Ep. 57: After the Surgery: Your First 72 Hours

Part 10:00

This is Beyond the Arches, where full-arch dentistry meets real talk. Let's get into it. Hello and welcome to Beyond the Arches. I am your host, Dr. Daniel Noorthoek. With me today, I'm joined by Erica. Hello. And Jessica. Hello. So today's going to be pretty fun. Today, we're going to talk about first 72 hours of a patient's journey into full-arch. I'm sure we'll talk a little bit about what a visit looks like when they first arrive at the office.

And that's probably where we'll start. But I'd also like to get into the random things and the situations that patients bring up

▶when they're kind of going through the restorative phase. So in the surgery, everyone sort of focuses on that in the very beginning when they're just doing the shopping and they're like, oh, I hate dentists, and they're scared of that. And that's the first sort of momentous thing that they have to get over. But after they're over that, there's a lot of interaction that comes with putting teeth on that Jess, as a restorative assistant, gets sort of firsthand view on. And so I want to use your input as much as we can and use your time to sort of get a feel for and bring that feel to the listener on what that looks like. But we'll go back. Let's start at the first visit. So I'm a patient and I'm, coming in for surgery. What, what do I expect the first, first time, first day of, of surgery day?

Yeah. You're a little nervous. You have all these people in your face who are super excited for whatever reason. Yeah. Yeah. You come in, you get your first x-ray pano. And then you get some before photos taken. I put these really awesome retractors in your mouth. You and retractors become best friends throughout your whole process. It is true. So, yeah, you get that. You get that. You get that. You get that. You get that. You get that. You get your before photos taken. I walk you back to your surgical suite. You get to sit with Dina, get to talk to the doctors. I don't really feel like you need to do much for that first appointment. Do you guys use the before pictures very much? Like what does it, what would a before picture be used for? Um, we like to use it. Cause you take a bunch of different pictures and a bunch of different angles. Yeah. We just like to see what you look like, you know, before and just, just to use it as inspiration. We don't ever promise to be right on the money. I don't think anybody will. I don't think anybody will. I don't think anybody will. I don't think anybody wants that back. So, um, yeah, just inspiration, like lip support and like facial support. Yeah.

▶Give us a good, a blueprint, I guess, of where we're going to start building. How often do you see a patient that says, I want this back? Um, not, not a lot actually. Yeah. Um, I feel like probably under 5%, right? 5%. Yeah. There are things about, um, the process. I don't feel like people realize they want back like their lip support, like, you know, fullness in their face, things like that. They don't really think about. You probably find that the, at, at its surface level before photos are probably pretty pointless because the patient doesn't want a lot back.

Yeah. But I bet you also find that unexpectedly you use it more often than not because it's something to sort of refer to. Yeah. Yeah. And it's good to have, I mean, in the middle of the process, we have patients who are like, I don't know, I don't know, I don't know, I don't know, for old photos. And they're just like, I don't even take pictures. And don't worry, we have it. Right. Cause they like, they like the shape of like their canine specifically, or they like that they have more rounded teeth. There's some, some sort of specific thing that they try to call out so we can actually reference it. How much of that do you refer to? Does that happen frequently?

Like in general, not even just our pictures, but maybe like an old picture. Do you guys refer, does a patient bring those up very often if they can find them? ▶I would say so too. Once they realize that we do give you that windowed, or not window, but you know, that opportunity to just like be involved in that process, they're just, they're excited. And they're like, yeah, actually let's, let's show these photos. Yeah. I think so too. I think that's something that I've learned from Nadia and Dr. Locke specifically that everybody's natural smile is what usually looks the best on their facial structure, like what you are born with. So any sort of thing that we can grasp from the past, is something that we try to incorporate and include into their new zirconia set. Cause it's just, it's what flatters them, their, their lip shape, their facial support, everything.

It's your smile, but better. Right. Yeah, absolutely. All right. So moving on, we've, I've had my surgery and we're moving on to after surgery. Yeah. That's all on you now. You are the pilot. Yeah. So give us, why don't you start with, we have a list of the sort of ideas of what we're going to mention. In terms of what you would hear. What do you think is the number one thing that you hear after surgery? Like just in general, what's the number one sort of comment or thing that you hear?

Do my gums look okay? ▶They look beautiful. They won already. They do actually. They heal a lot faster than you would think. Yeah. To the point that the, the calves that we put in to, to cover up the implants and, help them heal. Those are important because if you don't do that, and I'm sure you've had some patients that we, sometimes in surgery, patients start to feel something too much, or they're a little bit too excited to leave kind of scenario. They, we end up leaving them in the normal healing caps. And what will happen is there's such good healing that you get sort of like this fibrin clot, this sort of mesh spider web over top of it. And it's going to heal. And it's going to the implant almost immediately. It's pretty bizarre, right?

Yes. Yes. Um, so it's always pretty shocking how, how quickly that, that happens. Yeah. Um, so yeah, I feel like everyone's more concerned about their healing that next day. Um, but a regular appointment is, is so easy. Come in, I sit them down, I let them know, Hey, you know, this first appointment, I'm going to be removing these healing caps, like you mentioned. Um, and then I'm going to, you know, do what I can to keep you comfortable. Some topical.

▶Do you, what would be the percent of times that you need or use topical a hundred percent or? Um, I always do it the first go round. Um, and then I kind of leave it up to them if whether they liked it or not. Um, so I'll kind of use their judgment to gauge. Like it meaning like, uh, yes, it maybe felt comfortable, but it got down my throat and it numbed my throat and I don't want it anymore. Yeah. Some people just don't like that feeling or they don't want it cause they want to feel if anything's wrong, um, with their bite or, you know, that's later down the line, um, when they start to pick up on, on those things.

Um, what else is a, is a frequent, frequent flyer for, for things that they ask or say? Yeah. Um, color, color of the teeth. Are these my color? Is this what they're going to look like? I'm like, this is just the first set. You're going to, I'm going to sit you up and they're

Part 27:23

going to be a little wonky. That's a good thing that we can draw out real quick. Uh, with, with the 3d printing, it's essentially a goop. And that goop, it's not like a, sometimes there's two different types of 3d printing. There's what's called FDM. And then there's, uh, I don't know technically what it's called, but it's a resin printer. And FDM is what people think of as hobby printers. And it's the spools of little tiny wire, essentially, you know, plastic wire that gets melted in a fancy hot glue gun. And then there's the other kind that's, um, essentially all of the material floats in the tray.

The, the, what's called a build plate goes down to a really thin level. And then a projector shines a light and makes the material hard. It moves up and down to get more material in between goes back a little bit higher up and starts to build it in that way. Um, that goop is really messy and it's really hard to change the tray. The tray that the goop is in is really a big pain in the butt to change.

In and out. And specifically the printer that we use is sort of more of like on the commercial side. When you, when you're using a cheaper printer, you can buy a bunch of those trays and just trade them in and out. So you can have a lot of color variation. Um, but you're also, we found in our experience, you're also really likely to sort of damage the trays and they're sort of in the handling of moving them around. You kind of make a mess of things.

So in addition, you know, back to the whole thing that we're in more of a commercial printer and that tray really needs to be cleaned out every single time for different colors and cleaning it out as an absolute nightmare. So we've essentially made the decision that all of our prototypes go in a certain color and it's a very stock color. It's not yellow and it's not bright white. Um, and so, uh, just to cover that, that's, that's a, that's a, that's a thing that commonly comes up. Um, and so, um, and so, um, and so, um, and so, um, and so, um, and so, um, and so, um, I try to cover it in the consults. Like this is just going to be one color. Don't worry at your last appointment, you'll be, um, picking out the color. Yeah. We actually ran into a situation, not a situation, but we had a patient who mentioned this to us yesterday because they were in and they were receiving their finals. And the one comment he would over the moon, absolutely thrilled Facebook review, Google review, everything. So we had a great time like working with him, but he was like, I guys, I got to tell you the one thing that I wish I knew was about the temporaries. And I don't, I think it was the shade. And I, I think it was the material as well. That material. Yeah. He was like, I just, I wish you would have just told me that it was just this color. And we were like, Oh, you know, I didn't, I'm sorry. I didn't think about it. I didn't know. I try to bring it. There's only so many things that you can talk about with a 15,000 bullet points that you need to get out. Yeah. Which is the point of doing this.

Yeah. Um, but which actually makes me think, um, do you think that we've, chosen the appropriate color or since there's so many people that choose a wider color, should we just, should we maybe standardize? I don't think so. I don't think so either. I think the color that it's, it allows it to sort of pop when they get the real one. Exactly. I agree. I think that was the logic behind picking the color we did. Yeah. Yeah. Do we, I think it's a one or is it a two? It might be closer to an a one. A one. I think so. Yeah. So at any rate,

Part 311:03

so first, first set goes in. Um, and when any other like big off the top of your head sort of things that come out of patients' brains and. Yeah. Questions. Biting heavier on one side than the other. And that's probably number, number one. As soon as they sit up. Yeah. Yeah. It feels great, but you know, so. Do you find that the, uh, escort or the person that is coming with them? Cause. It's probably more often than not. We have somebody with them. Right. Would you say when they're more than 50% of the time, which is great. I encourage you like it. I was going to ask you if you like that better or worse. Um, so far it's been okay. Um, I like that they have somebody to have like a third opinion. Um, so it's been okay. Very commonly the, the person and very understandably the person that's gone through surgery.

Although not traumatized has gone through a big event. So big. And sometimes their head will just say it bluntly, like isn't screwed on all the way. Yeah. And, uh, I, I did, I agree with you to a level that the restorative day, the restorative appointments, it is sort of, um, nice to have the escort there, uh, be it a spouse or a brother or a sister or a mom or whatnot. Um, because they can kind of. Bring a rational opinion to the situation.

You just went through a really big thing the day before. Yeah. And then now we're asking you to make a bunch of decisions. Yeah. So Susie, calm down. The doctors, everything is fine. Yeah. Those teeth look great. Exactly. What would you say is the number one besides bite? Obviously the bite is sort of a lot of what we're learning on day one. Apart from the bite, what's, what would you say is the number one thing that we'll say we will classify it, categorize as we get wrong.

Meaning that they want to change immediately. Is it the size, size that they want to change first? Is it the position of the teeth that they want to change first? Is it the, you know, what is there, what's their number one? What do you think if you just had to guess off the top of your head, what's the number one thing that they want to change right away? Like what's the most frequent term? Um, I mean, I think we covered it, the color. Yeah. Honestly. Cause it's like the first thing that pops, you know?

Um, honestly, no, no, I don't think they even realize that that's a thing until we start going through it. And then everyone's, Oh, okay. I do see that. You know? Um, I really think it's, it's soup, something super, I guess, shallow is, you know, is color. And then we dive into changes. They get to learn our vocabulary and what things mean and what that does for their face, their mouth. That's when the other questions start. But in the beginning, it's really just aesthetic.

▶One difficulty you just made me think of something is that when one difficulty we had when we were doing conversions or any other different protocol was that you don't get the frequency of visits. You, you put a set of teeth in and then you don't see them for a long time. And then everyone else is weighing in. Yeah. Yeah. And so they get this sort of hodgepodge opinion on what should happen. And that's where they learn that they're saying their S is wrong. So to your point, maybe they don't know that the center line is off on day one because they don't know to go through that. And when you're in a different protocol, you can't just change it. So you're not going to walk them through all of the changes they

Part 414:58

need to make. And then, okay, by the way, you have to wear that for three months. Yeah. Mm-hmm. Yeah. Yeah. So I found it very difficult. They would come in with their list. And I just realized this, that part of your job is really just is to be the pilot, to be the guide. You're the hired tour guide. And one of the advantages we have is that it's not just a tour guide for getting a good result. It's a tour guide for the patient to walk them through this process where we are essentially the parents of, no, no, this is fine.

▶We're going to switch this tomorrow. Mm-hmm. You have that like frequent interaction with them to just hammer that in. It's kind of nice. And that's what I tell patients all the time is like, I love our process so much because, you know, we get to, we get to sit down, lock in on all these changes that we want to make that we see. It's very educational for the patient as well. And, you know, you're not stuck in these forever. We get to change it tomorrow. So don't get too comfortable in something that you hate because it'll be better.

Mm-hmm. Mm-hmm. Mm-hmm. Do you find that after the first 48 hours that they will sort of become pickier as they go along because you're teaching them these things? Or does it sort of keep a stable playing field? Both. And probably they're feeling better too. Yes. And feeling more. Feeling spicy. Feeling super spicy. I feel like the more that they, I guess like the numbing is like going away after surgery, they can feel more. ▶I feel like the more that they feel better is when they can start actually putting their opinions and what they're feeling in. But I always, always, always try to tell them to chase, you know, functionability and comfort before aesthetics.

Mm-hmm. It's all important equally, but let's, let's get there first so that we can get the aesthetics right after. Yeah. The, the changes in the look is much easier once you have the core built in. Yeah. When everybody's all in line and ready to go, then we can make it pretty. Yeah. So basically install carpets, drapes, everything in your house first before you start worrying about where the furniture goes. Yes. Make sure it's where you want it to be.

I want to know that when I go home. I try to do it all at once. Yeah. You can't do it all at once. What about the, the big thing with conversion dentures was always sounds of speech and those type of issues. Because a lot of times you're just sort of refitting. You're refitting something and making it work. But I'm sure that you deal with it. It's just a natural thing. ▶It's, it's not going to be a natural feeling and it's not going to be in the, in the correct position right away.

Right. Do you find that there, that's a part of a lot of the interaction is finding that, that function that, do you get that as a feedback a lot from patients? Yeah. Yeah. And we, we encourage them to, you know, exercise these things and what to expect. So you're not alone. Like I know those S's sound super soft, but it's a relearning process and you really just have to, to trust it and trust us. You got it.

What are the alphabetical sounds? What are the sounds that you're looking for? The S's. S's. What else? F's. And? What's the other one? T. T. H. T. V. Yeah. Yeah. The big ones are. The big ones are S, T, V, and F. Okay. Cause that's what you form with your upper teeth. Interesting. We had a patient on Friday who received a zirconia delivery. There was a word that was used that I've never heard been used before. Do you remember what it was?

Do you? I can't. I don't remember, but it was funny. It was a good word. I don't want, I don't think it was like excellent, but I think it was like elephant or like at some. I'll have to think. I have to think on it too. ▶It was a really good word that I haven't, I have never heard them say before. And I was like, Ooh, we gotta use that. Let's throw that in there. That's cool. It was a pretty good word.

We'll have to call them and find out. Yeah. M, M is a sound. Oh, well we can go through them real quick. And I'm not the world leading expert on it, but M is a sound that you make with both everything coming together. You know, you're putting your lips together and such. So it's a good test for the height being correct. Right. Um, F and V are made. Mm-hmm.

Part 519:32

You know, S and T are made with your lower lip against the upper teeth. So that's where we determine w if the upper teeth on the right place relative to the lowers. Can you also kind of indicate if the lowers are too short or too tall? Uh, and then S and T are made from the inside with air going around, and then also with your tongue touching the right place, uh, in the upper arch as well. Mm-hmm.

So they kind of give us, not only is it just the sounds. Mm-hmm. It also gives us an indication of where to kind of look for the problem i wouldn't this is so random i wonder if full arch would help somebody who like grew up with a speech impediment or anything like that potentially um potentially because it it could be a lot of different things i'm not a speech pathologist my grandfather was um random fact but um i'm not a speech pathologist but um a lot of that comes from i think laziness of of making the sounds they just get used to not not making it but i think there can be an anatomical component too i think so too because you're kind of relearning well yeah right and the the original bad sounds if you will uh would play into it anatomically that they're that things are just not in the exact right spot to make those noises yeah um okay let's why don't we go through a couple of these we just talked about the s sounds and the whistling whistling is comes from the s sound and air is escaping somewhere so if the s kind of comes through kind of slurred yeah uh it's sneaking out through the gap or around the teeth right yeah um do you you catch a lot of that s's being an issue um yeah um i do yeah i we used to we used it used to be a daily daily daily struggle with conversions because there was so much material their tongue would hit it before they could make the s and it was a horrible it was really hard to get control of yeah well now it gets resolved in like one to two appointments yeah it's amazing as they usually buy the second try yeah that's usually resolved it used to be a oh man i hope that they figure it out soon because i'm not going to be able to fix it with where the material is um what about uh let's see this one my husband says i look different not bad just different is my face actually changing shape no one's asked me that but i mean with the the you know the try-in process that first week that does come up like my cheeks are really sunken in or the other way around my cheeks look really full um so that's something that we we do work with and that we do see very frequently when somebody asked me yesterday in the consult about how we'll be able to figure it out when they're still swollen and there's a little bit of a learning curve when you started with us but it's surprising to me always that you actually can pretty well see where things need to be even through the swelling if you will but i'm sure that part of your job is managing if you're putting them in the right place and you're not going to be able to figure it out managing the fact that they're swollen and maybe that's the reason why their face looks different there's a lot of things that you're sort of juggling that all need to kind of mesh together yeah and that's where you know those before pictures come into play you know we're we're very hands-on we're following your natural anatomy so it's not like we're doing it blindly i would say i think this is more of a female common yeah for sure like comment as well and

Part 623:28

i know i've heard dr lock speak about like you know lip fillers and you know like the cheek fillers and like those are always options too as a backup obviously we're going to try what we can do first yeah um but that's always a good idea just because why not if that's what you're looking for and we can't achieve it there's always lip filler both i mean botox doesn't really do it but i don't yeah i think filler filler is a really good one that we encourage especially for like females who are like oh i noticed that when i put on my lipstick my lips are a little bit of a different shape or i don't get the same kind of like smile or there's that what do you call that a shell the um like when you smile and then you get that little bit of a dent the philtrum which is what it's called okay it's like when their lip gets caught on the top of the arch when they smile so it's like a little shelf yeah essentially and it creates a little in a female it creates like a little bit of like a wrinkle yeah so they don't like that there's a lot that goes into it which is the important part of your job being the concierge is to not allow them to freak out about you know how to fix it what needs to change and in a lot of ways it's i would argue that it's a little bit not more important than the restorative dentist obviously but you're going to catch a lot of those little you know non non-verbal communication pieces you're going to catch the little comments you're going to catch the way that they're talking they're looking at each other with the the escort maybe the husband or whatnot so you get a lot of that first part of the knowledge and have to capture it all and translate it which is kind of probably one of the more fun parts of your job yeah it's figuring out that puzzle yes yes it's a big puzzle get to know everybody yeah real well in terms of lip filler and stuff the the biggest problem that we always had with fighting to get somebody's face back is sort of when a person goes from a denture to a to a hybrid okay yeah because with a denture they're used to that material essentially filling up their upper or lower lip and you kind of have to push push it push the limit of the material to get that sort of feeling back as well or on the other way around when patients come in with wrinkles and then they think that teeth are gonna fix it well or you know back to filler botox or whatever like for sure and they're looking at the old photos of their old smile when it was okay which might have been a little bit more of a problem but they're looking at the old photos of their old it's been 10 or 15 years ago so not that we want you to get it yeah i think you're beautiful yeah for sure but it helps yeah if that's what your goal is i'm not saying this happens all the time i'm not even saying that this happens frequently but these are things that we have you know my four years here i i've come across them or i've heard patients talk about it and it goes both ways for sure what about biting of the cheek tell me what like tell us why that might happen do you hear about that yeah i think it's a good question i think it's a good question how do you hear it frequently how do you fix it yeah and especially in the beginning i do hear it a lot um but it's it's a whole relearning process getting yourself to bite again we talked earlier about like a gummy jaw you know your jaw is kind of just moving back and forth it doesn't really know where to go but you've got to relearn how to do that i guess um and that sounded kind of yeah no i've i've encouraged patients to go through that process as well as on my end you know start from the consultation patients ask like should i be on a liquid diet you know when we go through the whole diet situation no please don't be on a liquid diet because not only for a your health but b we actually encourage you to have these soft foods in your diet so you're you're kind of chewing a little bit you're learning a little bit you can actually understand what's going on because if you're not trying to eat at all these are things that you're not going to learn until later when you're already in a final so we want you to go have scrambled eggs the next morning and kind of use that as a way to learn how to do that so i think it's a good these try-ins and give us feedback yeah i i encourage the same thing like try to eat something i do want you to you know work your jaw get it going find where it needs to be um because it could be that that's the issue or it's a design thing that and that's something that we have to address right it's kind of like after you get like a knee replacement don't they make you walk like next day to make sure like everything's good yeah yeah oh yeah kind of kind of similar it's painful use it or lose it what about when in terms of like finding that bite would you say that they improve exponentially over the week that they're there or they still yeah yeah doesn't take long yeah it doesn't not take long do you get a lot of comments and your restorative appointments in terms of like wow i've never felt a bite like this or they're still enough yeah yeah i'm like i have patients who come in and i'm like you know i'm how how does everything feel right this is after like three three appointments and they're just

Part 728:37

like i i don't know i feel like there's too many teeth in here what am i biting down on um so you know they're going from maybe no molars at all to now they have a full mouth of tea yeah that's a big one so having to learn that too that's another reason why you might catch your cheek part of that yeah it's a huge learning curve yeah a learning curve in which you are a vital part to it to be that guide that's part of what you're paying for is to not just get teeth but there's a i don't i don't think many people realize how many variables go into it's not just teeth there's where's your bone where does the implant go was it strong you know who is the one that's designing it who's the one that's doing the restore there's so many things that go into it yeah it's very complex you know true i agree um do you get this one very often why does my jaw feel tired at the end of the day even months later because i feel like i have heard this one but have you ever heard it directly no no no i don't think i've ever heard that either i feel like i have um i don't know why it would be the case it's a big surgery it's a big scenario you're kind of exhausting everything yeah but uh i don't know i don't think i've heard it like that a random thing that i think of people don't realize or there isn't enough time in the day to fill them in on is the i don't think people are prepared for how much we need you to open for on the day of surgery yeah which then can parlay into soreness into your side as well yeah and you need them to open still to open and they're they're swollen and you know exhausted from the surgery i had a guy i bring it up because i had a guy yesterday ask me like or say you know i don't know i don't know i don't know i don't know i don't i don't mean you know i'm sedated i'm trying i'm falling asleep here like you could just prop my open my mouth open if you want and while that may be a little bit true putting a block or some sort of uh opening device in the mouth when you've got sort of two is well one you were trying to work in that space two uh when those teeth are gone there's always going to be some level of gum tissue on gum tissue just absolutely just sliding all over the place and i'm and so it's really hard to use a bite block on the day of i can't even imagine using it's horrible nadia used to work with a guy um who would do one quadrant at a time one section of the mouth at a time so that he could try to use one it didn't work well you can't you have to see everything out in front of you you can't just see one portion of it at a time yeah so doing a surgery in quadrants is a lot of work but it's a lot of work and it's a lot of work and it's a lot of terrible idea yeah um but i don't i back to the original point i don't think people are used to or are ready for essentially how long we need to have you open yeah and how little of help that i can provide yeah and that's probably a lot of the reason why i like to do my surgeries under the sedation that i do because i need you to do that yeah or i'm sitting there cranking it the whole time i think day of surgery or even week of week of your your process with us it would make sense

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to feel like physically like exhausted just because obviously the procedure and what we're what we're putting you through like you said like keep staying open and stuff like that but also just like medications that you're on it's your body healing it's your body recovering so that definitely makes sense to me but as far as like months later my jaw still hurts no no no no um it could also be sometimes people do feel tired after if the if the height could be wrong yeah that's what i was going to say is if it's my height i'm going to be tired after i'm going to be tired after i'm going to be down the line it might just be something within your design that we need to look at yes and we will agreed uh anything else you can think of as we're kind of closing up the ideas on just random things that people don't think about no just come in with an open mind trust the process trust your body that's healing um it'll get better and uh you're going to walk out with something that you're really happy with something very special and bring chapstick yeah that's a good one bring chapstick vaseline i have vaseline for you but if you don't like the way that tastes some chapstick would be great because you're open for so long yeah um closing thoughts erica that's it i agree with the vaseline other than that stay you know prepare with ice packs arnica post-op care we have a sheet on it too maybe we should run through that one day um but nothing too crazy at the end of the day it's it's your body your body needs to heal it knows what to do and it's going to heal and it's going to heal and it's going to heal and it's going to do so don't do anything that would make it kind of like freak out don't try to do any extra any extra things to induce the healing because it's right it knows what to do it's going to make a human i told somebody today it's going to be like a human band-aid um when those clots form after surgery yeah so it's as long as you kind of allow it accept it get some rest don't overdo it you'll be just fine yeah i agree and uh if you're a former patient and you thought of some stuff that we've kind of missed um feel free to forward it to us we can answer those as we go any uh insight and help would be greatly appreciated especially being then who better to know what they went through than patients so if you have any of those we would love to know any of those points um and also uh if you're interested in knowing more contact us for a consult um like subscribe all of that stuff we appreciate everybody listening thank you so much for for coming down and making the time out of your business you're welcome thanks everybody