Postoperative Instructions

POSTOPERATIVE INSTRUCTIONS

DENTAL CROWNS

A dental crown is a tooth-shaped “cap” that is placed over a tooth – covering the tooth to restore its shape and size, strength, and/or to improve its appearance.

The crowns, when cemented into place, fully encase the entire visible portion of a tooth that lies at and above the gum line.

WHY IS A DENTAL CROWN NEEDED?

A dental crown may be needed in the following situations:

To protect a weak tooth (for instance, from decay) from breaking or to hold together parts of a cracked tooth.
To restore an already broken tooth or a tooth that has been severely worn down.
To cover and support a tooth with a large filling when there isn’t a lot of tooth left.
To hold a dental bridge in place.
To cover misshaped or severely discolored teeth.
To cover a dental implant.

WHAT TYPES OF CROWNS ARE AVAILABLE?

Permanent crowns can be made from all metal, porcelain-fused-to-metal, all resin, or all ceramic.

Metals used in crowns include gold alloy, other alloys (for example, palladium) or a base-metal alloy (for example, nickel or chromium). Compared with other crown types, less tooth structure needs to be removed with metal crowns, and tooth wear to opposing teeth is kept to a minimum. Metal crowns withstand biting and chewing forces well and probably last the longest in terms of wear down. Also, metal crowns rarely chip or break. The metallic color is the main drawback. Metal crowns are a good choice for out-of-sight molars.
Porcelain-fused-to-metal dental crowns can be color matched to your adjacent teeth (unlike the metallic crowns). However, more wearing to the opposing teeth occurs with this crown type compared with metal or resin crowns. The crown’s porcelain portion can also chip or break off. Next to all-ceramic crowns, porcelain-fused-to-metal crowns look most like normal teeth. However, sometimes the metal underlying the crown’s porcelain can show through as a dark line, especially at the gum line and even more so if your gums recede. These crowns can be a good choice for front or back teeth.
All-resin dental crowns are less expensive than other crown types. However, they wear down over time and are more prone to fractures than porcelain-fused-to-metal crowns.
All-ceramic or all-porcelain dental crowns provide the best natural color match than any other crown type and may be more suitable for people with metal allergies. The newest ceramic materials are similar in strength to porcelain-fused-to-metal crowns; however, they may wear down opposing teeth a little more than metal or resin crowns. All-ceramic crowns can be made and cemented in a single appointment.
Temporary versus permanent. Temporary crowns can be made in your dentist’s office whereas permanent crowns are made in a dental laboratory. Temporary crowns are made of acrylic or stainless steel and can be used as a temporary restoration until a permanent crown is constructed by the dental laboratory.

BRIDGES

One or more missing teeth can adversely affect the appearance and f Dental_Bridges unctionality of your smile. Missing teeth can cause a change in occlusion (bite), shifting of the teeth, temporomandibular joint disorder (TMJ), speech impediments, an increased risk for periodontal disease and a greater chance of tooth decay.

Dental bridges, like implants and partial dentures, are used to replace missing teeth. There are several types of fixed dental bridges (cannot be removed), including conventional fixed bridges, cantilever bridges and resin-bonded bridges.

Typically, conventional and cantilever bridges require shaping of the teeth surrounding a missing tooth. Crowns are then placed on the shaped teeth and attached to an artificial tooth (called a pontic).

A resin-bonded bridge requires less preparation of adjacent teeth. It is often used to replace front teeth, provided that the gums are healthy and the surrounding teeth do not have extensive dental fillings.

THE DENTAL BRIDGE PROCEDURE

During the first visit, your dentist examines the health of your gums and other teeth to evaluate if you are a candidate for a dental bridge. If you are a candidate for a dental bridge, you are given a local anesthetic so your dentist can prepare the teeth required to support the bridge. If the support teeth are decayed or badly broken down, your dentist may have to build them back up before they can be used as support teeth for a bridge.

Next, your dentist takes an impression of the prepared teeth with a putty-like material that is used to create a model of your teeth. Your bridge is fabricated based on this model by a skilled lab technician so that it precisely fits the prepared teeth. It is important that your restoration fit perfectly to avoid additional oral health problems such as tooth decay.

While your bridge is being fabricated, your dentist fits you with a temporary bridge so the teeth and gums can be protected from damage until your permanent bridge is ready.

To complete the dental bridge procedure, you must return to the dental office for a second visit to have the bridge fitted and cemented.

THE COST OF DENTAL BRIDGES

The cost of dental bridges depends on several factors, including:

The potential need for additional procedures (such as fillings or root canals) in one or two of the adjoining teeth.
The artistic technique of the dentist and lab technician.
The location of the dentist.
The coverage provided by your dental insurance.
The type of material used in the bridge.
The preparation of teeth involved in the bridge procedure.

Dental bridges can range in price from $1000 to $3000 per tooth based on the aforementioned factors. If you exercise proper dental hygiene and visit your dentist for regular checkups, your bridges can last for many years. There are a number of variables that can affect bridge longevity, though it is not uncommon for a dental bridge to last for 10 to 20 years.

TEETH CLEANING

Teeth_Cleaning Teeth cleaning is the removal of dental plaque from teeth, to prevent cavities (dental caries), gingivitis, and periodontitis. It is part of a complete program of oral hygiene.

BRUSHING

Careful and frequent brushing with a toothbrush helps to prevent build-up of plaque bacteria on the teeth. These bacteria metabolize carbohydrates in our meals or snacks and excrete acid which demineralizes tooth enamel, eventually leading to tooth decay and toothache if acid episodes are frequent or are not prevented. Calculus (dental) or tartar buildup on teeth usually opposite salivary ducts is because of calcium deposits in resident plaque. Frequent brushing and swishing saliva around helps prevent these deposits. Cavities can be costly, in terms of the monetary cost to drill out the cavities and insert dental fillings, and in terms of the tissue already damaged. Fluoride- containing, or anti-plaque (tartar control) toothpastes may be recommended by the dentist.

Early tooth-brushing utilized powdered pumice stone as a polishing agent. Later, flavored powders were mixed with the powered pumice to develop a more tasty tooth-powder. In the late 1920’s, powdered pumice was mixed with a flavored paste to make toothpaste, with no added treatment agents as found in toothpastes today.

FLOSSING

In addition to brushing, the use of dental floss too may help to prevent build-up of plaque bacteria on the teeth.

Almost all cavities occur where food is trapped between teeth and inside deep pits and fissures in grooves on chewing surfaces, where the brush, toothpaste, mouthwash, saliva, and chewing gum cannot reach.

Special appliances or tools may be recommended to supplement (but not to replace) tooth-brushing and flossing. These include special toothpicks, oral irrigators, or other devices. Initially electric toothbrushes were only recommended for persons who have problems with strength or dexterity of their hands, but many dentists are now recommending them to many other patients to improve their home dental care.

Early tooth-brushing utilized powdered pumice stone as a polishing agent. Later, flavored powders were mixed with the powered pumice to develop a more tasty tooth-power. In the late 1920s, powdered pumice was mixed with a flavored paste to make toothpaste, with no added treatment agents as found in toothpastes today.

PROFESSIONAL TEETH CLEANING

Regular teeth cleaning (Prophylaxis) by a dental hygienist is recommended to remove tartar (mineralized plaque) that may develop even with careful brushing and flossing, especially in areas that are difficult for a patient to reach on his own at home. Professional cleaning includes tooth scaling and tooth polishing and debridement if too much tartar has accumulated. This involves the use of various instruments or devices to loosen and remove deposits from the teeth.

Most dental hygienists recommend having the teeth professionally cleaned at least once every 12 to 24 months. More frequent cleaning and examination may be necessary during the treatment of many of the dental/oral disorders. Routine examination of the teeth is recommended at least every year. This may include yearly, select dental X-rays. See also dental plaque identification procedure and removal.

However, in between cleanings by a dental hygienist, good oral hygiene is essential for preventing cavities, tartar build-up, and gum disease.

DENTURES

Dentures are replacement teeth that can be removed. Many people who are missing one tooth, several teeth or all their teeth benefit greatly from false teeth.

Prosthodontics improve your chewing and speech, and support your facial muscles. They make a big difference in your appearance and your smile, and can boost your self-confidence.

Made from acrylic resin, most dentures are very natural-looking and can be matched in color and appearance to your other teeth. Several visits to a denturist are usually required over the course of a month to take the impressions and make sure your false teeth fit right. These multiple appointments with a prosthodontist are necessary for receiving all the benefits you’ll gain from them — your increased ability to chew, a great-looking smile, and confidence when speaking.

COMPLETE DENTURES

A complete denture is for people who have no teeth in their lower jaw or upper jaw, or both jaws. In addition to the other suggestions for denture care listed below, complete dentures should be removed and cleaned two or three times daily to keep your gums healthy and to allow your tissues to relax.

PARTIAL DENTURES

Partial dentures are for people who have some natural teeth remaining, or who only need to replace a few teeth. The benefits are the same as for full denture wearers: your facial muscles will be supported, your smile improved and your ability to chew and speak will be enhanced.

IMMEDIATE DENTURES

If a tooth is damaged and cannot be restored, you and your dentist may decide to create temporary dentures. That way, the dentist can pull your tooth and you can wear the temporary denture until a permanent solution is designed for you.

This temporary solution allows you to continue with your professional and social commitments without showing a gap in your smile. Sometimes an immediate denture is used to replace a number of hopeless teeth at one time. Generally, the prosthodontics will require relining, re-basing, or being completely remade three to six months later.

GETTING USED TO YOUR FALSE TEETH

Even dentures that fit beautifully require an adjustment time. At first, you may experience minor speech changes and some eating difficulties. You may also notice an increased flow of saliva during this period.

While you’re getting used to your replacement teeth, you may want to keep high-profile events to a minimum and give yourself time to adjust. You may also want to start with soft food that is easy to chew, while your comfort level increases.

Some prosthodontics wearers notice a slight change in their facial appearance. Knowing what to expect helps to anticipate normal adjustments for denture wearers and to effectively manage them.

While the dentist may advise you to wear your false teeth initially at night, normally you will remove your dentures while you sleep. Taking a break for eight hours gives your tongue and saliva a chance to do its natural job of cleaning and stimulating your gums.

CARING FOR YOUR DENTURES

Handle with care.
Remove and brush daily.
Use a brush and cleansers designed for dentures.
Don’t use abrasive cleaners or abrasive toothpastes, which will leave scratches.
Don’t sterilize them in boiling water or in the dishwasher — the hot water will warp them.
If you wear a partial denture, remove it before you brush your natural teeth and clean it carefully with a brush and cleanser.
When the false teeth are not in your mouth, soak them in a glass of water or cleanser. Dry dentures can become brittle and crack or break.
Keep your dentures in the same place and away from children and pets — keep them safe and reduce the chances of losing or misplacing them.
Have your mouth and the dentures checked at least once yearly by your denturist.

DENTAL EXTRACTIONS

WHAT IS IT?

Tooth extraction is the removal of a tooth from its socket in the bone.

WHAT IT’S USED FOR

If a tooth has been damaged by decay or a fracture, your dentist will try to repair it and restore it with a filling, crown or other treatment. Sometimes, though, the damage is too extensive for the tooth to be repaired. This is the most common reason for extracting a tooth.

Here are other reasons for extraction:

Some people have extra teeth that block other teeth from coming in.
People undergoing orthodontic work may need teeth extracted to create room for the teeth that are being moved into place.
People receiving radiation to the head and neck may need to have teeth in the field of radiation extracted.
People receiving chemotherapy may develop infected teeth because chemotherapy weakens the immune system, increasing the risk of infection. These teeth may need to be extracted.
People receiving an organ transplant may need some teeth extracted if the teeth are at risk of becoming sources of infection after the transplant, when immunosuppressive medications are given.
Wisdom teeth, also called third molars, often are extracted either before or after they come in. They commonly come in during your late teen years or early twenties. Impacted teeth get stuck in the jaw and often need to be removed if they are decayed or cause pain. A wisdom tooth that has emerged partially may be blocked by other teeth or may not have enough room to come in completely. This can irritate the gum, causing pain and swelling, which requires the tooth to be removed.

PREPARATION

Your dentist or oral surgeon will ask about your medical and dental histories. He or she will take an X-ray of the area to help plan the best way to remove the tooth. If you are having all of your wisdom teeth removed, you may have a panoramic X-ray, which takes a picture of all of your teeth at once. This type of X-ray shows the relationship of your wisdom teeth to your other teeth, as well as the upper teeth’s relationship to your sinuses and the lower teeth’s relationship to the inferior alveolar nerve, which provides sensation to your lower jaw, lower teeth, lower lip and chin.

Some health care professionals prescribe antibiotics to be taken before and after surgery, but this varies by the dentist or oral surgeon. Antibiotics are more likely to be given to people with infection at the time of surgery or with weakened immune systems, those who will be undergoing longer surgeries, or very young or elderly people.

HOW IT’S DONE

There are two types of extractions:

A simple extraction is performed on a tooth that can be seen in the mouth. General dentists commonly do simple extractions, and most can be done under a local anesthetic, with or without anti-anxiety drugs. In a simple extraction, the dentist will grasp the tooth with forceps and move the forceps back and forth to loosen the tooth before removing it. Sometimes, an instrument called a luxator, which fits between the tooth and the gum, is used to help loosen the tooth.
A surgical extraction involves teeth that cannot be seen easily in the mouth, either because they have broken off at the gum line or because they have not come in yet. Another reason for a surgical extraction is that the tooth to be removed requires a flap be cut in the gum for access to remove bone or a section of the tooth. Surgical extractions commonly are done by oral surgeons. They can be done with local anesthesia or conscious sedation. Patients with special medical conditions and young children may be given general anesthesia. In a surgical extraction, the dentist will need to make an incision in your gum to reach the tooth. In some cases, the tooth will need to be broken into sections to be removed.

If you are having teeth extracted and are receiving conscious sedation, you may be given steroids in your IV line to help reduce postoperative swelling.

If you need all four wisdom teeth removed, they usually are taken out at the same time. The top teeth usually are easier to remove than the lower ones.

Here are the types of wisdom teeth in order from easiest to remove to most complex to remove:

Erupted (already in the mouth)
Soft-tissue impacted (just under the gum)
Partial-bony impacted (partially stuck in the jaw)
Full-bony impacted (completely stuck in the jaw)

Also, if your wisdom teeth are tilted sideways, they can be harder to remove than if they are vertical.

FOLLOW-UP

Most simple extractions do not cause much discomfort after the procedure. You may take an over-the-counter non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil, Motrin and other brand names) for several days, or you may not need any pain medication.

Because surgical extractions are more complicated, they generally cause more pain after the procedure. The level of discomfort and how long you have discomfort depend on the difficulty of the extraction. Your dentist may prescribe a prescription pain medication for a few days and then suggest an NSAID. Most post-surgical pain disappears after a couple of days.

A cut in the mouth tends to bleed more than a cut on the skin because the incision cannot dry out and form a scab. So after an extraction, you’ll be asked to bite on a piece of gauze for about 20 to 30 minutes to put pressure on the area and allow the blood to clot. The area may still bleed minimally for the next 24 hours or so and taper off after that. Don’t disturb the clot that forms on the wound.

You can put ice packs on your face to reduce postoperative swelling. If your jaw is sore and stiff after the swelling dissipates, try warm compresses. Eat soft foods for a few days then try other food as you feel comfortable. Rinse with warm salt water (1/2 teaspoon of salt in a cup of water) for the first few days to help keep the area clean. Most swelling and bleeding ends within one or two days of the surgery. Overall healing takes between one and two weeks.

If the extraction needs to be closed with stitches, the stitches are usually dissoluble and should disappear in one to two weeks. Rinsing with warm salt water will help the stitches to dissolve.

You should not smoke, use a straw or spit after surgery. These actions can pull the blood clot out of the hole where the tooth was. That causes more bleeding and can lead to a dry socket, which occurs in about 5% of all extractions. It is most common when lower back teeth are removed and happens more often in smokers and women who take birth control pills.

RISKS

Infection can set in after an extraction, although you probably won’t get an infection if you have a healthy immune system.

A common complication called a dry socket occurs when a blood clot doesn’t form in the hole or the blood clot prematurely breaks off or breaks down. In a dry socket, the underlying bone is exposed to air and food. This can be very painful and can cause a bad odor or taste. A dry socket needs to be treated with a medicated dressing to stop the pain and encourage the area to heal.

Other potential complications include:

Accidental damage to adjacent teeth, such as fracture.
An incomplete extraction, in which a tooth root remains in the jaw — Your dentist usually removes the root to prevent infection, but occasionally it is less risky to leave a small root tip in place.
A fractured jaw (a risk most often encountered in older people with osteoporosis of the jaw) caused by the pressure put on the jaw during extraction.
A hole in the sinus during removal of an upper molar. A small hole will usually close up by itself in a few weeks but may require additional surgery if it doesn’t heal spontaneously.
Sustained numbness in the lower lip and chin, caused by trauma to the inferior alveolar nerve (during removal of the lower wisdom teeth). Complete healing of the nerve may take three to six months. In rare cases, the numbness, although not disfiguring, may be permanent.

DENTAL FILLINGS

A dental restoration or dental filling is a dental restorative material used to restore the function, integrity and morphology of missing tooth structure. The structural loss typically results from caries or external trauma. It is also lost intentionally during tooth preparation to improve the aesthetics or the physical integrity of the intended restorative material. Dental restoration also refers to the replacement of missing tooth structure which is supported by dental implants.

TOOTH PREPARATION

Tooth preparation is usually required before placing a dental restoration. This process involves cutting the tooth usually with a dental drill to make space for the planned restoration, remove any dental decay and structurally unsound tooth. If permanent restoration can not be carried out after tooth preparation, temporary restoration is done.

A tooth preparation is the finished product of a tooth’s structure prior to restoration with a dental restorative material, such as gold, amalgam, composite, porcelain or any number of other materials.

There are two types of preparations.

Intracoronal preparations are those preparations which serve to hold restorative material within the confines of the structure of the crown of a tooth. Examples include all classes of cavity preparations for composite or amalgam, as well as those for gold and porcelain inlays. Intracoronal preparations are also made as female recipients to receive the male components of RPDs.
Extracoronal preparations are those preparations which serve as a core or base upon which or around which restorative material will be placed to bring the tooth back into a functional or esthetic structure. Examples include crowns and onlays, as well as veneers.

In preparing a tooth for a restoration, a number of considerations will come into play to determine the type and extent of the preparation. The most important factor to consider is decay. For the most part, the extent of the decay will define the extent of the preparation, and in turn, the subsequent method and appropriate materials for restoration.

Another consideration is unsupported tooth structure. When preparing the tooth to receive a restoration, unsupported enamel is removed to allow for a more predictable restoration. While enamel is the hardest substance in the human body, it is particularly brittle, and unsupported enamel fractures easily.

ROOT CANALS

Root_Canal A root canal is a treatment used to repair and save a tooth that is badly decayed or becomes infected. During a root canal procedure, the nerve and pulp are removed and the inside of the tooth is cleaned and sealed. Without treatment, the tissue surrounding the tooth will become infected and abscesses may form.

“Root canal” is the term used to describe the natural cavity within the center of the tooth. The pulp or pulp chamber is the soft area within the root canal. The tooth’s nerve lies within the root canal.

A tooth’s nerve is not vitally important to a tooth’s health and function after the tooth has emerged through the gums. Its only function is sensory – to provide the sensation of hot or cold. The presence or absence of a nerve will not affect the day-to-day functioning of the tooth.

WHY DOES THE PULP NEED TO BE REMOVED?

When nerve tissue or pulp is damaged, it breaks down and bacteria begin to multiply within the pulp chamber. The bacteria and other decayed debris can cause an infection or abscessed tooth. An abscess is a pus-filled pocket that forms at the end of the roots of the tooth. An abscess occurs when the infection spreads all the way past the ends of the roots of the tooth. In addition to an abscess, an infection in the root canal of a tooth can cause:

Swelling that may spread to other areas of the face, neck, or head
Bone loss around the tip of the root
Drainage problems extending outward from the root. A hole can occur through the side of the tooth with drainage into the gums or through the cheek with drainage into the skin.

WHAT DAMAGES A TOOTH’S NERVE AND PULP IN THE FIRST PLACE?

Nerve and pulp can become irritated, inflamed and infected due to deep decay, repeated dental procedures on a tooth and/or large fillings, a crack or chip in the tooth, or trauma to the face.

WHAT ARE THE SIGNS THAT A ROOT CANAL IS NEEDED?

Sometimes no symptoms are present; however, signs to look for include:

Severe toothache pain upon chewing or application of pressure.
Prolonged sensitivity/pain to heat or cold temperatures (after the hot or cold has been removed).
Discoloration (a darkening) of the tooth.
Swelling and tenderness in the nearby gums.
A persistent or recurring pimple on the gums.

WHAT HAPPENS DURING THE PROCEDURE?

A root canal requires one or more office visits and can be performed by a dentist or endodontist. An endodontist is a dentist who specializes in the causes, diagnosis, prevention and treatment of diseases and injuries of the human dental pulp or the nerve of the tooth. The choice of which type of dentist to use depends to some degree on the difficulty of the root canal procedure needed in your particular tooth and the general dentist’s comfort level in working on your tooth. Your dentist will discuss who might be best suited to perform the work in your particular case.