After Treatment Care

• When anesthesia has been used, your lips, teeth, and tongue may be numb for several hours after the appointment. Avoid any chewing until the numbness has completely worn off. It is easy to bite or burn your tongue or lip while numb. It is recommended that you take some ibuprofen (Motrin or Advil, 1-2 tablets every 4-6 hours as needed) before the anesthetic completely wears off. This will help with any swelling or pain at the injection sites where you’re anesthetic was administered. It will also help diminish any swelling in the nerve that may be existent (swelling often occurs in the nerve after cleaning out decay from the tooth).
• It is normal to experience some hot, cold and pressure sensitivity after your appointment. Your gums may be sore for several days. Rinse your mouth three times a day with warm salt water (put a teaspoon of salt in a cup of warm water, rinse and spit) to reduce pain and swelling.
• Your new composite fillings are fully hardened before you even leave the office; however, it is wise to chew on the opposite side from the location of the newly placed filling(s). One of the most common problems following filling placement with anesthesia, is an incorrect bite. If your bite feels uneven, if you have persistent pain, or if you have any other questions or concerns, please contact our office immediately to obtain help or advice.

• Following the first appointment for a crown or bridge procedure, a provisional temporary is usually placed on the tooth or teeth involved. This will protect them while the custom restoration is being made.
• The use of temporary cement is for easy removal on your next appointment. If your temporary comes off between appointments, slip it back on and call us for an appointment.
• Many crowns fit below the gum line. Therefore, you may experience some discomfort for a few days due to the irritation of that area during the procedure. The discomfort should improve with time.
• Sensitivity to cold or pressure is also possible. Sensitivity to hot and cold lasting a couple seconds is typical after dental treatment. If the sensitivity persists longer than one week and lingers for more than a minute, please call our office for a follow-up evaluation.
• After the anesthetic wears off, it may take a few days to get used to the provisional temporary crown or bridge. If you feel the bite in not correctly balanced, be sure to call our office immediately for a simple adjustment.
• Be sure to be aware of what you are eating while wearing your temporary crown or bridge. Avoid any foods that are sticky or may be too hard like gum and hard candy.
• Proper care includes BRUSHING and FLOSSING a minimum of twice daily. Proper maintenance will not only prolong the life of the restoration but will also help to prevent problems elsewhere in your mouth.

• Root canal therapy often takes two or more appointments to complete depending on the severity of the infection. At the start of treatment, your dentist may isolate the tooth with a rubber dam to prevent salivary contamination of the canal system and protect you from the irrigants used during the procedure. A temporary filling or crown is placed to protect the tooth between appointments.
• After each appointment when anesthetic has been used, your lips, teeth and tongue may be numb for several hours after the appointment. Avoid any chewing until the numbness has completely worn off.
• If the tooth was asymptomatic to start with there are usually no flare –ups between appointments. But if you came in with a severe toothache or a swelling it will take time to heal and expect to have flare-ups between appointments.
• Between appointments it is common for a small portion of your temporary filling to wear away or break off. You may even have a bad taste. If the entire filling falls out, or if a temporary crown comes off, call us so that it can be replaced.
• It’s normal to experience some discomfort for several days after a root canal appointment, especially when chewing. To control discomfort, take pain medication as recommended. To further reduce pain and swelling rinse three times a day with warm salt water.
• If antibiotics are prescribed, continue to take them as prescribed, even if all symptoms and signs of infection are gone. Since the tooth is very fragile following treatment avoid eating sticky and hard foods. Avoid chewing on that side until the permanent crown is placed. The permanent crown will protect the tooth from breaking in future.

• DO NOT DISTURB THE AREA: For the next few days, and especially the first 24 hours, it is very important to allow your body to form a good clot and start the natural healing process. Swishing, sucking through a straw, and smoking can all dislodge the clot. Keep anything sharp from entering the wound (crunchy food, toothpicks, eating utensils). Be sure to chew on the opposite side for 24 hours.
• BLEEDING: When you leave the office, you might be biting on a gauze pad to control bleeding. Keep slight pressure on this gauze for at least 30 minutes. Don’t change it during this time; it needs to remain undisturbed while a clot forms in the extraction socket. After 30 minutes you may remove it. You may bite on gauze or a tea bag for another 30 minutes if you feel it is still bleeding. Small amounts of blood in the saliva can make your saliva appear quite red. This is normal and may be noticed the rest of the day after the procedure.
• SMOKING: Smoking should be stopped following surgery. Healing and success of the surgery will be substantially reduced by the cigarette smoke chemicals in your body. Also the suction created when inhaling cigarettes can dislodge the clot. Smokers are at greater risk of developing a painful Dry Socket.
• PAIN: Some discomfort is normal after surgery. To minimize pain, take two Tylenol, Advil, or similar non-aspirin pain reliever every 3 to 4 hours until bedtime to maintain comfort. Take it before the anesthesia wears off. If prescription pain medication is prescribed, take it as instructed on the label. Don’t exceed the dose on the label. Taking with food or milk will help reduce upset stomach. Avoid driving or operating heavy machinery when taking pain prescriptions. Do not drink alcohol while taking prescription pain medications.
• NAUSEA: This is most often caused by taking pain medications on an empty stomach. Reduce nausea by preceding each pain pill with soft food, and taking the pill with a large glass of water. SWELLING: Applying an ice bag to the face over the operated area will minimize swelling. Apply for 15 minutes, and then remove for 15 minutes. Continue this for the first day.
• NUMBNESS: The local anesthetic will cause you to be numb for several hours after you leave the office. Be very careful not to bite, chew, pinch, or scratch the numb area. Sometimes the extraction causes residual numbness or tingling for six weeks or longer.
• BRUSHING: Do not brush your teeth for the first 8 hours after surgery. After this, you may brush your teeth gently, but avoid the area of surgery for 3 days.
• RINSING: Avoid all rinsing or swishing for 24 hours after extraction. Rinsing can disturb the formation of a healing blood clot which is essential to proper healing. This could cause bleeding and risk of dry socket. After 24 hours you may begin gentle rinsing with a saltwater solution (1/2 teaspoon salt + 1/2 teaspoon soda + 8 ounces warm water). Avoid commercial mouth rinses. DIET: Eat soft foods for the first two days. Maintain a good, balanced diet. Return to normal regular meals as soon as you are able after the first two days. Drink plenty of water. Avoid alcohol for 48 hours.
• ACTIVITY: After leaving the office, rest and avoid strenuous activities for the remainder of the day. Keeping blood pressure lower will reduce bleeding and aid healing.
• ANTIBIOTICS: If you were given an antibiotic prescription, take all of them as directed until they are gone. Women: some antibiotics can reduce the effectiveness of birth control pills. Use alternate birth control methods for two months.
• SINUS: If your sinus was involved in the procedure, you should avoid blowing your nose or playing a wind musical instrument for one week. Use of decongestant medications might be recommended.

FOLLOW-UP APPOINTMENTS:

You may need to return to the office to have sutures removed, or just for a brief follow-up healing check.
Please call your dentist if you have:

• uncontrollable pain
• excessive or severe bleeding
• marked fever
• excessive warm swelling occurring a few days after the procedure
• reactions to medications, especially rash, itching, or breathing problems

Following these instructions very closely will greatly help your comfort, and promote uneventful healing of the area. If any of the instructions are not followed, you might have significantly more discomfort, and the success of the procedure may be affected.

FOR THE REMAINDER OF THE DAY:

• Do not spit. Use a tissue to wipe your mouth as needed, or swallow your saliva.
• Do not use a drinking straw. Drink straight from the cup.
• Do not smoke.
• Keep fingers and tongue away from the surgical area.

Spitting, the use of a straw, smoking, and poking the surgical area can dislodge the blood clot that is forming and will cause bleeding from the area. Also, smoking can increase the chances of an infection.

BLEEDING:
Some minor bleeding is expected after dental implant surgery. It will usually subside quickly and stop within an hour or two after surgery. A little oozing is normal and may persist for several hours.

• Keep gauze on the surgical area with some biting pressure for 30–45 minutes.
• If all else fails, call the office.

SWELLING:
Most patients will experience some swelling after surgery in the mouth. It may be mild or severe and is different for every patient. The swelling may increase for the first 24–48 hours before it starts to go away. It may last for several days. Some bruising may also develop on the face.

DIET:
You may start with non-abrasive foods such as mashed potatoes, pasta, cottage cheese, soup, or scrambled eggs as soon as the local anesthetic wears off.
You may resume a regular diet as soon as you feel up to it; however, please try not to chew directly on the implant sites.

ORAL HYGIENE:
You may start rinsing tomorrow, very gently, with some warm salt water (1 tsp of salt in 8 ounces of warm water). You may brush your teeth per usual, though be very careful near the surgical sites.

SUTURES:
Unless told otherwise, the sutures used during your procedure are dissolvable and will fall out on their own. This generally occurs in the first week after surgery, but timing varies from 4–10 days.

BONE GRAFT MATERIAL:
If your surgeon placed bone graft material at the time the dental implant was placed, you might notice some gritty material in your mouth.

This is nothing to worry about and should subside within a day or two.

WILL I BE ABLE TO SEE THE IMPLANT?

Depending on the location and stability of the implant being placed, your surgeon may opt to bury the implant under the gum tissue. In time, you will return and have the implant uncovered so the implant can be restored.

If stability is optimal, the second stage procedure can be bypassed, and an attachment is placed that protrudes through the gum tissue, which will be visible. Once the bone has healed, the restoring dentist will be able to access the implant without the need for further surgery.

WHEN CAN THE CROWN / Final Denture BE PLACED?

A dental crown or final denture can be attached to a dental implant once the implant has fused to the bone. This is a process called osseointegration.

The length of time the bone must heal varies from case to case and will be discussed with your surgeon. Usually its about 4 to 6 months. The length of time needed for osseointegration is a function of the bone quality, quantity, and implant stability at the time of placement.

MEDICATIONS:
You were probably given one or more prescriptions for medications. Take all as directed on the bottle. Call us if you experience severe nausea or diarrhea, or cannot swallow your pills.

• Antibiotics: Continue until the bottle is empty. Do not quit halfway.
• Pain Medicine: Usually it is necessary to take narcotic pain medication in a scheduled fashion (every 4–6 hours) for the first 24 hours and as needed thereafter. Remember that narcotics can make you drowsy, so no driving, swimming, operating machinery, or drinking alcoholic beverages while you are taking them.
• You may wean yourself off of the narcotic medication and substitute 500 mg of acetaminophen (Tylenol®).
• If directed to do so, you may use ibuprofen, 600 mg, every 6 hours while awake, for the first 4 or 5 days.

ACTIVITY:
Once you are no longer taking narcotic pain medication, you may resume your normal activities as you feel up to it. Go easy at first with exercise and recreation, and increase your activity slowly over several days back to your normal routine.

Please follow these instructions as closely as possible. They are designed to help you heal quickly and comfortably.

These dentures are delivered as soon as the remaining non-restorable teeth are removed. They serve as a bandage to the sockets and help in controlling the bleeding. For the next 24 hours do not remove the dentures from your mouth. Apply firm pressure by biting on a gauze pad for 30-45 minutes following the appointment. You may have to repeat this several times. You may apply cold pack externally to control bleeding and swelling. Your immediate dentures will contain the swelling. Take the prescribed pain medication and antibiotics. Do not rinse your mouth vigorously. Restrict your diet to soft and cold foods. It is normal to see your pillow stained with blood. Do not panic. The following morning gently rinse your mouth.

As your sockets heal your dentures will get loose and will need to be adjusted several times. Learning to wear your new dentures (particularly full dentures) is much like learning a new sport. It takes practice and patience. Try not to become discouraged at first. Wear your dentures regularly so your dentist can locate the sore spots when you go in for an adjustment.

You may salivate more when you first get your denture. This is normal and usually stops anywhere from within the first few minutes to a few days. It is important that you practice talking. Talk to yourself, read aloud and sing. You should sound normal within a very short time.

You will also need to practice eating. Do not plan to eat your first meal in public. Cut your food into small bites, eat easy to chew foods and chew slowly. Some people feel more comfortable wearing adhesives under their dentures (particularly full dentures). You can experiment with over the counter adhesives. It is important to make sure you remove the entire adhesive each day when you clean your dentures.

At the end of 3 months your Dentist will reline your denture in house to make them fit tighter. Bone usually takes 365 days to completely heal. At the end of a year your Dentist will send your dentures for a lab reline. It is usually done within a day so be prepared to take a day off.

Transitional dentures are only for the period of gum and bone healing and your Dentist may recommend permanent dentures.

The removable partial or full denture must be removed at least 8 hours each day, preferably at bedtime. Letting the denture stay in the mouth 24 hours a day will cause you to develop sores and fungus under it. It should also be removed and cleaned after meals. When you take it out at bedtime, clean it with a brush and soak it in water, mouthwash or a denture cleaner. Do not let the denture dry out, as this can cause it to warp. When rinsing and brushing your denture over the sink, it is best to place a washcloth in the basin with some water to cushion the denture should you drop it. The acrylic will break if dropped.

Even if you wear a full denture, it is still important to see your dentist regularly. Your dentures should be checked routinely, along with both the fit and the bite. A poorly fitting denture can cause problems with the underlying tissues and bone loss. You will also be checked for oral cancer and other diseases that can show up in the mouth.