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GINGIVITIS - What is that really?

Translated into English, GINGIVITIS means gum (Gingiva) inflammation (itis). What is the significance of this, why does it happen, and how do we take care of it? 


According to Webster's Dictionary, INFLAMMATION is a "local response to cellular injury that is marked by capillary dilatation, leukocytic infiltration, redness, heat, and pain and that serves as a mechanism initiating the elimination of noxious agents and of damaged tissue". So what does this mean? Our bodies in their innate wisdom become inflamed as a response to injury, or local irritants, in order to get rid of whatever is causing the injury or irritation, so that it (our body) can heal and become healthy again. We get an increase in blood flow to the area (which is why it gets red), heat in the area, and it also becomes painful, and often swollen. One thing that we know about inflammation in the body is that inflammation somewhere equals inflammation everywhere.


Gingivitis is gum inflammation. It is one of the early forms of gum disease and is most often caused by a build up of bacteria on the tooth surface near the gum line. Our mouths are full of bacteria, probably one of the "dirtiest" places in our body. Over the course of approximately 24 hours some of that bacteria will stick to the tooth surface and start to irritate the gumline. This sticky bacteria is called dental plaque. If we don't remove it or disrupt it on a daily basis it can stay there and start the process which becomes known as GINGIVITIS. Our gums get red, swollen, sometimes sore, and they tend to bleed easily when touched, brushed, or flossed. Gingivitis can be mild, moderate, or severe depending on how much a person neglects to remove the plaque. GINGIVITIS can also lead to BAD BREATH.

Did you know that GINGIVITIS is completely reversible? That means with the proper care, you can get rid of it and keep it away.


Because the bacteria that cause GINGIVITIS are present in our mouths all the time we can never totally eliminate the risk of developing it without some effort. There is no magic cure. I often think of the manangement of gum disease much like the management of Diabetes. If a person with Diabetes takes their insulin or medication every day as prescribed, watches their diet, excercises regularly, they can live a normal healthy life. If that same person does not take care of theses things, their Diabetes will get worse. Diabetics must take personal responsibility for the success of their treatment. Similarly with GINGIVITIS, there are things that we can do in the dental office to help maintain healthy gums, but perhaps of even greater importance is the personal homecare routine that a person must develop to help maintain their gums in a healthy state with no inflammation. Dedication to good homecare on a consistent daily basis is essential.

Studies done over the last 15 years show a very strong connection between inflammation in the body and other medical diseases such as heart disease, stroke, diabetes, respiratory illnesses, low birth weight babies, and even cancer. This is why we as dental professionals "NAG" our patients to floss and brush daily. The key word here is DAILY. I have had patients come to my office and tell me how they floss religiously every other day. These people never quite get on top of the inflammatory process because on the "off" day they are allowing the plaque bacteria to do some damage. On the other end of the spectrum, some people come in and tell me that they floss 4 or 5 times a day. ... Every time they snack, drink, sneeze, speak, ... they are flossing. I don't discourage this, but it is really not necessary to floss that often. I hope that I have helped to clarify the condition called GINGIVITIS, and created some understanding as to its importance.

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



In my last post I spoke about the fact that most people are somewhat nervous or anxious about a visit to the dentist. I have been giving this topic more thought since then, and I feel it would be worth mentioning a bit more about this.

"Fear of the Unknown"

In most cases the fear is of unknown issues ... Will this hurt? ... How long will this take? ... What if I can't stand it? ... How will I get out if I can't take it? ... What will it feel like after the appointment? Will it hurt then? How much will it cost? Will I have to come back? etc. What I have found is that when things are explained in a calm way, my patients tend to relax. hmmm .... that sounds pretty simple doesn't it?

The other day I had a new patient in my office for an initial examination. I schedule at least one hour for that type of appointment, maybe even an hour and a half. At about the 45 minute mark, I could sense that the patient was getting fidgety and somewhat anxious. I asked if she was in a hurry, if she had to be out at a certain time. She said no, but she was concerned that the time we spent talking would increase my fee and she would have to pay more for the appointment. I explained that there was no extra charge on that appointment for my time, but that it was important to me to get to know my patients and start the process of building a relationship of trust and rapport. In this way, I feel that I can be more effective in treating her, and in helping my patients decide on the best course of treatment for them. She relaxed and we had a great meeting. I hope that she and all my patients will feel relaxed, comfortable, and open to discussing the various options that exist for their treatment.

In the treatment room, I have found that when I explain to my patients what I am doing as I perform work in their mouths, and tell them what to expect in terms of sound, vibration, possible discomfort, they are much more relaxed and tolerate the procedure much better. I think as a whole, dentists have done a pretty good job of creating an environment in their offices to help people feel at ease.

In all health care settings, and in particular in the dental office, relationship building, trust, and rapport are of the utmost importance. I believe that we are not just like machines with parts that occasionally wear out and need repair or replacement to stay healthy. We are much more than just a body ... yes we have body, but we also have a mind, feelings, spirits. To achieve complete healing and health the whole person must be treated. This to me is what "holistic" health care is all about.

Until next time I wish you excellent health and excellent relationships with your health care providers.

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




Do you know anyone who is nervous about visiting the dentist? Just about everyone that I know has some degree of anxiety when it comes to sitting in the dental chair. I remember a patient many years ago who had moved to Toronto from Israel. He had served his duty in the Israeli army and he said that he could stand unafraid with someone pointing a rifle at him, but somehow when he sat in the dental chair his nerves always got the better of him. Sometimes the tougher a person is, the more nervous they are about being in the vulnerable position of sitting in that chair.


The first and most obvious answer is that it can be very painful. ... but does it have to be? These days dental work should be delivered rather painlessly on a routine basis. Injections can be given without pain when a good technique is used. There are also numerous hi-tech devices that claim to help deliver painless injections. When the tooth and mouth are well "frozen" there should be absolutely no pain. There are solutions that are not yet available in Canada, but will be soon, that buffer the anesthetic solution and help deliver a smoother pain free injection that is less uncomfortable when it reverses. I am very excited for its arrival to our country in the near future.

The second aspect is "fear of the unknown". We have this idea in our minds that dentistry causes pain and we are anticipating that it will hurt. I remember giving a very nervous patient an injection one time and when I told her that I was done, she turned to me and asked, "That's it? You don't use needles any more?" ... I told her that she had just received "the dreaded needle". That was the ultimate compliment!

Third: The mouth is a very personal and intimate area. We eat, talk, kiss, communicate, taste. We humans have a natural space that we like to keep around us. When someone invades that space we feel uncomfortable and very vulnerable. When we dentists enter someone's mouth we are invading that space. Fear and discomfort are the result.


I have been using a neuroscience system for the last few years called NuCalm.  NuCalm is a patented system that resets the autonomic nervous system to help transform our state from the "fight or flight" of high stress, to the relaxed, peaceful feeling of an experienced meditator. It involves the use of a natural calming supplement, a device that aids in the absorption of that supplement into our brain, specially engineered beautiful music listened to on special headphones, and eye coverings to eliminate sensory/visual stimulation. It helps people tolerate dental procedures with ease, and feel wonderful by the end of the procedure.
has found use in helping people with Stage IV cancer who are under tremendous stress, and it is used by many professional athletes to help them reverse the adrenaline rush of a big game. They experience better rest and recovery and improved mental focus. If you are interested in experiencing the feeling of NuCalm let us know next time you are in the office. Those are just a few tools we have to make you feel comfortable in a dental office.

We know that many people would rather be just about anywhere else, but it is our Mission to help people relax in a dental chair and actually enjoy their experience.

Yours for better health,

Dr. Marty Frankel 3030-3080 Yonge Street, Toronto M4N 3N1, 416-770-8526 ... www.drmartyfrankel.

Your Jaws and bed-wetting

In my last post I mentioned a very interesting book by Dr. David C. Page called YOUR Jaws YOUR Life. We have spoken many times about the relationship of jaw position to our upper airway and its relationship to sleep disordered breathing. Dr. Page also devotes at least a chapter of his book to this topic. Another interesting fact is the relationship of jaw position to bed-wetting, also known as nocturnal enuresis. The cause of bed-wetting still remains somewhat of a mystery for modern medicine. He states that "normal bladder control should occur by age 3-4. It is considered medically abnormal when a child over age 5 chronically wets the bed. From 15 to 20% of all 5 year-olds and 10% of all 6-10 year-olds chronically wet the bed. ...." Bed-wetting can be very devastating psychologically. It is embarrassing, upsetting, humiliating, for the child and for family members. In spite of this it has been given very low priority by the medical community.

"Current medical treatment approaches ... include drugs, bed-is-wet alarms, psychotherapy, electro-physiology, and surgery." The alarm seems to be the most effective method to the date of his writing the book. "Drugs ... may be the least effective." Because the true cause of bed-wetting is not fully known, it is difficult to arrive at an effective targeted treatment. Interestingly dental treatment can be effective in reducing or stopping chronic bed-wetting.

In the 1990's it was found that children who had palatal expansion performed by dentists and orthodontists using palatal expansion appliances showed great improvement in the condition. It seems, according to research that a lack of oxygen due to obstruction of the upper airway can lead to bed-wetting. Reversing the airway blockage with oral devices helps change the children from mouth-breathers to nose breathers. Tonsil removal also opens airways and improves bed-wetting. Study results showed that dental treatment of this sort to be about 80% effective in reducing or stopping bed-wetting within a few months. It seems that the earlier this treatment starts, the more effective it can be.

There are so many ways that a healthy properly formed oral space can have a positive impact on the well-being of the body.  It is my mission to help people understand these connections and work together to improve their health and vitality.

Yours for Beautiful Smiles and More Health,

Dr. Marty Frankel,

3030-3080 Yonge St., Toronto Ontario, M4N 3N1, 416-770-8526


In his book Your Jaws Your Life, Dr. David C. Page tells us about how vitally important correct jaw position is to our overall health. I have talked about this in previous blog posts but mostly in regard to TMD (temporomandibular disorders) or OSA (obstructive sleep apnea), however he takes this one step further and discusses the importance of the jaws to teeth, heart disease, facial form and development, high blood pressure, and snoring to name a few. Never before have we known more about the connection between the mouth and the rest of the body than at this time, and the body of knowledge keeps growing. This has been termed "medical dentistry" and I find this to be fascinating and of vital importance to health and fitness.


This may seem at first to be an odd question. One might think that everyone would say "why of course I want to be very healthy!". I have found that everything in life has a price. This can be a financial price, or a time commitment price, or even a price of self-discipline or effort that is required to achieve the desired result. Not everyone is willing to pay the price to have what it is they want. Some examples of this could be: 1) Some people want great physical assets - large muscular arms, washboard abs, great posture, ... the question is, are they willing to do what it takes? Hours in the gym, eating a great clean, healthy diet, plenty of quality sleep, etc. 2) Some people want beautiful teeth - white, straight, functional, pain-free, beautiful, free of cavities, absence of gum disease ... are they willing to do what it takes? Daily flossing, eating sweets in moderation not excess, daily tooth brushing especially at night before bed, regular visits to the dentist for maintenance ... etc. Some are willing, some are not.
On some dental history forms there is a question: "On a scale of 1 to 10 how important are you teeth to you?."" Because we have separated the importance of our teeth to our life and body that question doesn't sound that crazy. But, what if I asked "How important are your eyes to you?". I think everyone would agree that virtually 100% of people would respond by saying that is a crazy question ... of course our eyes are of upmost importance to us! No one would willingly live without eye sight. I would like to propose that our teeth, gums, and jaws, are of vital importance to our health, well-being, and quality of life and should be valued and cared for.
A friend of mine who was diagnosed with high cholesterol and given a prescription for Lipitor by his physician said to me once "It's great! I can still eat ice cream, cake, and all the things I like and my cholesterol is in line." What is the price to pay? Compromised health? Complications of long term use of medication? Yes, cholesterol might measure fine, but what is the additional toll of eating the wrong foods? For me, the effort to avoid the medication would spur me to choose foods with care, increase exercise, and develop good health habits that would help me live with as much vibrant health as I could muster.


No one can really answer the question above for you, but I believe that if people would take the time to really think about what they want, more people would seek excellent health, and do the "healthy" thing. If you want more information about how to create health for your mouth and body, we are only a phone call or a click away. Yours for better health, Dr. Marty Frankel, 3030 - 3080 Yonge Street, Toronto Ontario, M4N 3N1 ...416-770-8526,



Just 2 days ago I returned from a fascinating course which highlighted even further the miraculous and infinite connections between the mouth and the rest of the body. The lecturer spoke about TMJ problems and how this is so intimately connected to our body alignment and breathing. He told of a connection that took him about 10 years to figure out. It seems that in medicine and dentistry we focus on the part of the body that the patient reports to be a source of discomfort. In chronic pain states this can often be misleading. Say for example, that you have a pain in your foot. In order to walk comfortably, you would probably avoid putting pressure on that foot and lean more heavily on the opposite foot. This in turn puts more weight on the leg of the normal foot and this pressure is accomodated for by the rest of the body. You might be able to imagine that after walking a mile in this condition, you might develop a pain in your neck from bearing up an unbalanced posture. This position that the body assumes is called a postural compensation and this is very common when a person is suffering from a chronic injury.


The connection that I referred to in the above paragraph was that after resolving his patient's TMJ issue, he found that the patient had a residual issue in the sacral area (low back). This always baffled him, and he found that this was a rather common occurrence. After seeing this pattern in many patients over an approximately 10 year period he had a flash of insight that he should look more closely at the patient's breathing pattern. The patient had a nasal obstruction. ... difficulty breathing (airway blockage or resistance) can cause us to move our head forward to decrease the resistance. This not only leads to jaw malpositioning, but creates a strain that extends all the way down the spine, in this case to the sacrum. After alleviating the obstructed nose with nasal spray, the patient's head straightened up and the sacral issue was amazingly resolved. I thought that was so cool!

I am continually amazed and awed by the connections that exist in our bodies and how all of our parts coordinate resulting in our abilities to live and perform on a daily basis. So I leave you today with the following thought ... When our bodies are healthy and functioning well, we can live happily, pain free, and full of energy.

My goal and Mission in life is to "Change people's Lives" for the better by helping to relieve and resolve long-standing pain issues that perhaps they have resigned themselves to endure, thinking that there is no solution in sight. Until the next time I wish you a Happy Canada Day and a peaceful relaxing summer.

Dr. Marty Frankel - Smiles by Design


3030 - 3080 Yonge St., Toronto, M4N 3N1
Posted by Dr. Marty Frankel at 2:37 PM No comments

Airway Is King!

OPEN FOR BUSINESS! On the dental front I would like to let everyone know that my new office is up and running, and filled with light and good feelings. The address is 3080 Yonge Street, suite 3030, Toronto, Ontario M4N 3N1. The main phone number is 416-770-8526, emergency cell phone number after hours is 416-400-2785, and you can reach us by email at

And now....the actual blog!

AIRWAY IS KING: I have been studying about the dental management of Sleep Breathing Disorders for the last 5 years or so.

It is interesting that most of us have never really thought about how intimately connected the mouth is to the upper airway. There are only 2 ways of moving air in and out of the body, and those are the nose or the mouth. I am currently reading an excellent book titled The Oxygen Advantage. In this book the importance of nose breathing is highlighted.

The following is a list of many reasons that NOSE BREATHING is so beneficial: 1) More oxygen uptake - 2) Nose breathing warms and humidifies the air that enters our body 3) The nose filters germs and bacteria from the air we breathe 4) Nose breathing improves the benefits we receive from the excercise we do 5) The nose is a reservoir for Nitric Oxide ... this is a gas that is essential for the maintenance of good health In previous blog posts I have discussed the benefit of nasal breathing to the proper development of the oral cavity and the face in general. The above 5 reasons are just a few of the many benefits to breathing through the nose. Dental development can have a huge impact on our ability to breathe through our nose, and our ability to breathe through our nose can have a huge impact on the proper development of our oral cavity. Just one more thought ... we can live without food for at least a few weeks, we can live without water for a few days, BUT we can only live without air for a few minutes. Breathing and its effect on our health is of extreme importance to all of us.

Dr. Marty Frankel

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.

"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,

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

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