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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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