Patient Information

Patient Forms From the first day you join our office, we will cater to your dental needs. As part of your first visit with us, you will fill out a comprehensive medical and dental history. For your convenience we've included these forms to the right. Click on the links to download and print out these forms at home, where you can fill them out at your leisure and bring them with you to your first visit.

Patient Info Dental History Health History

Financial Information

You can pay for your office visits and any treatments by cash, check, credit or debit card at the time of treatment. We also accept most major dental insurances, and CareCredit. To discuss your payment options or insurance coverage, please call (480) 820-3400.

Dental Emergencies

Knowing how to handle a dental emergency can mean the difference between saving or losing a tooth.

• Tooth knocked out: First, try to stick the tooth back in place and hold it there while you rush to see the dentist. If that's impossible, put the tooth is a container of milk (or water if milk is not available) and take it and the patient to the dentist immediately.
• Fractured Tooth: To avoid further aggravating the damaged tooth, place a piece of soft wax into the area of the tooth that was chipped. You should eat only soft foods and try to avoid food and drink that are hot and cold to the touch.
• Fractured Jaw:If you find that your jaw hurts when it is moved or if you cannot close your mouth in a normal fashion, it is likely that you have fractured your jaw. Seek professional medical help at a hospital emergency room. The hospital will be able to treat your injury as well as advise you whether you need to make an appointment to see your dentist.
• Bitten Tongue or Lip: Biting or lacerating your tongue may cause inflammation and possible bleeding. Use ice or pressure to control the swelling or bleeding. Any swelling should subside within twenty-four hours. Contact your Dentist if the pain persists or the laceration is deep.
• Bleeding After an Extraction: Slight bleeding after an extraction is normal. A clot will usually form within one hour. If bleeding continues, place a thick gauze pad over the extraction site. Apply pressure to the area to control the flow of blood. If bleeding still persists, you may try soaking a tea bag in water, placing it inside a thin gauze pad, and apply pressure for one hour. The tea leaves contain minerals which may aid in the clotting procedure.
• Mouth Sores: Canker sores are those very small and painful sores which occur inside the mouth. They can be caused by stress, biting the inside of the mouth or by a reaction to certain foods. If you find that you have developed a canker sore on the inside of the mouth, apply an over-the-counter medicine like Orajel or campho-phenique. This will produce a bandage-like film over the sore.
• Toothache: An aching tooth is a very common dental emergency. A toothache is often a sign of infection in or around a tooth. Tylenol or aspirin can sometimes be effective in comforting pain. If there is a hole in the tooth, you may place Oil of Cloves on a small cotton pellet and place it in the site to relieve pain.

Post Op Instructions

Composites   |   Crowns   |   Dentures/Partials   |   Night Guards   |    Root Canals   |   Veneers

Composites

Once we have restored your teeth with tooth-colored materials, these restorations will serve you well for several years. The resin (plastic) material used contains small “filler” particles of glass-like material for strength and wear resistance. They contain the finest and most up-to-date materials available today. However, you should be aware of the following information about your new restorations:

• As with natural teeth, avoid chewing excessively hard foods on the filled teeth (hard candy, ice, raw carrots, etc.) because the resin material can break under extreme forces.
• Composite fillings set up hard right away. There is no waiting time to eat. Children should be observed until the anesthetic wears off. Due to the strange feeling of the anesthetic, many children will chew the inside of their lips, cheeks, or tongue which can cause serious damage.
• Sensitivity to hot and cold is common for a few weeks following a dental restoration. Usually, the deeper the cavity, the more sensitive the tooth will be. If you feel the bite is not correctly balanced, please call for an appointment for a simple adjustment.
• The gum tissue could have been irritated during the procedure and may be sore for a few days together with the anesthetic injection site.
• The finished restoration may be contoured slightly different and have a different texture than the original tooth. Your tongue usually magnifies this small difference, but you will become accustomed to this in a few days

When a tooth has a cavity the Dentist removes the decay and fills the hole with a filling material, the tooth supports the filling. The ideal filling is no more than 50% of the tooth. This leaves half the tooth to support the filling. When you get a cavity that takes up 60%or more of the tooth, a crown is indicated. A crown covers the entire tooth and holds the tooth together. Sometimes we place a filling thinking there is enough tooth to hold the filling when actually there is not. The tooth then starts to break away because it can no longer support the filling. In this case we will credit the cost of the filling towards the cost of a crown.

Crowns

• Temporaries are not strong. They may break or come off occasionally. If so, slip it back on the tooth with some Fixodent™ (Denture Adhesive) and call us for an appointment. Please do not leave the temporary out of your mouth because the teeth will move and the final restoration will not fit. Please floss as directed.
• The size, shape, and color of the temporary does not resemble the final restoration.
• Temporary restorations may leak saliva or food onto the tooth. Sensitivity to hot, cold, pressure, or sweets is not uncommon. If you feel the bite is not correctly balanced, please call for an appointment for a simple adjustment.

Permanent Crowns

• After the final cementation of your restoration, it may take a few days to get used to the new crown or bridge. Hot and cold sensitivity is possible for a few weeks and occasionally lasts for several months. As with the temporary, if the bite doesn’t feel balanced please call us.
• Do not chew hard or sticky foods on the restoration for 24 hours from the time they were cemented. The cement must set up during this time to have optimum strength.
• Proper brushing, flossing, and regular 6-month (minimal) cleanings are required to help you retain your final restoration. The only area that a crowned tooth can decay is at the edge of the crown at the gum line. Often, small problems that develop around the restorations can be found at an early stage and corrected easily, but waiting for a longer time may require redoing the entire restoration.

Important Information on Crowns

Gold and Porcelain Crowns are the same for practicaly all cases except that porcelain can chip. Approximately 1 out of every 100 porcelain crowns chip and need replacement. This will never happen with gold crowns. This should be taken into consideration when choosing between a porcelain and gold crown.

Dentures/Partials

Sore Spots: Usually, your mouth will have a few “sore spots” after wearing the denture/partial for 24 hours. These areas can be relieved with very little effort during your next appointment.

• Chewing: The new bite may not feel completely comfortable for several weeks. We can adjust the contacting surfaces of your teeth after the dentures/partials have settled into place.
• Cleaning the Dentures/Partials and your Mouth: Your denture/partials can be cleaned easily by using a denture brush and a mild toothpaste. Periodic denture soaks are also very useful (ex: Polident). We recommend leaving your partials out of your mouth at night and soaking in water.

Dentures only: Brush your gums with a regular toothbrush once per day to toughen and clean them. Partials only: Use special care to clean parts of the partial that contact any natural teeth. Both the partial and the natural teeth must be kept very clean on a daily basis to reduce the chance of new dental decay starting.

We have done our best to provide you with well-fitted, functional, and esthetic dentures/partials. We feel confident that after a few weeks of becoming adjusted to the new dentures/partials, you will have years of satisfaction from them. Over time, your jawbone and gums shrink when there are teeth missing. When this occurs, your dentures/partials will feel loose and may require relining. Wearing ill-fitting dentures/partials for too long without refitting can cause severe bone loss and very serious oral disease. Please call our office if these symptoms occur.

Night Guards

Purpose: The purpose of splint therapy is to help your lower jaw function more properly. Since the treatment you are to receive is mainly orthopedic in nature, we have fabricated an orthopedic appliance to help reposition your lower jaw. This appliance will help to relax any of your jaw muscles which are in spasm and to reduce any muscle pain. There are many situations that may cause your lower jaw to malfunction including accidental trauma, developmental defects, peculiar oral habits, naturally occurring malocclusion (poor bite), psychological stress, clenching or bruxing of teeth, and other problems.

• Rationale: You have received an acrylic bite splint (occlusal splint). This treatment has been used for many years to keep the teeth from contacting while you sleep and to allow the lower jaw to return to a comfortable hinge position without interference and guidance from the teeth. It is essential that you wear your night guard every night and you may also wear it during the day if you find yourself clenching or grinding your teeth. When it’s not in your mouth, make sure your splint is placed in water to avoid warping.

Cleaning the Splint: Food will accumulate under the splint. After brushing and flossing your teeth very thoroughly, brush and rinse the inside and outside of the splint and return it to your mouth. Dental decay can be stimulated if you are not careful about the cleanliness of your mouth and splint. Fluoride containing rinses or gels are useful when placed in your splint once per day if you have a high dental decay rate. Using a dental soak cleanser (ex: Polident) on a monthly basis will help keep the splint fresh.

Root Canals

Endodontic treatment can take 1, 2, or 3 appointments depending on the case. It is possible to experience any of the following symptoms after any of these appointments: sensitivity to hot and/or cold; sensitivity to pressure; possible swelling. If you experience swelling, please call our office immediately as additional medication may be required.

• One common occurrence with a newly root-canalled tooth is for the tooth to feel high when you bite your teeth together. If this occurs it will cause your tooth to stay sensitive for a longer period of time. Please call us if your bite feels “high” as this problem is easily rectified with a simple bite adjustment.
• A temporary filling may be used to temporarily seal the tooth between visits.
• Be gentle on the tooth while eating until the final restoration is placed.
• The gum tissue could have been irritated during the procedure and may be sore for a few days together with the anesthetic injection site.
• During endodontic treatment, the nerve, blood and nutrient supply to the tooth is removed. This will cause the tooth to become brittle and prone to fracturing which could result in the need to extract the tooth. A full coverage crown is recommended to prevent this from happening.
• Do root canals always work? NO! A root canal is a therapy not a cure. It has a high success rate but almost 4% of them fail. If your root canal fails within a period of 3 years from the date of service, we will either refund the cost of your root canal or retreat your failed root canal. In addition, if the tooth cannot be saved, the cost of the crown placed in our office will be refunded during that 3-year period. This warranty is null and void if the patient does not maintain their 6 month continuing care cleaning appointments.

Veneers

• Plastic temporary restorations will serve you for a short period of time while your permanent veneer is being made. They are attached only slightly to the underlying tooth so they can be removed easily.
• If a veneer comes off, call us and we will replace it immediately. If you are in a situation that will not allow you to come in, place the temporary back in place with some Fixodent™ (denture adhesive). You must still see us as soon as possible.
• The size, shape, and color of the temporary does not resemble the final veneer.
• Temporary veneers may leak saliva or food onto the tooth. Sensitivity to hot, cold, pressure, or sweets is not uncommon. You may also see stains under the temporaries. These will be removed prior to final cementation.
• Avoid heavy brushing of the temporaries and do not floss between them because you may pull them off.
• Your final porcelain veneers will be as close to the natural beauty and function of teeth as possible. They look and feel normal in every way. Permanent Veneers We place our veneers with the finest materials and techniques available today. However, you should be aware of the following information about your restorations:
• As with natural teeth, avoid chewing excessively hard foods on the veneered teeth (hard candy, ice, raw carrots, etc.) because the porcelain material can break under extreme forces.
• Proper brushing, flossing, and regular 6-month (minimal) cleanings are essential to the long-term stability and appearance of your veneers. Often, problems that may develop with the veneers can be found at an early stage and repaired easily, while waiting for a longer time may require redoing entire restorations.

The gums may recede from the veneers, displaying discolored tooth structure underneath. This situation usually takes place after many years and requires veneer replacement.

Call Shumway Dental Care today for your next dentist appointment at (480) 820-3400!