Dentist Sonora Ca

Home Care Instructions

At our dentist office you will find that we value prevention and try to provide you with the tools necessary to avoid needing treatment.  The following items are designed to help you take care of your teeth, prevent periodontal disease and keep you healthy.


Care After Fillings


Fillings are placed directly into the prepared space left in a tooth after we remove the decay. It makes sense that this can be a traumatic experience for a tooth, and because we have removed decayed and damaged tooth structure, the tooth is often slightly sensitive after placement. This minor sensitivity is normal and usually consists of sensitivity to cold and sometimes biting for a few days or up to a week. We always place a protective medicine under our fillings that help to reduce or eliminate this risk. However, depending on the depth of the cavity, individual tooth responses, or the severity of the damage to your tooth some sensitivity may be unavoidable.

If symptoms persist for more than two weeks, or you develop discomfort to cold that lingers for more than 20-30 seconds or causes throbbing pain, please call the office.


Care after Crowns & Bridges


After a crown is prepared one of two things will happen. Dr. Wetherington will either make a digital impression and use a milling machine to make your crown in the office during your appointment, or he will make an impression of your tooth, send this impression to the lab and make you a temporary crown. If your final crown was made and cemented in the same day you may skip the next paragraph.

Your temporary crown is an acrylic resin crown that is cemented with temporary cement and is a very important part of your overall treatment. It functions as a place holder for the final crown. Without it, the teeth in the area will shift around, and the final crown will need significant adjustment. If your temporary crown comes off, or fractures, please call our office. Because of the materials used and the weaker cement, this can and does happen occasionally and is nothing to worry about, but it should not be off for more the 24 – 48 hours or so. Here are few guidelines to help make sure your temporary stays and that your gums stay healthy until you get your final restoration. Floss daily, but once you have the floss through the contact between the adjacent tooth and the temporary do not pull the floss out the top, let go with one hand and drag the floss out the side. Avoid crunchy or hard to chew foods like nuts and granola bars, and avoid sticky foods like candies that tend to pull the crown straight off.

Once you have your final crown, you may find the tooth is still a little sensitive for a few days to a week. If sensitivity persists or develops into throbbing discomfort, please let us know by calling the office. Your bite should feel normal with no high spots or irregularities. It does not happen very often, but your mouth can feel a discrepancy that is smaller than our bite papers will mark, so if you notice any irregularities please call our office

The instructions for bridges are identical to those under crowns with one key exception. We will provide you with a floss threader for cleaning underneath the temporary and the final bridge, and we will show you how to use it. The number one reason that bridges do not last as long as crowns is because too many people do not do this one simple cleaning step. Learn how to do it and become proficient at it and your restoration will last significantly longer.


Care after Root Canals


Given that a root canal involves the removal of a damaged or inflamed nerve from the inside of a tooth, it makes sense that some sensitivity may linger after the procedure is completed. The good news is that the precision provided by modern root canal equipment has greatly reduced the amount of inflammation around teeth requiring a root canal. For this reason most people find root canals to be a relatively painless procedure. Never-the-less, some biting tenderness is common for the first few days. Because we must use a rubber dam to isolate the tooth there is sometimes some tenderness in the gums around the tooth from the ring that holds the dam in place.

For all back teeth, when a root canal is completed, something must be done to prevent the tooth from fracturing. The process of doing a root canal significantly weakens the tooth. If a crown is not placed on the tooth the majority of these teeth will fracture in half, leaving a tooth that cannot be repaired. The longer you wait the higher the risk of fracture.


Fighting Dental Decay


If you have gone through one of our treatment counseling sessions because you have had a history of dental decay, you will find this a nice refresher of some of the basic home care and dietary information.  More background on the issue of dental decay can be found on the page “Treating high rates of dental decay”.  There is a lot of information in the following paragraphs but I strongly suggest anyone with this problem read through it.

Our preventive treatment of dental decay is based on three things:

Prescription strength toothpastes and MI paste  - which can only be obtained following a consultation with your dentist.

  • Clinpro 5000 (or other high prescription fluoride tooth paste like Prevident 5000)
    • I recommend that you floss your teeth first
    • Then brush for two minutes as you normally would
    • Spit out all toothpaste thoroughly
    • Do not eat, drink or rinse for 30 minutes after use.
  • MI Paste – a paste that releases Calcium and Phosphate for your tooth to absorb
    • Apply a small amount of the material on your index finger.
    • Use your finger to spread the gel around your mouth, trying to push the material in between your teeth
    • Hold the gel in your mouth 1-2 minutes.  As you start to salivate, you will be able to swish it around and in between your teeth.
    • Spit out thoroughly
    • Do not eat, drink or rinse for 30 minutes after use.
  • YOU NEED TO WAIT AT LEAST 30 MINUTES BETWEEN USING CLINPRO 5000 AND MI PASTE

Dietary controls to reduce the effect of the bacteria.

    • Since cavities are caused by bacteria that grow and survive on carbohydrates, we can reduce their effectiveness by reducing our consumption of carbohydrates, but it is not quite as simple as reducing quantities.  You see, cavities are caused because the bacteria release a lot of acid each time they process sugars to grow.  It is this acid that eats the holes in our teeth.  After taking one bite of bread, or one sip of a sweetened drink the acid levels spike in your mouth to a level high enough to cause damage to your teeth.  It takes 20 minutes for saliva to wash this acid away enough that your mouth returns to a safe state.  If you take one more sip or one more bite in those 20 minutes you have started the clock again.  This gives us the single most important lesson – THE FREQUENCY OF HOW OFTEN YOU EAT CARBOHYDRATES IS THE MOST IMPORTANT THING.
      • The most common foods we see causing problems for people are things they tend to snack on slowly like fruit (bowls of grapes are a common one), hard candies or cough drops.
      • We see a lot of damage done by things that people drink.  Some of the most common include: coffee with sugar in it, sweat tea, regular sodas like Coke or Pepsi, and energy and sports drinks.
    • Obviously foods or drinks with a lot of simple sugars will do more damage, but even more complex carbohydrates like whole wheat bread and pasta lead to damage.  A combination of cutting out the foods with really high simple sugar contents and reducing the frequency of snacking at eating can be very effective.
    • If you have a history of a high rate of dental decay and one of the dietary habits listed above, you will never get free of your pattern of dental breakdown if you don’t change.

Efforts to reduce the number of cavity causing bacteria.

    • One very effective thing that can be done is to chew gums containing xylitol.  Xylitol is a natural sugar that tastes sweet to us and can be processed by our digestive system, but acts like a poison to the bacteria that causes cavities.  The research, done mostly in Scandinavia, has shown incredible promise in reducing dental decay rates.  We recommend 100% xylitol gum found at www.epicdental.com.  Most over the counter gums have some xylitol but not enough to reach a therapeutic benefit.  The recommended amount for benefit is 6 grams of xylitol every day.  Less than 3 grams and you will get no benefit, while there is not really a greater benefit with more than 6 grams. Two pieces of epic gum chewed for 10 min 3 times a day is perfect.  You can also buy xylitol in bulk and use it for baking and cooking.  The Standard Nature food store has it in stock.
    • We will at times prescribe an antibiotic mouth rinse, but truly the research is still out as to whether or not there is really any benefit to this.  The most effective way to accomplish this is with very thorough home care.  I recommend you read the sections on brushing and flossing, and buy a Sonicare toothbrush


Post operative instructions – Extractions


Gauze or Gum pack

Keep your mouth firmly closed on the gauze for at least one hour after treatment. Replace the gauze with a clean one if the one in your mouth becomes to soiled. If bleeding continues or starts again after this initial hour, you can place another piece in the area.

Persistent Bleeding

Some mild bleeding following oral surgery is to be expected and can last up to 24 hours. If bleeding persists longer, or if there is an increase in the amount of bleeding, place a clean gauze pack on the surgical site and apply firm biting pressure. If this does not control the bleeding within in 30 minutes please call our office.

Do not Rinse your Mouth

Rinsing or gargling during the first 12 hours after oral surgery can delay healing by disrupting the formation of a blood clot. Begin gentle rinsing with warm salt water 3 times per day starting the day after you have surgery.

Ice packs to prevent Excessive Swelling.

Some swelling following oral surgery is to be expected. Placing an icepack on the affected side of the face is helpful during the first 8 hours following treatment. Apply the icepack in 15 minute intervals, resting 15 minutes between each application.

Pain or Discomfort

Some pain following oral surgery can be expected. If we expect significant discomfort, Dr. Wetherington will prescribe pain medication, which must be taken exactly as prescribed. Do not take more then the prescribed dose. More mild discomfort may be controlled by taking common pain relievers such as ibuprofen or naproxen sodium (Aleve) as directed.

Reduced Activity

Strenuous activities following oral surgery can prolong the healing process. Stationary rest is advisable for 24 hours following oral surgery.

Diet

Do not use a straw or do anything that creates a sucking effect. Avoid foods that are hard or granular (popcorn, rice, undercooked oatmeal) that could get caught in the treatment area. Do not chew near the affected area for at least 48 hours.


Fluoride


Fluoride is an important tool in our arsenal for the fight against tooth decay. There is no fluoride in the drinking water in the Sonora area, but for most adults this is not a factor for your dental health. For children Dr. Wetherington is conservative in prescribing fluoride supplements if a well balanced diet is in place. You can talk to Dr. Wetherington more about this if you like.

The application method of choice for fluoride in our office is a varnish that is painted on your teeth. This is actually the original way fluoride was developed for application, but for many years many offices used a gel that was placed in trays. Further research has found that the original delivery method was far more effective, and we have followed the science back to the use of varnishes.

The care instructions for after the placement of fluoride varnish are pretty straight forward. You can eat or drink as normal immediately after it is placed with a few exceptions. We ask that you do not eat or drink hot foods likes soups or Coffee for four hours after the varnish is applied.

Additionally, you will feel like you have a thin film over your teeth – because you do. We ask that you do not try to brush this film off for at least four hours as well. After this time you may return to normal eating and home care routines. You may find a few areas on your teeth where the film remains for a few days. This is ok, continue normal home care routines and it will slowly go away.


Choosing Oral Hygiene Products


There are so many products on the market that choosing the right one can be difficult.

Electronic toothbrushes are safe and effective for the majority of users. Oral instigators (water pick type of devices) will rinse your mouth thoroughly, but will not remove plaque. Scientific studies have found little to no improvement in dental health with the use of oral irrigators for patients with periodontal disease. You need to brush and floss. If you want to invest in something that will help you do a better job we strongly recommend Sonicare Toothbrushes. We see excellent results with these electric toothbrushes. Remember regardless of what toothbrush you use, nothing is a substitute for flossing.

You should always select a soft bristle toothbrush. The only use for medium and hard brushes is to clean dentures. Some toothbrushes have a rubber tip on the handle that is used to massage the gums after brushing. We provide these Rubber tip stimulators for our patients who we think will benefit from them. Their primary use is to aid in cleaning in areas where the separation between the roots on molars becomes exposed.

The most important toothpaste to use is the one that you think tastes good and makes you feel motivated to brush your teeth as long as it has fluoride in it. That being said, there are a few that I recommend. The Colgate Total line of toothpastes does have some slight benefits for helping to reduce inflammation and bacteria levels in the gums, and I think it tastes pretty good as well. I also prefer Sensodyne Pro Enamel for my patients with sensitive teeth – this is also a very tasty toothpaste. Remember to keep toothpastes out of reach of small children. they taste good and if they eat a whole tube it can be dangerous. Call the center for poison control if this were to happen.

Tartar control toothpastes will reduce tartar above the gum line, but because gum disease starts below the gum line, these products have not been proven to reduce the early stage of gum disease. They can also lead to an increase in tooth sensitivity.

Most mouth rinses have minimal benefit. One exception to this is using ACT mouth rinse (do not use for children under the age of 6) if you have a history of cavities. The higher fluoride concentration will help protect your teeth. If you have a high rate of dental decay we often prescribe a very specific regimen that is more effective than ACT mouth rinse alone. Listerine will only help with mild gingivitis, and is not a substitute for flossing. Any patient with periodontal disease will get no benefit from this mouth rinse.


How to Floss


Periodontal disease usually appears between the teeth where your toothbrush cannot reach. Flossing is a very effective way to remove plaque from those surfaces, and is the single most important thing you can do to improve the health of your gums and your teeth. However, it is important to develop the proper technique. The following instructions will help you, but remember it takes time and practice.

Start with a piece of floss (waxed is easier) about 18″ long. Lightly wrap most of the floss around the middle finger of one hand. Wrap the rest of the floss around the middle finger of the other hand. You should be able to stretch the floss tight without holding on to it because it is wrapped adequately around both middle fingers.

To clean the upper teeth, hold the floss tightly between the thumb and forefinger of each hand. Gently insert the floss tightly between the teeth using a back-and-forth motion. Do not force the floss or try to snap it into place. Bring the floss to the gum line then curve it into a C-shape against one tooth. Slide it into the space between the gum and the tooth until you feel light resistance. Move the floss up and down on the side of one tooth. Remember there are two tooth surfaces that need to be cleaned in each space. Continue to floss each side of all the upper teeth. Be careful not to cut the gum tissue between the teeth. As the floss becomes soiled, turn from one finger to the other to get a fresh section.

To clean between the bottom teeth, guide the floss using the forefinger of both hands. Do not forget the back side of the last tooth on both sides, upper and lower.

When you are done, rinse vigorously with water to remove plaque and food particles. Do not be alarmed if during the first week of flossing your gums bleed or are a little sore. If your gums hurt while flossing you could be doing it too hard or pinching the gum. As you floss daily and remove the plaque, your gums will heal and the bleeding should stop.


Brushing with an Electric Toothbrush


I strongly recommend the use of an electric toothbrush. I have found with great consistency that the patients who are using electric toothbrushes show far superior health on average than those who use a manual one. Of the electric toothbrushes that are available on the market I believe that the Sonicare is the best. We do not sell these tooth brushes in our office, but we do have some coupons for our patients so that they can get a reduced price at their local pharmacy.

When using an electric toothbrush it is important to remember that the toothbrush is doing most of the work for you. You only need to get the bristles where they need to be. Particularly with the Sonicare toothbrush it is important that you do not press the bristles tightly up against your teeth. This will dampen the effect of the sonic waves produced by the brush and make it less effective.

With an electric toothbrush we still want you to angle the brush at a 45 degree angle and point it at the junction of your gums and teeth, but we want you to move it in small circles with very little pressure. I like to say that you should hold the toothbrush with the tips of three fingers. This will prevent you from putting too much pressure on the gums. Use the built in timer to make sure you do the sides of your teeth thoroughly, then restart the toothbrush and brush the biting surfaces and your tongue.


Brushing with a Manual Toothbrush


If you are using a manual tooth brush you will find the following instructions useful. For those using a Sonicare or other electric tooth brush the instructions are a little different.

You should always use a soft bristle tooth brush. While brushing the outside surfaces of your teeth, position the brush at a 45-degree angle where your gums and teeth meet. Gently move the brush in a circular motion several times using small, gentle strokes. Use some pressure while putting the bristles between the teeth, but not so much pressure that you feel any discomfort. When you are done cleaning the outside surfaces of all your teeth, follow the same directions while cleaning the inside of the back teeth.

To clean the inside surfaces of the upper and lower front teeth, hold the brush vertically. Make several gentle back-and-forth strokes over each tooth. Don’t forget to gently brush the surrounding gum tissue.

Next you will clean the biting surfaces of your teeth. To do this, use short, gentle strokes. Change the position of the brush as often as necessary to reach and clean all surfaces. Try to watch yourself in the mirror to make sure you clean each surface.