Would you let your dry-cleaner cut your hair?

An odd title is it not? It does however provoke some thought.

I am sure you agree that you would not let your dry-cleaner cut your hair or would you ask your dermatologist to deliver your child. It may sound like an exaggeration but there is a point to make.

It is essential that prospective patients do their due-dilligence when seeking any service. You would not hire your local pharmacist to build you a house. Many people are unaware as to what is required to become an orthodontic specialist.

It is not a one-day course in questionable treatment practises that offer unrealistic results over-night. Years of training are involved beyond dental school. The qualifications of the practitioner in managing your care is what should be first investigated, before entering into the doctor-patient relationship.

Invisalign is a great tool for aligning teeth in select circumstances but the technician needs to be guided to ensure the planned movements are possible. Just because the computer says the teeth can be put in a particular position does not mean it is a healthy, biologically compatible movement. There are excellent general practitioners who can undertake certain limited treatment, that is not at question.

When choosing to undergo comprehensive orthodontic treatment it is imperative that all aspects of the care you should receive can be managed appropriately. Knowing when to refer and seek the advice of someone more experienced in the task at hand is the sign of a quality clinician. One must always know their limits. If a clinician cannot handle any potential complications, such as an infection, after placement of a dental implant, should they be placing the implant in the first place? Food for thought!

Please take some time to view this excellent video from the American Association of Orthodontists.


Experience Counts

If something sounds too good to be true, it usually is. Proper orthodontic treatment cannot be learned in a single course offered on a week-end. The public is bombarded with the modern version of the snake-oil salesperson on a daily basis. All manner of get-healthy-quick and straighten-your-teeth-in-weeks schemes abound. No matter what you are doing, whether it be renovating your house or your smile, choose the person to do it wisely!



Get Some Sleep!

As outlined in previous posts about sleep, this is another excellent article about the benefits of getting your required hours. Again, avoid caffeine late into the day as well as any phone/computer screens at least 1-2 hours before bed is critical. These are good habits especially for teens to start to learn early. Grinding/clenching of your teeth occurs when you do not enter a deep, rejuvenating phase of sleep (REM). Chronic clenching/grinding can cause problems with your teeth and jaw joints (TMJs).


The Importance of Sleeping Well

Issues surrounding poor sleep habits are very popular in the media. People are being diagnosed with sleep apnea (episodes at night where external breathing is suspended) at accelerated rates. A physician prescribed sleep-study is key. This issue is now found to be very common in younger patients. This can affect how orthodontics is performed. In many adult patients, orthodontic treatment combined with corrective jaw surgery, as discussed in a previous post, has worked very well for a number of my patients. In the growing patient however, certain bite-relationships (where the upper teeth are out in front of the lower teeth, known as a Class II malocclusion) may need to be seen in a different light. If there are sleep issues as children, conventional orthodontic treatment, in particular circumstances, not all, may not be appropriate. It may be necessary to await completion of growth so that corrective jaw surgery can be undertaken to help prevent the serious health effects of apnea in the future. Attached is a link to an interesting newspaper report. In addition, please refer to the previous blog post about orthodontic treatment. The xrays show the changes in the airway of a patient who underwent the procedure discussed today.



Design Award


Thanks again to JoeArchtiect for their excellent work and for winning an award from the IIDA (International Interior Design Association).

My goal was to create a space that was environmentally friendly. We have made efforts to reduce water/power usage and are close to becoming almost completely paperless!

It was also important to create a space that facilitated our goal of treatment provided directly by both myself and Dr. Stevens exclusively.

The access to the subway line has also been a big help for patients.

Please take a moment to see the IIDA award site. One of the judges even said the office made them want to have their teeth worked on! That is a big compliment.

Check out our award here:



My patient Alex just posted this great new video about achieving your goals.

I just placed SPEED lingual braces for the lower teeth (braces behind the teeth).

Alex is a very motivating and successful young entrepreneur who has great messages about work and life.

It is necessary to embrace the struggles along the way to any success. It makes the outcome that much more rewarding!

There is always some discomfort that we must overcome as we move forward and achieve our goals.

Please take a look at this terrific video.



Could Your TMJ Problems Really Be Something Else?

Temporomandibular joint disorder (TMD) is an umbrella term to describe chronic and acute pain generally relating to the temporomandibular joint. This joint can often become inflamed, displaced (the interposing disk) or injured. TMD can result in extreme cases of facial pain leading to disruptions of normal, facial functioning.

Typical TMJ Problem Area. Image via

Typical TMJ Problem Area. Image via

As in life, things are not always what they seem! TMD is a fairly common, and well-understood disorder. There have been cases though where a patient presents with TMD symptoms, but instead the real culprit is a lesion compressing the associated structures thus mimicking typical TMD symptoms. Such a lesion could be a Pleomorphic adenoma.

Pleomorphic adenoma is a common variety of salivary gland tumours, though clinical diagnosis can often be difficult. Especially when the tumour presents itself deep within the gland. While these tumours are usually asymptomatic, they do occasionally present with the symptoms of TMD.

 Read my case study of a 43-year old man who presented unique facial pain issues:

Now this can be a problem for both diagnosis and treatment of the tumour.

The slow-growing, and normally painless tumour can also be associated with facial palsy or chronic pain. If it were to grow large enough, it could also impede proper chewing, mandibular movement, and could cause entire muscular paralysis.

Read my full insight into Pleomorphic adenoma and its common association with TMD symptoms here:


Tension and Your Teeth: Parafunction & Bruxism

Have you ever been woken up by the dull crunch of your own gnashing teeth? Did you simply shrug it off only to find that, come morning, you had an awful pain in your jaw? You could be suffering from Bruxism, or teeth grinding.

Bruxism is a form of Occlusal Parafunction, which is a term given to oral behaviours that serve no function. Unlike most other parafunctions (such as nail-biting, thumb sucking, cheek-biting etc.) bruxism normally takes place in your sleep, and is not a learned behaviour.

Is it deadly? Thankfully no. Even so, Bruxism’s side effects can be much more drastic than other parafunctional behaviours.


Why am I grinding my teeth?

Some bruxism activity is rhythmic, quick and repetitive. When you’re chewing, for example, your bite force pulses are very minute, often only accounting for a fraction of a second. Other activities result in longer bite force pulses of 1 to 30 seconds, such as clenching and releasing your jaw.

A major cause for this second type of bruxism is stress. Tension and anxiety can cause people to unwittingly clench and unclench their jaws for several seconds at a time. If you’ve ever caught yourself biting hard in concentration, or tensing up your jaw while you focus on an important task, you’re familiar with how easily we can manipulate our jaw muscles involuntarily.

Work, stress, and active worry aren’t the only causes for bruxism however, since a great deal of tooth- grinding occurs while we sleep. Disturbed sleep habits and a misaligned bite can increase grinding and clenching, inviting bruxism activity even when you’re completely unconscious. For this reason researchers will often classify bruxism as a sleep disorder, as well as a parafunctional habit.

A disturbed sleep habit is not only unhealthy for your teeth. It can have an impact on your health in general. So what’s disturbing your sleep?


Computer/Tablet/Phone Screens 

In our modern world, it is not uncommon to spend the remaining minutes before bedtime sitting on your (insert electronic device here) checking emails or aimlessly surfing the web. This pre-sleep ritual could be affecting your ability to sleep properly.

The artificial light that emits from your device suppresses the release of the hormone melatonin. A hormone that helps you sleep, making your body more alert and more awake.

Plan to put away your device(s) at least an hour before bed. Spend the last minutes before you hit the sheets winding down.



 You’ve managed to reduce your caffeine intake to help with your sleep. The last cup of coffee you’ve consumed was four hours before bed. Unfortunately, that’s still going to disrupt your sleep.

Caffeine has been found to be just as potent when consumed six hours before bed, as three hours before bed. That means that that cup of coffee you had with dinner will stay with you.

Do your best to limit any caffeine to at least 8 hours before you sleep.

The Effects of Bruxism

Bruxism can have unpleasant and harmful effects on both your jaw and teeth. Since grinding and clenching overwork your jaw muscles, these behaviours can result in discomfort, headaches and earaches, in addition to slowly eroding your teeth. Severe grinding can also be so loud that it has the disagreeable habit of waking you or a partner repeatedly in the night.

Other effects of bruxism include:

  • Gum recession
  • Insomnia
  • Malocclusion, or misalignment of the teeth
  • Temporomandibular joint problems (TMJ): discomfort and poor functioning of the chewing muscles in the lower jaw
  • Disk derangement
  • Severe bruxism can result in pulpal exposure, or even pulpal death
  • Trauma to the teeth and tooth loss
  • A disturbed sleep habit can result in sleep apnea, which is not only worsens your quality of sleep, but also your quality of life [hyper link to sleep apnea blog]

Bruxism, Teeth Grinding

Effects of severe Bruxism: Image via


If you suffer from bruxism, a visit to an oral health care specialist is necessary. Your practitioner will help determine the best course of action to target the habits underlying your clenching and grinding. The primary goals of treating bruxism are to reduce discomfort, improve sleep, and prevent long-term damage to the jaw and teeth. Common treatments for the condition include:

Visiting a sleep lab: Sleep labs perform the most reliable diagnostic technique for diagnosing bruxism. They’ll be able to establish how severe your bruxism is, giving your oral health specialist the information they need to appropriately treat it.

Wearing a mouth guard: A dental guard is effective at reducing tooth abrasion and muscle strain. Your oral health care practitioner will create a mold of your mouth to ensure that the instrument is completely customized for your bite. The guard works by allowing the upper and lower jaw to move easily and independently of each other. This will provide a protective barrier and prevent the repeated, grinding contact that erodes the teeth and exhausts the jaw muscles.


Biofeedback device and Cognitive Behavioural Therapy:

Biofeedback devices work by sending out a signal when your jaw clenches beyond a pre-set threshold. This “signal” might be an unpleasant taste, sound, or mild electric shock, depending on the biofeedback mechanism. The purpose of these devices is to interrupt the grinding behaviour and thereby provide the wearer with a subconscious awareness of it.

This works on a deeply psychological level. It’s called classical conditioning. Every time the biofeedback device recognizes a negative behaviour, it immediately jolts you out of your sleep. It provides a negative consequence to dissuade your body from continuing. Most professional have found that reinforcing this classical conditioning with a positive behaviour (I.E. Brushing teeth) strengthens the whole process.

Certain other treatments believed to improve bruxism, such as Botox and dietary supplements, are still undergoing research to determine their effectiveness. If bruxism has damaged a person’s teeth visibly, dental procedures can replace the worn and damaged crown of a tooth with a prosthetic alternative.

Of course this is an end-scenario fix. With timely preventative treatments and diagnostic assessments, you can manage and contain the effects of bruxism, and simultaneously improve other symptoms you may not have realized were related to this condition.