Post Operative Instruction

Temporary Crowns

Temporary crowns are utilized for about 3 – 4 weeks while the permanent crown is being customized for your tooth. The temporary protects the tooth and holds its position during the interim so when the permanent crown returns from my custom dental lab it will fit beautifully.

The temporary crown is fragile and will not be as strong as the permanent crown. If it is broken or becomes dislodged, please call my office to schedule an appointment to have it replaced. You may carefully floss a temporary crown by pulling the floss down through the contact then straight out. Do not floss up and down as usual as this may dislodge the temporary crown.

If a crown does become dislodged, run it under hot water to soften the cement, then push back on. If it does not stay in place, call my office. A tooth that has had a root canal will not be sensitive if the crown comes off. A tooth with an intact nerve (no root canal) may be a little sensitive after a crown preparation has been completed. This is normal and to be expected. If the temporary crown does come off or if the sensitivity is more than expected do not hesitate to call our Bethesda dental office.

Anesthetic affects the feeling of your bite. If your bite does not feel balanced and even, once the dental anesthetic has worn off, please call me for an adjustment. A balanced bite is very important. High bites lead to pain and sensitivity.

In order to keep the gum tissue healthy, it is important to brush around the crown. Rinsing with warm salt water (1/2 teaspoon of salt in 8oz glass of water) can also be helpful to cleanse the area and aid the healing of irritated gum tissue.

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Permanent Crown

Your permanent crown is checked for fit and then cemented. You can eat on your crown immediately but it is wise not to for a day or so to allow the nerves to settle down following treatment. It is not uncommon for the permanent crown to be a little cold sensitive for a few weeks afterwards. A balanced bite is important so please be sure to inform me if you feel you have a "high" bite on any new crown.

It is, even with your perfectly fitted crown, important to floss the margins next to the gum line below the contact area to prevent periodontal disease and dental decay.

It is important to have your new crown checked regularly and cleaned by my hygienist. With regular hygiene appointments the permanent crown should last you many years.

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Resin Fillings

The anesthesia will begin to wear off in approximately one to three hours, depending on the time it was given. Until that time, avoid all hot foods and liquids. Do not chew on anything. This will prevent accidental burning or biting of your lips, cheeks or tongue.

You may experience some minor sensitivity to temperature and pressure for a few days. If your filling was especially large, it is not unusual to experience some sensitivity for a week or two. If you do experience any symptoms that seem unusual, please let me know. A simple adjustment or your bite may be necessary.

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Smile Makeover

Congratulations. You are on your way to a beautiful new smile. During the next several weeks, while you are wearing temporaries, you may have some questions. Hopefully, this information will give you all the answers, but if not, don't hesitate to call.

The evening following your appointment and several days after, take ibuprofen if you have discomfort. It helps to reduce inflammation. It is normal to feel sensitivity to temperature after your appointment. If the sensitivity persists or becomes worse, call.

You may notice some gum tissue changes after your appointment. It is normal for your gum tissues to turn whitish or slough off in the areas that I have treated. Simply do the best brushing until the irritation clears.

Your lips may feel very dry and could crack at the corners. This is due to the dryness of your mouth and lips during the procedure. You should vigilantly use your regular lip moisturizer. If given a prescription, use the medication on your lips and at the corners of your mouth, if necessary, to aid in lubrication and healing.

The temporary crowns or veneers are fragile and will not be as strong as the permanent crowns or veneers. Try to eat with a knife and fork, rather than biting things with your front teeth. If one is broken or becomes dislodged, please call me to schedule an appointment to have it replaced.

You will not be able to floss the temporary teeth, but in order to keep the gum tissue healthy, it is important to brush vigorously around the temporaries. Rinsing with warm salt water (1/2 teaspoon of salt in 8oz glass of water) can also be helpful to cleanse the area and aid the healing of irritated gum tissue.

Anesthetic affects the feeling of your bite. If your bite does not feel balanced and even, once the dental anesthetic has worn off, please call me for an adjustment. A balanced bite is very important. High bites lead to pain and sensitivity.

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Periodontal Treatment

You can take over the counter, non-aspirin, pain medication for any discomfort you may have.

Avoid eating crunchy, spicy or hot foods today. For example: chips, raw carrots, crispy fried chicken.

Rinse with warm salt water if your gums are sore and tender.

Brush gently today even if your gums are tender to help remove the plaque that has started to reform.

You don't have to floss or use any home care aids the day of your treatment if there is too much sensitivity. Starting the following day, do so daily.

Follow all of your home care instructions exactly as directed. Additionally, keep all scheduled hygiene appointments. These appointments are very important to the success of your treatment.

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Surgery

The Day of Surgery

  • Take all medications as directed on the instruction sheet prior to surgery.
  • Eat a light meal no less than two hours before surgery.
  • Do NOT drink grapefruit juice.

Post Surgery Instructions

If you were sedated:

  • You must not leave alone. You must be accompanied by an adult.
  • You may not drive or operate any vehicle or heavy equipment.
  • Women: Do not wear high heels or platform shoes.

Medications:

  • If antibiotics or steroids were prescribed, you should take them according to the instructions on the prescription bottle.
  • Take pain medication as directed in the instructions.
  • Do not consume alcoholic beverages until the healing process is complete.

Your dietary needs:

  • Do not consume hot liquids for 72 hours.
  • Do not try to eat solid foods until the local anesthetic wears off.
  • Do not use a straw when taking in liquids. The suction action may dislodge a clot.
  • Do take in liquids.
  • A nutritious diet throughout your healing stage is important to your comfort, temperament and healing. The diet for the first four days should be relatively soft foods. Increase Vitamin C intake.

Bleeding:

  • To slow and prevent bleeding, bite with light pressure on the gauze pack that has been placed over the surgical area. Pressure should be applied in thirty minute intervals and repeated until the bleeding is controlled. If profuse bleeding is still occurring 3 - 4 hour later, and the above measures have been taken, call this office immediately.
  • Do not forcefully swish when rinsing as this can dislodge the blood clot.
  • Do not exercise for 48 hours. Strenuous activity will increase your blood pressure and may dislodge the blood clot.

Swelling:

  • Swelling is part of the healing process and can be expected for several days.
  • Apply ice packs at 15 minute intervals to reduce swelling the day of surgery.
  • After 72 hours, light heat will relieve the swelling.

When you should notify Dr. Dougherty, Dr. Schlossberg, or Dr. Klotz:

  • If profuse bleeding continues after 3 - 4 hours of applied pressure.
  • If you are unable to maintain a nutritious diet after 72 hours.
  • If pain or swelling increase after the third day.
  • If the sutures become loose or dislodged prior to the third day.
  • If an oral bandage or dressing that was placed becomes dislodged prior to the third day.
  • If your body temperature remains higher than 100 degrees F. taken orally after the third day.
  • If you have any symptoms which may indicate a reaction or allergy to the medications, such as:
    • Skin rash
    • Hives
    • Elevated temperature
    • Increased or erratic heart rate
    • Nausea/vomiting
    • Dizziness
    • Blurred vision

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Wisdom Teeth Extraction

Care of the mouth following a surgical procedure, especially during the first three days, is essential to the healing process. Do expect that there will be a certain amount of swelling, discoloration, discomfort, and bleeding. 

If you were sedated:

  • You must not leave our office alone. You must, be accompanied by a responsible adult.
  • You may not drive or operate any vehicle or heavy equipment for 24 hours.
  • Women: Do not wear high heels or platform shoes.
  • Do get some assistance during the first day, when you walk to the bathroom.

Medications:

  • If antibiotics, steroids, or other medications were prescribed, do take them according to the instructions on the prescription bottle.
  • If you are able to take Ibuprofen (Advil) this has been found to be the most effective drug for pain control. You would have been directed to take 400mg prior to the surgery. Continue taking 400mg every six hours for the first two days.
  • If you cannot take non-steroidal anti-inflammatory drugs (NSAIDS eq. Advil or Alleve) then Tylenol can be used for pain management.
  • A prescription for a narcotic analgesic may have been prescribed. If so, take the drug as prescribed on the bottle, if Advil or Tylenol are not sufficient. Do not take pain medication on an empty stomach as it may cause nausea.
  • Some people have found Arnica to provide some relief of swelling and bruising. This can be found at health stores. Apply this lotion to the outside of the face in the surgical area. Do not take Arnica orally. 
  • Avoid the use of alcohol, smoking or carbonated drinks for the first 48 hours after surgery. This may interfere with clot formation and slow the healing process
  • NOTE: Antibiotics may decrease the effectiveness of birth control medications. Additional methods of birth control should be used while on antibiotics

Your dietary needs:

  • Do not consume hot liquids for 72 hours.
  • Do not try to eat solid foods until the local anesthetic wears off, as you might bite your tongue or cheeks.
  • Do not use a straw when taking in liquids. The suction action may dislodge a clot.
  • Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily. Try not to miss a single meal. A nutritious diet throughout your healing stage is important to your comfort, temperament, and healing. The diet for the first four days should be relatively soft foods. Be sure to chew away for the surgical area.
  • Increase Vitamin C intake.
  • Caution: If you suddenly sit up or stand from a lying position you may become dizzy. If you are lying down, following surgery, make sure you sit for one minute before standing.

Bleeding:

  • A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon and can continue for several hours. Avoid spitting and the use of a straw as they may provoke oozing.
  • Excessive bleeding may be controlled by first gently rinsing your mouth with cold water, then placing a gauze pad over the area and biting firmly for thirty minutes. Repeat if necessary. 
  • If bleeding continues, bite on a moistened, squeeze dried tea bag for sixty minutes, repeat as necessary. 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 is still occurring 3-4 hours later, and the above measures have been taken, call this office immediately. 
  • Do not forcefully swish when rinsing as this can dislodge the blood clot.
  • Do not exercise for 72 hours. Strenuous activity will increase your blood pressure and may dislodge the blood clot.

Swelling:

  • Swelling is part of the healing process and can be expected for several days. 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 body’s normal reaction to surgery and eventual repair. 
  • The swelling may not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be applied in 15 minute intervals continuously while you are awake. 
  • After 48 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. 
  • Forty eight hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of swelling.

Discoloration:

In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration. Also, the use of Arnica lotion can assist with this discoloration.

Other Issues:

If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as Vaseline.

Stiffness (Trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event which will resolve in time. 

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. The sutures will be removed approximately two weeks after surgery. The removal of sutures requires no anesthesia or needles. It takes only a minut or so, and there is no discomfort associated with this procedure. So it’s really nothing to worry about.

When you should notify Dr. Dougherty, Dr. Schlossberg, or Dr. Klotz:

  • If profuse bleeding continues after 3 - 4 hours of applied pressure.
  • If you are unable to maintain a nutritious diet after 48 hours.
  • If pain or swelling increase after the third day.
  • If the sutures become loose or dislodged prior to the third day.
  • If an oral bandage or dressing that was placed becomes dislodged prior to the third day.
  • If your body temperature remains higher than 100 degrees F. taken orally after the third day.
  • If you have any symptoms which may indicate a reaction or allergy to the medications, such as:
    • Skin rash
    • Hives
    • Elevated temperature
    • Increased or erratic heart rate
    • Nausea/vomiting
    • Dizziness
    • Blurred vision

Remember no question is too small and we are just a phone call away.

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