Fillings and Crowns …What You Need To Know

Injection of local anesthetic is common for most procedures: It provides patient comfort during restorative dental care. Two or three injections are often needed with normal effects ranging from 2 – 12 hours post injection. It is okay to eat and drink, but keep in mind that sensation to biting forces and temperature is impaired. Please be careful. Almost all discomfort associated with dental procedures postoperatively is due to the injection/s and/or trauma to the gum, and not the actual procedure to the tooth itself. Swelling, bruising and generalized discomfort at the injection site as a result of soft tissue trauma are common for up to 10 days. The discomfort may radiate and spread. Most patients feel little or no discomfort by the follow- ing day.

Fillings: Before a filling is placed; cracks, decay and all old defective restorative materials (usually amal- gam, gold, ceramic or old composite) are completely removed. Dental composite (white filling material) is placed over a bonding agent, which bonds composite to tooth structure. Sensitivity is normal and can last for 2-3 weeks following fillings, however 1-2 days is more common. Den- tal composites, similar to enamel, are very susceptible to acidic environments, and their lifes- pan is largely dependent on clenching/grinding habits, oral hygiene habits and oral pH. Similar to enamel, items with low (acidic) pH such as coffee, soda, tea and wine, greatly affect the life- time serviceability of restorations. Because patients are often “numb” when the bite is checked, fillings may feel “high” once the anesthesia wears off. In this case, please call and return to the office for a bite adjustment.

The crown and process The purpose of a crown is to replace the structure, function and esthetics of a damaged or defective tooth. This protects the tooth, and often nerve, from future damage. Crowns are all-ceramic, highly esthetic restorations that fully cover teeth. To prepare a tooth for a crown, the visible portion is reduced in all dimensions (360°) by 1 - 1.5mm. All damaged tooth struc- ture (including decay, fractures and old fillings) is removed. Sometimes, fractures decay and old restorations extend under the gum line. In this case, a laser is required to remove the gum tissue so that healthy tooth structure can be exposed and prepped. This process is called a “gingivectomy.” Tooth structure that needs to be replaced, to aid in the retention of the crown, is called the “buildup.” If a gingivectomy is needs, the gum tissue around the crown can be sore for 7-10 days. Proper hygiene less flossing should be continued to keep the gum area clean while it heals. The Motrin regiment below will be essential to limit discomfort during the tissue healing phase. Sensitivity One possible result from the process of removing the bacteria associated with decay and/or fractures from teeth is “sensitivity” after the procedure. After a period of months this sensitivity tends to subside or resolve completely. In cases where a tooth is still “sensitive” be assured the filling or crown is fine, the sensitivity is derived from nerve damage caused by the process of removing bacteria and/or bad tooth structure that was present prior to the procedure. In cases where the sensitivity is more than a patient would like to deal with, we recommend devitalizing the tooth by removal of the nerve. A root canal removes the nerve(s) from teeth which elimi- nates discomfort and sensitivity almost immediately.

Temporary crowns are temporary They protect the tooth and prevent space closure prior to final crown cementation. Temporary crowns can be in place for weeks to years. The temporary crown should not feel “high” and will not feel like a natural tooth or like the permanent crown. We recommend brushing the tempo- rary crown as usual, but not flossing around crown unless absolutely necessary. To avoid pulling the temporary crown off while flossing, pull floss “down” between teeth then pull floss out to the side to remove. Avoid sticky or hard foods, like caramel, chewing gum or nuts. If the temporary crown comes off and you have a scheduled appointment to have the permanent crown ce- mented, do not worry. You will not hurt the tooth underneath. Exposed dentin will often cause the tooth to be more sensitive, but it is not imperative that the temporary be replaced so long as the discomfort is manageable.

** For your comfort, we strongly recommend that all patients who are not contraindicated to use 600 - 800mg of ibuprofen (Advil, Motrin, etc.) every 8 hours for as long as 5 days following crown and filling appointments. It is best to take the first dose of ibuprofen before the anesthetic wears off.**