Post-Procedure

Post Operative Instructions for Restorations (Fillings)

• Advil can be taken after the procedure if needed.
• The restoration (filling) should feel completely normal when you bite down. When you are numb it is difficult to get an accurate bite. When the numbness wears off if you feel that you are biting on the teeth that were worked on more than your other teeth please call our office for an adjustment. It is very important to have an adjustment because if a tooth is high for a period of time it could lead to fracture or root canal.
• It is normal to have some soreness when biting on this tooth for 1-3 weeks after the procedure. It is normal to have some cold sensitivity for 1-3 weeks after the procedure.
• Avoid very hot or cold foods for 1-3 weeks. Stick to a soft diet for 1-3 weeks. An over the counter night guard is advised to help with soreness.
• Please remember that we performed surgery on your tooth and that your tooth needs time to heal.
• 3 weeks or more after the procedure, if you experience lingering pain from cold lasting 3-5 minutes, ache, or throb, please contact our office. It is very important to follow up with this type of pain because you could have an infection.
• GUM Soft-Picks which are available at any local drugstore, are highly recommended to clean between teeth properly.
• It is very important that if you have been told or know that you clench and/or grind, you need to wear your night guard every night!

• Advil can be taken after procedure if needed. This was a surgical procedure and tooth needs healing time.
• Some tenderness and soreness is normal for 5-7 days after procedure. Eat on the back teeth and stick with a soft diet for one week.
• Some cold sensitivity is common for 1-3 weeks after procedure. NO extreme hot/cold for at least one week. IMPORTANT: If you have been told or know that you clench or grind, you need to wear your night guard every night!
• 3 weeks after procedure, if you experience lingering pain from cold lasting 3-5 minutes, ache or throb, or sensitivity has not subsided, please contact our office. It is very important to follow up with this type of pain because you could have an infection.
• Do not eat sticky foods or candies because this will dislodge your crown. You should NEVER use your front teeth to bite into foods especially carrots, celery, corn on the cob, apples etc. This type of force on the front crowns could dislodge or break your crowns. It is best to cut your food and eat with your back teeth.
• GUM Soft-Picks which are available at any local drugstore, are highly recommended to clean around your crown properly. You may use floss. When flossing, place floss in and then pull through towards your lip to remove, do not pull straight up as normal. If a crown is not cleaned properly on a daily basis this could lead to decay and the need for additional treatment.

• Advil can be taken after procedure if needed. This was a surgical procedure and tooth needs healing time.
• Some tenderness and soreness is normal for 5-7 days after procedure. Eat on the other side and stick with a soft diet for one week.
• Some cold sensitivity is common for 1-3 weeks after procedure. NO extreme hot/cold for at least one week. IMPORTANT: If you have been told or know that you clench or grind, you need to wear your night guard every night!
• 3 weeks after procedure, if you experience lingering pain from cold lasting 3-5 minutes, ache or throb, or sensitivity has not subsided, please contact our office. It is very important to follow up with this type of pain because you could have an INFECTION.
• Do not eat sticky foods or candies because this could dislodge your crown.
• GUM Soft-Picks which are available at any local drugstore, are highly recommended to clean around your crown properly. You may also use floss. When flossing, place floss in and then pull through towards your lip to remove, not straight up as normal. If a crown is not cleaned properly on a daily basis this could lead to decay and the need for additional treatment or loss or your tooth.
• The restoration (crown) should feel completely normal when you bite down. If you feel that you are biting on that tooth more than your other teeth please call our office for adjustment. It is very important to have an adjustment because if a tooth is high for a period of time it could lead to FRACTURE OR ROOT CANAL.

***Please Note: Decay can form around the area where the crown and tooth meet requiring a new crown, or more extensive treatment depending on the amount of decay. It is very important to use soft picks around that area and of course keep a low sugar diet and brush twice per day.

Your endodontic treatment been completed and the root canals have been permanently sealed. WITHIN THE NEXT TWO WEEKS, PLEASE SCHEDULE AN APPOINTMENT TO PLACE A FINAL RESTORATION WITH YOUR DENTIST. This will protect the tooth against fracture and decay. Most teeth having root canal treatment require a crown. Delay in obtaining a filling or crown may result in fracture and possible loss of tooth.

You may eat and drink as soon as the numbness wears off. The tooth may be tender for several days or for as long as a few weeks. Although there is no nerve inside the tooth after treatment, there is still a ligament around the outside of the tooth. The ligament has nerve fibers that may become irritated as a result of treatment. We recommend taking 600mg of ibuprofen (Advil or Motrin) every 4 hours for the first two days following treatment. If you are allergic to ibuprofen, take 2 Tylenol tablets every 4 hours. Avoid chewing on that side of your mouth until your tooth is permanently restored.

Please contact the office if you develop swelling, severe pain, an allergic reaction to medication, a return of your symptoms, or if your bite feels high.

Antibiotic

If an antibiotic has been prescribed, start taking it the first day (unless directed otherwise) and use to completion. You can reduce stomach upset by taking it with food and/or plenty of liquid.

Ibuprofen

Unless you have a reason you can’t take ibuprofen (such as an allergy to ibuprofen or aspirin, or a stomach ulcer), take 600mg of ibuprofen at a time, at 6 hour intervals. Start the day of the surgery, and take for the next 2 days. After that you can still take it as needed for pain. Do not use ibuprofen for more than one week.

Pain pills

Take one pain pill as soon as you can after surgery. It will usually work better if taken before the numbness wears off. After that, take only as needed. Take any narcotic pain pills with food and/or plenty of liquid. Do not drive after taking any narcotic pain pill and do not take them with sleeping pills or alcohol. It is OK to take the ibuprofen and pain medication at the same time.

***Optimal medication combination: 400mg Ibuprofen and 500mg Acetaminophen. Take every 4-6 hours for 5 days then, as needed for pain. Disregard if you cannot take an NSAID.

Ice bag

Use a cold pack (a plastic bag of frozen peas works well) to the face over the area where the procedure was done for 10 minutes at a time, twice an hour, for the first 6 hours. You can periodically use an ice bag the rest of the day of surgery and the next day. If you use the ice bag as directed, you should have less swelling than you would have otherwise. Less swelling = less pain. Do not use hot packs or a hot water bottle.

Sleep somewhat inclined

For the first 2 nights after the procedure, sleep in a recliner chair or with your head propped up with some pillows. A recliner is a lot better. If you keep your head above your heart level for the first 2 days, it will significantly cut down on post-op swelling. Less swelling = less pain.

Swelling

Most people get some swelling and, if they do, it usually happens about 48-72 hours after surgery. Using the ice bag and sleeping inclined as directed above will help a great deal with keeping it to a minimum.

Oral hygiene

Do not use a water-pik or an electric toothbrush around the surgical area for 4 weeks after the procedure. After that, it should be OK. Around the surgery area, for the first 2 weeks use the red handled toothbrush as noted above. You can brush the areas not worked on with your usual toothbrush. Do not floss around the tooth/teeth worked on for 1 week, so you don’t accidentally take out any of the stitches. After 2 weeks, there should be no oral hygiene restrictions, except for water-piks & electric toothbrushes as noted above.

Salt-water rinses

Rinse your mouth out (don’t swish) with warm salt water (1/2-tsp. salt in 8-ounce glass of 120-degree water). Hold this in the mouth for 30 seconds and spit out. Repeat. Do this 4-5 times per day for 7 days. Start three days after oral surgery.

Exercise

Avoid strenuous exercise for the first 7 days. Strenuous physical activity may increase postoperative pain or cause post-operative bleeding and swelling. Less activity equals less pain.

Touching the surgical site

It is important that the surgical site remains untouched during the initial stages of healing. We recommend that you avoid stretching your mouth to look at the site, use caution when washing your face, and avoid playing with your tongue on the surgical sites.

Stitches

If the stitches are dissolvable, they should fall out in 3 to 7 days. If they dangle and bother you, cut the dangling part with a small bathroom scissors. If the stitches are not dissolvable, they will need removed in about 7-10 days.

Bleeding

“Pink” saliva is normal for a few days. If you get any bleeding, you need to apply pressure.Many patients will have some. Wipe it clean of any “blood clots” first. It has to be thoroughly cleaned first. Then apply gentle (it doesn’t need to be real hard) pressure to the cheek and tongue side of the surgical area for 10 straight minutes with a soaking wet tea bag (black tea works best), or a soaking wet gauze pad, or a clean wash cloth, etc. Be sure it is soaking wet. If it is not, the clot will stick to it and start bleeding again when you pull it away. If it just won’t stop, call.

Food

Stay on a soft diet, chew away from the surgery area and avoid any foods that would be more likely to get stuck in the surgery site, such as corn, popcorn, nuts, and seeds (fruits like strawberries have seeds). Do this for up to 3 weeks. Citric juices, carbonated beverages or acidic foods, like tomatoes, may make it hurt, but won’t damage the healing, though. For the first 7 days avoid really hot foods or drinks.

Several glasses a day for the 1st week or 2 of a nutritional food supplement (Carnation Instant Breakfast drink, Ensure, Slim-Fast, etc.) is advisable as a food supplement. Ensure makes a product called Glucerna for diabetics. After 3 weeks, there should be no eating restrictions. Nothing but light sucking with a straw for the first 2 weeks. No milkshakes with a straw for 3 weeks.

Nightguard

If you have a nightguard, you should wear it during the healing time and thereafter (if it causes you discomfort you don’t have to wear it until any discomfort goes away).

Smoking

Pain rates are higher and healing slowed with smoking within the first 3 weeks. If you do smoke, keep it 5 cigarettes or less per day and only smoke half the cigarette. No cigars or pipes.

Aspirin Unless you have a special medical reason for taking aspirin (tell us at least a week ahead of time if this is the case), do not take aspirin products for 7 days prior to thru 7 days after the surgery procedure. Aspirin can cause bleeding.

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 at least 2 weeks.

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 another 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. Pain can last up to 10 days and worsen at some point during this time period. 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.

***Optimal medication combination: 400mg Ibuprofen and 500mg Acetaminophen. Take every 4-6 hours for 5 days then, as needed for pain. Disregard if you cannot take an NSAID.

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, 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 mouthrinses.

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 the Doctor 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.

Antibiotic

If an antibiotic has been prescribed, start taking it the first day (unless directed otherwise) and use to completion. You can reduce stomach upset by taking it with food and/or plenty of liquid.

Ibuprofen

Unless you have a reason you can’t take ibuprofen (such as an allergy to ibuprofen or aspirin, or a stomach ulcer), take 600mg of ibuprofen at a time, at 6 hour intervals. Start the day of the surgery, and take for the next 2 days. After that you can still take it as needed for pain. Do not use ibuprofen for more than one week.

Pain pills

Take one pain pill as soon as you can after surgery. It will usually work better if take before the numbness wears off. After that, take only as needed. Take any narcotic pain pills with food and/or plenty of liquid. Do not drive after taking any narcotic pain pill and do not take them with sleeping pills or alcohol. It is OK to take the ibuprofen and pain medication at the same time.

***You may take a max of 2 Advil, 1 Tylenol and 1 Vicodin every 4 to 6 hours

Ice bag

Use a cold pack (a plastic bag of frozen peas works well) to the face over the area where the procedure was done for 10 minutes at a time, twice an hour, for the first 6 hours. You can periodically use an ice bag the rest of the day of surgery and the next day. If you use the ice bag as directed, you should have less swelling than you would have otherwise. Less swelling = less pain. Do not use hot packs or a hot water bottle.

Sleep somewhat inclined

For the first 2 nights after the procedure, sleep in a recliner chair or with your head propped up with some pillows. A recliner is a lot better. If you keep your head above your heart level for the first 2 days, it will significantly cut down on post-op swelling. Less swelling = less pain.

Swelling

Most people get some swelling and, if they do, it usually happens about 48-72 hours after surgery. Using the ice bag and sleeping inclined as directed above will help a great deal with keeping it to a minimum.

If Your Temp Comes Off:

• Clean any loose or excess “old” cement from the temp
• (Practice replacing in mouth so you know the correct orientation)
• Dry the temp
• With the cement we provide, on a sheet of paper, dispense equal amounts of base and accelerator onto the paper
• Mix together with the stick end of Q tip
• Dry tooth quickly with the cotton roll
• Apply cement inside of the temp crown and seat onto tooth
• Bite down on cotton roll for 4 minutes
• Excess cement that has been expressed out of temp can be cleared off after 4 minutes
• If we have not provided you with temporary cement, it can be found in most drug stores in the dental aisle.

• Brush and floss your teeth, brush your tongue and rinse your mouth prior to use.
• Allow the appliance to air dry in its container when not in use.
• The regular use of “over the counter” denture cleaners with a maximum 20 minute soak will help manage any accumulation of minerals or stains. DO NOT brush your night guard!
• In normal use, the appliance may vary from crystal clear to mildly opaque.
• Removal of the appliance is best accomplished by using equal pull on both sides of your mouth. This will minimize the risk of damage to the resilient portion of the appliance.
• Store safely away from pets as they love to chew on anything that has been in the mouth.

Most patients experience little or no discomfort after scaling and root planing. The most frequent complaints are: slight tenderness of the gum tissue, teeth that are mildly sensitive to cold drinks and foods, and discomfort when eating spicy foods. You may do the following to minimize any of these inconveniences:

Take an over-the-counter pain medicine such as Advil or Aleve® if you experience any discomfort. Later, you can take the same medication if you have any tenderness of the gums. If you must avoid these pain medicines because you are already taking NSAID's, are allergic to them, or you have ulcers, then you may take acetaminophen (Tylenol®). Please follow dosage recommendations on the product labels.

Any sensitivity should gradually go away in a few weeks; however, in some cases, the sensitivity can take longer to go away. If this is the case, try to avoid really cold liquids and foods for a few days or more after the scaling and root planing is performed. If needed, you can use sensitivity toothpastes, such as Crest, Aquafresh, or Colgate for Sensitive Teeth® to help reduce the sensitivity.

You may rinse with warm salt water as often as you wish. Stir no more than 1/4 teaspoonful of table salt and 1/4 teaspoonful of baking soda into a cup of warm water to use as your rinse solution. This will help soothe any gum tissues that may be tender after the root planing procedure.

It is MOST important to maintain good plaque control to promote optimal healing after scaling and root planing. Therefore, please perform all home care procedures as prescribed by your dentist or hygienist.

Please call the office if you experience any problems other than those listed above, 215-855-3489.

For the first 24 hours your immediate denture is not to be removed from your mouth. If the denture is removed, swelling may occur that will make it difficult or impossible to replace the denture.

After extractions, do not rinse, spit, smoke or suck on a straw. Do not rinse your mouth vigorously. Do not drink any hot beverages or carbonated beverages. See Extraction Post Operative Instructions for additional information on care of our mouth after tooth extraction

Your immediate denture not only replaces your missing teeth, but it is acting to protect the surgical site, control swelling, and control bleeding. The denture needs to be in place to be effective.

The fit of your immediate denture will change as your mouth heals from the

extraction of your teeth. As healing occurs, the dental ridges change shape – and they generally shrink in size. An immediate denture is often only a temporary denture which will require replacement or reline after final healing of the mouth.

The immediate denture will need to be adjusted and/or relined to compensate for the changes that will take place in your mouth as the gums heal. You will be instructed by your dentist to return for periodic appointments to monitor your mouth for changes that will require denture adjustments.

After the dental extraction sockets have healed over (two to six weeks) you may find a denture adhesive paste or powder to help stabilize your denture.

Dental extraction sockets can take 4 to 6 months to heal and fill in with new jaw bone. At that time, your dentist will speak to you about replacing your immediate denture with a permanent denture or a permanent reline.

Antibiotic

If an antibiotic has been prescribed, start taking it the first day (unless directed otherwise) and use to completion. You can reduce stomach upset by taking it with food and/or plenty of liquid.

Ibuprofen

Unless you have a reason you can’t take ibuprofen (such as an allergy to ibuprofen or aspirin, or a stomach ulcer), take 600mg of ibuprofen at a time, at 6 hour intervals. Start the day of the surgery, and take for the next 2 days. After that you can still take it as needed for pain. Do not use ibuprofen for more than one week.

Pain pills

Take one pain pill as soon as you can after surgery. It will usually work better if take before the numbness wears off. After that, take only as needed. Take any narcotic pain pills with food and/or plenty of liquid. Do not drive after taking any narcotic pain pill and do not take them with sleeping pills or alcohol. It is OK to take the ibuprofen and pain medication at the same time.

Ice bag

Use a cold pack (a plastic bag of frozen peas works well) to the face over the area where the procedure was done for 10 minutes at a time, twice an hour, for the first 6 hours. You can periodically use an ice bag the rest of the day of surgery and the next day. If you use the ice bag as directed, you should have less swelling than you would have otherwise. Less swelling = less pain. Do not use hot packs or a hot water bottle.

Sleep somewhat inclined

For the first 2 nights after the procedure, sleep in a recliner chair or with your head propped up with some pillows. A recliner is a lot better. If you keep your head above your heart level for the first 2 days, it will significantly cut down on post-op swelling. Less swelling = less pain.

Swelling

Most people get some swelling and, if they do, it usually happens about 48-72 hours after surgery. Using the ice bag and sleeping inclined as directed above will help a great deal with keeping it to a minimum.

Oral hygiene

Do not use a water-pik or an electric toothbrush around the surgical area for 4 weeks after the procedure. After that, it should be OK. Around the surgery area, for the first 2 weeks use the red handled toothbrush as noted above. You can brush the areas not worked on with your usual toothbrush. Do not floss around the tooth/teeth worked on for 1 week, so you don’t accidentally take out any of the stitches. After 2 weeks, there should be no oral hygiene restrictions, except for water-piks & electric toothbrushes as noted above.

Salt-water rinses

Rinse your mouth out (don’t swish) with warm salt water (1/2-tsp. salt in 8-ounce glass of 120-degree water). Hold this in the mouth for 30 seconds and spit out. Repeat. Do this 4-5 times per day for 7 days. Start three days after oral surgery.

Exercise

Avoid strenuous exercise for the first 7 days. Strenuous physical activity may increase postoperative pain or cause post-operative bleeding and swelling. Less activity equals less pain.

Touching the surgical site

It is important that the surgical site remains untouched during the initial stages of healing. We recommend that you avoid stretching your mouth to look at the site, use caution when washing your face, and avoid playing with your tongue on the surgical sites.

Stitches

If the stitches are dissolvable, they should fall out in 3 to 7 days. If they dangle and bother you, cut the dangling part with a small bathroom scissors. If the stitches are not dissolvable, they will need removed in about 7-10 days.

Bleeding

“Pink” saliva is normal for a few days. If you get any bleeding, you need to apply pressure.Many patients will have some. Wipe it clean of any “blood clots” first. It has to be thoroughly cleaned first. Then apply gentle (it doesn’t need to be real hard) pressure to the cheek and tongue side of the surgical area for 10 straight minutes with a soaking wet tea bag (black tea works best), or a soaking wet gauze pad, or a clean wash cloth, etc. Be sure it is soaking wet. If it is not, the clot will stick to it and start bleeding again when you pull it away.

If it just won’t stop, call.

Food

Stay on a soft diet, chew away from the surgery area and avoid any foods that would be more likely to get stuck in the surgery site, such as corn, popcorn, nuts, and seeds (fruits like strawberries have seeds). Do this for up to 3 weeks. Citric juices, carbonated beverages or acidic foods, like tomatoes, may make it hurt, but won’t damage the healing, though. For the first 7 days avoid really hot foods or drinks.

Several glasses a day for the 1st week or 2 of a nutritional food supplement (Carnation Instant Breakfast drink, Ensure, Slim-Fast, etc.) is advisable as a food supplement. Ensure makes a product called Glucerna for diabetics. After 3 weeks, there should be no eating restrictions. Nothing but light sucking with a straw for the first 2 weeks. No milkshakes with a straw for 3 weeks.

Nightguard

If you have a nightguard, you should wear it during the healing time and thereafter (if it causes you discomfort you don’t have to wear it until any discomfort goes away).

Smoking

Pain rates are higher and healing slowed with smoking within the first 3 weeks. If you do smoke, keep it 5 cigarettes or less per day and only smoke half the cigarette. No cigars or pipes.

Aspirin

Unless you have a special medical reason for taking aspirin (tell us at least a week ahead of time if this is the case), do not take aspirin products for 7 days prior to thru 7 days after the surgery procedure. Aspirin can cause bleeding.

Please contact our office at 215-855-3489 with any questions or concerns.