Dental amalgam has traditionally been called “silver amalgam”. More recently many have started naming them “mercury amalgam”. Why has there been this change in focus? Amalgam contains approximately 50% mercury and only 25% silver. I believe that the “silver amalgam” term was used to downplay the mercury content in these fillings. Dental amalgam has been the centre of controversy many times in it’s more than 150 year history. This controversy has focused mainly on the health risks of mercury. Mercury is a heavy metal and as such is not excreted by the body easily and is in fact stored in body tissues. The medical literature that I have seen is quite clear that this can pose a health risk. The World Health Organization updated fact sheet on “Mercury and Health” lists the following Key Points to consider when thinking about mercury: ” Mercury is a naturally occurring element that is found in air, water and soil. Exposure to mercury – even small amounts – may cause serious health problems, and is a threat to the development of the child in utero and early in life. Mercury may have toxic effects on the nervous, digestive and immune systems, and on lungs, kidneys, skin and eyes. Mercury is considered by WHO as one of the top ten chemicals or groups of chemicals of major public health concern. People are mainly exposed to methylmercury, an organic compound, when they eat fish and shellfish that contain the compound. Methylmercury is very different to ethylmercury. Ethylmercury is used as a preservative in some vaccines and does not pose a health risk.” Further on in the article they state the following about the use of dental amalgam … “Dental amalgam is used in almost all countries. A 2009 WHO expert consultation concluded that a global near-term ban on amalgam would be problematic for public health and the dental health sector, but a phase down should be pursued by promoting disease prevention and alternatives to amalgam; research and development of cost-effective alternatives; education of dental professionals and the raising of public awareness.”






The use of dental amalgam in recent years has been dramatically reduced around the world. I have not placed an amalgam filling in over 20 years. Although I believe that mercury in amalgam (mercury is about 50% of the amalgam of metals … mercury, silver, copper, tin, and zinc) could have a detrimental health effect, what I have noticed is that teeth with these filling tend to develop cracks and often break over time. Although these fillings are very durable and can last a long time, they do not add strength to teeth but rather tend to weaken teeth over time. The photo at the top of this post shows an extreme yet graphic representation of what can happen as a result of these fillings. If you can picture the behaviour of mercury in a thermometer … as the temperature increases, the mercury expands and rises up the column. As the temperature cools, the mercury contracts and moves back down the column. In our teeth, the mercury can expand when we eat hot foods. This puts an outward pressure on the remaining walls of the tooth; when we eat cold foods the filling contracts. Over the life time of the filling this slight change in the size and pressure of the filling can cause teeth to weaken and break. I have seen this countless times. As a general rule when the size of an amalgam filling is greater than 1/3 the width of the tooth this effect is much more enhanced. As you can see, however, in the photo above it can even occur in a tooth with a small filling. Tooth coloured fillings bond to the walls of the tooth and help to strengthen the remaining tooth structure. These are great for small to medium sized fillings. In teeth requiring larger fillings traditionally we have placed crowns (also known as ‘caps’). Another alternative which preserves more tooth structure and looks beautiful as well is the ceramic onlay.





Today when we are living longer on average than our predecessors, preserving tooth structure is a good thing. Banking tooth structure for the future is the name of the game. An argument that has been made in favour of amalgam is that it is much more durable than bonded fillings. Based on my years of observation of the destructive effects of amalgam … many teeth with these fillings break … even if they are more durable I choose the bonded alternative. I would much rather have my tooth remain in tact and outlive my filling, than I would want to have a durable filling that outlives my tooth after it causes it to break. What do you think?


Yours for better health …
Dr. Marty Frankel – Smiles by Design
3030 – 3080 Yonge Street,
Toronto, Ontario
M4N 3N1
(416) 770-8526


Protective mouthguards have been used for decades to protect the teeth from injury during competitive compact sports games, and to help prevent concussions. Even as far back as the 1960’s, attempts were made to fabricate mouthguards that would serve that purpose as well as improve performance. About 10 years ago, Dr. Anil Makkar, a dentist in Truro Nova Scotia who practiced with a neuromuscular approach, developed a mouthguard that actually improved performance in many ways. It was found to improve arm strength, shoulder strength, balance, range of motion, in particular. People who wore the guard felt that it also improved their breathing during activity.

Dr. Makkar ran training programmes to certify dentists to be able to make these mouthguards. I was trained at the time, in the method to fabricate these mouthguards which were called the “Pure Power Mouthguard” or PPM for short. The PPM quickly made its way into professional sport where a competitive edge can make an enormous difference to an athlete’s results. These guards were worn by NHL hockey players, MLB baseball players, NFL football and NBA basketball teams. Even golfers on the PGA tour started to wear the PPM guard because they found that it gave them better balance, range of motion on their swing, and helped them develop more power in their swing.


I will post a few videos which can be found on Youtube that give you some insight into the workings of the PPM. In 2009 the New Orleans Saints won the Super Bowl, and that year the entire team wore PPM’s. Here is a short clip of the announcers being completely amazed at the performance of the Saints.







Many NBA players wore the PPM as well. Here is a video of Michael Redd going through the motions training with the help of the PPM.







Mouthguards are very important for protection from injury for someone playing contact sports in particular. The performance guards add another dimension to the traditonal guard. For more information about this interesting mouthguard, feel free to ask us any questions you might have.

Yours for better health and performance,
Dr. Marty Frankel,

3030-3080 Yonge Street,
Toronto, Ontario M4N 3N1
(416) 770-8526



I remember a conversation that I had with my parents when I was a teenager. I had decided to persue a career as a professional musician after years of focusing on the fact that my goal was to become a medical doctor one day. Needless to say my parents were disappointed in my change of plans. In discussing possible options, my mother in her wisdom, suggested that I could become a dentist. To this I replied, “Dentist? How boring … I can’t imagine ever becoming a dentist!” Was I ever wrong … not only did I become a dentist, but it is anything but boring, and it has become my hobby and passion. 


Modern dentistry is nothing like the dentistry that was practiced for the preceding hundred years. In the last 33 years since I graduated, the global explosion in technology has hit dentistry, and allowed us to expand our offerings, abilities, techniques, and therefore our satisfaction levels. There are very few procedures that I perform in the way that I was taught in dental school. That is how much things have changed. One of the most rewarding procedures we dentists can perform is a “smile makeover”. This can be something as small as masking a discoloured tooth with a tooth coloured resin to make it match the colour of the other teeth, to Invisalign, Orthodontics, and combination of tooth movement and porcelain veneers, to full mouth reconstruction with porcelain restorations. The following photos can show you two rather dramatic improvements in smiles. 


This first set of photos shows two upper incisors which had fractured when the person tripped, fell, and fractured his teeth. The teeth were not able to be saved, and two dental implants were placed and restored with ceramic crowns. This was a young man and these restorations made it possible for him to smile with confidence at a time in his life when he was entering the work force and seeking employment.

In this second case, the person had inherited a condition in which some of the permanent teeth were absent and his bite did not develop properly. This resulted in excess wearing of his remaining teeth, which made him appear much older than his chronological age. Using a combination of dental implants, neuromuscular dental principles, and modern ceramics, we were able to achieve a beautiful smile and make him look 10 years younger. 

These are just 2 examples of what is possible today. This type of dentistry can change people’s lives. I plan to show you more interesting cases in future blogs.

Yours for better health,
Dr. Marty Frankel – Smiles by Design
3080 Yonge Street, suite 3030,
Toronto, Ontario M2N 1T7
(416) 770-8526


I thought I would take a few minutes today to tell you about my tag line … “SMILES BY DESIGN”. Why did I choose that line and what is its significance? 

These days many dentists talk about smiles, and most of us think of the dentist creating a beautiful smile for their patient. This is certainly possible with today’s esthetic, strong ceramics and the technologies that are available to us. I have studied extensively about the art and science of cosmetic dentistry and creating beautiful smiles for people is something I love to do. When I talk about smiles, although that is one of its meanings, I also like to go a little deeper. Some of the biggest challenges for people that threaten their ability to smile, are the following … a) fear and anxiety about dental visits and dental treatments, basically a fear of the unknown, b) fear and anxiety around showing their smile because they perceive it to be unattractive, and c) oral and facial pain such as tooth aches and headaches. Our mission is to eliminate the fear and anxiety of visiting the dental office by treating people with respect, gentleness, and sincere caring; to eliminate the embarrassment some people feel around smiling by creating beautiful smiles; and to eradicate pain of tooth aches and head aches by showing people how to prevent these problems to begin with, and by treating the pain when it occurs. 

When I say “BY DESIGN” I am talking about personalized care. Each person that I see is a unique individual with his or her own set of values, needs, desires, and level of health. I might see two people with a similar dental condition, but the treatment for those individuals could be very different. We take the time to get to know our patients, discover what is important to them, and together we develop a treatment plan that addresses their needs but at the same time feels right to them. This treatment planning process begins with a comprehensive complete oral examination where we perform six screenings to get a very clear picture of the existing conditions in a person’s mouth. I want to be sure that my patient thoroughly understands those conditions and their significance. Once that is accomplished we can then decide on the plan. I always start by presenting at least 2 or 3 options for treatment and by explaining the consequences of each choice. This is by no means an exhaustive selection of possible options, but is enough to open up a discussion of the various aspects of the treatment plan. My patients and I co-develop the final plan. 

People have many different types of goals. There are professional goals such as striving to get a certain job, financial goals of saving and investing for retirement, and many people have health goals such as losing a certain amount of weight or getting cholesterol under control. When it comes to “SMILES BY DESIGN” I like to discuss not only immediate goals such as eliminating cavities or inflammation of the gums, but also long-term goals. If we think about weight loss for a moment, many people go on diets, lose weight, and then in a short time gain it back. How can that be prevented and the weight loss maintained? We must begin with the end in mind. We have to develop an image of ourselves at our ideal weight and hold that image in our minds as much as possible. When that image is impressed on our mind, it becomes much easier to make good food choices and maintain our desired weight. What do you want your mouth to look like 5 years from now? … 10 years from now? If you hold an image of what you want in your mind, it will become much easier to achieve it and maintain it. Do you want straight teeth, whiter teeth, a pain free mouth, great functionality … This plan can become like your map which will help you get from where you are now to where you want to be. This goal setting is another aspect of our personal approach to dental care. What do you really want? We can help you get there. 

Yours for better health, 

Helping you get your SMILE BY DESIGN because as some friends of mine have said …

“When you smile, the whole world smiles with you”. 

Dr. Marty Frankel 
3030-3080 Yonge St. 
Toronto, Ontario M4N 3N1 
(416) 770-8526