Aftercare Instructions

A Step-by-Step Guide to Proper Tooth Brushing

1. Apply a small amount of toothpaste along the length of your toothbrush bristles.
2. Begin in one quadrant of your mouth (e.g., the upper right) brushing two teeth at a time, and gradually move to the other three quadrants (i.e., the upper left, lower left, and lower right).
3. Place the toothbrush bristles on your teeth at a 45 degree angle and begin brushing in short, circular motions. Use gentle strokes only.
4. Continue this pattern on all the surfaces of your teeth, which include the outside (facing your cheeks and lips), the inside (facing your tongue), and the top (or chewing surfaces).
5. In addition to brushing the tooth surfaces, you should also focus on brushing the gum line while in each quadrant.
6. Gently brush the top side of your tongue to remove harmful bacteria and freshen your breath.

Helpful Tips

• Only use soft-bristled brushes so as not to damage your teeth and gums.
• While brushing, hold the handle of the toothbrush with your finger tips only to avoid excessive pressure against the teeth.
• Brush for at least 2 – 3 minutes after breakfast and before bed.
• Use a basic fluoride-containing toothpaste like Crest Regular or Colgate Total. Specialized toothpastes used for whitening or tartar control can be more abrasive than is necessary and actually cause tooth and gum damage if used improperly.
• Flossing daily is very important because brushing cannot properly clean between your teeth, which is where the majority of dental disease begins.
• Try to avoid brushing when you are in a hurry or excessively tired, as you will have a tendency to brush too aggressively and/or for an inadequate amount of time.
• Replace your toothbrush every 6 months, as the bristles will wear and lose their cleaning efficiency.

Chewing

The temporary cement requires approximately 30 minutes to set up. Please do not chew during that period of time. We also encourage you to chew on the side opposite of where your temporary is located.

Temporary restorations are not strong and will occasionally break or come off. If this occurs, please call us and we will replace it. If it occurs after hours or during the weekend, purchase denture adhesive (e.g., Fixodent or Poligrip) at the local pharmacy. Replace the temporary on your tooth with a small amount of this adhesive paste to hold it in place. This adhesive will retain the temporary restoration until you can see us. Please do not leave the temporary restoration out of your mouth, as the teeth will move and the final restoration will not fit. Call us to make an appointment to have the temporary restoration recemented within a few days or the tooth may develop sensitivity.

Certain foods will stick to the temporary restoration. This will not happen with the final restoration to be cemented soon. Try to avoid chewing on the temporary restoration.

Brushing and Flossing

Brush the area gently, but thoroughly. Always remove floss by pulling out sideways and not lifting up on it, as you could lift the temporary off the tooth.

Color

The color of the plastic temporary does not resemble the color of the final restoration.

Shape & Size

The size and shape of the plastic temporary does not resemble the final restoration.

Tooth Sensitivity

Temporary restorations may allow saliva, bacteria, or food to leak underneath them. Sensitivity to cold, hot, or sweets is not uncommon. This sensitivity will not be present with your final restoration.

If you have any questions or concerns, please do not hesitate to call our office.

1. CHEWING: Do not chew hard foods on the restoration for 24 hours from the time they were cemented. The cement must mature for about 24 hours to have optimum strength.
2. SENSITIVITY: Do not worry about mild sensitivity to hot or cold foods. It will disappear gradually over a few weeks. It is rare that the sensitivity lasts longer than 6 weeks. Please tell us if this occurs
3. AGGRESSIVE CHEWING: Do not chew ice or other hard objects. Avoid chewing very sticky foods such as “hard tack” candy because it can remove restorations.
4. PREVENTIVE PROCEDURES: To provide optimum longevity for your restorations and prevent future dental decay and supporting tissue breakdown, please use the preventative procedures prescribed by your doctor.These include brushing and flossing after eating and before bedtime, rinsing for at least 30 seconds with a flouride rinse immediately before bed, use a prescription strength flouride toothpaste, use bridge cleaners, use an electric toothbrush as advised by us
5. RECALLS: Visit us at regular six-month examination periods. Often problems that are developing around the restorations can be found at an early stage and corrected easily. Waiting a longer time may require redoing the entire restoration. INADEQUATE RETURN FOR EXAMINATION IS THE MOST SIGNIFICANT REASON FOR PROSTHESES FAILURE. We will contact you when it is time for your Continuing Care appointment.
6. P R O B L E M S: IF ANY OF THE FOLLOWING CONDITIONS OCCURS, CONTACT US IMMEDIATELY TO AVOID FURTHER PROBLEMS:

• A feeling of movement or looseness in the restoration.
• Sensitivity to sweet foods.
• A peculiar taste from the restoration site.
• Breakage of a piece of material from the restoration.
• Sensitivity to pressure.

We have done our best to provide you with the finest quality oral restoration available today. However, as with a fine automobile or watch, only your continuing care and concern can assure optimum service longevity. Thank you!

Please observe the following post-operative suggestions:

• Do not chew on the restoration for 24 hours. The adhesive material continues to gain strength
  during this time.
• Small pieces of excess bonding material may be found by your tongue for a couple of days. These pieces will normally come off with regular tooth brushing. If you feel anything sharp to your tongue, please call our office and the piece can be removed easily with an instrument.
• If at first you cannot get floss between your teeth, just wait a few days and try again. If you continue to experience difficulty flossing, please call our office.
• It is not unusual to experience some discomfort for a few days after receiving extensive restorative dental treatment. Please take Tylenol or Ibuprofen when you get home and before bedtime.
• If your bite feels unusual after your anesthetic has worn off, please call our office.
• Do not chew on ice or other hard objects. Avoid chewing very sticky foods such as “hard tack” candy because it can remove restorations.
• To provide optimum longevity for your restorations and prevent future dental decay and supporting tissue breakdown, it is important to have regular 6 month preventive dental care. Inadequate return for examination is the most significant reason for failure of dental restorations.

We have done our best to provide you with the finest quality and natural dental restoration. We are committed to excellence and hope this restoration will give you many years of service.

Do not eat or chew until any numbness from anesthesia has worn off. If you are supervising a child who had treatment, make certain that they are not eating or chewing while numb. Please make sure they do not bite their lips or tongue as it can cause serious injury to their soft tissue. Avoid sticky, crunchy or hard foods for 24 hours.

Sensitivity to cold and heat, as well as any soreness, shouldn’t last more than a few days. Please call our office if you experience pain or discomfort for more than a few days.

• YOUR FIRST FEW WEEKS: A new denture always feels strange when first placed in your mouth. It is normal at first to experience a feeling of fullness of the denture and to have excessive saliva. Several days or even a few weeks will be required for you to feel accustomed to wearing a new denture.

• SORE SPOTS: Your mouth will usually have a few sore spots after wearing the denture for 24 hours. Don’t worry about these areas. They can be relieved with very little effort at your next appointment, which will be scheduled 1-3 days after you receive your denture. Another appointment 1 week later will usually eliminate any other sore areas.

• CHEWING: Begin with eating small quantities of soft food. Divide the food in half and chew with an equal amount on each side of your back teeth. Bread may be very sticky and adhere to the upper denture. Your new bite will not feel comfortable for a period of days. We will adjust the chewing surfaces of your teeth after 1-3 days and then again one week later after the denture has “settled” into place.

• SPEAKING: Bite and swallow before speaking to correctly position the denture. Speaking slowly will help avoid movements that dislodge the denture. Retention of your denture depends on your ability to hold it in place with the muscles of the lips, cheek and tongue. Time and practice will help overcome the difficulties of speaking.

• UPPER VS. LOWER DENTURES: Your upper denture will rest comfortably in place with light to moderate “suction” from the roof of the mouth. Although your lower denture will have adequate stability, it is not possible to get the “suction” feeling that you experience with the upper denture. We suggest that you initially avoid using denture adhesive to attempt to get used to your new dentures. Only use a denture adhesive if you have considerable difficulty with wearing your new denture or prefer the extra retention that denture adhesives can provide.

• CLEANING THE DENTURES AND YOUR MOUTH: Clean your denture daily over a sink full of water to avoid breakage in case it is dropped. Your denture can be cleaned easily by using a denture brush and nonabrasive, denture toothpaste. Denture soaks are also useful. Brush your gums and tongue with a regular soft toothbrush once a day to keep them clean. It is best to leave your denture out at night while sleeping. Leave the denture soaking in water when it is not in your mouth.

• THE FUTURE: Your jawbones and gums shrink up to 1/32 of an inch per year when your teeth are missing. This is one of the main disadvantages of dentures. As a result of this shrinkage, it is recommended that you have your denture and oral tissues evaluated once a year. We will inform you when relining or rebasing of the denture is necessary. Wearing ill-fitting dentures for too long without refitting can cause severe bone loss and potentially serious oral problems. An oral cancer screening is also performed as a part of the annual examination, and your dentures will be thoroughly cleaned ultrasonically. We look forward to helping you adjust to and enjoy your new dentures.

1. Be very careful not to bite or injure your cheek, lip, or tongue while you are still numb. It may take a few hours for the anesthesia to completely wear off. You may notice a tingling sensation as the anesthesia is wearing off.
2. The gum tissue may be tender for a few days. However, it is important to thoroughly follow the oral hygiene instructions you were given.
3. Tylenol or Ibuprofen may be taken for discomfort. Also, a warm salt water rinse may be helpful. Use 1 teaspoon salt in 1 cup warm water. Swish and spit out several times per day.
4. Avoid eating foods that may be difficult to remove or might get caught easily between your teeth (e.g., popcorn and sesame seeds). Make sure you eat a well-balanced diet.
5. Smoking contributes to the incidence of periodontal disease and diminishes the prognosis following periodontal treatment. Now is a good time to quit smoking.
6. Possible tissue alteration may occur as the tissue heals. With a reduction in the infection, there will be a reduction of the tissue swelling around the teeth. You may notice some gingival recession or open spaces between your teeth.
7. Approximately four weeks after your scaling and root planing procedures, it is important to have the probe depths around the gum tissue re-evaluated, as well as your oral hygiene. A maintenance schedule that is appropriate for you will then be set up. Studies have found that a thorough maintenance cleaning once every 3-4 months along with good oral hygiene are most beneficial in stabilizing your periodontal health.
8. Additional periodontal therapy may be necessary following the root planing if areas of disease are still present. This may involve antibiotic therapy or periodontal (gum) surgery. NOTE: Periodontal disease is the #1 cause of tooth loss in adults. Anyone who has had periodontal disease will always have the potential for the same problems to redevelop in the gum tissue. Your best defense to avoid further problems is to follow the professional cleaning schedule personally designed for you and to practice excellent oral hygiene at home.

1. For the next 30 minutes, do not eat or drink anything. You have a temporary filling that takes about 1/2 hour to harden. Please do not feel around your tooth with your tongue.
2. If any prescriptions were given, please have them filled promptly. If no prescriptions were given and you are not allergic, you may use any ibuprofen type of medication such as Motrin or Advil, 3 tablets (600mg) every 6-8 hours as needed for discomfort and alleviation of swelling. Alternatively, you may use Tylenol, 1000mg every 6-8 hours as needed. Do not exceed the guidelines printed on the label for any medication. If you are unable to achieve adequate pain control, please call our office.
3. You may find using an ice pack to the affected area helpful. Please do not apply ice directly to the skin; have a cloth between the ice and skin at all times. You may apply the ice for up to 20 minutes on and 20 minutes off for the next 6-8 hours as needed.
4. Once you begin to eat and drink, avoid chewing or biting on the area worked on until your permanent restoration is in place. The area may be more sensitive due to swelling. The temporary in place is a soft composite that is vulnerable to fracturing (cracking) with hard substances such as peanuts, pretzels, hard candy, ice cubes, etc. You will need to see a restorative dentist within a month to have a permanent crown placed. Please contact your restorative dentist to make an appointment at your earliest convenience. Waiting longer than a month increases the chances that the temporary will fracture and/or decay will develop, in which case, you are at fault and will be responsible for all costs to have it redone.
5. Please keep the area worked on clean by gently brushing the area and flossing regularly.
6. It is rare for a temporary filling to fall out although it may divot while in use. If the temporary falls out please contact your general dentist as soon as possible. If your temporary falls out after office hours you may purchase some temporary filling material from most pharmacies and follow the included instructions.
7. Some discomfort following the root canal is normal for 2 to 4 days after the treatment. In some cases the tooth and surrounding tissue may be sore for a few weeks following the treatment.
8. Normal brushing and flossing are okay, unless otherwise specified by your doctor. Follow any other instructions provided by the office on your visit. Please take all medications as prescribed.

THIS SECTION IS VERY IMPORTANT, PLEASE READ CAREFULLY While flare-ups are rare, they occur in about 5% of the cases and cause significant pain. They occur with teeth that are extremely irritated and/or infected or with teeth that have a history of prior treatment. These sometimes occur randomly, even on patients that have had root canals done in the past without problems. If you have a flare-up you may experience moderate to severe pain, swelling, throbbing or general discomfort; please contact our office. You may be prescribed additional medication such as antibiotics and/or you may be asked to come to the office for further treatment. Should you experience any of these symptoms, please contact the office, even after hours.

Bleeding

Bite on gauze placed over the socket for 30 minutes after extraction to allow the bleeding to clot. Replace the sponges with new, water-moistened gauze every 30 minutes until the bleeding stops, which may take 1 to 3 hours. If bleeding continues after this time, bite on a black teabag for 30 minutes. If bleeding still cannot be controlled, please contact our office.
Avoid spitting, rinsing, straws or smoking for 24 hours, as these all prolong bleeding and can cause a dry socket. If you must smoke, inhale very lightly with the gauze in place. _ Do not overexert yourself or perform any strenuous activities during the next 24 hours.
It is normal for a tooth socket to ooze slightly for 24 hours after an extraction. Sleep with a towel over your pillow tonight to prevent staining.

Diet

Once the bleeding has stopped, it is okay to eat cool, soft foods for the first 24 hours. Avoid hot, crunchy and sticky foods during this time. Drink plenty of cool fluids without a straw.
Avoid chewing on the side of your mouth where the tooth was extracted for the next 7 days, so as not to disturb the healing.

Pain

You can expect mild discomfort once the anesthetic wears off in approximately 2 hours. This discomfort peaks about 12 hours after the extraction and then diminishes rapidly after that.
To help manage the pain, you may take either 500-1000 mg of Acetaminophen (e.g., Tylenol) or 600-800 mg of Ibuprofen (e.g., Motrin or Advil) every 6 hours. It is best to take these medications with food or milk to decrease their irritating effects on an empty stomach.  If pain worsens significantly after 1-3 days, please contact our office, as we may need to see you back or call in a prescription to your nearest pharmacy.
Some swelling may occur and usually peaks 2-3 days after surgery. It may help to apply covered ice to your face on the side of the extraction in 15 minute intervals for the rest of today.

Oral Hygiene

Avoid brushing the teeth immediately adjacent to the extraction site for the next 24 hours. Continue to brush and floss the rest of your teeth as normal, but avoid rinsing afterwards for the next 24 hours.
After 24 hours, dissolve 1 teaspoon of salt in an 8 oz. glass of warm water and gently rinse your mouth out 3 to 4 times a day. This will keep the extraction site clean and promote healing.

Patient Instructions

• Only one arch will be treated at a time during your initial whitening experience.
• Avoid drinking coffee, wine, tea and carbonated beverages while wearing the whitening tray and for 2 hours afterwards. Drinking these beverages regularly will darken your teeth much faster after whitening.
• Brush with fluoride-containing toothpaste and floss your teeth before whitening. Rinse out your mouth well. Place a small amount of whitening gel into the front part of the tray for every tooth to be lightened. Use approximately 1/3 of the syringe for the entire tray.
• Carefully insert the tray over your teeth and spit out any excess gel.  

1. Option 1: Wear the tray for 1-2 hours. Studies show that the majority of the whitening activity will occur during the first two hours of each application.
2. Option 2: Wear the tray while sleeping. Some patients feel that this is more convenient and also achieves slightly more whitening than with the 2-hour application. This option may cause more sensitivity.

Note: Your teeth may feel like they fit together somewhat unusually after the tray is removed in the morning.  Your bite will start to feel normal again after a couple of hours. 

• Rinse and brush the tray after each use. Tip it upside down to allow complete drying before the next use.
• Discontinue bleaching if tooth sensitivity, gum irritation, or any other negative event occurs. Notify us of any problems immediately.
• The average time for optimum color change to occur with this whitening technique is 7-10 days. Effects may be noticed as early as 2-3 days.
• As with any form of tooth whitening, future applications may be necessary in 1 to 3 years. Keep the trays in a safe place. For future use, you may purchase tubes of whitening gel at our office. Keep gel refrigerated to maintain its effectiveness when storing for more than two weeks.

TOOTH SENSITIVITY – Mild tooth sensitivity during the whitening period is normal. If tooth sensitivity occurs, it will be necessary to decrease the whitening solution contact time or to utilize a desensitizing material. Please notify our office immediately if you experience any problems.

Certain types of tooth discoloration (e.g., tetracycline staining) may require many weeks of treatment and require the purchase of additional tubes of whitening gel. While this technique is highly effective, it does not always produced the desired results.

Examples are:

• Accidents
• Surgery
• Developmental defects
• Peculiar oral habits
• Many fillings placed over numerous years
• Naturally occurring malocclusion (poor bite)
• Orthodontics
• Psychological stress
• Clenching or bruxing (grinding) of teeth and other conditions.

The following self-administered treatment will usually relax the jaw muscles considerably if you are consistent in carrying out the exercises. Approximately 80 percent of patients with muscular jaw problems feel better when doing this therapy, but some patients feel worse. Please tell us if this treatment does not help you. Even if you feel better after doing the exercises, additional treatment may be necessary.

These exercises should be accomplished one time per day (unless directed otherwise).

A convenient time for the exercises may be before bedtime. If this time is not acceptable for you, please select another convenient and relaxed time.

Therapy

HEAT: Apply heating pad, hot washcloth, hot water bottle, or other heat source to the affected areas for 5 minutes before beginning exercises.

EXERCISES: Carry out the following exercises for 1 minute each (a total of 5 to 10 minutes). DO NOT PERFORM ANY MOTION THAT IS PAINFUL.

Open-close: Place fist under front of jaw to resist opening movement. Be gentle. Open and close jaw 30 times in one minute.
Forward: Move jaw forward and back with fist on front of chin.
Right: Move jaw to right with fist on right front of chin to resist movement.
Left: Move jaw to left with fist on left of front of chin to resist movement.
Neck turn: Sit up very straight. Rotate head as far right as possible and then gently force turn once every 2 seconds for 30 seconds. Turn head to left and repeat.

HEAT: Apply heat for another five minutes.

Further treatment such as a plastic bite splint to assist in making you bite in the correct position (occlusal splint), or slight, careful trimming of teeth and fillings to make your teeth and jaws come together correctly (occlusal equilibration), may be needed to assist in your treatment.

Please call if you have any questions.