Do I need to Premedicate anymore?

I graduated Columbia’s School of Dental & Oral Surgery  in 1994. At the time, the consensus recommendation established by the medical community was such that, “anyone who had a heart murmur should be premedicated prior to their dental visit, for life!”

As a matter of fact, the accepted protocol for dental premedication was a whopping mouthful—- 3.0 grams (6 x 500 milligrams pills) one hour prior to a dental appointment and then 1.5 grams (3 x 500 milligrams) eight hours after the initial dose.  To say nothing of the stomach upset………

Why should I premedicate? What is the thought behind premedication?

The thought behind premedication is based on transmission of bacteria. By the same token, transplanted bacteria from the mouth can act as a source of infection in another part of the body. Moreover, a simple local anesthetic needle puncture in the mouth can transport it from the cesspool of the mouth into the patient’s bloodstream. This bacterium, transported mechanically, would then be free to stroll the corridors of blood vessels. It can then nefariously deposit itself onto an already troubled heart valve or bionic prosthetic joint. To that end, it “sets up shop” and initiates a destructive process of tissue destruction. Subsequently, the patient can incur a shredded heart valve or a diseased prosthetic joint. Antibiotic premedication blasts those pesky bacterium dead. Essentially, the antibiotic blast creates a temporary sterile environment. Therefore, premedication offers a lesser potential for tissue damage.

Then and Now…….

The literature is all over the place.

Antibiotic prophylaxis is recommended for a small number of people who have specific heart conditions. The American Heart Association has guidelines identifying people who should take antibiotics prior to dental care. According to these guidelines, antibiotic prophylaxis should be considered for people with:

  • Artificial heart valves. 
  • A history of an infection of the lining of the heart or heart valves known as infective endocarditis, an uncommon but life-threatening infection. 
  • A heart transplant in which a problem develops with one of the valves inside the heart. 
  • Heart conditions that are present from birth, such as: 
    • Unrepaired cyanotic congenital heart disease, including people with palliative shunts and conduit. 
    • Defects repaired with a prosthetic material or device—whether placed by surgery or catheter intervention—during the first six months after repair.
    • Cases in which a heart defect has been repaired, but a residual defect remains at the site or adjacent to the site of the prosthetic patch or prosthetic device used for the repair. 

In addition, Artificial joint replacement premedication protocol is just as ambiguous. You can find conflicting literature all over the web. It’s best to speak to your orthopedic doctor for clarity on their personal guidelines.

I have my own opinions about premedication. I look forward to expanding on my ideas on my upcoming video release this weekend on my You Tube Channel. Stay tuned :

You Tube Channel. Robert Emilio DDS & Associates

Dr. Emilio & Associates,  Always Accepts  New Patients. He especially exceeds at treating same day emergencies patients suffering from tooth ache pains.

His goal is to keep his patients’ Teeth and Gums Healthy For Life.

Feel Free to appoint a Consultation with the Doctor. Open Six Days A Week

OPEN on Weekdays.  7:30am -8:00pm  (M<T<W<T)

Fridays.  7:30am-2:00pm

Weekends (Saturday only).  8:00am-2:00pm

111 East Avenue, Norwalk, Connecticut 06851.

You can always contact me directly via email  blog@robertemiliodds.com

You Tube : Robert Emilio DDS & Associates 

Instagram:  dentist_in_connecticut

Office (203)866-7164      www.robertemiliodds.com

Keto Breath

Summer is Coming!

The bright yellow bloom of the Forsythia signals the eventuality of Spring. To say nothing, we experienced a mild winter; not too much snow and ice. I am thankful. By the same token, warm weather is coming. In like manner, last year’s bathing suits must fit this year.

Now is a Great time to start losing some weight.

As a matter of fact, my wife and I decided to hit the gym more frequently and follow the Keto Diet

The Keto Diet:

Basically, one must eat foods of “low to no carbohydrates” and those high in fat. It will be almost a living hell for me. I love my wine, bread, pasta and french fries. Oh well, the sacrifices for a thinner existence……

In the Ketogenic Diet, your body burns up existing fat stores for energy. Once you’ve depleted your glucose stores from your last no carb meal, ketosis takes over. Your body eats your belly fat for energy, and as a result, you get skinny. 

In effect, stored bodily fats get converted into ketones, which are natural chemical by-products from from the fat burn metabolic process. These harmless “ketone bodies” include beta hydroxybutyrate, acetoacetate, and acetone. In brief, ketone bodies get released via urination and exhaled away thru respiration. Your significant others will interpret that as Bad Breath…. On the other hand, stinky breath is an indicator that you’ve entered ketosis and that you are on your way to fitting into those skinny jeans.

Since acetone is an ingredient in nail polishes, your breath smelling like nail polish remover will indicate a state of ketosis.

For the most part, the stinky breath usually lasts for a couple of days. The important thing to remember is that it occurs in the initial onset of the diet and slowly diminishes with time.

I plan to minimize my anticipated Keto Breath in the following ways:

1-I will drink more water.

Similarly along with exhalation, your body flushes acetone and ketones from your system through urination. As a result, staying hydrated dilutes and helps flush away ketones.

2. As always, I will practice good oral hygiene.

For example, I plan on brushing my tongue and teeth at least three times a day. Moreover, doing this will minimize the overall bad breath scene.

3. I will mask the odor with mints and gum.

Indeed, I’ve got these fabulous licorice sugar free mints that I plan on using during the course of the day.

4. I’m not a martyr. I will occasionally pump up my carb intake with Scotch and Champagne.

Scotch has no carbs. Slightly increasing your carbohydrate intake can also eliminate keto breath. Champagne has very little carbs. By all means, I purchased a 1/2 case of bubbly in preparation. Note: I do want to remain in a state of ketosis. I only will increase my daily amount of carbohydrates by a small amount.

Dr. Emilio & Associates,  Always Accepts  New Patients. He especially exceeds at treating same day emergencies patients suffering from tooth ache pains.

His goal is to keep his patients’ Teeth and Gums Healthy For Life.

Feel Free to appoint a Consultation with the Doctor. Open Six Days A Week

OPEN on Weekdays.  7:30am -8:00pm  (M<T<W<T)

Fridays.  7:30am-2:00pm

Weekends (Saturday only).  8:00am-2:00pm

111 East Avenue, Norwalk, Connecticut 06851.

You can always contact me directly via email  blog@robertemiliodds.com

You Tube : Robert Emilio DDS & Associates 

Instagram:  dentist_in_connecticut

Office (203)866-7164      www.robertemiliodds.com


Think Twice before you reach for that Energy Drink.

Think Before You Drink!

The Exam

Most recently, a “20 year old or something” patient presented with a chief complaint of pain, “Doc, I’ve got major tooth aches all over the place.”

To say nothing, on initial glance, many of this patient’s teeth appeared to be broken down. Clinical exam revealed multiple cavities. Not to mention, varying degrees of severe wear. In like manner, tooth cusps were dissolved away. Moreover, the chewing aspect of his teeth were flat. I had almost never seen that amount of worn down tooth in a person, especially not in their 20’s. In the same fashion, the sides of his teeth were pitted and punctured. Above all, radiographs were taken and reviewed. With findings in mind, the conversation was had. I had to determine if there were: para-functional habits, maybe possible acid reflux issues and questionable dietary issues. In view of findings, I confirmed the diagnosis.

I NOTED DENTAL CARIEs EVERYWHERe…… “It was a crime scene in there”

Seeing is believing. I can’t verbally describe the scope of tooth breakdown. To that end, a few words come to mind: Relentless. Destructive. Corrosive.

Notably, further conversation with the patient revealed a history of 1-2 Energy Drinks per day for the past four years. Red Bull was his favorite beverage during college,,,,,,,, besides beer.

What makes Red Bull so Bad for your teeth?

Red Bull ingredients are toxic. To point out, highly acidic and carcinogenic.

  • CAFFEINE
  • TAURINE–Taurine is an amino acid better known as amino sulfonic acid. Very acidic @pH = 4.1-5.6 (5% aqueous solution) .
  • B-GROUP VITAMINS
  • ASPARTAME & ACESULFAME (This is bad stuff)
  • ALPINE WATER

The Red Bull Experiment.

So I did the math……. Let’s say, it takes 5 minutes to drink a can of Red Bull. Not to mention, you are probably not brushing your teeth afterwards. Moreover, the Red Bull is lingering around in your mouth for 10 minutes after you finished the can. To put it differently, your oral cavity is helplessly exposed to the Red Bull drink for 15 minutes/can. With this in mind, a two cans per day habit translates into a 30 minutes of Red Bull acidic bath per day.

Thus, in the name of science. Firstly, I placed two freshly extracted non-decayed teeth into two separate baths. One extracted tooth (the standard) was placed in a bath of plain tap water and the other in a bath of Red Bull Energy Drink. Next, I left them undisturbed, covered in the shade for thirty days.

Minutes in a day calculation. One day has 24 hours, one hour has 60 minutes, so: 1 day = (24 hours/day) × (60 minutes/hour) = 1440 minutes/day …

In effect, 1440 minutes/day X 30 days of Red Bull Bath = A total of 43,200 minutes that the experimental tooth was subjected to Red Bull Bath.

To put it a another way, that’s a two can habit for 1440 days or for almost 4 years.

A picture is Worth A thousand Words!

This experiment simulates a “two can per day” habit for almost four years..

Extracted the same day and from same patient. The Tooth in left of the image was subjected to the Red Bull Bath. The Tooth in the right of the image was in the water bath.
Red Bull Victim………That’s big hole!

Observations/Conclusion:

As can be seen by the above. In brief, there’s not much to say. In essence, the tooth in comparison was dissolved, weakened, fragile and hopeless to restore.

To summarize. It’s bad stuff for your teeth. Moreover, something more profound should be apparent. To clarify, if Red Bull can destroy the elements of the hardest known tissue in your body; enamel. Just imagine what it can do your internal organ systems……

Credits:

Dr. Emilio & Associates,  Always Accepts  New Patients. He especially exceeds at treating same day emergencies patients suffering from tooth ache pains.

His goal is to keep his patients’ Teeth and Gums Healthy For Life.

Feel Free to appoint a Consultation with the Doctor. Open Six Days A Week

OPEN on Weekdays.  7:30am -8:00pm  (M<T<W<T)

Fridays.  7:30am-2:00pm

Weekends (Saturday only).  8:00am-2:00pm

111 East Avenue, Norwalk, Connecticut 06851.

You can always contact me directly via email  blog@robertemiliodds.com

You Tube : Robert Emilio DDS & Associates 

Instagram:  dentist_in_connecticut

Office (203)866-7164      www.robertemiliodds.com

A Big Thank You To My Lab Guy, Jimmy over at Nyberg Dental Lab

The Challenge

So often, cosmetic challenges may present. By the same token they can be beyond my technical abilities to troubleshoot directly due to lack of chair side material choices. In fact, I can always creatively envision a final outcome in my mind’s eye. The problem is that I may not have the tools and materials to deliver it right there on the spot on my office. CEREC has it’s limitations. At times, I will refer challenging cases to my local lab technician, Jimmy. The guy has a shop right down the street. Lucky me!

The Front Teeth

By all means, front teeth are animals. Particularly vicious. Specifically demanding and ultimately defining of a smile. Thus, they have to be right. For this reason, esthetics are driven by obvious factors: color, shape, size, proportion to adjacent teeth, and over all balance in harmony with the full smile. Some people just don’t care about their front teeth.

“It’s just a tooth.”

or My favorite,

“Who can see it anyway?”, I often hear.

My facial expression on hearing these bizarre statements is usually of incredulity.

My response usually goes like this, “That’s okay, but let me try to make it as perfect as possible.” This is a request to satiate my selfish quest for satisfaction. I always say in my office ,“God gave you the best.” However, with that being said . “Give me a shot. I like to be competitive.” That’s the passion. That’s the drive to make things interesting at my office everyday.

The Unsung Hero; The Lab Guy and his Shade guide

I very much appreciate when my lab guy comes in for the assist. In the first place, a single tooth can have multiple shades and physical attributes. Not to mention, it can look different in different lighting. Oh yeah….. What kind of light is shining on that tooth? Could it be natural sunlight, fluorescence light, or incandescence light? As a matter of fact, teeth can have “patches” of shades within a shade. In addition, there can be little lines running in various directions. These lines are called craze lines. Also, teeth can be very shinny or very dull upon light hitting them. In addition, a tooth can be square, ovoid or flat in profile. Unfortunately, shades of teeth do not always like to cooperate with my standard chairside shade guide or materials.

Sometimes we may need a custom blend of shades, a talented technician and a bit of imagination before we can realize “the one”.

Hence, my lab guy and friend, Jimmy from Nyberg Labs, sees all that stuff we take for granted in the makings of a tooth, for which I am very much thankful.

I placed the implant

Jimmy made the restoration

Credits:

Dr. Emilio & Associates,  Always Accepts  New Patients. He especially exceeds at treating same day emergencies patients suffering from tooth ache pains.

His goal is to keep his patients’ Teeth and Gums Healthy For Life.

Feel Free to appoint a Consultation with the Doctor. Open Six Days A Week

OPEN on Weekdays.  7:30am -8:00pm  (M<T<W<T)

Fridays.  7:30am-2:00pm

Weekends (Saturday only).  8:00am-2:00pm

111 East Avenue, Norwalk, Connecticut 06851.

You can always contact me directly via email  blog@robertemiliodds.com

You Tube : Robert Emilio DDS & Associates 

Instagram:  dentist_in_connecticut

Office (203)866-7164      www.robertemiliodds.com

Pass this Link to Your Friends:  robertemilioddsblog.wordpress.com

You Don’t Have To Leave Without a Front Tooth

Fractured root underneath an old crown

This Happened today……….

After Hearing The Bad News

It was determined that his tooth was hopelessly fractured. Unfixable. In fact, non restorable. With this in mind, all options for tooth replacement were discussed. The patient was adamant . He stated forcefully, “I do not want to leave here without a tooth and I do not want a flipper .”

The Plan

“Kill Two Birds with One Stone”

my Thought process

Foremost the best strategy, was to make the patient happy by fulfilling his expectations by the end of the visit. A fixed tooth in place was what he wanted. In this case, my plan was to extract the fractured tooth and simultaneously ,”fix the color” of his adjacent teeth.

That’s to say, we were going to do some cosmetic dentistry in addition to oral surgery today.

Ultimately, once the extraction site completely healed in several weeks, I would install the permanent restorations. To put in another way, a “3” unit ceramic bridge over the extraction site and two individual crowns of the adjacent teeth.

In short, kill two birds with one shot of anesthetic…….

The Flow of Today’s Appointment

“Firm in principle and Flexible in Procedure”

The Discussion

No Doubt, the tooth had to come out. By all means, it was fractured beyond repair. Absolutely, I would have loved to place an immediate implant, but the patient just wanted to leave with a tooth in place. An immediate implant to the site would have been a bit risky in the sense that, I could not guarantee that I would have been able to place an immediate crown on the implant on this same very visit. There are many factors that play on making the decision of immediate implant placement versus delayed implant placement. This was the best option for the patient because he wanted a definitive immediate tooth. In addition, he received a cosmetic benefit of all ceramic crowns on the adjacent teeth.

At the end of the visit, the patient went on to his very happy merry way with a fixed temporary bridge of a refreshing shade.
He will return in several weeks for a digital impression and subsequent final ceramic crowns. Today’s visit took on shot of Lidocaine and One Hour’s time.
pre-op.
Fractured lateral central incisor
Plastic temporary in place after extraction of fractured root
Close up of area with temporary in place

Credits

Dr. Emilio & Associates,  Always Accepts  New Patients. He especially exceeds at treating same day emergencies patients suffering from tooth ache pains.

His goal is to keep his patients’ Teeth and Gums Healthy For Life.

Feel Free to appoint a Consultation with the Doctor. Open Six Days A Week

OPEN on Weekdays.  7:30am -8:00pm  (M<T<W<T)

Fridays.  7:30am-2:00pm

Weekends (Saturday only).  8:00am-2:00pm

111 East Avenue, Norwalk, Connecticut 06851.

You can always contact me directly via email  blog@robertemiliodds.com

You Tube : Robert Emilio DDS & Associates 

Instagram:  dentist_in_connecticut

Office (203)866-7164      www.robertemiliodds.com

Pass this Link to Your Friends:  robertemilioddsblog.wordpress.com