Richmond Hill Sleep Dentistry

02/22/2025

Choose Wisely Canada - Dentistry - a toolkit to reduce overuse of antibiotics!

A shout out to the team's effort behind the scene in making the "ToolKit on using Antibiotics Wisely for Managing Tooth pain in Adult" available for public and Dental professionals.

Old habit is hard to change BUT with continuous effort, education and explanation with most updated evidence, it is hopeful - especially from the standpoint of - providing better care for dental patient and greater long-term benefit of populations as a whole.

The ToolKit is available at https://choosingwiselycanada.org/wp-content/uploads/dlm_uploads/2025/02/Dental_Toolkit_2024_3.pdf

10/27/2024

If you know of a child with
:poor sleep quality (snore, toss-and-turn/odd sleep position);
:poor diet choice/unhealthy diet preference;
:day-time lack of focus; irritability or
:other emotional or behavioral problem (hyperactive)....

The child might be suffering from Childhood Sleep Apnea ---

Consult with physician for proper diagnosis (sleep study);
Seek treatment, and diet counselling ASAP, exercise regularly
--- child's (and family's) quality of life can be greatly improved.

Prognosis:
With treatment, childhood sleep apnea symptoms can go away and won’t have a long-term effect on child as they grow. Untreated sleep apnea may be dangerous and can affect your child’s growth and development.

As Dental Professional, when a child presents with severe dental cavities; we do routinely spend time to review medical history, dental history, diet pattern and personality status to help family identify etiology. Treatment the cavity plus addressing the background causes will improve prognosis for child's overall well being!

ref: https://my.clevelandclinic.org/health/diseases/14312-obstructive-sleep-apnea-in-children
: https://www.mayoclinic.org/diseases-conditions/pediatric-sleep-apnea/symptoms-causes/syc-20376196
: https://www.ankitparakh.com/conditions-treated/sleep-disorders-in-children/obstructive-sleep-apnea/
: https://www.sleepadvisor.org/sleep-apnea-in-children/
: https://pmc.ncbi.nlm.nih.gov/articles/PMC10291126/

10/12/2024

Interprofessional collaboration with other healthcare providers:
- Oct 2024 World Dental Federation (FDI) has newly launched oral health fact sheets for other healthcare professionals - To expand access to oral health and to achieve the goal of affordable and accessible healthcare for all, there is a need to engage the wider healthcare workforce for the prevention and control of oral diseases.
- The FDI also run a Whole Body Health Project -which is a dynamic platform where research on the association between oral
diseases and the most common noncommunicable diseases (NCDs) is kept updated. Click on the following link to
learn how oral health relates to twelve different systemic conditions: https://whole-body-health.fdiworlddental.org/

Most oral diseases are preventable through straightforward, evidence-based interventions. However, there is a shortage of dentists in many parts of the world. To expand access to oral health and to achieve the goal of affordable and accessible…

07/01/2024

Advocating for Children's Health Ref: JCDA 2024 issue 3 pg 17-18

Oral health and general health are inextricably connected; The link between frequent dietary sugar and tooth decay is well-established. Unfortunately we also noticed
Few alarming statistics:
- Ultra-processed food consumption in Canada is highest in children between 9 and 13, making up nearly 60% of calories in their diet.
-Diet high in ultra-processed foods or sugary drinks are linked to an increased risk of cardiovascular disease; stroke; diabetes, cancers, tooth decay and mortality later in life.
- Children in Canada are bombarded with marketing for food high in salt, sugar and/or saturated fat on a regular basis across a variety of media and settings.
- Children are uniquely vulnerable to marketing due to their still-developing brains.

Working with a coalition of health care professions and stakeholders toward better nutrition through decreased marketing of unhealthy food and drinks to children, could make a big differences, not only for kids' teeth in the short term, but their health and well-being throughout their lives!
Ref: JCDA 2024 issue 3 pg 17-18 "Advocating for Children's Health"
: https://stopmarketingtokids.ca/

06/09/2024

Angelman Syndrome
ref: Journal of Clinical Anesthesia. 26(1):75-9, 2014 Feb.

* a genetic disorder characterized by
: Severe developmental delay
: Speech disorder >receptive language problem>,
: Ataxia (lack of muscle control in arms and legs) -- more susceptible to effect of neuromuscular blocking agent (more prone to falls/accidents after sedation-anesthesia).
: Craniofacial abnormalities
: Odd behavior accompanied by a happy disposition and occasional bouts of laughter.
* Prevalence from one in 10,000 to one in 40,000 - Variation in phenotypes.

*Perioperative Anesthesia consideration
: Variability in phenotypes
: Pharmacodynamic unpredictability

*Prognosis and Treatment
: for those with a longer lifespan, seizures typically persist with less severity and an improved EEG pattern over time.
: Adult with AG retain their behavioral uniqueness; but they have a calmer demeanor, are less excitable and have fewer outbursts of laughter than younger patients.
: Treatment limits to control of seizures. -- research suggests that pt has good therapeutic response to valproic acid, phenobarbital, and clonazepam, as well as other BZD -- as a result of changes in the GAGA-A system.

*Vagal Hypertonia -
: outburst of laughter might cause transient syncope secondary to vagal hypertonia.
: vagal tone might originate centrally and may be induced by changes in intrathoracic pressures and Valsalva-like maneuvers during the bouts of laughter.

Other ref:

Angelman syndrome is a severe neurological disorder characterized by developmental delays, epilepsy, and problems with motor coordination and balance. It is named after a British pediatrician, Harry Angelman, who first described the syndrome in 1965.  Individuals with AS do not develop functional s...

03/17/2024

"Trauma-Informed Care in the Dental Office" -(ref 1).
-may be a newer term to many, but "patient-centered care" has been the norm to Health-Care Providers.
-to many dental care provider; it is a good idea to apply the term "universal precautions to trauma and make the assumption that anyone walking into our office with any sign of anxiety, has had some form of trauma in their world or in their life."
-"People's resilience (i.e. their unique capacity to handle stress) fluctuates depending on the person and impacts their ability to cope with trauma".
-Few screening questions we can adopt
"What's it like for you to be here today?"
"Have you experienced anything about seeing a dentist that's scary for you?"
"Is there anything we can do to make you feel more comfortable or safer?"
Quoting Dr Friedman -- "Our role as dentists is to create a safe space for the patient. Encouraging self-regulation and re-engaging the parasympathetic nervous system are the best way to respond to a hyper-or hypo arousal state.".

ref 1: JCDA issue 1 2024-30-32 "Trauma-Informed Care in the Dental Office"
ref 2: https://oasisdiscussions.ca/2023/08/28/trauma-informed-care-in-the-dental-office/
ref 3: https://oasisdiscussions.ca/2022/01/24/trauma-informed-care-a-csdh-aboutface-panel-discussion/

12/24/2023

Happy Holidays. Our office is closed Dec 23 to Jan 2, 2024 and will resume office regular hour on Wed Jan 3, 2024.

Have a lovely X'mas season and keeping safe.
Sharing few tips for diet that's beneficial to oral health

Tips:
A healthy diet and adequate protein consumption are associated with positive overall and oral health. As per Canada’s food guide, aim for a quarter of each meal to contain protein and choose plant sources more often.
More information about Canada’s food guide for healthy eating can be found at: https://food-guide.canada.ca/en/. This website provides detailed guidance about healthy food choices and healthy eating habits, essentially ‘what to eat’ and ‘how to eat.’
Subscribe to e-mail updates about Canada’s Food Guide, including recipes, at: https://www.canada.ca/en/health-canada/services/canada-food-guide/subscribe.html
A helpful resource to check the nutrient content and profile of a food is the Canadian Nutrient File (CNF): https://food-nutrition.canada.ca/cnf-fce/?lang=eng
For general bone health, ensure adequate calcium and vitamin D intake, particularly if not regularly consuming dairy foods or plant-based beverages fortified with calcium and vitamin D.

Ref: Dietary Protein to Support Periodontal Health: An Update
10/10/2023. Oral Health Journal Oct 2023
by Mitchell A. Ianiero, BSc; Wendy E. Ward, B. Arts Sc, MSc, PhD

fig 2 - Pathways by which dietary protein may support periodontal and overall bone health, including retention of teeth.

Fig 3 - A comparison of foods to eat to achieve adequate protein intake and maintain overall health. Typical serving sizes (g) are provided for each food, along with the amount of protein (g) and energy (kcal) for the specified portion. Foods high in vitamin D and/or calcium are labelled in a yellow square, and foods high in flavonoids are marked with a dark green leaf. Nutrient profiles were obtained from the Canada Nutrient File available at: https://food-nutrition.canada.ca/cnf-fce/?lang=eng.

09/05/2023

As kids go back to school and most return to a routine schedule - Sharing Tips from Ontario Dental Association for good oral care routine.
To learn more about todays tips, visit: https://www.oda.ca/.../care-disease.../tips-for-kids/

07/23/2023

COVID Update - Public Health Ontario’s COVID-19 tool shows that case counts and rates are declining, while vaccination rates remain high. On Jul 19, 2023 Ontario's Dental Regulatory Body (RCDSO), Rescind it's COVID-19-specific guidance.
Dentist will continue to follow Public Health Ontario's IPAC guidance. A cardinal rule for elective dental care under sedation/anesthesia is careful analysis of risk and benefit.... If patient has signs of respiratory infection/communicable disease, we ask family to continue perform self-assessment and discuss result with our office - for decision of whether appointment at dental office should be deferred or maintained. https://www.ontario.ca/self-assessment/

ref: 1) RCDSO https://rcdso.informz.ca/informzdataservice/onlineversion/ind/bWFpbGluZ2luc3RhbmNlaWQ9MTQzMzg1MSZzdWJzY3JpYmVyaWQ9OTAxNDc1OTQ0
: 2_ PHO https://www.publichealthontario.ca/-/media/Documents/nCoV/ipac/2021/09/covid-19-summary-ipac-key-principles-clinical-office-practice.pdf?rev=77fa21bb02ec428f9d31d67d2af778ec&sc_lang=enRCDSRC

05/06/2023

In 2022 - There is update of American Heart Association's 2007 Recommendation for Prevention of Infective Endocarditis - related to select Dental Procedure.

The following procedures and events DO NOT need prophylaxis for high risk patients:
/ routine anesthetic injection through noninfected soft tissue
dental radiographs
/ placement of removable prosthodontic or orthodontic appliances
/ adjustment of orthodontic appliances
/ placement of orthodontic brackets
/ shedding of deciduous teeth
/ bleeding from trauma to the lips or mucosa
** For clarity, the AHA guidelines state that prophylactic antibiotics, which were previously routinely administered to certain patients, are no longer needed for such patients.

Antibiotic prophylaxis is reasonable before select dental procedures (^procedures that involve manipulation of gingival (gum) tissue or the periapical region -area around the roots - of teeth, or perforation of the oral mucosa.^) for people with heart valve disease who have any of the following:
/ Prosthetic cardiac valves, including transcatheter-implanted
/ prostheses and homografts.
/ Prosthetic material used for heart valve repair, such as annuloplasty rings, chords or clips.
/ Previous IE.
/ Unrepaired cyanotic congenital heart defect (birth defects with oxygen levels lower than normal) or repaired congenital heart defect, with residual shunts or valvular regurgitation at the site adjacent to the site of a prosthetic patch or prosthetic device.
/ Cardiac transplant with valve regurgitation due to a structurally abnormal valve.
Except for the conditions listed above, antibiotic prophylaxis before dental procedures is NOT RECOMMENDED for any other types of congenital heart disease.

In addition, antibiotic prophylaxis is NOT RECOMMENDED for patients with valvular heart disease who are at high risk of IE for nondental procedures (e.g., TEE, esophagogastroduodenoscopy, colonoscopy, or cystoscopy) in the absence of active infection.

Good oral health and infection prevention is the ULTIMATE GOAL - Patient can reduce the risk of IE by maintaining good oral health through regular professional dental care and the use of dental products such as manual, powered and ultrasonic toothbrushes; dental floss; and other plaque-removal devices.

Ref:
1) Canadian Dental Association Position 2021- http://www.cda-adc.ca/en/about/position_statements/InfectiveEndocarditis/
2) American Heart Association topics on infective endocarditis - https://www.heart.org/en/health-topics/infective-endocarditis

02/19/2023

A good read for dental colleagues with patients in mixed dentition.
Our clinic frequent see patient with rampant decay complex with malocclusion, we routinely explain to family about staged dental care that follows. There is no magic bullet, but constant practice & reminder about importance of daily habit, home care and knowledge accumulation.
With sleep dentistry, one main goal is prompt control of dental caries, infection and pain control for the very young, very scared and the special population; which is considered essential and at times - urgent. But there-after, the very young/the growing children definitely require long-term rehabilitation of oral health.... which frequently includes diet pattern change and daily oral hygiene routine improvement plus regular follow up with professionals …. Parental dental knowledge is critical (for motivation, which will hopefully translate to action).
Then Stage II - growth and space management - which will take months-to-years. But good daily oral hygiene and routine are fundamental for long term prognosis.

A 9-year-old female patient visited the orthodontic office for an initial consultation. She presented with a Class II malocclusion...

01/02/2023

Welcome 2023!

We thanks everyone for your diligence and compliance with Dental College and Public Health Ontario's guidance for Managing infection risks during in-person dental care, especially during in this Tridemic (the combination of three virals infection - Flu, Covid-19 and RSV).

Health and Safety is an critical aspect for everyone in our facility - We continue to ask patient-family to be screened for COVID-19 prior to entering the office using the COVID-19 self-assessment tool (https://www.ontario.ca/self-assessment/). This screening tool is regularly updated and an excellent guidance for patient/ family who has question about health-status prior to appointments.

We will re-open Wed Jan 4, 2023.

May Health and Peace be always presence.