Follow Up Instructions

• Brushing your teeth carefully, twice a day, is the foundation of good oral health.  By brushing, you will remove food particles and plaque and minimize the toxins that lead to decay and gum disease.
• Brush twice a day.
• Use a soft or extra-soft brush.
• Hold the brush at a 45-degree angle where the gumline meets the teeth.
• Gently rotate the brush in place to a count of ten.
• Move on to the next group of teeth and repeat on all tooth surfaces.
• Brush your tongue or use a tongue scraper to remove bacteria that cause bad breath.
• Allow two minutes.

• Flossing once a day will help you clean between the teeth and under the gumline.  It will also help you remove stubborn food particles and plaque that cause dental problems in the future.  Alternative devices are available to clean in between teeth when fixed bridges are present.
• Take about 18 inches of floss and wrap it around the middle finger of each hand.
• Make sure the floss is pulled tightly between your fingers.
• Using your thumb and forefingers, gently slide the floss between two teeth.
• Curve it around each tooth, move the floss up and down against each tooth and between the tooth and gums as high or low as it will comfortably go under the gumline.
• Move on to the next tooth, advancing to a clean section of the floss.
• Repeat the steps above for each tooth.
• Remember to floss the spaces behind your last teeth on the top and the bottom.
• Allow two minutes.

Patients often experience sensitive or painful teeth after receiving dental treatment or after grinding their teeth during sleep (nocturnal bruxism). The patient may or may not feel an obstruction or “high” bite. When the upper and lower teeth come together when swallowing or chewing, they should interdigitate (mesh together) properly without any prematurities.

If one of the teeth is not meshing well with the opposing teeth, the tooth will be traumatized and become hypersensitive. Usually the tooth will become sensitive to cold, or when biting into hard foods. Teeth are connected to our jaw bones by very small ligaments, which become sprained when the bite is “high” or “off”.

Recommended Treatment

1. The tooth or restoration that is “high” or “off” will need to be adjusted with a dental drill. Once the tooth is aligned properly with the opposing teeth, both when biting straight down and when rubbing the teeth together, it will take approximately two to six weeks to improve.

2. When a tooth or teeth are extremely sensitive due to the bite being “high” we apply desensitizing agents to the affected teeth and the patient is also given anti-inflammatory medication.

Patients are usually numb when undergoing dental treatment and are not thoroughly aware of their bite. After the anesthetic wears off, they regain a sense of their “normal bite”. If the bite does not feel right, we stress returning to our office as soon as possible for an adjustment. The longer the patient continues to bite incorrectly or function on a “high” tooth, the worse the pain will be as the tooth is being traumatized continuously.

Patients who grind their teeth while sleeping may traumatize one or multiple teeth, resulting in the same discomfort or sensitivity as a person with a “high” bite. For patients who experience discomfort due to grinding their teeth, we recommend adjusting the bite and fabrication of a nightguard to minimize undue forces on the teeth during sleep.

Dental caries (tooth decay) is caused by a number of contributing factors.  The decay process begins with bacteria metabolizing starches and sugars, resulting in acid production.  The acid dissolves the minerals on the outer surface of the tooth, resulting in dental caries (cavity).  Fluoride enhances the remineralization process and makes the tooth more resistant to these acids.  Below are the risk factors and recommendations for preventing caries.

Risk Factors

• High starch and sugar intake (frequent snacking, junk food, candy, etc.).
• Drinking beverages which are high in sugar or acid (fruit juices, soda, sports drinks, etc.).
• Drinking bottled water (non-fluoridated).
• Decreased saliva flow (often a result of medication).

To decrease the acid producing bacteria and increase tooth remineralization, we recommend the following regimen:

• Brush with Fluoridex (1.1% sodium fluoride toothpaste) twice daily.  Do not eat or drink anything for 30 minutes following brushing with Fluoridex.
• Floss, after brushing, at least once a day, preferably before bedtime.
• Rinse with 10 ml. of Peridex (0.12% Chlorohexidine gluconate) for 1 minute daily for the first week of each month prior to bedtime.
• There are various methods of fluoride treatments available. These applications should be performed 4 times a year in our office by the hygienist.

Dentin hypersensitivity (sensitivity to touch or changes in temperature) is a common oral condition that effects many patients. This condition is usually caused by gingival recession and erosive tooth wear. Gingival recession is frequently a result of periodontal disease (gum disease) and/or aggressive tooth brushing technique. When the gingiva recedes, the dentin on the root surface of a tooth is exposed resulting in hypersensitivity. The dentin surface has dentin tubules which communicate with the pulp inside a vital tooth. Therefore, any stimulus such as cold, heat, air, touch, sweets, or acidic food may cause dentin hypersensitivity. The most common area of a tooth affected by dentin hypersensitivity is the root surface near the gum line.

Recommended Treatment

1. Do not use an electric toothbrush. The bristle on most of these devices are too abrasive, causing gingival recession and tooth abrasion. Please use a sensitive or soft tooth brush and wet the bristles with warm water prior to brushing.
2. Do not use any bleaching (whitening) or abrasive toothpastes or bleaching agents. Please do not use any toothpastes that contain peroxide or baking soda. We recommend using Sensodyne or prescription toothpastes, such as Prevident or Fluoridex, twice daily. These toothpastes contain chemicals such as potassium nitrate that occlude (seal) the dentin tubules and decrease hypersensitivity.
3. Do not brush sideways (scrubbing horizontally, side to side). Brush at a 90° angle from the gum onto the tooth surface, not from tooth to gum.
4. The dentist or the hygienist can apply a desensitizing agent on the exposed dentin which can occlude (close or clog up) the dentin tubules.
5. Should the area of recession or abrasion be extensive, a composite resin filling may be placed over the area to protect the exposed dentin.
6. If the area of recession does not have extensive abrasion, a periodontist may place a gum graft over the site to protect the exposed dentin. This is the most natural modality of treatment by replacing the missing gum. The graft is usually taken from the palate on the same side of the mouth as the affected area.
7. Avoid acidic (low pH) foods and drinks such as wine, sports drinks, soda, oranges and plums.

By using one, or several of the suggested treatment options mentioned above, one can manage dentin hypersensitivity.

1. Do not rinse today. Avoid extremely hot foods or liquids.
2. Some swelling may occur during the first two days. For today, apply an ice pack to the outside of the face, ten minutes on, ten minutes off, as often as possible. Do not use ice after the first twenty-four hours.
3. Ordinarily, slight oozing may be noticed around the surgical site, do not be alarmed. Do not try to stop the bleeding by rinsing. Apply pressure with gauze or a wet tea bag. If the bleeding does not stop, call the office.
4. You were given a prescription for pain medication, and possibly an antibiotic. Severe swelling, difficulty in breathing, or appearance of a rash indicate an allergic response to the medication. Discontinue use at once and immediately seek medical attention.
5. Please refrain from smoking during the post-operative period. Avoid alcoholic beverages during this time, especially if you take medication.
6. Do not remove the denture until the morning following the surgery. This will prevent the extraction sites from swelling.
7. Remove the denture the morning following surgery and brush the inside and outside surfaces of the denture with toothpaste. At this time you may rinse out and clean the rest of your teeth as usual, but do not attempt to brush near the treated area. You may gently swab the area with a cotton tip applicator moistened in Listerine.
8. The denture is not to be worn at night while sleeping except for the first night following surgery.
9. The denture should be cleaned twice daily with toothpaste and left to soak in water (preferably with Efferdent) at night.
10. Until you return for post-operative care, eat softer than normal foods. Do all chewing on the untreated side of your mouth. Avoid foods that are hard, sharp, spicy, or very hot.

Please call the office if you have any questions.

OFFICE  212-486-6622

AFTER HOURS   800-285-7234

You need to have a new filling or replace an existing one. In the world of modern dentistry, you have several options as to which materials to use. So that you can make a more informed decision, we have compiled this synopsis for your review. The materials that we use today are much more esthetic (more natural) and durable than some of the older materials. We prefer not to place silver fillings because the margins corrode and the edges tend to fracture. We have listed choices of materials in order of strength, longevity and investment. Keep in mind that the stronger materials last longer, and while the initial investment is more, they won’t have to be replaced nearly as often. So in the long run, they actually cost you less. The life of any restoration depends upon your attention to home care and your compliance with regular professional visits.

GOOD- Composite, direct tooth-colored fillings: These direct-placed, one-appointment fillings are shaded to match the tooth and are bonded to the tooth for added strength. For small fillings, and fillings on anterior teeth, this may be your best choice. For larger fillings, they are not as strong.

BETTER- Lab-fabricated tooth-colored fillings: These two-appointment restorations require making a mold of your teeth and placing a temporary filling for about one week. Our dental laboratory will then custom make the fillings to fit the mold of your teeth. The restorations are made of a pressed ceramic material and are bonded to your tooth at the second visit. These fillings tend to be more natural-looking than direct-placed fillings, resist staining better, and are much stronger. We recommend these types of restorations for most cases as they are very esthetic and durable over time.

BEST- Lab-fabricated gold fillings: The strongest and most durable dental restorative material available to us today to place is gold. Like the other lab-fabricated restorations, gold fillings require two appointments, a mold of your tooth and a provisional restoration. Gold is much more esthetic than old, silver fillings because gold fillings do not stain the teeth. While some people may not care for the look of gold restorations, others want the added strength. If the fillings are in an area that is not visible when you smile, gold is your best option. We recommend these restorations for the back regions of the mouth where esthetics is not an issue.

As you can see, you have several good choices of materials to restore your teeth. All of them are functional, but the lab-fabricated fillings work better and last longer. If you have any questions or concerns, please don’t hesitate to ask. We are here to help.

Fluoridex® toothpaste is high-fluoride concentrated toothpaste (1.1% sodium fluoride) that helps to prevent the development of dental caries (tooth decay). It should be used in place of regular toothpaste.

• Apply a small amount of Fluoridex® toothpaste to the toothbrush and brush thoroughly for two minutes.
• Brush twice daily, preferably in the morning and at bedtime. Then floss to remove any residual food between the teeth.
• Do not eat or drink for thirty minutes following brushing with Fluoridex®.
• If you brush your teeth prior to eating breakfast, use an ADA approved toothpaste. After eating breakfast, brush with Fluoridex® toothpaste and do not eat or drink for thirty minutes.

Symptoms of OSA

· Snoring
· Gasping or choking during sleep
· Frequent awakening during sleep
· Morning headaches
· Daytime sleepiness
· Moodiness or irritability
· Difficulty with focus & concentration
· Dry mouth or sore throat

Treatment

For chronic problems, when a CPAP device is not tolerated, a custom-fabricated oral sleep apnea device (OSAD) can be made by a dentist as an alternative, more comfortable method of treatment. The device is designed according to the characteristics of each patient, thus offering a better fit to minimize discomfort and increase stability.

1. Custom oral appliances support the jaw in a forward position to help maintain an open upper airway. They can help reduce or even eliminate snoring and vastly improve sleep quality.
2. The appliance is meant to be worn comfortably every night while you sleep and can be titrated (adjusted) to maximize its comfort and effectiveness.

The occlusal nightguard appliance is designed to prevent grinding and wear of your teeth. This device is also used to relax your jaw muscles and decrease muscle activity, which may result in pain and tension headaches. The appliance is to be worn every night while you sleep or anytime when you feel like you are grinding or clenching your teeth together.

Placement: Firmly place the appliance onto your upper teeth using both of your thumbs. The appliance should snap into place and feel tight up against your teeth.

Removal: Place the nail of your index finger on the outside rim of the appliance and pull down. Use your thumbs to stabilize and prevent the appliance from hitting your lower teeth.

Cleaning: Every morning, after removal, brush the appliance with toothpaste. Once a week, place the appliance in a cup of water with a tablet of Efferdent.

Storage: After cleaning the appliance, wet a tissue or paper towel with Listerine or water, and wrap it around the appliance. The wrapped appliance can be stored in a Zip-Loc bag or in the retainer box supplied to you. Try to keep the appliance moist at all times or it may distort. If it distorts, just place it under hot water for a few seconds and place back into your mouth.

If the appliance does not fit or fits excessively tight, please call our office for an adjustment.

Home Care Instructions:
The oral sleep apnea device (OSAD) is designed to prevent snoring and obstructive sleep apnea. Custom oral appliances support the jaw in a forward position to help maintain an open upper airway. The appliance is meant to be worn comfortably every night while you sleep and can help reduce snoring and vastly improve sleep quality.

Placement:
Firmly place the top portion of the appliance onto your upper teeth using both of your thumbs, then place the lower portion of the appliance onto your bottom teeth.  The appliance should snap into place and feel tight up against your teeth.

Removal:
Place the nail of your index finger on the outside rim of the top portion of the appliance and pull down. Then do the same with the bottom portion of the appliance. Use your thumbs to stabilize and prevent the appliance from hitting the opposing teeth.

Morning Exercises:
After wearing the device for the entire night, it is normal to experience some difficulties in placing your jaw in its usual position. We suggest performing the following exercises to help reposition the lower jaw:

• Move the chin backwards and close your back teeth together while biting. Repeat 5 to 10 times.
• Eat breakfast slowly to help return to a normal bite.

Cleaning:
Every morning, after removal, brush the appliance with toothpaste. Once a week, place the appliance in a cup of water with a tablet of Polident.

Storage:
After cleaning the appliance, wet a tissue or paper towel with Listerine or water, and wrap it around the appliance. The wrapped appliance can be stored in a Zip-Loc bag or in the retainer box supplied to you. Try to keep the appliance moist at all times or it may distort.

1. A restoration (crown, laminate, inlay, onlay) has been cemented to your natural tooth with the use of an adhesive. The adhesive, and/or the tooth cleansing process prior to cementation, may result in a sensitive tooth. The discomfort or sensitivity may be brought on by hot/cold foods and liquids, or chewing. This is normal for the first two or three days and may take weeks to subside. This discomfort or sensitivity should decrease over time. If there are no signs of improvement, please inform our office so we can either make an adjustment or attempt to desensitize the tooth.
   
   
2. Following the cementation procedure, the gingival tissues (gums) are usually irritated and may be sore for two or three days. We ask that you take the analgesic prescribed, which has anti-inflammatory effects, for a few days until the tissues have healed. You may also use Listerine or warm salt water rinses (1 tsp of salt in a cup of warm water) several times a day.
   
   
3. Please use the extra soft or sensitive toothbrush provided to gently brush from the gum to the tooth in a sweeping motion. Do not use any electric tooth brushing devices for the first week. Do not brush vigorously, sideways or against the gum. This will only cause further irritation and recession of the gingival tissues.
   
   
4. Please do not brush with any baking soda, peroxide, or abrasive toothpaste.
   
   
5. Please do not floss for the first two days. Once you begin flossing, do not press the floss against the gum. Gently curve the floss around each tooth and move the floss up and down between the tooth and gums as high or as low as it will comfortably go beneath the gum line.
   
   
6. Please do not use any home bleaching agents for one week.
   
   
7. Schedule your regular maintenance visits with our hygienist and please remember that the restoration placed needs to be cleaned with dental instruments and does not need to be polished or air abraded, as do natural teeth during dental cleanings.
   
   
8. We hope that you will contribute to the longevity of this restoration by brushing, flossing, and returning to our office for routine maintenance visits.

Provisional onlays, crowns and bridges are usually made of plastic and are cemented to the teeth with a temporary cement. Adjacent units are often connected to each other. Since they are both fragile and can come loose more easily than metal or porcelain, we advise caution when eating or cleaning.

Avoid chewing anything excessively hard, tough or sticky. Chewing gum will stick to and dislodge temporary restorations. Keep them clean. Brush thoroughly. If you use dental floss, let go of one end and pull the floss through to the cheek side. Do not “pop” the floss out from between the teeth. When you use a toothpick, be a little more gentle than usual, so as not to pry them loose.

If they should break or come loose, save them and call our office to come in for repair or recementing. Don’t panic – it’s not an emergency, but it should be done within a few days. You may push them back into place temporarily and call our office to have them cleaned and recemented. If a tooth becomes sensitive it might be a sign that the provisional has loosened, or the bite may be high and should be evaluated.

If you will be wearing provisional restorations for several months, unless otherwise instructed, you should have them recemented and checked periodically.

The joint that connects the lower jaw to the skull is known as the Temporomandibular Joint, or TMJ. This joint is located in front of your ear on both sides of your head. Temporomandibular Joint Dysfunction (TMD) is an abnormality of the chewing muscles and joints. TMD is also sometimes referred to as myofascial pain dysfunction. As muscles and joints work together, a problem with either one can lead to stiffness, headaches, ear pain, bite problems (malocclusion), clicking sounds, or locked jaws.

Treatment

1.  For chronic problems, fabrication of a nightguard often helps to alleviate symptoms.

• The occlusal nightguard appliance is designed to prevent grinding and wear of your teeth. This device is also used to relax your jaw muscles and decrease muscle activity, which may result in pain and tension headaches.
• The appliance is to be worn every night while you sleep or anytime when you feel like you are grinding or clenching your teeth together.

2.  Palliative treatment for acute symptoms:

• Apply hot compresses to the area in front of your ear and lower jaw.
• If you do not have an occlusal nightguard, place one cotton roll on each side of the mouth between the upper and lower teeth. This will separate the teeth and jaws, resulting in a relaxation of the jaw muscles.
• Take a NSAID (Non-Steroidal Anti-Inflammatory Drug) such as Advil, Aleve, Motrin, Nuprin, Ibuprofen, or any prescription anti-inflammatory drug, as directed by your doctor. This will decrease inflammation in your Temporomandibular Joint and muscles of mastication.

Fluoridex toothpaste is a high-fluoride concentrated toothpaste that may help reduce sensitivity during the bleaching process.

• During the bleaching process, brush twice daily with an ADA approved over-the-counter toothpaste.
• Prior to bleaching, place a small amount of Fluoridex toothpaste in the bleaching tray (fill approximately one-third of each tooth) and wear for ten minutes.
• Remove and clean bleaching tray.
• Rinse your mouth to remove any remaining Fluoridex.
• Bleach as directed.
• If you experience sensitivity after bleaching, you may wear the tray with Fluoridex for ten minutes after bleaching.
• To reduce persistent sensitivity, you may use Fluoridex in place of your regular toothpaste.
• Do not eat or drink for thirty minutes following brushing with Fluoridex.

PROCEDURE:

1. Brush and floss your teeth.
2. Place a small amount of gel in each tooth compartment in the tray. Each syringe has eight calibrated treatment doses. Use approximately one dose per tray.
3. Place the tray with gel in the mouth.
4. Remove excess gel with finger or dry tooth brush. When inserting the tray, be careful not to push all of the gel out, but be sure that the tray is completely seated.
5. After whitening, remove and rinse the trays with cold water. If necessary, use a tooth brush to remove any residual gel. Place the trays in the storage case, and keep them in a cool, dry place. Rinse and brush excess gel from teeth.
6. Follow the above steps for 7-14 consecutive days, or until you obtain your desired shade. Please call our office, should excessive sensitivity occur. Depending on the severity of your symptoms, we may suggest discontinuing use for a few days, or recommend a prescription fluoride toothpaste.
7. During the bleaching process, the teeth are more susceptible to staining. For this reason, please limit food or drinks which can cause staining (i.e., coffee, tea, red wine, berries), and rinse your mouth out with water immediately after consuming.
8. Following treatment, the gel may be used one or two days per month, or after future dental cleanings as a booster in the event that you notice darkening of the teeth. Store the gel in a cool, dry place.