Bleach Tray Instructions

• Start by brushing and flossing your teeth.
• The best time to bleach is before going to bed so that your teeth can re-hydrate overnight. You can bleach during the day, but realize that your teeth may have a somewhat chalky appearance for a while afterwards.
• After brushing and flossing, place the bleach in the bubble portion of your trays. You can place little dots in each tooth, or you may place a line of bleach in the bubble areas. Apply sparingly – it is very easy to place too much.
• Place the trays in your mouth and press against your teeth. If any bleach comes out of the tray, wipe the excess from the gums with a cotton swab or tissue (if not removed, the gums could become irritated).
• Wear your trays for the amount of time indicated. Do not sleep with your bleach trays in your mouth – the whitening loses its effectiveness, and your teeth may become hyper-sensitive. Use the following guidelines for bleaching, depending on the percent strength:
      15% = 4-6 hours one time per day
      20% = 2-4 hours one time per day
      35% = 30 minutes one time per day
• After the time is up, remove the trays. Brush your teeth AND the trays to remove excess bleach.
• Place the trays back in their storage container. We recommend that you keep trays away from children and pets – they make fun chewing toys.

Some helpful tips:

• We suggest that you keep the models for the trays high up in a cabinet. If your trays ever go missing or get destroyed, we can sometimes use the models to make a new set for a minimal fee.
• The more consistent you are with bleaching, the better results you will have. If you have sensitivity, we recommend you take a break from whitening until the sensitivity is gone.
• Do not smoke or drink immediately after you bleach. Any stain from smoke or liquids will re-stain the teeth.
• We recommend that you bleach for 2-3 weeks.
• Bleach syringes will last 18 months OUT of the refrigerator and 24 months IN the refrigerator.
• Bleach must be warmed up to room temperature before use.

Crowns

• While numb, please do not chew gum or food, and do not drink any hot beverages.  After the numbness wears off, you can resume most normal activities, including brushing and flossing.  
• The cement takes about 1 hour to completely set up.  Again, please do not chew anything on the crown during this time.  For a permanent crown, you can chew, brush, and floss as normal after this 1 hour.  If the crown is a temporary, please be careful not to chew hard nuts, candy, or sticky foods that could either break or loosen the temp crown.
• Slight to moderate sensitivity to biting or cold is common for a few days afterwards.  If the sensitivity is severe or lasts longer than this time, please notify our office.
• The gums or cheeks may be slightly sore for a few days due to normal manipulation of these tissues.  Please notify the office of anything out of the ordinary.
• The crown might at first be slightly different than the original tooth structure, and your tongue can easily detect this.  Given a few days, you should be accustomed to the new feel.

Fillings

• For 1-2 hours afterwards, please do not chew any food or gum.  While numb, please do not drink any hot beverages.  After the numbness wares off, you can resume normal activities, including brushing and flossing.  
• Children should be observed carefully until the numbness has completely worn off.  It is very tempting for them to bite their cheek or tongue while numb, possibly causing trauma.
• Slight to moderate sensitivity to biting or cold is common for a few days following a filling procedure.  If the sensitivity is severe or lasts longer than this time, please notify our office.
• The gums or cheeks may be slightly sore for a few days due to normal manipulation of these tissues.  Please notify the office of anything out of the ordinary.
• The filling might at first be slightly different than the original tooth structure, and your tongue can easily detect this.  Given a few days, you should be accustomed to the new feel.

Tooth Extraction

• Bleeding:  Keep slight pressure on the gauze pack for 2 hours and replace it if bleeding continues.  Slight “oozing” of the site normally occurs for 2 to 3 days.  Use an old pillowcase for sleeping since the oozing may run out of the mouth and cause stains.  For 2 days, please avoid any activities that could suction the clot out of its place (e.g. smoking, use of a straw, forceful spitting).  If bleeding is excessive or of long duration, contact the office.
• Pain and Medications:  Some pain is expected after an extraction.  Please follow any prescription painkillers as indicated and do not drive or drink alcohol while taking medication.  If a prescription painkiller is not needed, you may take a non-aspirin painkiller as directed by the manufacturer.  Painkiller use is optional.  If an antibiotic (such as penicillin) has been prescribed, please take as indicated until the bottle is empty.   IMPORTANT:  If you experience any itching or swelling on your skin after taking any medication, contact the office IMMEDIATELY.
• Rinsing:  Do not rinse your mouth or spit for the rest of the day.  Tomorrow you can gently rinse your mouth with a glass of warm water mixed with ½ teaspoon of salt (avoid forcefully spitting).  You can do this every 3-4 hours.
• Swelling:  Following an extraction, some swelling and bruising on the inside or outside of you mouth can occur.  For a maximum of 20 minutes per hour, you can apply a cold moist cloth or an ice bag wrapped in a cloth to help reduce swelling.  If swelling is extensive or continues to increase after the second day, please contact the office.
• Stiffness:  Jaw stiffness can be alleviated by slowly and gently opening your mouth several times to stretch the muscles and tendons.
• Diet:  A light diet of mild liquids and soft foods is important for the first 2 days.  Do not chew near the extraction site.  Also avoid smoking, carbonated beverages, alcohol and hot liquids.
• Oral Hygiene:  Not even undergoing an extraction gives you freedom from brushing and flossing.  Resume dental care the following day, being very gentle near the extraction site.

Biphosphonate Treatment

Bisphosphonate-related Osteonecrosis (BON) of the jaw is a condition in which patients who have been treated with oral or IV bisphosphonates suffer from degeneration of a portion of jaw bone.  BON may occur especially after invasive bone procedures (e.g. teeth extractions or jaw surgeries).  Risk factors for BON include advanced periodontitis, smoking, diabetes, compromised immune system, poor oral hygiene, and prolonged corticosteroid use.

• Oral bisphosphonates create a much lower risk for BON compared with IV bisphosphonates
• Osteonecrosis after surgical procedures is estimated to occur in less than 1 in 2,260 cases for oral bisphosphonate users

Symptoms of BON

• Significant numbness, pain, or swelling in your jaw
• Significantly loose teeth
• Draining, infected, or exposed jaw bone

Common Oral Bisphosphonates

• Fosamax (alendronate)
• Actonel (risedronate)
• Boniva (ibandronate)

Common IV Bisphosphonates

• Zometa (zoledronic acid)
• Aredia (pamidronate)

Guidelines for Dental Care:

• Maintain excellent oral hygiene to reduce risk of infection, cavities, periodontitis (gum disease)
• Dental infections should be managed aggressively
• All routine restorative procedures may be performed
• Endodontic therapy (root canal therapy) is preferable to extracting teeth (when possible)

The bottom line is that as long as patients taking oral bisphosphonates (generally to prevent osteoporosis) maintain adequate home dental care and have routine dental cleanings/exams, they should not have any cause for concern.  Those who are at risk are patients who have been treated with bisphosphonates (especially IV bisphosphonates used to treat cancer) and require any type of tooth extractions or jaw surgery.

Dry Mouth

Saliva keeps the mouth clean and healthy, helps you swallow and starts the digestion process.  It is also the mouth’s main defense against cavities as it neutralizes acids from food, beverages or bacteria in the mouth.

Dry mouth (xerostomia) results from low salivary flow. It can be a side effect from certain medications or changes in one’s own physiology over time.

With less saliva, people can become much more prone to gum disease and cavities.  In fact, cavities can become rampant and very quickly destroy many teeth at once.  One mistake people make is constantly using lozenges or candy to help stimulate salivary flow.  The problem is that you are then exposing the teeth to a constant sugar source that will accelerate the cavity rate. 

Talk to our dentists about what can be done to deal with this.  There are some strategies and over-the-counter products that can help.

High Cavity Rate

We all know that candies, desserts and sodas have sugar, but there are other things we ingest that have sugar that we typically don’t think of as being unhealthy, such as yogurts, juices and sports drinks. 

Whenever you eat or drink anything with sugar, the bacteria that live normally in your mouth consume that sugar as well, producing acid that attacks tooth enamel (the very hard, protective outer layer of teeth).  Over time, this acid eventually eats away enough of the enamel that it opens up a hole, or cavity, in the tooth.  The tooth structure underneath the enamel is much softer, so the cavity growth accelerates quite a bit once it reaches this point.

The more often you ingest sugar, the faster the acid eats away at the teeth.  For example, if you sip on soda once every minute for an hour, that is 60 new acid attacks on the teeth!  The key is to limit how OFTEN you ingest sugar.  Here are some tips:

• Limit how many different sugary foods/drinks you have per day.
• Combine things with sugar into a set mealtime, then be done eating or drinking anything other than water between meals.
• Use regular fluoride toothpaste ideally after every meal, or at least after breakfast and when you’re done eating at night.
• If you cannot brush after a meal, you can use sugar-free gum, which helps salivary flow.  Saliva washes away food debris and helps neutralize acids from bacteria.  If you do not have sugar-free gum, at least swish with some water.
• Floss at least once a day to get to the areas brushing can’t reach.
• Beware of highly acidic beverages: even too much exposure to diet sodas, for example, can cause erosion of enamel and cavities.