DENTAL – MERCURY – SILVER AMALGAM

I previously wrote a BLOG about mercury amalgam (October 29, 2017) which you can find on my Website (www.drmartyfrankel.com). In that article I discuss the structural implications of amalgam restorations and my experience with the destructive effects of this dental material. For over 150 years, amalgam has been somewhat controversial due to the presence of mercury. Amalgam is an amalgamation of 5 metals: Mercury, silver, tin, copper, and zinc. 50% of amalgam is mercury, 25% is silver, and the remaining metals account for the other 25%. The stance of the “dental establishment” is that Amalgam is safe to use and provides a cost-effective solution with which to fill and repair decayed and fractured teeth. The stance of the so-called “wholistic or alternative” dental practitioners is that mercury is a neuro-toxin that is bad for the body and our health. I have always avoided this discussion because I feel that regardless of the truth in this argument, there are better materials to use to restore teeth these days. However, I have recently been reading a very informative book called WHOLE-BODY DENTISTRY BY Dr. Mark A. Breiner. He provides some very compelling data about mercury amalgam fillings that I feel are worth sharing. Something to Think About: This first point is something that I have thought about for many years. Did you know that in Toronto, and many other cities and municipalities around the world, dentists are required to have amalgam separators on their vacuum equipment to prevent scraps of amalgam from reaching our sewage systems? Waste amalgam must be disposed of by a special medical waste company. It seems that the only “safe” place for amalgam is in our mouths. How can that be? Following is a list of some of the dangers of mercury as articulated by Dr. Breiner in his book. • Mercury escapes from amalgam fillings continuously in the form of vapour. We then inhale this vapour through the lungs and into the blood stream. From there it is carried to virtually all the bodily tissues, including the brain. Stimulation to the fillings from chewing, tooth-grinding, drinking hot liquids, etc. increases the amount of vapour released. • The label of one brand of amalgam says “Danger: Very toxic to aquatic life with long-lasting effects … do not allow mercury to be released into streams or waterways”. Hmmm …. • Scientific evidence for mercury toxicity from these fillings states the following: o Mercury from these fillings continuously vaporizes into air in the mouth. o This mercury vapour is inhaled and absorbed into the body. o The mercury from the fillings then, becomes widely distributed through the body where it is stored for a very long time. o There is a correlation in autopsy studies between the amount of mercury in brain tissue, and the number, size, and number of tooth surfaces of amalgam fillings in the mouth. o The amount of mercury in the brain is directly proportional to the number of fillings someone has. o Mercury absorbed from amalgam fillings can cause changes in body chemistry – subtle changes which might not be apparent initially. • Mercury has been found to have a negative health effect on fertility and on children. Health Canada’s position on the use of amalgam recommends using non-metal fillings in primary teeth (baby teeth) and avoiding the use of amalgam in pregnant women and women in their child-bearing years. • Mercury passes through the placental barrier and accumulates in the fetus. • Mercury can also pass to the new-born via nursing. (it is found in breast milk) • Mercury has been implicated in the development of Alzheimer’s Disease, although to my knowledge this has not yet been proven. • According to the World Health Organization, the major source of mercury burden in the body is from fillings, not from food or the environment. There of course, is much more to say about this topic, but for the purpose of this article I have presented “food for thought”. The Canadian Dental Association and the American Dental Association feel that these fillings are safe for the general population. Some say there is no safe level of mercury for the human body. I don’t know the complete answer to this. What I can say however, is that in general, the fewer toxins our bodies have to deal with in our life-times, the healthier we will be. Toxins can come from food, the environment (such as the air we breathe, the water we drink), medications, materials implanted in our bodies such as amalgam fillings, and from poorly eliminated waste products of digestion, respiration etc. I feel that if we can limit our exposure to these toxins, we will be able to live healthier and happier lives. WHAT DO YOU THINK? If you have any thoughts or questions about this paper, please feel free to engage and leave comments. Yours for Better Health, Dr. Marty Frankel Smiles by Design 3030 - 3080 Yonge St. Toronto, ON M4N 3N1 416-770-8526

The RELATIONSHIP-BASED, HEALTH CENTRED practice.

We live in very interesting times. Life moves very fast and the focus of most businesses today is the so called "bottom line". Although this is a very important consideration, because businesses can not survive and sustain themselves without a profitable bottom line, I wonder, "at what cost?" Dentistry is no exception, in that it is a business. But what is our business? Dentistry is a people business. We take care of people. Unfortunately in the quest to improve the bottom line, the approach that started to become popular in the 1980s, evolved into what has been termed the "mass market" practice. In this approach, the more people that can be moved through a practice in a day, translates to profit. I feel that the cost of this approach is that there is no time left to service our patients in a way that they deserve, they are treated like machines and we fix the oral parts, they lose the personal touch that was once of central importance in a dentist/patient relationship, the solutions offered to ameliorate the found problems are often not personalized but rather become cookie-cutter solutions that repair the machine but are not always the best solution for that individual. There is also a cost to the dentist. The dentist is stressed, for he must work quickly so as to be able to fit more people into his schedule, he doesn't have time to get to know his patients and build the type of relationships that fuel his soul, he is often forced to cut corners to stay on time which leaves the dentist feeling unfulfilled at the end of a busy day, knowing that he did not always perform his best work on a given patient. In the end, the dentist burns out, loses his passion for helping people, and becomes a tooth mechanic as a opposed to a physician of the mouth. In this type of environment, the dental team is also stressed and rushed and can't always help the patient to the best of their ability. These types of considerations are what dehumanizes the approach to care in many dental offices. Is this what people really want? I believe that in the effort to be efficient, profitable, and "high tech", that something has been lost. We need to bring back "relationship" to our interactions. How can I deliver the best possible care to people I don't really know? How can people get their needs satisfied if their dentist doesn't take the time to find out what they need and truly want? Most people come to us with some degree of anxiety. Perhaps they have had one or more negative experience in a dental office ... a filling gone wrong, a crown that is uncomfortable and just "doesn't feel right", a cosmetic procedure that doesn't look attractive, orthodontic treatment that has left a person in pain experiencing headaches and jaw pain ... perhaps they are afraid that it will cost too much money to receive the treatment they feel they need ... maybe they don't trust dentists for one reason or another ... perhaps they feel like they have become invisible, just a number, just another cog in the wheel of the busy dental office. I fear that this can only get worse with the advent of corporate-style dental offices. It is in the light of these attitudes that I decided 5 years ago to venture out and start my new dental practice. My goal was to slow down, see fewer people, take the time to listen to my patients and really understand their fears, their desires, their health challenges and attitudes, and to discover what they really want. Once I know the answers to these and many other questions, I can be in a position to provide my patients with the best treatment to suit their unique needs. In a typical dental office situation it would not be unusual for a new patient to be seen first by the hygienist to have an examination done, the data collected, and then the dentist would look at the information, develop a treatment plan, tell the patient what they "need", and then book appointments to perform this work. The patient is often overwhelmed by this "whirl wind" experience, does not feel listened-to or understood, and is confused, not certain that they are getting treatment that they in fact need or want. The patient becomes a passive recipient of care. They are not empowered to create excellent oral health. In a relationship-based practice, I will spend approximately one and a half hours with my patient on the first visit. I understand that this approach is not for everyone because many people want to get in and get out in record time. I feel however, that given the fast pace of life in today's world, there are many people who crave sincere, helping relationships with their health-care providers. It is for those people that I have built my office. During that one and a half hour visit I can take the time to find out what the new patient's previous dental experience has been like, how they feel about being in a dental office, do they have any fears or concerns, what was their parent's oral health like, did their parents wear dentures or did they keep all their teeth, what are their oral health goals, how do they take care of the rest of their health ... Only after all this information has been gathered do I perform the examination. It is done as a "guided tour" of the mouth. I want my patients to fully understand and appreciate what I find in their mouths, and the risks that the newly uncovered conditions might pose to their future oral health. Only after I am certain that my patients know what their oral health status is, will I schedule a follow-up appointment to co-create a Master Plan for Health. We will set goals based on the patient's "wants" and develop a plan to help them get there. This is intended to set the stage for a trusting, long-term partnership between me and my patients. In this relationship to create health, my patients become active participants in the development of their unique oral health goals, the plan to help them achieve those goals, and the treatment/maintenance habits required to turn it into a reality. We become partners in the creation of their healthy mouth.

Everything you need to know about bad breath.

THE FOLLOWING IS AN INTERESTING ARTICLE ABOUT "BAD BREATH" ALSO KNOWN AS "HALITOSIS". Last updated Wed 10 January 2018 By Tim Newman Reviewed by Christine Frank, DDS What is bad breath? Treatment Causes Symptoms Home remedies Diagnosis Bad breath affects an estimated 25 percent of people. There are a number of possible causes of halitosis, but the vast majority come down to oral hygiene. It is also known as halitosis or fetor oris. Halitosis can cause significant worry, embarrassment, and anxiety but it is relatively easy to remedy. This MNT Knowledge Center article will discuss the potential origins of bad breath, diagnosis and how to treat it. Fast facts on bad breath Here are some key points about bad breath. More detail and supporting information is in the main article. Bad breath is estimated to affect 1 in 4 people globally. The most common cause of halitosis is bad oral hygiene. If particles of food are left in the mouth, their breakdown by bacteria produces sulfur compounds. Keeping the mouth hydrated can reduce mouth odor. The best treatment for bad breath is regular brushing, flossing, and hydration. What is halitosis? a woman with bad breath Although bad breath is associated with certain diseases, oral hygiene is the most common cause. Bad breath is a common problem that can cause significant psychological distress. There are a number of potential causes and treatments available. Anyone can suffer from bad breath. It is estimated that 1 in 4 people have bad breath on a regular basis. Halitosis is the third most common reason that people seek dental care, after tooth decay and gum disease. Simple home remedies and lifestyle changes, such as improved dental hygiene and quitting smoking, can often remove the issue. If bad breath persists, however, it is advisable to visit a doctor to check for underlying causes. Treatment The best method to reduce halitosis is good oral hygiene. This ensures that cavities are avoided and reduces the likelihood of gum disease. It is recommended that individuals visit the dentist for a check-up and cleaning twice a year. The dentist may recommend a toothpaste that includes an antibacterial agent or an antibacterial mouthwash. Alternatively, if gum disease is present, professional cleaning may be necessary to clear out the build-up of bacteria in pockets between the gums and teeth. Causes Potential causes of bad breath include: Tobacco: Tobacco products cause their own types of mouth odor. Additionally, they increase the chances of gum disease which can also cause bad breath. Food: The breakdown of food particles stuck in the teeth can cause odors. Some foods such as onions and garlic can also cause bad breath. After they are digested, their breakdown products are carried in the blood to the lungs where they can affect the breath. Dry mouth: Saliva naturally cleans the mouth. If the mouth is naturally dry or dry due to a specific disease, such as xerostomia, odors can build up. Dental hygiene: Brushing and flossing ensure the removal of small particles of food that can build up and slowly break down, producing odor. A film of bacteria called plaque builds up if brushing is not regular. This plaque can irritate the gums and cause inflammation between the teeth and gums called periodontitis. Dentures that are not cleaned regularly or properly can also harbor bacteria that cause halitosis. Crash diets: Fasting and low-carbohydrate eating programs can produce halitosis. This is due to the breakdown of fats producing chemicals called ketones. These ketones have a strong aroma. Drugs: Certain medications can reduce saliva and, therefore, increase odors. Other drugs can produce odors as they breakdown and release chemicals in the breath. Examples include nitrates used to treat angina, some chemotherapy chemicals, and some tranquilizers, such as phenothiazines. Individuals who take vitamin supplements in large doses can also be prone to bad breath. Mouth, nose, and throat conditions: Sometimes, small, bacteria-covered stones can form on the tonsils at the back of the throat and produce odor. Also, infections or inflammation in the nose, throat, or sinuses can cause halitosis. Foreign body: Bad breath can be caused if they have a foreign body lodged in their nasal cavity, especially in children. Diseases: Some cancers, liver failure, and other metabolic diseases can cause halitosis, due to the specific mixes of chemicals that they produce. Gastroesophageal reflux disease (GERD) can cause bad breath due to the regular reflux of stomach acids. Rarer causes of bad breath As mentioned earlier, the most common reason for bad breath is oral hygiene, but other situations can also be to blame. Rarer causes of bad breath include: Ketoacidosis: When the insulin levels of a person with diabetes are very low, their bodies can no longer use sugar and begin to use fat stores instead. When fat is broken down, ketones are produced and build up. Ketones can be poisonous when found in large numbers and produce a distinctive and unpleasant breath odor. Ketoacidosis is a serious and potentially life-threatening condition. Bowel obstruction: Breath can smell like feces if there has been a prolonged period of vomiting, especially if a bowel obstruction is present. Bronchiectasis: This is a long-term condition in which airways become wider than normal, allowing for a build-up of mucus that leads to bad breath. Aspiration pneumonia: A swelling or infection in the lungs or airways due to inhaling vomit, saliva, food, or liquids. Symptoms The specific odor of breath can vary depending on the cause of the problem. It is best to ask a close friend or relative to gauge your mouth odor, as it can be difficult to assess it yourself. If no one is available, one way of checking the odor is to lick your wrist, leave it to dry, and then smell it. A bad smell on this area of the wrist is likely to suggest that you have halitosis. Some individuals are concerned about their breath even though they may have little or no mouth odor. This condition is called halitophobia and can lead to obsessive mouth-cleansing behavior. Home remedies [Man flossing his teeth] Oral hygiene is the key to most bad breath issues. Other lifestyle changes and home remedies for bad breath include: Brush the teeth: Be sure to brush at least twice a day, preferably after each meal. Floss: Flossing reduces the build-up of food particles and plaque from between the teeth. Brushing only cleans around 60 percent of the surface of the tooth. Clean dentures: Anything that goes into your mouth, including dentures, a bridge, or a mouth guard, should be cleaned as recommended on a daily basis. Cleaning prevents the bacteria from building up and being transferred back into the mouth. Changing toothbrush every 2 to 3 months is also important for similar reasons. Brush tongue: Bacteria, food, and dead cells commonly build up on the tongue, especially in smokers or those with a particularly dry mouth. A tongue scraper can sometimes be useful. Avoid dry mouth: Drink plenty of water. Avoid alcohol and tobacco, both of which dehydrate the mouth. Chewing gum or sucking a sweet, preferably sugar-free, can help stimulate the production of saliva. If the mouth is chronically dry, a doctor may prescribe medication that stimulates the flow of saliva. Diet: Avoid onions, garlic, and spicy food. Sugary foods are also linked to bad breath. Reduce coffee and alcohol consumption. Eating a breakfast that includes rough foods can help clean the back of the tongue. If breath odor persists despite controlling these factors, it is recommended that an individual visits a doctor for further tests to rule out other conditions. Diagnosis Often, a dentist will simply smell the breath of a person with suspected halitosis and rate the odor on a six-point intensity scale. The dentist may scrape the back of the tongue and smell the scrapings as this area can often be a source of the aroma. There are a variety of sophisticated detectors that can rate odor more precisely. They include the following: Halimeter: This detects low levels of sulfur. Gas chromatography: This test measures three volatile sulfur compounds: Hydrogen sulfide, methyl mercaptan, and dimethyl sulfide. BANA test: This measures levels of a specific enzyme produced by halitosis-causing bacteria. Beta-galactosidase test: Levels of the enzyme beta-galactosidase have been found to correlate with mouth odor. The dentist will then be able to identify the likely cause of the bad breath. Written by Tim Newman

The Dental Diet

I have just finished reading a very interesting and informative book called The Dental Diet. It is written by Dr. Steven Lin an Australian dentist who came to the realization that although he was helping his patients by repairing dental disease, he was not getting to the root cause of the disease and therefore over time he was seeing a gradual aging and deterioration of people's mouths. He was helping people control disease but was not satisfied in that he felt he was not creating healthy mouths. In his research he discovered some very intriguing facts about how to eat for a healthy mouth, and as it turns out a healthy body as well. WHAT ARE THE 4 ELEMENTS OF DENTALLY GOOD FOODS? 1. EAT FOODS THAT REQUIRE CHEWING ... AND CHEW THE FOOD WELLResearchers have discovered that over the last few hundred years, our human jaws have gotten smaller than evolution would normally cause. This has been attributed to agricultural and industrialization. Our hunter gatherer forefathers ate much courser foods and thereby exercised their jaws and jaw muscles. Industrialization and processed foods, cooking of food, do not exercise the jaws in the same way, and as a result our jaws have gotten smaller. One of the outcomes of this fact is that more people require removal of their wisdom teeth which do not have enough room to erupt into the mouth. Smaller jaws tend to sit further back in relation to the skull and can impact our airways and contribute to the development of sleep apnea. As a result of this fact, one of the recommendations in the Dental Diet is to eat harder foods such as apples that require chewing and that excercise the muscles of mastication. 2. EAT NUTRITIOUS FOODThe second element of the a dentally good diet is to eat foods that give the mouth the nutrients it needs (with a focus on Calcium and fat-soluble vitamins). The fat soluble vitamins aid the body in using and distributing calcium to the proper tissues, among their other roles. Fat soluble vitamins include Vitamin D2, Vitamin A, and Vitamin K2. Vitamin D2 helps the absorption of Calcium, but Vitamin K2 helps transport the Calcium to the target tissues such as teeth and bone. It also keeps calcium out of the blood vessels which is important in the prevention of atherosclerosis. 3. KEEP THE BACTERIA IN THE MOUTH IN GOOD BALANCE There has been much research in medicine about creating a proper bacterial balance in the "gut". Since food enters the body through the mouth it is important to consider that the foods we eat will also impact the balance of bacteria in the mouth. There are basically 2 types of bacteria that reside in both the mouth and the gastro-intestinal tract. There are the "good" slow-metabolizing bacteria and the "bad" fast metabolizing bacteria. The fast bacteria feed in particular on carbohydrates such as sugars, grains, and their combinations such as cookies, cake, ice cream, soft drinks, etc. When these bacteria feed on those foods they produce acids which can either eat holes into the teeth (cavities) or the gums (gum pockets and loss of bone support for the teeth). These foods contribute to a proliferation of these fast-metabolizing bacteria. In this regard, it is good to consider eating probiotic foods which are for the most part fermented foods such as saurkraut, kombucha (fermented tea), kefir or yogurt, certain cheeses, to name a few. These foods help replenish and feed the friendly microbes which help prevent the harmful bacteria from taking over. There are also prebiotic containing foods which help feed the bacteria in the gut that we need to stay healthy. 4. EAT FOODS THAT PROVIDE HEALTHY MESSAGES TO OUR DNA (genetic makeup) The foods we eat are digested and the nutrients and bacteria are delivered to the rest of the body. They can affect the genetic expression of our genes which in turn can affect how our bodies operate. This is a very complex process and much too large in scope for this short article. Scientists are really just "scratching the surface" with their knowledge of these processes. Suffice it to say that the expression of our unique genetic makeup can be affected in a large part by the foods we choose to eat. Imbalance in these messages can predispose us to various chronic diseases (for example) such as tooth decay. Eating a dentally healthy diet as it turns out, is also very beneficial for our overall health. Once again this highlights another important connection between our mouth and the rest of our body. This is a very short summary of a very detailed and interesting book. If you would like more information about the Dental Diet please leave a comment or question below. I will do my best to provide an answer to your question. Yours for glowing health ... Dr. Marty Frankel - Smiles by Design 3030-3080 Yonge Street, Toronto, ON M4N 3N1 416-770-8526

HEALTH IS NOT JUST ABSENCE OF DISEASE

What is the difference? Around the 1970's a shift in focus in medicine started to take place. Prior to this time the main focus of medicine was to look for and treat disease. Once the disease was "cured", the person was considered to be healthy. In the seventies there were some doctors that started talking about optimal health. What did they mean? When a person is optimally healthy not only is there an absence of disease, but all their systems are working optimally and the person feels "alive" and filled with energy and vibrant health. In my view, a person with optimal health does not feel sluggish, has a brightness in their eye, a spring in their step, boundless energy, sleeps well, has clarity of mind, sharpness of thought, and is able to enjoy life fully without any interference from their body. Absence of disease on the other hand suggests to me that the person has no major illness, but may be controlling certain medical conditions with medication, and as long as they are controlling these conditions, they are not suffering from the illness, but they may not feel like the person that I described above. People with "absence of disease" may still feel sluggish, un-energetic, drag through their day, fall asleep at their desk or behind a steering wheel, get home after a day's work and fall asleep watching TV, etc. How does one achieve optimal health? Optimal health is within the reach of most people. It requires that a person take personal responsibility for their health and well-being. We must learn to develop and cultivate healthy habits. ... A few months ago I wrote a blog post call "An Apple a Day ..." This is what I was getting at ... What are some of the elements of a health-directed programme? 1. Proper sleep. Most people require 7 1/2 to 9 hours of sleep every night. Many people suffer from a condition called sleep apnea. Sleep apnea can be linked to many serious medical conditions. I believe that everyone should have a proper sleep study or polysomnogram. Sleep is both restful and restorative. Without sleep we would not be able to function physically or mentally with any consistancy. Lack of good quality sleep can predispose a person to mood swings and eratic behaviour. Sleep is also repairative. Our bodies need sleep to heal, to repair cuts, fractures, micro and macro injuries that may occur during a typical day. 2. Proper nutrition. The old saying "you are what you eat" is in many ways very true. I come back to "an apple a day" ... what if it were true? In other words if we made healthy, natural, choices for unprocessed, unrefined foods that feed and nourishour bodies there is a good chance that we would stand a better chance of living healthier more energetic, vibrant lives. This is especially true when we think of oral health. There is no question that the foods we eat can have a dramatic impact on the health of our mouths. Sugar is not only bad for our health, but is deadly for our teeth. 3. Proper Excercise This is the third element to living a healthy life. We don't have to be extreme, but it's very important to keep moving, stretching, practicing good posture, indulging in some resistance training, breathing through the nose, and challenging our cardiovascular fitness. Excercise improves circulation, delivers oxygen to our cells, keeps our body and our brain functioning, stimulates endorphin release which enhances our mood. It is difficult to be depressed when we are excercising. What Can we do to achieve optimal oral health? Because I believe that a person can't have optimal overall health without a healthy mouth, and that one can't have a healthy mouth independent of a healthy body, my advice is to start with the "big 3" outlined above and add to that the use of consistent, daily oral health care ... flossing, toothbrushing, and possibly the use of oral irrigators such as the Waterpik water flosser. This coupled with regular preventive maintenance visits to your dentist can go a long way to ensuring great oral health and teeth for life. We must work together as a team ... you doing those things that you can do on a daily basis, and the dental office doing those things that you can not do at home, every 3 to 6 months depending on the condition of your mouth. If you would like more information on this, or you would like help on achieving your best healthy self, let us know your thoughts and feel free to ask questions. Yours for better health, Dr. Marty Frankel Smiles by Design 3030 - 3080 Yonge Street, Toronto, Ontario M4N 3N1 416-770-8526

Revisiting Dental Amalgam

AMALGAM ... SILVER OR MERCURY? Dental amalgam has traditionally been called "silver amalgam". More recently many have started naming them "mercury amalgam". Why has there been this change in focus? Amalgam contains approximately 50% mercury and only 25% silver. I believe that the "silver amalgam" term was used to downplay the mercury content in these fillings. Dental amalgam has been the centre of controversy many times in it's more than 150 year history. This controversy has focused mainly on the health risks of mercury. Mercury is a heavy metal and as such is not excreted by the body easily and is in fact stored in body tissues. The medical literature that I have seen is quite clear that this can pose a health risk. The World Health Organization updated fact sheet on "Mercury and Health" lists the following Key Points to consider when thinking about mercury: " Mercury is a naturally occurring element that is found in air, water and soil. Exposure to mercury – even small amounts – may cause serious health problems, and is a threat to the development of the child in utero and early in life. Mercury may have toxic effects on the nervous, digestive and immune systems, and on lungs, kidneys, skin and eyes. Mercury is considered by WHO as one of the top ten chemicals or groups of chemicals of major public health concern. People are mainly exposed to methylmercury, an organic compound, when they eat fish and shellfish that contain the compound. Methylmercury is very different to ethylmercury. Ethylmercury is used as a preservative in some vaccines and does not pose a health risk." Further on in the article they state the following about the use of dental amalgam ... "Dental amalgam is used in almost all countries. A 2009 WHO expert consultation concluded that a global near-term ban on amalgam would be problematic for public health and the dental health sector, but a phase down should be pursued by promoting disease prevention and alternatives to amalgam; research and development of cost-effective alternatives; education of dental professionals and the raising of public awareness." HEALTH CONTROVERSY VS. STRUCTURAL IMPACT: The use of dental amalgam in recent years has been dramatically reduced around the world. I have not placed an amalgam filling in over 20 years. Although I believe that mercury in amalgam (mercury is about 50% of the amalgam of metals ... mercury, silver, copper, tin, and zinc) could have a detrimental health effect, what I have noticed is that teeth with these filling tend to develop cracks and often break over time. Although these fillings are very durable and can last a long time, they do not add strength to teeth but rather tend to weaken teeth over time. The photo at the top of this post shows an extreme yet graphic representation of what can happen as a result of these fillings. If you can picture the behaviour of mercury in a thermometer ... as the temperature increases, the mercury expands and rises up the column. As the temperature cools, the mercury contracts and moves back down the column. In our teeth, the mercury can expand when we eat hot foods. This puts an outward pressure on the remaining walls of the tooth; when we eat cold foods the filling contracts. Over the life time of the filling this slight change in the size and pressure of the filling can cause teeth to weaken and break. I have seen this countless times. As a general rule when the size of an amalgam filling is greater than 1/3 the width of the tooth this effect is much more enhanced. As you can see, however, in the photo above it can even occur in a tooth with a small filling. Tooth coloured fillings bond to the walls of the tooth and help to strengthen the remaining tooth structure. These are great for small to medium sized fillings. In teeth requiring larger fillings traditionally we have placed crowns (also known as 'caps'). Another alternative which preserves more tooth structure and looks beautiful as well is the ceramic onlay. AMALGAM VS. BONDED ALTERNATIVES: Today when we are living longer on average than our predecessors, preserving tooth structure is a good thing. Banking tooth structure for the future is the name of the game. An argument that has been made in favour of amalgam is that it is much more durable than bonded fillings. Based on my years of observation of the destructive effects of amalgam ... many teeth with these fillings break ... even if they are more durable I choose the bonded alternative. I would much rather have my tooth remain in tact and outlive my filling, than I would want to have a durable filling that outlives my tooth after it causes it to break. What do you think? Yours for better health ... Dr. Marty Frankel - Smiles by Design 3030 - 3080 Yonge Street, Toronto, Ontario M4N 3N1 416-770-8526 www.drmartyfrankel.com

ATHLETIC PERFORMANCE AND NEUROMUSCULAR MOUTHGUARDS

Protective mouthguards have been used for decades to protect the teeth from injury during competitive compact sports games, and to help prevent concussions. Even as far back as the 1960's, attempts were made to fabricate mouthguards that would serve that purpose as well as improve performance. About 10 years ago, Dr. Anil Makkar, a dentist in Truro Nova Scotia who practiced with a neuromuscular approach, developed a mouthguard that actually improved performance in many ways. It was found to improve arm strength, shoulder strength, balance, range of motion, in particular. People who wore the guard felt that it also improved their breathing during activity. Dr. Makkar ran training programmes to certify dentists to be able to make these mouthguards. I was trained at the time, in the method to fabricate these mouthguards which were called the "Pure Power Mouthguard" or PPM for short. The PPM quickly made its way into professional sport where a competitive edge can make an enormous difference to an athlete's results. These guards were worn by NHL hockey players, MLB baseball players, NFL football and NBA basketball teams. Even golfers on the PGA tour started to wear the PPM guard because they found that it gave them better balance, range of motion on their swing, and helped them develop more power in their swing. I will post a few videos which can be found on Youtube that give you some insight into the workings of the PPM. In 2009 the New Orleans Saints won the Super Bowl, and that year the entire team wore PPM's. Here is a short clip of the announcers being completely amazed at the performance of the Saints. https://www.youtube.com/watch?v=3DygOtLQIvQ Many NBA players wore the PPM as well. Here is a video of Michael Redd going through the motions training with the help of the PPM. https://youtu.be/5elbrUUdd2A Mouthguards are very important for protection from injury for someone playing contact sports in particular. The performance guards add another dimension to the traditonal guard. For more information about this interesting mouthguard, feel free to ask us any questions you might have. Yours for better health and performance, Dr. Marty Frankel, 3030-3080 Yonge Street, Toronto, Ontario M4N 3N1 416-770-8526

Modern Dentistry

I remember a conversation that I had with my parents when I was a teenager. I had decided to pursue a career as a professional musician after years of focusing on the fact that my goal was to become a medical doctor one day. Needless to say my parents were disappointed in my change of plans. In discussing possible options, my mother in her wisdom, suggested that I could become a dentist. To this I replied, "Dentist? How boring ... I can't imagine ever becoming a dentist!" Was I ever wrong ... not only did I become a dentist, but it is anything but boring, and it has become my hobby and passion. Modern dentistry is nothing like the dentistry that was practiced for the preceding hundred years. In the last 33 years since I graduated, the global explosion in technology has hit dentistry, and allowed us to expand our offerings, abilities, techniques, and therefore our satisfaction levels. There are very few procedures that I perform in the way that I was taught in dental school. That is how much things have changed. One of the most rewarding procedures we dentists can perform is a "smile makeover". This can be something as small as masking a discoloured tooth with a tooth coloured resin to make it match the colour of the other teeth, to Invisalign, Orthodontics, and combination of tooth movement and porcelain veneers, to full mouth reconstruction with porcelain restorations. The following photos can show you two rather dramatic improvements in smiles. The first set of photos shows two upper incisors which had fractured when the person tripped, fell, and fractured his teeth. The teeth were not able to be saved, and two dental implants were placed and restored with ceramic crowns. This was a young man and these restorations made it possible for him to smile with confidence at a time in his life when he was entering the work force and seeking employment.

In this second case, the person had inherited a condition in which some of the permanent teeth were absent and his bite did not develop properly. This resulted in excess wearing of the teeth that he did have, and this made him appear much older than his chronological age. Using a combination of dental implants, neuromuscular dental principles, and modern ceramics, we were able to achieve a beautiful smile and make him look 10 years younger.

These are just 2 examples of what is possible today. This type of dentistry can change people's lives. I plan to show you more interesting cases in future blogs. Yours for better health, Dr. Marty Frankel Smiles by Design 3080 Yonge Street, suite 3030, Toronto, Ontario M2N 1T7 416-770-8526

SMILES BY DESIGN

I thought I would take a few minutes today to tell you about my tag line ... "SMILES BY DESIGN". Why did I choose that line and what is its significance? SMILES These days many dentists talk about smiles, and most of us think of the dentist creating a beautiful smile for their patient. This is certainly possible with today's esthetic, strong ceramics and the technologies that are available to us. I have studied extensively about the art and science of cosmetic dentistry and creating beautiful smiles for people is something I love to do. When I talk about smiles, although that is one of its meanings, I also like to go a little deeper. Some of the biggest challenges for people that threaten their ability to smile, are the following ... a) fear and anxiety about dental visits and dental treatments, basically a fear of the unknown, b) fear and anxiety around showing their smile because they perceive it to be unattractive, and c) oral and facial pain such as tooth aches and headaches. Our mission is to eliminate the fear and anxiety of visiting the dental office by treating people with respect, gentleness, and sincere caring; to eliminate the embarrassment some people feel around smiling by creating beautiful smiles; and to eradicate pain of tooth aches and head aches by showing people how to prevent these problems to begin with, and by treating the pain when it occurs. BY DESIGN When I say "BY DESIGN" I am talking about personalized care. Each person that I see is a unique individual with his or her own set of values, needs, desires, and level of health. I might see two people with a similar dental condition, but the treatment for those individuals could be very different. We take the time to get to know our patients, discover what is important to them, and together we develop a treatment plan that addresses their needs but at the same time feels right to them. This treatment planning process begins with a comprehensive complete oral examination where we perform six screenings to get a very clear picture of the existing conditions in a person's mouth. I want to be sure that my patient thoroughly understands those conditions and their significance. Once that is accomplished we can then decide on the plan. I always start by presenting at least 2 or 3 options for treatment and by explaining the consequences of each choice. This is by no means an exhaustive selection of possible options, but is enough to open up a discussion of the various aspects of the treatment plan. My patients and I co-develop the final plan. GOALS People have many different types of goals. There are professional goals such as striving to get a certain job, financial goals of saving and investing for retirement, and many people have health goals such as losing a certain amount of weight or getting cholesterol under control. When it comes to "SMILES BY DESIGN" I like to discuss not only immediate goals such as eliminating cavities or inflammation of the gums, but also long-term goals. If we think about weight loss for a moment, many people go on diets, lose weight, and then in a short time gain it back. How can that be prevented and the weight loss maintained? We must begin with the end in mind. We have to develop an image of ourselves at our ideal weight and hold that image in our minds as much as possible. When that image is impressed on our mind, it becomes much easier to make good food choices and maintain our desired weight. What do you want your mouth to look like 5 years from now? ... 10 years from now? If you hold an image of what you want in your mind, it will become much easier to achieve it and maintain it. Do you want straight teeth, whiter teeth, a pain free mouth, great functionality ... This plan can become like your map which will help you get from where you are now to where you want to be. This goal setting is another aspect of our personal approach to dental care. What do you really want? We can help you get there. Yours for better health, Helping you get your SMILE BY DESIGN because as some friends of mine have said, "When you smile, the whole world smiles with you". Dr. Marty Frankel 3030-3080 Yonge St. Toronto, Ontario M4N 3N1 416-770-8526 www.drmartyfrankel.com