Postoperative Care for the Dental Patient...Showing You Care

The dental office is often forbidden territory for the general public. The fear of pain overwhelms, controls, and drives people to neglect their oral health despite the fact that dentistry has changed so much from the days when a local anesthetic wasn't even used. If patients experience a sore throat or a painful infection, they see their physician for a recommendation to help relieve the pain. We can become heroes in the dental office setting if we take time to recommend specific solutions to a condition that may cause discomfort after the patient leaves the dental office.

It is very important that as healthcare practitioners we are empathetic and show we really care. It is important to let patients know you care about their areas of possible discomfort and that you won't just ignore them. When patients know you have addressed a potential problem up front, they will respond with a 'thank you' versus the old 'that dentist (or the auxiliary) hurt me'

Many dental offices are providing full-mouth reconstruction procedures, and often patients sit in a dental chair for a long period of time with a rubber dam clamp or other dental device in their mouth, which can cause slight trauma to the gingival tissues. Other procedures that may cause patients to have pain include surgical extractions, endodontic treatment, orthodontic treatment, periodontal surgery, scaling and root planing, and even a regular dental hygiene preventive appointment. Many of these procedures require postoperative instructions pertaining to the specific procedure. This article will focus on minor postoperative discomfort of soft tissues that can result from various dental procedures, including basic hygiene procedures.
Chart. Postoperative Care Instructions.


After your appointment today your gums and mouth may feel tender. Please follow these instructions for best results:

•Avoid spicy foods, hard foods, or foods with seeds.
•Eat a soft diet for the next 48 to 72 hours.
•Avoid the use of tobacco.
•Take Advil, Motrin, or Tylenol (ibuprofen or acetaminophen) every 6 hours or as directed.
•The following products may be purchased and applied to the affected areas: Colgate Peroxyl rinse or gel, Colgate Soothe-N-Seal, Colgate Orabase Gel, Glyoxide by GlaxoSmithKline, Rincinol P.R.N. by Sunstar Butler, or Crest Pro-Health Rinse by Proctor & Gamble.
•If a fluoride gel has been recommended, apply this after using the rinse or gel for pain relief.

Numerous ancient remedies are still available and work well for postoperative care, but a few new, over-the-counter (OTC) products are also available that can be found in a grocery store or neighborhood pharmacy. These are also available to the dental practice for minimal cost, and they add to the quality of the practice. Sending the patient home with written instructions and recommendations along with product samples that can be used immediately can make your office a winner. The Chart is a sample postoperative care instructions handout for patients who may experience discomfort. Please note that the specific products cited in this sample are the ones discussed in this article. Many other products can be added or substituted based on the experiences and preferences of each dental office (Chart).

Following is a sample armamentarium of products that can help provide relief of postoperative soft-tissue discomfort. As mentioned previously, there are many excellent products available for this purpose, and the following examples are not intended to comprise a complete list.

SAMPLE POSTOPERATIVE ARMAMENTARIUM

Although the product examples discussed in this article are OTC products and thus are readily available to patients, it should be mentioned that the 'gold standard' of care for preoperative rinses' "a 0.12% chlorhexidine rinse1"has also been used as a postoperative care product for more than a decade. However, chlorhexidine can cause tenacious stain. This occurs when pellicle remains on the tooth surface, and this brown/black stain can become a problem with patient compliance. When patients are advised to use this as an at-home postoperative care product, a prescription is required.

OTC PRODUCTS: OLD- AND NEW-SCHOOL REMEDIES

For many situations involving minor soft-tissue trauma there is, of course, the 'old school' remedy of warm saltwater rinses, which can be beneficial. It should be noted that people with a salt-restricted diet or who have high blood pressure should not rinse with warm saltwater. Those professionals who have practiced dentistry for the past 2 decades have a 'box of remedies' for patients to buy at a local drugstore and use at home including the following:

Colgate Peroxyl Rinse, which is available in a mouthwash and also a spot gel for postoperative pain, is used to soothe and heal. This product begins to work immediately. The mouthwash comes in a sachet size, so patients can use it in the dental office immediately after treatment is completed, and the office can send them home with a few sachets to use as needed. This is also a great product for relief of pain from canker sores. It is recommended that Peroxyl be discontinued after 2 weeks of regular use. This product contains 1.5% hydrogen peroxide and 6% ethyl alcohol. The hydrogen peroxide is used to debride the gingival tissues, helps soothe oral irritations, and promotes healing.

Colgate also makes a product called Soothe-N-Seal. This product is used to treat canker sores and lasts up to 6 hours. The product has a protective barrier that promotes natural healing and is available in a liquid formula that is applied with an applicator.

Another choice is Colgate Orabase Gel, which contains 20% benzocaine. For patients who experience increased pain from canker and mouth sores, this can be very helpful, not only because of the anesthetic properties but because of the protective barrier that lasts for hours on the affected areas.

Glyoxide is another postoperative product that is also used as a temporary solution for postoperative discomfort. This product is manufactured by GlaxoSmithKline and can be purchased in half-ounce bottles for patients to take home after their dental visit. It is also available in retail stores. Glyoxide is specifically formulated to release peroxide and oxygen bubbles in the mouth. The peroxide and oxygen-rich microfoam help to gently remove unhealthy tissue and  then cleanse and soothe canker sores, minor wounds, and inflammation so natural healing can occur. Glyoxide can also help to clean stains from orthodontic appliances, dentures, and bridgework, since this product contains 10% carbamide peroxide. The hygienist can place a few drops of this into prophy paste or pumice to remove tenacious stains more easily, and it will immediately be absorbed into the gingival tissues to begin the healing process. This product is not to be used for prolonged periods of time.

Products Without Alcohol or Peroxide

Rincinol P.R.N. is a bioadherent gel sold by Sunstar Butler. This new postoperative product works instantly for relief of canker and mouth sores. It works by forming a thin, invisible, protective coating that promotes healing and prevents irritation of sensitive nerve endings for hours. It doesn't contain benzocaine, peroxide, or alcohol. It contains aloe vera, which helps soothe, hydrate, and heal affected tissues in the oral cavity. It does contain a small amount of licorice, which can help heal areas of inflammation, but patients who have high blood pressure need to be aware that licorice can also raise blood pressure.2 Since patients will be swallowing Rincinol and the licorice in such a small amount, this product should not affect patients with high blood pressure.

Recently, Proctor & Gamble introduced Crest Pro-Health Rinse to provide antiplaque and antigingivitis benefits. This is a new, alcohol-free rinse containing 0.07% cetylpyridinium chloride (CPC) in a high bioavailable matrix. CPC has a long history of use as a broad-spectrum antimicrobial against oral bacteria. It was 1 of only 3 antimicrobial systems the FDA Plaque Subcommittee classified as safe and efficacious for the treatment of plaque-induced gingivitis when formulated within a concentration range of 0.05% to 0.10%, following a 6-year review of more than 40 active ingredients. The other 2 active ingredients were stannous fluoride and essential oils. CPC acts primarily by penetrating the cell membrane, which causes leakage of components in the cell, disruption of bacterial metabolism, inhibition of cell growth, and finally cell death.3

The inclusion of alcohol can limit use of a postoperative product among certain patient groups (eg, children, patients with diabetes, alcoholics, patients with xerostomia, and members of certain religious faiths). Certain nonalcohol rinses provide gingival health benefits without the burn of alcohol, which encourages patient compliance.

TOOTHBRUSHING FOR POSTOPERATIVE CARE

When patients have sensitive gingival tissues after a dental appointment, it can add value to your team if the patient is given a special toothbrush to use for approximately the next 2 weeks. Sunstar Butler has a toothbrush called DELICATE, which is available for dental offices to purchase for this purpose. The bristles are 0.004 mm in diameter (most toothbrush bristles are 0.006 mm to 0.008 mm in diameter) and feel like a brush for a baby's hair. This can help provide a comfortable healing period.

THE BOTTOM LINE

There is so much that we can do for patients to prevent pain associated with the dental visit. When we take time to educate patients about the products available to them for postoperative care, they will remember the dental office as a pleasant place to be where there are people who care about them. A happy patient means a happy and successful team.


References

1. Beiswanger BB, Mallat ME, Jackson RD,et al. Clinical effects of a 0.12% chlorhexidine rinse as an adjunct to scaling and root planing. J Clin Dent. 1992;3:33-38.

2. Farese RV Jr, Biglieri EG, Shackleton CH, et al. Licorice-induced hypermineralocorticoidism. N Engl J Med. 1991;325:1223-1227.

3. Witt J, Ramji N, Gibb R, et al. Antibacterial and antiplaque effects of a novel, alcohol-free oral rinse with cetylpyridinium chloride. J Contemp Dent Pract. February 2005;(6)1:1-9. Available at: http://www.thejcdp.com; Past issues, Winter 2005. Accessed on June 21, 2005.



Ms. Seidel-Bittke is founder of Dental Practice Solutions. She lectures internationally about prevention, nonsurgical periodontal therapy and dental hygiene product updates, and consults nationally. She coaches dental teams on working as a team to increase the value and bottom line of the dental practice. She may be reached at (866) 206-6364, This e-mail address is being protected from spambots. You need JavaScript enabled to view it , or visit dentalpracticesolutions.com.