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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