Post Op Instructions

Post Operative Dental Hygiene Instructions

Oral Hygiene

• Rinse Gently
• Brush

Floss

• Other Acids

Possible Complications

Bleeding

Normal: Pink saliva 1-2 days from area scaled when you brush teeth or rinse out. You may also notice small blood clots between teeth. Do not remove these small blood clots or rinse vigorously.

Abnormal: If you notice, large blood clots, heavy or light continuous bleeding which last through the night and until the next morning. Please call the office 714-842-5593.

Discomfort

Tissue Soreness: You may have some tissue soreness in the area scaled for approximately 1-3 days. This will subside with good oral hygiene.

Root Sensitivity: You may experience root sensitivity along the gum line on areas that have been scaled. Cold sensitivity is the most common symptom. With good oral hygiene, professional and home fluoride, these symptoms will subside.

Tooth Mobility (Looseness)

If you have lost a significant amount of bone around one or several teeth due to periodontal disease, you may experience some increased tooth mobility after your treatment here. The reason for increased mobility after scaling is due to extra stress that was placed on the tissue fibers that help hold the tooth in place. This will decrease dramatically as you heal and your homecare improves.

Recession

If your gum tissues were very inflamed before treatment, you may notice some shrinkage and a return to health as you continue your homecare regimen.

Abscess Formation

If you noticed a localized, tender swelling in any area of the mouth along the gum line, you may have an abscess forming. Please call the office 714-842-5593.

Diet

Avoid hard, sharp or highly spiced foods for 24 hours after treatment.

Crowns and Bridges

You have just had some crowns or fixed bridges cemented onto your teeth. They will replace your missing tooth structure or missing teeth and should give you years of service if you observe the following suggestions:

Chewing

Do not chew hard foods on the restorations for 24 hours after they were cemented. The cement should mature for about 24 hours to have optimum strength.

Recalls

Visit us at your regular hygiene period. Often any problems that are developing around restorations can be found at an early stage and corrected easily. Waiting for a longer time, may result in redoing the entire restoration. We will notify you of your recall appointment.

Sensitivity

You may experience mild sensitivity to hot or cold foods. It will disappear gradually over a few weeks.

Agressive Chewing

Do not chew ice or very hard objects. Avoid chewing very sticky or "hard tack" candy because it can remove the restorations.

Preventive Procedures

To provide optimum longevity for your restorations and prevent future dental decay and supporting tissue breakdown, please use the following preventive procedures that are checked.

• Brush and floss after eating and before bedtime.
• Brush with 1.1% Sodium Fluoride toothpaste dispensed by us or by prescription.
• Use a 0.4% stannous fluoride gel after brushing and before bedtime.
• Use bridge cleaners as advised by us.

If one or more 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 fines quality restoration available. However, as with a fine automobile or watch, only your continuing care and concern can assure optimum service longevity.

OCCLUSAL Guard (Night Guard)

Every effort has been made to provide you with the most comfortable therapeutic dental appliance to meet your specific treatment objectives. Proper care and maintenance by you at home will help insure that the appliance will continue to function properly and minimize any deterioration of its excellent qualities.

• Never allow the appliance near high temperatures nor allow prolonged dehydration.
• When the appliance is in regular use, allow it to air dry after cleaning until the next use. If the appliance will not be worn for periods of time exceeding one week, it would be stored in a humidor. A seal able Tupperware type container with a wet paper towel is suitable.
• Soften the appliance under warm tap water prior to placement.
• Harden the appliance under cold tap water prior to cleaning using a soft brush if necessary to remove debris.
• If mineral deposits or discoloration appear, or you have difficulty keeping the appliance clean, contact your dentist whose laboratory can provide the appropriate cleanser.
• In normal use, the appearance of the retentive portion may vary from crystal clear to mildly opaque.
• If you notice any changes in your symptoms, appearance of y our mouth or gums, or changes in the appliance itself, contact your dentist.
• Removal of the appliance is best accomplished by using equal pull on both sides of your mouth. This will minimize the chance of damage to the resilient portion of the appliance.

Post-Oral Surgery Instructions

First Hour

Make sure that the gauze remains in place and maintain pressure as you were instructed.

Apply Cold Packs

Apply ice ina small plastic bag to your cheek in the area of surgery. A better alternative to ice is the use of bags of frozen peas - they can be better adapted to your cheek to keep the area cold. Buy extra bags so they can be refrozen while the others are in use. Apply for 20 minutes and then remove for 20 mintues. Repeat this prcedure until bedtime. Continue this procedure in the mjorning until 24 hours have passed since your surgery.

Rinse

Starting 24 hours after surgery rinse 4 to 6 times a day with warm salt water (dissolve 1 teaspoon of salt in a 8-ounce glass of warm water). A diluted solution of Chloraseptic mouthwash may be used if you prefer. This should be continued for 4 to 5 days.

First 3 Days

Suck on ice chips or crushed ice. This things the saliva and keeps the surgery site cold. Rest as much as possible.

Nausea

If you experience any nausea, take one ounce of a carbonated drink every hour for 5 or 6 hours. Then drink mild tea, clear broth and soft foods before resuming your regular diet.

Bleeding

A little bleeding or oozing is normal. If bleeding continues after you have removed the gauze, it can be controlled with simple pressure. Apply gauze to the wound area that is thick enough to apply light pressure when the mouth is closed. Do this for 20-30 minutes and repeat if necessary. If you have persistent bleeding, bite on a moistened tea bag for 20 minutes. Apply an ice bag to the cheek and lie down with your head elevated on 2-3 pillows.

Swelling

A certain amount of swelling is to be expected but it will be minimized by following the above instructions. After 24 hours apply heat to the outside of your face using a warm, moist dressing. DO NOT use heat continuously--only 20 minutes out of every hour.

Sharp Edges

If you feel something hard when you place your tongue on the surgical site, you may think it is part of the tooth. This is the hard bony wall that originally supported the tooth. Leave it alone and it will heal nicely.

Diet

A nutritionally balanced diet is very important. During the first 24 hours eat soups and soft foods that are easily chewed and swallowed. Meats, vegetables, and fresh fruits can be liquefied in a blender. Gradually progress to solid food. DON'T SKIP MEALS. If you take nourishment regularly, you will feel better, gain strength, have less discomfort and heal faster. Take any prescribed food supplement as directed. If you are a diabetic, maintain your normal diet and take medication as usual.

Medications

Continue to take any medication that you normally take and BE SURE to take regularly any medication that has been prescribed for you. Pain medication may sometimes cause nausea and if this occurs discontinue taking it or take it after having eaten.

If you have any discomfort or problems that concern you, be sure to call the office at 714-842-5593.

Tooth Colored Restoration

Diagnosis

During the preliminary examination, the dentist checks the location of the blood vessels, nerves and air pockets in the jaw. Based on the results of a panoramic X-ray or CT, the dentist decides on the most suitable implant, its length, width and location in the jaw.

Chewing

As with unrestored natural teeth, avoid chewing excessively hard foods on the restored teeth (hard candy, ice, bones, popcorn kernels, etc.) because the resin material can be broken from the tooth with extreme force. In the event that a breakage occurs, replacement of a restoration is not difficult. Natural teeth can be broken also with similar forces.

Recalls

Visit us at your regular examination period. Often small problems that may be developing around the restorations can be detected at an early stage and repaired easily. Waiting for a longer time may require redoing the entire restoration. We will contact you when it is time for your recall appointment.

Preventive Procedures

ITo provide optimum longevity for your restorations and prevent future dental decay and supporting tissue breakdown, please use the following procedures.

• Brush and floss in the morning, after eating, and before bedtime.
• Brush with 1.1% Sodium fluoride toothpaste dispensed by us or by perscription.
• Use a 0.4% stannous fluoride gel after brusing, before bedtime.

The Future

We expect that you will receive several years of service from these resotration. However, some unavoidable situations may oocur, which may require restoration replacement at a future time:

• Depending on the foods you eat and other factors, there may be a slight change in color of the restoration over a period of years. If the color becomes objectionable to you, they can be replaced.
• Some restorations may demonstrate slight stains at locations around the edges. Please tell us if this occurs.
• If you had veneers placed on your upper front teeth, after a period of time the gums (gingiva) may recede from the veneers, displaying discolored tooth structure underneath. This usually takes place over several years and may require replacement.

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

Patients Instructions Following Scaling and Root Planing

Your oral hygiene will determine the type of healing response that occurs in your mouth. On the day of scaling and root planing, gently brush around the gum line. Start flossing the day after the procedure is done. Tenderness when brushing and flossing may last for several days. Thorough plaque removal must be accomplished and will help reduce tenderness and sensitivity. Maintaining an adequate diet is essential to ensure proper healing. There is no restriction regarding diet, but be careful of foods that can get lodged between the gums and tooth (i.e. popcorn, nuts, chips, etc.) Smoking and the heat it produces can irritate the gums, retarding the healing response. It is advisable to not smoke for a few days following the scaling and root planning in order to insure proper healing. The majority of patients experience an uneventful post-operative healing period, yet please be aware of the following potential side-effects.

• Bleeding: Slight bleedinga nd tissue irritation following hte procedure for the first few days is not unusual.
• Tooth Sensitivity: varying degrees of root sensitivity following the scaling and root planing can occur. This can result from exposure to cold and or hot air and liquids, sweet, salty, spicy and or acidic foods, as well as mechanically from brushing and flossing. In most individuals this sensitivity will last a few weeks before gradually subsiding.
• Gum sensitivity: discomfort following scaling and root planing varies from patient to patient. Usually ibuprofen or acetaminophen (Advil, Motrin, Tylenol) taken as directed will relieve any discomfort. Warm salt water rinses (1 tsp. salt to 8 ounces water) every 6 hours for the first few day will aid in healing irritated areas.

Post Operative Instructins Following Tooth Extraction and Bone Grafting

You have completed an oral surgical procedure. During this procedure we carefully extracted one or more teeth, removed any infection in the area then placed a bone graft to enhance the volume and quality of surrounding bone.

Your bone graft is made up of many particles. You may find some small granules in your mouth for the first several days. Do not be alarmed by these. It's normal to have some of them come out of the graft site and into your mouth. There are some things you could do to minimize the amount of particles that become dislodged:

Immediately Following Surgery

• Do not disturb or touch the wound.
• If a gauze pad has been placed over the surgical area, it should be kept in place for 30-45 minutes. After this time, the gauze pad should be removed and discarded. If the bleeding or oozing still persists, insert another gauze pad and bite firmly for another 30 minutes. You may have to do this several times.
• Unless otherwise instructed, take your first dose of ibuprofen (Motrin or Advil) 400mg (2 tablets) before the local anesthesia wears off to decrease the initial pain. If you feel it is necessary, you may take the prescribed pain medication.
• If it is necessary to take a prescription medication for pain, you may take it in conjunction with the ibuprofen or staggered with the ibuprofen.
• Avoid rinsing or spitting for 2 days to allow blood clot and graft material stabilization.
• Do not apply pressure with your tongue or fingers to the grafted area, as the material is movable during the initial healing.
Do not lift or pull on the lip to look at the sutures. This can actually cause damage to the wound site and tear the sutures.
• Do not smoke.
• Restrict your activities the day of the surgery and resume normal activity when you feel comfortable.
• Place ice packs to the side of your face where surgery was performed. Refer to the section on swelling for an explanation.

Pain

For moderate pain, ibuprofen 800mg should be taken every five to six hours on a regular schedule. By taking this pain medication regularly and keeping the blook levels constant, the medication can work better and often less prescription narcotic pain medicine is necessary.

If you cannot take ibuprofen, you can take two, regular strength (325mg) acetaminophen (Tylenol), or one extra strength (500mg) every three to four hours, keeping in mind that no more than 4 grams may be taken in 48 hours. The prescription medication may have some of this medication in it as well and should be taken into account.

For severe pain, take the tablets prescribed as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. You may take the prescription medicine in conjunction with the ibuprofen staggered with the ibuprofen.

Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding ma be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for 30 minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag (regular tea, not herbal) for 30 minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.

Swelling

The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the bodys normal reaction to surgery and eventual repair. The swelling will not become apparent until the day following the surgery and will not reach its maximum until two to three days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. In some cases you will be provided with ice packs. Plastic bags filled with ice, ice packs, or frozen peas should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 36 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Thity-six hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Diet

Do not use straws when drinking from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical site(s). High calorie, high protein intake is very important. Try to maintain a normal diet. You should prevent dehydration by taking fluids regularly.

Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least five to six glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort, and heal faster if you continue to eat.

Oral Hygiene

No rinsing of any kind should be performed until the second day following surgery. Following the secod day, gentle rinsing is allowed but not too vigorously as you can again disturb some of the bone graft granules. You can brush your teeth the night of the surgery, but avoid the surgical area.

REMEMBER: A clean wound heals better and faster.

Surgical Dressing

A surgical dressing may have been placed over your gums. Do not worry if the dressing falls off before your next appointment. This should ot adversely affect your healing. If you are concerned, feel free to call the office.

Activity

Keep physical activities to a minimum immediately following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exericising. Be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light header, stop exercising.

Discoloration

In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneth the tissues. This is a normal postoperative occurrence, which may occur two to three days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics

Antibiotics are not always given, but if you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions.

Nausea & Vomiting

In the event of nausea andor vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on Coke, tea, or ginger ale. You should sip slowly over a 15minute period. When the nausea subsides, you can begin solid foods and the prescribed medicine.

Weating Your Prosthesis

Wearing of partial dentures, flippers, or full dentures after suger will vary by patient. Please be sure to clarify with the doctor when you can wear your prosthesis. This is commonly discussed in the preoperative consultation.

Finally

Sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged. This is no cause for alarm. Just remove the suture from your mouth and discard it. If the sutures are not the dissolvable type, they will be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is no discomfort associated with this procedure. So it's really nothing to worry about.

Your case is individual. No two mouths are alike. Do not accept well-intended advice from friends. Discuss you problem with the persons best able to effectively help you, Dr. Gamarnik or your family dentist.

It is our desire that you recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call the office. Please try to call during office hours, 714-842-5593.