Richmond Hill Sleep Dentistry

02/28/2026

Cognitive Health Around Surgery

Great to see Sunnybrook Health Sciences Centre launch its first-of-its-kind Perioperative Cognition Clinic — right here in Ontario. This clinic provides wrap-around cognitive care for patients before and after surgery, particularly those at higher risk of cognitive changes.

Postoperative Neurocognitive Disorders (P-NCDs) can affect memory, attention, and thinking after major surgery, especially in older adults and individuals with frailty.

The good news? Research shows that simple, healthy habits may help reduce risk:

✔️ Nutritious diet
✔️ Good hydration
✔️ Regular physical activity
✔️ Quality sleep
✔️ Brain exercises (puzzles, reading, games)
✔️ Maintaining familiar routines

Supporting overall health is one of the best ways to support brain health — before and after any surgery.

Learn more:

Sunnybrook’s new Perioperative Cognition Clinic welcomed the first patient to its integrated perioperative care model.

12/24/2025

Merry Christmas and Happy 2026 to all.
Office is Closed for a brief Holiday break from Dec 24 to Jan 1, 2026.
Wish everyone a lovely holiday season!

11/02/2025

Pediatric Rental Tubular Acidosis (RTA)
- a rare kidney disorder that can affect how a child's body balance acid and base.

💧RTA happens when the kidneys don’t properly remove acid from the blood. Over time, this can cause:
: Low blood bicarbonate (“acidic” blood)
: Low potassium
: Muscle weakness, tiredness, and slow growth
: Sometimes kidney stones or bone problems

For most children, RTA is well controlled with medication (like bicarbonate or citrate) — but it’s important for the child's care team members to be aware of diagnosis and management.

😴Why It Matters for Dental Sedation or Anesthesia
During sedation or anesthesia, a child’s body must maintain steady breathing, heart rhythm, and chemical balance.
Because RTA affects acid–base and electrolyte levels, it can:
- Change how the body responds to anesthetic or sedative medicines
- Make breathing or blood pressure less stable if acidosis isn’t well controlled
- Affect how quickly some medications leave the body

That’s why extra care and monitoring are needed — especially when procedures involve deep sedation or general anesthesia.

🩺 Consideration for optimized patient care
Before any procedure, it is important to:
: Review medical history carefully – including RTA type, medications, and recent lab results.
: Coordinate with child’s physician or specialist (nephrologist) to make sure their condition is stable.
: Check hydration and acid–base balance —want everything in a safe range before starting.
: Adjust the sedation plan to choose the right medications and dose.
: Monitor breathing, heart rate, and oxygen levels closely during and after the procedure.

🩵 Safe dental care starts with shared information.
Always let your care team know about your child’s medical (kidney or metabolic) conditions — it truly helps us care for them safely.

References:
1) Gafsi B et al., “Anesthesia management of children with renal tubular acidosis” (HK Paediatric J) //Hong Kong J Pediatr Res 2019; 2(2): 28-29
2) Clinical Approach to RTA in Children, Pediatrics in Review
pedscases.com // Pediatr Rev (2024) 45 (11): 665–669.

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