Space Maintainer Instructions  

Post-Extraction Instructions  

Pulpotomy (Nerve Treatment) Information  

Pit and Fissure Sealant Information  

Composite Restoration (Tooth Colored/Bonded Filling) Information 

Crown (Cap) Home Care Instructions  

Space Maintainer Instructions 

We have recommended and placed a space maintainer(s) in your child's mouth to either maintain the space for erupting permanent teeth or to maintain the current position of already erupted permanent teeth.  Without this space maintainer your child's teeth may have difficulty in erupting or staying in their proper position.  We want to provide you with some information which will allow you to care for your child's space maintainer in the best manner possible.

• Diet - All of our space maintainers are cemented with strong dental cement, however, the space maintainer still can be dislodged if the wrong types of food are eaten.  We do not recommend that your child eat any of the following: caramels, taffy, hard candy, chewing gum (any type), gummy bears, jolly ranchers, ice cubes, hard crunchy foods, or any sticky, chewy food.  Sugary foods should be kept to a minimum.

• Oral Hygiene - While almost all of our space maintainer designs are easy to clean, your child must have above average oral hygiene.  Space maintainers will catch extra food debris and plaque so your child will have to make an extra effort in brushing and flossing to maintain healthy gums and teeth.

• Periodic Evaluation - Patients with space maintainers should be seen by the dentist at a minimum of every 6 months for routine examination for evaluation of the bite, fit of the bands, and tooth eruption.  Failure to return for follow-up visits can lead to gum problems, cavities, and crooked teeth.  Once the space maintainer is ready for removal the dentist will remove it.

• Patient Cooperation - The space maintainer is not a toy.  Do not "flip" the appliance with the tongue, because it may loosen the fit.  Do not pick at the wires or bands with fingers.

• Loose Space Maintainer - Should the space maintainer come loose for whatever the reason, call the office immediately.  If the space maintainer is loose enough to come out of the mouth, place it in an envelope, store it in a safe place, then call the office immediately.  Many times a loose space maintainer can be easily re-cemented if the appliance has not been bent or broken and your child is seen as soon as possible.  A delay in getting in for an appointment could cause the need for the space maintainer to be remade.

• Patient Comfort - Space maintainers are a passive (they do not move teeth) appliance, therefore, there should not be any pain or discomfort associated with space maintainer.  Pain or discomfort could be an indication that something is wrong with the space maintainer.  Call the office if your child has any pain or discomfort associated with the space maintainer.  With a new space maintainer there may be an initial accommodation period of a few days to a week.  During this time there may be an initial difficulty in speech and the appliance's presence will be noted.  Usually, after this time the space maintainer is hardly noticed.

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Post-Extraction Instructions 

 After extractions of teeth many patients have questions concerning care after the procedure.  The following information will give you general guidelines for after-extraction care.

• Bleeding - Bleeding is to be expected when teeth are extracted.  A majority of the heaviest bleeding will be in the first 15-30 minutes after the tooth extraction.  Oozing of blood from the extraction site can  continue for  3 to 6 hours post-extraction.  Placing direct pressure on the extraction site for a continuous 10-15 minutes with gauze, washcloth, or tissue paper can control a majority of normal bleeding.

• Pain - Some patients may have pain with dental extraction.  If and how much pain each individual child may have depends on several factors.  All patients who have dental extraction will have the extraction area numbed with local anesthetic before the extraction.  This local anesthetic will last 1 to 3 hours after the tooth extraction.  To help with the potential pain, each child should have an age/weight appropriate dose of ibuprofen (Advil, Motrin) before the numbness wears-off.  Once the numbness wears off, the ibuprofen should be continued for the next 24 to 48 hours as needed for pain.  Children under 100 pounds in weight are best treated with liquid children's ibuprofen (read packaging for dosage) and those over 100 pounds can take up to 600 mg of adult ibuprofen tablets every 6 hours as needed for pain.  Use of aspirin is discouraged.

• Diet - It is recommended to have a soft/liquid diet for the first 6 to 12 hours after dental extraction.  Drinking through straws is discouraged.  Cold foods, i.e., popsicles, milk-shakes, crushed ice, may feel the best during this first 6 to 12 hours.

• Oral Hygiene - Brushing and flossing are encouraged as normal except in the immediate extraction site area for 3 days.  In the extraction are just use a moistened washcloth to cleanse the teeth and gum tissue.  Mouth rinses, i.e., Scope, Listerine, or salt water are fine, but try to keep them to a minimum as frequent rinsing may lead to continued bleeding.

• Packing/Stitches/Healing - Sometimes packing is placed in the extraction site to aid with bleeding control.  This packing will dissolve by itself or will fall out.  If stitches are placed, your child may need to return to have them removed.  The office staff or dentist will inform you what needs to be done for stitches.  Within 14 days almost all patients will be healed from extractions.  Antibiotics are rarely needed for patients after extractions even when the patient has had a preexisting dental infection.

• Questions or Concerns - Call if your child has: prolonged bleeding, pain after the first 48 hours, or an extraction site that won't heal after 14 days.  If you have any questions or concerns about dental extractions, please do not hesitate to call (405) 946-0686.

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Pulpotomy (Nerve Treatment) Information 

We want all of our patients and their parents who have a tooth in which a pulpotomy (nerve treatment) has been performed, to have the right information on how to care for and what the benefits are of a pulpotomy.

• When decay enters the nerve of a primary (baby) tooth, a pulpotomy procedure becomes necessary to save the tooth.  A pulpotomy is the removal of the nerve tissue and blood vessels inside the crown portion of a primary tooth.  Once the decay and tissue have been removed, a medicated filling is placed in the space previously occupied by the nerve tissue and blood vessels.

• While serving in a capacity similar to a root canal, a pulpotomy is not a root canal.  The human body can dissolve all materials used in a pulpotomy.  Primary teeth with pulpotomies will be lost in the same way that other baby teeth are lost when the permanent tooth replacing them dissolves the root enough for them to be lost.  There are no special concerns if the baby tooth with a pulpotomy is lost due to the eruption of a permanent tooth.

• A temporary filling is placed over the medicated filling to build the tooth up to a more natural contour.  This temporary filling will usually last 1 to 3 months.  With few exceptions, all teeth that have had a pulpotomy will need a stainless steel crown (cap) in the near future to prevent breakdown of the tooth.

• Pulpotomies have been shown to have an 85% to 90% clinical success rate in primary teeth.  It must be noted however, that some pulpotomies will fail unpredictably and the primary tooth may need to be removed in the future.  

• In order to give your child's tooth with the pulpotomy the longest possible life span, please have your child avoid the following foods: ice or ice cubes, hard candies, taffy, caramels, and jaw breakers.

If you have any questions or concerns about pulpotomies, please do not hesitate to ask our team.

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Pit and Fissure Sealant Information  

• Sealants are a plastic resin that is flowed into and bonded to the natural grooves that occur on the chewing surfaces of the back primary and permanent teeth. Sealing the grooves of a back tooth is a procedure to prevent dental decay from occurring in the pits and fissures in the chewing surface of a back tooth.

• Sealants do not protect the smooth surfaces of teeth including the surfaces between teeth. Flossing is the only way to clean between the teeth and to prevent tooth decay between teeth.

• Sealants have been clinically shown to last up to 9 years and seal the grooves of teeth where around 60% of all tooth decay begins.

• As a service to our patients, as long as our patients come back for their 6-month preventive re-care visits on a consistent basis, we will repair any of the sealants we placed on their teeth for no fee.

• If decay-occurs on one of our patient's tooth surfaces where a sealant had been placed in our office, we will reduce the fee of the needed restoration by the fee paid for the sealer as long as the patient has been returning for their 6-month re-care visits on a consistent basis.

• In order to give your child's sealant the longest possible life span, please have your child avoid the following foods: ice or ice cubes, hard candies, taffy, caramels, and jaw breakers.

• Your child's sealants will be evaluated at each re-care visit to make sure that they are intact and in no need of repair.

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Composite Restoration (Tooth Colored/Bonded Filling) Information 

We want all of our patients and their parents who have a tooth in which a composite restoration (tooth colored/bonded filling) has been placed, to have the right information on how to care for and what the benefits are of a composite restoration.

• Local anesthesia (lidocaine) is administered to your child for the majority of composite restorations. If local anesthesia has been administered, your child's mouth will be numb for I to 2 hours after you leave the office. Please watch your child to make sure they avoid chewing on their lips, cheeks, or tongue while they are still numb. If your child wants to eat immediately after the appointment, then give liquids or soft foods (i.e. yogurt, ice cream, milk shake, pudding, or mash potatoes) to your child to eat until the numbness is gone.

• The composite restoration must be maintained with effective removal of plaque by brushing and flossing daily, home care fluoride prescription, and a low sugar diet to avoid cavities returning to the edges of the composite restoration.

• Over time, all composite restorations will become darker. This change in color is due to the intake of stains into microscopic pores in composite restoration surface. These stains come from the foods and beverages that have natural or artificial pigments (i.e., coffee, tea, coke, Kool-Aid, grape juice, blueberries, chocolate, etc.). To slow the change in color of your child's composite restoration, have them avoid intake of pigmented foods or drinks when possible.

• In order to give your child's tooth with the composite restoration the longest possible life span, please have your child avoid the following foods: ice or ice cubes, hard candies, taffy, caramels, and jaw breakers.

• If you have any questions or concerns about your child's composite restoration, please do not hesitate to ask our dental team.

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Crown (Cap) Home Care Instructions  

• The gum tissue surrounding your child's crown may be red, inflamed, bleed easily, and sore immediately after placement of the crown. This is normal at this time and may persist for 7- 1 0 days after crown placement. For the first 72 hours after crown placement do not brush the crowned tooth with a tooth brush, but use a moistened wash cloth or gauze with tooth paste 3 times per day to clean the crown surfaces. All the other teeth

• are to be brushed with a toothbrush as normal. After the first 72 hours the crowned tooth and all the other teeth are to be brushed with a tooth brush and tooth paste 3 times per day as normal.

• While crowns are one of the strongest restorations, nothing is stronger than an undecayed natural tooth. Crowns are not able to withstand the forces of biting on non- food items such as anything made of plastic, wood, or metal. Have your child avoid biting on all non-food items. Crowns will also not withstand the forces of trauma from a fall or blow to the face and/or dentition.

• All crowns are either bonded or cemented onto the existing tooth. This bond or cement is strong, but if hard, sticky, or chewy foods/candy are eaten the crown may be dislodged. In order to avoid this from occurring, it is recommended to have your child avoid the following foods/candy: gummy bears, Jolly Ranchers, hard candies, salt water taffy, chewing gum, caramels, suckers, fruit roll-ups, corn nuts, beef jerky, raw carrots or ice.

• Baby (primary) teeth with crown restorations will be lost in the same way that other baby teeth are lost when the permanent tooth replacing them dissolves the root enough for them to be lost. There are no special concerns if the baby tooth with a crown is lost due to the eruption of a permanent tooth.

• If your child grinds his/her teeth excessively, a hole can be worn through a crown which could lead to decay and/or the loss of the crown. If you notice a hole in your child's crown, bring it to the dentist's attention.

• If your child's crown is loose or has come off, call the office immediately. Many times a loose crown can be recemented, if your child is treated immediately. If your child's crown is off, store it in a plastic baggy and bring it into the office immediately. Delay in seeking treatment could lead to need for a new crown, decay, or loss of the tooth.

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