Yuck Mouth! AKA Bad Breath!

The Plot

I was visiting an old high school friend few years back. He confided that he had a problem. For sure, the problem was personal. He knew that I was a dentist and a close friend. “Rob”, he said. “You’ve got to help me.” Sure Billy, I replied with a nod of seriousness. “Well” he reluctantly said. “My girlfriend’s breath really stinks so bad.”

Bad breath is like an onion. The process of eradicating it is like peeling away a layer at at time. Incidentally, there could be multiple simultaneously occurring sources.

Halitosis

What is halitosis? Halitosis, better known as Bad Breath, is essentially gas compounds released from bacteria. Moreover, these “smelly gas molecules” are called volatile sulfur compounds (VSC’s) . Indeed, the VSC’s is the rotten egg smell we abhor.

Sources of Halitosis

Halitosis has many sources. In general, there are three sources of origination of these VSC:

Oral Cavity-Mouth (80%)

By far, the most common source is the oral cavity. There are many factors related, that may come into play. They are as follows:

Poor dental hygiene

Periodontal disease

By far, this is a complex chronic condition. It effects the bone foundation of your teeth. Moreover, it’s a bacterial infection that attacks your jaw bones. However, when caught early, it’s easy to stop destructive progression. More importantly, most types of periodontal diseases are treated to a successful outcome.

Dental caries

Tobacco products

Dental infections

Dry mouth/ xerostomia

Go to my recent blog on xerostomia or see my YouTube Channel.

Certain Foods

Garlic and raw onions do it for me

Nasal Cavity -Maxillary Sinuses (10%)

post nasal drip

Sinus infection

Gastrointestinal-Stomach (10%)

Low Carb/High protein diets produce “ketone bodies”.

These “aromatic” keytone bodies are byproducts in the metabolic breakdown of the body’s stored fat.


Vitamin Supplements

Medications

Certain medications specifically those that contain nitrates as seen in blood pressure medications.

Acid Reflux

Chronic reflux of gastric acids (GERD).

Diagnosis/Treatment

Once the offending source is identified, education and treatment can be specifically focused on attacking it.

Locate- Kill- Neutralize

The approach to fresh breath can be simple. To begin with, locate the origin. Next, kill the bacteria. Afterwards, neutralize the VCR’s.

TIP:

Incidentally, a huge source of oral mal odor originates from the tongue. By the way, a real easy tip to do is scrape your tongue. Use a tongue scraper. In short, a lot of bacteria can lodge within the tongue’s top surface. In summation, a simple swipe of the tongue once a day in the morning will mechanically remove the bacteria. Finally, finish off with an alcohol free mouthwash. Alcohol free is important. As a final point, alcohol is an astringent. That is, it will dry your mouth. Furthermore, a dry mouth will promote more bacteria. Hence, more VCR’s.

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

Quadrant Dentistry

The One Visit Cosmetic Turn-Around

I routinely replace amalgam fillings for various reasons. For example, a restoration demands replacement due to a failing marginal seal. Particularly, others fail after many years of function due to simply being worn down. As a result, they just outlive their usefulness. Many patients are concerned about an amalgam’s chemical composition. Silver fillings consist of 50%mercury. Speaking about this, there is a legitimate concern of general health implications. By far, most patients want their silver fillings replaced because of esthetics. Indeed, silver fillings are just ugly.

The Process

With this in mind, I prefer to work on a quadrant at time. That’s to say: Upper right. Lower right. Upper left. Lower left. Quadrant dentistry is easy for me. Quadrant dentistry is a super process to replace a string of adjacent amalgams. By the same token, it’s easier for the patient and always fewer shots of local anesthetic. Thus, everybody likes that!

A “string of silver fillings” waiting to be evicted.

Treatment

For a start, one shot of anesthetic. Above all, I prefer to isolate the area with a rubber dam. Indeed, the is mutually beneficial. Even more, it protects you from me. My dental drill can be annoying to curious tongues. Regardless, the dam will catch any tooth and silver filling debris from being swallowed. Albeit a bit claustrophobic for some. Besides being cumbersome for myself to place correctly. Above all, it’s best when the opportunity presents itself.

Rubber Dam Isolation in place

Result

Filling replacement required about an hour’s time. Despite the dam’s isolation of “stretching” patients open, many patients actually appreciate it afterwards.

Lastly, the final restorations were tooth colored bonded composites. All teeth were restored to beautiful form. Furthermore, I expect many years of function.

Final Restorations 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

Frenum/Frenectomy?

What is a Frenum? (Pronounced “Free-num”)

A Frenum is a fold of tissue that connects the lip directly to gum tissue which usually contains strands of muscle tissue.

Where does a Frenum Exist in the Mouth?

They are in many areas. Just explore your mouth with your tongue! You can find a frenum attaching from the inner of the upper lip above the central incisors attaching to the gum. Similarly, you’ll find the same on the lower lip. In addition, another important frenum will be responsible for attaching the floor of your mouth to the base of your tongue. This is called the lingual frenum. Frenums can run great lengths of attachment to underlying tissue and vary in thickness.

Can a Frenum be a Problem?

Most of the time, frenums are not a problem. However, it depends.

What’s a Frenectomy?

That’s simple. For one thing, it involves a tiny bit of local anesthetic. Without delay in about 5 seconds the laser obliterates the tedious attachment. At an instant, all gone. Furthermore, no bleeding and no stitches. In a word, maybe an Advil later on during your day.

Laser Scalpel utilized for the deed.

Frenums and Newborns

For example, let’s examine a long frenum on a baby’s tongue. Notably for a newborn baby whose breastfeeding, a high lingual attached frenum can frustrate and impair the newborn’s ability to “latch on” to the mother. In this case, the tightly bound tongue is restricted from the mechanical suckling action for the baby. Subsequently, nourishment can be compromised.

Poor Baby……

Fenums and Orthodontics

Frenums can be problematic for the orthodontist if you want the gap in between your teeth closed. On the negative side, this thick muscle attachment is notorious for pulling and splaying front teeth apart. Consequently, I always advise to get your frenectomy BEFORE you begin your orthodontic treatment. Most importantly, this will potentially minimize the chances of the gap annoyingly reappearing post orthodontic completion. On the other hand, a frenum can be responsible for your iconic identity.

The Gorgeous Lauren Hutton, dare I say…..

Frenums and Periodontics

A high frenum attachment will pull the gingival attached tissue AWAY from your teeth further exacerbating gingival recession. Ouch! That hurts me just thinking about it. Consequently, gingival recession results in exposed roots. Thus, teeth will be more sensitive to cold temperatures.

Thick Frenum Attachment ( Before Laser )
After Laser

Note: the gum receding away (Before Laser)
(After Laser)

Frenums and Speech Impact

Verbal communication is paramount in life. If one is “tongue tied”, the complications of how that affliction can impact the social, emotional and general well being of the individual is staggering. It’s mind blowing. The thought of a simple zap with the laser swipe and how it could subsequently release a tenacious frenum. In the first place, elimination is simple. Secondly, it’s inexpensive. Of course, it’s nonthreatening. Likewise, it takes about 5 seconds. In the final analysis, it could have a profound impact. As a result, it’s life altering. In effect, a crippling speech impediment eliminated.

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 

What is a Sinus Intrusion?

The Consultation

Several years ago, a new patient presented for an implant consultation. The “spirit of the conversation” went something like this……..According to her, she was in desperate desire to chew again, on her right side. Her two previous dentists told her that in order for her to get the desired dental implant in the upper right side, she would need to get a full blown sinus lift procedure. She implored,” I don’t want that big surgery. The thought of it makes me cringe. My friend had it done and she was swollen for days. Can you help me?”  

My Introspective Thought

After that sincere plea for help it got me thinking about an alternative procedure being promoted at a dental seminar several months prior. I was thinking, rhetorically, can I do this for this beautiful lady? In brief, it was a minimally invasive procedure. Generally, I could potentially create sizable bone for the future implant. Lastly, there would be a minimal discomfort. After all, I wanted to help her. I had the motivation and glimmer of curiosity. In short, I said, “Let’s take a radiograph and I will see what I can do for you.”

The Lateral Wall Sinus Lift Procedure

A Lateral Wall Sinus Lift procedure is probably the most invasive procedure we execute in dentistry. Essentially, the dentist breaks into the maxillary sinus compartment with a drill, teases a thin delicate membrane off the floor of the fractured sinus and raises it, utilizing a set of specifically designed curved curettes. That’s to say, once the Synerderian membrane is gently displaced, cadaver bone is furthermore augmented to the newly created space to create a pseudo sinus floor. Subsequently, this augmented site provides the footing foundation for the future implant fixture. (I write about this in great detail in a previous blog. See “Sinus Lift” or visit my You Tube Channel Robert Emilio DDS & Associates, to witness the actual procedure live).

By the way, the implant can not be immediately placed until this new bone matures. Grafted bone needs to heal. Ordinarily, post operative swelling lasts about 3 days. Furthermore, this newly grafted bone can take up to six months to heal. Lastly, there’s a needed secondary surgery. Similarly, the implant must get inserted later on. Oh yes. Then there is an additional healing period of three months.

Evaluation & Discussion of the Cat Scan

To summarize, I said, “No problem”, with confidence. Furthermore, I continued on.”To begin with, how does it sound if I make a tiny incision and work thru a little tiny hole of 5.0 mm diameter? Next, I will then gently plunge saline water thru this little access hole to “push” the sinus membrane off the sinus floor. In short, it goes like this. Usually, one shot of local anesthetic is all that is needed. Incidentally, one small incision. So I then, push away the sinus membrane off the floor. Lastly, I will insert the bone graft and then finally, simultaneously, place the implant fixture. In short, does that sound agreeable? ” This is called a Sinus Intrusion Crestal Approach. To sum up, as I explained,” I can do it for you. I do it regularly(in my head)! Furthermore, book it today.”

Check it Out Live, If you Dare!

( You can see this procedure live on my You Tube Channel Robert Emilio DDS & Associates. Sinus Intrusion The Crestal Approach

Needless to say. She came in the other day for routine hygiene check. In conclusion, everything looked great. Likewise, see below radiographic progression

The Two Year Radiographic Follow Up

Pre Op Schematic. Tooth #3 Missing
Post Op. Fabulous Bone height achieved on Implant #3 (part of the bridge (#3-#5)

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

A Late Night Emergency. Ouch! The Split tooth.

Almost Gone……..

Notes for the day written up, jacket on, briskly heading out and almost at the exit door last night. “Where you going? Didn’t you look at the schedule?” Natalie, pulled me aside and said, “wait, we got an emergency.”

Emergency Radiograph

Bicuspid Tooth. Upper Right. A two rooted tooth split down the middle
Clinically fractured tooth. Almost split in 1/2. Ouch!

First of all, the patient had no idea how it happened. Furthermore, it just hurt real bad. Sharp pain upper right side. An incessant throbbing pulse originating from a single tooth. It seemed like the radiograph revealed no decay, although there was a very small amalgam filling. Clinically, it was grotesquely obvious. I did not need my high powered eyeglasses. There was a rude fracture running front to back through the tooth. Subsequently, Dr Swanson and myself concluded that the tooth had to go.

Restorative Options

Unfortunately, an extraction was only treatment “option”. Likewise, restorative options were limited. The No tooth option was discussed. In contrast, the patient was reluctant to be toothless. The dread of a removable partial appliance was not desired either. For that reason, the only non removable options were either a bridge or an implant. Certainly the cemented “fixed” bridge option was discussed, but we’d have to section off and further extend a perfectly healthy, functional, existing bridge anterior to this hopeless tooth. It seemed obvious. Almost instantly we agreed. He said,”Let’s do what we did several years ago; another implant.”

Treatment

The Immediate Implant was opted

Surgical Removal of fractured Tooth

Above all, local anesthetic consisting of 2% Lidocaine was delivered by Dr. Swanson. Subsequently, I surgically removed the tooth in total in an uneventful manner.

This tooth was split all the way down to the trunk aspect. Very difficult to do.

The immediate Implant Placed

Hence, a (4.1 x 12mm) Straumann BLT Dental Implant was immediately placed by me in replacement/substitute of his hopeless tooth.

Bone Graft and Collagen Barrier Placed

In addition, I carefully grafted cadaver donated bone material to fill the remaining “empty space” ie, socket void. Finally, I like to layer a bio-resorbable collagen barrier over the graft to direct the maturation of the new gingival growth. This is called a Guided Bone Regeneration Technique (GBR). I really enjoyed demonstrating the nuance of this technique to Dr. Swanson. Dr Swanson is currently enrolled in a prestigious Implant training Program in Florida. In addition to working full time here at the practice, she’s a full time mom. Way To Go Collisha!

Implant Placed in lieu of removed fracture tooth
Grafted and Barrier in Place prior to closure
Implant Placed in it’s proper position in solid bone.

Conclusion and Analysis

Hence, 7:30 PM presented a perfect opportunity for an immediate implant. The tooth area was free from underlying infection due to the timing of the acute injury. This patient was a non smoker; therefore extremely healthy with no underlying metabolic disease. His bone quality and quantity was ideal.

The most obvious advantage of the immediate implant is my ability to preserve bone integrity and “fake the body out”. The seamless switching a natural root for a man made one(implant) is a nifty trick. We know that loss of a tooth cascades into an immediate and rapid dissolution of surrounding bone structure. Therefore, it’s imperative to replace a tooth immediately, when one can, to minimize future degenerative changes.

Actually, his timing couldn’t have been better, for an expected excellent outcome. It would seem that immediate access to me was critical. Certainly, it was the end of a long day. The thought making a positive impact in my patients’ life is what energized my enthusiasm to do the right thing. Emergencies, as such, are untimely. Rather, this is the nature of my job. It appears that I am always on call. Who would of thought? I am a dentist not a medical doctor? LOL. I love what I do and it seems that it really is not work when you are doing what you love to do any time of the day/night.

It would have been easy for me to dismiss the patient with a prescription and a reappointment. Time with the onset of the inevitable acute infection would have transpired within a short time if the tooth was not immediately extracted limiting our restorative options further. Most note worthy, we did what we had to do to get the job done. Consequently we ultimately provided a tremendous service to another great patient.

As a result, in 3 months, the implant will be restored by Dr.Swanson to function with a perfectly functional crown.

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