Pre and Post-Op Instructions
If you would like to download a copy of the following instructions, please click here.
The following guidelines are NOT intended to serve all patients. The subsequent regimens are intended for a “healthy adult,” body weight of 120 pounds or more, with no history of liver or kidney disease. Any individual who has a known allergy to any medicine should NOT ingest the medicine. Additional medications a patient is taking may interact with the medications listed below. It is the patient’s responsibility to contact either the prescribing physician or Dr. Angell if there is any question regarding cross-reactivity of medications. The dosages and timing of the medicine schedules that follow are stricitly intended for shorter-term management of discomfort as related to inflammation and/or infections and are NOT appropriate for long-term pain relief.
After your root canal therapy has been completed, it would not be out of the ordinary for the tooth to feel tender or “bruised.” Most patients experience minimal tenderness that is typically managed by over-the-counter anti-inflammatory medicines. Infrequently, some individuals may be aware of post-operative symptoms for up to a couple of weeks.
A reasonable indicator/predictor regarding expected duration of symptoms after completed root canal therapy is that the duration of the symptoms (post-op) can be roughly equivalent to the length of time that discomfort existed prior to treatment.
Several variables exist which influence the symptoms you feel and the method by which Dr. Angell will help you manage the tenderness. The discomfort – and subsequent method of management – can chiefly be related to inflammation, infection or a combination of the two.
Inflammation and Analgesia:
The vast majority of the treatment performed by Dr. Angell is confined to the internal aspects of the tooth structure. Necessarily, however, surrounding tissue is affected at the tip(s) of the root(s). The over-the counter anti-inflammatory medicine, Ibuprofen, can minimize the symptoms you experience as your body’s inflammatory response attempts to heal the tissue affected by the root canal procedure. The dosage of ibuprofen in either brand name or generic tablets is commonly 200mg per tablet. Neither brand name nor generic forms of ibuprofen have been demonstrated to provide more efficient relief of the symptoms related to inflammation. Dr. Angell recommends:
• Ibuprofen 800mg pre-operative dose,
• Ibuprofen 800mg every 4 hours after the initial pre-operative dose for the remainder of the day of treatment (even if you are still numb and even if you experience minimal discomfort),
• Ibuprofen 600mg – 800mg every 4-6 hours as necessary for the next several days while the symptoms related to the inflammation resolve. Take with food to reduce risk of upset stomach or injury to stomach lining,
• Ibuprofen should not be taken if patient has a history of stomach ulcers, kidney problems or allergy to aspirin,
• Patients who are currently taking Coumadin should NOT take ibuprofen,
• Do NOT exceed 3200mg of Ibuprofen (sixteen 200mg tablets) in a 24-hour period.
Over-the-counter ibuprofen tablets (200mg each) allow the patient to decrease the dosage of ibuprofen from 800mg (4 tablets) to 600mg (3 tablets) to 400mg (2 tablets) etc., as symptoms allow. The frequency of the doses should remain at 4-6 hour intervals as the dosage decreases.
For patients who cannot take ibuprofen, Dr. Angell recommends over-the counter acetaminophen. Regular strength dosages of acetaminophen are typically 325mg/tablet; extra strength dosages are commonly500mg/tablet. Recommended acetaminophen schedule is as follows:
• Acetaminophen 1000mg pre-operative dose,
• Acetaminophen 1000mg every 4-6 hours after the initial pre-operative dose for the remainder of the day of treatment (even if you are still numb and even if you experience minimal discomfort),
• Acetaminophen 1000mg every 4-6 hours as necessary for the next several days while the symptoms related to the inflammation resolve.
• Patients with mild-moderate liver problems should limit total daily dose of acetaminophen to less than 2000mg, avoid acetaminophen entirely if severe liver problem exists.
• Do NOT exceed 3000mg Acetaminophen (six 500mg tablets or nine 325mg tablets) in a 24-hour period.
If symptoms necessitate, any prescription pain medicines prescribed by Dr. Angell may be taken in addition to the above listed over-the-counter anti-inflammatory medicines. Prescription pain medicines may also be taken on a 4-6 hour dosage frequency schedule. The dosage timing schedules for the over-the-counter anti-inflammatory medicines and the prescription pain medicines should be overlapping, but offset by 2-3 hours such that the patient is taking alternating medicines every 2-3 hours, each on a 4-6 hour schedule. This dosage timing frequency will allow for peak affectivity of one medicine as the other medicine’s effects are tapering down. Pay careful attention to any instructions packaged with narcotic medicines and modify your behavior accordingly.
Infection and Antibiotics:
Patients who have root canal therapy do NOT always need antibiotics. Antibiotics may be indicated when radiographic evidence of bone destruction (chronic infection) exists or when Dr. Angell’s clinical observations suggest the development of acute infection within the tooth and/or surrounding bone. Antibiotics serve to assist your body’s own immune response as it battles the infection in the bone around the tooth. Root canal therapy performed by Dr. Angell is designed to remove the source of the infection from within the tooth; however, your body will require time to completely heal the infection in the bone. Typically, 24 to 48 hours of the appropriate antibiotic schedule will allow for control of symptoms related to infection.
Whenever antibiotics are prescribed, ALWAYS follow the instructions on the packaging as indicated by the pharmacy and ALWAYS complete the course of antibiotics (unless unintended side effects develop) in order to minimize the chance of bacteria developing resistance to the antibiotic.
Women who are concurrently taking antibiotics and oral contraceptive medicines should understand that taking a course of antibiotics will decrease the effectiveness of the oral contraceptive. Pay careful attention to any instructions packaged with antibiotic medicines and modify your behavior accordingly.
Patients who are required by their physician to “pre-medicate” with antibiotics prior to receiving dental care MUST pre-medicate with antibiotics, in accordance with the American Heart Association recommendations, before all consultation, treatment and follow-up appointments with Dr. Angell.
If you have any questions, please call our office at Newport Beach Office Phone Number 949-640-0020