What are those Hard Bumps in my mouth?

I had a patient come in yesterday complaining of a pain in her mouth after devouring a very “big bag” of potato chips. I was curiously thinking, when she was explaining the event in the dental operatory, “how big of a bag of potato chips does one need to eat to warrant a visit to the dentist?”

Instantly upon inspection of her mouth the source of pain was revealed, a cut tori. Apparently, the sharp potato chips shred the thin fragile  tissue which lay over her mandibular tori.  I reassured her that she did not need to give up potato chips, but to eat less of them maybe with a bit more caution in the future.

Twenty percent of the population will have tori. The hard bumps on the sides of the lower jaw are called Mandibular Tori. Tori can also be found on the hard palate area of the upper jaw; they are called Maxillary Tori.

Mandibular Tori
Mandibular Tori
Maxillary Tori
Maxillary Tori

Tori are bony growths that out crop from the underlying jaws. They are NOT the manifestation of a cancerous growth. They are more common in females than males. Some tori may be small  and pimple-like, while  others are huge and uncomfortable because the thin overlying gum tissue tends to tear upon sharp crusty foods.

They can cause pain when the gum tissue on them is gouged for those who are unlucky enough to have a potato chip addiction.

Tori can begin to form in your early twenties and are believed to be  manifestations  of  jaw clenching. The clenching action stimulates bone formation of the underlying jaws. They continue to expand and with time can be very problematic for a few where quality of life issues arise.

Treatment is none, unless you want recreational surgery. An oral surgeon will remove them with trepidation. The surgery and recovery can suck.

I would much rather give up potato chips than get tori removal surgery…….

 

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’t they make a drill without that sound?

If scientists  and engineers can design, fabricate and blast a small car-like high tech laboratory thru space and gently land it  on a tiny red planet 54.6 million kilometers away from the Earth, why can’t they make a silent dental drill?

Dentists have had access to “silent” drills for many years.  The reason why dentists use that noisy apparatus is because it works very efficiently. It blasts away dental caries and enamel very well.

A dental drill is powered by air compression. This compressed air pushes a micro turbine mounted in the head of the handpiece. This tiny turbine is pushed by the compressed air up to 200,000 RPM. That’s an incredible amount of spin action on anything that’s fixated to it; a dental bur. As the air gets tossed out from the dental drill exhaust you hear the shrill of the drill. It’s the work horse for everyday “drill and fill” dentistry.

Enamel is harder than bone. In fact,  enamel is the hardest tissue in the human body. A smooth cutting sharp diamond bur spinning at a minimum of 180,000-200,000 RPM is needed to cut away tooth structure due to enamel’s inherent durability.

On the other hand, the electric hand piece is silent. They are used for specialized procedures such as root canals and dental implant placement. Electric hand pieces produce a steady consistent slow rotation of the bur at a high torque. Higher torque tools are indicated to achieve different outcomes on tissues other than enamel, such as cementum and bone.

With that being said, next time in my office, grab one of my Bose headsets and plug into your iPhone and chill to a music playlist or book on tape. Tap the volume on extra loud and chill. It works for me!

 

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

 

 

 

“I Think I Got My Dad’s Teeth”

When my wife confirmed to me she was pregnant with our first child, I knew big changes were coming. The stunning announcement of pregnancy brought me both joy and extreme anxiety.  The biggest stress was not the actual nine months of pregnancy (my wife was healthy and strong, tip-top health) but  a result of me unsuccessfully attempting to predict the unknown future.

The actual pregnancy was classic and uneventful. As an expecting father, I gained my customary 8 pounds in sympathy. February 20th, arrived, game day in the delivery room at Norwalk Hospital. Liza wasn’t a screamer during the delivery process, just some groans now and then for about 5 hours. Like I said, she’s tough.

Delivery was natural and smooth, no complications. It felt like it was all happening too fast. Then ,out of no where a little alien appeared.  “That’s my son?”  I see this little scrawny humanoid thing in the doctor’s hands. Birth is an incredible feeling to witness live. You dads know what I’m talking about. I knew in an instant, my life had just changed in an instant.  Extreme joy and the weight of immense pressure in the same sandwich.

In seconds after delivery, the nurse swept my son from the doctor’s safe arms and confirmed vitals and other tests nearby.  Soon after, he was confirmed by the nurse and deemed healthy and beautiful, he was lovingly brought to mom’s loving embrace, swaddled and nursed. This was truly a breath-taking experience to witness. The nature of instant bond between child and mom is magical. My son was then placed in the radiant incubator which minimize further trauma from the delivery.

As I approached the warming bed to embrace my boy, which was now positioned besides his mom, I witnessed the power of genetics.  Exhausted, content sleeping under the warm light, supine, tightly swaddled,  snug blue head skull-cap fitted, with his tiny right arm conveniently popped out from the soft white blanket, with backhand to his forehead. “That’s me when I sleep”,  I thought out loud. Right hand on my head is where I find the most comfort and relaxation. “It’s my move and now, my son’s move.”

Nature or Nurture, that is the age-old question. It’s actually both. Everything is genetically driven. We are a function of our DNA. The rule is 80% genetic and 20% environmental. There are millions upon millions of characteristics that we have inherited that defines our phenotype.

We are products of our DNA. From our attitude to the gait in our walk; we are our parents, the good and bad. Tooth shape, tooth shade, predisposition to tooth decay, predisposition to periodontal disease, jaw alignment………. everything.

The 20% is our ability to change and modify to create a healthier lifestyle. You are in control of your 20%.

Brush more per day and eat the right foods. Stay away from candy and sugary drinks so you get fewer cavities than your mom or dad. You are still getting cavities, but fewer……..

Get those braces so that your teeth are in a better alignment so that your toothbrush has better accessibility to the your entire mouth.

Get your teeth cleaned more frequently than two times year because your mom lost all her teeth due to periodontal disease before the age of fifty. Get an electric tooth-brush, a Waterpick and floss regularly.

Give up smoking because you know your dad died from oral cancer.

Don’t eat late at night,  stay away from  acidic foods, and cut back on the coffee in order to help prevent root caries,

So let’s embrace our genetics and try to abide by some simple philosophies.

It’s my approach to tackle hardship in life. It works for me. It took me twenty years get here. I try not to question or get frustrated too much about stuff I can’t control.

However I do my best, to make changes in order to make up for my short comings and embrace the facts.

Making positive choices in your lifestyle, may or may not make a difference in the role our genetics play but it certainly can help create a more meaningful existence!

 

Dedicated to Rob A. New dad and patient

 

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

 

 

 

 

 

Mini Implants.

I recently had a new patient (Patient B) come in for a consultation in regards to “fixing her rocking”, upper 4 Mini Implants over-denture. The patient said that her previous dentist was not able to fix the problem and she was recommended to me by a friend who had a similar problem for which I was able to remedy.

Initial inspection of the under surface aspect of the rocking denture revealed only two, properly imbedded  metal “female” basket housings. There were also two gouged out areas  where two other two baskets formerly resided within the denture.  In the final processing of an implant over denture, the female basket component is imbedded within the denture and designed to receive the “male” counter which is usually the “ball” component of the Mini Implant (see photograph above). Consider the ball aspect as an extension of the implant. This ball aspect of the Mini Implant protrudes thru the gingiva, and is responsible for engaging the imbedded denture basket and thereby creating the “snap” you hear upon insertion of the over denture. Because all Mini Implants are of narrow diameter, they must be manufactured as one solid fixture. They would be inherently  too weak  and unable to resist forces of chew during mastication if they were not one piece.  They would snap like a toothpick. A Mini Implant is not like a traditional implant where you have component parts and abutment choices (see previous blog on implants for description of What Is An Implant).

Immediately, I thought to myself, easy fix with just a simple chair-side cold cure. Add two new basket attachments where she had lost the two, twenty minute appointment, go to lunch.  I  keep baskets on hand inventory for such an emergency. Everybody happy.

Boy, was I wrong!

Upon further inspection during the intra-oral examination, I realized that, unfortunately, her over denture had never and would never work properly.

The 4 mini implants were originally placed in divergent directions. As a result of  implant placement and choice of the implant ( a one-piece fixture ), the denture had No One Path of Insertion or Withdrawal. It just could never engage all the ball fixtures.  In defense of the doctor. The one piece nature of the Mini Implant offers no room for error in surgical placement. All implants MUST BE Parallel. The female basket may offer a slight degree of variance for the slightest bit of angulation error.  The dentist had good intentions to help this patient via the advantage of implant stability. He lacked the surgical skill in pre-implant placement; specifically bone augmentation. He had not anticipated the prosthetic hurdles created by his in experience. This was truly a very difficult case because the patient had minimal bone quantity and poor quality to start with. The implants were also placed too close to each other and too far anteriorly in the maxilla (upper jaw) where the bone naturally becomes very narrow and flares upward dramatically. Her denture never engaged  her implants. Subsequently, the metal balls of the Mini Implants were responsible for smacking and cracking the acrylic. Ultimately  the metal baskets became dislodged from the denture. The fit of all components when they come together in a snap on denture must be passive. A passive fit leads to less lateral loads on the implant fixture. Lateral loads are disastrous on a dental implant.

It is of my opinion that, lateral loading onto excessively angled placed implants, in poor quality bone, with compromised bone volume with inadequate implant diameter led to this catastrophic failure for patient and dentist.

Patient A: This patient her MINI Implants were placed sideways. Denture’s female housing could never engage implant male aspect properly
Patient B: Note the proximity and angulation of these Mini Implants. All have been since been removed from this patient.

A rocking denture does not mean a failing implant case. There are many reasons for a rocking denture other than failing implants. Patients can lose weight or change medications resulting in physical changes of their oral tissues. Metal housings can pop out due to manufacturing flaws by the laboratory, “O” rings wear out, denture acrylic cracks, things can just break yet, the implants can be just fine, do not despair.

There are many important difference to remember in type of rehabilitations there are. A subtle and very significant difference with an Implant Over Denture Prosthetic versus a totally Fixed Implant Prosthetic is chewing power.

An acrylic implant Over Denture engages the implant’s male part, however, the denture is still 100% tissue supported. Gum tissue is compressible. The oral tissue carries the chewing load. The implants only keep things in place from shifting. The acylic denture does not drop or slide. You will bite and chew 100% more efficiently than the non implant denture person. You’ll be fine with 95% of the foods out there with confidence of knowing they will not fall out when you sneeze or laugh.(This has been reported to me by previous non implant denture wearers). You can not bite nearly as hard as the fully implant supported prosthesis on 6-8 implants. This is the real deal. Hardcore chewing power. Totally implant supported with no tisue compression discomfort.  Your brain magically knows thu the wonders of muscle physiology. You can break rocks with your prosthesis(not advised). This is not a denture snap on option.

A bit of Trivia: The hardest food in the human diet is a raw carrot.

 

The previously case failed for this patient for numerous reasons:

1-The Mini Implants placed were just too narrow.  It is my clinical experience that mini implants in the maxilla have a very high failure rate; more so than a regular traditional  diameter implant. I only utilize mini implants for the mandible ONLY (mandible jaw) because the quality of the lower jaw bone is much better than the quality of the upper jaw bone.

In General in terms for categorizing Quality of Bone: The Best Quality bone is in the lower anterior mandible. The Poorest quality of bone is in the upper posterior maxilla (upper jaw bone).

As a Rule: If the implant Diameter is increased by 1mm (in a 10mm long implant) you will have increased the surface area of the implant 25%. That much more surface will be available to osseointegrate.

2-The Mini Implants were too short. The more length the more surface area to stick to the bone. That’s better than shorter implants. As mentioned previously, the dentist attempted to fit the implant for bone available. There are several options to overcome this issue; not to mention for this discussion.

3-The Mini-Implants were too close to each other. Think of this simple analogy. A table has a better foundation when the legs are spaced further away from each other as opposed to next to each other. Better spread of the implants leads to a better stable over denture

4-The angulation of the Mini Implants were less than Ideal, NOT parallel. This was a function of bone architecture available to the dentist upon surgery.

5-Lack of Preparation. A 3-D (CBCT) analysis preoperatively providing visualization of bone morphology  PRIOR to picking up the scalpel would have demonstrated the degree of difficulty ahead for surgeon and patient. I personally refer out to dentists in my area frequently for the most challenging cases that require super I.V. Sedation or more advanced surgical care.

 

Don’t get me wrong…………I love Mini-Implants. When used appropriately in the anterior mandible, they are fantastic! Many of my elderly patients benefit from this life changing approach of stabilizing their lower denture. I only use 2.8 mm x 14.0 mm Mini Implants and place a minimum of two and as many as five to deliver a “snap on” lower denture . It’s tremendous. Every implant patient I treat must have a preoperative CBCT so that I can anticipate complications and plan appropriately to avoid any surgical or prosthetic nightmares.

Treatment rendered for this patient B: Removal of all  4 Mini Implants  with simultaneously bone grafting to implant removal the sites and bilateral Sinus Lift procedures. She now has a ton of available bone waiting for implant placement this upcoming month.

Some of My Cases:

Patient C: Pre-Operative Radiograph of a 87 y.o. patient with failing lower dentition

 

Patient C: From same patient as directly above. Mini Implants Placed. This x-ray is a post op three years after placement of 3 Mini Implants with locator attachments. Everything looking good.

 

Patient D: Full Arch Upper and Lower Implant Case. I post because we utilized non -Mini implants here for both arches. I restored Upper arch with a fixed non removable ceramic arch. I will restore lower arch with the same material. Currently we are utilizing these lower implants to act as an over denture(over engineered) with the intention of converting in the near future.

 

Patient E: All upper Mini Implants are almost gone here. All 5 failing Upper Mini Implants are at different stages of failure. I have intermittently placed 4 Non Mini Implants (not seen here) in-between the Mini Implants and converted to a fixed denture in transition. The patient was adamant and did not want to go back into the denture in the process. Technically a difficult case for me. It will be successful. Ultimately, to deliver a totally screw down case here; 100% implant supported.

 

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’s Oil Pulling?

Oil pulling, involves trapping a tablespoon of oil in your mouth and moving your cheeks with your closed lips for around 20 minutes or so. This pulling technique has been around for thousands of yearsWebMD.  There is some opinion out there that this action of oil pulling eliminates general body ailments such as hangovers, sleep disorders and skin diseases. This swishing with the oil supposedly draws  toxins out from your body, to improve your overall health. I dont believe those claims one bit.

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Clinically, as a dental health care observer/provider,  I do see a benefit from the oral aspect with less plaque accumulation as noted in routine hygiene follow ups by my patients who practice this technique consistently on a daily basis.

I do not  “Oil Pull” because it’s difficult for me to consistently find twenty minutes in my day where I am not interrupted, asked a question or simply bombarded with stuff needing immediate attention home and office alike. For those of you who know me, I got to talk. It is impossible for me to sit there, silently, swishing, suppressing my opinion or thought from being verbally expressed.  I do believe it’s a worth the while if you can find the time in your daily routine. Think of it as “another feature in your dental home care cap.”

My Choice Oil is Coconut Oil.

Coconut Oil is antimicrobial. A particular study demonstrated that coconut pulling significantly reduced the number of cavity producing bacteria called Strepococcus Mutans study . Yes! You can potentially get fewer cavities if there is lesser of a concentration of the destructive bacteria in your mouth.

Coconut Oil contains Lauric Acid and is the active triglyceride that kills bacteria that creates gum problems. A decrease in the amount of bacteria decreases your gum’s inflammatory response, better known as ginivitis. Less gingivitis is a good thing.

Coconut Oil also has anti fungal properties. People who get fungal diseases of the mouth most often have dentures or are undergoing radiation or chemotherapy treatment.

How about keeping your teeth as white as possible? Don’t panic, it’s organic…….Oil in general is a lubricant and creates a lower surface tension on your teeth and gums so that the bacteria and stains just slide off your teeth and gums resulting in displaying you beautiful white teeth.

And Finally, Coconut Oil tastes good. Who doesn’t love coconut embedded foods? Coconut Shrimp, Coconut Cake, Macaroons; my top three favorites. That’s all good stuff, right?

Coconut Oil Pulling Technique

1-Brush your teeth properly

2-Take a tablespoon of Coconut Oil and use it like mouthwash.

3-Go for it! Do Not swallow..

4-After 20 minutes spit the oil in the trash. You don’t want to clog the plumbing of the house or septic system. The oil may solidify in your pipes.

 

It’s not the cure-all. You still need to brush your teeth and see me for regular check ups.

PS. My wife Actually got this great tasting Coconut Toothpaste from Whole Foods.  If you want the name of it, you’ll have to subscribe to my blog. LOL. Just kidding, shoot me an email for the request.

 

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