Do I need to Premedicate anymore?

I graduated Columbia’s School of Dental & Oral Surgery  in 1994. At the time, the consensus recommendation established by the medical community was such that, “anyone who had a heart murmur should be premedicated prior to their dental visit, for life!”

As a matter of fact, the accepted protocol for dental premedication was a whopping mouthful—- 3.0 grams (6 x 500 milligrams pills) one hour prior to a dental appointment and then 1.5 grams (3 x 500 milligrams) eight hours after the initial dose.  To say nothing of the stomach upset………

Why should I premedicate? What is the thought behind premedication?

The thought behind premedication is based on transmission of bacteria. By the same token, transplanted bacteria from the mouth can act as a source of infection in another part of the body. Moreover, a simple local anesthetic needle puncture in the mouth can transport it from the cesspool of the mouth into the patient’s bloodstream. This bacterium, transported mechanically, would then be free to stroll the corridors of blood vessels. It can then nefariously deposit itself onto an already troubled heart valve or bionic prosthetic joint. To that end, it “sets up shop” and initiates a destructive process of tissue destruction. Subsequently, the patient can incur a shredded heart valve or a diseased prosthetic joint. Antibiotic premedication blasts those pesky bacterium dead. Essentially, the antibiotic blast creates a temporary sterile environment. Therefore, premedication offers a lesser potential for tissue damage.

Then and Now…….

The literature is all over the place.

Antibiotic prophylaxis is recommended for a small number of people who have specific heart conditions. The American Heart Association has guidelines identifying people who should take antibiotics prior to dental care. According to these guidelines, antibiotic prophylaxis should be considered for people with:

  • Artificial heart valves. 
  • A history of an infection of the lining of the heart or heart valves known as infective endocarditis, an uncommon but life-threatening infection. 
  • A heart transplant in which a problem develops with one of the valves inside the heart. 
  • Heart conditions that are present from birth, such as: 
    • Unrepaired cyanotic congenital heart disease, including people with palliative shunts and conduit. 
    • Defects repaired with a prosthetic material or device—whether placed by surgery or catheter intervention—during the first six months after repair.
    • Cases in which a heart defect has been repaired, but a residual defect remains at the site or adjacent to the site of the prosthetic patch or prosthetic device used for the repair. 

In addition, Artificial joint replacement premedication protocol is just as ambiguous. You can find conflicting literature all over the web. It’s best to speak to your orthopedic doctor for clarity on their personal guidelines.

I have my own opinions about premedication. I look forward to expanding on my ideas on my upcoming video release this weekend on my You Tube Channel. Stay tuned :

You Tube Channel. Robert Emilio DDS & Associates

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

Keto Breath

Summer is Coming!

The bright yellow bloom of the Forsythia signals the eventuality of Spring. To say nothing, we experienced a mild winter; not too much snow and ice. I am thankful. By the same token, warm weather is coming. In like manner, last year’s bathing suits must fit this year.

Now is a Great time to start losing some weight.

As a matter of fact, my wife and I decided to hit the gym more frequently and follow the Keto Diet

The Keto Diet:

Basically, one must eat foods of “low to no carbohydrates” and those high in fat. It will be almost a living hell for me. I love my wine, bread, pasta and french fries. Oh well, the sacrifices for a thinner existence……

In the Ketogenic Diet, your body burns up existing fat stores for energy. Once you’ve depleted your glucose stores from your last no carb meal, ketosis takes over. Your body eats your belly fat for energy, and as a result, you get skinny. 

In effect, stored bodily fats get converted into ketones, which are natural chemical by-products from from the fat burn metabolic process. These harmless “ketone bodies” include beta hydroxybutyrate, acetoacetate, and acetone. In brief, ketone bodies get released via urination and exhaled away thru respiration. Your significant others will interpret that as Bad Breath…. On the other hand, stinky breath is an indicator that you’ve entered ketosis and that you are on your way to fitting into those skinny jeans.

Since acetone is an ingredient in nail polishes, your breath smelling like nail polish remover will indicate a state of ketosis.

For the most part, the stinky breath usually lasts for a couple of days. The important thing to remember is that it occurs in the initial onset of the diet and slowly diminishes with time.

I plan to minimize my anticipated Keto Breath in the following ways:

1-I will drink more water.

Similarly along with exhalation, your body flushes acetone and ketones from your system through urination. As a result, staying hydrated dilutes and helps flush away ketones.

2. As always, I will practice good oral hygiene.

For example, I plan on brushing my tongue and teeth at least three times a day. Moreover, doing this will minimize the overall bad breath scene.

3. I will mask the odor with mints and gum.

Indeed, I’ve got these fabulous licorice sugar free mints that I plan on using during the course of the day.

4. I’m not a martyr. I will occasionally pump up my carb intake with Scotch and Champagne.

Scotch has no carbs. Slightly increasing your carbohydrate intake can also eliminate keto breath. Champagne has very little carbs. By all means, I purchased a 1/2 case of bubbly in preparation. Note: I do want to remain in a state of ketosis. I only will increase my daily amount of carbohydrates by a small amount.

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


You Don’t Have To Leave Without a Front Tooth

Fractured root underneath an old crown

This Happened today……….

After Hearing The Bad News

It was determined that his tooth was hopelessly fractured. Unfixable. In fact, non restorable. With this in mind, all options for tooth replacement were discussed. The patient was adamant . He stated forcefully, “I do not want to leave here without a tooth and I do not want a flipper .”

The Plan

“Kill Two Birds with One Stone”

my Thought process

Foremost the best strategy, was to make the patient happy by fulfilling his expectations by the end of the visit. A fixed tooth in place was what he wanted. In this case, my plan was to extract the fractured tooth and simultaneously ,”fix the color” of his adjacent teeth.

That’s to say, we were going to do some cosmetic dentistry in addition to oral surgery today.

Ultimately, once the extraction site completely healed in several weeks, I would install the permanent restorations. To put in another way, a “3” unit ceramic bridge over the extraction site and two individual crowns of the adjacent teeth.

In short, kill two birds with one shot of anesthetic…….

The Flow of Today’s Appointment

“Firm in principle and Flexible in Procedure”

The Discussion

No Doubt, the tooth had to come out. By all means, it was fractured beyond repair. Absolutely, I would have loved to place an immediate implant, but the patient just wanted to leave with a tooth in place. An immediate implant to the site would have been a bit risky in the sense that, I could not guarantee that I would have been able to place an immediate crown on the implant on this same very visit. There are many factors that play on making the decision of immediate implant placement versus delayed implant placement. This was the best option for the patient because he wanted a definitive immediate tooth. In addition, he received a cosmetic benefit of all ceramic crowns on the adjacent teeth.

At the end of the visit, the patient went on to his very happy merry way with a fixed temporary bridge of a refreshing shade.
He will return in several weeks for a digital impression and subsequent final ceramic crowns. Today’s visit took on shot of Lidocaine and One Hour’s time.
pre-op.
Fractured lateral central incisor
Plastic temporary in place after extraction of fractured root
Close up of area with temporary 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:  robertemilioddsblog.wordpress.com

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