Can Obstructive Sleep Apnea Kill You?

What is Obstructive Sleep Apnea?
You are likely hearing more about Obstructive Sleep Apnea (OSA) as it is becoming more common and thanks to an increase in practitioners who are able to assist in the diagnosis. OSA can most easily be explained as the complete or partial obstruction of the upper airway during sleep, leading to decreased breathing or episodes of no breathing at all. This happens because muscle tissues around the throat relax during sleep, covering the airway.
Who is likely to get it?
Research has shown that OSA is more likely to affect men than women. More specifically, there is a higher risk for men who are overweight and middle aged or older. Regardless of age and gender, OSA prevalence is likely going to keep rising because of the increase in overweight individuals in affluent societies. The prevalence of OSA also depends on different facial structure, tongue volume and total upper airway soft tissue volume. It is not surprising for children to develop OSA symptoms due to anatomical features. At times, children are already at high risk before they have the chance to grow out of the symptoms.
Negative effects
OSA is not something that leads to immediate death, but it does have many ugly side effects. From a health standpoint, OSA increases the chance of high blood pressure and sudden heart attacks or strokes. It also leads to a pretty serious condition called hypoxia, which is a loss of oxygen supply to body tissues. From a functioning standpoint, those affected by OSA often have daytime fatigue, increasing comprehension issues, and an overall lower quality of life. Relationships with a bed partner also tend to be poorer due to loud snoring at night and/or gasping related to the closing and opening of the airways. Luckily, it's often our bed partners who notice the issue may be more than just snoring and alert us to seek an evaluation. Another issue worth addressing is the increase in chances of car accidents by people with OSA. In Ontario, for example, the law requires all physicians to report patients who may be unfit to drive a vehicle due to medical reasons. If an individual is reported to have a clinical condition that is not under control, the Ministry of Transportation has the right to suspend the driver's license.
Diagnosis
Most people with OSA symptoms are referred by a doctor to do a polysomnogram for further evaluation. A Polysomnogram, also called an overnight sleep test, is a very effective way to detect OSA. Overnight sleep tests are done at sleep clinics where licensed technicians monitor patients' heart rate, lungs, brain activity, blood oxygen levels, breathing patterns, and sleeping patterns throughout the whole night. Patients can also choose to do the sleep test at home for a cost if they don't want to go to OHIP covered sleep clinics. By the end of the test, an Apnea-Hypopnea Index (AHI) is shown to represent the number of apnea and hypopnea events per hour. An AHI lower than 5 indicates no OSA. AHI between 5 - 14 indicates mild OSA, 15 - 29 indicates moderate OSA and anything higher than 30 indicates severe OSA.
Treatment options
Luckily, there are quite a few treatment options out there. For a more conservative option, patients can benefit from lifestyle changes such as weight loss and quitting smoking. Patients can consider using a CPAP machine that constantly keeps the airway open by blowing air through the passage. While CPAP is the golden treatment standard (especially for those with severe OSA), some people find it difficult to adapt to it.

A more adaptable option is using a dental appliance. These simple oral appliances are designed to open the airway when worn. There is no complete way to cure OSA. The most straightforward, yet invasive option is surgery such as Tonsillectomy and Uvulopalatopharyngoplasty. Tonsillectomy is a surgical procedure to remove tonsils and Uvulopalatopharyngoplasty is a surgical procedure to remove and or remodel tissues in the throat. Both procedures are done to reduce the chances of airway blockage.
To put everything into perspective, OSA is not a disease that will kill you instantly. However, its side effects can certainly drive you closer to it. If you are presented with OSA symptoms, it is important not to put them aside. Given the many treatment options available, it is worthwhile to speak to a dental or medical professional who can assist in screening and making a diagnosis.

Click here to learn more about Dentistry on Dundas Sleep Apnea treatment options.

Rosemary's Before and After Dental Makeover

Beautiful Smiles are within your reach! Improvement in ones appearance can lead to greater confidence and zeal for life. See how Rosemary achieved her newly enhanced smile with the use of dental crowns.

                                       

Why was Rosemary a good candidate for these procedures?

She was motivated to improve her quality of life and her smile.  Her oral hygiene was good as well.

                                                   Before

After

 

How did you develop a plan for treating Rosemary's concerns?

We always start with exhaustive records.  We determine the challenges of the patient's bite, teeth and the surrounding structures. We discuss the patient's concerns and goals and set forth a realistic treatment plan that takes into account the patient's budget.  In addition, a  discussion of the procedures involved and the physical and emotional tolerances of the patient. This may include fears and length of treatments.
Was her treatment out of the ordinary?

The treatment was extraordinary in that it involved rather large space between the front teeth. We discussed all options from orthodontics to close the space to going directly to the restorations (i.e. Porcelain veneers and crowns).  Consultation with our ceramics lab prior to treatment, which included a diagnostic wax up (i.e. a wax mock-up of the final restorations), revealed that a satisfactory result was possible without the use of orthodontic treatment.  This meant that treatment could be completed in several weeks instead of several months or a year. Significant savings were possible by eliminating the orthodontic component. 

                                    Dr. Mark Librach, Dentist

Use of Cannabis and Your Oral Health

We have talked about smoking tobacco and its consequences on oral health. Now with the legalization of cannabis in Canada, let’s discuss how its regular use affects your dental health.

Regular cannabis users usually have poorer oral health, which is evidenced by higher rates of tooth decay, missing teeth, inflamed gums, and cavities as compared to non-users.

Effects of cannabis on oral health:

• Xerostomia

Have you ever experienced the cotton-mouthed feeling when smoking pot? This means your mouth is dry due to lack of saliva. This oral condition of dry mouth is known as xerostomia, which is due to the reduced salivary flow. While under the influence of cannabis, the nervous system reacts by reducing the production of saliva.

This lack of saliva can create a whole range of problems. Saliva plays an important role for your healthy oral condition. It helps with breaking down food for easy intake, rinses your teeth and gums to remove food particles after meals, helps with rebuilding tissues, and provides disease fighting substances to keep your mouth healthy.

With the lack of saliva in the mouth, it eventually leads to cavities, as the enamel on the surface of your teeth becomes damaged, and teeth can appear worn and shorter, and extremely sensitive. Lack of saliva also causes bad breath.

• Periodontal Disease

Cannabis use can lead to periodontitis, which is the inflammation of tissue around your teeth, causing shrinkage of gums and loosening of teeth. Apart from teeth and gums, regular cannabis use also damages other soft tissues in your mouth like lips, tongues, cheeks and the roof of your mouth.

• Stained Teeth

It is not a surprise that heavy tobacco smokers have stained and yellow teeth. Heavy cannabis users also have similar teeth in appearance, with worn out gums, resulting in a not so 'pearly-white' smile.

• Mouth Cancers

Abusing cannabis also creates a condition called cannabis stomatitis, which is the damaging of the lining of the mouth. This leads to sores that are painful to treat, and often don’t go away, and eventually take the form of oral cancers.

As dentists, we recommend to avoid consuming cannabis as much as possible. If you are a regular cannabis smoker:

• Avoid using alcohol based mouthwashes as they dry your mouth.
• If you are scheduled for a dental procedure, avoid cannabis at least one week prior to your procedure as epinephrine in anesthetics used for numbing, combined with high THC levels, and anxiety, can be life threatening.
• There is an increased failure rate of a dental implant for you due to cannabis’s effect on new bone development and so this procedure may not be right for you.
• You could use in-office teeth whitening procedures to improve the appearance and try to regain some of the whiteness of your teeth.

Etelka's Smile Transformation Using Digital Dentistry

How our team of Dentists, Specialists and Digital Dentistry restored Etelka's smile and dental function.

Etelka grew up in Europe and had a lot of dental work as a child. After moving to Canada, she had further extensive dental procedures throughout her adult life, then came to Dentistry on Dundas in 2016. She was quite frustrated and self conscious about her oral condition and was committed to making a permanent change. This would include a multifaceted collection of procedures including periodontal surgery, Root canal therapy, orthodontics, fillings, dental implants and crowns. This was done by various specialists, including myself, Dr. Dana Levy, Periodontist and Dr. Mark Librach providing orthodontics.

Dr. Lanys:

1. Why was Etelka a good candidate for these procedures? She was an excellent candidate for this lengthy and comprehensive treatment plan. She was ready, eager and committed to creating an oral state of health which was aesthetically pleasing.

2. What were her biggest concerns about the procedure? Etelka had many concerns. She wanted to keep all her existing teeth and replace all missing teeth with implants. She did not want her upper anterior bridge any longer; for there was food impaction and she did not like the way it looked. She had an extremely "high demanding" job in downtown Toronto and wanted only evening appointments.

 

 

Before

3. How did you develop a plan for treating Etelka’s concerns? Etelka's concerns were rather challenging but definitely not impossible. There were compromises to be made and the main one was that the course of treatment was going to be lengthy and extensive. The treatment plan was devised with our team of professionals and specialists. There was a specific order of procedures that was essential to follow to ensure the best possible results.

                           Cone Beam Implant mapping Dr. Librach

4. Was her treatment out of the ordinary? The treatment was not out of the ordinary. All aspects of her treatment were quite routine. The challenge was that almost every tooth had to be treated or retreated. This was superimposed with a difficult "bite" that had to be corrected with braces. It was, therefore, all "ordinary", however, just a lot of timely "ordinary" work.

5. How long did Etelka’s transformation take? The entire course of treatment was approximately two and a half years.

6. What steps do these procedures involve? The order of steps was very important. Initially, there were various consultations, x-rays and exams in the different disciplines. Periodontal and restorative were necessary first. This would include cleaning, pocket reduction, fillings and extractions of hopeless teeth. Bone grafts were placed in those areas to prepare for implants. Lower braces were then placed to upright the teeth to create a more favorable bite to ensure the implants and crowns were in the correct positions. After the bone grafts healed for approximately 4 months, the implants were placed and also had to heal for a subsequent 4 months. Finally, all the crowns were placed.

                       Digital imaging for crown restorations, 5Axis

7. Is there an ideal candidate for these procedures? The ideal patient for this full mouth reconstruction must be committed emotionally, physically and must put in the time. Most patients have partial treatment of this kind or just a few procedures of this nature which is rather quick and routine.

8. Are there any at-home steps patients should follow after procedures like these? Once any treatment of any kind is completed, it is up to the patient to maintain a healthy and regular regime of home care with excellent oral hygiene, and also return for regular maintenance visits to the dental office. Quite often a night guard is recommended to protect the teeth from wear and keep the jaw in a good state.

 

After      

9.What advice would you give those debating whether or not to get dental surgery? I would recommend that anyone who wants to make a change for the better regarding any aspect of their health, to investigate all options and find the doctor that is right for them. In most cases, there is nothing more rewarding than watching a patient look in the mirror and seeing the look on their faces when they see the reveal!

Dr. Levy:

For our patient Etelka we provided different forms of treatment which included overall thorough Periodontal therapy which would provide a healthy foundation for all future prosthetic treatment. Among those treatments were included: deep cleaning of the gum pockets, antibiotic therapy, home care and physiotherapy, regeneration of advanced bone loss, extraction of teeth that were deemed non-treatable as a result of either decay or Periodontal (gum) disease.

1. Why was Etelka a good candidate for these procedures? Etelka was an excellent candidate since she was healthy, non smoker and very keen to achieve maximum results with a deep commitment to achieving all of our objectives.

2. What were her biggest concerns about the procedure? The biggest concerns were, of course, pain or discomfort, time to recover, making sure her teeth and replacements provided excellent aesthetics during all procedures.

 

3. How did you develop a plan for treating Etelka’s concerns? our treatment plan is always developed as a team approach: each practitioner does a comprehensive clinical exam, followed by any additional imaging or study models which will allow us to then brainstorm together which options are best for our patient, from good to better to best.

4. Was her treatment out of the ordinary? Treatment was not out of the ordinary as more and more adults which have had dental treatment done through their adult years, is starting to break down and the demands for proper treatment and oral health are higher, both from the patients perspective and the dental professionals.

 

5. Is there an ideal candidate for these procedures? Ideal candidates are always patients who are healthy and under regular care of their medical doctor as well as their dentist. Of course, non smokers will always achieve great results and patients tat are committed to having a healthy mouth will always be those who will see the outcomes which are hoped for from the outset.

6. Are there any at-home steps patients should follow after procedures like these?  patients receiving this and any type of complex dental care must know that proper home are and physiotherapy as well as frequent maintenance visits to the dental office are imperative in order to maintain the achieved outcomes and maintain healthy foundations for their prosthetic reconstruction.
7. What advice would you give those debating whether or not to get dental surgery? In order for patients to commit to complex care, it’s important to measure patients desires, objectives and realistic outcomes. Overall, wanting to achieve a beautiful smile and proper function, will require time commitment and perseverance as well as the knowledge that what took many years to occur, will not be resolved in one or two appointments. However, the ultimate result will far outweigh the hard work on behalf of their dentists and dental specialists and of course the hard work of each and everyone of our patients.

                                     Dr. Michelle Lanys, Dentist

                                                   
                                     Dr. Dana Levy, Periodontist

Dr. Mark Librach, Dentist

                                   Connie, Treatment Coordinator

Struggling With Sensitive Teeth?

When you enjoy ice cream do you fear the sharp pain that may accompany the chocolate flavour? Ice cream, cold or hot drinks and foods are luxuries that some people can't simply enjoy if their teeth are sensitive to temperature.

Dentin hypersensitivity is caused by stimulation of cells located in the dentin (the layer under your tooth enamel which can become exposed through wear and tear or dental maladies). When this happens, eating and drinking hot or cold foods and beverages, touching your teeth, often even exposing them to cold air can be painful.

We have options that will allow you to enjoy all of your favourite foods.

If your teeth are sensitive to hot or cold, book an appointment for a diagnostic evaluation and to rule out more serious problems such as a cavity or abscess. If you have dentin hypersensitivity, we may seal the sensitive area or for less severe cases you may be prescribed a special fluoride gel or told to use one of several over-the-counter toothpastes for sensitive teeth containing potassium nitrate or strontium chloride.

If you have any apprehension with hot or cold foods, call our office today for a consultation, then stop for an ice cream on the way home, you'll be glad you did.

7 Ways to Help Prevent Tooth Decay, Gum Disease, & Dental Health Problems

An ounce of prevention is worth a pound of cure.
Proper dental prevention and regular check-ups are your best bet for a healthier, pain free, beautiful smile. But how? Isn't brushing and flossing regularly enough? You do floss regularly, right!?!?

No sweat, we're here to help! Here are 7 ways to help prevent tooth decay, gum disease, & dental health problems.

Invest In an Electric Toothbrush

Manual toothbrushes can only clean your teeth so much. Electric toothbrushes are a popular and beneficial alternative to get a deep clean in order to prevent oral health issues such as tooth decay and gum disease. A few options for electric toothbrushes are Sonicare or Oral B which have replaceable brush heads.

Tips For Using an Electric Toothbrush:

• Press lightly when brushing - you don't need to put too much pressure with an electric toothbrush.
• Clean brush heads by running it under water or rinsing it with mouthwash to avoid bacteria from building up.
• Replace the brush heads regularly, especially when the bristles are out of shape or discoloured.
• Talk to your dentist and hygienist about any questions or concerns you may have about electric toothbrushes. They'll provide you with all the information you need!

Floss!

You shouldn't miss this step because flossing helps remove any extra debris that a toothbrush can't reach. Flossing daily with a proper technique will reduce your chances for cavities, gum disease and will improve your oral health overall. Ask your dentist and hygienist on good flossing techniques to ensure you're doing the most you can for your teeth.

Choose Foods & Beverages Thoughtfully

Your choices of food and beverages also play a large role in your dental health and in preventing health issues such as tooth decay.

Avoid Foods & Drinks That Are:

• Sugary - Foods and drinks that are high in sugar, especially fruit juices are not healthy choices for your teeth and gums.
• Acidic - Beverages that are high in acidity like soda and coffee can have adverse effects such as demineralization and tooth decay.
• Sticky - Dried fruits like raisins or prunes are perceived as healthy, but these sugary snacks can get stuck and damage your teeth.

Choose Foods & Drinks Like:

• Leafy Greens - Spinach, broccoli, kale
• High-Fiber Fruits and Veggies
• Nuts like Almonds and Legumes
• Unsweetened coffee and tea

Rinse Regularly

Rinsing your mouth with fresh water can be more beneficial than brushing your teeth after every meal. When consuming foods or beverages with high acidity, it weakens the tooth enamel. Brushing right after can be detrimental, as the tooth is weakened after being in contact with high acidity food/drinks. Therefore, gently rinsing your mouth with water is a safer alternative. In addition, alcohol-free mouthwash freshens your breath. It is less harsh than mouthwashes that contain alcohol which can lead to dry mouth and gum disease.

Make Health a Priority in Your Life

Your dental health is influenced by your overall physical health and wellness, so it's important to take care of your whole body. For instance, untreated gum disease is directly linked to heart disease, diabetes, and many other chronic health issues. Speaking and visiting your dentist regularly can help with preventing health problems as well as identifying the early stages of oral cancers and other issues through non-invasive preventive screenings during your dental exams.

Take a Proactive Approach to Treatment

A proactive approach will help prevent oral health issues such as tooth decay, gum disease and keep your body healthy long-term. Don't wait to treat health issues when they are intolerable, especially when it comes to aches, pains, and other uncomfortable symptoms.

Schedule regular dental checkups and appointments with your doctor. Prevention is generally an easier process than treatment. For instance, cavities that are caught early will have more treatment options and will be a less-invasive approach.

Listen To Your Body

Remember to take the warning signs of dental health problems seriously. Seek help if you're suffering from:

• Headaches when waking up
• Poor sleep
• Red, bleeding, swollen, or irritated gums
• Pain when biting or chewing
• Sensitivity to hot or cold foods
• Chronic bad breath

Even if these symptoms seem minor in the beginning, it may lead to serious health issues in the future. Remember to schedule dental checkups regularly!

Dental Makeover! Cheryl's before and after

Fixing gaps and wear on Cheryl's upper teeth gave her a bright new youthful smile! 

Procedure: Dental Crowns

Dentist by: Dr. Mark Librach

1. Why was Cheryl a good candidate for these procedures?

Cheryl was very motivated and considered all treatment alternatives.  She wanted to correct her smile but when presented with the treatment plan that was based on the protection of her front teeth by building strong back teeth, she took to the idea.

2. How did you develop a plan for treating Cheryl's concerns?

Records are always critical to the creation of a treatment plan that is customized to our patients needs.  Comprehensive photos, models and X-rays are critical in presentation to the patient, other adjunctive professionals and our lab technicians.  A temporary mock up was also used on this case that gave us and the patient a clear picture of what the final outcome would feel and look like.

The above shows the extensive wear on the inside of Cheryl's upper teeth.

 The above shows the post-treatment crowns.

3. Was her treatment out of the ordinary?

There really is no such thing as “ordinary treatment”. Every case presents with complexities that are unique to that case.  In this case, the posterior teeth were in rough shape due to erosion and bruxism( grinding).

4. How long did (Patient’s) transformation take?

A few months and approximately 5-6 appointments.

Anterior view of Cheryl's front upper teeth prior to crown placement.

Anterior view of Cheryl's front upper teeth post-treatment with porcelain crowns.

5. Are there any at-home steps patients should follow after procedures like these? 

For most patients with extensive dental care we recommend the use of a night guard to protect the teeth and the dental work at night time. This decreases wear and tear and protects her teeth while the patient sleeps. 

Read what Cheryl had to say!

1.     What made you decide to undergo these procedures?

Due to years of erosion and night grinding I was told that I was going to start losing my teeth. I had so many spaces between my front teeth that I was self conscious about smiling.

2.     Why did you choose Dentistry on Dundas/Dr. Librach?

I had been told that he was really good.

3.     What were your procedures like?

I am very nervous about going to the dentist to have anything done. I gag easily and feel claustrophobic when things are put in my mouth. A couple of the procedures were very long appointments. Dr. Librach and Joan were awesome, gentle and understanding. The procedures were basically pain free. Dr. Librach did his best to ensure that things were removed from my mouth as quickly as possible and was always checking to see if I was comfortable. Both were willing to answer any questions I had too which I appreciated.

4.     How do you feel about your results?

Great!! I have had many positive comments and now I can smile again!!

Dr. Mark Librach 

Dental Implants

Dr. Mark Librach has been published! Though there are a number of ways to replace missing teeth, dental implants are considered state of the art. "For the appropriate candidate, they can be a smile-changing and a life-changing experience," says Dr. Mark Librach of Dentistry on Dundas in Downtown Whitby. 

Meagan's Myofunctional Orthodontic Transformation

Meagan is an excellent example of how myofunctional orthodontics can transform a patients bite and profile. Meagan's bite is what we consider a class III malocclusion. In simple terms a class III malocclusion is an underbite where the bottom teeth overlap the top teeth. Megan had seen several dentists who had recommended to her that this problem could only be corrected through orthognathic surgery. This type of surgery is very invasive and requires a hospital stay of two days followed by a recovery time of several weeks where her mouth would need to be wired shut. Megan‘s parents were hesitant to go forward with the surgery. I offered them a treatment plan that would require her to wear and appliance every evening while she slept plus 2 hours per day. 






This type of treatment known as myofunctional orthodontics and works by retraining muscles of the face and jaws to reposition her maxilla and mandible to the correct relationship. Megan’s transformation was completed in one year of treatment. As you can see in the photos her teeth are now in a very good class one relationship and her profile has improved dramatically. 
Megan will need to continue to wear her appliance for two years while sleeping. This will prevent her teeth and jaw from relaxing to the original position.







We asked Meagan's Mom how she felt the treatment went....

1.     What made you decide to undergo orthodontic treatment for Maegan?

Maegan had a class 3 malocclusion. Which is a pronounced overbite. Before coming to Dr. Millman, we were told the only way to correct this overbite was surgery.

2.     Why did you choose Dentistry on Dundas, Dr. Millman, for this treatment plan for Meagan?

Dr. Millman was the only dentist we met that offered us a non surgical procedure for her overbite.  The Myobrace Dr Millman fitted Maegan has successfully corrected her overbite without surgery 

3.     How did Meagan tolerate her orthodontic treatment?

The myobrace treatment was painless and easy for a young girl to manage on her own. What was really important to my teenage daughter is this treatment was done at home. She didn't have to wear it in public.

4.     How do you and her feel about the results?

We are extremely pleased with the results. Maegan's overbite has been corrected without painful surgery or the use of braces. The Myobrace was the perfect treatment for my daughter.                            

Dr. Steven Millman

New Patients Welcome

Michelle's Dental Makeover!

Dr. Steven Millman explains Michelle's treatment plan....

Michelle's case is an excellent example of how we can use porcelain veneers to correct a person smile instantly without orthodontic treatment. 

The patient was very concerned with the symmetry of her smile and her mid-line being off. She also did not like the anatomical shape of her teeth.

                                                       Michelle before

A treatment plan was developed with the help of our lab technician Jonathan Murisac and our periodontist Dr. Dana Levy. Prior to treatment we created a wax mock-up of her smile in order to correct her concerns. Once the patient was able to visualize the changes we could  make to her smile, she accepted going ahead with this treatment.

The transformation was completed over a month of treatment. We started off by placing temporary veneers to correct the position of the gingival tissue and to create a symmetric smile. Once the patient was satisfied with the cosmetic result we then replaced the temporaries was permanent veneers. 

                                                           Michelle after

There are many potential patients that could benefit from this type of treatment. This is a relatively non-invasive treatment that can correct crooked misaligned teeth without orthodontic treatment. As you can see by the photos the cosmetic result was excellent. Both myself and the patient extremely pleased with the final results. 

The beautiful porcelain veneers can be easily maintained with routine brushing and flossing. We also highly recommend six month cleaning at the dental office with a skilled hygienist. 

From the Michelle....

1.     What made you decide to undergo these procedures?  Saw an orthodontist and due to the crowding of my teeth and the extended years of work that needed to be done they didn’t feel it was an good option for me at my age and I would not get the result I was looking for since I was missing the canine tooth. 

2.     Why did you choose Dentistry on Dundas/Dr. Millman?  He is my family dentist so didn’t feel the need to look elsewhere.

3.     What were your procedures like?  It was definitely time consuming, however this was due to my specific case as we were turning another tooth to appear to be a canine. Other than that, there was nothing intolerable. 

4.     How do you feel about your results?  Anyone who sees them think they look perfect and have had comments on how perfect they look from people who don’t know I had them done.  

                                                    Dr. Steven Millman