At West 85th Dental, it’s important for us as a service provider to answer all of your questions and give the best information about our services and treatments. Read below to get answers to our patients’ most frequently asked questions. If your question is still unanswered, give us a call to talk to one of our experienced professionals.
Insurance and Payments
What to Do if I have an Emergency
Dental emergencies with spontaneous pain (without any stimulation) and swelling more often than not indicate a dental infection, call the office to get in for an emergency appointment. If it is after hours please call the emergency number at 4035601965. If you are having a swelling that is causing difficulty breathing you will need to go to the hospital, most dental infections involving major swellings can be controlled with IV antibiotics until definitive treatment can be provided.
Post Op Care Instructions
Some teeth are embedded or positioned in the jaw in such a way that bone surgery is necessary for their removal. This is especially true of impacted wisdom teeth. The removal of such teeth is quite different from the extraction of erupted teeth. The following conditions may occur, all of which may be normal in the first few days after surgery.The area operated on will swell. The swelling will reach its peak about 36 hours after surgery. Trismus (tightness) of the muscles may cause difficulty in opening the mouth.
You may have a slight earache and a sore throat may develop. Note that we have given you a long-acting local anesthetic. This anesthetic may last as long as 8 to 12 hours. Even if your procedure involved I.V. sedation, your doctor will give local anesthetic although you may not remember even getting it. Therefore, you will experience numbness for several hours. Numbness around the corner of the mouth or in the lip or tongue on the side from which the tooth was removed may persist. This is called “paresthesia” and is generally a temporary condition which will resolve. It may persist for a few days to several months. In remote instances, it may be permanent. If numbness persists long-term, there may be surgical treatment available.
If the corners of the mouth are stretched, they may dry out and crack. A cream or ointment keeps moist your lips. There will be a cavity or socket where the tooth was removed. This will eventually fill in with tissue. Black and blue or yellow discoloration may occur on the outside of the face near the area of the surgery. This occurrence is not unusual and will disappear within several days.
There may be a slight elevation in temperature for 24 to 48 hours. If this continues, please notify the office.
Instructions Following Removal of Impacted and Surgically Extracted Teeth
Instructions Following Removal of Impacted and Surgically Extracted Teeth - PAIN
Take your pain medicine as directed. Patients must follow very carefully medication instructions including not exceeding doses. Not combining different medications unless specifically directed, and not driving, operating machinery, or making important decisions while taking medication. Taking medications cause drowsiness or impair judgment. Note that elevation of the head (i.e. not lying flat) and use of ice packs as described below will both contribute to the relief of pain. Note also that some pain medications may cause dizziness. You should stand up slowly while taking these medications. If you are lying down, sit up first and then stand up slowly to avoid dizziness that could result in a fall. Do not drink any alcohol while taking pain medication.
Swelling -To help minimize ordinary immediate postoperative swelling, apply an ice pack to the face over the operated area (15 minutes on, 15 minutes off, repeat) for the first 36 hours following surgery. After 36 hours, discontinue the ice packs and begin moist heat compresses. It is not unusual to have additional swelling on the second or third day. Do not go to sleep with an ice pack or hot compress in place.
Bleeding -A certain amount of bleeding is to be expected following the operation. Blood tinted saliva may be seen for about 36 hours. If bleeding occurs after you return home, place a small moistened gauze pad (about the size of a tea bag) or a moistened tea bag directly over the socket for at least 30 minutes, holding it in place with firm biting pressure. If your wisdom teeth have been removed, the correct position of the gauze pack will be behind the last tooth in the mouth. It may be necessary to repeat this procedure. If bleeding continues, please call the office. If bleeding is excessive, call the office immediately.
Do not disturb the blood clot -Its grayish or yellowish appearance and slight odor do not indicate an infected condition. Keep fingers, toothpicks, or other matter that may cause infection out of the mouth. Keep your tongue away from the surgical area. Do not smoke, rinse your mouth vigorously or drink through a straw for 48 hours. These activities create suction in the mouth which could dislodge the clot and delay healing. Forceful spitting and excessive physical activity tend to increase and prolong bleeding as does bending over to pick up objects. A semi-reclining position and rest for the first few hours are recommended. Limit strenuous activity for at least 24 hours after the extraction. This will reduce bleeding and help the blood clot to form. Avoid vigorous exercise for the first 3-5 days. Contact sports should be avoided until healing is complete to avoid the possibility of jaw fracture.
Mouth rinsing -Vigorous mouth rinsing may stimulate bleeding by breaking clots which have formed. Therefore, do not rinse the mouth for 24 hours following extractions. The exception to this would be the patient on anticoagulants who is prescribed tranexamic acid, as discussed below. After 24 hours, you may gently rinse the mouth with a warm salt water solution (½ teaspoon salt in an 8-ounce glass of warm water) 4-5 times a day for several days. If bleeding continues, stop all mouth rinsing and follow instructions in paragraph 3 above regarding bleeding. Do not rinse with commercial mouthwashes. After 24 hours you may gently brush the teeth.
Bone fragments -During the healing process, small sharp fragments of bone may loosen and work through the gum. These fragments, which are not roots, usually work out on their own accord, but if they are annoying, return to the office so the dentist can advise or treat you.
If antibiotics have been prescribed for you, take them in accordance with the instructions on your prescription. Discontinue the antibiotics immediately if a rash, hives, itching, swelling, or difficulty breathing occurs. This may be the sign of a serious allergic reaction. The patient who experiences difficulty breathing or swelling and constriction of the throat, mouth and face area should call 911 or their local emergency medical service, as serious allergic reactions can be fatal if not treated promptly. Notify the office so that a different antibiotic can be prescribed. Any infection should be taken seriously and reported to the office.
It is important to maintain a good diet. A liquid to soft diet is advisable for the first few days. It is very important to drink plenty of fluids (6-8 glasses per day). Avoid drinking very hot liquids as these may cause resorbable sutures to break down too quickly. Nutritional intake is very important during the healing stages following surgery. Now is not a good time to go on a diet.
You should supplement your vitamin and mineral intake with a supplement such as Centrum, which is available both in tablet form as well as liquid form. Calcium, vitamin D, magnesium, and manganese are important for proper bone healing and can be obtained in a single product form such as Caltrate Plus. A complete nutritional supplement such as Ensure can be taken to ensure complete nutrition.
Be very careful with anesthetized areas so you do not bite your lip, cheek, or tongue. Do not chew anything until after the numbness wears off. However, you can begin liquids right away provided that they are not too hot. Hard, crunchy foods should be avoided until healing is complete to avoid the possibility of jaw fracture.
Post-operative office care
Most patients are seen approximately one week after surgery for evaluation and suture removal. If you have any doubts concerning your progress and recovery, please feel free to call the office. There may be a slight elevation in your temperature for 24-48 hours. If this continues, or if any other unusual events such as persistent weakness, lethargy, or malaise occur, please notify the office immediately. You may be seen sooner than one week if you so desire. If pain or swelling occurs after the surgical site has apparently healed, return for an examination. When this type of condition occurs, it usually happens on the third or fourth day after surgery. It may be indicative of a condition called “alveolar osteitis” (dry socket) and is generally treated by placing a medication into the tooth socket with almost immediate relief.
Special Instructions for Special Circumstances - Nausea
If you experience any nausea with your pain medicine, try taking it with milk, yogurt, ice cream or a milkshake. In rare cases, an anti-nausea drug may be prescribed. In very rare cases when nausea is so severe that the patient cannot keep oral medications down, anti-nausea medication can be administered in suppository form. While significant post-operative nausea is uncommon, it is more common in women and in patients with a history of motion sickness and migraine headaches.
If you still experience pain after taking your prescription pain medication, you may add ibuprofen (such as Advil or Nuprin) or acetaminophen (such as Tylenol). The maximum adult daily dose of ibuprofen is 800 mg three times a day for a total of 2400 mg per day. The maximum adult daily dose of acetaminophen is 1000 mg four times a day for a total of 4000 mg per day. Keep in mind that many prescription pain medications (for example, Vicodin and Percocet) contain acetaminophen and some (for example, Vicoprofen) contain ibuprofen. If your pharmacist fills your prescription with a generic drug, note that the letters “APAP” on the label means that this product contains acetaminophen. Maximum daily doses include all sources of a drug added together. Acetaminophen taken in excess can cause liver failure and death, especially if combined with alcohol. Please be careful not to exceed the maximum daily dose.
Women of childbearing age should keep in mind that all antibiotics have the potential to interact with birth control pills and lessen the effectiveness of the oral contraceptive. Although this has never been proven, alternative non-hormonal forms of birth control should be used after checking with your physician and should be continued for one full week after antibiotics are completed. You should also continue to take your oral contraceptives according to their directions while you are using antibiotics.
We will not do any treatments or restorative work on pregnant women. Nor will we provide x-rays unless an emergency calls for it. Our goal is to stay as safe as possible. We do invite you to come in for a general checkup, however.
Antibiotic mouth rinses
You may receive a prescription for an antibiotic mouth rinse containing chlorhexidine (Peridex, PerioGard, etc.). Do not use this rinse for 24 hours following extractions. After 24 hours, you should use this rinse after meals and before bedtime until the surgery site has healed. Do not swallow the rinse – swish it gently and then spit it out. Although extremely effective against micro-organisms, these rinses may cause staining of your teeth. This is not permanent staining and it can be removed with professional polishing. Staining can be minimized by thoroughly brushing and flossing your teeth at least twice per day.
Special instructions for patients on anticoagulants and patients with bleeding disorders
If you are taking Coumadin (warfarin) or other anticoagulant medication or if you have a bleeding disorder, you may be given a special prescription for a mouthwash called tranexamic acid to minimize bleeding. Following the surgery appointment, rinse your mouth with 1 tablespoon for 2 minutes four times daily (every 6 hours) for 7 days. Do not swallow the rinse – swish it gently and then spit it out. Do not eat or drink during the first hour after using this mouthwash. Eat only a liquid diet on the first day after surgery. Contact the doctor if bleeding develops that cannot be controlled by compression by a gauze pad for twenty minutes while sitting upright.
Special information for patients with immediate dentures
If you have had immediate dentures placed at the time of surgery, it is extremely important that you do not remove these dentures for any reason until you are instructed to do so by the doctor. If the dentures are taken out too soon, there will most likely be additional swelling and it will be impossible to place the dentures in the mouth again. Please call the office for specific instructions as to when you should remove your immediate dentures.
Special instructions for diabetic patients
Sinus precautions – postoperative instructions for patients with sinus involvement
Additional instructions for IV sedation patients
Since you may be drowsy following the appointment, a responsible adult must escort you home. Two adults should accompany children. Arrange to have the entire day off work and limit your activities for the remainder of the day. Do not drive, operate machinery, drink alcohol or make any important decisions or judgments for 24 hours after the appointment as your faculties and abilities will likely be impaired.
Have someone assist you in and out of the car on your way home and up and down the stairs. Stand up slowly; if you are lying down, sit up first and then stand up slowly to avoid any drop in blood pressure that might make you dizzy. If you experience any unusual reactions, report them to the office as soon as possible. Occasionally, the injection site of the IV may become inflamed and tender. This is caused by the anesthesia drugs irritating the vein. If this happens, apply moist heat to the area and the inflammation will eventually resolve.
Filling postop: Composite fillings set up hard right away. There is no waiting time to eat. Children should be observed until the anesthetic wears off. 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. Sensitivity to hot and cold is common for a few weeks following dental restoration. Usually, the deeper the cavity, the more sensitive the tooth will be. If you feel the bite is not correctly balanced, please call for an appointment for a simple adjustment. The gum tissue could have been irritated during the procedure and may be sore for a few days along with the anesthetic injection site. The finished restoration may be contoured slightly different and have a different shape than the original tooth. Your tongue usually magnifies this small difference and will become adjusted to this in a few days.
Endo postoperative: Root canal treatment can take 1, 2, or more appointments, depending on the conditions present in each case. During that time any of the following symptoms may be present: sensitivity to hot or cold, sensitivity to pressure, or swelling.
When to see an orthodontist?
Typically we like to assess children for orthodontics by 6 years old, most commonly parents will bring the child in for an emergency and are concerned about the adult lower incisors coming in behind the baby ones. This usually is the first indication that orthodontics require. At this point we wait for the upper and lower permanent incisors to come in as well as the six year molars and then send for consultation for orthodontics. This typically occurs around 8-9 years old.
My child hit their tooth and its changing colours.
This is a very common occurrence in children, the change in colour means that the tooth is “dead,” if it is a baby tooth we will allow it to fall out on its own as long as no infection or swelling is present. If this is an adult tooth we will need to assess whether a root canal is required at this time.
My child’s adult teeth are coming in behind their baby teeth.
This is very common with children getting their lower incisors, the baby teeth will still fall out on their own in most cases; however, in some cases we do need to help the child with a painless removal. Ultimately this most often indicates that there will be future crowding and need for orthodontics as there is most likely a spacing issue.
Why do I have sensitive teeth?
Teeth are like you skin where you have pores that allow for hydration, sensation and vitality. Most commonly you can stop the sensitivity by plugging the pores and that is essentially how sensitive tooth pastes work. In some cases your dentist or hygienist may recommend a higher level of desensitizing with a dental product only available by use of professionals.
What is Invisalign?
What are my teeth whitening options?
I don’t think I clench or grind my teeth, but my dentist says I do.
Many people go through periods of time where they will clench or grind their teeth. This can be during times of stress, if you are getting interrupted sleep, or during sickness. The clenching or grinding can occur without any symptoms initially. Common symptoms that occur include fracturing teeth, temperature sensitivity, muscle/jaw soreness. Even if none of the symptoms are noticed, your doctor or hygienist may see signs of grinding/clenching and can let you know what can be done to prevent damage to the teeth and soft tissue.
Is snoring a dental concern?
Snoring from a dental point of view can result in dry mouth and irritation to soft tissue. Systemically we are more concerned with snoring as it can indicate sleep apnea which needs to be diagnosed by your physician (sleep study would be required), your dentist can refer you to a physician that can help with the diagnosis as not all people who snore have sleep apnea. Mild snoring can be treated with an oral appliance that your dentist can make.
Why should I change my silver fillings?
Silver fillings should be changed once the margin (tooth and filling interface) has started to lift. Over time silver fillings tend to expand, the most common emergency we get is a tooth that has cracked due to years of use and expansion of the filling. Not all silver fillings need to be changed and your dentist can let you know the best time to change them.
We personally use the Sonicare diamond brushes and have found them to be reliable, easy to clean and the most effective shape for plaque removal.
Use MI Paste for desensitizing due to before and after teeth whitening.
For children six years and under and pregnant women
Indicated for patients with:
I am pregnant and my gums are bleeding
It is common during pregnancy for expectant mothers to see changes in their oral health, particularly their gums. The changes in hormones that occur during pregnancy can cause swelling and bleeding. With proper home care and continued hygiene with your dental professional during your pregnancy – the second trimester – you can see improvement in the health of your gums.