Emergency Dental Information in Apex and Cary NC

1. Post Operative instruction after Extraction.
   Controlling bleeding from the extraction site.

   Some bleeding may occur for some time after your tooth extraction. In most cases this bleeding can be effectively controlled and stopped by placing a piece of moist clean gauze over the empty tooth socket, and then biting firmly on this gauze for 45 minutes to an hour. Make sure that the gauze is positioned so when you bite down it applies pressure directly onto the extraction site. If you bite down and your teeth come together fully you may not be placing much pressure on the gauze.

   It is both firm pressure and maintaining this pressure over a prolonged period of time (45 minutes or so) that are important factors when this technique is used. Don’t keep changing the gauze, just put some in and then clamp down on it for 45 minutes to an hour.

   If the bleeding seems to persist, a slightly moistened tea bag can be a very effective substitute for gauze. One of the components of tea (black tea, the regular stuff you would make iced tea from) is tannic acid. Tannic acid can aid in the formation of blood clots and this technique can be very effective. (Same instructions as above, just substitute the tea bag for the gauze.)

   If a small amount of bleeding persists after 45 minutes then repeat these instructions. If heavy bleeding is still present then contact the office immediately.

   A blood clot needs to form in the empty tooth socket.

   The blood clot that forms in the extraction socket is an important part of the healing process, so be careful not to do anything that will dislodge it. Remember, events that occur during this time frame will affect the healing process for days to come. (It is thought that the development of ” dry sockets” is related to the loss of blood clots.)

   This means you should avoid vigorous rinsing or spitting during the first 24 hours after your tooth extraction. Also, creating suction, such as that produced by using a straw or smoking, can dislodge the blood clot that has formed. Hot liquids will tend to dissolve blood clots, so stay away from hot coffee or soup.

   Swelling may occur after a tooth extraction.

   The trauma created by the tooth extraction process can cause swelling. This swelling might present itself as a slight fullness that you can feel but is not readily apparent to others, or at the other extreme a clear enlargement of facial tissue. In general, the more difficult the extraction has been the more likely swelling will occur.

   Any swelling that does occur can be kept to a minimum by placing ice on your face in the area where the extraction has taken place. Position the ice on your face for 10 minutes, and then leave it off for the next 20 minutes. Repeat this cycle as you feel is necessary for up to 24 hours after the extraction.

   Do not smoke after a tooth extraction.

   Those people who smoke tend to have more complications with extraction site healing (including the development of ” dry sockets”) than people who don’t. If you can avoid smoking for the first 48-72 hours after your tooth extraction, it will be to your benefit.

   Post extraction discomfort and the use pain medications.

   You may not experience much pain after your tooth has been extracted. If you do, for minor pain you might use of non-prescription drugs such as acetaminophen (Tylenol) or ibuprofen (Motrin or Advil). You will, of course, need to read and follow the directions and warnings that accompany these products so you know that their use is appropriate for you and your circumstances.

   Alternatively, if Dr. Chirnalli has prescribed prescription pain relief medication for you and you have decided to take it, make sure you read and adhere to the precautions and directions associated with the use of this product. If you have any questions about your medicine, the manner in which it should be taken, or else problems associated with taking your medicine, you should discuss them with Dr. Chirnalli or your pharmacist.

   The pain reliever Dr. chirnalli prescribed may contain a narcotic (such as codeine). If so, most narcotic pain medications will have a tendency to upset your stomach, so it is usually best to take them with food. Narcotics can also make you drowsy or act strangely. If you take narcotics, you should let those around you know you are doing so. Also, you should limit your activities (driving, operating machinery, etc…) while taking narcotics. Ask Dr.Chirnalli or pharmacist for specific instructions.

   Take prescribed antibiotics as directed.

   Any antibiotics prescribed by Dr.Chirnalli should be taken as directed, even if it means continuing on with them after your tooth has been extracted. Failure to do so can lead to the development of bacterial resistance to the antibiotic.

   Minimize activities that might make it harder to control the bleeding from the extraction site.

   So to reduce the amount of bleeding which occurs, and so to promote the formation of a blood clot in the tooth socket, avoid strenuous exercise or other such activities for 24 hours after your tooth has been extracted. If you lie down, use an extra pillow so to elevate your head.

   Food and eating.

   After a difficult extraction a soft or liquid diet may be indicated for 24 hours or so after your dental surgery. For simpler extractions just making sure that you do your chewing with those teeth that are distant from the extraction site should be sufficient. Hot liquids will tend to dissolve the blood clot that has formed in the extraction socket, so avoids them for the initial 24 hour period. Also, you should avoid alcoholic beverages for at least 24 hours.

   Brushing and cleaning your teeth.

   It is important to maintain good oral hygiene during the healing process. On the day of the extraction it might be best to avoid brushing the teeth directly neighboring the extraction site. The next day you can resume cleaning these teeth in a gentle manner. During the first 24 hours after the extraction don’t rinse vigorously when you clean your teeth because it might dislodge the newly formed blood clot. Do not rinse with mouthwash or a mouth rinse.

   Addressing swelling that still exists 24 hours after the extraction.

   Any swelling caused by the trauma of the tooth extraction process should reach its maximum after 24 to 48 hours. So to bring this swelling down more quickly, apply a warm moist towel to the swollen area for 20 minutes followed by 20 minutes of no application. Repeat this cycle, as you find necessary.

   Keeping the extraction site clean.

   In general, the cleaner you keep the extraction site (the hole in the bone where the tooth has been removed, also referred to as the tooth’s socket) the quicker it will heal. Beginning 24 hours after your tooth extraction, you can gently rinse the socket with warm salt water (1/2 teaspoon of salt in a cup of water) after meals and before bed. Do not use commercial mouth rinses. They may irritate the extraction site.

   Stitches (resorbable and non-resorbable).

   Dr.Chirnalli may have found it necessary to place sutures (“stitches”) in the extraction site after removing the tooth. Some types of stitches are resorbable (absorbable) and therefore will disintegrate and dissolve away on their own, others are not and will need to be removed by Dr.Chirnalli. If stitches were placed, make sure you know which type have been used. Usually Dr.Chirnalli will want to remove stitches that don’t resorb in about a week or so after the extraction. The process of removing stitches is usually very easy and quite painless.

   Dry sockets.

   One of the more common complications people experience after a tooth extraction is that of developing a “dry socket.” It is thought that dry sockets occur when either a blood clot has failed to form in the tooth socket (the hole left after extracting the tooth), or else the blood clot that did form has been dislodged. Since the formation of a blood clot is an important part of the healing process, the normal healing of the extraction site is interrupted.

   Dry sockets are most frequently associated with difficult tooth extractions or extractions that have been traumatic in nature. An extraction that has involved the removal of bone from around a tooth in order for Dr. Chirnalli to access it, which is often the case when teeth are removed surgically, would be considered to be more traumatic in nature than an extraction where this step was not required.

   People who follow their post-extraction recommendations will reduce their chances of developing a dry socket. Dry sockets are found to occur more often with women (even more so with those taking oral contraceptives), people over the age of 30, and smokers.

   Typically dry sockets manifest themselves as a dull throbbing pain which doesn’t appear until three or four days after the tooth extraction. The pain can be moderate to severe in intensity and often seems to radiate from the area of the extraction site to the ear. Dry sockets typically create a foul odor or bad taste. Visually, if you can see down into the socket, the extraction site appears “dry,” in the sense that you just see exposed bone. There is no formation of pus.

   Dry sockets need to be treated. And don’t be hesitant to let us know that you need help. We knows that there is no way to predict who will develop a dry socket, and if one occurs after your extraction we will be eager to assist you.

   In most cases we will place a medicated dressing into a dry socket as a treatment. This will help to soothe and moderate the pain. The dressing is usually removed and replaced every 24 hours until the dry socket’s symptoms

   subside, which can, in some cases, take some number of days.

   Bone sequestra and tooth fragments.

   Sometimes small fragments of dead bone (called a “sequestrum” [singular] or “sequestra” [plural]) will come to the surface of an extraction site as they are ejected by the patient’s body during the healing process. This is more likely to occur in those cases where the tooth extraction has been relatively difficult or traumatic. Along these same lines, if the tooth broke or splintered during the extraction process you may find that small shards of the tooth may come to the surface of the extraction site, even some weeks after the socket seems to have healed. You may be able to remove the smallest of these splinters of bone or tooth on your own, or you may find that you require, or want, Dr.Chirnalli’s assistance in removing them.

   Completion of the healing process.

   Of course after a tooth has been extracted there will be a hole left in your jawbone where the tooth has been removed (the tooth’s socket). As time passes the shape of this hole will smooth over and fill in with bone. While it can take many weeks and months for this healing process to occur fully, from a practical standpoint after 1 to 2 weeks enough healing will have occurred that the extraction site should be of only minor inconvenience to you.

2. Post Operative Instruction After Periodontal Therapy
   What to expect after Scaling & root planning
   Discomfort:

   Discomfort immediately after treatment is usually associated with slight throbbing or aching and occasionally may be uncomfortable. This discomfort usually subsides in about four hours. Any discomfort due to brushing should get better in one to several days. Your gums may become “itchy” or uncomfortable and Dr.Chirnalli may recommend ibuprofen to aleviate discomfort. Swelling or jaw stiffness occur very rarely, however if it does, apply warm, moist towels to the face in the area of the stiffness.

   Sensitivity:

   Sensitivity to temperature changes and/or sweets may temporarily occur. Removing all plaque from the tooth with a tooth brush or Q-Tip, placing a dab of sensitive toothpaste or fluoride toothpaste on the tooth should stop sensitivity within a few days. If tooth sensitivity persists, use desensitizing toothpaste such as Sensitive Crest , and avoid Tartar Control Tooth Paste. If a local anesthetic was used, avoid chewing foods until feeling returns to avoid injury to the tongue or cheeks. If the sensitivity is severe and prolonged, professional application of a desensitizing agent may be required. The sensitivity to temperature may be intense the first several days and usually diminishes quickly.

   Bleeding:

   Some slight bleeding may occur during the next several brushings but the bleeding should steadily decrease after two or three days. If you have heavy non-stop bleeding contact the office.

   Appearance:

   Root surfaces may be more exposed as the swelling of the inflamed gum tissue goes away. This may result in more space between the teeth.

   Although this treatment is necessary, please understand that this is not a cure. Risks associated with scaling and root planing includes, but is not limited to, the following:

   • Hot & cold
   • Sensitivity
   • Sweet sensitivity
   • Discomfort
   • Pain
   • Abscess
   • Injection pain
   • Numbness
   • Bleeding
   • Throbbing
   • TMJ
   • Infection

   Please do not smoke following scaling and root planing procedures. Tobacco smoke is an irritant to healing. Refrain from smoking for 48 hours.

   Diet & Eating:

   If extensive root planing was performed, chewing hard foods, such as meat or raw vegetables may be uncomfortable. Avoid any hard foods such as potato chips, fritos, popcorn, etc. for the next 3-4 days. This should last no longer than a few days. A diet of a softer consistency would be advised until chewing becomes more comfortable. Your first meal should be soft. The worse thing you could have is hot soup. No hot food or beverages for 2 days.

   Oral Hygiene:

   It is recommended that patients who have received this type of treatment return for a 4-6-week re-evaluation and then cleanings every 3-4 months for the first year.

   If after treatment symptoms are severe or persistent, or an abscess (gum boil) should appear, please call the office immediately.

3. Surgical periodontal therapy Home Care
   • It is important to complete careful brushing and flossing in all areas of the mouth EXCEPT the area of surgery.
   • If you had a Connective Tissue Graft DO NOT brush the grafted area until we evaluate healing at your first follow-up visit.
   • Start the prescription mouth rinse 10 days to 2 weeks following the post-op appointment.
   • You are not to begin brushing the surgery site until we check for healing at your first follow-up visit.
   Activity
   • Avoid strenuous physical activity, i.e. contact sports, weightlifting, running, swimming, etc. for 48 hours following your procedure.
   • Get plenty of rest and resume normal activity, as you are comfortable.
   • We suggest complete rest for the first 6-12 hours, as this will reduce discomfort, decrease swelling and speed healing. Work can be resumed the following day, but we suggest 2-3 days to allow for optimum healing.
   Smoking
   • Do NOT smoke for the first 24 hours after your procedure.
   • Smoking irritates the gums and retards the healing process.
   • Try to reduce the amount of smoking for two weeks after your procedure.
   Diet

   Do not eat any foods that require chewing until anesthesia has completely worn off.

   We suggest that you restrict your diet to soft, nourishing foods, Drink plenty of liquids. Maintaining this diet after your procedure is important for proper healing. Chew on the opposite side of your mouth and avoid extremely hard, hot, and spicy foods. You will be more comfortable eating soft foods for the next week. Foods that minimize the need for chewing before swallowing will be best.

   Some suggested foods: Dairy products, eggs, instant breakfast, ice cream, Jell-o, pudding, yogurt, milkshakes, blended or pureed foods, and/or dietary supplements (Ensure, Boost, etc.) A daily multi-vitamin supplement is also a good idea.

   • DO NOT drink through straws
   • DO NOT drink carbonated beverages or juices
   • DO NOT eat popcorn
   Antibiotics
   • If antibiotics were been prescribed, depending on your procedure, it is very important to take antibiotics as directed.
   Bleeding
   • A slight amount of bleeding 24 – 48 hours following your procedure is normal. Do NOT rinse your mouth vigorously, suck through a straw, eat or drink extremely hot foods or use carbonated beverages for the first week following your surgery as these can disrupt the blood clotting and cause delayed healing.
   • If excessive bleeding occurs, take a moist tea bag or gauze and hold with firm pressure over the bleeding site for 20 minutes. Drinking ice water or sucking on ice cubes will also help slow bleeding.
   • If bleeding persists please call our office.
   Sensitivity
   • You may experience increased sensitivity to cold or hot liquids, air, and foods. Your teeth may also feel more sensitive when you brush, floss, or while chewing.
   • It is important to clean your teeth as directed, avoid tartar control and whitening toothpaste and use the sensitivity toothpaste provided (if you were given one). Most procedures do not require this.
   • This sensitivity may last a few weeks and then subside. If your teeth remain sensitive please let us know.
   Pain
   • Some discomfort may be present once the local anesthesia wears off. If pain medications have been prescribed, take as directed.
   • Do NOT drink alcohol while taking pain medications.
   • You may experience increased soreness 3-4 days following your procedure. Take pain medications as needed. If your prescriptions are not keeping you comfortable please call our office.
   Bruising and Swelling
   • An ice pack (or crushed ice in a zip-lock bag, covered with a thin towel) held on the lip or cheek over the surgical site for 20 minutes on and then 1 hour off will help reduce swelling (during the initial 24 hours). If swelling appears to be increasing beyond the initial 72 hours please call our office.
   • It is important to eat and drink ice cold foods and beverages for the first 24 hours to minimize bruising and swelling.
   • Slight swelling and bruising of your gums and sometimes face is normal. If your gums change color from whitish gray to bluish purple this is a normal part of healing and should not be a concern. If you experience swelling accompanied by fever, a bad odor, or pain that intensifies and is not relieved by pain medications please call our office.
   Sutures
   • If sutures (stitches) were used for your procedure they will need to be removed by our office in 7 to 10 days depending on your individual case. Do not remove your own sutures as they can compromise healing.
   • Different types of sutures are used for different procedures and surgical locations.
   • Follow-up visits are important to ensure proper healing.
   • Rinse with warm salt water to remove debris. (1/2 teaspoon salt to 8 ounces of warm water.)
   • If periodontal packing was used this sometimes comes out on its own. When it falls out discard it and begin cleaning the area as directed.
4. Post of instruction after ROOT CANAL TREATMENT

   After your Root canal treatment you can expect mild to moderate discomfort. This discomfort is due to inflammation around the root of the tooth and is a normal part of the healing process. The symptoms will usually be a dull ache and sensitivity to chewing, biting, or touch, which may intensify during the first 3-4 days after treatment but should gradually decrease soon after. The symptoms can be minimized by taking an antiinflammatory medication soon after completion of the root canal treatment. The key is to take the medication regularly, as prescribed. Pain medication will probably be necessary and can be taken as needed. Your bite may feel “off” for a few days, but should return to normal after the inflammation subsides.

   If you have a tendency to grind your teeth habitually, the duration and degree of the discomfort may be intensified and last longer as the inflammation does not have an opportunity to subside due to the constant trauma on the tooth. Should the discomfort continue to intensify after one week, or not subside, it is important to call our office so further evaluation can be done.

   It is important that teeth with root canal treatments have crowns placed upon them. Endodontically treated teeth are more prone to fracture than untreated teeth, and may also experience additional complications, including extraction and a higher risk of infection, if not sealed with a crown.

   Should your symptoms continue or worsen, an apicoectomy, may be required. This is a surgical procedure in which the end of the root is sealed via a small opening in the gum and bone overlying the root tip.

5. Post operative instruction after immediate denture

   Your denture will be ready to wear the same day that your teeth are removed. Your denture must stay in for one full day to act as a “bandage” after extractions. After the first 24 hours, take it out every night. You must return within the next few days for Dr.Chirnalli to see how you are doing.

   The denture will act as a “bandage” while your tissues heal, and will also allow you to smile, talk and eat. During the first week or so, your gums will be sore, and you should eat mostly soft foods or liquids. Your denture may feel loose. If your denture is too loose, return for a soft reline appointment. If you have a sore spot that is bothering you, return for an adjustment appointment (usually, the same day will be available when you call). Chewing and speaking will feel different than with natural teeth, and you will make progress with this as you heal. You must return in about 3-4 months for a permanent dentures.

6. Post Operative Instruction After Implant Surgery.

   Dental implants are an alternative to dentures and bridges for the replacement of missing teeth. Implants can be recommended for patients missing one or all of their natural teeth.

   Implants are certainly not a “quick-fix”, but the process is well worth the time commitment. The implant process can take anywhere from three to nine months to complete. The majority of implant recipients can enjoy their implants for many years or for a lifetime. A patient with good oral hygiene and health is more likely to reap lifetime benefits from their implants. The rate and determination of success depends heavily on a patient’s physical and oral health.

   The implant process requires two surgical procedures and several follow up appointments. The first procedure is to place the implant and the second is to place an abutment, which will eventually be holding the prosthesis in place. Both surgeries are usually done with intravenous sedation and local anesthesia.

7. Post Operative Instruction For Temporary Crown

   Occasionally a temporary crown or bridge may break or come off before the permanent one is ready to be placed. It is very important that it is replaced as soon as possible to prevent the teeth from shifting position and compromising the fit of your final restoration. If possible, try to reposition the temporary on your tooth and call us immediately so it can be repaired and recemented. To keep your temporaries in place, avoid eating sticky foods (gum), hard foods, and if possible, chew on the opposite side of your mouth. It is important to brush normally, 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.

   It is normal to experience some temperature and pressure sensitivity while wearing your temporary. The sensitivity should subside a few weeks after the placement of the final restoration. Mild pain medications may also be used as directed by our office. If your bite feels uneven, if you have persistent pain, or if you have any other questions or concerns