Dental Post Op Instructions

CONGRATULATIONS on completing the Zoom Whitening process! Now that your teeth are significantly whiter, there are a few guidelines to help maintain the look of your new smile. The teeth have a protective laver called the protein pellicule. This layer contains the surface dental stains and is removed during Zoom treatments. It takes twelve to twenty four hours for the barrier to fully develop again. First, use the custom trays at home with the provided supplemental sealer/whitener as indicated during the appointment. Also, during this period, we ask you to avoid certain staining foods and products. Here is a list of what you CAN and CAN NOT eat or drink after the procedure. You do not want eat any food with color (anything that would stain a white shirt) for 24 hours after the procedure. YOU CAN EAT Drink: milk, water, clear soda Fruits: bananas, apple (no peel) White bread or flour tortillas Plain yogurts, white cheese, sour cream Cottage cheese, white rice, baked potato Plain pasta and white sauce Turkey or skinless breast YOU CAN NOT EAT Red wine, dark cola’s, coffee, tea Grapes or any fruit with color Mustard or Ketchup Red sauces Soy sauce or steak sauce No smoking and No lipstick Red meat (steak or hamburger) You may experience some tooth sensitivity during this period. To prevent this, take 600mg of Ibuprofen (3 tabs of regular Advil or Motrin) every 4 hours for 24 hours. Also, we recommend that you brush your teeth with sensitive toothpaste such as Sensodyne for the next few weeks to help reduce the sensitivity. The teeth will get back to normal soon. Please feel free to call us should you have any questions or concerns.

We hope you just had a great new dental experience and enjoyed your visit. Today, we did not JUST do a cleaning. We also:

• Performed an Oral Cancer Exam
• Checked your gums for blood, pus or pockets
• Checked for decay
• Took x-rays to check for cavities in between the teeth and infections
• Checked your fillings for leaks and cracks
• Checked for loose teeth, shifting and drifting teeth
• Checked your bite for wear facets and TMJ problems
• Evaluated your smile for orthodontic and cosmetic issues
• Consulted with you about your concerns Remember that regular cleanings and examinations are the key to long term oral health.

We are reserving time specifically for you at your next re-care appointment. We will do everything in our power to get you in and out on time. For that, we need your help! Please direct us to a time of day that works best and where there will be the least chances of something coming up that would interrupt your treatment. Any changes in the schedule affects many people. Be safe and keep smiling. We will see you soon!

What to expect after your Crown or Bridge procedure. Your tooth or teeth have been prepared for permanent restoration as a crown or a bridge. While we are waiting for the final custom made porcelain restoration to arrive from the laboratory, a temporary restoration has been placed to help cover your tooth, protect it from sensitivity and to keep the tooth from drifting into a different position in your mouth. Don’t worry, it is normal to experience some hot and cold sensitivity and this should subside in a few days. The teeth require some time to heal after removal of tooth structure and will be sensitive in the interim. Your gums may also be sore for a few days. If this sensitivity is severe and does not dissipate, please call the office for an evaluation. Remember that it will take time to adjust to the feel of your new bite. When the bite is altered or the position of the teeth is changed it takes several days for the brain to recognize the new position of your teeth or their thickness as normal. If you continue to detect any high spots or problems with your bite such as pain on chewing, call us so we can adjust it.

• Do not eat anything sticky, hard or chewy as this may pull the temporary off or break it. If it does come off, slip it back on the tooth with some toothpaste or temporary cement purchased at the pharmacy, then call us and we’ll re-cement it or make a new one. Please do not leave the temporary out of your mouth because the teeth will move and the final restoration will not fit.
• Be careful brushing and DO NOT floss around your temporary crown, as you may accidentally pop off or dislodge the temporary. You will, however, be encouraged to floss when your final crown is on.
• The size, shape and color of the temporary do not resemble the final crown. The final crown will be perfectly custom made by master technician in a laboratory and will be much smoother that the temporary.

We also recommend that you take 600mg of Ibuprofen every 4-6 hours (3 tabs of 200mg of the brand name drug Advil or Motrin) for the first 24 hours to aid with your healing and to help manage any discomfort. This is a medication that will reduce the inflammation in the area that was treated. If you have any questions or concerns following your treatment, please do not hesitate to call our office and speak with a staff member. If your call is after hours, the office voicemail will indicate how to reach the doctor on call.

What to Expect After A Filling Appointment Following a procedure in which the lip or cheek are numb, be careful not to chew or eat on the affected side. When you leave the office, your filling is hardened to about 90%. Please avoid chewing on very hard foods (such as almonds, popcorn, candy, ice…) for the next 24 hours while the fillings harden the last 10%.

• You can eat and drink normally right after the appointment, being careful not to bite your numb lip, cheek or tongue.
• Brush and floss the areas as you normally would.
• Sensitivity to hot and cold is not uncommon if the decay or preparation was deep or close to the nerve. If the tooth is responding and healing, sensitivity only lasts for a short time after the cold is introduced and does not linger. Gradually over time the thermal sensitivity decreases, as the tooth develops a healed, protective layer. It is not uncommon for this minor sensitivity to last for up to 4 weeks.
• Pain might be experienced due to muscle tightness or tenderness following operative procedures, especially at the site of the injection. Common remedies would be an anti-inflammatory pain medication such as Advil, Motrin or Ibuprofen.

Very important!

If a filling or other restoration feels ”high” and does not allow the other teeth to close together or you are having PAIN WHILE CHEWING, please contact us within a few days of your appointment for a slight adjustment of the biting surface of the tooth. Do not wait thinking it will settle down. While you are numb, you might have difficulty ”feeling” if your bite is correct because the sensation is skewed.

A repair or new filling or crown makes a change, however small, in the way teeth fit together. The tongue and cheeks will notice a change and adapt to the new addition. The filling might also feel rough to the tongue for a few days. As you brush your teeth, the filling will become smoother. The finished restoration may be contoured slightly different and have a different texture than the original tooth. Your tongue usually magnifies this small difference, but you will become accustomed to this in a few days Please do not hesitate to contact us for an adjustment if the bite does not feel right after 48 hours.

What Should Children Expect After A Filling Appointment Children should be watched carefully to make sure they don’t bite their lips, cheeks or gums before the numbness wears off. The numbness should only last a few hours. Due to the strange feeling of the anesthetic, many children will chew the inside of their lips, cheeks, or tongue which can cause serious damage. If a child develops lip or cheek swelling after a filling, it is almost always due to trauma from the child biting his/her lip. Please give them Motrin for kids as indicated for their weight and age because there is no other treatment for this condition. Allergic reactions to anesthetic are very uncommon and would present with a rash, weezing, difficulty breathing and swelling that extends beyond the area where the filling was placed. In addition, an allergic reaction would most likely occur in the office, not at home. Although unlikely, if these symptoms occur, please take your child to the ER immediately.

• Children should brush and floss around the new fillings as they normally would.
• Following a procedure in which the lip or cheek are numb, be careful not to chew or eat on the affected side. Avoid hard crunchy foods at the next meal.
• Thermal sensitivity is not uncommon if the cavity or preparation was deep, close to the nerve. If the tooth is responding and healing, sensitivity only lasts for a short time after the cold is introduced. Gradually over time the thermal sensitivity decreases, as the tooth develops a healed, protective layer.
• Pain might be experienced due to muscle tightness or tenderness following operative procedures, especially at the site of the injection. The finished restoration may be contoured slightly different and have a different texture than the original tooth.

The child might complain that they feel something is stuck on their teeth and this is normal. The tongue usually magnifies this small difference, but they will become accustomed to this in a few days Please do not hesitate to contact us if you have any questions or concerns about the procedure.

What to expect after your Root Canal procedure So, it was not as bad as you thought, right? You handled the procedure very well. Now, it is normal for your tooth to be sore and sensitive for the first few days after the root canal therapy has been completed – especially if there was pain or infection before the procedure. Initially, soft foods are recommended, as they will provide less discomfort while chewing. The soreness may continue for up to a few weeks. Your tooth may feel differently the second and third week but will get better with time and start feeling normal again. We also recommend that you take 600mg of Ibuprofen every 4-6 hours (3 tabs of 200mg of the brand name drug Advil or Motrin) for the first 24 hours to aid with your healing and to help manage any discomfort. This is a medication that will also reduce the inflammation in the area that was treated. If we prescribed other medication, please take it as indicated. Finally, you should not chew or bite hard food on the treated tooth until you have had it restored (usually with a full coverage crown) because it could fracture and decay… The crown should be completed on a timely basis, if not done today. The root canal will fail if treatment is not completed in its entirety. This could necessitate to extract the tooth that you just spent so much time and effort trying to save. If you have any questions or concerns following your treatment, please do not hesitate to call our office and speak with a staff member. If your call is after hours, the office voicemail will indicate how to reach the doctor on call.

What to Expect After The Removal of Primary (Baby) Teeth Your child will have a numb lip, cheek and/or tongue for around thirty minutes to three hours following the extraction, depending on how many teeth were removed. Please monitor your child, making sure they don’t chew on that side until it is once again “awake”. Children can bite on their cheeks and tongue and not realize how much force is being exerted. This will lead to swelling of the lip or tongue and there is no treatment for this situation.

• Remind your child not to bite their lip, cheek and/or tongue.
• Keep your child’s diet soft for 24 hours. Avoid hard, crunchy foods.
• Keep your child’s activity monitored for the remainder of the day - no high activity, please!
• Continue biting on the gauze for 10 minutes straight, then change. Repeat until the bleeding stops.

It is normal for the area to “ooze” and bleed lightly for up to 24 hours. It is not uncommon to have a light bloodstain on the pillow the night of the extraction. Often just rubbing on the pillow while asleep will cause a mixture of saliva and blood flow that may cause concern. A small amount is within normal range. If bleeding persists more than 24 hours after the extraction, please call the office.

What To Do And What To Expect After Your Extraction(s) Refrain from spitting, using a straw and smoking for 4-5 days to ensure rapid healing and to avoid complications that could be both harmful and painful to you.

• Bleeding: To prevent unnecessary bleeding, maintain gentle pressure over the sockets by biting on gauze placed over the surgical site. You have been given a supply of gauze pads. If more are required they are readily available at supermarkets and drugstores. This procedure should be continued for 60 minutes and the gauze should be replaced every 15 minutes until the bleeding stops. A tea bag, which has been moistened and wrapped in gauze, is also effective. It is not unusual to have some slight oozing for up to 24 hours. Rest today and keep your head elevated. Do not engage in physical activity since it promotes bleeding.
• Rinsing and Brushing: Do not rinse for the first 24 hours since this will contribute to blood clot dislodgment and dry sockets. After 24 hours, rinse with warm salt water (1/2 teaspoon table salt in 8 oz water) twice a day. Starting the night of your surgery, gently brush the areas of the mouth not affected by the extractions. DO NOT SPIT water out of your mouth but instead, let it drool out.
• Medications: Unless you already have your medication, pick it up as soon as possible and take it as directed. Generally, a long lasting local anesthetic is used which may prolong numbness and pain relief for up to 5-6 hours. Please take prescribed pain medication before the numbness wears off to promote a smooth transition.
• Eating: Eat soft, non-spicy and non-hot food for 2-3 days. It is important to get adequate nutrition after the surgery to help the healing process. You may want to start with fruit juices or nutritional supplements (Boost, Ensure) and then progress to a soft diet. Begin chewing foods when you are able to do so without pain.
• Ice Packs: If bone was removed, ice packs should be placed on the sides of your face adjacent to surgery sites to help prevent swelling. To the extent possible, apply for periods of 20 minutes on and 5 minutes off until bed time during the day of the surgery. By 48 hours, swelling should go down. In the event of facial or neck bruising, its resolution can be expedited with frequent heat packs and massage.
• Unforeseen Complications: If you suspect any problems with the normal course of healing, do not hesitate to call immediately. Sometimes patients develop allergies to medications (generalized rash, itching, etc), infection (foul taste, unusual or prolonged swelling), or dry sockets (throbbing pain occurring 3-7 days following procedure). These and other potential problems are treatable if brought to our attention. Please call us in L.A. (213)382-555

Muscle and Joint Relaxation Instructions We use our mouths for many activities: talking, eating, yawning, and laughing. When we are not engaged in these activities, we need to allow our jaw muscles and joints to relax. Many people have developed habits that do not permit their jaw muscles or joints to relax sufficiently. The steps listed below will help you learn how to relax these muscles and joints and reduce the jaw pain you are experiencing.

• Use hot or cold packs. If you are in extreme pain, apply moist heat, or ice, or a combination of the two to the painful area(s). Most people prefer heat, but if that increases your pain, use either a combination or the ice alone. Apply moist heat for 20 minutes two to four times each day. Wet a towel with very warm water, keeping it warm by wrapping it around a hot water bottle or by placing a piece of plastic wrap and a heating pad over it. The towel can also be rewarmed in a microwave oven or under very warm tap water.
• Use the combination of heat and ice 2-4 times a day. Apply the heat as recommended above for 10 minutes then lightly brush the painful area with an ice cube wrapped in a washcloth. Repeat this sequence 4-5 times.
• Apply ice wrapped in a thin washcloth to the painful area until you begin to feel some numbness (usually in about 10 min)
• Eat soft food Confine your diet to soft foods such as rice, pasta, fruit, soups, eggs, and yogurt. Do not chew gum or eat hard foods (such as raw carrots) or chewy foods (such as caramels, chicken, steak or bagels). Cut other food into small pieces and chew on both sides of your mouth to reduce the strain on one side.
• Rest your jaw muscles Keep your teeth apart and practice good posture.
• When you are not chewing your teeth should never touch (except occasionally when you swallow). Closely monitor your jaw position for signs of clenching. Try placing your tongue lightly on the top of your mouth behind your upper front teeth allowing the teeth to come apart and relaxing the jaw muscles.
• Good head, neck, and back posture help you maintain good jaw posture. Try to hold your head up straight, and use a small pillow or rolled towel to support your lower back. Avoid habits such as resting your jaw on your hand or cradling the telephone against your shoulder. Most of the joint pain is due to muscle fatigue.
• Avoid caffeine Caffeine stimulates your muscles to contract and, therefore, you become more tense. Caffeine and caffeine like drugs are in coffee, tea, most sodas, and chocolate. Decaffeinated coffee also has some caffeine.
• Watch your habits Avoid oral habits that put strain on the jaw muscles and joints. These include, among other things, clenching the teeth; grinding the teeth (bruxism); touching or resting the teeth together; biting your cheeks, lips or objects you put in your mouth, pushing the tongue against the teeth and tensing the jaw. Also, chewing gum is a very bad habit.
• Sleep smart Avoid sleeping habits that strain your jaw muscles or joints. Don’t sleep on your stomach or your side. Instead, sleep on your back to keep your neck and jaw aligned.
• Don’t open wide Until the pain has been reduced, avoid activities that involve opening the jaw such as wide yawning, yelling, and prolonged dental treatments.
• Using medications Use anti-inflammatory and pain-reducing medications like Ibuprofen, Motrin or Advil to reduce joint and muscle pain. Avoid medications with caffeine, such as Anacin (Whitehall), Excedrin (Bristol-Myers Squibb Company).

Today is your delivery appointment for your new Nightguard. Here are a few tips to maintain your appliance in top notch condition.

Start wearing your Nightguard every night. In the beginning, the guard might feel a little tight. It’s like a brand new leather shoe: it takes a little time to break it in. As you wear it, the appliance will feel more and more comfortable.

If you feel the appliance could use an adjustment after wearing your occlusal guard for a week, please call us to make a short appointment. Do not attempt to adjust it on your own! x ALWAYS keep your occlusal guard in the provided case when you are not wearing it. Dogs, kids and other members of the family love to play with, chew and ruin your new appliance.

Keep it safe in a drawer or cabinet out of reach!

Clean your appliance everyday with cold water and mild hand soap. NEVER use hot water as this will might warp the appliance with time. Do not use toothpaste as this will prematurely discolor your occlusal guard.

We are supplying you today with a sample of a retainer cleaner. Use the retainer cleaner every couple of days as directed on the packaging. Some patients have found Retainer Brite in stores but it is not available in all pharmacies. Retainer Brite is always available online at: http://www.smileshop.com/ or http://www.dentakit.com/. Bring your occlusal guard with you to all of your check ups to receive a free professional cleaning of your appliance by your dentist.

As always, if you have any questions or concerns please call us and we will be happy to assist you.

X-rays are necessary to be taken on a regular basis and is an important part of the examination. We take bitewing x-rays once a year to check for fractured fillings and cavities in between your teeth and we take a Panoramic x-ray every 3 to 5 years to check for cysts, abscesses or cancer. If you have any concerns or objections, please feel free to discuss them with our doctors and staff. Since most of the disease process such as decay, cysts, cancerous tumors, benign tumors and congenital abnormalities can only be detected with radiographic procedures, they are a critical part of your examination and dental evaluation. It may be comforting for you to know that the amount of exposure to radiation in our office is extremely low. We use the state of the art digital x-ray system that uses a fraction (less that 10%) of the radiation of regular film based radiography. We meet and exceed the California requirements and maintain levels that are recommended safte for you. If you refuse x-rays in our office, you understand that it is against medical advice and in direct opposition to our recommendations. Just Smile Dental, Dr.regala and his Associates cannot be held responsible for any tooth problems, jaw problems or undetected tumors that are a direct consequence of the lack of diagnostic tools available to them. If you repeatedly refuse radiographs, we may ask you to seek services at an office that would agree to treat you without radiographic examination. I decline the recommended x-ray procedures and I understand that I cannot hold Just Smile and the doctors liable for misdiagnosis or undetected tumors.