Tooth Decay ... Otherwise called Dental Caries

What is tooth decay? What causes it? How does it develop? What are its risks? Can it be prevented? How is it treated? These are good questions and I dare say ones that we may think about but never really ask. CAUSE Tooth decay is actually an infectious disease. It is caused by bacteria that are present in the mouth. These bacteria can be transmitted from one person to another by sharing utensils and kissing to name two. The bacteria feed on carbohydrates in particular, and produce acids. The acid demineralizes the tooth surface and creates an avenue for the bacteria to grow into and invade the tooth. It's a little like worms in apples. They eat through the apple skin and can burrough down into the core. With time they can cause the apple to rot. When decay bacteria are left alone they behave in a similar manner, they multiply and can move right into the core or pulp of the tooth. This can lead to the need for root canal treatment or tooth extraction. It can also cause infection and abscess formation. Can you see the areas of decay in these teeth?

RISKS Some of the risks of not treating tooth decay are Pain, breakage of the tooth, loss of the tooth, infection which can spread to other parts of the body, abscess, and the nerve can die leading to the need for a root canal treatment.

As you can see above, when decay is not treated in a timely fashion, the bacteria can eat through the tooth until there is nothing left but the roots. PREVENTION Prevention of tooth decay is multi-faceted. Diet: Sugar and carbohydrates are the main culprit. If you eat these frequently, the mouth doesn't alway have time to clear the sugar attack and neutralize the acid before the next onslaught and eventually the teeth lose the battle. Acidic foods eaten frequently can cause erosion of enamel and tooth structure and leave the tooth open for bacterial invasion. Homecare: Brush your teeth at least twice a day, floss at least once. Water irrigators such as the waterpik - water flosser, are very helpful as well. Fluoride in proper amounts have a protective effect against decay. Regular dental visits: Some people think that they don't have a dental problem until it hurts. Tooth pain is usually a sign that it is too late or a more advanced problem. Regular visits to the dentist enable the cavity to be detected early. This allows for very conservative repair, less time spent in the dental chair, less painful treatment, less cost, and most importantly you save tooth structure which helps you keep your teeth for your entire life. Treatment: When we discover decay early, we can place small tooth coloured fillings. These are virtually invisible, help keep the tooth strong, and usually don't require anesthetic. (freezing). If we are replacing older fillings, especially the old mercury metal fillings, the replacement is often more extensive, and so the options available are slightly different. That will be a topic for future postings.

As you can see by this photo of mercury fillings replaced with tooth coloured alternatives, not only is this more esthetic, but these restorations make your teeth stronger. As always I sign off Yours for Better Health, Dr. Marty Frankel, 5775 Yonge St., suite 1000, drmartyfrankel@rogers.com, 416-770-8526

A few statistics about sleep ... Did you know?

DIAGNOSIS OF SLEEP APNEA:Some people wonder why dentists are involved in the manangement of sleep apnea and why we might be at the front lines of discovering and referring people with sleep apnea to their medical doctors for further investigation. Sleep apnea in many ways is a disease of anatomy. Certain anatomic features can predispose people to developing sleep apnea. Did You Know * When the tongue does not have enough room between the teeth either due to the tongue being too large or the dental arches being too narrow, it must move back toward the throat to find room for itself. This can restrict air flow through the upper airway. When the tongue needs more room its sides often push against the teeth and indentations of the teeth can be seen on the sides of the tongue. This creates a scalloped appearance. When I see a scalloped tongue, I know there is a 70% likelihood that the person will have sleep apnea. * Sleep apnea if discovered in children can usually be cured. It cannot be cured once we become adult. At that point it can only be managed at best. * 33% of all fatal truck accidents are due to sleep deprivation. * Driving impairment is the same whether the driver is drunk or sleep deprived (sleep apnea can have this effect) * Studies have shown that the risk of motor vehicle accidents increases by 2 to 7 times when a person has sleep apnea. * 58% of people with Diabetes have sleep apnea. * 35% of people with high blood pressure have sleep apnea. * 50% of people with congestive heart failure have sleep apnea * Even mild sleep apnea poses health risks * Some risk factors for sleep apnea include ... Obesity 60-70% of people with sleep apnea are obese, Male gender, Increasing age, Family history of sleep apnea, alcohol or sedative use, bite problems (dentist's territory), smoking, endocrine (hormonal) and metabolic disorders * Some symptoms of sleep apnea include: ... Heavy snoring,- 90% of loud snorers have sleep apnea, Stop breathing in sleep and then "snort", High blood pressure, morning headaches, restless sleep, depression, severe anxiety, short term memory loss, tempermental behaviour, poor job perforkmance, imptoence, dry mouth upon awakening, mouth breathing, excessive daytime sleepiness. * Most people with sleep apnea have what is termed a forward head posture ( the head is postured forward of the body) * A high palatal vault (where the hard palate is) is 90% predictive of sleep apnea - this can be caused by mouth breathing * A retruded lower jaw or what might appear as a retruded chin predisposes a person to sleep apnea about 70% of the time I have seen marriages saved by treating sleep apnea. Not only does the person sleep more easily and peacefully, you will find it is much quieter too. When a person sleeps better, their mood is better and they are generally less grumpy. This alone has a huge impact not only on a person's marriage, but on their entire outlook on life. SERIOUS CONDITION: As you can see, sleep apnea is associated with many serious medical conditions. It is important to speak with you family doctor about this issue, especially if you feel that you are tired often, or you snore. It could save or prolong your life. Until next time ... Yours sincerely, Dr. Marty Frankel 416-770-8526 drmartyfrankel@rogers.com 5775 Yonge St., Suite 1000

Straight Teeth and everything else ....

ESTHETICS: When I was a child, orthodontics (getting teeth into a good alignment) was thought of as a cosmetic procedure. It was performed most of the time on adolescents to ensure that they would grow up with an attractive smile and not feel self conscious. Many people still have that attitude. As important as esthetics are to a person's sense of self-confidence, undergoing orthodontic treatment has many more benefits. TMD's - TEMPEROMANDIBULAR JOINT DISORDERS: In growing children orthodontic treatment addresses airway issues which can impact not only the way the "bite" develops, but also facial development and growth. Airway issues in childhood can predispose a person to sleep breathing disorders such as Sleep Apnea in adulthood. These issues can also create a malocclusion or improper bite which can lead to TMJ (temperomandibular joint) disorder. This encompasses a host of symptoms which can range from sounds in the joints of the jaw to severe, often debilitating chronic headaches, and many other issues. I have touched on these in previous postings and will address them in more depth in the future. PERIODONTAL DISEASE: One of the other conditions which can be influenced and worsened by crowded, misaligned, tipped teeth is periodontal disease or gum disease. One of the features of most forms of gum disease is that it is painless. People are not aware of the problem until it is too late or they are told by their dentist. When the teeth are like this they are very difficult to clean properly. It is difficult to floss and the brush cannot adapt to the necks of the teeth to clean the gum line properly. Gum disease is caused by a build up of bacteria around the teeth which inflame the gums and then attempt to burrow down under the gum to eat away at the jaw bone. When the teeth are clean, the inflammation of the gum disappears. When the teeth are crowded, it's like dishes stacked too close together in a dishwasher. Not all the dish surfaces can be properly cleaned because there is no space for the water to swish around the dishes. Straightening the teeth allows a person easier access to the surfaces of the teeth that are the "in-between-the-tooth" surfaces. The result is better health of the gums. The other aspect of alignment of the teeth has to do with the forces that are exerted on the teeth when we chew our food. Teeth are designed for the force to be directed from the biting surface through the length of the roots. When a tooth is in proper alignment this occurs. When a tooth is tipped, the forces of chewing create torque on the teeth which put uneven pressure on the supporting bone under the tooth and bone loss can occur. Many years ago I had a patient who had severely crowded teeth. Along with this crowding, very deep periodontal pockets developed. When I spoke to the patient about this he didn't get the seriousness of the problem and replied that he didn't care to treat this condition because in his words "I don't have any problems". Now I knew that he had a problem but because it was painless he didn't feel the need to do anything. What he really meant was that he had no pain. The importance of periodontal disease has grown over the last 10-15 years because research is linking it to many medical conditions. It behooves us all to have regular periodontal assessments (at least annually), to develop excellent oral hygiene habits, and to consider the importance of properly aligned teeth. I want to wish everyone who reads this blog a very Happy, Healthy, and Successful 2015. I also want to thank you all for allowing me to do what I love to do as a dentist, namely providing dental care and information to those who want it. With Gratitude, Dr. Marty Frankel 5775 Yonge Street, suite 1000 Toronto, 416-770-8526 drmartyfrankel@rogers.com