Home Care Instructions

 After Cosmetic Reconstruction

Remember that it will take time to adjust to the feel of your new bite. When the bite is altered or the position of the teeth is changed it takes several days for the brain to recognize the new position of your teeth or their thickness. If you continue to detect any high spots or problems with your bite, call our office so we can schedule an adjustment appointment.

It is normal to experience some hot and cold sensitivity. The teeth require some time to heal after removal of tooth structure and will be sensitive in the interim. Your gums may also be sore for a few days. Warm salt water rinses (one teaspoon of salt in a cup of warm water) three times a day will reduce pain and swelling. A mild pain medication (one tablet of Tylenol or ibuprofen (Motrin) every three to four hours) should ease any residual discomfort.

Don’t be concerned if your speech is affected for the first few days. You’ll quickly adapt and be speaking normally. You may notice increased salivation. This is because your brain is responding to the new size and shape of your teeth. This should subside to normal in about a week.

Daily brushing and flossing are a must for your new dental work. Daily plaque removal is critical for the long-term success of your new teeth, as are regular cleaning appointments.

Any food that can crack, chip, or damage a natural tooth can do the same to your new teeth. Avoid hard foods and substances (such as beer nuts, peanut brittle, ice, fingernails, pencils, and/or sticky candies. Smoking will stain your new teeth. Minimize or avoid foods that stain such as coffee, red wine, tea, and berries.

If you engage in sports, let us know so we can make a custom mouthguard. If you grind your teeth at night, wear the night guard we have provided for you. Adjusting to the look and feel of your new smile will take time. If you have any problems or concerns, please let us know. We always welcome your questions.

 After Crown & Bridge Appointments

Crowns usually take two or three appointments to complete. Bridges usually take three to five appointments to complete. In the first visit, the teeth are prepared and molds of the mouth are taken. Temporary crowns or bridges are placed to protect the teeth while the custom restoration is being made. Since the teeth will be anesthetized, the tongue, lips, and roof of the mouth may be numb. Please refrain from eating and drinking hot beverages until the numbness has completely worn off.

Occasionally a temporary crown may come off. Call us if this happens and bring the temporary crown with you so we can re-cement it. It is very important for the temporary to stay in place, as it will prevent other teeth from moving and compromising the fit of your final restoration.

To keep your temporary 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 dont pull up on the floss which may dislodge the temporary but pull the floss out from the side of the temporary crown.

It is normal to experience some temperature and pressure sensitivity after each appointment. 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, please call our office at 212-246-1333.

 After Tooth Extraction

After tooth extraction, its important for a blood clot to form to stop the bleeding and begin the healing process. Thats why we ask you to bite on a gauze pad for 30-45 minutes after the appointment. If the bleeding or oozing still persists, place another gauze pad over the wound and bite firmly for another 30 minutes. You may have to do this several times.

After the blood clot forms, it is important not to disturb or dislodge the clot as it aids in healing. Do not rinse vigorously, suck on straws, smoke, drink alcohol, or brush teeth next to the extraction site for 72 hours. These activities will dislodge or dissolve the clot and retard the healing process. Limit vigorous exercise for the first 24 hours as this will increase blood pressure and may cause more bleeding from the extraction site.

After the tooth is extracted you may feel some pain and experience some swelling. An ice pack or an unopened bag of frozen peas or corn applied to the area will keep swelling to a minimum. Take pain medications as prescribed. The swelling usually subsides after 48 hours.

Use the pain medication as directed. Call the office if the medication doesn’t seem to be working. If antibiotics are prescribed, continue to take them for the indicated length of time, even if signs and symptoms of infection are gone. Drink lots of fluids and eat nutritious soft food on the day of the extraction. You can eat normally as soon as you are comfortable.

It is important to resume your normal dental routine after 24 hours. This should include brushing and flossing your teeth at least once a day. This will speed healing and help keep your mouth fresh and clean.

After a few days you will feel fine and can resume your normal activities. If you have heavy bleeding, severe pain, continued swelling for two to three days, or a reaction to the medication, call our office immediately at 212-246-1333.

 After Composite (White) Fillings

When an anesthetic has been used, your lips and tongue may be numb for several hours after the appointment. Avoid any chewing and hot beverages until the numbness has completely worn off. It is very easy to bite or burn your tongue or lips while you are numb.

It is normal to experience some hot, cold, and pressure sensitivity after your appointment. Injection sites may also be sore. Ibuprofen (Motrin), Tylenol or aspirin (one tablet every three to four hours as needed for pain) work well to alleviate the tenderness. If pressure sensitivity persists beyond a few days or if the sensitivity to hot or cold increases, contact our office.

You may chew with your composite fillings as soon as the anesthetic completely wears off. Composite fillings are fully set when you leave 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 212-246-1333.

 After Equilibration of Your Teeth

Your Equilibration was performed for several of the following reasons:

• To allow as many back teeth to contact as possible, when you bite or tap on your back teeth.
• To allow these back teeth to touch simultaneously and with equal pressure when tapping or biting on them.
• To reduce sideways and “locked in” damaging contacts that can fracture, loosen or cause back teeth to become sensitive.
• To allow for smooth rubbing contacts on your front teeth when you move off of the back teeth.
• To minimize any vibrations or looseness of your teeth when you tap, rub or bite against them.
• To provide a stable, repeatable and comfortable fit of your teeth. this becomes a repeatable biting target, or “home base” to design any of your future dental restorations.

After your Equilibration you may notice:

• That you may have teeth that are touching that you never felt touch before. This newness may feel dominant for a few days, then it will often be forgotten.
• That some of your teeth may feel as if they were sharpened. They can easily be smoothed if they bother your tongue.
• Some areas of roughness may not have been polished enough to satisfy your tongue. Most of this self-corrects, yet we are more than happy to provide more polishing.
• Your jaws may feel increased tiredness if significant changes were made or the appointment was a longer one. A softer diet for a few days allows the joints and muscles to recover. If you can safely take it, some find relief with ibuprofen (Advil, Nuprin, etc.). Call me if this persists beyond 48 hours.
• Some teeth may become very sensitive to chewing or cold if dentin was adjusted. this can take from 2-14 days to reach a satisfactory level.
• Loose teeth may begin to feel more solid.
• You may begin to feel imperfections or irritations to your bite that were not noticeable when you left the office. Rebounding of your compressed teeth, along with joint and muscle settling may account for these changes. Call our office to further refine these areas if an appointment is not all ready set up.

After your Equilibration, we ask you to:

• Try to not focus consciously on how your bite feels. Try to let go of actively evaluating your bite and the newness to the feel of your teeth. Giving active feedback of the feel of your bite during treatment is encouraged and very helpful. Continuing this at home or at work is not normal and can lead to obsessive behaviors. If you try hard enough, most of us can find minor imperfections in our bites that are of no functional consequence. Chasing these has no benefit.
• Report to us any bothersome changes in your bite that stands out without you having to actively search for them.
• Call me to report any headache, muscle or jaw joint discomfort or noises that increase after your equilibration.

At your second Equilibration visit, we will:

• Ask you to report any observations that you have regarding the feel and the comfort of your bite. Does it feel more/less solid? Is chewing easier/harder? Why?
• Ask you to report any observations that you have regarding any headache, jaw muscle, jaw joint or jaw noise changes.
• Ask if you have any suggestions for refinements or polishing that we can make to improve your comfort or the feel of your teeth.
• Go through our evaluation of your fit to see if there are areas to refine that you do not notice. This is similar to the first visit, yet you may have more observations to report now that you have had time to use your refined bite.
• Remember try to not focus on your teeth. Let go of trying to be observant and let any awareness come to you naturally.

 Home Bleaching Instructions

Using the bleach trays:

1. Always brush and floss (using un-waxed dental floss) on your teeth before bleaching– improper removal of plaque will not allow the bleaching gel to lighten the tooth where plaque remains.
2. Fill bleach trays one third the height of each tooth compartment in the tray. Overfilling will only waste bleach and possibly irritate the gums.
3. Fill bleach trays from bicuspid to bicuspid only. Express bleach from the syringe continuously from tooth to tooth in the bleach tray to minimize bubbles.
4. Avoid areas that have crowns or bridges, as these teeth will not change color, and you will waste bleach.
5. 16% Nite White or Colgate bleach should initially be used for 1 hour (1/2 hour for sensitive patients). Gradually increase use over the course of one or two weeks up to 3+ hours. If 3 hours of wear occurs without sensitivity or soreness, you may sleep with the trays if that is easier. Note that the bleach is active for about 4 hours, so if you wake up in the middle of the night, you can take the trays out.
6. 22% Nite White bleach must never be used for more than 1 hour total per day.
7. If you have a history of tooth sensitivity, you should pre-use desensitizing toothpaste for 3-4 weeks before and through the bleaching process.
8. You dont have to bleach every day–you can bleach every other day or even every third day– but the closer the bleach intervals, the faster they will see results.

After bleaching:

1. After whitening, remove and rinse the trays with cold water. If necessary, use a toothbrush on the tray to remove any residual gel. After drying the tray with cotton you should store the trays on the models (preferred) or in the case (if for a short period).
2. To maintain your bleach, store the gel at room temperature and avoid exposure to heat or sunlight. Do not refrigerate.
3. It is ok to rinse with lukewarm water, but the teeth should not be brushed right away. Wipe excess bleach off the teeth with a cotton q-tip. Do not eat or drink for hour after bleaching and avoid coffee, tea, red wine, citrus fruits and juices for longer (the exception is overnight use).

What to expect:

1. Most patients see results in 2 to 3 home sessions. You will probably need to use most of the syringes, but save one or two for future use. The area of the tooth closest to the gum takes longer to lighten and will remain darker than the biting edge. Some teeth may initially appear to have whiter streaks than other areas, but this should even out in time. Once treatment is complete, your teeth may be slightly whiter than they will remain. The final color will be achieved approximately three weeks after finishing the bleaching process.
2. The results will last, but there may be some relapse depending on red wine, coffee, tea, or juice intake. Most patients typically require at least one full bleach kit to attain desired results, but bleaching can be continued for 6 to 9 months longer if desired. Most patients reach a plateau where further lightening of the teeth is not obvious.
3. Some patients never have to repeat the process but using the bleach trays once every year or so is probably a good idea to maintain the color since a certain amount of reversion almost always occurs. If additional bleach is required, we always have some in stock.
4. It is normal for the gums to be a little sore and the teeth to be a little sensitive right after bleaching. If any of these symptoms occur and are more than mild, you should discontinue the treatment on a daily basis and try every other day or every third day. You may also take over-the-counter pain medication as you require (do not exceed recommended doses). Most symptoms subside within 5 to 7 days.

If you have any questions feel free to call the office at any time.

 Bite Appliance Instructions for Use

Your Bite Appliance was provided for several of these reasons:

• To protect your teeth from unconscious/conscious clenching or grinding. Unprotected, these habits can cause your teeth to have excessive wear, gum recession, and root exposure, sensitivity, fractures, loosening mobility, position changes or pain. This places the teeth at risk of requiring crowns, accelerating periodontal disease or even root canals. These habits can wear out your teeth and your dental work.
• To assess if headache pain, muscle or jaw pain, as well as joint pain is related to the fit of your teeth and what you do with your teeth.
• To further assess if physical therapy, behavioral therapy or other modalities will be needed to help you cope with your symptoms.
• To discover more of what you do with your teeth before any complex restorative care is given.
• To find out where your teeth should fit when your joints and muscles are most comfortable, stable and noxious habits are reduced.
• To assess how you will adapt to planned improvements in your bite that are made with a reversible appliance prior to any irreversible changes.

Your Bite Appliance is designed to:

• Fit without rocking or squishing.
• Provide solid support for your bite. This helps to provide improved muscle function and jaw joint comfort.
• Provide equal and simultaneous pressure when biting or tapping on your back teeth.
• Provide smooth contacts with your front teeth when you move away from your back teeth and onto the front teeth.

How to use your Bite Appliance:

• The most common use is nightly while sleeping to protect from unconscious clenching/bruxing.
• Some will wear it during the day when engaged in activities that they find themselves clenching or are uncomfortable with headache, jaw or jaw joint pain.
• A few may even wear it all day and night, even when chewing to provide better comfort and support.

What to expect from your Bite Appliance:

• For the first few days the splint will feel large and speaking may be a difficult task. However after a short period of time you will be able to speak more clearly and the splint should feel quite comfortable.
• You may notice an increase in saliva and swallowing.
• You will notice when you first remove the bite appliance from your mouth for eating or cleaning that the teeth will contact differently. This is because of muscle relaxation and the seating of the jaw joint. The teeth are actually interferences in this seated jaw joint path of closure; however, the jaw muscles will quickly modify their action and return to the original path of closure dictated by your teeth.
• If it bothers you too much, try wearing it for a shorter period to help adaptation.
• Some may notice they clench more with the appliance, as it brings previously unconscious activity to the conscious mind.

How to care for your Bite Appliance:

• Your bite appliance is made of hard, processed dental material, much like that of which dentures are made. It is strong and durable if properly cared for. You should clean it thoroughly with toothpaste and toothbrush, rinsing it completely to remove any toothpaste film. If this film remains and hardens the appliance will feel very tight! Occasionally soak it in any commercial denture cleanser such as Efferdent to remove stains.
• Store it in your provided case, labeled with your name, address and phone number if lost. Do not place it in a pocket or suitcase outside of its case. Never leave your appliance in direct sunlight or where it can become overheated. If it is lost or broken, it usually necessitates starting over with a new one. That takes time and can be very expensive!
• Let it air-dry in the opened case in a closed drawer.
• Keep the appliance well out of the way of pets, especially dogs. Dogs may find it to be an irresistible treat!
• Wet the appliance before using.
• Hold the appliance between thumb and fingers, by one wing only. Holding it in the palm of your hand may allow you to squeeze it and easily fracture it.

What to report at your next visit:

• Any obvious changes in how your bite fits with your appliance? You do not have to try to search for these differences. Let them find you if they stand out.
• Any irritating areas against your tongue, gums or tightness of fit against your lower teeth?
• Any changes in your awareness of clenching or grinding activities?
• Any changes in your comfort related to muscle tension/pain, headache pain, jaw joint pain or jaw joint noises?
• Any changes in tooth pain or temperature sensitivities?
• Compare the fit/comfort of your bite with your appliance in place to the fit/comfort of your bite without the appliance in place. Which bite do you prefer and why?
• Discontinue use and call me if any pain or symptoms are made worse with its use.

Other considerations:

• Additional follow-up appointments (modification phase) may be scheduled to modify your bite appliance as your muscles and jaw joint relax. It is VERY IMPORTANT that you not miss your appointments. It is critical that you are monitored during this treatment and, with the doctors tight schedule, appointments can be difficult to obtain.
• We recommend that the fit of the appliance be evaluated every six months at your preventive appointments. We will also ultrasonically clean the appliance at that time.
• Whenever we restore any of your teeth, the appliance may need to be refitted to the shape of your new restorations. There may be a charge for this refinement especially if you forget the appliance and another visit needs to be scheduled.
• Reducing jaw muscle tension and protecting those forces from the teeth may allow compressed teeth to relax and change positions when not overly clenched upon. These changes are common and may require alterations of the teeth to improve your bite through reshaping, placing restorations or orthodontics. Consultation as to what additional treatment is indicated and the fees for that treatment will be given after the appliance therapy is completed.
• Reducing jaw muscle tension may allow the jaw joints to achieve their most natural, relaxed position (if they weren’t in that position to begin with) and allow the jaw to close in its best and most natural path. This may be different from what you originally started with. This is considered a diagnostic event, and while it is not a common occurrence, it presents as symptoms are relieved, demonstrating that your jaw-joints had not been in their ideal positions. There is no test to determine in advance if the jaw-joints are in their ideal positions.
• One example of an improvement in jaw relationship results in the farthest back molars contacting before the other teeth do, while the front incisors may not contact as well as they did before or in rare cases, may not be able to touch each other at all. In this event, we may recommend modifying your teeth to achieve the most efficient closure or bite. This may be done by varying therapeutic combinations which may include reshaping the teeth, placing restorations, moving them by orthodontics (braces) or surgery.