After Routine - Advanced Cosmetic Dentistry

Select Your Current Condition:

Intro

This section is a compilation of after dental procedure instruction sheets. All of these sheets were written and customized by Dr Landers. Via patient suggestions and advancements in dental care, these sheets have been through many updates over the past 16 years. Since these sheets are updated at our office, these documents will continually be updated to help you and your friends to manage your after visit concerns.

#1 Post Operative Instructions for Root Canals

Numbness may last for several hours. It is recommended that you do not eat until the anesthetic wears off.
The tooth is now hollow and fragile. Chewing on that tooth should be avoided until final restoration is complete. Eating on the tooth could result in tooth fracture and tooth loss! Additionally, eating could result in food impaction and a gum tissue infection.
It’s normal for the tooth and surrounding area to be tender to mastication for as long as two weeks. Be careful chewing. Please avoid directly chewing on the tooth until the final dental restoration is placed.
It is normal to have discomfort for 24-48 hours, tenderness for one week, and during the second and third weeks the tooth will feel different from the rest of your teeth. Remember, when symptoms continually get better, you are going through the normal healing process.
It is advisable to take an anti inflammatory/ pain reliever such as Advil, Motrin or Naprosin.
If discomfort is prevalent at nighttime, sleeping at an incline with your head above the level of your heart will help relieve pressure to your throbbing tooth (i.e. sleep slightly reclined in a Lazyboy chair or stack your pillows and/or couch cushions to elevate your head were you sleep).
Jaw soreness may also be an unfortunate side effect due to keeping the mouth open for unusual lengths of time. Unfortunately, it’s also normal to experience soreness from dental injections. This soreness should not last for more than a few weeks.
If you are in between appointments and your root canal is not complete, it is very normal to experience discomfort. If you have an unusual amount pain, please call us. Depending on your symptoms we may prescribe medicine. Please do not miss your scheduled final fill appointment.
Please rest!!!! Limit physical activity for 24-48 hours.
The dental temporary is made to last for two weeks maybe a month or so at the most.
The temporary will have a medicinal taste. It is possible that the “clay like” temporary may wear away or seem like it fell out. Don’t be alarmed. Use a well lit mirror, and try to look into your tooth and/or feel with your finger or tongue. In most situations, the temporary has simply worn down and the seal is intact. If your temporary is intact, simply keep your next scheduled appointment.

If Your Root Canal Is Complete & You Have Lost Your Temporary
If you are unsure, Dr. Landers usually finishes Root Canal Therapy in a single visit. As long as the root canal is complete, your main concern should be: don’t eat in the area as to avoid tooth breakage. You should, though, still make sure you have a temporary. Over time, bacteria will leak into the root canal sealer cement. If this happens you may need to redo the root canal therapy.

If your Root Canal Is Not Complete and You Loose Your Temporary
If your root canal therapy is not complete and you have lost your temporary. Call our office as soon as you get a chance. It’s not likely to cause pain, but the temporary seals in medicine and seals out bacteria. If the temporary is not professionally replaced in a timely fashion, the bacterial leakage could affect the success of your root canal therapy. If the seal is broken for more than a few days it is likely that you will need to use an antibiotic and have a new temporary place by Dr. Landers.

I was told my root canal is now finished. Is my tooth finished?
In general, the “root canal” therapy is completed solely to clean & fill the roots of your tooth. In all situations, after the root canal filling has been placed to seal your roots, you will need a final restoration to replace the chewing surface of your tooth. Dr Landers usually recommends a Post & Crown. A crown will also help support the remaining tooth and seal out bacteria. With out a final restoration as a seal, the bacteria could eventually break down the root canal cement.

#2 New Denture Pain Help & Suggestions

Do expect a challenge in handling different types of foods with your new appliances. When chewing, the seal, which holds the full dentures in place, will be broken from time to time no matter how good the fit is. You must learn to chew food on both sides of your mouth evenly to avoid unseating.
Do clean the denture with soap and water and brush after every meal.
Do exercise care with dentures when cleaning and handling. Fill the sink with a few inches of water so that dentures won’t fracture if accidentally dropped.
Do expect the return of good speech within several days after you start wearing the appliance. Your tongue is a muscle and if you have not had teeth or dentures it will grow into the empty space. Don’t worry because after some time your tongue will become smaller again to accommodate the new denture
Do expect to return at least 2 times for adjustments for full or partial dentures. Soreness or Sore Spots Always Occur and give the dentist an indication were and how to adjust your denture.
Do recognize the fact that no denture is permanent. ALL dentures require inspection and service for the rest of your life in order to keep the tissues healthy and to prevent rapid shrinking of the bone. We recommend that you return once per year for routine care and check-up.
Do recognize the fact that poor cleaning habits can result in extremely dangerous infections or tissue reactions which may require 6 to 8 weeks of treatment to heal, and may result in permanent damage to the tissue.
Do remember that any appliance that has to be repaired because of breakage never fits quite as good as before it was broken.
Do expect an increased amount of saliva in your mouth for 24 hours.
Do not use abrasive substances to clean the denture. An overnight soaking solution is available to use if soap and water is inadequate.
Do not expect the lower denture to be as stable or as comfortable as the upper denture. The only way to improve a full lower denture function is to place implants that utilize precision attachments to stabilize your denture.
Do not use denture powders or adhesives at first so it can be determined how retentive the denture is. After a while an adhesive will probably be necessary for a better seal.
Do not expect to master the handling or control of complete upper and lower dentures in a few days. It will probably take 2-3 months to master the control of them. Remember that dentures are not “teeth”, they are “tools”.
Do not under any circumstances attempt to file or scrape your dentures.
Do not wear the dentures at night unless doctor OK’s this.

#3 Over the Counter Recommendations for Pain

Adult Dosages

Rx Aspirin 325mg (OTC)
Disp
Sig 2 to 3 tablets every 4 hours

Rx Ibuprofen 200mg (OTC)
Disp
Sig 2 to 4 tablets every 4 hours, up to 16 tablets (3200mg) per day

Rx Acetaminophen 325mg (OTC)
Disp
Sig 2-3 tablets every 4 hours

#4 I Have Pain-Do I Need a Root Canal

To give you a better understanding of weather or not you need a root canal its best if you first understand dental pain in general. Toothache pain is very difficult to understand and dental pain can be poorly localized. It’s easier to understand the reason for your pain, if you first try to imagine the anatomical form of the tooth and nerve. The nerve is centrally located in the tooth and is anatomically shaped like a tree. In short, there is a trunk, limbs and thousands of tiny branches which radiate into the surrounding tooth structure. If you have a history of nerve trauma, for instance, deep decay removal near the nerve, it’s likely and common that many tiny branches of the nerve were traumatized. This traumatic process will commonly cause swelling of the nerve and tissue inside the tooth. The result is pain! Dentists universally refer to this nerve swelling as pulpitis. As a general guide, pulpitis is categorized into two subcategories: “reversible” or “irreversible” and there is a lot of “gray area” in between. It’s also important to note, each person will uniquely experience dental pain differently.

Reversible Pulpitis

In general, if you have reversible pulpitis your symptoms are:

Initially very painful but get better quickly (i.e. 1-2 days)
Initiated by a stimulus i.e. chewing, cold or hot
Short duration i.e. 30 seconds or less

Patients with reversible pulpitis will usually get considerably better after a few days following their dental visit. Most often these patients will not require any further therapy. It is normal for Patients with Reversible Pulpitis” to experience small amounts of sensitivity for as long as a few weeks or even months. In this case, a desensitizing tooth paste is a great idea. Remember, when symptoms continually get better, it’s likely you are going through the normal healing process. In all cases, It’s important to make sure your bite feels normal. Remember, you were numb when you had your filling placed and may not have been able to mark your bite accurately. If your bite does not feel normal you must return to the dentist for an adjustment! If it is left untreated, a tooth high in the bite is likely to cause tooth nerve trauma.

Rule out:
Extreme flash of Sharp pain upon biting-Cause: possible Cracked Tooth Syndrome

Irreversible Pulpitis

On the other hand, as the name implies, Irreversible Pulpitis is permanent nerve damage and ultimately the tissues of the tooth will necrose or die. Some tips with regard to understanding symptoms of irreversible Pulpitis:

Possible Symptoms

Dull, throbbing, Intense pain
Spontaneous Pain
Continuous pain
The Tooth may be Loose
Lingering pain with thermal changes (esp. cold)
Percussion sensitivity (tap your finger nail on each tooth)
Slight elevation of the tooth out of the socket
Pus drainage around the tooth
Grey colored tooth with a history of trauma
Intra-oral or extra-oral “pimple-like” draining pump or sore
Possible swollen Lymph nodes
Possible low-grade fever

Rule out:
Common Mouth Sores
Gum Tissue Swellings (Periodontal Disease)

If you suspect Irreversible pulpitis, you should call for an appointment as soon as you can. You can not keep a tooth that is non-vital and it’s not advisable that you delay needed therapy.

All Of The Gray In Between

In some situations, it is difficult to clinically decide at what point the nerve of the tooth is to be categorized as “irreversible” and subsequently inform the patient they need a root canal or tooth removal. The former is true because parts of the tooth nerve often remain alive while the infected tooth is degenerating. Generally speaking, the more the pain disrupts the patient’s lifestyle, the more likely it is caused by irreversible pathosis. It’s important to note, each person will uniquely experience pain differently.

Why doesn’t my dentist just take an X-ray and tell me I do or don’t need a Root Canal?

Most of the time, your dentist will be able to clearly advise you based on your symptoms and clinical testing. Unfortunately, necrotic pulps may not produce radiographic changes in early stages. Other clinical testing and your symptoms may place you into the in between category or “Gray area.” This is when clinical experience and clear patient communication play a huge roll. In short, let the patient decide to watch the tooth (1-2 weeks) or immediately begin treatment.

Initial symptoms of “reversible Pulpitis” can be similar to the classic symptoms of “irreversible Pulpitis”. If you have extreme pain in the first 24-48 hours, you might decide you just can’t wait to find out whether or not you may be able to avoid a Root Canal. You may elect to begin the root canal therapy simply to relieve the severe pain. Remember your dentist does not want to see you suffer, if you are truly “sitting on the fence” between reversible and irreversible Pulpitis and are experiencing extreme pain, your dentist may agree and advise you to have a root canal. On the other side of the coin, if you have extreme pain initially and you decide to ride it out and try to avoid root canal therapy, remember, it’s possible you could have pain for some time and still need the root canal therapy.

Note from Dr L
If there was some test that could help dentists in all clinical situations, determine with 100% accuracy when a patients would need a root canal, all dentist would use this test. Unfortunately, there is no such test.

In some situations, the clinical judgment of the dentist with your input is what ultimately helps you to decide the therapy needed. If you are truly in the gray area you will likely get different advice from a variety of dentists. One dentist might say, “I’m 100% sure you need a Root Canal”. While still another, may review your symptoms, explain you options, and help you to decide what is best. By the way, I’m the second dentist. I respect the opinion of my patients. I will take the time to review your symptoms and explain your options. On the other hand, if your clinical signs and symptoms clearly indicate that you need a root canal, I will not hesitate to say, you need a root canal.

For further understanding please review our online section emergency section subsection tooth ache.

In all of the following examples, it is not normal to experience night awakening with continuous throbbing tooth pain. It is also not normal to experience continuous throbbing pain which is a result of chewing force and/or cold stimulus. Please note the key words which are; continuous and throbbing pain. If you experience this type of pain please call our office, you may have indirectly damaged the nerve of the tooth and may need root canal therapy to save your tooth.

Often when patients present with pain with a longer duration, initially Dr. Landers will treat your tooth situation conservatively. He will try to save you from root canal therapy. This is when fiber optic dental handpiece technology is a wonderful advantage and service to our patients. Clinically, the use of fiber optic hand piece illuminate deep areas of your tooth structure. The improved vision not only allows Dr. Landers to more accurately remove dental decay, but the improved vision helps avoid the nerve of your tooth. The end result is a better chance to avoid unneeded root canals.

You can not keep a tooth with an infected nerve. It’s not advisable that you delay needed therapy.

If you have a carious nerve exposure or cracks into the nerve, you will need a Root Canal. You will receive modern day dental treatment at our office. Dr. Landers uses a mini computer to automatically measure the root length for accurate cleansing and place medicine to permanently restore your tooth to health. This process is more accurate and takes less time then older root canal techniques. The end result is less time in the dental chair, increased comfort, and better therapy.

Infections in the bone move fast or slow and can exist with or without pain. If left undiagnosed, these bone infections may spread into the soft tissues of the body.

Untreated Dental Infections Can Be Life-Threatening
Ludwig’s angina is potentially life-threatening, rapidly expanding diffuse inflammation which invades the submandibular (lower Jaw bone) and sublingual (under tongue) spaces. It occurs most often in young adults with dental infections but can occur at any age.

Link: Rapid Swelling under Tongue & Jaw (Onset: 1 – 2 days)

If you suspect you need a root canal, you should call for an appointment as soon as you can.

#5 Jaw Soreness from dental injection

CLINICAL PRESENTATION

Patient reports pain in area of injection (dull ache)
Palpation over injection site elicits pain
Decreased range of opening (<40mm)
Side to Side Jaw movements are normal

TREATMENT
This condition is almost always self-limiting and will improve in 5-10 days. For this reason, no definitive therapy is indicated. We recommend that you take Advil or Motrin as needed and begin this routine after 48 hours:

First use chewing gum at short intervals
Then use your thumb on the upper teeth and middle finger on lowers to complete gentle stretching exercises. These exercises are completed by relaxing your jaw muscles and holding your mouth open for short intervals. These jaw muscle exercises are very similar to the exercises used to stretch other muscles in your body i.e. legs or back stretching exercises.
Apply moist heat to affected area

Muscle soreness
Difficulty in opening the jaws and muscle stiffness are common after some extractions, particularly wisdom teeth.

#6 Pain After New Filling or Crown -What’s Normal?

Discomfort Usually Is A Result Of One Of The Following Reasons

1. Initially your gums will be very sore from the tooth preparation process. It’s likely the tissue around your tooth was shaped during tooth preparation. Crowns for instance are needed when there is a lot of missing tooth structure either from decay or breakage at or near the level of the gum tissues. The dentist will remove this weakened tooth structure near your gums, and you will likely experience gum tissue tenderness. The tenderness is similar to gum tissue soreness that results after contact with hot food. This will heal in a few days.
2. Gum tissue soreness from a dental impressions. (If you had an impression or mold of your tooth for a crown). Dental retraction cord is usually packed between the tooth and gum collar to keep the area of the tooth near the gum tissues dry for accurate dental impressions. This is important for proper impression technique since saliva and blood will interfere with the accuracy of the impression material.
3. Also note it’s normal to have post operative tooth sensitively from a dental drill or shaping procedure. Remember, a non root canal treated tooth is alive. With deeper decay or the need to remove deep fillings near the nerve, it makes sense that there will be more post operative sensitivity. Once your final restoration has been placed this sensitivity may continue for a few days or even weeks. Remember as long as the sensitivity is continually getting better this is a normal healing process. You should not experience a night wakening type of pain.
4. During the removal of deep decay, the nerve of the tooth may have been traumatized. If you have continuous throbbing pain and/or awakening at night from the pain, call our office ASAP!
5. You notice a sharp part of the tooth. Your best option is to purchase orthodontic wax at your local drug store. Just take a small piece of wax and cover the area.
6. It’s normal to have dental injection soreness. Though it is not very common, occasionally patients may experience difficulty opening after a dental procedure. If you have difficulty opening, please call our office as soon as you get a chance.
7. Your new temporary tooth could be too high when you bite, chew or grind. See the following.

If Your Bite Feels High
First, check with your fingernail to make sure that no excess temporary cement or dental acrylic is on your upper or lower teeth. Please check both upper and lower. If you find cement, don’t be shy scratch it off.

Once the anesthetic wears off you may notice that your bite is a little different. The chewing surface of your final restoration will be properly equilibrated and adjusted in your bite.

To test your bite, try the following test. Bite only on the teeth on the left side. The right side should not interfere. Then bite only on the right side. The left side should not interfere. Finally, bite on both sides at the same time. All posterior teeth should occlude with equal force. The new restoration should not hit first, hit and slide, or interfere with your bite.

When patients are numb, they can’t always find the proper orientation of their jaw and bite in the wrong position. This gives your dentist a false marking and occasionally results in a temporary which is too high or interferes with your bite. Please return to the office after the anesthetic has completely worn off. It is less likely you will bite improperly when you’re not numb! Please don’t underestimate symptoms that could result from a high bite. This could be quite uncomfortable. Call for an appointment as soon as your sure your bite is too high.

If you feel that the previous section does not explain the reason for your pain, Please review the section #3 Tooth Ache.

If you have severe pain read: “Do I Need a Root Canal”