OMG. Be Careful. It’s Killing Me!

The New Patient Introduction

A new patient, female of middle age, came in today complaining of excruciating pain emanating from the internal aspect of her lower lip. The first and only thing she said with urgency, was not Hello. Instead, in brief, “Be careful. It’s killing me. My lip is on fire. It must be an abscess or worse.” In light of the urgency, I dispensed with the formalities of the introduction.

Evaluation

Visual inspection of the area took me all of 2 seconds to make the diagnosis. The teeth were fine in the area, moreover, no obvious decay. No need for the routine radiograph. Oh yeah. It was bad. No joke. Very bad. Raised and fire engine red in outline. Not to mention the yellow jellylike cratered center in form. Yes, very painful to experience. I rarely get them. Equally important, my wife suffers with them and is at their mercy.

Diagnosis

In the final analysis, Aphthous Ulcer/ A.K.A. Canker Sore

Who/What/When/Where/Why

Location/size

Canker sores are NOT the same as cold sore ulcers. In fact, canker sore ulcerations develop in the non keratinized tissues of your mouth. Moreover, they are observed in the movable cheek areas (base of your gums, soft palate, under your tongue and inner lips).

Most canker sores uniquely are outlined in red with a yellow core, oval in shape, very painful because of the inherent movable tissues they are imbedded in.

Causes:

Who knows? Viral in nature perhaps? Its probably related to STRESS….. Stress, of course presents in many aspects. I frequently see patients present with canker sores this time of year especially when life gets hectic, Cold weather, change in season, lack of sleep, subtle exposure to irritating viruses, Christmas gift bills to pay, poor diet…. It’s a cumulative series of stressful events that culminate with a manifestation of ulcerations of the mouth.

NOTE: I have personally experienced the onset of aphthous ulcerations with the use of a certain toothpaste.

Who gets them?

Mostly women and teenagers contract canker sores. They are not contagious.

Foods To Avoid?

Canker sores may be brought on by certain acidic foods such as pineapple, grapefruit and oranges.

Duration:

12-14 days from onset time.

Treatment:

In the final analysis, nothing really. Get some stress relief. Yoga? Hit a heavy bag? T.M.?

If there is really BAD pain, I can help. When quality of life is severely compromised, I can always write a prescription (like our Friend who presented as a new patient today) for Magic Mouthwash. I request the pharmacist to make a concoction rinse that has a combination of three components in equal parts: Benedryl, Malox and Viscous 2%Lidocaine. I generally require patients to utilize this mixture as a rinse and expectorate as needed for pain relief.

There is some literature that taking a daily amino acid supplement of Beta Lysine may prevent the formation of the ulceration.

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

My goal is to keep my 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 

Why Do My Teeth Feel Sensitive?

The Story

My second patient of the day was complaining of tooth sensitivity. “It’s up there, up there on the left top, some place. When I drink cold water, it bothers me”, as she pointed upward towards my ceiling with vague clarity.

The Evaluation

During my clinical exam with my trusty explorer instrument, I ticked off my mental checklist. Exam revealed nothing out of the ordinary for this 40 year old individual. Existing fillings looked good and sealed, no cracks in the enamel of the teeth. No obvious decay. Some wear of cusps. Recession of the gums on the molar was noted. The radiograph showed nothing obvious, otherwise boring.

The Subsequent Questions I asked of my patient and my Silent Mental Response (S.M.R.) was as follows:

Q: First of all, does it hurt when you chew,,,,, just straight up and down?

A: No

S.M.R. : Good. Hence, no dying nerve requiring a root canal procedure. When a tooth’s nerve is in the early stage of dying, it swells within the pulp chamber. As a result, the tooth “pushes” itself out of the tooth’s socket only the slightest bit. Consequently, when one bites straight down on the tooth, the bruised pulp nerve with its surrounding supporting tissues get compressed. This is interpreted as, “pain on chew”. Combine chewing pain with cold sensitivity that means root canal.

Q: Similarly, Does it hurt when you chew side to side?

A: No

S.M.R. : Good. Not a fractured tooth or a fractured restoration. Either fracture would illicit the same cold sensitivity. A fractured anything, most noteworthy, allows a wicking of cold liquid within the seam of the fracture. The cold liquid gets intimately close to the sensing nerve when it is drawn thru the crack. As a result, one can feel the cold temps..

Q: Does the cold linger or does it shoot away very quickly?

A: Quickly

S.M.R. : Very Good. A healthy nerve will respond quickly and rapidly dissipate in response when the stimuli is removed ( in this case- cold water is swallowed).

The Diagnosis:

I said, “Hmmm , X-ray looks good. No decay noted radiographically. The nerve is healthy. No cracks anywhere. Some recession of the gum line of those teeth. I’m not a mind reader and it’s difficult for you to pin down which tooth……It seems like recession of the gums sensitivity. Go with the over the counter for sensitive teeth stuff and go easy on the brushing!”

The 411

A tooth’s root is poros. Within these microscopic pores, lie extended from the pulp core, tiny nerve fibers suspended in a gelatinous sea. These fibers reach out to the surface of the root and are in a direct communication with the outside world. Toothpaste for Sensitive Teeth formulas essentially are toothpastes containing microscopic boulder elements that are sized exactly to plug perfectly into the dentin pores. These microscopic pores thereby, in effect, are closed “off” isolating the nerve fiber denticles from the outside world. Subsequently, you and I interpret that effect as— O.M.G, no more pain when we drink cold water. In effect, a mechanical barrier is created (sort of like Trump’s proposed border wall). Application of this toothpaste over time creates layer upon layer of pore closings with the desired effect of less and less cold sensitivity.

Other Causes Of Cold Sensitivity :

As mentioned previously above

Aggressive brushing, decay, cracked tooth and/or a cracked dental restoration

Acidic Foods

Tooth Grinding

Tooth Whitening Toothpaste

Recent dental work

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 

Does Charcoal Toothpaste Work?

The Setting

Last night, my wife and I were invited for dinner at a dear friend’s house. The occasion was nothing other than a post holiday chill evening. We had a fabulous time reminiscing enjoying excellent food, great wine and light conversation. “Kimberly you have a dazzling white smile” my wife said, admiring in awe . “It’s the charcoal toothpaste”, Kimberly replied. ” I just brush it on and leave it there for a bit, then brush off .”

I’ve got to admit, Kim’s teeth were very white but not just white: they were an opulent natural white. I was thinking that perhaps I should further investigate this magical dentrifice.

The Research

Charcoal is everywhere. It’s incorporated into a range of products from cosmetic facial astringents to supplemental pills for colon cleansing. Essentially, think of the charcoal molecule as a large porous sponge molecule that is capable of straining smaller microscopic particles through a physical exchange of motion. In other words, as particle ridden fluid washes through the bigger charcoal (sponge) molecule, they get trapped or absorbed within the physically convoluted configuration of the charcoal molecule. This thereby allows the fluid carrying the tiny debris to exit the larger charcoal molecule clear and debris free because the smaller caustic debris was trapped behind within the charcoal molecule.

The Test and Results

Charcoal powder on a wet toothbrush and brushed regularly.One time for about 60 seconds.

Before…..Not Too Bad…
Give me a Kiss
After One minute brush application

Conclusion

Charcoal product does not whiten teeth. It just removes the surface stains exposing the underlying natural luster of nature’s best. 

The Charcoal is just another abrasive cleanser , albeit organic, when it’s on the end of a toothbrush.

There is No fresh tingly taste to the charcoal product. In fact, there is NO TASTE.

There was no sensitivity in the application or post application of the charcoal paste. Many people suffer from tooth sensitivity to cold temperatures soon after at home or professional tooth whitening. However, charcoal toothpaste may be a nice simple organic measure to lighten up without the hassle of that dreaded tooth pain post whitening.

It made a big mess in the bathroom vanity. Be prepared for a cleanup of your work area. Keep paper towels nearby for the cleanup. Most importantly, the mess may be worth the result!

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

Instagram:  dentist_in_connecticut

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

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

What Color Do You Want?

The Story

A new patient in her 60’s came in today with a broken piece of her tooth in a mini zip lock baggie. She was really bent out of shape. “Not another tooth….I can’t lose another tooth “, she frantically screeched.

The Evaluation

She sat uncomfortably in the chair, when I said,”smile”. With a slight demure hesitation she released her puckered lips and showed the faintest smile. It was her upper left first bicuspid that suffered a shattering. The tooth was within her esthetic zone (it showed BIG when she smiled). She reported no pain or temperature sensitivity. “Those damm almonds”, she said (you can read about that one in one of me previous blogs).  I quickly instructed my assistant to take an X-ray, but deep inside I knew before evaluating the digital radiograph, that she was keeping the tooth based upon her clinical symptoms. In my head, I knew with my technical talent and technology that I could save the remains of her tooth and her, the torment of another extraction, but that was not the problem. What freakin color do I go with? That was the biggest problem…….

Fractured First Bicuspid

The Assessment

Radiographic confirmed that the overall remaining  tooth structure  was sound and No Problem for me to restore. 

The Plan

I told her that I could save the tooth easily with the CEREC technology. One visit crown. Done! I then asked the question, “What color do want?

The Discussion/Options: The Following are only THOUGHTS  that go through my head when faced with the complexity of tooth shade selection.

Option #1  Do I match the pre-existing previously selected  dentistry tooth shade?

1a

This is always preferred. On the other hand, what if there is no other pre-existing dentistry? This may be the patient’s first crown. How about, what if the patient has tetracycline stained “ribboned colored” teeth from taking antibiotics as child? I have never met a patient who loved their wrecked enamel dark stained teeth.

or

1B

What if all the pre-existing crown dentistry  was simply mis-matched? A classic checkerboard smile. It’s my experience, when it comes to color that some patients just don’t care…. “Ahhh doc, it’s a back tooth. Who’s going to look back there anyway?” A patient may have many dentists over a life time. For instance, different lighting in operatory rooms will offer different shading. Some days may not offer the benefit of natural lighting for optimal tooth shade selection. Incidentally, some dentists are just bad at color selection. I have multiple assistants come to a consensus to pick color for dental work. They are experts at that.

Option #2  Do I CREATE a new potential tooth shade Standard?

Do I say to the patient,”Get rid of that  corn cobb yellow.  Just screw it! Go for those bright white teeth that you always wanted. Now is the time to commit. Let’s do them all!” (some what exaggerated perhaps)

Option #3  Do I keep everything the same and custom shade and blend ceramics?

This option requires multiple visits and time. Many returns back and forth to a specialized local laboratory sculpted by my kind, patient, valium induced ceramist.

ANSWER: Not for me to decide. I’ll give you all the options. They are your teeth, your body. Your Choice.

The End Result

Restored tooth via CEREC Crown

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

Instagram:  dentist_in_connecticut

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

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

Why Can Dentistry Fail?

Dentistry

A Quick Story about a Failure

Several days ago, I had recall a 70 year old female patient several months ago who came in for a recall visit since her last recall visit 5 months ago. Five months ago, in the hygiene room, it was determined that she had a massive implant failure in the upper left quadrant of her mouth. Three teeth on two implants were failing. There was a tremendous amount of bone that just disappeared over a period of 6 months. She had no pain or symptoms. The amount of bone destruction was radiographically staggering. The only choice was for me to remove the implants and curette the site clean. Soon after the procedure, I had a “sit down” follow-up with the patient. Nothing made sense to me. Medical history was clear. Her home care was excellent, recall great, implants not fractured, lab work looked awesome…”why the failure?” , I asked myself.

I asked the patient, “when was the last time you went for a medical check-up?” She replied, that she did not remember the last time. I suggested to start there.

Upon follow up with her PCP, it was determined that she had never gone for a colonoscopy. The GI doctor found a 5 centimeter cancerous mass in her colon with minimal metastasis. She had subsequently had the resection surgery and chemo. All was back to normal 5 months later. She currently feels great( the same prior to surgery) and we plan to replace those implants in 2020.

The Practice of Dentistry

The practice of dentistry involves, technical ability, artistic vision, emotional empathy and constant troubleshooting  of the most esoteric situations. Dentistry is 95% predictable. Technical materials and delivery systems have greatly improve over the decades. However, with that being said, not every filling, root canal or implant is a success.Why?????? I would like to think we as Dentists are only as good as our materials, but it’s much more.

Dentistry fails for either One of            Three Reasons.

First reason for failure and most common. The patient neglects home care and professional prophylaxis maintenance with routine check ups. This is tacit. You got to show up. I can catch something when it’s small,  easy and inexpensive to fix.

Second reason, “Ugh. I’m having a bad day.” The least probable and thankfully, usually not the case. We are imperfect beings working on other imperfect beings hammering away at a microscopic problem with macroscopic instruments in a sea of emotional conflict saddled from previous dental experiences. I approach work everyday enthusiastic, rested and prepared. I love being a dentist.

The third reason for failure is third party associated. For example, an out sourced local laboratory technician mis stepping in model preparation or just not reading a lab slip correctly. Sometimes their technical abilities are stretched and they may often struggle with their own limitations.

My solutions are as follows:

We have a strong recall program in the office. Eight hygienists full time by 2019. The hygienists are up to date with C.E. training and are always free to suggest their opinions on how to improve their care. Approaches to prevention and elimination of periodontal disease and peri-implant related diseases is always being updated with the most current findings.

I eagerly await to acquire more advanced educational training and knowledge. So far, I have scheduled  three dental seminars for 2019. This upcoming year, I am on track acquire 50 more C.E. hours to achieve my Full Diplomat with the I.C.O.I..  This  drive to learn more and apply fuels my passion. Everyday is my first day at work.

Third party outsourcing has been limiting over the years. I currently create 90% of my dental work via the CEREC in house lab CAD/CAM and milling unit.This control ultimately insures a better product for you. The Dental Laboratory as I knew it, will be no more. The great Old school technicians are a dying breed,  and  sadly shall be never more.

The 5% Stress

What about the other 5%? The human body ultimately decides on what works. Dentistry is invasive.  My feeling is that the body when stressed with a subtle covert underlying illness may not be able to tolerate an additional stress such as a dental implant, a root canal or a bone graft for example. Immunity resistance is a subjective quality that can not be quantified or measured. It’s best to know your body and respect it’s limitations.