Before Endodontic Treatment
General information: If you are scheduled for treatment, the procedure will be performed using local anesthesia. There are usually no restrictions after an endodontic procedure concerning driving or returning to work, unless oral sedation is performed. If oral sedation (triazolam) is used, an escort is required, and the patient should not drive.
Please continue all medications for blood pressure, diabetes, thyroid problems, and/or any other conditions as recommended by your physician. If there is a question, please call our office prior to your appointment.
Please eat a full breakfast or lunch as applicable. If you have been advised by your physician or dentist to use antibiotic premedication, please do so. If there is a question, please call our office prior to your appointment.
If you can take ibuprofen (Advil) or naproxen sodium (Aleve), this can help reduce inflammation when taken
pre-operatively.
If you have any questions, please call our office at (619) 295-3636.
After Completion of Endodontic Treatment
Your tooth (periodontal ligament) and surrounding gum tissue (gingiva) may be tender for as many as ten days following treatment, as your body continues to heal. This tenderness is normal and no cause for alarm. These temporary symptoms are usually relieved by over-the-counter pain medications.
If a posterior (molar) tooth has had a root canal, cuspal coverage (crown or onlay) will often be necessary to help prevent fracture of the tooth. Avoid chewing on a molar tooth until your general dentist or prosthodontist restores a root canal-treated tooth with cuspal coverage (crown or onlay). You should continue your regular dental hygiene regimen.
Discomfort may be alleviated by doing one of the following:
Unless medicallly contraindicated, one can take 600 or 800 mg of ibuprofen (Advil or Motrin are trade names) every six hours with eight ounces of water. Adults should not exceed 3200 mg in any 24-hour period. This 800 mg dosage level assumes a 150 pound, adult patient.
An adult patient can also take 1000 mg of acetaminophen (Tylenol is trade name) every six hours with eight ounces of water. Adults should not exceed 4000 mg in any 24-hour period. This dosage level assumes a 150 pound, adult patient. Acetaminophen should never be taken in greater than recommended dosages, as this medicine can be dangerous to a patient's liver if taken in excessive quantities.
Another effective treatment protocol for adult patients (unless medically contraindicated) is to take both ibuprofen and acetaminophen medications simultaneously. For example, a patient can take 600 mg of Advil plus 1000 mg of Tylenol, every six hours. However a patient should not take two medications in the same drug class (ie: two non-steroidal anti-anflammatories NSAIDS) at the same time.
NOTE: It is recommended to refrain from ingesting alcohol while taking any of these medications.
Should you experience discomfort that cannot be controlled with the medications noted above, or you have developing swelling, please contact our office immediately at (619) 295-3636. If you need to call after hours, please have your pharmacy number available.
A recall examination to evaluate healing is often performed six months after treatment. This appointment will require only a few minutes, and no additional fee will be required.
After Root-End Surgery
On the first day...
Avoid strenuous activities or any unnecessary lifting for 24 hours. Take it easy. Should you decide to lay down, protect your pillow case from any oozing with an old towel.
Fill any prescriptions on your way home and take them as directed.
Apply an ice-bag to the face over the surgical site, alternating every ten to twenty minutes. Continue this for six hours. This will minimize swelling and discoloration. Do not use ice after the first day.
Eat soft foods for the first 24 hours after surgery. The idea is to avoid foods that could possibly disrupt the healing soft tissue, near the surgical site. Avoid alcohol, carbonated beverages, acidic beverages and smoking.
You should brush your teeth in the treated area, but be careful not to disrupt the surgical site for at least 24 hours. Avoid tooth paste near the surgical site for 24 hours. Do not agressively rinse your mouth or us a water irrigation (water pik) device after surgery.
If you experience significant bleeding, apply direct pressure. This should be enough, however if the bleeding is persistent, place a moistened Lipton tea bag on the affected area. Do not cut open the tea bag. Rest with your head elevated for 20 minutes with slight to moderate pressure over the area. Remove the tea bag and confirm that the bleeding has stopped. If it has not, repeat with a new tea bag. If the bleeding persists, call the office or the doctor's emergency number immediately.
On the second day and beyond...
Gently rinse your mouth with warm salt water (half a teaspoon in a large glass of warm water) after meals.
After 24 hours after surgery, one can use an antispetic rinse (chlorhexidine gluconate 0.12%). twice or three times a day. This rinse should be discontinued after seven to ten days, as this solution can stain the plaque on the teeth a dark brown. This rinse should not be used for the first 24 hours after surgery, as this can disrupt blood clot formation, which is a normal part of the healing process after surgery.
Although severe pain seldom occurs, some discomfort will usually take place. Use the
anti-inflammatory medication as directed. There may be some swelling after surgery which will usually be notice for the first 24-72 hours after surgery. The treated tooth may feel loose for a brief time.
Return to our office for suture removal as directed.
If you experience discomfort not controlled by your prescription, or any signs of infection or swelling, please contact the office at (619) 295-3636.
Regarding Oral Sedation
Triazolam (Halcion), is a medication (in pill form) that can greatly minimize anxiety that might be associated with treatment with your endodontist. In a more relaxed state, you will be able to communicate with our doctors while treatment is being performed. Even though triazolam (Halcion) is relatively safe, effective, and is metabolized after the dental visit, you should be aware of some important precautions and considerations. Our team will review this with you prior to your appointment.
Side effects may include light-headedness, headache, dizziness, visual disturbances, amnesia, and nausea. In some patients, oral triazolam may not work as desired. Smokers will probably notice a decrease in the effect of the drug. Nitrous oxide (laughing gas) may be used in conjunction with triazolam. Local anesthetic is used with all treatment patients. Dr. Stalder and Dr. Lewis have a permit issued by the California State Board of Dental Examiners that is required to administer sedation techniques that fall under minimal conscious sedation.
There are certain medical conditions in which triazolam should not be used: during pregnancy or while breast feeding, in a patient with advanced liver or kidney disease, or in an individual who is hypersensitive or allergic to benzodiazapenes (Valium, Ativan, Versed, etc.).
Tell Dr. Stalder or Dr. Lewis if you are taking the following medications, as they can have a drug-drug interaction with triazolam: nefazodone (Serzone), cimetidene (Tagamet, Tagamet HB, Novcimetine, or Peptol), levodopa (Dopar or Larodopa) for Parkinson's disease, antihistamines (such as Benadryl and Tavist), verpamil (Calan), diltiazem (Cardizem), erythromycin and the azole antimycotics (i.e., ketoconazole, clarithromycin, or itraconazole, or Nizoral, Biaxin, Sporanox, respectively), HIV drugs such as indinavir (CrixivanA) or nelfinavir (ViraceptA) and alcohol. Of course, taking recreational or illicit drugs can also cause adverse reactions.
Before Oral Sedation
To ensure you have been informed prior to taking triazaolam (Halcion), you will be provided and must sign a consent form before being provided the prescription. The consent form can be printed here. Should you have any questions about oral sedation, please call our office at (619) 295-3636. Please note that the consent form must be signed at the time of consultation, before the medication is actually prescribed or taken.
Please plan to arrive 30 minutes prior to your scheduled appointment and take triazolam as Dr. Stalder or Dr. Lewis have directed you. The onset of triazolam is approximately 15-30 minutes, but can take as long as an hour depending on various factors. Do not drive after you have taken the medication.
Please have an adult come with you to act as an escort and drive you home after the procedure. This person will need to wait for you in the waiting room until the procedure is completed, unless otherwise directed.
Eat a light meal prior to your appointment.
On the day of your procedure, wear loose-fitting, comfortable clothing with short sleeves or sleeves that roll up easily. If you are taking medications, other than the medicines prescribed in this office, please bring them or a list of them with you. Please bring the remaining triazolam pills with you to your appointment.
If you are unable to keep your appointment, please let us know as soon as possible.
After Oral Sedation
On the way home, the patient should be in the reclined position in the car.
Dr. Stalder or Dr. Lewis may prescribe pain medications to minimize or eliminate any post-treatment discomfort. These may be taken as needed and as directed. Do not take any medications with narcotics in amounts greater than directed, due to risk of respiratory depression (slowing of respirations).
If the patient is taking any prescribed mediations (blood pressure, heart or seizure medication, etc.), these should be resumed on the normal schedule, unless instructed otherwise.
The patient should be able to rest (with supervision), lying down, for the rest of the day if necessary. The patient should have someone accompany him/her into the restroom if he/she feels dizzy or loses balance when standing up. If the patient feels dizzy or faint, have him/her lie down immediately. Supervision is needed for the day of the procedure and possibly through the night, depending upon the time of day the procedure was performed.
It is important that the patient receive enough fluids and calories after the procedure, especially if surgery was completed.
There should be no driving or outside activity for the rest of the day. The patient should refrain from operation of machinery (e.g., cars or lawnmowers) or potentially dangerous toys (e.g., bicycles or scooters) for 24 hours.
The patient should not consume alcoholic beverages or any other central nervous system (CNS) depressants (e.g., sleeping pills) for at least 24 hours after taking this medicine.
If you have any questions, please call our office at (619) 295-3636.