Tooth Loss ... Can it affect our health?

When teeth are infected it is not advisable to leave them and do nothing about them. Research says that inflammation and infection somewhere really means inflammation and infection everywhere. Inflammation can contribute to heart disease, diabetes, and kidney disease, to name just a few. The risks of these diseases goes down when the inflammation is removed from the mouth. When a person loses their infected teeth their general health can improve, but this can be a trade off. Nature doesn't like a vacuum and when teeth are lost and not replaced the remaining teeth can shift, tip, and drift. This changes the way forces of chewing and function are applied to the teeth which can result in more tooth loss. As well, the oral volume can change, and the jaw position can also change. This can lead to a set of new problems. The face can develop a caved-in appearance leading to esthetic problems. Speech patterns may change and a person might have to learn new ways to create the sounds that were once second nature. Chewing efficiency can decrease leading to dietary changes ... less fresh fruits and vegetables, more soft highly processed fattier foods. These dietary changes can again lead to diabetes, heart disease, gastrointestinal disorders. Complete tooth loss can also predispose a person to sleep disordered breathing ... sleep apnea. This is because the anatomical changes that occur can lead to narrower upper airway. We once thought that the only reason to replace teeth was for better chewing efficiency and esthetics. We now know that these are not the only reasons. Replacing missing teeth as they are lost can support the jaws and airway to help prevent sleep apnea (a potentially life-threatening problem) , maintain a healthy diet to prevent susceptibility to diseases. Our goal in the 21st Century is to save teeth and keep them healthy. There are still certain times that tooth removal is the only option. In these situations is important not only to remove the offending tooth, but to replace it as well. Sincerely, Dr. Marty Frankel 5775 Yonge St., Suite 1000., 416-770-8526, drmartyfrankel@rogers.com

"I have TMJ" ????

WHAT IS THE TMJ: Many people come into my office and tell me that they have "TMJ". This term needs some clarification. Most people don't know what TMJ stands for let alone what it means. TMJ stands for Temporo-Mandibular Joint. It is the name of the joints of the jaw. It is the spot just in front of the ears ... on both the right and left sides. Saying that "I have TMJ" is like saying "I have 'elbow' or 'knee'". Most people have these body parts. What we mean when we say that we have "TMJ" is that we have a problem there. One term that has been assigned to this condition is "TMD". This stands for Temporomandibular Disorder. What this means is that there are a host of symptoms related to the joints of the jaw and the structures that support them. WHAT STRUCTURES ARE RELATED TO THE TEMPOROMANDIBULAR JOINTS: Since we're talking about terms, ... what is TEMPOROMANDIBULAR? TEMPORO- relates to the skull, the temporal bone, and MANDIBULAR relates to the lower jaw, the mandible. The TMJ is the joint between the lower jaw and the base of the skull. The lower jaw is basically a bone that hangs from our skull, held by a sling of MUSCLES. These MUSCLES make up a very important component of the TMD picture. There are also NERVES, TEETH which support the jaws when we swallow and chew, and a DISC of fibrous tissue between the JAW BONES which prevents the BONES from rubbing against eachother. The DISC is held in place by LIGAMENTS and MUSCLES. Behind the joint there is very sensitive tissue which has many nerve endings that can lead to pain when all these structures don't work together harmoniously. To add one more layer of complexity to this picture, these body parts that I have listed do not work in isolation. They are attached to the rest of the body. As a result of this connection, the TMJ can be influenced by the rest of the body, and the body can be influenced by the TMJ. As a result of all this, treatment for these problems can be quite a tricky puzzle to solve. WHAT ARE SOME CLUES THAT YOU HAVE A TMJ PROBLEM? a) Do you hear clicking or popping or grating sounds when you open or close? b) Do you have pain in the joints of your jaws? c) Do you get headaches? d) Do suffer from dizziness or ringing in your ears? e) Do you have difficulty opening your mouth wide? f) Do you grind or clench your teeth? g) When you open or close your mouth does your jaw move in a smooth straight path? h) Does your jaw ever lock open or closed? i) Do you sleep well at night? Do you wake rested? Can you get to sleep? Can you stay asleep? k) Do you have pain on opening your mouth? l) Do you pain in your shoulders or back? m) Are your eyes sensitive to light? If you answered YES to one or more of these problems, seek some advice from your dentist. Not all of these need be treated, but TMJ problems can definitely worsen with time. Don't wait until it is too late. Yours for excellent health ... Dr. Marty Frankel, 5775 Yonge St., suite 1000, Toronto, 416-770-8526, drmartyfrankel@rogers.com

Modern tooth repair options

HISTORICALLY SPEAKING: Last week I talked a bit about tooth decay and the impact it can have on our teeth. Today I would like to mention some of the modern options for repairing and restoring teeth that have been broken down by tooth decay. In the past, we typically would fill back teeth with mercury amalgam fillings which are very durable, but offer no strength to the tooth. Mercury is also known to be a neuro-toxin and its safety has been debated for over a hundred years. Some claim that in the form of an "amalgam", the mercury is bound and safe. Some studies done in the past seem to show otherwise, that mercury vapor is released from the fillings in small quantities for years, and that traces of mercury can be found in various body tissues and organs. Other options which eliminated the mercury question included gold restorations ... these have been considered the standard against which to measure other options. Gold was usually costly compared to the amalgam fillings and therefore amalgam was often the restorative material of choice. In the '60's the ability to bond filling material to tooth structure was developed. At that time dentistry and medicine focused on amputation, or removing body tissue in order to repair a problem (surgery). Today the focus is on Augmentation. Our goal is to preserve as much healthy body tissue as possible and add back what is missing. This is true of both medicine and dentistry. Dental technology has advanced by leaps and bounds since then, but the discovery of bonding has changed the course and face of dentistry. PROPERTIES OF AN IDEAL RESTORATIVE MATERIAL: Research is always being conducted to improve dental materials and make them more ideal. Some desirable properties of restorative materials would be:1) Durable and functional 2) bond to tooth structure - thereby strengthens tooth 3) ability to seal the tooth with the filling 4) conservative preparation - ability to preserve tooth structure 5) esthetic i.e. looks like a tooth 6)Bio-compatible - does not harm us to have the material in our mouths. Bonded restorations are able to deliver these requirements. We can bonded resin based filling materials and porcelain restorations to tooth structure. These are such things as tooth coloured fillings, porcelain or resin-based onlays, porcelain veneers, and porcelain or resin-based inlays. All-ceramic crowns can also be bonded to tooth which seals the tooth and creates a durable bonded to tooth which in turn strengthens the crown. With modern dental materials and techniques it is possible to create beautiful, long lasting, health-supporting, smiles. This is by no means exhaustive but rather intended to let you know some of the possibilities that are available. Until next time I sign off sincerely, Dr. Marty Frankel 5775 Yonge Street, suite 1000 Toronto, Ont. 416-770-8526

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

Sleep breathing disorders and Dentistry

So many times I will question a patient about a possible condition that they might be experiencing physically in their body. They might reply by saying that "Yes, I do have that symptom, but I'm sure it's not related to my teeth. THE KNEE BONE CONNECTED TO THE THIGH BONE Hmmmm ... Do you remember that old song from grade school? It really is true, we just never put it all together to connect the dots. The lower jaw is just a bone that is suspended from the base of the skull by a sling of muscles. Depending on how the jaw is postured which in large part is connected to how our teeth come together, this jaw position may or may not be a comfortable spot for the muscles that must support and move the lower jaw when we chew, speak, swallow, and even clench and/or grind our teeth. The muscles of the head and neck are part of a long chain of muscles that extend into our neck, shoulders, arms, down our back, and right down to our feet. If the jaw muscles are imbalanced, that imbalance can be transmitted from our head to our toes. This can lead to poor posture, body pain, and a multitude of symptoms. Did you know that the front of our upper airway (the part that passes through our neck or pharyngeal area) is the back of the oral cavity? Did you ever stop to think that the roof of our mouth is the floor of our nose? If the muscles of the neck are imbalanced or in spasm they can have an effect on the amount of resistance present in the upper airway. If a person has a narrow constricted dental arch, often the hard palate is very high. If that is the case, it can compromise the nasal airway, which in turn can increase resistance of the air passing through the nose. THE BITE AND THE AIRWAY Orthodontists are very concerned about a person's airway and how it will impact the stability of their treatment. If you breathe through your nose you will notice that your tongue is postured up against your palate. The tongue is a very powerful muscle. It exerts an outward force on the upper teeth. The cheeks and lips also house muscles which exert an opposing inward force on the teeth. The teeth will find a neutral position between these opposing forces. Someone who breathes through their mouth will have to drop their tongue down toward the floor of their mouth to allow for air to pass through. This removes the outward force on the teeth. As a result the cheeks and lips win the battle and the teeth and therefore the dental arches become constricted. This can start a cascade of events that effectively impact the upper airway which can contribute to sleep disordered breathing, most notably Obstructive Sleep Apnea. (to be discussed in a future posting) WHAT DO WE DO? Traditionally we have not realized the important connections that exist between our mouths and our bodies. As new information becomes available, we have to shift our paradigm (how we view our health and our body's functioning) to enable us to solve complex health issues. Dentists and medical doctors and other health care practitioners will have to form alliances and learn to collaborate and understand the interconnections that exist. Dentistry is coming of age. It is now important for dentists to be true "mouth doctors" and expand our scope beyond the teeth and gums. Yours for excellent health, Dr. Marty Frankel 5775 Yonge St., suite 1000 Toronto, Ontario M2M 4J1 416-770-8526 drmartyfrankel@rogers.com

It's All About Prevention

Fortunately, most dental problems are preventable, and if we are unable to prevent a problem, if we can catch it soon enough (in an early stage) it is usually very easy to treat. One of the earliest dental problems that can occur is a condition called "Early Childhood Caries". Caries is the dental term for tooth decay or cavities. This is tooth decay that starts on the baby teeth very early in life. It can cause pain, infection, inability to eat or sleep, and very often requires extensive, which can be expensive, dental treatment. This can be prevented by introducing your child to good oral hygiene practices very early ( I flossed and brushed my kids' teeth every night until they were close to 10 years old). Start flossing as soon as the baby molar teeth (the larger back teeth) enter the mouth. This is especially important as the permanent first molars erupt around 6 years old. These teeth can become closer together as the permanent molars erupt and decay-causing bacteria can be more difficult to remove from between these teeth. Thumb sucking should be stopped by 4 years old. Sucking can place excessive forces on the teeth and have a deleterious impact on the "bite" ... the way the teeth and jaws utimately come together. This is corrected by orthodontic/orthopedic treatment. Children are very accident prone. They are learning to walk and finding their way around in the world. Proper precautions should be taken to prevent damage from these accidents. Proper car seats are very important to prevent oral/facial trauma. Accident proof your home with proper locks on closet doors, gates etc. Don't leave your child unattended in walkers, jumpers, bath seats, the play pen. It only takes a second for something serious to occur. Wear properly fitted helmets for bike riding, roller blading, scooters, skateboarding. If your child has an accident that involves a tooth, broken or not, it is very important to see your dentist right away. Only approximately 1/3 of the tooth is visible above the gum. Even though a tooth might look fine after an accident, there could be damage to the nerve inside the tooth, to the jaw bone, and other related structures. The best time to take your baby to the dentist for their first dental visit is sometime between 6 and 12 months. This visit is very important for many reasons. This is a well-baby visit. It helps the child get accustomed to being in a dental chair in what is usually a very non-threatening appointment, and allows the dentist the chance to learn the child's medical and birth history, to assess the current health status of your child's mouth, and to educate the parent and provide guidance on how to care for and maintain their child's teeth. Regular dental visits can help with the maintenance of good oral health, allows for early detection of tooth decay and gum problems. This is the best way to start your child on a path to good oral health habits, and life long excellent oral health. To summarize, here are the steps to healthy teeth for life ... 1) HEALTHY PREGNANCY 2) HEALTHY NUTRITION - EXCELLENT DIET 3) GOOD ORAL HYGIENE PRACTICES 4) APPROPRIATE USE OF FLUORIDE 5) REGULAR DENTAL VISITS I hope you have found this information to be of value and that you will take action to ensure the very best for you and your children. Yours for excellent health, Dr. Marty Frankel, 5775 Yonge St., Suite 1000, Toronto, Ontario Canada, 416-770-8526, drmartyfrankel@rogers.com

Caring for your child's teeth - A few more TIPS

To continue from last week I would like to speak briefly about Fluoride. This has been a controversial topic for as long as I can remember. I am a supporter of Fluoride, but just the right amount. Do you know that there are places in the world where fluoride occurs naturally in the water in quantities as high as 80 parts per million (ppm)? Someone who is pro-fluoride would actually remove 79 ppm from that drinking water to bring it in line with the optimal level. Years ago it was determined that the optimum level of fluoride should be slightly less than 1 ppm. This provides a very good level of protection to the tooth ( the tooth becomes more resistant to tooth decay). We find, that as the level of fluoride increases a condition called Fluorosis becomes more common place. Signs of Dental Fluorosis include white or brown discolouration of the dental enamel and unattractive texture to the tooth surface. If you live in an area where fluoride is added to the water system it would be good to find out what the level of Fluoride is in your water. Also be careful to limit the amount of fluoride your child receives from other sources such as toothpaste and foods that may be made with water added that might contain fluoride. Tooth decay and gum disease are caused by bacteria in the mouth. This bacteria can be transmitted in such ways as play, kissing your child, sharing cups, spoons, etc. It is important for parents to have excellent oral hygiene practices to help minimize the risk of transmitting this bacteria to their children. Another common cause of tooth decay is the act of putting your baby to bed with a bottle containing juice or milk. If your child needs a bottle once they are in bed try your best to train them to take water. Other drinks can be excellent sources of sugar which bathe the teeth all night and can lead to severe dental decay. Next week I will share a few more important points on the care of your child's teeth. Until then I wish you all well. To your excellent health, Dr. Marty Frankel 5775 Yonge Street, suite 1000 416-770-8526 drmartyfrankel@rogers.com

Some Thoughts on Baby Teeth (The Primary Dentition)

In my last blog post I talked about children and Obstructive Sleep Apnea. This got me thinking about "baby teeth" and their importance. I thought this would be valuable for expectant parents or parents of young children. The primary teeth are needed for chewing - so that children can progress from a liquid diet to a full spectrum of foods, for speech - many sounds that we make such as "t", "s", "d" "f" "l" and others rely on teeth and tooth position, for appearance, and for the proper development and eruption of the permanent teeth. The primary teeth start to develop during the first 3 months of pregnancy. As such it is very important for the pregnant mother to keep all her doctor visits, eat enough calcium in her diet, avoid non-prescription medications, not smoke, and avoid alcohol. The first baby teeth erupt at about 6 to 7 months. They are normally the 2 lower incisors. By 12 months there are usually 8 to 12 teeth present and by 2 to 3 years the full complement of 20 teeth should be present. One of the uncomfortable things that children experience as the teeth erupt through the gum is teething pain. This is the feeling of the teeth "cutting" through the gums. This can be accompanied by mild fever, a rash around the mouth, and ear infections. A cool teething ring can be very soothing. It is also very important to start cleaning the teeth as soon as they appear in the mouth. You can use a gentle toothbrush made for infants, or initially even a gentle cloth or cotton guaze can be used. If your child drinks from a bottle it is important not to let them sleep with the bottle, especially if it contains juice or milk, two sources of sugar. In the next few postings I will continue with this line of thought. With proper care most dental problems are preventable. This can help achieve the goal of "healthy teeth for life". Yours for excellent health, Dr. Marty Frankel, 5775 Yonge St., Suite 1000, Toronto, Ontario, 416-770-8526, drmartyfrankel@rogers.com, www.drmartyfrankel.com