Please click on the below link to review the instructions
following your specific dental treatment
EXTRACTION
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you've just had a tooth
extracted. We hope to be able to avoid any concern on your part regarding the
next several hours by giving you the following information. Should anything
occur that seems out of the normal, please give us a call.
INSTRUCTIONS
Do Not Disturb the Wound
In doing so
you may invite irritation, infection and/or bleeding. Be sure to chew on the
opposite side for 24 hours and keep
anything sharp from entering the wound (i.e. eating utensils etc. ).
Mouth Wash Avoid all rinsing for 24 hours after extraction. This is to
insure the formation of a healing blood clot which is essential to proper wound
healing. Disturbance of this clot can lead to increased bleeding. You may use
warm salt water or mild antiseptic rinses after 24 hours only if prescribed.
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Excessive Bleeding: When you leave the office, you will be given verbal
instructions regarding the control of postoperative bleeding. A rolled up gauze
pad will be placed on the extraction site and you will be asked to change this
dressing every 20 minutes or so
depending on the amount of bleeding that is occurring. We will also give you a
package of gauze to take with you to use at home if the bleeding should
continue. Should you need to use the gauze at home, remember to roll it into a
ball large enough to cover the wound. Hold firmly in
place, with finger pressure, for about 20-30
minutes. If bleeding still continues, you may fold a tea bag in half and bite
down on it. Tea contains Tannic Acid , a styptic, which
may help to reduce the bleeding. If bleeding still continues, call for further
instructions.
Pain :
Analgesic tablets ( i.e. Aspirin, Tylenol etc. ) may be taken under my
direction. Prescription medication, which may have been given to you, should also
be taken as directed. If pain continues, please give us a call.
Swelling :
To prevent swelling, apply ice or a cold towel to the outside of your face in
the area of the extraction . Apply alternately, 20 minutes on then 20
minutes off, for an hour or longer if necessary.
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ENDODONTICS Return to top
What Is It and Why Do I Need It?
today we
may have suggested to you that Root Canal Therapy ( otherwise known as Endodontics)
was needed for a particular tooth. We may have briefly discussed some of the
facts concerning the procedures involved in root canal therapy but perhaps you
would like some more information.
a badly infected tooth, or one that just
had significant decay, was doomed to be extracted. Today the majority of these
teeth can be salvaged through a procedures utilized by
both the General Dentist and the root canal specialist, the Endodontist.
Extraction is truly
our last resort!
Root canal
treatment consists of :
1. The removal of
the infected or irritated nerve tissue (Fig.2) that lies within the root of the
tooth. It is this infected pulp tissue that causes an eventual abscess.
2. The first step in
a root canal is to obtain access to the nerve. This is accomplished by
establishing a small access opening in the top of the tooth. It will be done under
a local anesthetic. ( Fig. 3 )
 Healed Infection
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3. At the same
visit, the canal where the nerve is located will be reshaped and prepared to
accept a special root canal filling material. This filling procedure will
probably not occur until your next visit. The number of visits necessary to
complete your root canal will depend upon several factors including the number
of nerves in the tooth, the infected state of the nerve and the complexity of
the procedure. (Fig. 4)
4. The final step in
your root canal will be the sealing of the root canal with a sterile, plastic
material, called gutta percha This is done in order to prevent possible future
infection.( Fig. 5)
5. The tooth will
then possibly need a post and core and a crown in order to re-establish normal
form and function. This decision will be based upon several additional factors.
(Fig. 6)
If treated early, root canal
therapy need not be uncomfortable. With
the use of local anesthetics, the entire procedure can be totally painless.
Another "
Old Wive's Tale
" is that by removing the nerve the tooth becomes " dead ". This
is not true. The tooth is very much alive and functioning because it receives a
source of blood supply and nerve supply from the surrounding tissues that hold
it in place in your jaw bone. The tooth will have no sense of feeling to hot,
cold or sweets but will be responsive to biting pressures etc. With the proper
restoration the tooth should last as long as your
other teeth and can even be used as an anchor tooth for a partial denture or
cemented bridge. The success rates for root canal therapy have been reported to
be as high as 95%.
Sometimes when
there has been long standing infection or abscess, there may be some soreness
associated with the first or second root canal visit. If this should turn out
to be true you will be given specific instructions to follow to minimize the
discomfort. When an infection is present, it may be necessary to take an
antibiotic. If pain should be present, analgesics may need to be prescribed. In
either case, be sure to call the office if either of these problems should
arise.
POSTOPERATIVE
INSTRUCTIONS:
1.
Postoperative discomfort is sometimes experienced after a
treatment visit. This is due to irritation of the bone surrounding the tooth
and may range from a mild discomfort in the area to an occasional episode of
considerable pain. This discomfort will usually maximize
in approximately 48-72 hours and then subside. Please avoid chewing on the
treated tooth for a few days.
2.
If a throbbing sensation occurs please keep your head
elevated as much as possible and place extra pillows under your head when lying
down. Avoid as much as possible any strenuous activity as well.
3.
If your tooth has been left open to aid in drainage of an
infection, please place cotton in your tooth as directed. Do not leave the cotton in the tooth between meals.
4.
If swelling of the gum is present or should appear after a
treatment visit, please rinse the area every 1-2 hours with a solution of warm
salt water prepared by adding a teaspoon of salt to an 8 oz. glass of warm
water.
5.
If swelling of the face is present or should appear, apply
an ice pack to the area for 5 minutes every 1/2 hour.
6.
If antibiotic medication has been prescribed please take it
as indicated until you have finished ALL of the medication. If you encounter
any difficulty in breathing or a skin rash, or gastric disturbance should
occur, please discontinue the medication and call the
office.
If medication for pain has been prescribed
, please take it as indicated. It is important to bear in mind that
narcotic medications such as Codeine, Percodan and
Demerol may make you drowsy. Therefore, caution should be exercised in
operating any potentially dangerous machinery or an automobile.
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WHITE FILLINGS
Composites Return to top
you've just
had a white filling placed. Seemed kind of simple, but there is a lot more to
it than may meet the eye. First let me explain a little bit about the various
types of white fillings that are currently available.
The
most simple form of 'white filling' is technically
called a Composite. It is made up of a composite quartz resin and
usually contains some sort of light sensitive agent. These light cured
composites are extremely cosmetic and most often bonded into place. They can be
used in both the front of the mouth as well as in the your
back teeth. Some of these composite materials have been specifically designed
to actually withstand the incredible forces you can exert when chewing on your
back teeth.
In
order to bond a filling material to your tooth it is first necessary to remove decay,
prepare the tooth and then to condition the enamel and dentin. Once
conditioned, a thin resin is applied which bonds to the etched surface. The
bond strength of these fillings is incredible. Today we can bond plastics and
even amalgam (silver fillings) to your teeth. Bonding increases the strength of
these restorations far beyond those of only a short time ago.
After
placement, composites are hardened by shining a light on them for a
specified period of time, usually around 40 seconds. Since we tend to
look at this light all the time ( many times a day) it
is necessary for us to protect our eyes from it with an orange shield. It is
not necessary for us to protect your eyes since you look at this light only
once in a while. However, it is probably a good idea for you not to look
directly into the light anyway. An ounce of prevention,
is indeed, worth a pound of cure!
you probably asking the question, " When can I eat?". Well,
after placement, as long as you brought your own food and you share, you may
chew right away. These fillings are instantly hardened by the light.
Your teeth may experience some degree of temperature sensitivity for a few days
to a week. If it does not disappear within that period of time, please give the
office a call.
The other
type of 'white filling' is call a Composite or
Porcelain Inlay. These fillings are usually placed in back teeth when
esthetics is of utmost concern. In order to increase their strength and
longevity, they are fabricated in the laboratory and then bonded into position
in the office. This is a two visit procedure rather than the one visit required
to place a composite filling. However, when it comes to strength and cosmetics,
the extra time and expense is well worth it! I hope that you now understand a
little bit more about your new white (composite) filling. ,if you have any questions regarding this or any other treatment
procedure, please feel free to call at any time.
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Your New Crown
What To Expect ! Return to top
At your clinical examination, it was suggested that the
proper means of restoring your tooth was a crown. our reasons
for making that suggestion can vary from case to case. Some of the indications
for a crown are:
1.
A previously filled tooth where there now exists more filling than tooth. The existing tooth structure
becomes weakened and can no longer support the filling.
2.
Discolorations and compromised esthetics.
3.
Fractures
4.
Root canal - After root canal, teeth tend to become
brittle and are more apt to fracture. They, therefore, need to be protected by
a crown.
5.
Replacement of missing teeth requires crowning
adjacent teeth in order to support the missing teeth
During your visit today, we began the fabrication of your new
crown. (By the way, the word crown and
cap are synonymous). I'd like to take a moment to explain what went on and
what you can expect over the next several days.
We began by giving you a local anesthetic. Depending upon the
type of local anesthetic we used, you can expect to be numb for one to four hours.
If your anesthesia should last longer, do not be concerned. Not everyone reacts
to medication in the same manner. One word of caution : While you are numb, please be
careful not to bite your lip or tongue. A soft diet or no meal at all while you
are numb is probably a good idea. If your child has been the patient, please
watch them carefully to be sure they do not play with their tongue or lip while
it is numb.
Once you were numb, we prepared your tooth in a very specific
way in order to maximize the retention and esthetics of your new porcelain to
metal crown. After the tooth was fully
prepared, we proceeded with the impression stage. We used a thin of retraction cord
which was placed around your tooth in
order to get the impression material under the gum where the crown ends. Please
rest assured that this small piece of cord was removed prior to the end of
today’s visit.
Should you
experience any discomfort you can take a mild analgesic (Tyleno™l, Advil™, Anacin™, etc.) as long as there is no medical
contraindication based upon your medical history. Typically, you can take
anything you would normally take for a headache. If the discomfort persists,
please call the office.
Once the impression stage was completed , we placed a temporary (transitional ) crown (or
bridge if multiple teeth were involved) on your tooth. These plastic (acrylic) restorations are placed on
teeth to protect them and the gum tissues between dental visits. The temporary
cementing medium used is designed to allow me, or my hygienist, to easily remove them at your next scheduled
visit.
There
are a couple of additional facts you should know regarding the care of your temporary
crown:
1.
Home care is
extremely important while your temporary crown is in place. The health of your gum tissue and the
success of your final treatment restoration depends
upon it. PLEASE do not be afraid to
clean your teeth between visits. With a minimal amount of home care, you should
be able to maintain the continued health of your teeth and gum tissue during
the time required to fabricate your new crown.
1.
Sometimes, even
with meticulous care, temporary crowns or bridges may become loose between
visits. If this should occur, please place the temporary crown or bridge back
on your tooth immediately. Putting a drop of Vaseline™ in the temporary crown or
bridge will very often increase the retention and hold the temporary in place
until you can schedule an appointment. Once again, REPLACING THE TEMPORARY CROWN IMMEDIATELY IS VERY IMPORTANT ! It
only takes a short time for teeth to move if the temporary is not put back into
its proper position. This could affect the final restoration significantly and
may necessitate new impressions and a great deal of time. If you can not
replace the temporary crown yourself, put it in a safe place and call the
office. We will be happy to recement it for you at
the earliest possible moment.
2.
At your next
visit ( in the case of a bridge, additional visits are
necessary ) we will most probably place your final crown. At that time we
will check your crown for accuracy, adjust for any bite discrepancies and evaluate the
esthetics.
we hope that this brief instruction sheet will answer
most of your questions regarding today's visit. Following these simple
guidelines will help us provide you with the finest in dental care. If you have
any questions regarding this or any other procedure, please do not hesitate to
call. Our goal is to make your dental experience as comfortable and rewarding
as possible.
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PORCELAIN LAMINATES Return to top
All About
Porcelain Laminates :
Porcelain Laminates are
probably the most esthetic means of creating a more pleasing and beautiful
smile. They require a minimal amount of tooth reduction (
approximately .5 mm ) and are, therefore, a more conservative
restoration than a crown. Porcelain laminates allow us to alter tooth position,
shape, size and color. They are not the only alternative for all esthetic
abnormalities but are truly a remarkable restoration when they are the
treatment of choice.
Some facts you might want
to know about Porcelain Laminates :
Since they
require approximately .5mm of tooth reduction, porcelain laminates are NOT considered a reversible form of treatment.
<
Occasionally the
preparation of a Porcelain Laminate Veneer does not necessitate the use of a
local anesthetic. However, for those patients that are particularly sensitive
or anxious, a local anesthetic is advisable.
The laboratory
time required for the fabrication of a Porcelain Laminate Veneer is
approximately one week. Due to the minimal amount of tooth reduction, it is
usually not necessary to fabricate any type of temporary restoration. Should a
temporary be needed, they can, in most circumstances, be made at the time of
treatment.
Between your
preparation visit and the insertion visit, you can expect some sensitivity to
hot and cold. This is normal and is due to the removal of a small portion of
the enamel covering of the tooth. This sensitivity should disappear after the
placement of your Porcelain Laminate Veneer.
Your second
visit, the insertion of your laminate, can be accomplished, once again , with or without local anesthetic. This visit is
usually longer in length. The laminates are placed with a light sensitive resin
which is hardened by using a white light.
Once placed your
laminates are very strong and will resist most of the forces placed upon them
by a normal diet. Porcelain has great crushing strength but poor tensile
strength. Therefore, you should avoid anything that will tend to twist the
laminate. Opening pistachio nuts with your teeth, chewing on bones or jelly
apples is probably not a good idea. As with most things, common sense should
prevail.
Maintenance of Your New
Porcelain Laminates :
The maintenance of your
Porcelain Laminate Veneer is relatively simple. A few suggestions, however, are
in order:
1.
Some sensitivity
to hot and cold may be experienced after the placement of your laminates. This
relates to the amount of enamel left on your tooth after preparation, the
proximity of the nerve as well as several other factors. Some sensitivity is
absolutely normal and usually dissipates after one-two weeks. If this
sensitivity should remain or concern you at all, please give us a call.
2.
As mentioned
before, a normal diet should pose no problem at all. Please avoid anything that
will tend to bend or twist the laminates.
3.
If you are known
to be a bruxer or clencher,
please let us know. We will fabricate a soft nite
guard for you to wear to minimize the stresses placed upon your teeth while you
sleep.
Please brush and floss as you normally would
to prevent oral hygiene problems. Once placed, Porcelain
Laminate Veneers are typically the kindest restoration to the gum tissues that
we currently have in our prosthetic armamentarium. Do not be afraid that you
will damage your laminates by either flossing or brushing. Any non-abrasive
tooth paste is acceptable. A good home care regimen will insure the esthetic
success of your laminate restorations for years to come.
Approximately
one week after the placement of your laminates you will be asked to return to
the office for a treatment evaluation. This visit is extremely important. It
gives us the opportunity to evaluate the placement of the laminates, the tissue
response and to answer any questions you might have regarding your new smile.
,we hope
that your Porcelain Laminate Veneers have fulfilled all of your esthetic goals.
With proper home care and scheduled evaluation visits, they can provide you
with a beautiful smile for years to come. If you have any questions concerning
any aspect of your
dental care, please give us a call.
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PERIODONTICS Return to top
SOFT TISSUE
MANAGEMENT
over the past several years we
have formulated a Soft Tissue Management Program which is specifically designed
to assist you in maintaining your periodontal health. The goal of this program
is to control the bacteria that cause the infection. Thorough root planing ( the mechanical removal
of plaque and calculus in the office ) and proper home care techniques are
essential for successful periodontal therapy and good oral health.
Exactly how does Soft Tissue Management work
?
1.
The Initial
Phase consists of patient education in proper oral hygiene techniques.
Without a strong foundation, a house can not stand for long!
1.
The Treatment
Phase involves the removal of all causative factors and may include
correction of bone and gum defects by surgical or non-surgical means,
correction of malocclusion ( bite ) problems, and the
replacement of missing teeth in order to re-establish proper form and function.
2.
The Control
Phase begins immediately after the treatment phase. Once the disease
process has been eliminated, it is your responsibility to seek regular
preventative treatment. We are here to help at all times. You need only to ask!
Our Soft Tissue Management Program is designed to instruct
our patients in the techniques necessary to maintain a proper state of
periodontal health. Sometimes it will be necessary to utilize the skills of a
specialist, a Periodontist. In coordination with the periodontist, your dental team will do all it can to insure
your predictable periodontal health.
LIFE AFTER
PERIODONTAL THERAPY
Congratulations
You've
just finished your periodontal therapy and have been told to return to our
office for the completion of your treatment. But what's in store for you now?
Where do we go from here? Let me give you some idea of how we will proceed.
1. First, we will re-evaluate the condition of your gums, teeth
and bone. If you have done your homework, your gum tissues should be pink and
firm. Your teeth should demonstrate little or no mobility, and there should be
no bleeding upon probing.
2.
Prior to your
periodontal therapy, we prepared all or some of your teeth in order to
facilitate the access to you gums needed for periodontal therapy. The
transitional restoration also served to support the weakened teeth during the
surgical procedures.
3. Usually, as a result of periodontal therapy, there is a
change in the position of the gum tissues. If all of the above criteria are
met, we will reprepare your teeth and refit your
temporary caps to the new preparations or, if you have not had temporary caps
placed prior to your periodontal therapy, we will prepare your teeth for the
final restoration and place temporary (transitional) caps.
By re-adapting your temporary caps to the new gum position, some , if not all, of the sensitivity you may have
experienced during the healing phase of your periodontal therapy may disappear.
When refitting your temporary caps, we will also attempt to close some of the
enlarged spaces between your teeth which may have occurred as a result of your
periodontal surgery. Some spaces, called embrasures, must be left in
order to allow for proper cleaning of your new prosthesis.
During the coming months, it is extremely important for you
to continue the home care regimen prescribed for you during your periodontal
therapy. Life-like porcelain restorations can only be accomplished when the gum
tissues are absolutely healthy.
After
relining your temporary caps, we will proceed with impressions of your teeth,
trying in of the undercastings and eventually,
evaluation and customizing of the actual porcelain. Once we, both you and I, are satisfied with
the esthetics, function and phonetics of your new restoration, we will return
the prosthesis to the laboratory for final glazing. At your next visit, we will
temporarily cement your new prosthesis so that we can evaluate the form and
function of the restoration during normal everyday use. After a suitable period
of time, we will " permanently " cement your
prosthesis.
A
well controlled home care regimen is now your main defense against periodontal
disease. Several instruction sheets are available to assist you further with
the maintenance of your new prosthesis. If you need additional help with any of
the home care techniques you have been instructed to use, please feel free to
discuss this with either our office or the office of your periodontist.
The future success of your new bridge is now in your hands. If you have any questions regarding this or any other aspect
of your dental care, please let us know.
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POSTS Return to top
WHAT ARE THEY
AND WHY DO I NEED ONE?
What is a post, what is it made of, and why do I need one?
These are questions that are very often asked about a procedure that is
required in order to rebuild the proper support for a cap or crown. Let me take
a moment to explain....
1. First of all, a post is a metallic structure
that is placed within the body of the root of a tooth that has had previous
root canal therapy.
2. It can only
be placed in a tooth that has had endodontic therapy ( root canal )
since once the dentist enters the nerve, the nerve dies. Root canal therapy
prevents further infection and discomfort. During root canal therapy, the space
previously occupied by the nerve is filled with a sterile
plastic material call gutta-percha.
3. In fabricating your post, we remove some of this
plastic material making sure we leave the last two to three millimeters to seal
the end of the root. This space that is fabricated is necessary in order to
anchor the post within the root of the tooth.
There are different types of posts. The type that is
chosen for you will depend upon a number of factors. The post can either be 1)
prefabricated or 2) it can be cast at the dental laboratory. In either case,
the result of anchorage for a crown is the same.
The part of the post that shows is called the core. It
is upon this core that we can anchor a cap or crown. The post is cemented permanently
into your tooth usually separate from the crown. The crown (
or cap ) is then ready to be placed.
Although posts are usually recommended when there is
minimal support for a crown, they are not always necessary. The use of a post
will be determined on an individual basis based upon support and structural
requirements.
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All About DENTURE RELINES Return to top
There are basically two (2) different types of denture
relines.
A Hard
permanent reline which can either be done here at the office with an
office-cured plastic or else it can be sent to the dental laboratory and
processed in a laboratory cured plastic.
Due to the special processing, the laboratory reline tends to last
longer. Unfortunately this will require our taking your denture from you for a
few days. Please try to coordinate this with our Appointment Coordinator so
that you may be inconvenienced for as few days as possible.
A Soft
reline can be done here at the office or else it can be done at the
laboratory in a more permanent fashion. The permanent type, lab processed, may
last up to one year without having to be replaced. The office processed soft
liner tends to be more fragile and will need to be removed and replaced with
greater frequency.
Denture relines are necessary in order to accomplish
several goals. These goals include:
Increasing retention of old, existing dentures
or new dentures that, for one reason or another, have lost retention. Sometimes
this may be due to recent extractions or alteration in the gum tissue due to
other surgical procedures.
Repairs.
Relining of old dentures hoping to avoid the
necessity of remaking them entirely.
Gum tissue conditioning which usually relies on
the gentle action of soft tissue materials ( soft
liners ) to allow your abused gum tissue to return to a proper state of health
prior to the fabrication of new dentures.
The process of relining usually
involves taking an impression in the tissue bearing surface of your existing
denture ( the undersurface) and then sending it (your denture)
to the laboratory. The teeth are usually left as is but the pink plastic is
removed and then replaced with brand new plastic. Your denture will look just
like new. I hope that this will clarify some of the issues surrounding denture
relines.
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Your New Bridge Return to top
Well, it's almost over.
That's right....you're on your way out of the office with your new cemented
bridge. We really hope you're happy with both the esthetics and the comfort of
your new bridge. A lot of time and effort, on everyone's part, went into the
fabrication of your new prosthesis.
we'd like to take one more minute of your time to explain the
events of the day and what you can expect in the future:
Your bridge has been checked for accuracy and fit.
We adjusted the bite prior to cementation and have
evaluated, with you, your esthetic needs. However, sometimes fine tuning is
necessary. If you feel there is any aspect of your bridge that needs adjustment
( i.e. the bite, esthetics, etc.) please let us know.
In order to be able to accomplish the above goals, we
have cemented your new bridge with a transitional
cement. One that will allow us to remove the bridge, if necessary, and make any
needed adjustments. You can, however, treat your new bridge as if it is
permanently cemented. Sometimes, due to the accuracy of the fit of your new
bridge, it is
not possible to remove a transitionally cemented bridge. Don't be alarmed. The
marginal integrity of your new bridge should prevent any problems from arising.
If you feel any movement, however, it is important that you notify us
immediately so that we can remedy the situation. The chances of it coming loose
are minimal. Don't be afraid to give it a good test ride.
If your new bridge is an anchor for a removable
appliance, please be sure to follow our instructions as to the removal and
replacement of the removable section. ( Be sure to
hold the cemented bridge with your fingers when removing the removable section
in order to avoid loosening of the cemented bridge.)
If your new bridge should, by chance, come loose there
are a few things we would like you to do.
Most important
:
1.
You Must Make
Sure Your New Bridge Is Never Out Of Your Mouth For Any Time. If you leave your
bridge out, there may be some tooth movement
which will necessitate remaking your bridge.
Call our office as soon as you realize there is a
loosening of your bridge. We will be happy to schedule some time for recementation.
If you are away, try to call any dentist and ask them
to recement your bridge with any temporary cement. (
i.e. Opotow Temporary Cement™, Zone™ Temporary
Cement, or TempBond™ )
Care of Your New Bridge
now that you've received your new bridge, it is very
important that you follow the hygiene instructions given to you by our
hygienist. Just in case you've forgotten or were confused at that time, here is
a list for your review. If you have any additional questions, please give us a
call.
·
Treat your new
bridge as you would treat your own teeth. It should be brushed and flossed as
usual.
·
If you have a
tooth that was missing and it has been replaced by a tooth on your bridge, it
will be necessary to thread the floss
between the teeth using Floss Threaders™. If you
need a demonstration on Floss Threading, please let us know.
·
If we prescribed
either a RotadentR and/or an InterplakR be sure to
use it on the new bridge as well as on your natural teeth.
We hope you enjoy
your new bridge and that it continues to serve you well for many years to come.
, if you have any problems, or questions, please feel free to
give us a call at any time.
Return to top
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Arthur A. Kezian, D.D.S. :: Narine Tashjian, D.D.S.
443 North Larchmont Blvd., Los Angeles, CA 90004
Phone: (323) 467-2777 :: E-mail: kezian@msn.com
