When it comes to sleep apnea, how can we help our children

One of the most important things we can do as medical/dental professionals is to help prevent problems from occurring in the first place. When it comes to Sleep Apnea, as we were discussing this in our last post, with adults, the best we can do is manage it, but with children we can actually cure it. If you think about it, the mouth is one of 2 openings to the upper airway. One is the nose, and the other is the mouth. The healthiest way to breathe is through the nose. The cilia (little hairs in your nose) filter the air to remove allergens, bacteria etc., the nose also humidifies the air. When a person breathes through their nose, the tongue normally postures up against the hard palate and the lips close together and seal the oral cavity. The final position of the teeth in the dental arches is a neutral one found between the outward pressure exerted by the tongue and the inward pressure of the muscles of the lips and cheeks. Early in life for many children, the nose may block due to allergies to the environment, milk, and other foods and items. This forces the person to breathe through their mouth. In order to do that, the tongue must drop down towards the floor of the mouth. Now, the inward force from the muscles of the lips and cheeks cause the dental arch to become constricted. This can lead to the palatal vault rising upward and in turn cause an increase of nasal resistance. Parents should pay attention to the breathing patterns of their children. Do they snore? Do they breathe through their mouth, or through their nose? Do they have food allergies. If these are found, have the family doctor refer you to a pediatric ENT (ear-nose-throat) to eliminate the problem. In future postings I will elaborate on this issue. If you have any questions or comments, you can always reach me at drmartyfrankel@rogers.com, 416-770-8526, or on Facebook at Dr. Marty Frankel - Smiles by Design.

Sleep Apnea - Let's wake up and do something about it!

I just returned from an in depth course about sleep apnea and the dental management of it. Sleep has become a huge area of interest in medicine over the last few years ... and rightly so. Poor quality sleep and apnea affect so many different areas of our health that it should really be of interest to everyone. I will briefly mention a few things about sleep apnea. Apnea occurs in our sleep and it refers to an episode where we stop breathing for 10 seconds or more. When a person has an overnight sleep study this is one of the parameters that is measured. During the study the number of times a person stops breathing is totalled along with some other breathing issues. A calculation is then done to determine how many times a person has breathing issues per hour. This is know as the AHI and the degree of severity is scored as follows. AHI less than 5 is normal. From 5 to 15 is mild, 15 to 30 is moderate, and above 30 is severe. I have a patient who stopped breathing more than 80 times per hour. Consider that 80 X 10 is 800 seconds per hour that he was not breathing fully. That is more than 10 minutes per hour! This places a huge strain on the heart which must work harder to ensure that the person gets enough oxygen to their system. This could be an explanation for why some people have heart attacks in their sleep. Poor oxygen uptake can impact the endocrine system ... our production of hormones of particular interest is stress hormones and insulin which is related to diabetes, our moods ... people who don't sleep well can be very grumpy and short-tempered which in turn impacts their outlook on life and their relationships (of interest to psychiatry) to name a few. Over-tiredness can make it very dangerous to operate machinery such as automobiles (can lead to more motor vehicle accidents), airplanes - I wouldn't want a tired pilot, transport trucks, trains etc. ... The toll that improper sleep takes on society is enormous. How is it that dentistry has become involved in this area? If you think about it, the mouth is an opening to the upper airway. It can play a major role in creating airway resistance. It is also below the nose and the anatomy of the mouth has a direct impact on the nasal passages. It can have a dramatic impact on nasal resistance, snoring, and sleep apnea. It should come as no surprise that dentistry plays an important role in the treatment of Obstructive Sleep Apnea (OSA). The standard medical solution for OSA is CPAP (continuous positive air pressure) which is the gold standard for apnea treatment. Many people do not find it comfortable however, and it is good to know that there is an alternative in the form of Oral Appliances which are very effective for the treatment of mild to moderate sleep apnea, and can be useful in combination with CPAP for more severe forms. I hope you found this interesting and of value. I believe that it would be important for every adult and some children to have sleep studies to evaluate their sleep quality. I'll be back soon with more information from the world of dentistry ... Dr. Marty Frankel, 5775 Yonge Street, Suite 1000 Toronto, Ontario M2M 4J1 416-770-8526 drmartyfrankel@rogers.com

Does forward head posture cause a bad bite?

https://www.youtube.com/watch?v=LJ5DqWYywPA&feature=youtu.be In this episode of LVI TV, Dr. Bill Dickerson explains the link between head and neck posture, and the way our teeth come together. He also touches on how this can lead to symptoms of Temperomandibular Disorders (TMD). This further highlights what I mentioned in my last blog post. Dr. Marty Frankel, 416-770-8526, drmartyfrankel@rogers.com, 5775 Yonge Street, Suite 1000, Toronto M2M 4J1

Muscles in Dentistry

Most people including many dentists do not realize the important role that muscles play in Dentistry. The movements of our jaw in chewing, speaking, yawning, eating, swallowing are all controlled by muscles. The muscles must work in harmony with the teeth and the joints of the jaw. When this harmony does not exist it can lead to a variety of problems such as bite problems, muscle pain, and jaw joint problems to name a few. A number of years ago, a study was performed to investigate the effect of an imbalanced bite on the alignment of the spine of rats. Pre-study x-rays were taken of the rat's spine. A small filling was bonded to the biting surface of one of the rodent's molars. This created an imbalance in the bite of the animal. A few weeks later another x-ray was taken and the result was that the spine developed very obvious curvature. At this point the small filling was removed and another x-ray taken a few weeks later revealed that the spine had returned to its normal pre-study shape. What does this mean to we humans. The planes of the body such as the line of our shoulder heights, or the line drawn through our hips or our knees seek to be level to the world. If an unbalancing stimulus is introduced, such as the filling in the rat, our bodies will compensate for the irritation by shifting the balance of our weight and the muscle alignment can and will change. Imagine a pebble in your shoe while you try to walk a few city blocks. As this pebble becomes more and more irritating, we will try to shift our posture to avoid the irritating feeling of the pebble. This can lead to muscle pain in our legs, excess pressure on the hip on the opposite side to the pebble, perhaps a sore back, and eventually the neck and even the jaw muscles. This same cascade of events can occur in the opposite direction when the bite is imbalanced and the muscles of the head and neck become strained as a result. This consideration of the effect of muscles in dentistry is one of the aspects that the approach to dental treatment called "physiologic neuromuscular dentistry" takes into account. If you suffer from chronic headaches, jaw pain, limited jaw opening, neck pain, and many other symptoms, then this may be an approach to dental care that can help. Over the next few postings, I will discuss some of the applications of this approach and how it may be of help to many people. Dr. Marty Frankel, 416-770-8526, drmartyfrankel@rogers.com

What happens if you don't remove all the plaque and have regular examinations

Yesterday I received a phone call from a patient saying that she bit into something soft and her upper left "eye tooth" broke off at the gum-line. There was no pain, but she was embarrassed to smile and was worried about what would have to be done to give her a tooth so that she could smile and function in a social setting. Why did this happen? She had gotten busy and neglected to appear for a hygiene visit for about 4 years. During that time (a stressful time for her) she developed extensive tooth decay on about 6 teeth. A few of these will need to have root canal treatment because the decay has eaten it's way into the nerves of those teeth. The tooth that I looked at today may not need the root canal treatment. ... but the decay was so extensive, it had eaten into the tooth like a beaver chews into a tree, that the tooth could no longer support itself and it fractured. It was very tricky to restore, and it challenged me and forced me to be creative, but after about 1 1/2 hours I was finished repairing the tooth. This was a temporary repair and the options for final treatment are rather complex. This patient will need extraction and implant replacement of the tooth, extraction and a bridge, or root canal treatment followed by gum surgery and a crown. Had she been more consistent with her dental hygiene appointments I would have been able to catch the decay sooner and avoid this unfortunate situation. It seems from my experience that if we go longer than 2 years between x-rays that it is possible for tooth decay that may have been too small to be detected at first, to grow into a full blown area of tooth decay on the tooth. It's good to have x-rays taken at least every 2 years to catch decay before root canal treatment is needed. Dr. Marty Frankel 416-770-8526 drmartyfrankel@rogers.com

Dental Tips

Greetings from Toronto. Today I am resuming my blog posts. I will be posting to this space approximately once a week and will be talking about topics of dental interest. I will also submit information that is currently available from other sources on dentistry and related topics. Today I would like to talk about a few things related to cleaning teeth. I had a patient who came into the office last week for a hygiene visit. It had been a little over a year since she had last had her teeth cleaned. Although she has excellent homecare, she brushes and flosses regularly, she was surprised to find that she had a lot of build up of bacteria and debris under the gum line. She didn't realize how important her office visits were. Cleaning of teeth is a job that is best shared. There are things that we can do in the dental office and things that people must do at home. Plaque, which is basically bacteria, builds up around the teeth. It is soft and can be removed at home with a tooth brush and floss. It only takes 24 hours to build up on the tooth surface. If it's not removed at home daily, it can grow down around the tooth and get under the gum where it can destroy the bone that supports the tooth roots, and it can also enter the blood stream where it can cause or contribute to health problems such as heart issues, stroke, diabetes, respiratory issues, and the list goes on. Over time that bacteria along with mineral deposits on the teeth, (know as calculus or tartar) can adhere to the tooth. These deposits are hard, and must be removed professionally. Different people will build up deposits at different rates. This is what we do at the office, we remove the hard deposits, and help to set up an appropriate interval for maintenance visits. Look out for more "Dental Tips" as we move forward over the next while. Sincerely, Dr. Marty Frankel 5775 Yonge Street, Suite 1000 Toronto, Ontario, M4M 2J1 416-770-8526

While building and transitioning into my new practice, I am practicing a few days a week at my friend Dr. Alex Koranyi's office in North York. The address is 5775 Yonge Street, suite 1000. To make an appointment please call Arlene at 416-770-8526. We can still be reached at 416-224-8087, and drmartyfrankel@rogers.com

I am very pleased to announce that I will be opening my new office in North York Ontario in the very near future. When that occurs I will resume my blog on a more regular basis and provide you with interesting information in the world of dentistry, physiology, and the neuromuscular approach. For the time being, if anyone cares to contact me I provide the following contact information: Web page: www.drmartyfrankel.com Phone #: 416-224-8087 email: drmartyfrankel@rogers.com Please stay tuned ... Sincerely, Dr. Marty Frankel

To 2010 and a bright future

With the Holidays upon us I have been reflecting on my life and what it means to me to be a dentist. What is it that is so special about my profession? Some see dentistry as a boring profession where people burnout due to the daily repetition of tasks. Many have commented to me that they have heard that dentists have the highest suicide rate of all the professions.

Dentistry to me however is a very noble profession. How many people get to help others every day of their life doing something that is very creative and challenging? Dentistry is no longer just drill, fill, and pull. With the advances in technology over the last 15 or so years, dentistry has become a fascinating endeavour. It is no longer a mundane boring repetitive job. People, thanks to modern research efforts, are now realizing the links that exist between oral health and overall health of the body. Periodontal disease in particular has been shown to have a very strong link to Diabetes and the ability of an individual to control their Diabetes as well their susceptibility to Diabetes. Other links exist between Periodontal Disease and Heart Disease, Stroke, low birth-weight babies, and respiratory illnesses.

Adhesive dentistry (bonding to tooth structure) allows us to be very conservative with our tooth preparations when treating cavities. The surgical paradigm of cutting away parts of the body to heal it continue to evolve into an additive philosophy where we retain as much of the healthy tissue as possible and add to it to restore to the original shape, function, and beauty. This and the neuromuscular appoach to dentistry are my real passion.

Neuromuscular dentistry can help people in so many ways. Not only can it relieve the pain associated with headaches, neckaches, upper back and shoulder, it can improve the entire physiology of the body by bringing structures into better alignment which can allow for a more optimum flow of blood, lymph, and nerve transmission through out the body.

One of the exciting developments in recent years which I have written about before is the Pure Power Mouthguard. This is a sports mouthguard built to a neuromuscular jaw position which has been shown to allow an athlete to increase strength, range of motion, flexibility, and balance. We believe that it will change the face of sports in the near future. ... Performance enhancing mouthguards ...

As you can see, the future looks bright for us all. Thank-you to my TEAM at Downtown Dental Associates, my patients (who are like my extended dental family), the brilliant research taking place at LVI (more on that in a future blog), and all the people who inspire me daily.

I wish everyone a happy, healthy, and peaceful 2010. May it be your best year ever.

With Love and Gratitude in my heart,

Sincerely,
Marty Frankel DDS

the Makkar Pure Power Mouthguard

This Past Monday on Monday Night Football the sports casters were blown away by the Pure Power Mouthguard. I believe that about 40 members of the New Orleans Saints football team were fitted for this incredible device. The traditional sportsguard offers protection from tooth fracture and concussion. The PPM does this but because of the way it aligns the lower jaw, it creates a total body alignment that helps balance the body's musculature and allows the athlete to tap into better balance, range of motion, flexibility, and strength. The football announcers could not believe the "moves" that they saw by members of the Saints team.

The different designs make the mouthguard adaptable to just about any sport. Many pro football players, hockey players, baseball players, golfers ... yes golfers, boxers, MMA fighters, soccer players, skiers, cyclists, joggers/runners to name a few, are wearing this device and seeing amazing results.

We have talked about how the Neuromuscular approach to dentistry can help eliminate headaches and many other related symptoms, we now see another application for the neuromuscular bite, and that is the Pure Power MOuthguard. This mouthguard was developed by Dr. Anil Makkar in Truro Nova Scotia and is set to turn the sports-world upside down.

For more information you can contact me at Downtown Dental Associates, 416-368-4500. Feel free to visit the PPM web-site at www.makkaradvantage.com