Dr. Zadeh has treated thousands of patients, and nearly all of them have questions regarding their procedures or treatment plans. While we are always happy to answer questions during office visits or over the phone and email, here are a good number of some of the more commonly themed inquiries that we have been asked. Remember, there is nothing to be ashamed about at the dentist and asking questions is the best way to help both reduce anxiety/fear and find ways to improve your treatment plans.

Oral Surgery Questions
General Dentistry Questions
Patient Questions

Oral Surgery Questions:

1. What is most important in the FIRST HALF HOUR after oral surgery?

Make sure the dressing remains in place. Do not displace it with your tongue or finger.

Start applying the ice pack over the area of surgery as soon as you can. This will minimize the swelling. Apply the ice pack for a few minutes and keep it off for a few minutes. Continue this until you go to bed.

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2. What should I do with the gauze piece or dressing in my mouth?

If a gauze dressing is placed you should remove it after half hour.

If dental packing is used, DO NOT DISTURB IT!

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3. Following any oral surgery including soft tissue grafts, bone grafts and dental implant surgery what should I do to avoid bleeding?

DO NOT SMOKE!

DO NOT DRINK ALCOHOLIC BEVERAGES!

DO NOT EAT any food or drink anything that is HOT in temperature.

DO NOT SPIT! If you wish to empty your mouth, bend over a sink, let the contents flow out and wipe your lips with a napkin.

ALL OF THE ABOVE CAN CAUSE BLEEDING FROM A FRESH WOUND AND MUST BE AVOIDED DURING THE FIRST 24 HOURS!

Most importantly, do not use hydrogen peroxide or any peroxide containing product as this will dissolve blood clots and cause bleeding.

Most important of all try to REST. Any physical activity even walking around the house will increase your level of swelling and pain in the days that follow. The first 24 hours after oral surgery, is the best time to catch up with books, TV, movies, sleep, video games, or the Internet. If you have pets, please enjoy them as companion animals are proven to help healing and ease stress — just make sure to not let your more cuddly or friendly pals bat your face.

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4. How much bleeding is acceptable and normal following oral surgical procedures?

Some seepage of blood from the wound is to be expected and should cause no alarm. Blood streaked saliva may persist for 24 hours-If there is no dental dressing and bleeding is excessive, place a roll of clean gauze over the area and bite firmly for 20 minutes, continuously. If dental dressing is placed over the wound, try to keep the area cool by placing ice pack over the face and while you keep your head elevated, immobilize your head.

In either case, if excessive bleeding does not stop in 15 minutes, call the office.

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5. When can I start brushing my teeth following grafting and implant procedures? Can I use a mouth wash?

VERY IMPORTANT: DO NOT USE hydrogen peroxide or any peroxide containing product for 6 weeks following any oral surgical procedure. Peroxides totally destroys blood clots and regenerative processes by causing lysis (cellular bursting) of the healing tissues. This can inhibit and lengthen your healing for all procedures, including implants.

You can start brushing your teeth and tongue except the site of surgery from the second day. Make sure you do not place any peroxide containing toothpaste in your mouth.

After the first 24 hours: Dissolve about half teaspoon of salt in an 8-oz glass of warm water. Rinse the area of surgery very gently so as not to disturb the wound and blood clot. Repeat the above every 4-5 hours over the next 2 days. Warm salt water cleanses the wound, prevents infection, and promotes healing and protects against bacteria.

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6. What can/should I eat after oral surgery for dental implants, bone grafts, and guided tissue regenerations?

A nutritionally balanced diet is essential following surgery. Your body needs protein and fresh vitamin C to heal the wound. A great diet would be two cans of Ensure, one in the morning and one in the evening with a glass of freshly squeezed orange juice whenever you feel like it. Initially you can eat only soft foods, which are easily chewed and swallowed. Eggs (with the yolk) are highly nutritious and a very good source of protein and minerals. You can also make milk shakes with fruits or protein powder for a complete drinkable meal. Do not skip meals! If you eat or consume sufficiently nutritious food regularly, you will feel better, gain strength, have less discomfort, and heal faster.

If you are diabetic, you must maintain your normal diet in terms of carbohydrate intake and take your medication as usual.

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7. What can I do to minimize swelling and pain after oral surgery for gum lift, gum graft and implant surgery?

Swelling is number one cause of post surgical pain of oral surgery. Additionally, if you have had a regenerative procedure like a sinus elevation, bone graft or a gum graft, excessive swelling can cause the procedure to fail. Therefore, for your comfort and to ensure the success of the procedure, you must take the following steps to minimize the swelling.

a. Apply ice over the area of the surgery for the first 24 hours.

b. Do not apply anything for the 2nd 24 hours.

c. Apply moist heat over the area for days 3 and 4.

Remember that the swelling is maximum on the third day and starts to subside from the 4th day onward. Your care during the first 24 hour period will determine the amount of swelling on the third day. Resting, especially during the first few days, is the most important factor in minimizing the swelling.

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8. How soon can I work out after surgery implants, gum lifts, and grafting and regenerative procedures?

We insist on the following resting regimen to ensure the success of these procedures.

a. Absolute bed rest for the first 24 hours. We advise that you get your medications and food for the first 3-4 days so that you can go straight home without having to stand on your feet in a pharmacy or a grocery store after the surgery.

b. For days 2 and 3: You must restrict your physical activities to the inside of your house. This is a great time to catch up with books, internet, and TV. Remember that “talking” is considered “heavy activity” for the mouth following oral surgery. If you have traveled from out of town, it is better if you do not travel back until the 5th day.

c. Days 5 thru 9: You can resume all normal activity except strenuous work outs.

d. 10th day on: No special consideration for the procedure is needed.

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General Dentistry Questions:

Q: How often should I have a dental exam and cleaning?

Cleanings every 3-6 months (we recommend once every four months!) and an exam once a year with a full x-ray panel once every two to three years.

Regular cleanings and exams are one of the best ways to keep a healthy mouth and prevent serious complications that prevent you from keeping your teeth for life.

A highly-trained hygienist will tell you and the dentist that there are some suspicious areas during the cleaning process. If these problem areas are caught early, they can be treated with preventative measures or stopped before they become more serious. Ignoring dental issues like tooth aches can lead to serious issues down the road.

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Q: How often should I brush and floss?

Two to three times a day.

Depending on your schedule sometimes it’s not realistic to do this three times a day, but there are a number of products available such as sugarless gum and disposable, single use tooth brushes that can help you maintain a good dental hygiene schedule..

We recommend doing it at least twice a day. Once in the morning after breakfast (or just when you wake up if you don’t eat breakfast), and once after dinner or before you go to bed. It is especially important to floss at this time because without flossing you can easily miss 35-40% of your tooth surface with just brushing alone.

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Q: Is flossing that important?

Yes! There is no substitute for flossing.

Where do you normally get food stuck? Between your teeth! This is where the majority of tartar and plaque build up occurs that causes tooth decay and certain forms of discoloration.

Lack of flossing is the leading cause of cavities and unnecessary damage to your teeth, followed only by bruxism.

Also, remember after flossing and brushing to use an oral rinse to get any additional debris out of your mouth. This step is not as necessary as many claim it is, but it does help freshen your breath, so if you feel comfortable doing it, please do so.

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Q: I brush, floss, and rinse consistently and still get cavities, gingivitis and other issues. Why?

It has been shown that some people are more likely to have gum disease and some people are more likely to have tooth decay simply based on genetics. People with porous teeth or a family history of cavities are unfortunately more likely to get them, but there are ways to prevent it from becoming a big problem.

The next biggest factor in tooth decay is diet and habits. Someone who eats a diet that is less harmful to the teeth or gums needs less maintenance. Avoiding candy and soda is recommended, as they are the biggest causes of sugar and acid related tooth decay. Having regular fluoride treatments also helps prevent caries (cavities) from forming.

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Q: Are amalgam fillings safe? What’s this talk about mercury?

Yes, the amounts of mercury are trace bound to the other components of the amalgam filling, but Dr. Zadeh does not use them. He prefers resin or composite filling as they look far more natural and require less of the tooth to be drilled for the filling to stick. While the mercury is safe, the amount of drilling and work required for an amalgam filling takes up a greater surface of the tooth and may actually weaken the tooth, leading it susceptible to cracking, chipping, and breaking.

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Q: What are my options if I have missing teeth?

BRIDGE: Just like the name, this dental bridge is meant to fill a gap and buttress the neighboring teeth for natural and complete look and helps keep the remaining teeth healthy and secure.

DENTURE: These are a traditional option for people who have lost all or most of their teeth, whether through accidents or wear/age and can provide a natural, healthy look.

IMPLANT: A dental implant is an artificial root, usually made of titanium or zirconia that is surgically placed into the jaw bone to replace missing teeth. After they are placed into your jaw bone, a crown is attached to it.

These are the most common options, but as always, you can discuss your needs with Dr. Zadeh.

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Q: I grind my teeth, what does it mean and what can I do about it?

Grinding or clenching is often called bruxism and is a result of parafunctional habits. While there is no cure-all for this, there are a number of techniques and options available depending on the situation. I have dealt with many cases of bruxism and parafunctional habits over the years. While grinding or clenching when you are conscious can be avoided by a deliberate effort and stress relaxation techniques; when it occurs in your sleep it can be a little more complicated. If you wake up with neck pains or headaches, you may be grinding your teeth while you sleep. If this is the case, I can fashion night-time splint for you, that you wear while you sleep that will keep your teeth from grinding.

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Q: My jaw clicks and pops. What’s wrong?

There are a number of reasons for this, many of which are benign. Like all joints, the jaw can sometimes get air bubbles trapped between the cartilage, muscles and bones, which creates the popping sound.This is totally harmless, especially if it happens occasionally.

If it is a recurring problem, there may be misalignment of the joints, which is often caused by a condition called TMJ. When your teeth keep your jaw from closing correctly and your jaw muscles squeeze your teeth against each other, the jaw joint pops out. The noise you often hear is the joint ‘popping’ back into its correct location. In many cases, this can be treated with combination therapy and splints to help settle the joints and muscles into their correct place.

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Q: I have sensitive teeth, what can I do?

Try a toothpaste like Sensodyne or Crest® Sensitive. Usually this helps reduce sensitivity. If with the use of toothpaste, your sensitivity issues continue, you may have an issue such as a cavity. If your sensitivity is extreme or bothersome to the point that it is affecting your quality of life, come in as soon as possible to have your problem evaluated. It’s better to have it checked out than face the dreaded root canal procedure!

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Q: My tooth is badly damaged and it will cost a lot to have it repaired, shouldn’t I just have it pulled?

No! Absolutely not. The removal of a tooth can have drastic effects on the rest of your teeth. The other teeth will move and may become loose, causing other teeth to fall out or ruin years of previous dental work. There are always options in financing for any of our dental procedures, and many are very affordable with most insurances. Money should never be a reason to extract a tooth. In fact, Dr. Zadeh offers his patients 0% financing as a sign of good faith and affordability.

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Q: There’s all this talk about dental implants. Is it better just to pull my tooth and get an implant or save it?

Natural teeth are better than anything man made and if a tooth can be saved, we will save it. However, if a tooth or teeth are hopeless, such as extensive breaking, root death, or other problems, Dr. Zadeh will discuss your options with you. Sometimes a dental crown is enough if there is enough tooth to save. Otherwise, we can talk about your options with implants or bridges.

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Q: I’m curious about veneers because I have stained teeth and they look very promising! Are there any drawbacks?

As far as porcelain veneers go, Dr. Zadeh recommends them for patients who have severe internal staining, broken, cracked, or worn teeth or minor crowding/crookedness that does not require or call for the length of a night-time retainer system, Invisalign, or braces treatment. If you want them because your teeth are stained, he might advise you to try a tooth bleaching first, because veneers are permanent. When a veneer is installed, you have a slight bit of your enamel removed, which will expose your teeth and make them potentially very sensitive. You cannot undo veneers, so it is better to look at less ‘drastic’ options if you are simply worried about the color of your teeth. However, if you have crooked or damaged teeth, they may be a very good option for you!

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Q: Why is my tooth/teeth loose?

GUM / BONE DISEASE (PERIODONTITIS) OR TRAUMATIC OCCLUSION.

Periodontitis causes the foundation of the tooth to be weakened. The less support you have the more mobile the tooth becomes. This is why treating periodontal disease and regular check ups are so important. If you lose over 50% of the support structure, the tooth will become mobile and loose.

Traumatic occlusion (usually caused by bruxism, accident or injury) means undue force and pressure was placed on the tooth or teeth, causing the periodontial attachment to become loose. Fortunately, if it is minor enough, it can be resolved naturally. If a more serious injury occurred, please contact your dentist immediately. Ask your dentist or periodontist to consult with you on loose teeth. If you don’t currently have a dentist, schedule an appointment and come see us.

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Q: Why do I have bad breath?

Halitosis, commonly known as bad breath, is a common and embarrassing problem for many people, but it can often and easily be resolved with proper dental hygiene. Flossing and brushing your tongue can solve most issues relating to bad breath, as the majority of bad breath comes from the back of the tongue. If this does not resolve your bad breath, there may be a far more serious issue or something may be stuck in your gums or under a tooth.

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Q: What exactly is a ‘deep cleaning’?

Your teeth have ‘moats’ around them we call ‘pockets’. If you hear numbers called out by your dentist or hygienist they are measuring these pockets. Numbers between 1-5 are most common and can go up to 12 or more. When your pockets are shallow (1-3) you need a regular cleaning. When your pockets are deep (4+) you need a deep cleaning.

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Q: It hurts when I chew, what is going on?

You probably have an infection. One of the most common reasons is an infection of the area surrounding the roots. Your teeth have rubber band fibers that suspend it in the air and keep it from touching the bone when you chew. When you have an infection, the bacteria destroys these fibers and it causes the tooth to move and grind against the bone which hurts! If you believe you have an oral infection, get it checked immediately.

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Q: What is the difference between a professional tooth whitening treatment like Zoom or Take-Home Kits and a kit or system I can get at my drug store?
LOTS. Laser whitening and in-office teeth bleaching will get your teeth several shades whiter in one visit. In combination, with take-home teeth bleaching trays, you can have your teeth at their very whitest for years. Here are some advantages of professional take-home trays:

• Professional whitening trays fit better than the ones you can buy at a drug store.
• Professional whitening trays use a gel that continues to whiten up to 24 hours after you stop using it while over the counter kits stop working almost immediately.
• Professional whitening trays irritate the gums less than over the counter varieties.

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Q: You claim to be painless or near painless, how is this possible?

Technique and the effective use of localized anesthesia and IV sedation. Most of our patients report little to no pain during all of our procedures, and I am one of the few dentists that is IV Sedation Certified, so for more intense or complicated cases, you can sleep through the entire procedure and feel absolutely nothing. I also specialize in helping patients with dental anxiety issues, so there is never anything to fear from a visit to my office.

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Q: Are dental X-rays safe?

Absolutely! Dental x-rays have developed to a point where the radiation exposure is minimal. We are all exposed to natural radiation in our environment. The amount of radiation exposure from a full mouth series of x-rays is equal to the amount a person receives in a single day from natural sources. In fact, you receive more exposure to radiation lying on the beach for a day or during a 6 hour plane flight. In addition, the amount of radiation from 20 digital x-rays equal approximately 1 analog (film) x-ray! This is another reason to use digital x-rays!

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Q: How often should dental x-rays be taken?

Once every 3 years for a full set, and a checkup once a year
• A full set is 18-20 xrays.
• A checkup set is 6 xrays.

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Q: I keep hearing about these alternative to titanium implants called Zirconium Implants, but I have also heard about Zirconia Implants – are they the same thing and which one is correct?

Theoretically, they are the same, but the name implies something else.

The proper name would be zirconia, which is a form of ceramic. Zirconium (Zr) is a elemental metal that forms the basis for zirconia, but is a totally separate material. There is a common misunderstanding for which is the right word, but zirconia is correct. Pure zirconium is a metal, but is used to create sturdy, aesthetically pleasing ceramics known as zirconia. This is probably why the misconception occurred.

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Q: What are the advantages of zirconia implants over titanium implants?

There are a few advantages that make zirconia implants a strong runner up to titanium implants. First off, zirconia implants are made of a ceramic which appear far more natural and are easier to clean and maintain. Second, there is very little risk of allergy with ceramic implants, while a small percentage of the population (4-5%) may have allergies to titanium and its alloys. Also, ceramic (zirconia) implants may last longer because they do not corrode like metal implants. However, you should always talk about the advantages and disadvantages of implant systems with your dentist before making any decisions.

Titanium implants have a longer track record, and there is little reason to not use them if your body will tolerate them. Very few people have a titanium allergy, and the properties of titanium have been proven to have good bone integration and other qualities that zirconia does not have the track record of quite yet.

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Individual Questions by Patients:

Good morning from South Africa, Dr. Zadeh. I hope you’re well.

I’m writing because I completed my antibiotics and I feel like my mouth (gums around the two extractions) has become more inflamed over the past 24 hours or so. What should |I do? I am in the company of a doctor who can write prescriptions if necessary.

I appreciate you!

L.

Answer:
Hi L.:

I think you may be exerting yourself too much for your body to heal. You need to locally try not to irritate the wound by not eating crunchy or spicy food and not touch it with your tongue. I know it is easier said than done due to the fact that you have wounds on both sides of your mouth.

Systematically also you need to try taking it easy for your body to spend the resources to heal your wounds rather than keep you going! Again, easier said than done due to your traveling.

As for antibiotics, you have already taken two courses. If you are not experiencing any adverse reactions like diarrhea or yeast infection, and you feel you are worse than previous days, you can do a third course.
However, if you going to do a third course, you should try something stronger.

I recommend Levofloxecin 750mg , once a day for 10 days.

But remember that it is your body that heals the wound and the antibiotics just keep the germs in control for your body to heal. Allow your body to work on the wounds.

Please contact me if you have any other questions.

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