Dental Crowns and Bridges
Dental crowns and bridges usually take 2 or 3 appointments to complete. On the first appointment, the tooth/teeth are prepared, impressions are taken, and a temporary crown/bridge is placed on your tooth/teeth. A custom fit temporary restoration will be fabricated to protect your teeth and gum tissue while your permanent crown or bridge is being created at the dental laboratory. The temporary also prevents the tooth from shifting or moving, so it is essential that the it stay in place for the duration of the time in between appointments.
While your temporary is in place it is important to keep your gum tissue as clean and healthy as possible. You may need to alter your oral hygiene habits in the interim as temporary restorations are cemented with a special cement that is designed to come off easily. Continue to thoroughly brush and floss everyday. However, when flossing, take special care to pull floss out from the side rather than out from the top. Pulling out from the top can cause the temporary to come loose. If your temporary does come off, call us immediately so we can arrange to cement it back into place. Do not attempt to “glue” the temporary crown back in yourself or “go without it” as the teeth may become sensitive or shift slightly, preventing placement of the permanent crown. You can use a denture adhesive like Fixodent or toothpaste to hold the crown or bridge temporary in until you can get to our office.
Once your permanent crown or bridge is cemented, it is important to remember that these porcelain restorations do not decay, but the teeth underneath them do. The most susceptible area for decay is at, or below, the area where the tooth and restoration meet. If this area is not routinely cleaned bacterial plaque will form around the restoration, which oftentimes lead to decay. This is the most common reason for needing to replace permanent crowns and/or bridges. Therefore, it is important that you maintain a diligent daily home care program to clean your teeth and gums.
Fixed dental bridges require addition cleaning under the pontic (missing tooth). Since this “false tooth” is connected to the adjacent teeth a bridge threader is used to thread floss under it to remove plaque. These are readily available at most pharmacies. We would be happy to demonstrate how to use them for you.
Although your temporary restoration should be very comfortable, you will need to alter your chewing habits to ensure the temporary stays in place in the interim in between appointments. Avoid chewing hard and sticky foods on the temporary crown such as gum, caramels, taffy or hard candy. Also, if possible, chew on the opposite side of your mouth. If your bite feels uneven or your teeth do not come together as they did before please contact us immediately.
After the permanent restoration is placed it is normal to feel slight pressure and sensitivity to hot or cold for a few days. If, however, after 2-3 days your bite still feels uneven or if you feel discomfort when chewing on the tooth, call our office. Delaying the necessary adjustments may damage the tooth permanently. If the sensitivity gets increasingly worse or does not begin to subside after several weeks, please call our office.
Bleeding after surgery is normal and may continue for several hours following your appointment. The best way to stop excessive bleeding is with pressure. Apply pressure by placing a folded, sterile and dampened piece of gauze over the extraction site and gently bite for 30-60 minutes. Rest quietly with your head elevated. If bleeding continues, use additional gauze or bite on a tea bag for 30 more minutes. Bleeding should always be evaluated by looking directly at the surgical site. Pink or blood-tinged saliva may be seen for 2-3 days following the surgery and does not indicate a problem.
Swelling is the body’s normal reaction to surgery and healing. The swelling will not become apparent until the day following surgery and will not reach its peak for 2-3 days. After this time, the swelling should decrease but may persist for 7-10 days. Swelling may be minimized by the immediate use of ice packs. Apply the ice packs to the outside of the face 20 minutes on and then 20 minutes off while awake for the first 24 hours. After 48 hours, begin use of a warm, moist compress to the cheek.
Unfortunately, most oral surgery is accompanied by some degree of discomfort. If you do not have an allergy to non-steroidal anti-inflammatory medications like Ibuprofen (Motrin, Advil) we recommend taking this prior to the local anesthetic wearing off. If you are prescribed a narcotic pain medication alternate Ibuprofen and the narcotic medication for best pain relief. Alternate these medications as prescribed. While taking a narcotic pain medication you may not drive or operate mechanical machinery. The prescribed pain medication will make you drowsy. Once you feel like you can stop the narcotic, use Ibuprofen or Tylenol. All medications should not exceed the recommended dosage.
For the first 48 hours you should rest and relax with no physical activity. After 48 hours, you may resume activity as tolerated.
Bad breath is common and will disappear as healing occurs. Two to three days following surgery, white, possible hard tissue may be seen in the surgical site. This signifies normal, healing tissue. Complete healing of the extraction site may take 6-8 weeks.
Sutures will resorb or fall out on their own usually 5-7 days following surgery. However, it is normal for a suture to come out on the day of surgery. If bleeding occurs because the sutures have fallen out, bite on gauze to apply pressure as described on the first page.
If a dry socket occurs (loss of blood clot from socket) there is constant pain that may radiate to other areas including ear, jaw, and teeth. Symptoms of a dry socket do not typically occur until the 5th to 7th day after the procedure. If you do not have improvement during the first few days following the procedure, call the office. A medicated dressing may be placed or a medicated syringe may be given if the medications taken by mouth do not resolve the discomfort. To help prevent a dry socket avoid vigorous rinsing, sucking on the wound, spitting, using a straw, smoking and exercising for 2-3 days after procedure. You may gently rinse your mouth with a dilute mouth rinse of your choice after one day.
If an antibiotic is prescribed, take the tablets or liquid as directed. Take the entire prescription until gone. Antibiotics can be given to help prevent infection. Make sure to call the office if a rash or other unfavorable reaction occurs.
While numb, patients should avoid hot liquids or foods. Patients may have applesauce, pudding or jello. Once numbness wears off patients can progress to solid foods, chewing away from the surgical sites. Patients should avoid foods like nuts, sunflower seeds, popcorn, etc., which may get lodged in the socket areas.
Good oral hygiene is important to normal wound healing. For the first 24 hours following surgery, avoid rinsing your mouth or using mouthwash. Many mouth rinses contain alcohol which may be painful to use during the healing process. Salt water rinses are preferred as they both anti-bacterial and are non-injurious to healing gum tissue. The day following your extraction we recommend starting a regimen of these salt-water rinses. Rinse gently with warm salt water (1/2 tsp. salt in 8 oz. water) several times a day for three or four days. Brushing should also be resumed, being careful to avoid the surgical site for the first two days.
Scaling and Root Planing
Scaling and root planing is a non-surgical treatment for periodontal disease. The purpose of the treatment is to remove bacterial plaque and tartar from around teeth and under the gum line and smooth out rough target areas thereby eliminating the inflammation and infection that is the causative factor in gum disease. The progression of gum disease can be halted by removing inflammation and disrupting bacterial bio-film development with regular maintenance visits and meticulous home care.
After treatment you can expect to notice less redness, less bleeding, and less swelling of your gum tissues. Your teeth may feel smoother and your mouth will taste and feel better. The following tips will make you more comfortable, help to prevent any possible compilations and ensure the success of the procedure.
You may take an over-the-counter pain reliever for any tenderness or discomfort. Take ibuprofen (Advil/Motrin) or acetaminophen (Tylenol) as directed unless you have medical conditions or allergies.
It is not unusual for the teeth to be more sensitive to hot or cold temperatures, and/or sweets. This is normal. This occurs as the gum tissue heals and shrinks in size and should gradually resolve in a few weeks with proper home care. Consistently brushing two to three times daily with sensitivity toothpaste or using fluoride rinses may alleviate this over time. Avoid toothpastes with “whitening” or baking soda, as this will contribute to the problem. If sensitivity continues or is severe, professional application of a desensitizing agent may be required.
To help soothe the area, rinse your mouth 2-3 times a day with warm salt water rinses. If you are prescribed Peridex/Chlorhexidine, use as directed.
Resume your home care regimen of brushing twice a day with a soft bristled toothbrush and daily flossing immediately, but be gentle with the area recently treated. Your gum health must be maintained with proper home care, as instructed, and regular dental visits. You may use a WaterPik if recommended.
Refrain from smoking for 24 to 48 hours after scaling and root planing as tobacco will delay healing of the tissues. Smoking cessation is highly recommended.
After scaling and root planing, avoid chewing in the area until the anesthetic has worn off completely. It is easy to bite or burn your cheek, tongue or lip while numb.
For several days following treatment a soft diet is recommended. Avoid any hard foods such as tortilla chips, potato chips, popcorn, or seeds.
Minor bleeding that results in a pinkish tinge to your saliva is normal and may occur during the first 48 hours following treatment. You may rinse your mouth with warm salt water. If excessive bleeding should occur, apply light pressure to the area with a moistened gauze or moistened tea bag and call the office immediately for more assistance.
We ask patients to return in 6 weeks following scaling and root planing for an additional periodontal evaulation. At this appointment the healing response of your periodontal tissues will be evaluated as well as the effectiveness of your oral self-care in order to determine if further periodontal treatments are necessary as well as the frequency of your recall interval. This appointment will include re-probing the periodontal tissues.
Endodontics - Root Canals
By saving your tooth with root canal treatment, you have made a significant step towards better oral health. We have prepared this guide to answer any questions that you may have about the post-operative period and to give you information on how to preserve the health of your tooth following root canal treatment.
The irritated tissue and bacteria that caused you to need root canal treatment have been removed from your tooth following thorough cleaning of the root canal system. It is normal to feel some tenderness in the area over the next few days as your body undergoes the natural healing process. You may also feel some tenderness in your jaw from the local anesthetic and keeping it open for an extended period of time.
These symptoms are all normal, only temporary and usually respond very well to over-the-counter pain medications. It is important that you follow the exact instructions on how to take these medications. If you are prescribed and take narcotic medications for pain management you may not drive or operate mechanical machinery. The prescribed pain medication will make you drowsy so please exercise caution when taking them.
Your teeth may continue to feel slightly different from your other teeth for some time after your root canal treatment has been completed. However, contact the clinic immediately if you experience any of the following symptoms:
- Severe pain or pressure lasting more than a few days
- Visible swelling inside or outside your mouth
- An allergic reaction to medication (rash, hives or itching)
- Your bite feels uneven
- The temporary crown or filling, if one was put in place, comes out (losing a thin layer is normal)
Symptoms you experienced prior to treatment return if you should experience severe pain or pressure that lasts more than a few days, please contact the clinic as soon as possible.
It is important to note that root canal treatment is only one step in returning your tooth to full function. A proper, full-coverage restoration such as a crown is essential in ensuring long-term success of the tooth. The final restoration should be started within one month of completing root canal treatment.
As long as your endodontically treated tooth is restored properly it has the potential to last as long as your natural teeth. It is essential however that you practice good oral hygiene, to include regular brushing and flossing as well as routing checkups and cleanings. We will continue to monitor your tooth at subsequent checkups to monitor its healing. At times, the tooth may become painful or diseased months or even years after successful treatment. When this occurs, repeating the endodontic procedure at the specialist may be required to save the tooth.
Your anesthesia will wear off in approximately 1 to 3 hours after the procedure. It is very important not to chew on the numb side (to prevent biting tongue, lip, etc.) until the anesthesia wears off.
Children should be observed until the anesthesia has worn off. Due to the strange feeling of the anesthetic, many children chew on the inside of their cheeks, lips and tongue which can cause serious damage.
Your tooth (or teeth) may be sensitive to hot, cold or pressure following the placement of fillings. This is completely normal. The possible symptoms of hot, cold or pressure sensitivity will cease within a few days to a couple of weeks. In very few instances, this sensitivity could last longer than a couple of weeks. As long as your teeth or gums are continuing to feel better, (not staying the same, or getting worse) everything is fine, and there is no need for concern.
Once the anesthesia has worn off, if you feel as though any of the teeth we have worked on are hitting first when you bite down, please give our office a call immediately. This imbalance with your bite may cause further discomfort and should be adjusted.
The gum tissue can sometimes be irritated during the procedure and may be sore for a few days. The anesthetic injection site may also feel sore or bruised. If your gums are tender, rinse with warm salt water, dissolving 1/2 teaspoon of salt in an 8 oz. glass of warm water. An analgesic such as Tylenol or Advil will help to decrease discomfort.
With silver fillings, you should not chew hard foods or chew directly on the new fillings for the first 24 hours. If possible, chew only on the opposite side of your mouth. Composite (white) fillings set up right away and can be chewed on as soon as the anesthetic wears off.
Although the treatment that was performed is quite durable, the underlying tooth is still vulnerable to decay, especially at the interface between the tooth and filling. 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 restoration. If you have any other questions or concerns, please call our office.