush your teeth for the first 6 hours after the surgical appointment. Then use warm salt water (1 teaspoon salt in 1 cup of warm water) after tooth-brushing and every 2 hours.

 

Bacterial Plaque Control

• Brush the teeth gently.
• Avoid the surgical site.

 

Rest

Get plenty of rest, at least 8 to 10 hours of sleep each night. Avoid strenuous exercise during the first 24 hours, and keep the mouth from excessive movement. Physical activity can cause bleeding, loss of the blood clot, and slow healing time.

 

Diet

• Use a liquid or soft diet high in protein.
• Drink a large volume of water and fruit juices.
• Do not drink through a straw because this may promote bleeding.
• Avoid hot food for the first 24 hours after surgery because this may promote bleeding.
• Eat a soft diet for the first 24 hours after tooth extraction.
• Avoid foods that require excessive chewing.
• You can resume a normal diet the day after tooth removal.

 

Pain and Discomfort

• Some discomfort is normal after surgery. It can be controlled by taking the pain medication your dentist has prescribed or recommended.
• Start taking your pain pills before the numbing medication has worn off.
• Take your pain pill with an 8 oz. glass of water and/or a small amount of food to prevent nausea.

 

Swelling and Ice-packs

• Swelling after surgery is a normal body reaction.
• Swelling reaches its maximum about 48 hours after surgery, and usually lasts 4-6 days.
• Applying ice packs over the area for the first 24 hours (no longer than 20 minutes at a time) helps control swelling and make you more comfortable.
• Heat is not used for swelling.

 

Bruising

• You may experience some mild bruising in the area of your surgery.
• This is a normal response in some persons and should not be cause for alarm.
• It will disappear in 7-14 days.

 

Sutures or Stitches

If stitches were placed in the area of your surgery, your dentist will tell you if and when they need to be removed (usually in about 1 week). Many times stitches are used which are self-dissolving (7-10 days) and do not require removal.

 

The removal of impacted wisdom teeth and surgical extraction of teeth is quite different from the extraction of erupted teeth. The following conditions may occur, all of which are considered normal:

The surgical area will swell.

• Swelling peaks on the 2nd or 3rd postoperative day.
• Trismus (stiffness) of the muscles may cause difficulty in opening your mouth for a period of days.
• You may have a slight earache.
• A sore throat may develop.
• Your other teeth may ache temporarily. This is referred pain and is a temporary condition.
• If the corners of the mouth are stretched out they may dry and crack. Your lips should be kept moist with cream or ointment.
• There will be a space where the tooth was removed. After 24 hours this area should be rinsed following meals with warm salt water until it is healed. This cavity will gradually fill in with new tissue.
• There may be a slight elevation of temperature for 24 to 48 hours. If temperature continues, notify us.
• It is not unusual to develop bruising in the area of an extraction.

 

Call your Dentist or a Hospital Emergency Room if:

• You experience discomfort you cannot control with your pain pills.
• You have bleeding that you cannot control by biting on gauze.
• You have increased swelling after the third day following surgery.
• You have a fever.
• You have any questions.

 

Keeping Infection Under Control After Tooth Extraction

The removal of teeth can allow germs in the mouth to enter the bloodstream and cause infections in other parts of your body. If you have difficulty fighting off infections you may need to take antibiotics after tooth extraction. This includes those who:

• Have had bacterial endocarditis, an infection of the lining of the heart.
• Were born with heart defects.
• Have damaged or artificial heart valves.
• Have artificial joints, such as a hip replacement.
• Have diabetes or another disease that causes an impaired immune system.
• Take steroids for other conditions, such as Crohn’s disease or asthma.
• Feel free to contact us if any doubt arises as to your progress and recovery.

Your anesthesia will wear off in approximately 1 to 3 hours after the procedure. It is very important not to chew on the numb side (to prevent biting tongue, lip, etc.) until the anesthesia wears off.

Your tooth (or teeth) may be sensitive to hot, cold or pressure after this procedure. Your gum tissue may also be tender. This is completely normal. The more invasive the procedure, the more sensitivity you may experience. The possible symptoms of hot, cold or pressure will cease within a few days to a couple of weeks. In very few instances, this sensitivity could last longer than a couple of weeks. As long as your teeth or gums are continuing to feel better (not staying the same, or getting worse) everything is fine. There is no need for concern.

• We highly recommend rinsing with warm salt water or a half/half mix of hydrogen peroxide and water three times per day.
• Ibuprofen (Advil) or Naproxen Sodium (Aleve) usually works very well to control pain.
• If we prescribe a particular pain medication, please use only as directed.
• Sore jaw joints may be soothed with an application of warm compresses. We recommend a moist heating pad to be applied 15 minutes on and 15 minutes off. While applying, open and close your jaws very slightly.

Temporary Veneers, Crowns, and Bridges

It is extremely important for the temporary crown/bridge to remain on the tooth until we seat your permanent crown. If your temporary crown becomes loose or comes off at any time, please call the office immediately. Your tooth can shift within a day if your temporary is missing, which can inhibit the placement of your permanent crown. You may also experience sensitivity if your temporary comes off.

Please note: With your temporary, avoid hard and chewy foods (such as ice, hard candy, gum, taffy). These are known to pull temporaries off the prepared tooth.

If your temporary comes off or becomes loose, please gently replace your temporary back onto your prepared tooth or place it in a plastic bag and call the office (you cannot put your temporary back on incorrectly because it will only fit one way).

It is important to floss your temporary. However, instead of pulling the floss back up through the teeth, release one end of the floss and pull it through the side of the tooth.

Once the anesthesia has worn off and you feel as though any of the teeth we worked on are hitting first, please give the office a call immediately. This imbalance with your bite may cause further discomfort and should be adjusted.

Here are some important instructions for whitening systems.

Whitening Post Operative Instructions

Stay away from foods that stain for 24 hours for the best whitening results. If it would stain a white shirt it will stain your teeth (often spicy, pigmented, or acidic foods stain the most). Do not consume: Wine, Tea, Soda, Sports Drinks, Berries, Sauces, Sweets, and Tobacco products.

Occasionally patients will experience sensitivity to cold with some minor gum irritation during treatment. This difficulty normally resolves on its own 1-3 days after interruption or completion of the whitening treatment. Ibuprofen 400 mg every 6 hours is a great way to manage the discomfort. We also have the option of supplying a fluoride gel or desensitizing agent that can be placed in the appliance in place of the whitening agent. Alternating the fluoride therapy with the whitening therapy is of great assistance, should sensitivity persist. Please see our instructions for at home fluoride tray use. Simply waiting a day or two after sensitivity occurs before restarting the whitening process is another method to alleviate symptoms. Please decrease the interval or duration of bleaching to titrate your bleaching results with your personal comfort.

Whitening Instructions for At-Home Use

Here are some important Instructions for At-Home tooth whitening systems. The amount of whitening you obtain during the tooth whitening process is dependent on three factors:

• The length of time the appliance is worn.
• The number of times the appliance is worn.
• The susceptibility of your teeth and its internal contaminants to the whitening agent.

Instructions:

• Thoroughly brush and floss your teeth prior to applying the whitening gel.
• Load the appliance by gently depressing the syringe cap expressing the material only on the front 10 teeth on the surfaces that face toward the lip using about 1/4 of the syringe per whitening. Place the trays over your teeth and wipe off excess material with finger tip.
• Wear for only 15 minutes and check the condition of your gums and teeth. Sensitive teeth or white gums are a sign that you have worn the trays for too long. Everyone responds differently to bleaching so pace yourself to start and extend the bleaching time in 15 minute increments. Wear for 15 minutes to 2 hours per application. This can be accomplished during sleep time or during waking hours as long as the tray is firmly held on the teeth and does not risk a choking hazard. The thin tray is very comfortable and can be worn easily while accomplishing other tasks.
• When the appliance is removed brush teeth and gums thoroughly. The ‘tray’ should be rinsed thoroughly and placed in the appliance case – ready for the next application.

Precautions

Please keep the whitening carriers away from heat and/or direct sunlight at all times. The whitening agent will break down and become ineffective, should this occur. It is best to store the material in a refrigerator. Please remember, never attempt to use any household or commercial bleaching agents in your mouth. Only use the teeth whitening agents we prescribe; those that have been tested and approved for intraoral use. Keep out of reach of children and pets.

We have never had one patient experience any irreversible effects to the teeth from the whitening process!

* Women please note: Some antibiotics may interfere with the effectiveness of your birth control pills. Please check with your pharmacist.

** Consult with your primary care physician, pharmacist, and dental team regarding your medications before and after care.

***These instructions are for patients who have or will undergo dental procedures and are used in conjunction with oral and written instructions from your dental team.