Treatment Instructions

Temporary Crowns, Bridges, and Onlays

Your temporary restoration is vital to the overall successful restoration of your tooth. Please refer to the following list of general guidelines in order to care for and manage your temporary restoration properly.

1.  Do not eat for at least one hour following the completion of your appointment.

2.  Avoid any sticky foods (caramel, taffy, chewy or sticky candy, etc.) while your temporary is in place.

3.  Avoid any hard foods (hard pretzels, nuts, etc.) while your temporary is in place.

4.  Flossing is okay. Slide the floss between your temporary and your natural teeth and move the floss back and forth, as usual with flossing. However, when you are done, pull the floss out through the side of your temporary. DO NOT pull the floss up and out as with normal flossing, because this action will greatly increase the risk of accidental removal of your temporary.

5. You may experience tooth sensitivity/gum soreness and slight discomfort in your tooth/teeth after the anesthetic wears off, which should subside after a week or so, or after the placement of the permanent crown. Warm salt-water rinses should be used to soothe the gum tissue. Medication you would normally use for a headache (Advil®, Tylenol®, etc.) can also be used to help with discomfort. If any symptoms are present and become more severe before your next appointment time, please call our office. DO NOT wait until your next scheduled appointment.

6. If your temporary becomes dislodged for any reason, please let us know ASAP, even if your next appointment is close. Your temporary plays an essential role in protecting your underlying natural tooth and in maintaining proper spatial relationships between neighboring teeth. A dislodged temporary, if left out, can cause irreversible damage to the pulp (nerve) of the tooth and/or cause the permanent restoration to fit poorly.

7. A packet of take-home temporary cement may be dispensed to you, especially if you are going to be out of town or your temporary is to be in place for longer than the usual three to four weeks. If you need to use this cement to re-place your temporary, please make sure to contact our office ASAP.

8. Once the permanent restoration is placed, you may feel slight pressure for a few days. Also, the bite may feel different for a day or two. If the bite feels uneven, or you feel discomfort chewing on the tooth after two to three days, call our office. Delaying the necessary adjustments may damage the tooth permanently.

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Post-Operative Instructions After Tooth Extraction

  • No rinsing or spitting forcefully
  • No using a straw for liquids
  • No heavy lifting
  • Performing any of the above actions could force the blood clots out of the extraction site(s), which can result in a dry socket. This can be very painful and will require additional treatment.
  • Perform warm salt-water rinses beginning 24 hours AFTER the completion of surgery. However, DO NOT USE FORCE WHILE RINSING OR SPITTING. Dissolve one teaspoon of salt in eight ounces of warm water. Use this liquid by taking some into your mouth and gently rocking your head back and forth in order to move the liquid around. When finished, allow the liquid simply to fall out of your mouth while you stand over the sink.  (If you had Socket Preservation completed along with your extraction, you will perform Chlorhexidine rinses with the special syringe you were given at your appointment, instead of salt water rinses.)
  • Avoid alcoholic liquids, including mouthwash such as Listerine®.
  • Avoid spicy and acidic foods (tomato sauce, orange juice).
  • Avoid food with small particles (rice, seeds).
  • Select foods that are warm or cold, and nothing too hot. Choose high-protein foods to promote healing (protein shake, eggs).
  • Lie in a reclining position with your head above heart level.
  • Sleep with a cover on your pillow.
  • Ice can be applied to your face in the area of surgery in 15-minute intervals, on and off, in order to help with any swelling. DO NOT use ice for more than two to three days, because this can delay healing.

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Instructions for Patients with Dentures

1. Dentures should be worn for 24 hours after they are inserted, until the first adjustment.

2. After the first follow-up visit, your dentures should be kept out at night to allow your gums to rest. Whenever your dentures are left out of your mouth, they should be kept in a denture bath or container with enough water to keep the dentures fully submerged, which will prevent warpage.

3. Always wear dentures at least six hours before an adjustment is to be made. Do not use any denture adhesive in the denture when you’re about to come to the office for an adjustment.

4. Necessary adjustments will be made to the denture at subsequent appointments, as sore spots are encountered. Never attempt to adjust the denture yourself. Doing so may void any warranty, if applicable.

5. It is natural to experience fullness of the mouth with new dentures. Also, increased salivary flow may be experienced.

6. Many dentures will have a feeling of looseness, especially a lower full denture. Some adjustment time is required to become accustomed to the fit and feel of your new dentures. Denture adhesive is often necessary to achieve acceptable denture stability and retention.

7. Start out with small bites of soft food, chew straight up and down, and try to chew on both sides.

8. Bite food as far back in your mouth as possible.

9. In biting an apple or similar hard fruits or vegetables, exert a force toward the teeth rather than pulling away from the teeth. This pulling force could dislodge them.

10. You should brush the dentures inside and out at least two times a day with a denture brush. Do not use regular toothpaste, because that will dull the finish of your denture. The denture brush can be used with plain running water, very mild hand soap and water, or denture cream paste (toothpaste for dentures) and water. Denture cream paste should be available at any drug store. To further clean the dentures, soak them overnight in denture cleaner. Never soak dentures in any alcohol-containing liquids, including mouthwashes such as Listerine®.

11. Clean dentures over a sink filled halfway with water or over a wet hand towel placed on a countertop to prevent breakage in case they should be dropped accidentally.

12. It will be more difficult to adjust to new dentures if you had old dentures or no teeth for a long period of time.

13. It is common for some food debris to collect under dentures.

14. Sneezing can often dislodge any denture.

15. The fee for dentures includes a six-month adjustment period necessary to give comfort. Further periodic adjustments will not be included in this fee. The fee for these appointments will depend on what needs to be done.

16. The use of an excessive amount of denture adhesive to retain ill-fitting dentures indicates that there is a problem, which may require more involved treatment to correct.

17. Partial denture wearers should maintain periodic checkup appointments of at least every six months in order to evaluate and maintain the health of existing natural teeth, and to assess the health of oral soft tissues and the condition and performance of the dentures.

18. Full upper and lower denture wearers should maintain yearly checkup appointments to evaluate the health of oral soft tissues and the condition and performance of the dentures.

19. Please call us if we may be of further service to you.

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For Patients Wearing an Immediate (Temporary) Denture

(in addition to the "Instructions for Patients with Dentures" above)

1. Immediate dentures will often be loose, especially a lower full denture. Immediate dentures will become looser as the three-month post-surgical healing period progresses. Periodic adjustments to the denture will be necessary during this period in order to accommodate for sore spots caused by the loosening denture. Adjustments during this three-month period are included in the fee for immediate dentures. Any adjustments after this period will not be included in the denture fee and will entail an additional fee. This fee will be dependent upon the nature of adjustment needed.

2. Immediate dentures will need to be replaced after three months of healing from any extractions or other surgical procedures. The dentures do not change, but the underlying tissue does.

3. Soft relines of immediate dentures may be required after about six weeks of post-surgical healing, depending on patient comfort. Soft relines are a temporary solution to loosening immediate dentures, are required only on a case-by-case basis, and require a fee separate from that for the dentures.

4. Denture adhesive may be recommended for use with immediate dentures. If so, how and where to place the adhesive will be reviewed. It is best to avoid adhesive in areas of recent surgical treatment, and adhesive may NOT be recommended until three to four weeks after surgical treatment.

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NTI Tension Suppression System: Patient Instructions

Wear the appliance(s) while sleeping or daytime napping, and for the first couple of weeks, during stressful daytime occasions.

Never wear an NTI appliance while eating. (Doing so may be painful and possibly damaging to the opposing teeth.) Discontinue all gum chewing even when you’re not wearing the NTI. Depending on your diagnosed condition, you may need to avoid chewing hard or rubbery foods for some time. Note: Use your container when you take out your NTI and don’t wrap it in a napkin. Lost appliances will need to be remade, at the patient’s cost.

Avoid sleeping on your stomach. Sleeping on your stomach forces your head to be turned to the side, which may create significant muscle strain and headache perpetuation.

Bring your NTI with you to all future dental appointments for wear assessment and adjustment, as needed.

NTI use should temporarily be discontinued (and adjusted by the doctor) if:

  • It is uncomfortable, too tight or binding, too loose (can easily be removed with minimal tongue or lip movement), or damaged.
  • When wearing the NTI, your back teeth or canine (eye) teeth can somehow touch each other in various jaw positions.
  • You notice that your teeth are no longer coming together as they did prior to NTI use. This is an indication that your jaw is re-aligning. Although this is usually a good sign and occurs as symptoms have resolved (or are resolving), the improving alignment of the jaw may be undesirable without some type of modifications to the teeth. Otherwise, you may continue to have jaw pain, headache, or damaged teeth.

The patient should understand that:

  • The NTI suppresses the intensity of muscle dysfunctions and is NOT an orthodontic appliance, which can move teeth. Daily chewing (without wearing the NTI) will maintain each tooth’s original position. Those familiar with any type of removable custom mouthpiece realize that a mouthpiece may fit poorly if it has not been worn for an extended period. This is due to the constant slight adjustments teeth make to the forces around them.
  • Jaw-joint noises (clicking) may not necessarily be indicative of disease or damage, but of an adaptation to previous injury. The NTI may allow the degree of “loudness” to decrease or resolve completely. Sounds could also increase (as your jaw’s range of motion increases). Dr. Tosto will recommend diagnostic tests for specific jaw joint disorders.
  • Complete resolution of your symptoms may not occur immediately (the night-time jaw muscle hyperactivity “searches” for new ways to perpetuate the symptoms its been causing). Typically, the jaw’s range of motion improves. Symptoms may change over time and must be reported to our office. Sometimes Dr. Tosto must modify the device as the condition adapts and attempts to “defeat” the NTI.
  • Reducing jaw muscle tension (clenching intensity) may allow the jaw joints to realign to their most ideal orientation (if they weren’t in that position to begin with), and thereby enable the jaw to close in its best and most natural path, which may be different from what the patient started with. This is regarded as a “diagnostic event,” and while it is not a common occurrence, it presents as symptoms are relieved, and demonstrates that your jaw joints had not been in their ideal positions. This occurrence can demonstrate that the jaw positions, which allow for maximum tooth contacts and the jaw positions taken by the ideally realigned and oriented jaw joints, can be significantly different positions. There is no test to determine in advance whether 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 incisor teeth 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, Dr. Tosto may recommend modifying your teeth to achieve the most efficient closure (or “bite”). This may be done by varying combinations of shaping the teeth, adding to them by fillings or caps, or even moving them by orthodontics (braces).
  • Historically in dentistry, a “full coverage” mouthpiece has been provided for intense clenching and grinding activity. These appliances cover all the upper (or lower) teeth and are intended to deflect, absorb, or modify the forces generated by muscle clenching or tooth grinding. Unfortunately, these appliances can also allow for the intensity of muscle forces to increase, by simply providing a more efficient surface to bite on. The NTI appliance is specifically designed to suppress muscular bad habits.
  • After removing the device in the morning, brush it gently with a soft toothbrush and cool water. (Do not put it in the dishwasher or microwave!) It is not mandatory to soak the device during the day, but you may use a 50:50 mix of hydrogen peroxide and water to soak the device while in its container, if desired. Once in a while (once a month or two), you may have to soak it for a half hour in diluted white vinegar if crusty deposits start to develop. Soak, then brush. Note: The plastic portion of the NTI may change color with time. This will not affect the function of the appliance.
  • Keep the appliance away from pets. They love to chew on them.

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Periodontal Disease and Recommendations Following Periodontal Therapy

The following recommendations are designed to maximize comfort and prevent possible complications following periodontal scaling and root planing. Please review them carefully.

Scaling and root planing is a non-surgical periodontal treatment designed to remove the bacterial plaque and calculus that have accumulated around the tooth and under the gum line. The goal of this procedure is to produce clean, smooth teeth and roots, which will promote healing and reduce bleeding, inflammation, and infection associated with periodontal disease.

Local Anesthesia

Please be aware that your cheek, lip, and tongue will be numb and care must be taken in order to avoid accidentally biting these areas.

Oral Hygiene

Periodontal disease is not curable, but it can be maintainable, following successful scaling and root planing. However, continued success in managing periodontal disease depends heavily upon diligent oral hygiene at home and regular (quarterly) maintenance visits with us. Consequently, you, the patient, play the most important role in the success of periodontal treatment.

Tooth Sensitivity

The gums may recede as they become healthier and inflammation subsides, which will make cleaning the surfaces of the teeth much easier. However, you may also experience sensitivity to hot, cold, and sweets. Please be assured that this result is a common one and the use of a prescribed fluoride and/or desensitizing toothpaste will help relieve your sensitivity.

Gum Sensitivity

Your gums may be sore after therapy, especially as the numbness wears off. Tenderness is part of the healing process and can be eased with a mild analgesic such as Advil® or Tylenol®. Some slight bleeding may occur during the next several brushings, but the bleeding should decrease steadily after two to three days.

Warm salt-water rinses two to three times per day (one teaspoon of salt to eight ounces of warm water) can also help to soothe sore gums, reduce bleeding, and promote healing.


Your next meal should be soft. Avoid any hard or crunchy foods for the next two days.


Please do not smoke or use any other tobacco products following scaling and root planing procedures, because their use can delay healing and allow periodontal disease to progress.


Please do not hesitate to call our office. We will be happy to assist with any questions or concerns.

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