Ep. 55: Why Didn't Anyone Tell Me? Real Questions, Real Answers

Part 10:00

▶This is Beyond the Arches, where full-arch dentistry meets real talk. Let's get into it. Hello and welcome back to Beyond the Arches. My name is Erica and today I'm joined with Dr. Daniel Noorthoek. Here we are. Once again. Today's interesting because it's actually just the two of us. Sometimes we have a special guest on or different team members and things like that. I'm feeling kind of empty. I know. I kind of miss everybody, but it's okay. We're going to do kind of an interesting episode today too. It's going to be why didn't anyone tell me episode? So it's kind of sensitive, you know?

Yeah. I do my absolute best in consultations, even pre-op phone calls, everything, full transparency. I think if Dun & One actually had like a motto, it would be like full transparency is all we got. Like I tried to over-prepare everybody in every aspect, but there are some things that kind of just come up naturally. So we have a couple questions here from... ▶Our actual patients and as well as some online information sources that we're going to chat about.

Yeah. And so today we will answer these questions as best we can. I think that they came from a combination of sources, like places where people posted maybe to a Facebook group or a Reddit post kind of thread, different centers, different locations. So they're going to be a little sensitive. They're definitely not the easiest. I've looked over... Really quickly. They're not the easiest questions to answer. And some of them may kind of be, I'm not really sure. But it's good and important to talk about these things because as a person is looking to do surgery, it's important to know what you need to know and the things that you didn't expect or the plan.

We don't hide anything. Nothing's under the rug. Nope. We have a very clean rug. You want to start off? You want me to kick it off? Sure. Let's go. So the first one is a person saying, I'm three days post-op and one side of my face is way more swollen than the other. Is that normal or do I call the office? Now, I'll kick that to you from the beginning side of things to the question. Is it normal and do I call the office? And what do you see in our patients?

▶Okay. I think this is absolutely normal being three days post-op. I think that at the end of the day, it's a huge search. Even if you see online, some patients don't have bruising. Some patients don't have swelling, but you do. You are still normal. This is completely expected. Everybody's body reacts to surgical procedures in a different way. So I would say do not be alarmed. This is absolutely expected. Swelling is your body's reaction to the healing process. And absolutely call the office.

I think that's definitely something that's valid to check in on. It's not a bother. We get so many patients who are like, I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't I'm sorry to bother you. I promise you are not bothering me, especially if you are in your current surgical week. Like call us at any point, any time, any questions. We're always happy to chat about it. If I don't know the answer, or Lily doesn't know the answer, we always are more than happy to pass the phone, take a message, anything like that to get any of our doctors on.

And it would be obviously urgent if it's something, you know, especially like that, any, any discomfort or anything. But I would say that's normal. You agree? Yeah, I would say, falls within the category of normal from like a medical side of things i think that it's very easy for um all the marketing and all of the places that we are we and everyone anyone in this profession this surgery as a whole is very easy to fall in the line of like yeah it goes really well every single week and it does for many many places but like i try to tell people every single minute of that i'm talking to them it's the human body things are different so being swollen on one side of the face versus another can happen you know they had infection on that side or that area that was a little bit worse than the other could have been that it could have been that that was the end of the surgery and was sort of like not as compliant because of the sedation uh could have been they slept on that side fluids accumulate and go to the point of least resistance which would be gravity i've seen that before actually yeah i think it's kind of a little bit later in the questions too that were where um it says something about sleeping but you could sleep on the wrong side um different cells leak fluid and slash bleed into spaces more than others sometimes uh person to person um so it all goes into the whole scenario if it's where the big trend would be concerning you know if you've got patients constantly from xyz place or you know five other people from a location that has this problem consistently that's where you would be a little bit concerned otherwise i would say everything's in the bounds of potential um we have people that come next day with bruising already very few but some we have more people that come in on day two with bruising and bruising happens in different shades different shades different amounts yeah um and real quick i don't think we've ever covered it but bruising really um can we think of it as like oh i got punched and i'm bruising or i fell and i'm bruising here well what bruising really is is just kind of bleeding underneath the skin right so when we're taking teeth out when we're doing surgery that all requires us to move the gum tissue out of the way and then what do we do we stitch it all back up together when we stitch it all back up together we're essentially locking any of that bleeding underneath the the flap so underneath the gum tissue so bruising could be from trauma could be from sleeping on it wrong or something you know doing something to it not enough ice not enough reduction of swelling the own the person's body but it also can be just that person was bleeding underneath the gum tissue more than say normal it collected and then once it collected the body has to figure out what to do with it and then that's what turns into the bruising this is kind of off topic actually so sorry but there's a trend going on on tiktok right now i don't know if you've seen it or not where people are actually drinking like pineapple juice before their wisdom teeth removal okay and i've heard a handful of our patients do i think brie actually mentioned it on her tiktok that she tried it out and she had really good healing honestly so i don't know if it's because she was younger and you know her in particular she was a bit younger or it's because she tried this but do you think it's because she's a little bit younger or it's that that has anything to do with the bruising or swelling or healing it could potentially you know you are what you eat and you are what you take as a supplement etc that being said is there any you know dan's recommended beforehand to prepare i don't think that i have an official list okay um but you're gonna see more active healthy younger people that do things like that you're gonna see them take care of it the only thing i hate when it comes to supplements are being careful that the supplements don't encourage bleeding there's a bunch of stuff i like fish i can't think of yeah one big one is saw palmetto um there's a lot of ones that people don't think of as creating bleeding and they can kind of get in the way and that that affects our quality of the surgery because the bleeding is in the way um more than anything right um but could also affect bruising afterwards um the other thing is that anytime a person is putting especially homeopathic stuff topically on the surgical site not necessarily outside of the face echinacea is okay for bruising i think um but um i've had some problems with patients putting random stuff on the inside of their mouth it can kill the gum tissue yeah there's a lot going on there like be as gentle and chill with it as possible we always like arnica though that's something that we provide in our travel package bag and it's something that we talk about almost daily when when people come back in the day after surgery if they have any bruising it's the first thing that we suggest it's just a topical that you put like on the outside of the the skin area kind of on your chin lip you know region and it helps with the healing too it's really hard to predict if a patient's going to have bad swelling or bruising because you'd have to almost like run a full panel of their health and their blood and and then just random luck and then um it's also really hard to predict their their pain i know this question didn't have anything to do with pain but those two things are very hard to predict yeah we we can throw you on a slot and approximation but yeah very hard to pinpoint for sure it's so challenging again back in the consults i always say it's it's difficult to say how your body's going to react to things and what your pain level

Part 29:20

is going to be like i think our average patient patient probably um takes about a week and a half off of work i would say that's probably the average that weekend hump is usually a good um time for recovery um before that zirconia delivery but it's it's so challenging i again i'd rather over prepare you than under prepare you that way you're like oh that wasn't that too you know that wasn't too bad yeah and that's the point of doing this is not to scare anyone away but to bring out the things that maybe they haven't thought of and and the differences that are there i'll mention that being a person having bruising does not necessarily mean a surgeon that did it was good surgeon versus bad you'd have to really look at all their cases to determine um different than if you have no bruising then probably the person did a pretty good job you know like a good person can still get bruising yeah a bad surgeon is a little bit tougher to get no bruising i've seen some again back to tiktok too sorry but i have seen some recent videos up on my feed because i have a whole you know my my whole entire page is it has a dental algorithm and it's funny to see like other offices and not necessarily compare just see what else is out there and there are some patients that are posting like post-surgical um videos just kind of showing their bruising and stuff and it makes me feel like ours goes really well i don't know if that's the conscious sedation as well that plays a part into it but i would say our patients look pretty darn good i'm so far removed from really looking at other offices and protocols that it's hard to make a statement on that um but i will say that our protocol has really worked to be over educating and hey this worked for somebody and things from all the way from the front desk to you know the little recommendations to the recommendations from facebook to the you know hammering it in on here the hammering it in to the patient's escort when they leave i think a lot of those things in addition to the the way that we've built our protocol is is the least invasive that we could be um so we've tried to put up all those fences that we could for the for the patient so i think that we probably have certainly less bruising issues than i did when i first started but at the same time it still is it's an interesting thing when they come in with bruising you don't expect it they always have to throw in a little jab of well you know i didn't know you're going to take me out back the last night you know and you always feel like dude you have no idea that really didn't have anything to do with it that surgery went awesome yeah it's great it's crazy so okay let's move on to our next question so i have how do i sleep the first week every position hurts and i keep waking up choking on saliva one of those ones are you're just like oh i'm not sure um again we try to make sure to eliminate as many of those issues as possible um one big thing is sleeping somewhat elevated um the first night you're going to absolutely bleed or or ooze on something um the main reason as we talk about with patients that we don't do teeth on the same day is one we don't want to drag out that day any longer than it really has to be psychologically and experience wise and trauma for back to bruising right um but it's also to kind of be able to still get them home while they're a little bit sedated and can get some sleep in and sort of ease into the pain more than anything get on their um pain meds etc um i think that probably a lot of people under ice and under treat themselves with um ibuprofen if they can take it in the pain meds um i think that that gets skipped a lot more often than than not when you look at the compliance numbers of how a patient will typically take a medication plus you add the fact that they just had a big huge day and they weren't necessarily there for the instructions that we give that mostly to the escort that can play a big role into how you set yourself up for success yeah um in terms of sleeping elevated on a really old towel something that can not really worry about whether or not you're oozing um toss it when you're done yeah generally speaking um that saliva issue is a big part of it and i think that's a big part of it is probably still a little bit of that clot and the saliva mixing so i would be very um intentional about making sure that you use the gauze to stop it up and the tea bag to stop it up my guess would be if this is sort of a main complaint that maybe you just fell asleep right before you were done taking care of that yeah that bleeding yeah back to the the elevation part i just want to emphasize you don't have to sleep on a sleeping pad you don't have to sleep on a sleeping pad you don't have to sleep on a sleeping pad like sleep like standing up by any means you don't even have to sleep at like a 90 degree angle anything you know you don't need to turn into a horse anything is going to be beneficial to help your you know help you first of all breathe too um we did cover it a little bit the you do want to sleep on your back even though it may not feel like it because of the the saliva and the bleeding but sleeping on your side and sleeping on your stomach is going to have a tendency to allow that blood to accumulate in areas that you don't want bruising and back to bruising again uh bruising like we talked about collects right um and you're going to see the bruising happen the reason why you see it happen in the corners of the lower and the eyes of the upper is this is where your skin is essentially the weakest and the most see-through so that's where fluids collect and can be told you can see where it's an issue so um it can come from a different place it's just going to find its way to the weakest point so definitely on your back definitely not if you you're sleeping on your face you might end up making things worse than they need to be i have a question i'm going to throw in there this is actually an erica question so i'm gonna catch you off guard with it let's go something i always prepare patients is for after the procedure when they leave our office they're going to be numb so obviously yes bring an old towel with you because when you're numb you're not feeling the you know expected to be falling out mixed with a little bit of blood so just make sure you're wearing a dark colored t-shirt and you have a um kind of a towel to just lay on the bed so you're not having a mess to clean up the next day um but the thing that i was going to say that i was going to mention is that i always prepare patients and their escort for when they go home after that surgery how they're going to take their first pain pill yeah because that can be a challenge too when you're numb it is so difficult to kind of like swallow water feel what's going on you it's it's a very confusing and can be like overwhelming process to take that first ibuprofen when you get back home i know obviously those pills are also kind of large in my opinion um but if just swallowing a sip of water you're not sure what's going on you're not sure what's going down you're not sure what's coming out you're not you know is there any any advice that you can give on that one no um actually when you were mentioning that the first thing i was thinking of is i don't have a lot of experience with being in that scenario but i have a lot of experience of just being secondhand like watching a assistant or treatment coordinator try to help um and it's a lot like the experience of giving a pill to a dog right i know it's terrible to say but you know you're just like just take it and it ends up on the floor and then you know not on the floor but yeah um you know you could cut it in half and give it into two pieces uh for ibuprofen specifically people think that the the prescription ibuprofen is some magic way of taking ibuprofen that makes it work versus not it's it's not um i personally if i get a prescription for it sometimes i'll fill it but if it's say 600 milligrams that's three normal pills of of um advil or whatever brand of ibuprofen you want to use so there is no magic to more being in the same pill so you could break it down those have a lot of different coatings that your prescriptions aren't going to have on it either so you might have a better chance there i think um i've seen a little bit more success i'd say when it's not necessarily like a water and it's not immediately after surgery um maybe taking it in like uh people have done it in like yogurt do not crush them up or break them up or pour the capsules in because they're very intentional about the way that it distributes the medication to you but um you can get unique um like i was just thinking you know maybe a smoothie may work um better for getting it down than just water water is thin enough that it leaves the pill alone and then your body can only think of how it's not going down so giving it some time you know finding alternatives that are smaller and maybe um giving it giving them something with some sort of substance to it like a yogurt or a smoothie would be my guess is like we said we weren't going to answer all these those would be my best attempts at how to take those yeah i would agree i would say my best advice and suggestion is usually just either kind of tilt your head back take two or three big sips of water kind of consecutively so you don't allow it that opportunity to come back up um protein shake is a really good one as well um but i always tell patients if you try like two or three times just you know give it a little bit of a break relax your body relax your mouth your throat your now you're now you're okay and you're going to be okay and you're going to be okay and you're going to overworking it and now you're kind of like freaking out freaking once it comes to like the cognition portion of the patient's brain it's over um yeah and i so just you know if it doesn't work the first couple of minutes it's okay especially if you're still numb take a breather would be another bullet point yeah don't it doesn't have to go in that second give it a 10 minute break yeah give it a couple minutes protein shake applesauce anything like that i have had one patient's wife told me the next day they actually used a turkey baster to help it get down because he just tilted his head back i guess

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kept swallowing and she was pouring and i'm not sure what that scene looked like but whatever you gotta do i remember you mentioning that yeah yeah at that point it's kind of like whatever you can do short of crushing the pills or making the patient super uncomfortable um yeah tough these are tough questions these are not necessarily black and white true or false answers no but something to you know prepare for and again i prepare all my patients for that i tell them right when they walk in first thing what you do is going to take your pain pill when you get home but can be challenged a lot of these things too being that these are like the what what didn't tell what you didn't what they don't what they didn't tell me is going to heavily be on the now right after surgery so most of these questions almost honestly are for the escort yes or the person that's going to be with them helping them yes like a lot of this is sort of like therapy of like you don't need to be worried you got this which we try to do our best with as well but a lot of this is like patient escort or partner therapy absolutely um i bit down on something hard on day four and i felt a pop i'm terrified what do i actually do right now um this is a very interesting one because you shouldn't be biting on anything anything hard yeah what i like about this question uh or statement rather is that um the person admitted it right and i don't want them to tell me everyone comes in and they say well this broke on a soggy piece of bread is the old adage the old joke um when we know that's not what the case was but um so the first thing i would say out of this question the little uh imperceptible pullout for me would be i like that they're admitting that they bid on something i also like that they're terrified now and um maybe longer term they'll be a little bit more mindful so that's one thing um and the other thing would be number one this is a perfect example of you can tell somebody you can tell somebody soft i i can in the consult dr laxcan and the consult dr can tell it a thousand times we can give them videos that are daily that they watch them till the day of surgery and it still doesn't land um so these are things that we deal with all the time um but uh i would say in general if you feel a pop i wouldn't worry about it call us call us um day four one you're probably not in the final yet so it's probably just a um plastic temporary light prototype um doesn't happen as much now but back when we first started doing prototypes uh the plastic and the metal sort of interaction it's not a perfectly made piece yet so sometimes you could get additional settling and sometimes the plastic and the metal sort of rubbing or popping on each other can be a little bit jarring so that could be a case or a use of it as well um if this is a case of a patient who let's say was getting a conversion denture at another office um the pop could be the metal piece that gets glued into the denture essentially becoming unglued because that's done inside the mouth um in that case you haven't necessarily heard anything um and really in either of the cases that i've just explained you haven't really heard anything um but that is a scenario where you're not going to be able to do anything you're not going to be you definitely would want to get checked out if you have an implant that's come loose out of your temporary that you're going to have to wear for three months that's that can be a serious issue that you won't know until it's too late and actually probably won't ever be able to point your finger at what happened but that could have been the reason that could have been avoided because at day four they're still strong enough the office could take them out re-glue it in to be a little bit more secure and then now the implant is a part of that healing yeah that's i would say call us we'll check it out we'll see you in the office like you said it's probably more than likely it's a temporary so it's it's you know hopefully we can take everything out take it apart assess from the ground up we'll have the doctors take you know if needed an x-ray or something like that just to make sure the implants are still looking stable nothing was harmed there um i would say thank you for being terrified don't worry too much yeah still call us still call us that's my number one thing is call us let's see what's going on don't don't think because it only popped once and not twice you're in the clear i would say that's definitely like still out of the ordinary shouldn't really expect something like that to happen um definitely not something i prepare patients for so definitely call we'll see you and we'll see what's going on and assess and reassure that either everything will be okay or if it's not okay we'll fix it i will say i'm gonna make a ludicrous statement that you'll love that i made it's gonna seem like it's out of left field um but it could be its own episode interacting with the office it goes so much smoother if you keep your wits about you we didn't try to make you in pain we didn't hurt your teeth erica sometimes wasn't even involved in the case a good attitude goes a really long way there's very little that's like super serious we're gonna put you on a path to fix it and it can be very hard for a patient to keep their wits about you um but it could be its own episode interacting with keep that in mind when they're in pain and making this statement is gonna have no bearing on the world at all it's still gonna be what it is but i i just had to bring it out and say it that yes call us always try to keep in mind that we're human we empathize and we want to fix you we're not trying to put you in a scenario that's either dismissive or um that we want you to have felt this pop in are terrified and you're upset it's natural to feel that way um but it would be awesome if somebody somewhere listens to this and goes oh yeah when i call them it's probably okay they're trying to help yeah yeah i i completely agree especially in this circumstance i think it's very alarming for a patient i think it's concerning for a patient if they're hearing a pop the first couple of days um but just know that you you have somewhere to go to that's going to take care of it so that comes with picking out your office and having trust you know built building trust with your team feeling comfortable letting us know hey this happened because i promise we'll more than likely see you same day we'll probably even offer you the same hour to come come right in yeah um so i think it's yeah i i have a lot to say about that about life in general going i figured you would yeah i thought it was worth mentioning since that sort of has been the theme of today's call absolutely be nice we're gonna fix it and help you absolutely um when does this metallic taste go away and my numb lip so this doesn't this question or statement doesn't really have a timeline on it um metallic taste can be it can be just from the surgery it can be sort of from experiencing the bleeding in your mouth it can be from a lot of different things um if it's immediately after surgery i wouldn't be concerned about it there was a lot that went into your mouth there was a lot that was worked on it's not anything that would be concerning to me where it would come into play um i don't use it much anymore but we used to use paradex all the time paradex over time if you use it for weeks and weeks and weeks and weeks the reason why it isn't on the shelf as a grab and go like a crest pro health or any other listerine is because over time it can create sort of this like constant metallic taste in your mouth so um maybe that's where that came from like i said we're not i'm not sure where these sources are but that could have come from that so that's interesting the girls in their restorative team do use paradex occasionally yeah it's not like that this is like three weeks four weeks this is a long time okay um it has a tendency to coat the reason why i don't use it is it coats it's an antibiotic basically and it um versus an antiseptic and antibiotic uh i believe it's an antibiotic it coats and attaches to the surfaces that are exposed well in a surgery that can go inside of your surgical site which isn't like dangerous but it does prevent that coating can heal from happening sort of altruistically or completely so that's one of the reasons why i've avoided a little bit i've actually never heard if i don't i've never heard anybody ask this question the numb lip no the metallic taste i mean either i've never heard any of our patients say that i've had a couple who have come in say for a consult and they're like yeah i have this weird metallic taste and you know i've been using this uh prescription mouth rinse that my friends uncles you know gives me for you know time on time i've had that maybe two or three times um numb lip now numb lip can be serious can be nothing if it's an hour after surgery you're probably still going to be numb keep your wits about you if you're concerned maybe call the office but more than likely just let the numbness wear off different different anesthesia wears off in different time points so there's ones that we can use that are probably like 20 30 minutes

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max there are different areas we can inject that would take that 30 minute max and turn it into like an hour but a much more complete version of the portion of the jaw and then there's versions that can last two three hours there's a also one that we use as an injection that's um lasts somewhere between three and five hours it can vary a lot but you know if it's four or five hours after that's not really concerning that's kind of a good thing kind of the point yeah it's kind also just as a random fyi there are 72 hours uh versions of sort of pain agents and numbing that an office could use that would make you lip your lip long term sort of numb the medium like don't worry about it um and it's been a day or two uh is generally the um the nerve that and it's mostly for the lower the nerve that serves the um lower lip uh essentially comes out right here in your jaw and your lower jaw and it's also the nerve that we're watching out for for the back teeth right and um that lower nerve where it comes out kind of comes out like a if you think about like a tree you know it comes out of the the main stem and then it branches out in surgery just in we want to see it sometimes if we can't see it on the ct correctly so maybe we'll see it physically and we'll do that intentionally sometimes it's really shallow and we we get to it right away um most of the time numbness is going to be transient in that way in the lip because it was just sort of more or less like accidentally not even accidentally from a result of the surgery incidentally moved disrupted or pissed off that can cause medium short-term sort of numbness the that's where if you were to get a complaint say a day later after the numbness is definitely supposed to be of worn off that's probably where i would guess 97 of your numb lips is just a guess and i wouldn't take that to the bank but we'll just say 97 of the time it's just because it got disrupted in surgery it's not anything serious it's reversible it will heal um it could also be that unfortunately it was cut into from some instrumentation accidentals and uh instrumentation or worse case scenario would be uh an implant sort of uh protruding or intruding into the canal that serves the nerve now that's worst case scenario that is a serious situation it is something that needs to be addressed quickly it is something you call the office about and what the office should do if you have that situation is um let's say at a at a 24 hours or whatever um they should do sort of sensation testing and then they should do sort of sensation testing and then they should do sort of and map out where the sensation stops and where it begins um and then refer unless they want to handle it themselves but like they should refer that out pretty much immediately to some sort of nerve specials if they suspect that that implant is touching the nerve yeah i i would agree i think some most i would say from experience most of these phone calls that come in which it's pretty rare um but in just in regards to kind of still being numb it's always after the procedure i've never never I personally have never experienced it like the few days following um and it's usually the last procedure of the day so it's usually like the family's home now they're eating dinner they're trying to watch movies or they're trying to laugh and they're still like kind of having that sensation um it's always something that goes noted it's never something that is unnoticed on our end it's absolutely the first thing that we're taking a look at the next day because like you said sometimes it's not serious but i just want to make sure that you know someone's getting eyes on you that is going to be able to tell you your nerves are okay because that's that's actually usually the first thing that patients jump to they're like oh did they hit my nerve or something in surgery i'm like we'll take a look we'll take a fresh x-ray have the surgeons you know it's usually one of the surgeons that is going to assess for that honestly um but it is absolutely something to mention to the office that you're working with the reality is nerves are everywhere and yeah we did mess with your nerves we missed with a whole lot of them we just want to avoid

Part 534:25

the big ones yeah so little things that i you know that's not on here since we're talking about nerves is the one on the roof of the mouth that can kind of stimulate or create a pizza burn sort of feel let's talk about that that is a huge one that i get the pizza burn on top of the earth the pizza burn on the roof of the mouth yep so uh when we're trained in school we're trained to doesn't sound bad but just in general everyone more or less we're trained to do a lot of things that less is essentially trained to basically ignore it so you can kind of cut it up cut it in half remove it do whatever you want to it now the healing is going to turn out more likely more than likely as a pizza burn um that's the more extreme situation that would be like uh let's say that you are using a guide okay this is a perfect example of a guide needs more gum tissue moved out of the way more completely so that's going to be the one that's going to be the one that's going to be something that's affected more often um uh another back in the day i don't i don't know if that's still a current thing or not but there were surgeons placing implants into that hole because it was a place that you could put an implant in i'm sorry i need to clarify yeah are we talking about the roof of the mouth yep so there's a little hole where the nerve comes out okay and in that hole because you know you have good bone sort of around it there was a trend maybe 10 years ago where you could put a good bone around it and you could put a good bone around it that was sort of pitched as a place that you could put an implant in the middle not in the middle of the roof of your mouth but we're talking about like towards where your two front teeth meet okay uh i've probably done it once or twice in a pinch of like an emergency but the point is that it can be done and it doesn't really affect the the patient's world in the long run or medium run so the logic behind not worrying about that nerve so much is that your nerves are so big from the blood to the blood to the blood to the blood to the blood to the blood to the blood to the blood supply in the back of the roof of the mouth on either side that it essentially takes over eventually and makes it so that it's fine um i know it's probably a little bit confusing but yeah so let's let me i have a couple follow-up questions so that's so the pizza burn on the roof of the mouth just for clarification that's caused by the injections that they received during the procedure not necessarily no it's more probably because that nerve butts really close to where we needed to work or where the tooth was uh on the roof of their mouth so where that nerve actually sits is essentially right behind the two front teeth okay that's where it is like it's the little nub that's like right behind the two front teeth okay so those that just naturally has to be moved out of the way if the surgery like say for a guide or the person wants to put an implant in that spot has to work there you have no choice but to move it out of the way or cut it or whatnot and it's always going to cause sensation of a pizza burn not necessarily okay um the reason why they don't they say you can ignore it is one it's a very common place to have to work two the nerves will come back because there's the nerve innervation from the back is so great that it'll kind of take over and help uh and then it's like a weight of like better practice versus you know not having a pizza burn sort of weight um where it plays into our process more often than not it's always a surgical risk um but the i used to get it a lot because see if i can explain this easily a person has good gum tissue on the front side of their teeth when they have teeth and then the whole roof of the mouth is that style of gum tissue when you are doing a full large procedure you're trying to keep as much of the good type of gum tissue on the from the front side of the teeth as you can and so when you put the gum tissue back together after your surgery after the implants and the teeth are all out sometimes that gum tissue overlaps each other like a lot too much that you can't even control it so rather than cut the good stuff off the front you essentially will sacrifice the stuff off of the back the back where the where the nerve is that makes sense and that's more or less where your pizza burn comes from interesting so i used to adjust that much more aggressively so that the nerve was a little bit more stable and i was able to cut the good stuff

Part 638:56

more exposed okay now i treat it a little bit differently where i have a tendency to overlap it a little bit the way that i suture it i'm not going to propose that it's anything ground breaking or anything that's you know anyone should necessarily fix to but it has fixed our problem and not created any issues um not fixed our problem it's reduced the amount of that we get i would agree while at the same time not creating any um healing issues so some patients like to ask if they can have like a paradox rinse or something a magic mouth rinse to help with those sensations is that the proper way to like treat that pain if it's not necessarily a something with i i don't know yeah the the better way than just like putting like topical nerve gel on it like a benzocaine like a aura gel would probably be a magic mouth rinse because that has topical lidocaine it has a steroid in it on it has you know malox mylanta um i say it's it's yeah uh mylanta yeah benadryl mylanta and then the numbing agent it's very palliative and gets a good result it's very transient but can provide some relief so it's acceptable to do that it's just impossible to find at pharmacies it's impossible because it has to be compounded yeah um and uh yeah it's just it's a tough scenario to be in because most of most of the time when that happens it was just sort of like an honest need there wasn't really any avoiding it okay that doesn't that truly i would say it doesn't really have any bearing on quality of surgeon yeah no that was a really good one to bring up i'm really glad that you mentioned that because that is more one of the more common things that we do receive that we we actually don't touch on at the console or for pre-op yeah that's not that serious as nerves go um the serious one is the lower lip face those kind of things yeah um those need to be mapped right away need to be looked at right away and then the decision to refer depending on what they see also needs to be made pretty much right away okay i'm a single parent and have nobody to help me out for the first few days what's the realistic minimum support i need lined up good question um my opinion is probably one to two days what's yours i would say i would agree with that i would say minimum 48.

hours i like that um maybe 30 i'm a woman we have different opinions yeah no i'm not like disagreeing with your opinion it's it's definitely more than 24 that i'd like somebody around yeah i agree there's also a bunch of different choices you can make you know there's a lot of people that exist without a significant other and without with a kid that they have to take care of so maybe the child has to go stay with a grandparent and then they're kind of on their own and then they're they have the freedom to do it but they're on their own depending on the financial resources some things that we've done in the past is line up a home health care night nurse yes um what is that that runs like five to seven hundred dollars a night right i would have to look it up to get the exact i think it was something like that yeah we're more than happy to set that up for patients when they've uh they don't take us up on it very often but we have had to rely on it and have used it several times that's a really nice peace of mind for me yeah um i of course don't have hospital privileges so i can't admit them or anything so it's it almost feels like you have that in a very small sense that you can send them there and let them take care of it yeah um and you know that anything that's truly emergent they're going to be on even more than say a significant other because they've seen these things um the funny thing about this answer is obviously when i bring up night nurse i'm gonna bring up the husband and wife couple that we had i think mentioned the story before yeah um were you around for that one you were right it was like my second week yeah probably that makes sense we had a husband and wife couple fly in from out of state the we met the wife the wife during the surgery um of the husband went back to the hotel i think that we got him back we rewrote we escorted him back to the hotel got him in the hospital and while he was in this first 20 minutes probably in the first 20 minutes back

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the night nurse because i think we did it on our own we hired the night nurse to go yeah i think we sent them there that night uh sent them there that night to be with him and then uh the daughter came in and he actually if i remember the story correctly he went home before his daughter and

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travel patients they're not local it's like this is totally an unfamiliar environment they're staying in a hotel they don't know the hospital they don't have a doctor here but i think she

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[redacted] and we were like oh my goodness they handled

it like champs and it was one of those unforeseen things that we have to pivot on occasionally like we always say we'll work with the patient you know this is a scenario that's out of their hands and out of our hands there isn't a single thing we would have done different they came with an escort you know even if they were at home at home it probably would have been relatively similar because who knows what the daughter was doing that night etc i mean oh yeah it was just one of those freak accidents but that was um that was sort of a little bit in the background of what we were doing and i think it's a good thing that we're doing it beginning um of when we really kind of went travel package and whatnot and that was a a good lesson in the better our team can stay in communication with these people and the more they can feel at home which we really try to foster um the better everything will will flow because they weren't they weren't upset they couldn't be upset about anything but they weren't upset they took it in stride we did our side they did their side and everything came out and worked out fine yeah if anything i think it was a more it was a great situation because i'm pretty sure dr lindsey got them in the hospital within that same week which

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pays to know people it's all who you know around the area yeah um so i guess like sort of to wrap that that thought up realistic minimum support minimum minimum first night realistically boy side 30 hour recommendation woman's side recommendation 45

Part 746:28

48 hours 48 hours i think it takes i mean obviously it takes at least 24 hours for your sedation to wear off but on top of that i still think that your adrenaline needs to calm down to a point that you can fully grasp what's going on um regardless of like pain you know maybe you're with a child you're not taking pain medications maybe you are taking pain medications whatever it is i think come it it's such a huge problem you know a huge procedure that i just i think adrenaline i'm the type of person like if i fall down i'm not going to feel it till like four hours later even though i'm like oh my gosh um i i just think it takes a little bit longer to really get a better grasp on your bearings and what's going on and how you're feeling and maybe you're taking an ibuprofen and you're going to see how your mood is going to react to that or you know just i don't want to it's not like nursing it's not like full-time nursing care you're not going to be in a hospital bed this is an outpatient procedure totally um but to your point you're not going to be a normal functioning human being society uh just because and your your mental faculties will not be what they are supposed to be so um i agree with that i'm fine with it okay we'll agree to disagree and agree it again uh day five and i cried for an hour for no reason is the emotional crash a real thing or is it just me i'm going to kick this mostly to you because you're going to be the one that sees this and gives me an opinion on this is actually something i don't think i've ever really done in my life i don't think i've ever really done in my life i don't think i've ever really considered or experienced but i i'll throw in only one thing which is we do and i alluded to it earlier but uh we always have to constantly keep in mind that day out of surgery four days out of surgery this is a big procedure it can be more uh painful than they expect they are in pain when they're trying to interact with us about something that is in that they're concerned about so sometimes the nicest person in the world can turn into the meanest person in the world and you have to keep that in mind as you work with them so maybe that has a role with the emotional crash um i'm not sure but that was the one thing that i was going to incorporate in there i mean i think this is a hundred percent legitimate i see patients crying before surgery after surgery day after surgery usually not around day five honestly but it's still valid because there are so many emotions running through you like you said is is it pain is it emotional support that you need is it confirmation that you need that you did the right thing in making this decision and moving forward with this procedure is it that the first try and came back in a in a way that you didn't think it would and you thought it would look better than it does um are you hungry are you hot is it the medic you know again is it the medication um but there's there's a lot that goes into that i yes it happens it's it's valid we're here to help you and support you i think the biggest thing is trying to stay calm and knowing that you're working with a good team it was a good decision and we're gonna get through this at the end of the day um but there's that i mean i'm the type of person that like if you know i used to have to do public speaking and i would cry like maybe you have to tell the clinical team something that you see something that you don't like and you have to like that's the first time ever like you have to speak up for something and you're like getting teary-eyed i i believe it yeah i do too it can it can hit you and this is a deeply emotional thing this ties to people's identity it ties like we say all the time it ties to a lot of shame for a lot of people it ties to a lot of trauma for a lot of people and so i would say maybe less than an emotional crash it's more of like an emotional like just upswell or like it's part of the healing it's that's the right after surgery is the lowest of the low that you'll ever be yeah and something i try i've tried to be more cognizant of or tried to be more active in is that first day after surgery i don't care what their attitude is um and i don't to some level don't care what their result is so far because i know that when you get a set of good totally flips and that doesn't even none of it even matters and so it's it's hard to filter that out but still be an empathetic person um but uh i would say you know it's reasonable to have an emotional crash at any point in this scenario you're talking about the pictures and the face and the what you've been told to brush your whole life and you had trauma with the last dentist and it's shameful and it's expensive like yeah who wouldn't i agree i mean i think there's so many emotions that are brought up and i think it's it's it's it's it's it's it's it's it's it's it's it's like you said past trauma could be family could be another dental office could be a previous bad relationship it could be anything there's the the the limit on this does not exist i just think it's important for for everyone to know that this is a hundred percent valid we are not judging you especially if you're crying day of day after first week um it's okay it's okay

Part 851:51

and uh something i was just thinking of um when you were um discussing that is if anyone's ever ridden on a roller coaster with a kid or remember riding as a kid with an adult it's kind of like that moment where you say you know let's just say that you're the kid it's the patients are going through that moment where you are getting to the top or just on your way down and you're thinking i know i said i was 10 and i was a big kid and i know i was tall enough to be on this ride but i should not be here and you go through all that like there's nothing i can do and you're panicking and the person that's like watching over you is right there but they're not able to do anything for you and you're in this state and then you get through the ride and you're like that was the best thing i've ever done right oh yeah on the flip side the parent and i hate to be like a parent child like we're sitting there as a guardian of the patient but in a lot of ways it is as the parent taking a kid on that ride you're like i know they're freaking out i'm not gonna speak to it i know that they're mad that i talked them into this ride i'm not gonna speak to it i'm not gonna speak to it i'm not gonna speak to it i know that they think i'm i'm tall enough but what am i doing here and you know the panic that they're going through but then it is rewarding when you get to the end they get off and then they're like so proud of what they did and oh yeah so getting through that first initial fear dump on it as much as you want cry as much as you want we understand it's not we don't want to be dismissive of it it's gonna happen because the end of the ride is coming where you're gonna feel really proud of what you did yeah i i completely agree it's the build-up of the butterflies in your tummy when you're standing in line holding you know whoever's saying i mean everybody's got that this very similar experience i think um and it it can be frightening yeah but on the other side there's a picture there's a picture to be bought for 34.99 i agree i agree um i that's pretty much my questions i can't think of anything um i would say i'm really grateful that you brought up that pizza burn yeah i'm really glad that we touched on that that's not something i normally would touch on so there's so much to unpack yeah and all of this it seems at its heart a very simple thing it's something that we do every day it's questions that we answer every day that feels like it's been done over and over and over again um and there's so but there's so many like what ifs and hoods uh and coulds and shoulds and all of those that um you know that's what gives us content so i agree i agree i love it well thanks for chatting i'm really glad that we got the opportunity to do that again and touch on some of these things that you know hopefully help people understand that they're not so scary they can be normal and we'll get through it just because you don't think that they told you doesn't mean you can't get through it exactly or you can always call and ask yeah all right thanks everybody for watching thank you