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Protective mouthguards have been used for decades to protect the teeth from injury during competitive compact sports games, and to help prevent concussions. Even as far back as the 1960's, attempts were made to fabricate mouthguards that would serve that purpose as well as improve performance. About 10 years ago, Dr. Anil Makkar, a dentist in Truro Nova Scotia who practiced with a neuromuscular approach, developed a mouthguard that actually improved performance in many ways. It was found to improve arm strength, shoulder strength, balance, range of motion, in particular. People who wore the guard felt that it also improved their breathing during activity.

Dr. Makkar ran training programmes to certify dentists to be able to make these mouthguards. I was trained at the time, in the method to fabricate these mouthguards which were called the "Pure Power Mouthguard" or PPM for short. The PPM quickly made its way into professional sport where a competitive edge can make an enormous difference to an athlete's results. These guards were worn by NHL hockey players, MLB baseball players, NFL football and NBA basketball teams. Even golfers on the PGA tour started to wear the PPM guard because they found that it gave them better balance, range of motion on their swing, and helped them develop more power in their swing.

I will post a few videos which can be found on Youtube that give you some insight into the workings of the PPM. In 2009 the New Orleans Saints won the Super Bowl, and that year the entire team wore PPM's. Here is a short clip of the announcers being completely amazed at the performance of the Saints.

Many NBA players wore the PPM as well. Here is a video of Michael Redd going through the motions training with the help of the PPM.

Mouthguards are very important for protection from injury for someone playing contact sports in particular. The performance guards add another dimension to the traditonal guard. For more information about this interesting mouthguard, feel free to ask us any questions you might have.

Yours for better health and performance,
Dr. Marty Frankel,

3030-3080 Yonge Street,
Toronto, Ontario M4N 3N1



I remember a conversation that I had with my parents when I was a teenager. I had decided to persue a career as a professional musician after years of focusing on the fact that my goal was to become a medical doctor one day. Needless to say my parents were disappointed in my change of plans. In discussing possible options, my mother in her wisdom, suggested that I could become a dentist. To this I replied, "Dentist? How boring ... I can't imagine ever becoming a dentist!" Was I ever wrong ... not only did I become a dentist, but it is anything but boring, and it has become my hobby and passion.


Modern dentistry is nothing like the dentistry that was practiced for the preceding hundred years. In the last 33 years since I graduated, the global explosion in technology has hit dentistry, and allowed us to expand our offerings, abilities, techniques, and therefore our satisfaction levels. There are very few procedures that I perform in the way that I was taught in dental school. That is how much things have changed. One of the most rewarding procedures we dentists can perform is a "smile makeover". This can be something as small as masking a discoloured tooth with a tooth coloured resin to make it match the colour of the other teeth, to Invisalign, Orthodontics, and combination of tooth movement and porcelain veneers, to full mouth reconstruction with porcelain restorations. The following photos can show you two rather dramatic improvements in smiles.


This first set of photos shows two upper incisors which had fractured when the person tripped, fell, and fractured his teeth. The teeth were not able to be saved, and two dental implants were placed and restored with ceramic crowns. This was a young man and these restorations made it possible for him to smile with confidence at a time in his life when he was entering the work force and seeking employment.

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In this second case, the person had inherited a condition in which some of the permanent teeth were absent and his bite did not develop properly. This resulted in excess wearing of his remaining teeth, which made him appear much older than his chronological age. Using a combination of dental implants, neuromuscular dental principles, and modern ceramics, we were able to achieve a beautiful smile and make him look 10 years younger.

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These are just 2 examples of what is possible today. This type of dentistry can change people's lives. I plan to show you more interesting cases in future blogs.

Yours for better health,
Dr. Marty Frankel - Smiles by Design
3080 Yonge Street, suite 3030,
Toronto, Ontario M2N 1T7



I thought I would take a few minutes today to tell you about my tag line ... "SMILES BY DESIGN". Why did I choose that line and what is its significance? 

These days many dentists talk about smiles, and most of us think of the dentist creating a beautiful smile for their patient. This is certainly possible with today's esthetic, strong ceramics and the technologies that are available to us. I have studied extensively about the art and science of cosmetic dentistry and creating beautiful smiles for people is something I love to do. When I talk about smiles, although that is one of its meanings, I also like to go a little deeper. Some of the biggest challenges for people that threaten their ability to smile, are the following ... a) fear and anxiety about dental visits and dental treatments, basically a fear of the unknown, b) fear and anxiety around showing their smile because they perceive it to be unattractive, and c) oral and facial pain such as tooth aches and headaches. Our mission is to eliminate the fear and anxiety of visiting the dental office by treating people with respect, gentleness, and sincere caring; to eliminate the embarrassment some people feel around smiling by creating beautiful smiles; and to eradicate pain of tooth aches and head aches by showing people how to prevent these problems to begin with, and by treating the pain when it occurs. 

When I say "BY DESIGN" I am talking about personalized care. Each person that I see is a unique individual with his or her own set of values, needs, desires, and level of health. I might see two people with a similar dental condition, but the treatment for those individuals could be very different. We take the time to get to know our patients, discover what is important to them, and together we develop a treatment plan that addresses their needs but at the same time feels right to them. This treatment planning process begins with a comprehensive complete oral examination where we perform six screenings to get a very clear picture of the existing conditions in a person's mouth. I want to be sure that my patient thoroughly understands those conditions and their significance. Once that is accomplished we can then decide on the plan. I always start by presenting at least 2 or 3 options for treatment and by explaining the consequences of each choice. This is by no means an exhaustive selection of possible options, but is enough to open up a discussion of the various aspects of the treatment plan. My patients and I co-develop the final plan. 

People have many different types of goals. There are professional goals such as striving to get a certain job, financial goals of saving and investing for retirement, and many people have health goals such as losing a certain amount of weight or getting cholesterol under control. When it comes to "SMILES BY DESIGN" I like to discuss not only immediate goals such as eliminating cavities or inflammation of the gums, but also long-term goals. If we think about weight loss for a moment, many people go on diets, lose weight, and then in a short time gain it back. How can that be prevented and the weight loss maintained? We must begin with the end in mind. We have to develop an image of ourselves at our ideal weight and hold that image in our minds as much as possible. When that image is impressed on our mind, it becomes much easier to make good food choices and maintain our desired weight. What do you want your mouth to look like 5 years from now? ... 10 years from now? If you hold an image of what you want in your mind, it will become much easier to achieve it and maintain it. Do you want straight teeth, whiter teeth, a pain free mouth, great functionality ... This plan can become like your map which will help you get from where you are now to where you want to be. This goal setting is another aspect of our personal approach to dental care. What do you really want? We can help you get there.

Yours for better health,

Helping you get your SMILE BY DESIGN because as some friends of mine have said ...

                            "When you smile, the whole world smiles with you".

Dr. Marty Frankel "
3030-3080 Yonge St.
Toronto, Ontario M4N 3N1

What is the Cost of Neglect?

There are so many things in life that get worse if we do nothing about them. Take for example a garden ... if we tend to it, remove weeds, water it, ensure proper light and fertile soil it will flourish and grow to show beautiful flowers or delicious vegetables. If we neglect it, the weeds will always overtake leaving us with a wild area with poor yield. There is a story about a clergyman who was driving through the country side when he came a upon a farm that was so well taken care of. The plants were full of beautiful fruits and vegetables, the lawns were manicured to perfection, the farm house was cleanly and crisply painted. It was truly like a picture postcard. The clergyman was so taken with the land that he stopped his car and spoke with the farmer. He said, "My good man, God has surely blessed you with a wonderful piece of land" The farmer paused for a moment and replied, "Yes Reverend, but you should have seen it when God had it all to himself." We are custodians of our property and that includes our bodies and our health.

In my title I mention the cost of neglect. Most people would think of money, but there are so many costs to neglecting our dental health. I will mention a few ...

1) I have encountered many people who tell me that they don't go to the dentist regularly because every time they go the dentist finds problems. This is in the most part a self-fulfilling prophecy. People who avail themselves of regular dental care and dental maintenance visits will catch problems early, before they develop into larger more expensive problems. Regular dental visits are the best way to avoid costly dental treatment.

2) Many people do not enjoy being in a dental chair. Once again, regular maintenance can usually ensure shorter visits and less time spent in the dental chair. Time is a commodity that many people wish they could have more of. For busy people, this is the best way to reduce time in the chair ... another cost.

3) One of the main reasons that people avoid the dentist and prefer not to be in our offices is the fear of pain. Again, regular visits can minimize the occurance of pain associated with dental treatments. To summarize up to this point, three costs of neglecting dental treatment are money, time, and discomfort. As important as these are, in my opinion one of the biggest costs is to our overall health.

4) In previous blogs I have spoken about the relationship of a healthy/unhealthy mouth to the overall health of our body. We often take things that seem OK for granted. "I feel fine ... that doesn't bother me ... it's not covered by my insurance, I'll just wait ... It doesn't hurt, I think it'll be OK ..." I have found that most dental problems don't hurt or bother us until it is too late. It's like a sinking ship. Perhaps there is a little hole in the bottom of the boat. At first we don't really notice the ship sitting lower in the water as it continues to sink and then suddenly the water hits a critical point and the boat tips and goes under very quickly. Cavities get bigger and as they do, the decay grows closer to the nerve in the tooth and will not hurt at first but will eventually do so if untreated. Gum disease is virtually a painless condition until it is so advanced that infection arises under the gum line, the teeth get loose, or they fall out. Tooth wear from tooth grinding starts slowly at first. It can take years to wear through the hard enamel layer, but once that happens, the next tooth layer called dentin wears at a much faster rate. There are many conditions in our bodies that we learn to live with.

At first we adapt to a condition, but if we leave it long enough, it can become a significant enough problem that it can severely impact our lives. I encourage you to listen to your dentist and hygienist when they recommend dental floss, regular tooth brushing, regular hygiene visits. These actions can save you from the cost of dental neglect.

Our mouths serves us so well in so many ways. Do your best to keep it healthy, pain-free, and functional. It will greatly impact your quality of life.

Yours for excellent health,

Dr. Marty Frankel
Smiles by Design
3030-3080 Yonge Street,
Toronto, Ontario
M2N 1T7


AN APPLE A .....?

"An apple a day ... " Can you complete that saying? Most people can. It is so much a part of our upbringing, but how does it affect our behaviour? An apple a day keeps the doctor away. There are so many sayings that are intended to help us like this. Another one is "A stitch in time saves nine". What are they saying and do we live our life in a way that shows that we value this way of thinking?

This gets down to a discussion about our habitual patterns of behaviour. It can explain why we might make the same mistake over and over again. We know what we should do, how we should behave, but we don't do what we know we should. Why is that? We all have our habitual patterns of behaviour that have been ingrained into our subconcious minds by repetition from the time we were born. Our parents, teachers, past experiences, all contribute to help create our way of acting and behaving. These behaviours don't always serve us well, yet even though we know that, it is very difficult to do something about it and change.

I have patients who routinely say to me, "well, I don't floss as much as I should". I always wonder, "if you know that you should floss more, why don't you?" There is no judgement intended here. I am just really curious as to why we humans behave the way we do, and why we don't change those behaviours that are not good for us?

Coming back to the opening statement that "an apple a day keeps the doctor away" ... what would we do if this were really true? I heard someone on Youtube the other day and he said, "they don't say 'a Hershey a day keeps the doctor away'. " Some people might say that they eat a Hershey a day and they are doing just fine thank you very much. But I wonder what the cost of a habit like a daily Hershey bar, or 2 or 3 cans of Coke a day would be after 6 years, or 10 years. What is the cost of a sedentary life-style for 20 years, or a fast food diet for 10-15 years.

This leads me to think about the value of prevention. In dentistry, we are very big on the idea of prevention. Tooth decay can be prevented, gum disease can be prevented or minimized, poor bites and jaw development can be prevented if caught early enough. Even the idea of treating a cavity while it is small rather than waiting for it to get bigger. It means less time in the dental chair, less destruction to the tissues of your tooth, less cost, avoiding such things as root canal treatment, crowns, and more complex dental procedures.

How can we minimize the impact of our poor choices and choose the "right" thing to do? It is not easy, but first we must take the time to think about what we really want, then determine what actions we will need to take to reach our goal, making a DECISION to pursue the goal, and then COMMITTING to it with all of our enthousiasm and whole heartedly with self-discipline and passion.

Next time I will discuss a new pre-orthodontic system that can help prevent orthodontic tooth related problems in growing children without the use of braces. This system is really not about the teeth. It is really about developing health in our growing children ... creating open airways, proper sleep breathing habits, good posture, proper tongue and lip function, and excellent swallowing patterns.

There is still much work to be done, and much to learn, but it is very possible to create healthy mouths and maintain them that way throughout life. All it takes is the desire and commitment to do it.

Yours for better health,
Dr. Marty Frankel - Smiles by Design
3030 -3080 Yonge Street,
Toronto, ON M4N 3N1


We have 2 ears and only 1 mouth ... What makes for good Communication?

I have heard the expression many times before ... " you have 2 ears and 1 mouth" ... Listen before you speak and more than you speak.

How does this relate to dentistry?

I believe that a good dentist is one who has much more than just the technical skills required to perform a dental procedure. As dentists we must first seek to understand our patients. Each person comes to the office with his or her unique story, past dental experiences, phobias, preconceptions, and misconceptions. Some people want beautiful white straight healthy teeth; others want a healthy mouth but are not concerned about the appearance of their teeth; still others want only emergency care. Most people have some degree of anxiety about being in a dental chair.

The mouth is a very personal area. We all have a natural "comfort zone" of at least 18 inches. If someone invades that space it makes us uncomfortable. Dentists invade their patients' comfort zones all the time. Add to that a person's fear of the unknown and possible pain associated with the dental procedure, and you have a situation that is full of potential discomfort for the dental patient.

Over the years I have heard stories from my patients about situations with their previous dentists that were less than positive. Often these occur when the person is a child and the trauma of the experience stays with them for the rest of their life. These negative events are often the result of the dentist's lack of sensitivity, lack of compassion, and often, a lack of patience. A number of years ago I surveyed a small group of my patients in an effort to discover what was most important to them when visiting the dentist. There were many different answers, but the one thing that all the patients had in common was a desire to have a relationship with their dentist, ... they wanted to be valued as a person, not to feel like a number. They wanted to feel that their dentist cared about them and was interested in their well-being.

This takes me back to my opening statement. It is of the utmost importance for dentists to learn to listen, to find out what is most important to their patients. What do they desire? What are their goals for their mouth? Most people have not given this concept much thought.

Most of us take our teeth for granted. We think of them as inanimate objects that have little to do with our overall health. On the contrary, teeth are complex biologic structures. They are attached to living bone, with a blood supply and connected to our nervous systems. The bones are moved by muscles, and the alignment of the bones affects and is affected by the alignment of the rest of the body. Inflammation in the mouth, in the form of gum disease in particular, can affect our overall health in many ways, contributing to heart disease, respiratory distress, cancer, diabetes, stroke, low birth-weight babies. Development of our face and mouth is affected by and can have a dramatic effect on our upper airway. This can predispose us to develop sleep apnea, airway resistance, and other medical conditions.

The oral cavity (the mouth) is the gateway to our health. The health of the mouth has a tremendous impact on the health or the lack of health of the whole person. This means that to have a trusting, open, respectful, compassionate caring relationship with your dentist is of the utmost importance to help you grow and heal and achieve the highest levels of health and wellness. Our patients have a right to understand the conditions in their mouths, to be educated about various options for treatment that exist, and to be given the ability and freedom to make informed choices for their care.

If you have any thoughts or questions about what has sometimes been called the "relationship-based, health centred practice" please contact us to learn more and share.

Yours for better health,

Dr. Marty Frankel
Smiles by Design
3030 - 3080 Yonge Street
Toronto, Ontario M4N 3N1



Why doesn't my insurance plan cover the treatment the Doctor is recommending?"

The first thing to understand about dental insurance is that it isn't insurance at all. Insurance originated as, and is by definition, a pooling of funds to pay for a rare, but catastrophic event. Fire insurance is an excellent example of this. Originally, medical insurance was also designed this way. Payment for routine office visits, basic medications, and low deductibles are a relatively recent modification in medical policies intended to create additional employee benefits that are not true insurance but "tax-free" benefits. Unlike events such as cancer or your house burning down, dental disease is neither rare nor catastrophic. Therefore, dental insurance isn't insurance at all, but really a method for people to receive "tax-free benefits".
Rather than insurance, it is more accurate to refer to them as dental benefit plans. When they were originally introduced in the 1970's these plans were very simply designed. To keep the premiums reasonable, total benefits in any one year were limited to $1000.00. Forty years later, most benefit plans still have close to the same annual limit. Premiums have gone up, of course, because the costs for administering these plans (employee wages, cost of living, etc.) have increased. In an effort to keep the insurance premium costs down for employers and to continue to serve the insurance company's shareholders with profits, health care companies have made significant modifications to the original plans. As a result there are many different plans available.


The differences in these plans are usually found in the limitations that exist. The most common of these limitations is in the services that are excluded. Most plans will assist with basic services such as examinations, x-rays, dental hygiene visits, fillings and extractions. As more services are included, the costs for the plans increase. Some plans pay toward root canal treatment, or periodontal treatment. Some will include orthodontics, or major restorative treatments such as crowns, bridges and dentures. Some plans do not.
Another limitation is the "Alternate Benefit Clause". Essentially this clause allows the insurance company to choose to pay a lesser amount for the cheapest material or treatment that they deem adequate for you. This decision is often made by a clerical person who knows very little about dentistry and nothing about a person's unique situation and dental needs. Even when referred to a dental consultant (a dentist who works for the insurance company) for assessment, the judgement as to whether a treatment qualifies for payment is made by someone who has not personally seen the condition being treated. Decisions were once based on need, but now they are often based on the specific terms of the contract negotiated between the employer and a health-care insurance company.


If people take the attitude that they will "only do what is covered by the insurance plan", it can have serious impact on both the quality of care they receive, and the ability to achieve optimal oral health. I feel that oral health is too important to allow the insurance to dictate what can be done. Dental plans don't "cover" treatments, they assist with payment on certain procedures. In our office we feel that it is of utmost importance to take the time to get to know you, perform a thorough examination in order to make an accurate diagnosis, and then to help you understand your current level of dental health and explain the treatment options that exist. I feel our job is to help you understand your problem, your treatment options, and the consequences of each choice, so that you may choose what is best for you. Because our obligation is only to you, once you choose your care, there will be no compromises in rendering it. Even though our contract is with you only, we will do our best to help you understand your dental plan and its limitations. We will provide you with the necessary documentation, so that you can receive the reimbursement that you are entitled to. We are your dental health advocates, and are available to answer your questions and concerns regarding your dental benefits.


The implication when a payment is denied or reduced by the insurance company seems to be that the treatment is not necessary, or the fee is too high. We feel that you are the best judge of your needs and not someone at an insurance company who does not even know you. Our response to the insurance company regarding the issue of fees is that their benefits are too low. You are the best judge as to whether the fees you pay match the quality of care that you receive. I hope that this explanation of a complicated and continually changing subject is helpful. Please feel free to ask us any questions about your care and insurance benefits at any time.

Yours for better health,

Dr. Marty Frankel
Smiles by Design
3030-3080 Yonge Street, Toronto, Ontario M4N 3N1 416-770-8526


My grandparents were smokers. They each smoked for approximately 60 years. My grandfather lived to the ripe old age of 87, and my grandmother to 96. Why, if smoking is so bad for our health did they live that long and not succumb to lung cancer? I have patients ... married couples where one member of the union takes meticulous care of their teeth and gums (usually the wife) ... flossing, brushing, rinsing, every day and still gets cavities and gum problems, whereas the other person (usually the husband) neglects good oral home care and they rarely have a dental issue ... no cavities, no gum problems, no pain. Although this is not the norm, why do things like this happen?  We hear stories about healthy young people who die of a heart attack after jogging a few miles on a beautiful sunny day ... why if they are fit enough to run miles would they have a heart attack? These are questions I have wondered about for most of my career.

There is something that has been called "HOST RESISTANCE and HOST RESPONSE". What does this refer to exactly? We (human beings) become and reflect the sum total of various influences that act upon us.

THE ROLE OF GENETICS: Genetics plays a very key role in the development of our physical attributes. That is why we look the way we do and have our unique hair colour, eye colour and shape, tooth size and shape, etc. This is the result of the combination of genetic material that we inherit from our parents and our ancestors. This is why certain physical traits can skip a generation or two. Genetics can also play a role in how we respond physically to, and express certain diseases, disease processes in our lives. When we attend a dental appointment or medical appointment for the first time we are asked to fill out a medical history form. One of the questions which appears on this form has to do with family history. Is there any heart disease, diabetes, cancer in the family? Often we will see people that tell us that their father died of a heart attack, 2 uncles had heart attacks, their grandfathers had heart attacks, and they expect to have a heart attack as well. This is true of diabetes, cancer, and even dental diseases. People will often tell me stories of how their parents wore dentures, their aunts and uncles and grandparents wore dentures, and that they are resigned to eventually wearing dentures as well. Others tell me they are terrified of the prospect of wearing dentures and will go to great lengths to preserve and save their teeth. If genetics plays such a strong role in health, how can we reverse that genetic pull?

EPIGENETICS: The following quote sums it up ... "What is Epigenetics? Epigenetics is the study of potentially heritable changes in gene expression (active versus inactive genes) that does not involve changes to the underlying DNA sequence — ... Epigenetic change is a regular and natural occurrence but can also be influenced by several factors including age, the environment/lifestyle, and disease state.

Epigenetics and the Environment:
How Lifestyle Can Influence Epigenetic Change from One Generation to the Next

The field of epigenetics is quickly growing and with it the understanding that both the environment and individual lifestyle can also directly interact with the genome to influence epigenetic change. These changes may be reflected at various stages throughout a person’s life and even in later generations. For example, human epidemiological studies have provided evidence that prenatal and early postnatal environmental factors influence the adult risk of developing various chronic diseases and behavioral disorders. ..."

SO WHAT DOES THIS ALL MEAN AND HOW DOES IT IMPACT DENTAL HEALTH? Basically what this is saying is that although we have no control over WHAT we inherit from our parents, by changing the environment around a certain condition, we can influence HOW that genetic information expresses itself in our life. For example, someone with a family history of heart disease or diabetes can minimize the risk of developing cardiac problems or diabetes by eating healthy foods, following a programme of regular excercise, and getting proper rest and relaxation. Stress reduction techniques such as meditation and visualization can also impact the genetic expression of a disease. Similarly someone with a genetic susceptibility to tooth decay or periodontal disease can minimize the risk by eating a healthy diet, attending regular dental hygiene maintenance appointments, and most importantly practicing excellent oral hygiene at home.

There are many other examples of this, and there is much research ongoing in the area of epigenetics and its application to our overall health. It is a fascinating idea and the possibilities for human potential development are huge. I hope you find this concept helpful to your dental and overall health and well-being.

Yours for better health,

Dr. Marty Frankel
Smiles by Design,
3030 - 3080 Yonge St.,

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