Post-Operative Instructions

During your appointment today, one or more of your teeth was prepared for a crown or bridge. A temporary crown was fabricated for each prepared tooth. Temporary crowns are cemented with a temporary dental cement to allow for easy removal at your next appointment.

Temporary crowns are of universal size and shade. Your final restoration will be shaped and shaded to match your other teeth in both color and function.

Until your next appointment:

• Whenever anesthesia is used, avoid chewing on your teeth until the numbness has worn off.
• You may experience sensitivity to temperature and pressure, gum soreness and slight discomfort on the tooth / teeth; it should subside after the placement of permanent crown.
• Avoid hard or sticky foods that may dislodge temporary crowns, such as:
  • Hard chewy breads such as bagels or French bread.
  • Chewy candies such as taffy, caramels or gum.
  • Hard crunchy foods such as corn nuts or popcorn kernels.
  • Do not bite into foods such as corn on the cob or apples.
• If a temporary crown becomes loose or comes off, try to place it back onto the tooth and call the office at your convenience to get the crown re-cemented. Temporary cement is also available at most drug/grocery stores.
• Rinse your mouth with Listerine™ mouthwash or warm salt water to minimize inflammation of the gum tissue.
• Acrylic temporaries attract more bacterial plaque than natural teeth; therefore it is important to brush normally, at least three times a day. Floss at least once a day, but floss carefully and don’t pull up on the floss which may dislodge the temporary. Pull the floss out from the side of the temporary crown.
• You may experience sensitivity to hot or cold foods or beverages after treatment.
• Mild to moderate discomfort after dental work is common. An over the counter pain reliever/anti-inflammatory is recommended for patients who are able to tolerate them. (Tylenol™, Advil™, Aleve™, etc.) If discomfort increases, please call the office.

If your bite feels uneven, if you have persistent pain, or if you have any other questions or concerns, please call our office at 210-561-1530.

During your appointment today, we permanently cemented your new crown(s) or bridge. It may take a few days to get used to the new restoration.

• You may experience some minor discomfort for the first few days following your treatment. An over-the-counter pain reliever/anti-inflammatory, such as Tylenol™, Advil™, Aleve™, is recommended for patients who are able to tolerate them. If discomfort increases or lasts more than 2-3 days, please call our office.
• Hot and cold sensitivity is possible for a few weeks and occasionally will last for several months.
• Your bite was carefully checked at your appointment. If you feel the bite is not correctly balanced, please call us immediately for a simple adjustment appointment. Do not overlook calling us, even if it appears that the bite is off slightly. This slight amount can make the tooth sensitive to pressure, hot, and cold, and also potentially cause pain in the neck, head, and jaw.

Although crowns and bridges are often the most durable of all restorations, the underlying tooth is still vulnerable to decay, especially at the interface between the tooth and crown (along the gum line). We recommend professional maintenance and evaluation at least twice a year. If you have had a periodontal problem (gum disease) in the past, you should see us a minimum of three times a year.

Proper care of your new crown(s) or bridge includes brushing and flossing a minimum of twice daily and regulating your intake of sugar-containing food and drinks. Proper maintenance will not only prolong the life of the restoration, but will also help to prevent problems elsewhere in your mouth.

If you have any other questions or concerns, please call our office at 210-561-1530.

Instructions Following Extractions

Bleeding

• A gauze pad has been placed on the extraction site to control bleeding. Moderate pressure should be applied for one-half hour. If bleeding continues, place new gauze for 1 hour. If placing new gauze, first wet it with water, squeeze out the excess water and bite on it with steady, firm pressure on the extraction site. For proper healing, it is important for a good blood clot to form.
• Keep your head elevated with pillows to control bleeding.
• If bleeding is not easily controlled in the first two hours, place a run a teabag under water, squeeze out the excess water, and bite on it with firm, steady pressure on the extraction site. (The tannin in the tea will help to constrict the blood vessels in the area and stop the bleeding).

• Red tinged saliva is normal for a few days following surgery and is not indicative of bleeding. Gauze placed against the wound will draw blood from the clot and this, likewise, is not a sign of bleeding.
• Place an old towel over your pillow for the first night to reduce risk of staining.
• If the bleeding persists, contact the office.

Control of the Blood Clot

• After the surgery, a blood clot forms protecting the extraction socket. If the blood clot is lost this may cause a “dry socket”.
• To keep the clot intact, avoid touching the extraction site with your tongue or fingers.
• DO NOT:
• Drink liquids through a straw
• Spit vigorously or
• Smoke
• FOR 5 DAYS as the suction created by these activities could result in a “dry socket”.
• Blowing your nose or sneezing violently can also dislodge the blood clot and impair healing, so if you have an upper respiratory infection or suffer from allergies, be sure to have the appropriate sinus medication on hand.
• Symptoms of a “dry socket” can present in the 2 weeks following an extraction, they include: throbbing into the ear, persistent ache, bad taste, a general feeling that the pain is getting worse after the third day, instead of getting better

Swelling

• Swelling is normal after any kind of surgical procedure and will peak 72 hours after the surgery.
• Ice packs may be helpful in reducing swelling. Apply ice for 20 minutes every hour for the first 24 hours.
• If no pre-extraction infection was present, heat may be applied after 3 days.

Anesthesia

• The local anesthesia may produce numbness for 2 -12 hours depending on the type used.

Hygiene

• It is important to continue to brush and floss your teeth. Brushing your tongue can help eliminate bad breath and unpleasant taste that are common following extractions.
• Avoid brushing directly over the surgical site until it has healed.
• Sutures may have been used to close the surgical site. If resorbable sutures are used, the sutures will dissolve on their own anywhere from 3-10 days. If non-resorbable sutures were used, they should be removed in the dental office in 7 to 10 days.
• Warm salt water rinses can start 24 hours following the procedure if desired. Gently rinse using 1/2 tsp. of salt to 8oz of water. Gently rinsing after meals will aid in keeping food out of the surgery site. Do not rinse vigorously as this will disturb the clot.

Diet

• You may eat soft foods (i.e. eggs, soups, noodles, ice cream, yogurt) after the bleeding has been controlled and the gauze has been removed.
• Avoid hard foods such as seeds, rice, nuts, chips, and popcorn.
• You may resume a normal diet in 3-5 days or as tolerated.

Activity

• Relax as much as possible and avoid all strenuous activities for the first 24 hours following surgery.
• By approximately 1 week after surgery, most routine activities may be resumed.

Pain

• Discomfort after an extraction is normal. Take all pain-relieving medication  as prescribed. If possible, begin before the anesthetic wears off.
• If you were not given a prescription for pain medication, take 3 tablets (600mg) of ibuprofen (Advil, Motrin, generic) every 6hrs. If you are unable to take ibuprofen due to stomach upset or stomach ulcers, consult your dentist or physician for an alternative treatment.
• For children, the pain relievers of choice are children’s Tylenol or children’s Motrin.

Prescribed Medications

• You may be given narcotic pain medication after surgery – DO NOT DRIVE if you are taking such medication.
• If an antibiotic is prescribed it should be taken until gone unless otherwise instructed.
• Please eat when taking medications to prevent nausea.

Bony Edges

• Occasionally small slivers of bone may work through the gums during healing (4-6 weeks). They are not pieces of tooth and, if necessary, we will remove them. Please call our office if you are concerned.

If you develop unusual symptoms, including a high fever, contact the office right away at 210-561-1530.

The provisional set of teeth is made entirely of acrylic resin, which places less stress on your new implants during their first few months of use. We will ask you to be selective in the foods you eat. The purpose of this is because your implants have not integrated in bone fully and disruption before this occurs, especially in the very beginning, can cause larger problems down the road.  Solid foods can be eaten after you have undergone the All-on-4™ Procedure that same day. However, we must define what we mean by solid foods. We are talking about a modified food diet, defines as foods that are soft enough to be cut with a fork. Examples of modified food diet are:

❖ Scrambled eggs

❖ Meatloaf

❖ Mash potatoes

❖ Hamburgers (with fork)

❖ Fish

❖ Pasta

Please do not eat foods that require any tearing or biting with your front teeth.

❖ Pizza

❖ Sandwiches

❖ Bagels

Also avoid hard foods such as carrots, chips, apples, nuts and…

ABSOLUTELY NO GUM CHEWING!

Maintain this modified diet until you receive your permanent prosthesis, usually about 6 months. Once you final bridges are made with the titanium frame as reinforcement, you can resume your normal diet. That being said, we hope you love your new prosthesis and we look forward seeing you back for your recall appointment!  Let us know if you have any questions.

BLEEDING:  Small amounts of blood in the saliva can make your saliva appear quite red. This is normal and may be noticed the rest of the day after the procedure.

SMOKING:  Smoking should be stopped following surgery. Healing and success of the implant will be substantially reduced by the cigarette smoke chemicals in your body.

PAIN:  Some discomfort is normal after surgery. To minimize pain, Take two Tylenol, Nuprin, Advil, or similar non-aspirin pain reliever every 3 to 4 hours until bedtime to maintain comfort. Take it before the anesthesia wears off. If prescription pain medication is prescribed, take it as instructed on the label. Don’t exceed the dose on the label. Taking with food or milk will help reduce upset stomach. Avoid driving or operating heavy machinery when taking pain prescriptions. Do not drink alcohol while taking prescription pain medications.

NAUSEA:  This is most often caused by taking pain medications on an empty stomach. Reduce nausea by preceding each pain pill with soft food, and taking the pill with a large glass of water.

SWELLING:   Applying an ice bag to the face over the operated area will minimize swelling. Apply for 15 minutes, then remove for 15 minutes. Continue this for the first day.

NUMBNESS:  The local anesthetic will cause you to be numb for several hours after you leave the office. Be very careful not to bite, chew, pinch, or scratch the numb area. Sometimes the implant procedure causes residual numbness or tingling for six weeks or longer.

BRUSHING:  Do not brush your teeth for the first 8 hours after surgery. After this, you may brush your teeth gently, but avoid the area of surgery for 3 days.

RINSING:  Avoid all rinsing or swishing for 24 hours after your procedure. After 24 hours you may begin gentle rinsing with a saltwater solution (1/2 teaspoon salt + 1/2 teaspoon soda + 8 ounces warm water). Avoid commercial mouthrinses. You may be instructed to use a prescription antimicrobial mouthrinse.

DIET:  Eat soft foods for the first two days. Maintain a good, balanced diet. Return to normal regular meals as soon as you are able after the first two days. Drink plenty of water. Avoid alcohol for 48 hours.

ACTIVITY:   After leaving the office, rest and avoid strenuous activities for the remainder of the day. Keeping blood pressure lower will reduce bleeding and aid healing.

ANTIBIOTICS:  If you were given an antibiotic prescription, take all of them as directed until they are gone. Women: some antibiotics can reduce the effectiveness of birth control pills. Use alternate birth control methods for two months.

SINUS:  If your sinus was involved in the procedure, you should avoid blowing your nose or playing a wind musical instrument for one week. Use of decongestant medications might be recommended.

REMOVABLE APPLIANCES, DENTURES:  Your dentist will give you specific instructions about your prosthesis. To avoid putting any pressure on the new implants before they have healed, your denture might be adjusted or significantly modified. In certain cases you will need to go without your dentures for a period (days or weeks) after the implants are placed. Sometimes a temporary removable appliance is made for cosmetic purposes, until a new non-removable one can be made.

FOLLOW-UP APPOINTMENTS:  You may need to return to the office within the first 14 days to have sutures removed, or just for a brief follow-up healing check. You may need to return after the implant has integrated for a small second procedure to expose it in preparation for the final restoration.

Please call your dentist if you have:

• uncontrollable pain
• excessive or severe bleeding
• marked fever
• excessive warm swelling occurring a few days after the procedure
• reactions to medications, especially rash, itching, or breathing problems

Following these instructions very closely will greatly help your comfort, and promote uneventful healing of the area. If any of the instructions are not followed, you might have significantly more discomfort, and the success of the procedure may be affected.