This procedure will be performed using local anesthesia (“Novocain”).  Please eat a full breakfast or lunch at least an hour before your appointment, as it is advised not to eat after your visit, because of your numbness.  

Wear loose, comfortable clothing.

Continue all medications for blood pressure, diabetes, thyroid problems and any other conditions as recommended by your physician. If there is a question, please call our office prior to your appointment.

If you have been advised by your physician or dentist to use antibiotic premedication because of mitral valve prolapse (MVP), heart murmur, hip, knee, cardiac or other prosthesis, or if you have rheumatic heart disease, please make sure you are on the appropriate antibiotic on the day of your appointment. If there is a question, please call our office prior to your appointment.

If you normally pre-medicate with an antibiotic before dental treatment, please remember to do so for your endodontic treatment. 

If you can take ibuprofen (Advil) or naproxen sodium (Aleve), it does help reduce inflammation when taken pre-operatively. We recommend 2 tablets of either medication 2-4 hours before endodontic therapy, unless you have a toothache.  If Dr. Marshall must determine which tooth is causing your problem please do not take any medication for a few hours before your appointment, as it might mask your symptoms and it might be impossible to make a diagnosis. 

If you have any questions, please call our office at 603-624-9786

What you might feel

We usually will suggest you take 2 Advil before you leave our office (if you can take this medication) and most of the time this is all you will need.  You can take more later, as needed.  Dr. Marshall will give you instructions specific to your situation and other prescriptions (such as pain medication and antibiotics), if he thinks that is prudent.  

Do not eat anything or drink hot beverages until the numbness in your mouth wears off.  This will prevent you from biting your cheek or tongue, or burning yourself.  If you are hungry you could have a milk shake, soup (as long as it is not hot), or similar foods.

It is normal to have some discomfort following treatment, especially in the first 24 hours and your may feel some tenderness in your jaw from keeping it open for an extended period of time.  These symptoms are temporary and usually respond very well to over-the counter pain medications.  Biting discomfort is to be expected.  Please avoid chewing on the treated tooth, as it will get better faster and decrease the chance you could damage it before your dentist has the opportunity to restore it.  Your tooth may continue to feel slightly different from your other teeth for some time after your root canal treatment has been completed, but should eventually feel normal.

Advil (Ibuprofen) is usually the best medication for post-operative discomfort, as it has excellent anti-inflammatory properties.  If you can not take anti-inflammatory medications, Tylenol would be the next choice.  If you require narcotic medications, remember they may make you drowsy and caution should be exercised in operating dangerous machinery or driving a car after taking them.

Do not drink alcohol when taking your medications, as it will sometimes cause them to be ineffective.

What you need to do after treatment

Although the internal root canal system has been permanently sealed, the outer surface of your tooth is sealed with a temporary restoration.   We will usually ask you to call us after 2 weeks, if you still have any symptoms.  If all is well, you should call your dentist and schedule a follow-up restoration to protect your tooth against fracture and decay. Please telephone your restorative dentist for an appointment after 2 to 3 weeks, so you won’t forget.   A complete report of treatment will be sent to your restorative dentist.

Your tooth is more prone to fracture immediately after endodontic treatment.  You should chew on the other side until your restorative dentist has placed a core build-up and a protective restoration, usually a crown.  If your tooth’s strength is seriously compromised, your dentist may place a post for retention of the restoration.  You can be confident your dentist will determine the appropriate restoration to best protect your tooth. 

A proper final restoration of your tooth is extremely important in ensuring long-term success.  Contact your dentist within 2 to 3 weeks to arrange your next appointment.

After the tooth has been restored, it can still develop decay and periodontal problems, so you need to practice good oral hygiene, including flossing, regular checkups and cleanings.

Recall examinations

Sometimes, depending on the problem your tooth had, we might recommend a follow-up examination to evaluate the progress of healing. This appointment might be several weeks or several months after your treatment and will require only a few minutes and no additional fee will be charged for the first check-up visit. Please follow through with this recall appointment, if it has been recommended, as it can be crucial to see if your problem is healing properly.  

Blood thinners cause excessive bleeding, complicating the procedure and possibly compromising the success we are hoping to attain.  Usually it is necessary to cease their use up to 10 days prior to the date of your appointment.  Please notify us if you are taking any medications, substances or supplements that might affect clotting.  Medicines prescribed by your physician might include:  Warfarin (Coumadin), Jantoven, Clopidogrel (Plavix), Dipyridamole (Persantine), Ticlopidime (Ticlid), Aggrenox or any aspirin-containng products.  Keep in mind that many over-the-counter dietary supplements and pain medicines may contain aspirin products.  The other supplements that are of concern because of their blood thinning properties include:  Vitamin E, Fish Oil, Multivitamins, Folic Acid, St. John’s Wort, Ginkgo Biloba, Garlic, Ginseng, Dong Quai and other items commonly found in health food stores.  We also ask that you do not take Ibuprofen, Advil, Motrin, Aleve, Naproxyn, Voltaren, Excedrin, baby aspirin or any anti-inflammatory medication for 10 days prior to the procedure.  If a physician has ordered these medications for a specific condition please let us know so we may contact them for how long you may stop the medications.

This procedure will be performed using local anesthesia (“Novocain”).  Please eat a full breakfast or lunch at least an hour before your appointment, as it is advised not to eat after your visit, because of your numbness.  

Wear loose, comfortable clothing.

Continue all medications for blood pressure, diabetes, thyroid problems and any other conditions as recommended by your physician, other than blood thinners, as mentioned above.  If there is a question, please call our office prior to your appointment.

If you have been advised by your physician or dentist to use antibiotic premedication because of mitral valve prolapse (MVP), heart murmur, hip, knee, cardiac or other prosthesis, or if you have rheumatic heart disease, please make sure you are on the appropriate antibiotic on the day of your appointment. If there is a question, please call our office prior to your appointment.

If you normally pre-medicate with an antibiotic before dental treatment, please remember to do so for your endodontic treatment. 

If you have any questions, please call our office at 603-624-9786

1)  If prescriptions have been given to you, be sure to take them according to the instructions.  Usually Extra Strength Tylenol is sufficient for pain.

2)  To reduce post-operative swelling, keep ice on the area for the next 4 to 6 hours.  The ice should be applied to the outside cheek, or lip area and be applied for 20 minutes then removed for 10 minutes then repeated.  Continue this for the next 4 to 6 hours.  The most noticeable swelling will be 2 to 3 days following the procedure and then will gradually subside.

3)  Keep your head elevated for the next 6 to 12 hours.  This will help reduce the swelling by allowing drainage of the fluids down the lymph nodes.

4)  Take it easy today!  This will keep your blood pressure from increasing which could cause excessive bleeding, in some instances.

5)  Do Not rinse the surgical area today, as you may disrupt clot formation.  Starting tomorrow, a salt water rinse (1/2 cup of warm water, 1/4 tsp. of salt) should be used to gently rinse the area a few times per day (especially after eating) to keep the surgical site and sutures free of debris.  It is OK to brush your teeth, but be very gentle in the treated area.

6)  Do Not smoke, Do Not drink through a straw and Do Not drink alcoholic beverages for 48 hours. All of these could dislodge the blood clot formation and impede healing.

7)  Do Not eat crusty foods (pretzels, crackers, potato chips, toast, etc.) or extremely hot or cold foods.  These could result in dislodgement of the incision and affect healing.

8)  Do Not worry if the site bleeds slightly.  This is a normal occurrence just like when you have a tooth extracted.  If bleeding is steady, place a gauze and hold firmly for 10 minutes – no peaking, or you should start over!

9)  Do Not raise your lip to look at the incision area as this might loosen the stitches.

10)  Keep up your nutrition so healing will occur as expected.  Nutrients from a good diet will help you heal.

11)  If complications occur, please call us.

12)  Please call us tomorrow to report your progress.

Are There Any Potential Problems After surgical Treatment?

• Lower teeth and nerve injury. There is a slight possibility that nerve injury can occur during root canal surgery to the lower posterior teeth. Your endodontist is trained to assess this possibility prior to treatment and will advise you accordingly. For lower posterior teeth, the root tips may be near a nerve that supplies feeling to the lip, chin and gums. Your endodontist is trained to design your surgery to minimize the chances of damaging this nerve. Rarely, this nerve can become irritated during the process of surgery. In these cases, when the local anesthesia wears off, you may experience tingling, altered sensation or, in rare cases a complete lack of feeling in the affected tissues. Should this occur, it is usually temporary and will resolve over a period of days, weeks or months. In rare cases, these changes can be permanent and/or painful.
• Upper teeth and sinus communication. The upper teeth are situated near your sinuses, and root canal surgery can result in a communication between your mouth and the adjacent sinus. Should this complication occur, it will usually heal spontaneously. We will give you special instructions if this is apparent at the time of surgery. We prefer that you don’t blow your nose for two to three days after surgery. If you have to sneeze, you should sneeze with an open mouth into a tissue. You should not create any pressure in the sinus area. If you sense a complication after surgery, please contact us.