Why does it hurt? I had the root canal.

The Presentation

An existing patient of my practice presented today complaining of soreness on chew, especially something hard. “It hurts somewhere up there, on top to the left”, she said.

The Analysis

The first thing to remember; there was no swelling of the patient’s face, nor around the gum of the teeth in question. Another key point, was that there was no response to cold or hot stimuli. Specifically, the patient exhibited a dull pain upon chewing down on my carefully positioned cotton roll. Subsequently, a radiograph of the maxillary first molar area was taken by my assistant. Behold! Not to mention, THIS TOOTH WAS PREVIOUSLY TREATED BY ME WITH ROOT CANAL THERAPY SEVERAL YEARS AGO. Moreover, the radiograph demonstrated an area of radiolucency (black shadow) just at the tip of the roots of the first molar. In other words, this indicated inflammation/infection.

The Assessment

Failing Root Canal of the Maxillary First Molar

The Plan

For that reason. I initiated antibiotics to keep area in “check” until I can get the patient back to Re-root canal the First Molar.

The Discussion

A root canal is a technically difficult procedure performed by a dentist. The process consists of two parts. First, the dentist mechanically removes infected biological material( nerve) utilizing very fine nickel titanium files from within tooth’s core. Second, the dentist packs inert material (gutta percha) to hermetically seal this evacuated space. In effect, the dentist removes the nerve of the tooth via a micro rotor-router approach and fills the emptied nerve chambers with rubber.

But Why Did That Previously Root Canal Treated Tooth Fail?

A previously root canal treated can fail creating that annoying discomfort for any number of reasons:

The most dominant reason of failure is due to insufficient irrigation by the operator in removing the infected biological debris from within the nerve chamber and canals. In short, bleach irrigation floats debris out of the shaped canal space. In essence, remaining debris can set up an environment for reinfection. In summary, every thing biological must come out from within the tooth.

On occasion, an Accessory Canal can be missed. Incidentally, canals are extremely small; the width of a human hair sometimes. Moreover, I use magnifying loupes in practice and I still miss identifying them, although rarely. By the way, the maxillary first molar has accessory canals 69.2 % of the time.

Sooner or later, an Improper fill can lead to a seepage of bacterial laced saliva back into tooth to reinfect. This is one reason why I strongly recommend to cover and ultimately seal your root canal treated tooth with a crown.

Generally speaking, a cracked root will lead to a failure of a previously treated root canal tooth. In a word, that’s a bad failure. In the final analysis, out comes the tooth and in goes the implant.

Above all, many retreatments can be successful. In reality, a failing root canal treated tooth can be resurrected with a little bit of patience and clever skill.

Below is another one of my many successful root canal treated cases in chronological order.

There is a large infection at this lateral central incisor( Black spot at root)

The Day of Completion of Root Canal Procedure -Day 1-

Three months out. Day -90-
Look and see how black spot at tip is fading away. That’s a good sign…..
One year out. Day 365- Healthy Bone fill has replaced the previously infected black spot

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

“I don’t want braces, but can you fix this one tooth?”

The Demand

This is a common request in my office. Often, patients just don’t want to go through the hassle of straightening their teeth via conventional orthodontics. In addition, the time to get teeth straightened can take years. Not to mention, such an endeavor can cost a small fortune.

The Thought Process Prior To Treatment

First, I evaluate every situation unique to that patient. Before any treatment begins, there needs to be a discussion of the pros and cons. Equally important, esthetic expectations are shared. When patient and dentist are in alignment, we can then begin.

Treatment Flow

To begin with, I inject usually one shot of lidocaine locally. Next, there’s about seven minutes of preparation with the drill. Finally, there is a quick digital impression of the area with the CEREC capturing wand. The virtual design of the restoration takes me about 4 minutes. Soon after, milling of the unit may take another 8 minutes. Without delay, the unit is carefully placed by my assistant into the ceramic furnace for a 15 min cure. In due time, the restoration gets bonded into place, which takes me about 4 minutes flat.

Final analysis

In conclusion, many times there can be a simple solution. From time to time, a simple change can be delivered in a seamless manner with minimal cost, time in the chair and no complications. In this case, a single Emax ceramic veneer was bonded to place. LOOK CAREFULLY. IT IS THE LATERAL UPPER INCISOR. The key is that it should fit in and be not so “perfect”. Intentionally so. It’s important to realize, the entire visit took less than an hour. With this in mind, the patient left with a smile.

BEFORE___”Tucked behind” front lateral incisor
AFTER___Smile Line. The Veneer “fits in” with the other teeth
AFTER___Retracted lip

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

Avoid Perimplantitis: Dental Implants and their Maintenance

ICOI World Congress XXXVI

The International Congress of Oral Implantologists ( I.O.C.I. ) is an association of general dentists, oral and maxillofacial surgeons, periodontists, prosthodontists, endodontists, orthodontists, laboratory technicians, auxiliaries, industry representatives, researchers, faculty members, pre and post doctoral graduate dental students as well as the general public.


The I.C.O.I. is Devoted To Dental Implant Education.

Last year’s meeting was centered around Implant Failure. In particular, the seminar focus; Cause For The Dental Implant Failure. Coupled with remedies for dentists to manage failing implants.

The Take Home Message for Me.

Prevention and implant maintenance is critical. In the first place, failures are more common than early reported in the literature. By the same token, do not be despondent if you currently have dental implants or choose to embark in future implant dentistry. On the contrary, the future is bright.

Recent Findings for Implant Failure

1-PERIODONTAL DISEASE can cause Implant failures. When it is diagnosed, it must be eradicated PRIOR to implant placement. The mouth must be periodontal disease free……… The reason : Periodontal disease is a bacterial infection. These bacterium will “jump” from your natural teeth onto your new implant. Subsequently, you will get periodontal disease on the implant. Under those circumstances, this inflammatory condition of bone loss around an implant is called periimplantitis.

2- Smoking causes a higher incidence of implant problems. In other words, non smokers retain more implants. For this reason, smokers should consider a cessation program.

3-Poor Metabolic Control patients. Diabetics have a greater loss of implants. In addition to Immunocompromised patients ( H.I.V.) and those with Chronic Obstructive Pulmonary Disease C.O.P.D

4- Less Than Ideal Placement by the Dentist, can be a factor for failure. The implant needs to placed in the most functional, accessible location to your toothbrush by the dentist. Less than ideal placement, may contribute to its demise. Guided surgery, which I preform in my office helps avoid this complication. Many of my implant cases are driven via guided surgery. Look to my future YouTube posts at Robert Emilio & Associates for my actual guided surgery procedure.

5-Cement contamination remnants. In several words, lack of removal of all dental cement upon placing the final crown can be problematic. Infact, this cement irritant will act as a nidus for bacterial infiltration. Subsequently, an infection around the implant can ensue.

6-Lack of better quality bone. High cholesterol patients tend to have “fatty” bone, of lesser quality. Essentially, not all bone is the same in quality. Lack of Vitamin D is drawing a lot of attention. The data is still formulating. Stay tuned.

Strategy that I have Executed in My Office To minimize failure is pretty simple. This is what I tell my patients……………..

“I want No Problems as much as YOU want No problems. This is what You Must Do!”

My Recommendations Implemented in My Office For My Existing Patients with dental Implants and Future Recipients .

1- With out delay, periodontal disease must be treated prior to implant placement. In this case, scaling and root planning under local anesthetic.

2-For my smokers, I understand it’s an addiction. I am not perfect either. I am not here to judge or point a finger. As a brief aside, I will enjoy a Padron 1926 cigar, if it’s an occasion,,,,but the question to ask yourself…”Are you ready to deal with the consequences?”Consider a Smoking Cessation Program. That’s to say, consult your MD on getting that started.

3-Check Up with your M.D. It must be remembered there is a connection between teeth and body. A good idea is to make sure your cholesterol, Vitamin D levels, and sugar are in normal range.

4-With this in mind, I would prefer an additional Vitamin D uptake of 2000 IU/day.

5-Professional Hygiene Maintenance 3x year by may talented hygienists. In the final analysis, they are my gatekeepers who are responsible for your maintenance education and early the detection of potential problems.

6- Purchase a Waterpik device. For the most part, they are great when used properly. In the long run, a fabulous investment. In brief, you will be amazed “how much you missed”, after you brushed. Are you up to the challenge?

7-In light of the afore mentioned, use a Chorahexadine rinse once a week. In reality, it is industrial strength mouthwash. This is the next best thing to safeguard those implants.

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

Dental Tourism


The Story……….

Notably, a new patient recently presented for a consultation. In fact, her chief complaint was some lingering pain in the upper front area of her mouth. “Actually”, she said,” it’s been there for some time now; since I got back from Mexico.” I donned a pair of latex gloves and began my clinical exam. Subsequently, I noted severely edematous, bleeding gums draining pus. I was silently thinking, “not good” and a formulated a plan to find the source. With this intention, I instructed my assistant to proceed with a set of radiographs.

A Small Piece of My Philosophy

Given that I enjoy traveling and always seek to broaden my professional education, it only makes sense to travel and learn. Accordingly, on my travels, I have befriended talented dentists from big cities to small towns. This exploration of people and places gives me great joy and furthers my appreciation for humanity. Although we may talk different languages, enjoy different past times, savor different spices in our foods, people really are the same in creation. As a final point, People are good.

Dentistry is technically difficult. There are many fabulous, incredibly gifted clinicians around the world. To get back to the point, I would be a fool to think that only the best dentists are from the United States. To put it another way, Norwalk, Connecticut is not the center of the dental universe. Indeed, Norwalk has got just as many more/less talented dentists as there are in Cuauhtemoc, Mexico (same population of 90,000 citizens). More importantly, I can not believe that a dentist in Mexico is less driven to deliver the best quality of care he/she is capable of delivering. Granted, people are the same. Even more, your dentist in the states is just as motivated to provide quality dental care as a your dentist in Mexico.

DO YOUR RESEARCH. More importantly, ask yourself these questions in the process before you commit.

Things To Consider………..

The Top Reason For Dental Tourism

The Money. It’s always the money. The Lower Fee!

The Reasons To Beware of Dental Tourism

Infection Control

Is infection control being applied in that dental office?Are instruments being sterilized? Is the autoclave being tested weekly for spore count? Is the dental assistant trained properly? Are water lines being flushed? What’s the standard of water in Mexico? What about the quality of the water running through the water lines. Is that local water unfiltered? Do you believe you are medically safe from untreated water getting pumped into a fresh extraction/implant socket? Are ALL surfaces being wiped down with bactericidal chemicals in between each patient care?

Inadequate Training

Above all, self explanatory. Is the dentist trained by a legit dental school? What’s the standard of care in that country?

Unapproved Materials

Are the materials that will be placed in your mouth FDA approved? Are you really paying for what you think you are getting? Is it really a gold alloy porcelain fused to metal crown? Is there a substitute base metal in that crown? Incidentally, Nickel is a cheap metal substitute that can go into a crown’s fabrication. Most importantly, many people are allergic to Nickel. If left in place, a nickel alloyed crown will destroy your gums and jaw bone.

Technology

Does the dentist offer high quality digital dentistry such as CEREC and digital radiographs and CAT scan imaging.

Lack of Follow-up………….. What if???

What happens if you need follow up care? If something goes wrong, are you able to go back there to get it fixed?

The Story Continued……

The opening patient required removal of two front teeth due to recurrent decay and two dental abscesses. In addition, two veneers, four crowns and two dental implants which was all done by me in my office via guided CAD CAM Implant surgery. She’s doing fine now and prefers to visit the beautiful beaches of Mexico instead of the dental clinics.

When it’s all said and done. If you research, you can save significant money because there are many gifted dentists with superbly trained staff outside of Norwalk, Connecticut.

Granted. One Can make the same argument for selecting an American trained dentist. This leads us back to my initial point. The same criteria should be used in picking your dentist here in Norwalk Connecticut.

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

Put That Gummy Candy Down!

We are flawed……..

You may want to think twice about reaching for that Swedish fish or Gummy Bear. If you are like me, I am flawed when it comes to having something sweet. Despite my professional wisdom, I do on occasion indulge in a chocolate chip cookie or a scoop of chocolate ice cream after dinner. In general, my will power is firm but once and awhile, I will “go for it”.

Scenario

My patient “went for it” yesterday. In reality, she lost. “I felt a sharp pain and heard a pop and knew something was wrong. It was a Starburst”, she added.

Clinical and radiological exam revealed a fractured root. Incidentally, the tooth had been previously root canal treated. In this case, the assessment was to extract and place an immediate dental implant. In fact, existing bone quality and quantity was great. The patient was motivated. I was ready for the challenge.

Treatment

To begin with, I administered 2% lidocaine locally. Without delay, I sectioned the roots and removed the scoundrel segments. In a moment, the dental implant was precisely placed into its proper orbit. Shortly after, donor bone graft was packing to keep everything firm in place. Adjacent to this immediate implant, I placed a second implant to close the molar gap. This had been a longtime desire of the patient. The gap bothered her, when she smiled.

My Philosophy

Life can be challenging . On occasion, after taking care of everyone around us, it is okay to treat yourself to a simple joy such as a delicious sweet candy or an extra glass of Riesling. With that being said, pick and choose your “poison”. For this reason, gummy type candies are equivalent to playing Russian Roulette with your teeth. It is important to realize not to complicate your life with unintended consequences.

The root was under the crown
Split in 1/2

Two implants placed
Two Implants.

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