Diet Restrictions for Sealants

Sealing over the pits and grooves of teeth is a very wise and preventive measure, congratulations!

The following are precautions you should be advised of to get the most benefits from the sealants.

It is very important to follow the diet restrictions listed below:

  • Do not eat sticky candy such as taffy, “Red Hots”, “Jolly Ranchers”, etc. This can pull the sealants out. (chewing sugarless gum is okay)
  • Do not bite on extremely hard foods such as hard, clear ice cubes, unpopped popcorn kernels, etc. This can break or chip part of the sealant out leaving the tooth susceptible to decay.

Parents should keep these diet restrictions in mind when allowing your child to snack. We offer a one year guarantee on all sealants. Any that are lost in less than one year (excluding abuse) will be resealed at no charge. However, with reasonable diet and care, most people get many years of service from a single sealant. All previously sealed teeth will be checked at preventive hygiene visits for any possible loss or breakage of the sealant.

Thank you for allowing us to be your preventive health care team.

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 arrives when 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 methods 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 ability 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 artificial substitute, regardless of how painstakingly fabricated, will ever function as efficiently as the original living tissues. Research has shown that the chewing efficiency of experienced denture patients 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 ensure 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 a 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 temperature. A denture, however, functions as a single tooth, is anchored to nothing, 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 patients 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 tend to upset. The long term result 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 provided 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 multi vitamin is recommended. Avoid the usual tendency to overindulge in soft 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 helps 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. Dentures should be stored overnight in a denture cup and commercial denture cleaner may be used if desired. Such cleaners can make dentures 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, an 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 appearance, 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 their 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 always 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 yourself.

Temporary Crowns and Bridges – Post-Treatment Instructions

After your first crown or bridge appointment, refrain from eating for at least 1 hour and until the anesthesia has worn off.

Temporary: A temporary crown or bridge will be placed on the prepared teeth while the permanent restoration is being made. The temporary serves very important purposes. It protects the exposed dentin so it is not sensitive, prevents food and bacteria from collecting on the tooth preparation, and prevents the tooth from shifting or moving, which can make seating of the permanent restoration more difficult or even impossible. The temporary is placed with a cement that is designed to come off easily, so avoid chewing sticky foods such as gum or taffy or anything very crunchy. Use your toothbrush to clean the temporary as you normally do your other teeth. However, when flossing, it is best to slide the floss out below the contact rather than popping up through the contact between the temporary and the tooth next to it.

If your temporary comes off between appointments, even if there is no discomfort, slip it back on and call our office in order to have us recement it for you. It cannot be stressed too much how important this is.

A little denture adhesive or even toothpaste placed inside the crown can help to hold it in place in the interim.

Sensitivity: Sensitivity, especially to cold, is common while you are wearing the temporary. If you experience this, avoid extremely hot or cold foods and beverages. It is normal to have discomfort in the gums around the tooth after the anesthesia wears off. If your gums are tender, rinse with warm salt water by dissolving 1/2 teaspoon of salt in an 8 oz. glass of warm water. An analgesic, such as whatever you would take for a headache, will help to increase your comfort.

Permanent Crown or Bridge: Typically, we will have your permanent crown or bridge around 2 weeks after the appointment which the tooth or teeth were prepared. It may take a few days to get used to the new crown or bridge, after your permanent restoration is finally cemented. If your bite feels high or unbalanced, please be sure to call our office for an appointment for a simple adjustment.

Home Care after seating your Permanent Crown or Bridge:Although crowns and bridges are often the most durable of all restorations, the underlying tooth is still vulnerable to decay, especially at the interface between the tooth and crown. It is important to resume regular brushing and flossing immediately. Daily home care and regulating your intake of sugar-containing foods will increase the longevity of your new restorations.

If you have any problems or unanswered questions, please feel free to call our office at (888) 429-8157 any time so we may be of assistance to you.

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

  1. 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.
  2. Use a less abrasive toothpaste and one that is not highly fluoridated.
  3. Although laminates are strong, avoid excessive biting forces and habit patterns: nail biting, pencil chewing etc.
  4. Avoid biting into hard pieces of candy, chewing on ice, eating ribs.
  5. Use a soft acrylic mouthguard when involved in any form of contact sport.

Mouthrinses

Acidulated fluoridated mouthrinses 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.

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:

  1. Brushing and flossing after eating and especially before bedtime.
  2. Swish vigorously with Colgate FLUORIGARD or Johnson & Johnson ACT mouthrinse for 30 seconds daily before bedtime (.05% neutral sodium fluoride).
  3. Brush with Colgate Prevident or Gel Kam (0.4% stannous fluoride) daily before bedtime.(This is available in our office.)
  4. Use the Rotodent as advised by us.
  5. 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:

  1. A feeling of movement or looseness in the restoration.
  2. Sensitivity to hot, cold, or sweet foods that doesn’t disappear in a few weeks.
  3. A peculiar taste from the restoration site.
  4. Breakage of a piece of material from the restoration.
  5. 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.

Composite Fillings – Post-Treatment Instructions

  1. 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 he anesthetic, many children will chew the inside of their lips, cheeks, or tongue which can cause serious damage.
  2. 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.
  3. The gum tissue could have been irritated during the procedure and may be sore for a few days along with the anesthetic injection site.
  4. 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.

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 a 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 the failure of any dental restoration is the failure to return for your routine hygiene visits.

Preventative Procedures

  1. Brush and floss after eating and before bedtime.
  2. 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.
  3. Use a fluoride toothpaste or a toothpaste containing chlorine dioxide such as Oxygene.

Vital Pulpotomy Care Instructions

We have just completed a procedure called a “vital pulpotomy”. Simply put, we have removed part of the pulp (nerve) from the inside of the tooth, placed a soothing medication, and covered it with a temporary filling. This is an emergency procedure which is usually successful in reducing or eliminating pain.

Although you should feel considerable relief when the anesthetic wears off, some soreness is to be expected. Due to the unpredictable amount of internal breakdown, the amount of improvement cannot always be accurately predicted, and further treatment may be needed to provide you with relief. Take medication for pain as needed. Ibuprophen ( such as Advil or Nuprin) is usually quite effective. Please call our office at any time if you have any questions or concerns.

A pulpotomy is meant only as a temporary measure for relief of a painful condition. You will need further treatment, usually endodontic therapy (root canal), to save the tooth. Please don’t put off continued care. An untreated pulpotomy almost always leads to painful abscess formation and possible tooth loss.

Post-Op Instructions – Extractions

The post-operative instructions listed below should be followed accurately in order to speed your recovery.

  1. 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.
  2. Please note that a gradual increase in pain from days three to five is not uncommon.
  3. Keep your head elevated at all times for the first five to seven days following surgery. This will help decrease swelling and pain.
  4. 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.
  5. DO NOT SMOKE. Smoking in any amount in the first few weeks can cause a dry socket and will dramatically delay wound healing.
  6. 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.
  7. 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.
  8. DO NOT drink alcoholic beverages, drive or operate machinery for 12 hours following general anesthesia. DO NOT combine pain medication with alcohol.
  9. 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.
  10. Swelling is to be expected and usually reaches its maximum during the first three days. Apply ice to the side of the face 15 minutes on and 15 minutes off as often as possible for the first 48 hours. Frozen vegetable bags wrapped in dishtowels work nicely as they contour to the jaw. Change to heat (a heating pad or hot water bottle) 48 hours after surgery. Continue to use heat until the swelling has receded.
  11. Bruising may occur, especially along the jaw line. This is not unexpected and should disappear soon.
  12. Keep lips moist with ChapStick or Vaseline to prevent chapping.
  13. Tightness of the jaw muscles may make it difficult for you to open your mouth for up to two weeks.
  14. 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.
  15. If any unusual symptoms occur or if you have any questions concerning your progress, do not hesitate to call the office during business hours—(888) 429-8157 —or if an emergency arises we may be reached 24 hours a day by calling (604) 534-7200.

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:

  1. Take prescription medication as directed.
  2. Do not smoke for at least two weeks. Smoking is a severe irritant and significantly delays healing.
  3. 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.
  4. Try not to sneeze, as sneezing will cause an increase in sinus pressure. If you must sneeze, do so with your mouth open.
  5. Do not drink through a straw for at least two weeks.
  6. Do not forcefully spit for at least two weeks.
  7. Do not rinse vigorously for at least two weeks. Gentle saltwater swishes may be used as needed.
  8. 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 contact us anytime you have a question or concern.