• To prevent bleeding, bite down on the gauze for about 30 minutes after leaving the office. Oozing may still be expected for several hours. You may want to put a protective cover on your pillow tonight to prevent staining your pillowcase.
• Have your prescription filled on the way home and take one tablet as soon as you get home, following the dosage instructions on the label. If you feel nauseous, don't take any more tablets. Call our office.
• Take Ibuprofen (Motrin, Advil) or Naprosin (Aleve) pain relievers as soon as you get home; then take two tablets every four hours as needed or following label instructions.
• Use ice pack(s) to help swelling. Apply ice as soon as you get home, and alternate with periods of ten minutes on, then 10 minutes off for the first 24 hours if needed.
• Do not eat until anesthesia (numbness) wears off. After that, you may eat a soft diet as tolerated to keep up your nutrition.
• Do not drink alcoholic beverages for 2 days or while taking any prescribed medication.
• Do not smoke for 24 hours. Avoid heavy lifting, spitting, smoking, drinking through a straw, or carbonated beverages for 24-48 hours. These activities may cause the clot to dislodge, which can cause complications with healing.
• Rinsing Instructions. Do not rinse today. Tomorrow, begin rinsing your mouth with warm, slightly salted water (1 tsp to 6 oz. Warm water), five to ten times daily. Continue for several days or until your mouth feels comfortable. You may begin brushing again in this area when comfortable.
• Take it easy today. Tomorrow you can go back to any activities you like, as long as they don't make you uncomfortable. Today, take it nice and easy.

• To prevent bleeding,bite down on the gauze for about 30 minutes after leaving the office. Oozing may still be expected for several hours. You may want to put a protective cover on your pillow tonight to prevent staining your pillowcase.
• Take children’s Ibuprofen (Motrin, Advil) as soon as you get home; then take two tablets every four hours as needed following label instructions.
• Use ice pack(s) to help swelling. Apply ice as soon as you get home, and alternate with periods of ten minutes on, then 10 minutes off for the first 24 hours if needed.
• Do not eat until anesthesia (numbness) wears off. After that, you may eat a soft diet as tolerated to keep up your nutrition.
• Avoid heavy lifting, spitting, strenuous activities, drinking through a straw, or carbonated beverages (pop) for 24-48 hours. These activities may cause the clot to dislodge, which can cause complications with healing.
• Rinsing Instructions. Do not rinse today. Tomorrow, begin rinsing your mouth with warm, slightly salted water (1 tsp to 6 oz. Warm water), five to ten times daily. Continue for several days or until your mouth feels comfortable. You may begin brushing again in this area when comfortable.
• Take it easy today. Tomorrow you can go back to any activities you like, as long as they don't make you uncomfortable. Today, take it nice and easy.
• Special note to parents: Your child needs a few hours of special attention because of the dental anesthesia. He or she may bite his or her tongue or chew the inside of their cheek when the anesthetic wears off. Please take a little time to make sure this doesn't happen; otherwise it can really hurt later on. If you have any questions or problems, call our office.

Morning and Bedtime
1. Brush teeth and rinse mouth
2. Use ½ ounce (to fill line) and swish for 30 seconds
3. Do not eat or drink for 30 minutes

Possible temporary side effects
• Brown staining may appear on teeth which your hygienist will polish off.
• Foods may not taste quite as salty as they normally do but you should not add more salt.

• Brush teeth thoroughly, preferably after each meal or at least twice a day.
• Load gel into your bleaching tray, use a small drop per tooth.
• Then insert tray, adapt tray sides to teeth.
• Remove excess gel with soft toothbrush. Rinse twice; do not swallow rinses.
• Leave trays in for one hour twice day.
• Clean tray with soft brush and cool tap water. Store try in case provided.

Precautions:
• Store gel in the refrigerator. Keep gel out of heat/sunlight. Do not freeze
• Tooth colored fillings, veneers, and crowns do not respond to tooth breaching
• Foods and juices high in acid may cause sensitivity
• Do not use tobacco products or eat while bleaching
• Drinking pop especially cola may cause teeth to stain

1. Brush teeth and rinse mouth
2. Chew 1 tablet. Swish around for 30 seconds. Do not swallow. EXPECTORATE.
3. Rinse with water. The red color remaining on teeth indicates where harmful dental plaque was overlooked when brushing.
4. Thoroughly remove the DARK RED COLOR by brushing and flossing. The red color will slowly disappear from the tongue and mouth tissue after use.
5. Use periodically to monitor plaque removal.

1. Apply a pea sized amount of toothpaste to your toothbrush.
2. Brush thoroughly once daily for two minutes, preferably at bedtime.
3. Expectorate (spit out) after use.
4. For best results, do not eat, drink, or rinse for 30 minutes after brushing.

Precautions:
• Do not swallow excessive amounts of product
• Recommended for adults and children over 6 years of age

Oral Hygiene: Excellent oral hygiene is essential for complete healing after any periodontal therapy. Although you may notice signs of bleeding while brushing and flossing, continue with oral hygiene measures. As healing progresses the bleeding will gradually disappear. Brush three times a day and floss once. You may also use a mouth rinse such as Listerine or Crest Pro-Health once daily. It will be very important to continue hygiene maintenance appointments recommended by your Dental Professional. Failure to maintain your oral health may require this extensive treatment again.

Sensitivity: Tooth sensitivity can follow root planing and scaling due to tissue shrinkage. These teeth may be quite sensitive to cold, hot, and/or sweets. Sensitivity can be caused by exposure of the root area following healing of the gums. This sensitivity should diminish shortly. If this sensitivity persists please contact the office. Your hygienist or dentist will have recommendations to help the sensitivity.

Eating: If the area has been anesthetized, avoid eating until the numbness goes away. If extensive root planing and scaling on teeth with deep tartar has been performed, the patient may find it uncomfortable to chew hard foods for a few days. If tender to chew, you may switch to a softer diet for the next few days. Make sure the diet is still nutritionally balanced.

Discomfort: You may experience a minor degree of tissue soreness after root planing and scaling. The intensity or duration of this discomfort is dependent on the degree of inflammation that existed before the procedure. Discomfort usually subsides in a few hours, but could last up to 2-3 days. To help with the discomfort take Ibuprofen immediately following the procedure.

Bleeding: The amount and duration of postoperative bleeding after root plane and scale depends on the degree of tissue inflammation. Persistent bleeding is rare, although deep pockets or severely inflamed tissue may ooze. If persistent bleeding occurs, try rinsing with cold water. This will constrict the blood vessels and reduce blood flow to the area. If persistent bleeding does occur, please call our office.

There are several benefits to a dentist-prescribed whitening system.
- A bleaching system from your dental office is a prescription-strength material which will more effectively whiten your teeth.
- A dentist will also make custom trays designed to specifically fit your mouth. This makes sure the bleach material stays on the teeth only.
- Store-bought bleaching systems can leak onto your gums and cause damage. They may also be swallowed and cause problems with your digestive system.

You can whiten your teeth if you have previous dental work. However, fillings, crowns, and other dental work will not be affected by whitening, so as your teeth lighten in color, the previous dental work will stay the same color. This may mean you have to replace the restorations down the road to improve the cosmetic appearance. Sometimes, if the whitening is done carefully, previous dental work may still look fine.

We usually, but not always, recommend saving baby teeth until they would normally be replaced by permanent teeth for two reasons. Children need these teeth to properly chew their food and develop correct speech patterns. Children who lose baby teeth prematurely can develop speech problems, which may be difficult to correct later. Additionally, the primary teeth are holding space for the permanent teeth. Baby teeth lost early can cause adjacent teeth to shift, losing space needed for later-erupting permanent teeth. If this happens, the child's bite may need extensive orthodontics later. An uncorrected bite may eventually cause damage to permanent teeth or the supporting bone and gums. Early loss of permanent teeth may also occur. A poor occlusion (bite) can also cause later jaw pain.

Our office suggests a Fluoride treatment for adults as well as children. Fluoride is a proven, natural cavity fighter. The "topical" fluoride applied to teeth during dental visits is absorbed into the tooth structure strengthening the tooth. The dosage of Fluoride given in the dental office is prescription-strength, which is stronger than that found in toothpaste and other over the counter products, so it is more effective in preventing tooth decay and sensitivity.

Our office recommends x-rays based on individual needs. Some people with limited previous dental work or previous decay may not need x-rays as often as people who have had previous decay or restorations. We may recommend x-rays more often to detect problems early and correct the problems while they are small. Waiting can cause increased tooth damage, which weakens the tooth in the long term, leading to an increased need for extensive and costly dental work.

Persons needing dental restorations or replacement restorations should make an informed decision after speaking with their dentist. Silver fillings (amalgams) have been around for many decades and have proven to hold up long term. However, recent improvements in white or resin fillings have made them an option for dental restorations anywhere in the mouth, even in back teeth. Many people choose white fillings for an improved appearance of their smile. Others are concerned with the composition of materials in silver fillings, especially mercury. The mercury in silver fillings is minimized and much more controlled than silver fillings in the past. Our office will normally present cost options for both silver and white fillings. Dr. Wragge is comfortable placing both types of restorations and will give patients recommendations if he feels one type of filling will be more beneficial than another.

We are committed to providing you the best possible dental care. In order to continue keeping our fees as low as possible, full payment or estimated co-payment is expected at the time services are rendered unless other arrangements have been made with the business office in advance. We accept cash, checks, Visa, and Mastercard. For cases requiring a dental lab such as CROWNS, BRIDGES, PARTIALS and DENTURES, at least one half of the fee is due at the time of the impression and the balance at the time of placement. After 60 days, past due balances will accrue interest at 22.8% per year with a $2.50 monthly minimum.

We offer a 5% courtesy on services PAID IN FULL by cash or check the day of service, or in advance of services. If you have insurance, claims will be made for the reduced fee and benefits paid directly to the subscriber. We are unable to offer this courtesy to Blue Cross insurance subscribers because payment is made directly to the office with a PPO fee adjustment.

If you have dental insurance, we will gladly submit your claims and assist you with receiving reimbursement from your insurance company. Payment of your estimated portion is expected the day of service.

Investment in your dental health may require arrangements to extend payment over a period of time. Such an agreement must be made in advance with the business office and will take into account the total treatment fees, estimated insurance coverage, and the amount of time your treatment will cover. We encourage you to discuss your concerns with the business staff and will be happy to arrange a financial consultation, however, we are not a lending institution. As a small business, we cannot make long term or "indefinite" payment plans available. For patients with an established credit history in our office, we can offer short term payments. We also have a longer term outside financing plan available as a courtesy to help budget your dental care needs and make investing in your dental care more financially feasible. If an account is past due, it is the policy of Pierce Dental Office not to permit additional fees for service to accrue on the account. Should an unexpected financial situation affect prompt payment of your account, please contact us as soon as possible.

If you have dental insurance, as a courtesy, we will file your claims and are happy to assist you with receiving the correct reimbursement from your carrier. We must emphasize that as a dental care provider, our relationship is with YOU, not your insurance company. All charges are your responsibility from the date services are rendered. We expect payment for the co-pay and any amounts not covered on the day of service. If your benefits have not been paid within 30 days of service, it is your responsibility to contact your insurance carrier to determine the status of your claim.

If you have a problem receiving payment for a covered claim, contact us as soon as possible so we can work with you and your insurer to resolve the issue. Please let us know of any changes in your dental insurance information. Many companies have issued new employee identification numbers and no longer use Social Security numbers. Incorrect ID numbers may cause payment delays or claim denials.

We can submit a pre-treatment claim to help you determine coverage and estimate the benefit you have available. Estimated coverage amounts are approximate and not a guarantee of payment. Your specific plan may have deductibles, waiting periods, age restrictions, or coverage limitations for certain treatments. Any difference is your responsibility.

If you have DELTA DENTAL or another company that pays benefits to you, rather than to our office, we expect full payment at the time of service as if you have no insurance. We will still file your dental claims and assist with any claim problems. If you have a secondary insurance plan, you are responsible for filing your own secondary claims or providing us with an Explanation of Benefits so we can file with your secondary insurance provider. This also applies if you have other non-PPO insurance and elected to pay in full by cash or check to benefit from our 5% courtesy.

Generally our office chooses not to become a Participating Provider for insurance companies. Insurance companies work hard to promote dental offices to become PPOs and market this as a benefit to you, their customer. In reality, they often dictate what treatment our office can perform and limit the amount they will allow for needed treatment. We feel decisions about your dental care are best made between the patient and provider and feel our patients will benefit more by our not becoming a PPO. We accept all insurance plans and they will still pay a benefit for services provided at this office. Pierce Dental Office was a Participating Provider with Blue Cross Blue Shield of Nebraska when Dr. Wragge acquired the practice and will remain so at the present time. We are a Participating Provider with Ameritas Insurance.

Extended payment plans are available through Citi Health Cards for qualified applicants. You may apply at our office or online at www.healthcard.citicards.com.