Emergency Care at John Rubin, D.D.S. / Montgomery Plaza Dental, Fort  Worth Texas

We recognize that you can have an emergency situation arise and we will do our best to respond to your need promptly because relief of your discomfort is important to us. If an emergency arises when the office is closed, please call (817) 332-PLAZA (332-7529) and your call will be directly forwarded to Dr. Rubin.

Dental Emergencies

Knowing how to handle a dental emergency can mean the difference between saving or losing a tooth.

Tooth knocked out: First, try to stick the tooth back in place and hold it there while you rush to see the dentist. If that's impossible, put the tooth is a container of milk (or water if milk is not available) and take it and the patient to the dentist immediately.

Fractured Tooth: To avoid further aggravating the damaged tooth, place a piece of soft wax into the area of the tooth that was chipped. You should eat only soft foods and try to avoid food and drink that are hot and cold to the touch.

Fractured Jaw: If you find that your jaw hurts when it is moved or if you cannot close your mouth in a normal fashion, it is likely that you have fractured your jaw. Seek professional medical help at a hospital emergency room. The hospital will be able to treat your injury as well as advise you whether you need to make an appointment to see your dentist.

Bitten Tongue or Lip: Biting or lacerating your tongue may cause inflammation and possible bleeding. Use ice or pressure to control the swelling or bleeding. Any swelling should subside within twenty-four hours. Contact your dentist if the pain persists or the laceration is deep.

Bleeding After an Extraction: Slight bleeding after an extraction is normal. A clot will usually form within one hour. If bleeding continues, place a thick gauze pad over the extraction site. Apply pressure to the area to control the flow of blood. If bleeding still persists, you may try soaking a tea bag in water, placing it inside a thin gauze pad, and apply pressure for one hour. The tealeaves contain minerals which may aid in the clotting procedure.

Mouth Sores: Canker sores are those very small and painful sores which occur inside the mouth. They can be caused by stress, biting the inside of the mouth or by a reaction to certain foods. If you find that you have developed a canker sore on the inside of the mouth, apply an over-the-counter medicine like Orajel or camphophenique. This will produce a bandage-like film over the sore.

Toothache: An aching tooth is a very common dental emergency. A toothache is often a sign of infection in or around a tooth. Tylenol or aspirin can sometimes be effective in comforting pain. If there is a hole in the tooth, you may place Oil of Cloves on a small cotton pellet and place it in the site to relieve pain.

 Post-Op Instructions

• Dentures & Partials
• Porcelain Veneers
• Night Guards
• Endodontic Treatment
• Composite (White) Fillings
• Porcelain Crowns, Bridges & Onlays
• Post Surgery Instructions

Dentures & Partials

• Sore Spots: Usually, your mouth will have a few "sore spots" after wearing the denture/partial for 24 hours. These areas can be relieved with very little effort during your next appointment.
• Chewing: The new bite may not feel completely comfortable for several weeks. We can adjust the contacting surfaces of your teeth after the dentures/partials have settled into place.

We have done our best to provide you with well-fitted, functional and esthetic dentures/partials. We feel confident that after a few weeks of becoming adjusted to the new dentures/partials, you will have years of satisfaction from them.

Over time, your jawbone and gums shrink when there are teeth missing. When this occurs, your dentures/partials will feel loose and may require relining. Wearing ill-fitting dentures/partials for too long without refitting can cause severe bone loss and very serious oral disease. Please call our office if these symptoms occur.

We look forward to helping you adjust to and enjoy your new dentures/partials.

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Porcelain Veneers

Temporary Veneers

• You have just received a plastic temporary restoration that will serve you for a short period of time while your permanent veneers are being made. They are attached only slightly to the underlying tooth so they can be removed easily.
• If a veneer comes off, call us and we will replace it immediately. If you are in a situation that will not allow you to come in, place the temporary back in place with some FixodentTM (denture adhesive). You must still see us as soon as possible.
• The size, shape and color of the temporary do not resemble the final veneers in any way.
• Temporary veneers may leak saliva or food onto the tooth. Sensitivity to hot, cold, pressure, or sweets is not uncommon. You may also see stains under the temporaries. These will be removed prior to final cementation.
• Avoid heavy brushing of the temporaries and do not floss between them because you may pull them off. But you must keep your gums healthy by brushing softly and rinsing with the rinse we gave you.
• Your final porcelain veneers will be as close to the natural beauty and function of teeth as possible. They look and feel normal in every way.

Permanent Veneers

We place our veneers with the finest materials and techniques available today. However, you should be aware of the following information about your restorations:

• As with natural teeth, avoid chewing excessively hard foods on the veneered teeth (hard candy, ice, raw carrots, etc.), because the porcelain material can break under extreme forces.
• Proper brushing, flossing, and regular 6-month (minimal) cleanings are essential to the long-term stability and appearance of your veneers. Often, problems that may develop with the veneers can be found at an early stage and repaired easily, while waiting for a longer time may require redoing entire restorations.
• The gums may recede from the veneers, displaying discolored tooth structure underneath. This situation usually takes place after many years and may require veneer replacement.

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Night Guards

Purpose: The purpose of splint therapy is to help your lower jaw function more properly. Since the treatment you are to receive is mainly orthopedic in nature, we have fabricated an orthopedic appliance to help reposition your lower jaw. This appliance will help to relax any of your jaw muscles which are in spasm and to reduce any muscle pain. There are many situations that may cause your lower jaw to malfunction including accidental trauma, developmental defects, peculiar oral habits, naturally occurring malocclusion (poor bite), psychologic stress, clenching or bruxing of teeth, and other problems.

Rationale: You have received an acrylic bite splint (occlusal splint). This treatment has been used for many years to keep the teeth from contacting while you sleep and to allow the lower jaw to return to a comfortable hinge position without interference and guidance from the teeth. It is essential that you wear your night guard every night and you may also wear it during the day if you find yourself clenching or grinding your teeth. When it's not in your mouth, make sure your splint is placed in water to avoid warping.

Cleaning the Splint: Food will accumulate under the splint. After brushing and flossing your teeth very thoroughly, brush and rinse the inside and outside of the splint and return it to your mouth. Dental decay can be stimulated if you are not careful about the cleanliness of your mouth and splint. Fluoride containing rinses or gels are useful when placed in your splint once per day if you have a high dental decay rate. Using a dental soak cleanser (ex: Polident) on a monthly basis will help keep the splint fresh.

*Please call if you have any questions or difficulty.

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Endodontic Treatment (Root Canals)

Endodontic treatment can take 1, 2, or 3 appointments depending on the case. It is possible to experience any of the following symptoms after any of these appointments: sensitivity to hot and/or cold; sensitivity to pressure; possible swelling. If you experience swelling, please call our office immediately as additional medication may be required.

One common occurrence with a newly root canaled tooth is for the tooth to feel high when you bite your teeth together. If this occurs it will cause your tooth to stay sensitive for a longer period of time. Please call us if your bite feels "high" as this problem is easily rectified with a simple bite adjustment.

A temporary filling may be used to temporarily seal the tooth between visits. It may flake away a little bit and this is OK. If the whole "plug" comes out, either replace it immediately, or call us so we can replace it for you.

The gum tissue could have been irritated during the procedure and may be sore for a few days together with the anesthetic injection site.

During endodontic treatment, the nerve, blood, and nutrient supply to the tooth is removed. This will cause the tooth to become brittle and prone to fracturing which could result in the need to extract the tooth. A crown or onlay is recommended to prevent this from happening.

Proper brushing, flossing, and regular 6-month (minimal) cleanings are essential to the long-term stability of your teeth.

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Composite (White) Fillings

We have restored some of your teeth with tooth-colored materials. The resin (plastic) material used contains small "filler" particles of glass-like material for strength and wear resistance. These restorations will serve you well for several years. They contain the finest and most up-to-date materials available today. However, you should be aware of the following information about your new restorations:

• As with natural teeth, avoid chewing excessively hard foods on the filled teeth (hard candy, ice, raw carrots, etc.) because the resin material can break under extreme forces.
• Composite fillings set up hard right away. There is no waiting time to eat. Children should be observed until the anesthetic wears off. Due to the strange feeling of the anesthetic, many children will chew the inside of their lips, cheeks or tongue which can cause serious damage.
• Sensitivity to hot and cold is common for a few weeks following a dental restoration. Usually, the deeper the cavity, the more sensitive the tooth will be. If you feel the bite is not correctly balanced, please call for an appointment for a simple adjustment.
• The gum tissue could have been irritated during the procedure and may be sore for a few days together with the anesthetic injection site.
• The finished restoration may be contoured slightly different and have a different texture than the original tooth. Your tongue usually magnifies this small difference, but you will become accustomed to this in a few days.
• Proper brushing, flossing, and regular 6-month (minimal) cleanings are essential to the long-term stability and appearance of your restorations. Often, problems that may develop with the fillings can be found at any early stage and repaired easily, while waiting for a longer time may require more extensive treatment.

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Porcelain Crowns, Bridges & Onlays

Temporaries

• You have just received a temporary restoration that will serve you for a short period of time while your permanent crown is being made. This will protect the tooth and hold the tooth in position so the permanent restoration will fit properly.
• Temporaries are not strong. They may break or come off occasionally. If so, slip it back on the tooth with some Fixodent (Denture Adhesive) and call us for an appointment. Please do not leave the temporary out of your mouth because the tooth will move and the final restoration will not fit. Brush softly and floss carefully around your temporary. Be careful not to lift the temporary up when you floss - just pull it through. It is imperative that the gum tissue remains healthy or we may not be able to seat your new restoration.
• The size, shape, and color of the temporary does not resemble the final restoration.
• Temporary restorations may leak saliva or food onto the tooth. Sensitivity to hot, cold, pressure, or sweets is not uncommon. If you feel the bite is not correctly balanced, please call for an appointment for a simple adjustment.

Permanent Crowns/Onlays

• After the final cementation of your restoration, it may take a few days to get used to the new crown or bridge. Hot and cold sensitivity is possible for a few weeks and occasionally lasts for several months. As with the temporary, if the bite doesn't feel balanced please call us.
• Do not chew hard or sticky foods on the restoration for 24 hours from the time they were cemented. The cement must set during this time to have optimum strength.
• Proper brushing, flossing, and regular 6-month (minimal) cleanings are required to help you retain your final restoration. The only area that a crowned tooth can decay is at the edge of the crown at the gumline. Often, small problems that develop around the restorations can be found at an early stage and corrected easily, but waiting for a longer time may require redoing the entire restoration.

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Post Surgery Instructions

General Instructions

1. Unless otherwise directed do not rinse the mouth the day of surgery.
2. Ice packs should be used continuously to minimize swelling for the first 24 hours. Moist heat may be used after 24 hours for comfort.
3. Avoid hot liquids, carbonated and alcoholic beverages for 24 hours.
4. Do not smoke or use soda straws.
5. Avoid spitting the day of surgery.
6. It is very important to keep your mouth very clean following surgery: A soft toothbrush, cotton swabs or gentle rinsing with salty water (1/2 teaspoon salt glass of warm tap water) is helpful before going to bed the night of surgery.
7. Beginning the next day, gently rinse the mouth using a full glass of warm water in which teaspoon of salt has been dissolved - three times a day. If you cannot get a supply of salt, use warm water anyway. You may brush your teeth gently and use a commercial mouthwash. Do not add salt to the warm water if you have high blood pressure or heart disease.
8. Eat soft foods (warm or cold) and maintain adequate daily fluid consumption.
   (Liquid food supplements, juices, malts, soup, etc.)
9. Small stitches may have been placed in the gums. These are dissolving sutures, which will disappear in 6 or 7days. You should have a return appointment for post-operative check.

In Case of Bleeding

1. After your teeth were removed, a gauze compress was placed on the wound and you were asked to keep your jaws closed tightly for 30-60 minutes. This was to help stop the bleeding and keep saliva away from the open socket. This compress may then be discarded.
2. Should slight bleeding continue, it is a good plan to put a fresh gauze compress on the bleeding place in the same manner, large enough so that it maintains-pressure when the jaws are closed tightly. Hold it thus for 30 minutes by the clock. This may have to be repeated 3 to 4 times.
3. If bleeding continues in spite of the above, make a small amount of strong tea, boiling it for 5 minutes, then soak a small gauze compress in the tea, and place firmly on the tooth socket, which is bleeding. Close the jaws tightly and hold this way for 30 minutes. Repeat if necessary.
4. It also helps to stop the bleeding if you will lie down, with the head raised on pillows. Apply ah ice bag or cold compress to the cheek on that side. Do not become alarmed or excited. Slight oozing may continue for 1-2 days. Almost all bleeding will be controlled by these measures. Remember that bleeding may appear to be more than it actually is because of dilution in the saliva.

Explanations of Symptoms That May Occur

1. Swelling and an elevated temperature of some extent follows nearly every extraction. This is nature's way of beginning the healing process. It does not mean infection is present. After the removal of impacted teeth or trimming of bone, swelling is often quite severe. It is often most marked on the 2nd or 3rd day and begins to disappear on the 4th or 5th day.
2. Stiffness of the jaws is also nature's way of resting the part which needs to be repaired, and usually relaxes about the 4th or 6th day.
3. Black and blue marks on the face are caused by bleeding internally into the cheeks or chin. This appears first as swelling, but after the 2nd or 3rd day it may discolor the face yellow, black, or blue. It will gradually disappear in a week or ten days. A wet towel may be applied for ten minutes, three times a day. This will be comforting but will not speed up the fading process.
4. Slight numbness of the lip or tongue may occur as was previously explained.
   The doctor who operated is entitled to be consulted first in case of trouble. He will appreciate the courtesy. Do not hesitate to call in an emergency.
5. If intravenous medications were administered, slight redness or tenderness may occur in the region of the vein. Apply warm moist towel and call the office the next day.
6. After sedation, drowsiness may persist up to 24 or 36 hours. If this occurs, do not drive a motor vehicle or remain without supervision.
7. The prescription for relief of postoperative discomfort should be taken as directed. Alcohol or other medications may increase the sedative effects of the medicine.

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