Patient After-Care Instructions

A certain amount of swelling, pain, and bleeding is normal.

The following instructions are provided to make your postoperative recovery period as short and pleasant as possible:

• Bite down and maintain firm pressure on the gauze pack that was placed at the end of your surgery. Do this for at least 30 minutes.
• At that time, remove the pack and replace it with another gauze sponge as provided. Repeat this as necessary.
• There should not be excessive bleeding. Bright red blood rapidly pooling in the area is not normal. If this occurs and does not decrease with pressure, please call the office immediately.
• If you were asleep for the surgery, be sure to eat soft, nutritious food prior to taking any medications. This will decrease the chances of post-surgical nausea.
• You were prescribed an antibiotic after surgery. This should be continued until all the pills have been taken.
• Take your pain medications as needed in accordance with the directions. Codeine, hydrocodone, or Demerol can be supplemented with Advil-type medications.
• Be sure you have no allergies that the doctor does not know about.
• Do not rinse or spit for a minimum of 72 hours and longer if possible. This tends to disturb the blood clot, open the wound, and can prolong bleeding and slow healing. Saliva can be swallowed.
• Do not brush the teeth in the area of surgery for 48 hours. When brushing, be gentle. When spitting, BE GENTLE.
• If you used a prescribed mouthwash prior to surgery, it should be continued starting 24 hours after your surgery. Place the mouthwash in the area of the surgery and let it sit for 30-60 seconds. Do not rinse with it until after you have returned for suture removal (two weeks after implant placement).
• Apply ice immediately in the area where the surgery was done. If your surgery was in the anterior upper jaw, you can expect swelling and discomfort up into the nose and even under the eyes. Bruising and discoloration is not unusual.
• Crushed ice or equivalent should be placed in a plastic bag, then in a washcloth, and placed on the face. Apply for 30 minutes, then off for 20-30 minutes. This should be done on a near continuous basis (or as much as possible) for the first 48 hours and longer if possible or if this helps reduce your pain.
• Avoid excess physical activity and exercise.
  In addition, DO NOT SMOKE. Smoking increases the risk of implant failure.
• Do not drink with a straw or drink carbonated liquids (minimum three days).
• Do not consume alcoholic beverages while taking your pain medication.
• You will notice that you cannot see any implants in your mouth as the gums cover the area. This is good. Do not stretch your lip daily to inspect the area. This can cause wound breakdown.
• In many instances, a healing cap was placed over the implant. This will look silver and will be emerging through the gums. Do not stretch your lip daily to inspect the area. This can cause wound breakdown.
• Be very cautious not to eat on these temporary caps as it will place undue movement on the implants below.
• If you have a temporary flipper to wear, do not place it until the numbness in the area is gone.
• When it is placed, it should not touch the gums in the area of the surgery. If it does, this can cause ulceration of the wound edges and breakdown of the suture margins.
• If you have questions about the fit of your flipper, do not wear it until your general dentist at this office can see you.

Most follow-up appointments are scheduled for one week after surgery. If something arises that you consider unusual, please do not hesitate to contact the office immediately.

Your dental professional has applied fluoride varnish onto the surfaces of your teeth. You may feel a thin coating on the treated areas, which is a temporary condition, and should be left undisturbed in order to provide the greatest results.

In order to receive the maximum benefit of your treatment, we recommend the following guidelines:

• Fluoride varnish should remain on your teeth for 4-6 hours after application.
• Maintain a soft diet and avoid hot liquids and beverages containing alcohol, including mouthwashes and rinses, during the treatment period.
• Do not brush or floss during this treatment period. If possible, wait until the next day to resume normal oral hygiene.
• If you take supplemental fluoride under prescription, do not take it for at least 3-4 days, unless otherwise instructed by your dentist or physician.
• The day after treatment, a thorough brushing and flossing will remove any fluoride varnish remaining on your teeth.

• Do not soak in mouthwash, denture cleaner, or hot water.
• Do not place in direct sunlight.
• Do rinse well with warm water before and after use and store dry.
• Do clean appliance with soap and warm water only.
• If it becomes loose, tight, or causes you any discomfort, please contact us to set an appointment for an adjustment.
• Bring your night guard to your cleaning appointments for routine checks.

The purpose of the root canal treatment is to remove diseased tissue from inside of the root and seal the root end. Depending on each case, endodontic treatment may be completed in one, two, or three appointments. Once started, it is important to complete the root canal therapy.

After your root canal therapy has been completed.

• Post-Op Pain: Your root canal therapy will usually relieve the pain you may have been experiencing. Please avoid biting on the tooth for the next few days, as this will help it heal faster. Also, avoid biting your lip, cheek, and tongue while numb since this may cause damage to them. You may have some pain or tenderness in the area for up to a few days after the completion of root canal treatment. If your tooth was in pain prior to starting the treatment, it will take up to a week or more for the tooth to get back to normal. Give the therapy a chance to work.
  
  If your tooth was not in pain prior to beginning treatment (likely because the tooth was abscessed or had a deep cavity that had not begun to hurt yet), your tooth may be quite sore for a few days after the appointment. This will be alleviated with time; it may take as much as a week or more. If you have pain that you cannot tolerate, abnormal swelling, fever, or significant pain, please call our office immediately.
• Pain Management: Over the counter analgesics such as aspirin, acetaminophen, ibuprofen, and naproxen sodium products usually alleviate the discomfort. Take pain relievers before the anesthetic wears off and continue taking for two or three days as directed. We recommend taking an anti-inflammatory such as ibuprofen (if not allergic). Take 600 mg (3 x 200 mg) Advil or Motrin four times per day for 2-4 days.
  
  You may be given a prescription for a narcotic medication if we feel it will be necessary. Narcotic medications should never be taken in combination with alcohol, histamine blockers (antihistamines), tranquilizers, muscle relaxants, or any other agent that depresses the central nervous system. Narcotics increase the effects of these medications on the brain, and overdose can result from their combined use. Remember that you must NOT drive a car or engage in any type of activity requiring mental alertness while taking narcotic or sedative-type medications.
• Swelling: If you were swollen prior to treatment, the area may be tender for several days while it heals. If the swelling does not reduce after several days or increases, please call our office.
• Antibiotics: In most cases, antibiotics are not required after endodontic therapy. You will be given a prescription for antibiotics if we feel it will be necessary.
• After-Care: You may continue your regular dental hygiene regimen. Avoid biting or chewing on the tooth during the first few days. Avoid crunchy and sticky foods like caramel, jellybeans, or gum since they may loosen or remove the temporary filling, which was placed. If the temporary filling feels loose or completely falls out, please call our office. It may need to be replaced.
• Final Restoration: A permanent restoration is recommended after having a root canal and may require additional appointments. This is the only way to ensure the longevity of the tooth. We usually place a temporary filling in the tooth, so it is important that you schedule promptly for a permanent restoration because the temporary filling will eventually allow bacteria to leak in and contaminate the tooth. Failure to complete the final restoration in a timely manner may result in the need for retreatment of the root canal(s) in your tooth at an additional cost, or possibly severe pain and infection or loss of the tooth due to fracture of the tooth and/or recontamination from leakage.
• After Treatment: Teeth treated with endodontic therapy can still decay. As with other teeth, proper dental care requires regular brushing and flossing, a nutritious diet, and regular dental visits. Please call our office if your tooth feels unusual or if discomfort persists after completion. Fortunately, most root canals heal with about a 90-95% success rate. Sometimes despite our best efforts, a small percentage of patients may need to have the root canal(s) retreated or will need root-end surgery to achieve adequate healing.

During your appointment today, one or more of your teeth were prepared for a crown or bridge. A temporary crown was fabricated for each prepared tooth. 

Temporary crowns are cemented with temporary dental cement to allow for easy removal at your next appointment. Temporary crowns are of universal size and shade. Your final restoration will be shaped and shaded to match your other teeth in both color and function.

Until your next appointment:

• Whenever anesthesia is used, avoid chewing on your teeth until the numbness has worn off.
• You may experience sensitivity to temperature and pressure, gum soreness and slight discomfort on the tooth/teeth; it should subside after the placement of the permanent crown.

Avoid hard or sticky foods that may dislodge temporary crowns, such as:

• Hard, chewy breads such as bagels or french bread.
• Chewy candies such as taffy, caramels, or gum.
• Hard, crunchy foods such as corn nuts or popcorn kernels.
• Do not bite into foods such as corn on the cob or apples.

If a temporary crown becomes loose or comes off, try to place it back onto the tooth and call the office at your convenience to get the crown recemented. Temporary cement is also available at most drug/grocery stores.

• Rinse your mouth with alcohol-free mouthwash or warm salt water to minimize inflammation of the gum tissue.
• Acrylic temporaries attract more bacterial plaque than natural teeth, therefore it is important to brush normally at least three times a day. Floss at least once a day, but floss carefully and don’t pull up on the floss which may dislodge the temporary. Pull the floss out from the side of the temporary crown.
• You may experience sensitivity to hot or cold foods or beverages after treatment.
• Mild to moderate discomfort after dental work is common. An over the counter pain reliever/anti-inflammatory is recommended for patients who are able to tolerate them. (Tylenol, Advil, Aleve, etc.) 
• If discomfort increases, please call the office. 
• If your bite feels uneven, if you have persistent pain, or if you have any other questions or concerns, please call your doctor.

We have just finished your new white (composite or resin) filling. Here is some important post-operative information:

• If we used a local anesthetic to numb the area we treated, this numbness in your lips, teeth and tongue might last for several hours after the procedure. To avoid damage to your tongue and lips, you should avoid any chewing until the numbness has completely worn off.
• It is normal to experience some sensitivity to heat, cold and pressure after your appointment. It is not uncommon for the tooth to be sensitive for several weeks or months. You can also expect some soreness in your gums for several days.
• White fillings set completely immediately after they are placed, so as soon as the numbness from the anesthetic subsides, you can chew as you would normally. If your bite feels uneven, or if you have any questions or concerns about your new filling, be sure to give us a call.

Sometimes, due to the effects of the local anesthesia, it is quite difficult to make sure that your bite is exactly right. If you feel any discomfort in chewing, please let us know. A minor adjustment is usually all it takes to make you comfortable. 

• Don’t wait too long! Teeth can become quite sensitive if the bite is “high.” You can generate in excess of 40,000 pounds per square inch when chewing on your back teeth. If the filling feels high, come in for an adjustment. 
• If you do not do this, your tooth will become irritated, and a toothache could result.

A couple of factors that are unique to multiple extractions are listed below:

If excessive bleeding is encountered, it is important to determine which site is the one that is causing the hemorrhage. 

• A gauze pad moistened with ice water should then be placed directly over this site, and by biting down on the gauze, the pressure should control the bleeding. 
• A tea bag moistened with ice water can also be used.

When multiple teeth are removed that are adjacent to one another, it is common to feel small, bony projections in the area between the tooth sockets. These are the small triangles of bone that were located between the teeth. 

• These are normal, and will smooth out over time as the sites heal.

If a new denture is worn over the sites and denture adhesive is used, it is important that the adhesive is not placed near the stitches. 

• This would result in the adhesive adhering to the stitches, which would pull on the stitches when the denture is removed.

When an immediate denture is placed following multiple extractions, it should not be removed during the first 24 hours. You will be scheduled for a follow-up appointment within 24-48 hours for removal by your dentist. 

• This is to prevent swelling and help to heal immediately after extractions.

After the first 24 hours, it is best to remove and clean the denture after meals. The denture can be cleaned with warm water and a toothbrush. 

• Standard post-extraction instructions should still apply. The denture can then be replaced.

It is important you use the dentures during the day to help get used to them. 

• If the denture is left out for extended periods of time shortly after the surgery, the soft tissue can swell, and you won’t be able to get the denture to fit properly back in the mouth.

It is normal for there to be a “settling” process, as the swelling goes down over time. This occurs as your gums and bone heal and shrink over time. This results in pressure sores in areas where the denture is rubbing excessively. Your dentist will make periodic adjustments to the denture to make it more comfortable. After these adjustments, the denture will settle again, and new sores will develop in different areas, requiring further adjustments. This “settling” process will eventually resolve as the extraction sites heal, and the denture will become comfortable and stable. This process may take up to a few weeks.

With multiple extractions in patients 50 and older, considerable bruising, sometimes even in areas quite distant from the surgical sites, is common. Like any other bruise, these will usually resolve in between 7-10 days. The presence of bruising does not necessarily mean that there are any impending problems with the surgical sites.

• Restrict your diet to soft foods, which are comfortable for you to eat. As the wounds heal, you will be able to advance your diet.
• When the corners of the mouth are stretched, as is necessary during this type of surgery, they may dry out and crack. Your lips should be kept moist with an ointment like Vaseline after surgery.
• There may be a slight elevation of temperature for 24-48 hours. If temperature continues past this time, or elevates to 101.5 or greater, please notify our office.

What To Expect With Braces

• Jaw soreness and sensitive teeth (take ibuprofen as needed for the soreness).
• Teeth may be tender to biting pressure for a few days.
• Brackets may create sore spots on cheeks, lips, or tongue (place wax on brackets to help alleviate rubbing).
• Minimal gum swelling (it is very important to maintain proper oral hygiene, such as brushing twice a day and flossing).
• Loosening of teeth is to be expected at times during treatment. Don’t worry! It’s normal. Teeth loosen first so they can be moved. The teeth will again become rigid in their new positions.
• Don’t be alarmed if a wire, bracket, or band comes loose. This happens occasionally. If the wire protrudes and is irritating, use a blunt instrument (back of a spoon or the eraser end of a pencil) and carefully, gently push the irritating wire away from your cheek. Call our office as soon as possible if any piece of the braces comes off, save it and bring it with you to the office.
• To successfully complete the treatment plan, you must work together with Dr. Mun. The teeth can only move toward their corrected positions if you consistently wear the rubber bands.

Orthodontic Avoidance List

While having braces, hard and chewy foods can break orthodontic appliances and delay treatment. The following is a list of things to avoid:

• Corn on the cob, apples, or any fruits that require biting into (apples can be eaten if they are cut into small pieces).
• Beef jerky, ribs, or wings (meats that one has to bite down and pull on).
• Crunchy food like nuts and ice.
• Candy like Jolly Ranchers, Sour Patch Kids, licorice, caramel, taffy, and Snickers.
• Gum that is very sticky (sugar-free gum or with xylitol can be chewed if placed on the cheek to make it soft before chewing).
• Chewing on hard things such as pens, pencils, and fingernails can damage brackets.

Your treatment today included scaling and root planing (deep cleaning). As a result of the therapy, you may notice:

• That your gums will be tender for the next few days.
• Mild soreness at the injection site for the next 24-48 hours if you received local anesthetic.
• Slight aching and throbbing in the area.
• Some slight bleeding in the area.
• That your teeth may be sensitive to chewing pressures.
• That your teeth may be sensitive to temperature changes and/or sweets.
• Spaces between your teeth where calculus used to be.

The discomfort you experience should not be severe or sharp and will subside in a few hours to a few days. Patients typically remark that by the third day following treatment, any discomfort is gone.

To Reduce The Symptoms

Use a rinse of salt and warm water. 

• Mix one teaspoon of salt in a glass with eight ounces of warm water. With each mouthful of the rinse, hold the solution next to the tender area and then try to force the solution between the teeth. 
• Do not swallow the salt water. 
• The warm salt water is soothing to the tissues and will help to reduce swelling in the area. You may repeat the rinse procedure as often as you like.

Take an over-the-counter medication. 

• It is most beneficial if you take an over-the-counter medication that is designed to reduce everyday aches and pain and reduce swelling (inflammation), such as a product containing ibuprofen (Motrin, Advil, Nuprin) or naproxen (Aleve). 
• However, do not take an ibuprofen product if you have an allergy/sensitivity to aspirin. If you cannot tolerate ibuprofen, then a product containing acetaminophen (Tylenol) is recommended. 
• When you take an over-the-counter product, be sure and follow the manufacturer’s instructions. You can develop a sensitivity to a medication even if you have been taking it regularly for years. So if you notice any signs of an allergic reaction, seek medical help right away.

Tooth Brushing & Flossing

Brush and floss after every meal.

• Even though your gum tissues may be tender, it is important that you break-up the dental biofilm (plaque) regularly. You will find toothbrushing to be more tolerable if you soften your toothbrush bristles which can be done by holding them under hot tap water.

Chlorhexidine

• Use the rinse you received twice daily (after breakfast and before bed) until gone. Swish for one minute, then spit.

Eating

• If local anesthetic was used to make the area numb, avoiding chewing foods or drinking hot beverages until the feeling returns. Be careful not to chew on your tongue, cheek, or lips.
• A diet of softer foods may be more comfortable if your teeth are sensitive.