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

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I want that Gap in Between My Teeth Closed!

The very common procedure of Bonding is routinely utilized for closing a front tooth gap.  For some people their front tooth gap defines their individuality; their face and attitude with a mere smile. For others, the gap represents a disfigurement; a cruel trick played by Mother Nature.

I do believe that bonding technology originated from the NASA Space Program. NASA scientists engineered the process of securing(bonding) ceramic tiles to the hull of the space shuttle. Bonding was proven to be  a reliable, durable, easily repairable, and most effective approach of securing ceramic tiles to the hull of the space shuttle. The ceramic tiles were crucial in heat displacement and essential for the survivability of our returning astronauts. The process of Bonding is both Science and Art.

Bonding is technically a process of fusing two like or unlike surfaces. In dentistry, we are constantly bonding enamel to a host of dental materials such as composite resin, ceramic, ceramic /resin hybrid material and metal such as gold alloy.

The process of bonding first involves surface preparation of the surfaces planned to be bonded. Tooth enamel is etched with 37.5% Phosphoric Acid for 15-30 seconds then washed off with water. This etching process creates a microscopic roughness of the surface enamel. Once etched, the surface is air blown super dry. A clear colored bonding agent (unfilled resin), gets vigorously scrubbed and applied with a tiny micro brush by me, to the prepared surface. This unfilled resin supersaturates the previously micro-textured enamel surface. The resin seamlessly fills into the micro-roughen landscape of the enamel engaging unbelievably small undercuts of enamel rods which make up the enamel surface you and I can not see with our naked eyes. A specifically engineered Ultra-Viloet Blue light is then shown onto the applied resin by the dental assistant. The light initiates and activates a polymerization (hardening ) shrinking of the applied resin. This “curing” acts to fuse or “bond” the unfilled resin with incredible adhesion to the enamel of the tooth. Once the bonding agent is fully cured in about 20 seconds, multiple incremental layers of tooth colored  material is artistically  added and contoured to mimic a desired shape, by me.

The Principle of Bonding is Classic. It’s been around since the 70’s. What has improved are the materials of adhesion and options of bondable materials.  The choice of materials to be bonded to enamel all require slight nuances in their preparation prior to being bonded to the unfilled layer of the enamel.

Pictured Below:

In this case of gap closure performed today, the surface materials are the patient’s enamel and composite resin material. It took me twenty minutes. No shot indicated. No Pain. Everybody happy!

 

IMG_6429
Before

 

IMG_6431
After

 

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

 

 

 

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

 

Do I Still Need To Take My Antibiotics?

I recently had a wonderful elderly female patient who was complaining of jaw pain status/post Third Molar (wisdom tooth) extraction in my office.

The previous day, I had extracted the fractured vital tooth. Beautifully removed with minimal effort and stitched up to perfection by me. Her Past Medical History was unremarkable. She was taking no medications of concern that should have alerted me to potentially a risky post operative recovery.  I had no reason to believe there could be an issue with the post operative care of the area.

Dry socket is always a concern. Dry socket ( alveolar osteomyelitis) is a condition where the extraction site clot is dislodged and the underlying bone of the socket gets exposed to the harsh oral environment. This is a very painful situation such that the pain is unique and radiates thru your entire jaw, face and neck on the side of the tooth extraction. Although a rare occurence for my patients, clinical experience demonstrates a higher predisposition to dry socket in the lower third molar area than any other area in the mouth.

She was in pain. She was feeling drawn out and called me directly on my emergency contact. Timing was essential and aided in my diagnosis of the origin of post operative pain.

The patient stated that she was sore and feeling slightly febrile the very next day; I estimated, twenty-four hours since the surgical event.

“I need antibiotics to Knock Out the infection” , she stated with confidence. She continued on stating that she was ,”….. a bit febrile,,,,I’m running a bit higher than usual”.

I conceded and with a very slight reluctance, but obeyed to the wisdom of this implacable women. I prescribed the antibiotics because I respected the patient’s desires. I do believe that some patients can be their best and worst doctors. It’s definitely was possible she was in the early cascade of infection,,, most likely, not. She presented initially non infected. It was too early for in infection to be present so soon after the extraction. Typically, infection would start on the THIRD DAY after a surgical event.

I called her one day after the initiation of the antibiotic therapy and she stated, “I am feeling so much better now. Thank you.  Do I need to finish the antibiotics?”

MY ANSWER WAS…EMPHATICALLY…….. YES!

My feeling was such that she was not truly infected, but instead feeling beat up from the extraction  event (the message not the messenger). Post operative edema peaks 24-36 hours a surgical event; that’s when the post extraction pain was the worst.

Dental extractions are always traumatic. It involves, local anesthesia which initiates an Adrenaline rush through your system. In response to the needle shot in anticipation of the surgical event, corticosteroids get surged out from your adrenal glands to help cope and compensate for the traumatic event you are about to endure; this is the Flight or Fright response. This is a totally natural occurring biological response to an average dental visit (comparable to getting charged by a saber tooth tiger—-that’s a joke….). It’s Normal to feel zonked after seeing me for a denatl procedure.  You will be tired the next day, especially after an extraction.

The patient’s febrile component was most likely associated with a slight dehydration effect that impacts body temperature in the slightest fashion. That’s why it’s important to drink your fluids. It’s on the post op instruction sheet..

Upon follow-up phone call, on the Second day after extraction, and one single dose of antibiotic, she reported to be just fine…Her next question was,  “Do I need to finish my antibiotic?”

Yes, was my response the current theory states that :” Treating bacterial infections with an antibiotic kills those bacteria, but this may take a week or more to accomplish. If you stop treatment early, you have only killed the weaker of the bacteria, those bugs most readily wiped out by the antibiotic. The ones leftover are the tougher bacteria, which would have been killed if the treatment continued but now, in the absence of antibiotics, have room to multiply and pass their genetic-based resilience to their progeny. Next time around, the infection is that much tougher.” Finishing your antibiotic

However, the same article states the mindset of this theory is changing. Each situation of infection type needs to be addressed individually. The debate is duration time period of antibiotic consumption. An Excellent read. I suggest you read the details.

Dedicated To Regina.

 

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