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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, 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

Does forward head posture cause a bad bite? 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,, 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,