• You must use the brushes 3 times a day, morning, noon and night, after brushing your teeth with a soft-bristled toothbrush. This should become a habit.
• The brushes should always be used gently and carefully without traumatizing the gums. (small back and forth movements)
• Access the space between 2 teeth to be cleaned from the outside and also the inside!
• At the beginning of the use of the brushes, the gum which is inflamed will gradually fade during the first few weeks.
• You must clean the plaque on the bristles of the brush between each use (use your fingers and/or put the brush under water).
• You can rotate the head of the brush for better access to the area to be cleaned (especially the back teeth - molars)
• Like the bristles of a broom, as soon as they are worn out you have to change the brush because it becomes ineffective.

• The basic treatment is 3-4 weeks. We will re-evaluate by taking photos at the follow-up appointment.
• Brush your teeth 3x/day thoroughly with SENSODYNE Rapide or ELMEX (avoids potential sensitivities)
• Wear the aligners for 1 hour the first evening. Then, if no sensitivity appears, increase to 2 hours the second night. Increase progressively up to 3 hours in the evening, or even all night if you can stand them. At any time if sensitivities appear, go back to the time that did not give you any sensitivity.
• Brushing and flossing before each use of the thinning trays. The gel is much more effective on clean teeth.
• Place a small drop of gel (the size of half a lens) on the inside of the tray at the level of the teeth to be lightened. Be careful to press gently on the plunger of the syringe to make the product come out.
• Dry the teeth well (cotton pads) then insert the tray in the mouth and position it well on the teeth. Remove the excess with a cotton swab. Burning sensation of the gum indicates that the product has been put in excess.
• Sensitivities may occur: if this is the case, interrupt the treatment for one night, rinse your mouth and use the desensitizing gel (SENSODYNE Rapide or ELMEX) that you will put in the tray like the lightening product for one night. Resume the treatment by decreasing the time to the one that does not give you any sensitivity.
• Remove the tray, rinse your mouth and brush your teeth with a wet brush. Rinse the tray with water, dry it and store it in a specific box with ventilation.
• Please follow these dietary guidelines during treatment. Avoid tea, coffee, tobacco, red fruits, red wine, any food or drink that can stain the teeth. The more you respect this, the better the results will be.
• If it is not possible to avoid certain foods, take them 2 hours after removing the mouthpiece. Keep the syringes in the refrigerator, avoid heat and light. Be careful with children.
• Do not decide alone to reuse the lightening product.

This type of dental tray is a dental appliance in the form of a prosthesis.

The anti-bruxism dental trays are designed to avoid contact between the upper and lower teeth. Their purpose is to avoid premature wear of the teeth, caused by their repetitive rubbing. The occlusal prosthesis creates a physical barrier that protects the teeth. They also help reduce grinding noises and cure TMJ (Temporomandibular Joint) disorders.

The benefits of anti bruxism aligners are multiple:

• They prevent the erosion of teeth by forming a barrier between the upper and lower teeth;
• They help to distribute the pressure exerted by the jaw and consequently reduce facial pain;
• They increase the durability of dental crowns, fillings and implants. This is especially important for porcelain (ceramic) restorations, as they can be prone to fracture under the force exerted by teeth grinding;
• They relax the jaw muscles;
• They can improve the position of the jaw, which can relieve TMJ disorders, pain, headaches and other related problems.

The disadvantages are as follows:

• Some people can't stand them because they can be cumbersome. It will take time to adapt and to get used to them, like a new pair of shoes.
• In very rare cases, they can increase the painful symptoms. If this happens, stop treatment and call your dentist.

It is advisable to wear your aligners as much as possible, starting at night and then during the day if possible.

• You have just undergone surgery, this is not trivial.
• It is essential to gently brush the area using an extra soft bristle toothbrush; the goal is to eliminate the maximum food debris and dental plaque on the area, always gently and carefully with the bristles of the toothbrush.
• Sensitivities may persist after the operation, hence the need to take the prescribed drugs as soon as possible to take over from the anesthesia: it is easier to fight against pain before its installation rather than after.
• The prescribed mouthwash will start 24 hours after the operation. It helps disinfect the area but does not replace mechanical brushing using the soft-bristled toothbrush.
• If the area begins to bleed again, bite again on a compress for 20 minutes.
• It is important not to spit, gargle, clear your throat because this can eliminate the blood clot (favorable to good healing) and cause bleeding. If saliva or blood accumulates on the area, let it flow above a sink.
• Apply an ice pack to the area (simple ice cubes in a plastic bag will suffice) as soon as possible. Glaze to the maximum.
• Avoid blowing your nose hard & sneezing with your mouth open.
• No physical activity for 24-48h.
• Avoid the lying position, prefer the sitting position or the raised head.
• Do not eat foods that can infiltrate the area: rice, semolina, grains, bread crumbs, etc.
• Do not touch the intervention area with your tongue or fingers.
• EAT COLD and SOFT for 3 to 5 days.
• Chew preferably on the side opposite to the intervention.
• DO NOT SMOKE or DRINK ALCOHOL at the risk of suffering pain, tissue necrosis, delayed healing or even infection and therefore returning to the office urgently
• In case of EMERGENCY: call
  • weekdays 7:30 am - 5:30 pm: the practice +590 690 66 55 55
  • on weekends: Louis Constant Fleming Hospital Center: +590 590 52 25 25
  • In the worst case: firefighters (18) or SAMU (15)

• Your tooth has just been devitalized, which means that the nerve inside the tooth (pulp) has been replaced by a biocompatible material (gutta percha).
• The tooth had to be opened and cleaned: sensitivities may persist for a few dayss, hence the need to take the prescribed medication (an anti inflammatory).
• A temporary bandage was placed in the mouth to guarantee the watertightness of the treatment (ten days maximum).
• This is temporary. It is essential to restore the tooth with a more permanent solution that guarantees the strength and watertightness of the tooth: an estimate was given to you for this purpose (onlay or post/crown).

• Your tooth has just been prepared to receive a future prosthetic restoration (inlay, onlay, overlay, crown, bridge, etc.), it is therefore more fragile.
• You must chew on the side opposite the intervention area.
• Put as little strain as possible on this area (risk of fracture).
• Favour a soft diet (no hard or sticky foods).
• Sensitivities may appear (especially in case of proximity with the nerve) for a few days: these will disappear gradually with Doliprane or the prescribed anti-inflammatory.
• The bandage is temporary, i.e. it protects the tooth effectively for a few weeks, not more.
• Finally, wait for the anesthetic effect to wear off (1h-1h30) before chewing food on the opposite side.

Proper positioning and removal of your appliance

There is only one possible solution for your appliance: position your prosthesis in relation to the remaining teeth and press without forcing with your fingers to insert the clasps around the teeth.

To remove it, gently pull on the clasps with your thumbnail while holding the clasp support tooth with your index fingers.

If the prosthesis does not have clasps (complete appliance), pull with measure on the edges of the appliance to remove it.

Wearing the appliance

When it is a first appliance, the first weeks can be difficult: congestion, discomfort, nausea, abundant salivation, irritation, injury, etc. You must force yourself to keep it in place to get used to it and wear it as regularly as possible.

Speech difficulties may also appear during the first days: practice your voice as much as possible by reading a book aloud for 10 minutes, three times a day.

In spite of everything, a new device can cause unpleasantness in the mouth: the control visit after the delivery of the appliances is essential to adjust the appliance and to avoid these inconveniences.

Any mucosal irritation that may occur can be soothed with prescribed analgesic gels (ELUGEL, DYNEXAN).

Ideally, keep your prosthesis on at all times, including when you sleep, and only remove it after meals to clean it and your mouth.

Maintenance

It is essential to maintain your prosthesis for its lifetime.

It is absolutely essential to maintain your remaining teeth, which ensure the retention of your appliance, by brushing them, as well as your gums, which serve as a support surface for it. These must also be brushed or massaged with an antiseptic gel.
Dentures should be cleaned after each meal and out of the mouth.
Brush your dentures on all sides with a suitable denture brush and soap in the sink. Rinse with lukewarm water before putting it back in your mouth.
In addition to brushing, effervescent tablets can be used by limiting the soaking time to 15 minutes and rinsing the appliances thoroughly with clear water.
If the prosthesis is not worn at night, it is advisable to keep it dry in a suitable box rather than leaving it to soak.

ALWAYS consult your dentist in case of persistent pain or recalcitrant inflammation of your gums.

Periodontal diseases concern all the tissues that support the teeth: the gum, the ligament (between the root of the tooth and the bone), the cementum (tissue that partially forms the root of the tooth) and the surrounding bone.

Within the periodontal diseases, it is important to distinguish gingivitis, which only affects the gums. They are most often benign and easy to treat.

On the other hand, periodontitis affects all the supporting tissues of the tooth (ligament, cementum, bone). More serious, they can lead to the loss of teeth and affect the whole body. They can aggravate for example a diabetes or a cardiovascular disease. They require a treatment.

The classic symptoms are the following: change in color of the gums to red or even purplish, swollen gums (inflammations or even infections), "loosening", gums bleed easily, pockets appear, destruction of the bone, lengthening of the visible part of the tooth (gingival retraction), mobility of the teeth, loss of teeth, etc.

Many patients wrongly believe that this situation is inevitable and resign themselves to wearing a denture around the age of 60-70, like their parents. This situation can be avoided!

Recent studies highlight the relationship between periodontal disease and general health:

• Pregnant women with severe periodontitis have an increased risk (3 to 7 times) of delivering a low birth weight child prematurely
• Patients with periodontitis have a 25% increased risk of cardiovascular disease.

One thing is certain: there is always an infection. Bacteria accumulate at the tooth/gum junction and mineralize over time into tartar. If, in addition, tobacco or unbalanced diabetes, the disease worsens.

To look after these periodontal diseases passes by: a rigorous and careful brushing 3 times a day with the prescribed material, the follow-up of the therapy as well as regular check-ups.

In case of damage, therapeutic measures are necessary. They are based on a simple principle: the decontamination of infected tissue. These treatments for the sanitation of dental and gum surfaces are usually sufficient to stop the decay process.

Slowing down the appearance of the signs of aging or reducing those already visible while remaining natural is a frequent wish, hence the increasing demand for soft techniques of aesthetic medicine.

Hyaluronic acid is considered the reference product used in medical volumetric rejuvenation thanks to its biodegradable nature, its minimal and exceptional side and its immediate results.

Indications

Hyaluronic acid is a product giving volume which can be used at the level of the body (notably intimate indications) or the face. Its volumizing action is used to:

• erase wrinkles and fine lines: jugal folds for example
• erase furrows: nasolabial fold, bitterness fold for example
• increase the volume of the lips
• create volume, either in the "lack of volume" indication or in the "accentuation of a volume" indication
• perform a medical facelift (lifting of the ptosis malar fat, improvement of the jowls, etc.)
• perform a medical profiloplasty: profile improvement by injection of the lips, nose chin and forehead
• fill in scarred hollows

How the operation works

The hyaluronic acid used for the injections is a medical device, with a CE marking and a batch number that identifies it. The main action of a medical device is obtained by a physical means, whereas for a drug it is obtained by pharmacological means, immunological means (botulinum toxin - BOTOX - is for example a medicine).

On the market there are multiple brands (Restyalane, Juvederm, Stylage, Teosyal, Voluma, Emervel, Pluryal...) which differ in particular by their viscosity and their more or less volumizing character.

During the aesthetic consultation, whether it is a new patient or a patient already known, the questioning and the clinical examination allow us to collect precious information, in particular to eliminate contraindications and identify the patient's request.

The clinical examination is carried out with good lighting in a semi-seated position, observing the face from the front, from the side, from above and below, at rest and with a facial expression.

We define :

• the phototype
• the type of skin: thin, thick, oily
• the type of wrinkles: fine or wide, superficial or deep, static or dynamic
• the existence of depressions, fatty melts...
• possible asymmetries
• skin slackening
• the type of aging, by comparing the current face with 'youth' photos.

The patient is informed about the different products available (and the one to be used), the degree of correction, the average duration of effectiveness of the treatment and is given an informed consent and an estimate.

On the day of the injection, we check that the patient has respected the recommendations before the treatment:

• stop taking vitamin C and NSAIDs 8 days before the injection
• no superficial peeling or laser treatment 6 days before the injection
• no alcohol or sun exposure a few hours before the injection

After removing make-up and disinfecting the skin, we redefine with the patient the sites to be injected and the result. Photos are taken and the patient may or may not have applied an anesthetic cream (EMLA) before the session.

The duration of the procedure varies between 10 minutes and one hour, depending on the areas to be injected (the injection of the lips lasts 10 minutes, the injection of the entire face lasts one hour).

The area to be treated is disinfected before the injection. The injections are done using needles or micro-cannulas. The micro-cannulas are like long needles with a rounded tip, their length allows to treat a large surface without pricking the person several times and the rounded tip allows to avoid the need to inject the skin. These two characteristics reduce the pain (even minimal) felt during the injection and the hematoma.

Techniques

The following techniques are essentially practiced:

• the linear retro-trace technique: holding the syringe parallel to the wrinkle or surface to be injected, the needle is penetrated into the skin and advanced along its entire length. The needle is withdrawn slowly, pressing evenly on the plunger to deliver an equal amount of product along the entire length of the treated area. The pressure is released just before the needle is withdrawn.
• the multipuncture technique: multiple injections are repeated over the entire surface to be treated, without leaving any space between each one to obtain a regular and continuous correction
• the fan technique consists of starting from a single point of penetration, moving the needle slightly in a fan shape and performing several retro-traceable mini-injections
• the layering technique: multiple retro-traceable injections, in a grid pattern, both vertical and horizontal
• the ladder technique: injection perpendicular to the wrinkle, retro-traceable
• the fern or zipper technique: the injections are done on both sides of the wrinkle or the central part of the sulcus, towards the outside, perpendicular to the line or depression, creating a "padded" area under the depressed part.

The imperatives of any injection are:

• respect for the patient's wishes
• natural result
• no over correction
• inject only the desired areas

At the end of the session, the injected areas are disinfected with an antiseptic massage with a moisturizing cream to even out the result, a cold pack is applied to any  possible haematoma, the patient is given a make-up (if he/she wishes), the patient is given an injection booklet with the batch number and the name of the product injected (every patient must know what he/she has been injected with - respect for traceability).

A follow-up consultation can take place 2 to 4 weeks after the treatment to check the result and correct any imperfections or make the result more visible (e.g. injection of the lips in two the lips in two times for example).

Post-operative advice

The result is immediate. Certain indications, such as dark circles and lips, can be achieved in two sessions. The product remains in place for an average of 18 months (about 3 years for dark circles 8 to 12 months for lips).

After the injection, you will be given a sheet with the following instructions:

• Do not take any anti-inflammatory medication for 48 hours
• For the first 48 hours, avoid exposure to strong sunlight or intense cold, avoid alcohol, intensive sports and violent efforts
• Do not go to the sauna or steam room for two days following the treatment
• Do not clean your skin for one week
• No lasers on the injected area for one month
• Do not go to the dentist for one week (if treating the peri-oral area)

There is no social eviction, possible bruises can be camouflaged with make-up, edema will be prevented by taking medication such as SOLUPRED.

The injection of the lips and dark circles may cause significant edema despite the use of preventive medication. This edema may bother the patient for one or two days (it is better to schedule the injection of the lips and dark circles on Friday).

Complications

Despite the good overall tolerance of the injections, immediate and minor reactions can be observed, which are transient and disappear without any reactions between 3 and 10 days.

• Ponctiform hematomas, most often due to the use of certain medications (salyclilates, NSAIDs, vitamin E....). More frequent after injections on thin skin, they can be prevented (and treated) by taking arnica (5CH or 9 CH) before and after the operation
• Erythema at the injection site or along the injected path which disappears in the hours following the injection
• Edema, minimal or sometimes impressive (lips and dark circles) whose spontaneous disappearance is accelerated by taking extranase and solupred (the latter is not systematic)
• Some patients complain of local hypersensitivity or minimal pruritus at the injection sites for a few days
• A herpetic recurrence is possible in case of a previous history of herpes labialis and is prevented by prescribing aciclovir in tablet form
• In the dark circles, if the injection is too superficial (technical error), the hyaluronic acid can turn into a bluish color.

The other possible complications (necrosis, visible product, asymmetry, unnatural appearance, etc.) are due to a technical due.

Counter-indications

Absolute counter-indications:

• Allergies/hypersensitivity: in fact allergies to adjuvant products (xylocaine, mannitol)
• Pregnancy / breastfeeding
• History of injection of NON RESORBABLE products: QM +++ (practitioner's responsibility, activation of quiescent granules)
• Unrealistic request

Relative counter-indications

• Herpes
• Auto immune disease

Anti-coagulants have no effect.

Conclusion

The procedure is quick, almost painless and does not require social eviction (you can return to your daily activities immediately after the injections). The result lasts 12-18 months.

What is a wisdom tooth?

Third molars, commonly called "wisdom teeth", appear in adolescence.
Since they have less space in the dental arch than the other teeth, they are more at risk of complications.

They can be :

• Included: not visible in the oral cavity, covered by gum and bone
• Semi-included: partially visible.

Why and when to remove a wisdom tooth?

Wisdom teeth need to be extracted:

• When there is no room for them to come out normally
• In case of pericoronitis (inflammation and infection of the gum around the partially erupted tooth)
• If there is bone loss or decay on the adjacent tooth.

The following symptoms may be experienced:

• Pain in the posterior region of the oral cavity
• Swelling
• Presence of pus
• Decreased opening of the mouth
• Fever.

Ideally, wisdom teeth should be extracted at a young age, between 16 and 20 years old, because the formation of the dental root is not complete, which reduces the risk of postoperative complications.

How is the diagnosis made?

To know if you need to extract your wisdom teeth, a clinical examination by a dentist is necessary. On this occasion, he/she will prescribe an X-ray examination. The orthopantomogram (OPG) is a panoramic radiograph that shows the exact position of your teeth, especially in relation to the nerves. Sometimes, the OPG is insufficient.

Are there alternatives to extraction?

There is no real alternative. In some cases, monitoring or or hygiene care can be offered.

THE SURGERY

Do I need to prepare myself?

For patients in good health, no particular preparation is recommended before the operation, except for having eaten.

What anesthesia?

The extraction of wisdom teeth is an operation that takes place in most cases under local anesthesia in the jaw. General anesthesia is reserved for patients whose teeth are very complicated to remove.

How is the procedure performed?

The dentist opens the gum and sometimes removes a little bone around the tooth in order to clear it. In some situations, the tooth is cut into several pieces to make it easier to remove.
In the end, stitches are used to close the wound. This procedure is painless, but you may feel pressure.

What are the risks?

The risks of wisdom tooth extraction are as follows:

• Pain and swelling: Apply ice to your cheek or put ice cubes in your mouth. Pain medication is prescribed to treat these symptoms.
• Bleeding: Bleeding is common in the aftermath of surgery. Bite on compresses for 30 minutes and avoid rinsing your mouth to stop it.
• Hematomas: Sometimes, due to the trauma of the extraction, hematomas ("bruises") may appear on the face or neck. These will resolve over time. Patients taking anticoagulants (blood-thinning drugs) are more at risk of developing them.
• Infection: Sometimes the extraction site becomes infected two to three days after surgery. To solve the problem, the dentist prescribes an antibiotic for seven to ten days.
• Alveolitis: Inflammation of the tooth socket occurs two or three days after the procedure and causes severe pain. In case of alveolitis with pus, painkillers and antibiotics are prescribed. Sometimes a new operation, under local anesthesia, is necessary to clean the wound (curettage of the socket).
• Sensitivity disorders: It is sometimes necessary to press on the nerves close to the roots with an instrument. This may cause, after the operation, unpleasant sensations such as tingling or pins and needles in the lower jaw. In the vast majority of cases, these are temporary.

The exceptional complications are:

• A complete loss of sensitivity (permanent paresthesia)
• A fracture of the jaw
• The expulsion of the upper wisdom tooth into the maxillary sinus or back into the infra-temporal fossa (below the zygomatic arch). This may require a new surgical procedure to recover it.

The dentist will explain to you what the highest risks are in your situation and how to manage them.

AFTER THE SURGERY

Are the aftermath painful?

During the first few days, you will often have pain, especially at night, and feel swelling in your cheeks. Be sure to follow the medication prescriptions.

What precautions should I take?

Follow some advice during the first few days so that the postoperative period goes as smoothly as possible:

• do not smoke
• do not spit and avoid mouthwash
• brush your teeth normally
• do not consume hot food or drinks
• choose chopped food if your jaw is painful.

Is a work stoppage prescribed?

Generally, there is no work stoppage after the operation. However, the dental doctor may stop you for a few days if the operation was difficult.

How often are check-ups required?

One week to ten days after the operation, you will be called in for a check-up to ensure that the wounds are healing properly and to remove the stitches. Additional checks are sometimes necessary.