Mar
08
2014

Protecting Yourself From Environmental Toxins

Environmental toxins are toxins that may be in your drinking water, in what you eat, in the air you breathe, or they enter your body through your skin when you swim in contaminated water or walk on a sandy, wet beach.

In the following blog I will address some of these issues and how we can defend ourselves against toxins.

The youngest and most vulnerable

Toxins are particularly bad for infants and premature babies.

The reasons for this are the following ones: their kidney function (tubular secretion) is only 20% to 30% of that of an adult; the cytochrome P-450 enzyme system in the liver, one of the toxin eliminators is slowed down to only 25% to 50% of the adult activity and glucuronidation in the liver, another detoxification process, reaches adult levels only at the age of 3 years. The kidneys and the liver are limiting the removal of toxins by way of urine and bile in the newborn. Stomach acidity in a premature has a pH of 4.7, in a full-term newborn 2.3–3.6 and in an adult 1.4–2.0. This is important to note as a lack of stomach acid increases susceptibility of newborns and infants to gastrointestinal infections and cause diarrhea. Percutaneous absorption in newborns is much higher than in adults, which makes them very susceptible to absorbing toxins through the skin (Ref.1).

Diabetes from environmental toxins

Environmental toxins can cause insulin resistance and type 2 diabetes.

Bisphenol A (BPA) is used to make polycarbonate and epoxy resins and is found primarily in food and beverage containers. The world population has been exposed to this since 1957 and as a result 90% of US residents have detectable levels of BPA in their urine. Ref.2 explains that the higher the urine concentration of BPA, the higher the risk is for developing diabetes.

Persistent organic pollutants are another source of concern: pesticides and herbicides, dioxins, polychlorinated biphenyls, hexachlorobenzene, and hexachlorocyclohexane have all been found in humans. Several investigators have shown that virtually all of the risk in obese patients to develop diabetes comes from the fat-soluble persistent organic pollutants (Ref.2).

Inorganic arsenic is another pollutant that is found in soil and rock naturally and finds its way into the drinking water. About 8% of the public water system of the US exceeds 10 mcg/L for drinking water, which has been set as the safe limit for drinking water by the US Environmental Protection Agency’s standard. Anything above those levels is considered toxic.Ref.2 describes that people who ingest inorganic arsenic will excrete it in the urine; the highest group with arsenic in their urine had a risk of 3.58-fold to develop diabetes when compared to the lowest group. Curiously enough organic arsenic that is found in fish and shellfish is excreted in the urine unchanged and does not cause diabetes. Overall this indicates to me that nobody should consume or cook with contaminated water that contains inorganic arsenic. Reverse osmosis filters will protect you from this risk.

Protecting Yourself From Environmental Toxins

Protecting Yourself From Environmental Toxins

Other toxins around the house

Volatile organic compounds are often contained in carpets, but also in laser and inkjet printers. They are part of everyone’s life as this link shows. Varied symptoms like irritation of eyes, nose or throat, breathing problems, headaches, loss of coordination, damage to the liver, kidneys and the brain have been reported after exposure to volatile organic compounds. Long-term exposure can even cause cancer in animals and has been suspected to cause cancer in humans as well.

Air fresheners and cleaning solutions that contain ethylene-based glycol ethers and terpenes have been the subject of a study that examined concentrations in the air and interaction with ozone that can also be released by some cleaners. As this link shows the investigators concluded that with exposure to high enough concentrations and long enough exposures to these fumes lung cancer can be caused in cleaning personnel. They recommended to use cleaning solutions only in diluted form and to air out the premises well after cleaning. Another component of many air fresheners and cleaning chemicals is paradichlorobenzene, the same chemical that is contained in mothballs.

There have been problems with flame retardants: polybrominated diphenyl ethers, which are cancer producing; they have been outlawed in the US since 2004, but older mattresses, upholstery, television, computer casings and circuit boards may still contain them.

Lead and mercury poisoning, and radioactive pollutants

Manufacturers were not allowed to use lead in paints anymore since 1978. Paint from buildings older than that still may contain lead. There have been serious lead poisonings in children who were gnawing on items painted with lead containing paint. Lead causes problems with your central nervous system, brain, blood cells and kidneys. Just last year a news story about lead found in fashion jewelry surfaced warning about cheap fashion jewelry from China. Lead form these items can be absorbed through the skin and cause lead poisoning. Because of the apparent lack of regulations in China it is my recommendation not to buy anything that goes into your mouth or on your skin, if it has been grown or produced in China.

Mercury from tuna and other predator fish: It is sad that the oceans are polluted to the point where it has become unsafe to eat predator fish as there is an accumulation of mercury through the food chain.

How did things develop this way? Back 100 years and more ago gold panning and the purification process of gold caused mercury to enter into rivers and allow mercury to end up in the oceans where it has since accumulated; it just sits there as it has nowhere to go.

Coal burning (yes, there is mercury in coal) has also contributed to this by smoke being emitted from smoke stacks containing mercury vapors, which ended up returning to earth as polluted rain and drained through the river system into the oceans.

It is monomethylmercury that accumulates in the tissue of humans. It affects many organs, such as the brain, kidneys, lungs, and skin. It causes various symptoms like red cheeks, fingers, and toes; there can be bleeding from the mouth and ears; it can cause rapid heartbeats, high blood pressure, intense sweating, loss of hair, teeth, and nails. It also can cause blindness, loss of hearing, impaired memory, and lack of coordination, disturbed speech and birth defects. You may think all mercury comes from the outside. However, silver amalgam fillings in your teeth could also be the source of mercury poisoning. It is a good idea to replace amalgam/mercury fillings with ceramic fillings.

There are many forms of other marine pollution as this link shows.

One particular concerning aspect is pollution with radioactive materials as the Fukushima disaster in Japan has shown. Following the catastrophe on March 11, 2011 there have been several leaks of radioactive material into the ocean, which are described here. Dr. John Apsley II pointed out that with the explosions in Fukushima there were also several releases of radioactive pollution into the stratosphere. This pollution has subsequently traveled around the globe and has come down as radioactive rain. He has made it his ambition to help people minimize radiation exposure from nuclear accidents such as Fukushima.

Protecting yourself from toxins

Having said that pollution and toxins are problems that we are living with, how can we protect ourselves from all of that?

1. Avoid as many unsafe chemicals around you as you can. This includes checking ingredients in hair care and body care products, toothpaste, hair dyes, cosmetics, mouthwashes and underarm deodorants.  I have written a blog about toxins in the bathroom and what you should watch for.

2. I would recommend you switch from a standard food to organic food. It has become unsafe to eat non-organic meats, leafy vegetables, vegetables and fruit. There are too many residues of herbicides and pesticides contained also in meat, not only in vegetables and fruit. Washing will not remove these substances, even though some merchants may tell you otherwise. Buyer beware!

3. Detoxification methods are available and I have reviewed them in this blog. Briefly, to remove lead and mercury a formal intravenous chelation protocol should be followed.  Depending on how many heavy metal toxins you have on board, you may need only a few treatments or else up to 20. Here is a more conservative website stating that it would be safe to have silver amalgam fillings. I think that gold and ceramic fillings are much safer.

4. Genetically modified food is another danger as I have summarized in this blog. This is another reason why I like to stick to organic food. There is evidence that GMO food causes autoimmune diseases, infertility and chronic inflammation that can eventually lead to cancer. It may take decades to prove this, but I am not willing to be a human guinea pig.

5. I have mentioned in a prior blog that we live in a toxic world. You need to carefully look at your home and remove toxins. You need to assess your drinking water. A water analysis can tell you how good the water in your home is and whether there are concerns about inorganic arsenic. Usually places that sell filter systems can advise you in that regard. Your drinking water should either be bottled pure water or else reverse osmosis water that can be part of a filter system in your house.

6.Vitamins and supplements have been shown to support your cell integrity and have anti-inflammatory and antioxidant effects that protect you from toxins. I discussed this in detail in my NetHealthBook under nutrition. For instance vitamin D3 in doses of 5000 IU or more and CoQ-10 are powerful anti-inflammatories and CoQ-10 is also an antioxidant and preserves mitochondrial function. High fish oil supplements (3 to 6 Grams per day) have anti-inflammatory effects and protect your cell membrane integrity. With these overlapping qualities of vitamins and supplements your body will be in a much stronger position to defend itself against the negative effects of toxins. When you take multivitamins, this translates into telomere lengthening of 5.1% (or converted into a survival advantage of 9.8 years when it is accumulated over a life time). Ref. 4 explains this in more detail.

7. Exposure to radioactive substances is a scary thought, but this is becoming more and more a reality, at least for those who live close to disaster areas such as the Fukushima site in Japan or the Chernobyl site in the Ukraine. But according to Dr. Apsley II low dose radiation that we have already received in the US and in Canada following the Fukushima disaster is equally disastrous (Ref.3). Many of the vitamins and supplements I have mentioned are also cell and mitochondria protective and will help with DNA repair following radiation damage, but you must avoid sugar and other refined carbs and starches to reduce the oxidative effect on cells and on LDL cholesterol to prevent premature aging and cell death. Ref. 3 contains a lot more detail about this and explains what specific supplements can be taken to detoxify your system from specific radioactive elements that function as free radicals. There are specific antidotes for radioactive iodine-129 and iodine-131, radioactive cesium-137 and others.

Conclusion

Many people shrug their shoulders when they hear that pollution has an effect on their lives. They feel that they are powerless and cannot do anything about this. The truth is far from this! Above I mentioned seven points that you can follow to counter toxins. On top of that you can get politically active and urge your government representative to create a nuclear free zone in your area. Ref. 3 contains compelling evidence why this is so important not only for us now, but for future generations and the future of mankind. We need to hold those who provide us with food and beverages accountable for the quality of these. Shrugging it off is not good enough. Get involved. Buy organic food. Avoid the section in the grocery store where sugar and high carb foods are sold. It’s good for your own health, but it will collectively change the mentality of the grocery store owners who will notice that they are stuck with the comfort foods that sold well in the past. This new trend will result in cheaper prices for healthy foods and more availability of organic food.

References

1. Shannon: Haddad and Winchester’s Clinical Management of Poisoning and Drug Overdose, 4th ed. © 2007 Saunders. Chapter 18:“Toxicologic Issues in the Neonate”.

2. Rakel: Integrative Medicine, 3rd ed. © 2012 Saunders. Chapter 31: “Insulin Resistance and the Metabolic Syndrome”.

3. Dr. John W. Apsley II : “Fukushima Meltdown & Modern Radiation: Protecting Ourselves and Our Future Generations” © 2011. Temet Nosce Publications, Sammamish, WA 98075

4. Xu, Qun, Parks, C.G., DeRoo, L.A., Cawthon, R.M., Sandler, D.P. and Chen, H. Multivitamin use and telomere length in women. American Journal of Clinical Nutrition 89 (April 2009):1857-63. Full text (PDF): http://ajcn.nutrition.org/content/89/6/1857.full?sid=9aab0e13-b4d2-42ad-b44c-15cffc6771c3

Last edited March 8, 2014

Jul
27
2013

Flossing and Brushing Saves Your Heart

It was not until about the mid 1990’s when it became apparent that gum infections and severe tooth decay could cause inflammation in the blood measurable by using the CRP marker (C-reactive protein). As this link shows Dr. Joseph Muhlestein at the University of Utah demonstrated in 1996 that chronic gum infection could cause a heart attack. He isolated the bacterium Chlamydia pneumoniae in 79% of patients undergoing coronary bypass surgery, while samples from heart transplant patients isolated this bacterium in only about 5%. The new thinking was that bugs that multiply in diseased gums could migrate into the blood and cause platelets from the blood to clump together and block coronary arteries causing heart attacks. Harvard University researchers have confirmed this. In the past it was known that a bad tonsillitis with an aggressive bacterium, Streptococcus viridans, could cause subacute endocarditis, a dangerous infectious disease of the heart valves, which can be responsible for sudden death in younger persons. Neglected cavities in teeth can also harbor this bacterium. Another study in 2009 showed that two particular strains of bacteria in infected gums, Tannerella forsynthesis and Preventella intermedia, were associated with an increased risk for heart attacks; but it was more the overall burden of bacteria in the infected gums than the specific bacteria strains that mattered most.

Flossing and Brushing Saves Your Heart

Flossing and Brushing Saves Your Heart

 

Preventing heart disease by brushing and flossing

With this background it is easier to understand that we need to take good care of our teeth and gums, if we want to maintain good health. As a start most people should see their dental hygienist (who usually works in a dentist’s office) twice a year. The dental hygienist will probe the depth of gingival pockets with a periodontal probe. A normal depth measures up to and including 3 mm. Deeper pockets than that usually indicate that the patient did not floss regularly. One needs to floss at least once per day, better twice per day and it should not bleed after flossing (initially when a person flosses for the first time the gums tend to bleed a bit).

The hygienist will do scaling of plaques on the tooth enamel. Any cavity that is detected will be brought to the attention of the dentist. At the end of the scaling procedure fluoride is applied, which puts a coating on the tooth surfaces to prevent tooth decay.

When deeper pockets (6 mm or more) are detected a trial of subgingival root brushings has shown to have a very beneficial result within only 14 days.

Periodontal pockets were improved and bacterial counts of periodontal infections were shown to have improved as well.

Oral care and cavity prevention in the population

It has been accepted for quite some time that a combination of brushing and flossing are the best methods to control dental plaque, which is the precursor for cavities.

In order to test the knowledge of adults in families with small children these authors from the School of Public Health of the Maryland University investigated Maryland’s adult population knowledge regarding caries prevention. It turns out that there were deficiencies in knowledge about the prevention of dental caries and the importance of fluoride to create strong, decay resistant enamel.

A randomized, prospective study is planned in Hong Kong which will start teaching oral hygiene to kindergarten children aged 3 and will be reinforced several times later to instill good dental hygiene behaviors into these children’s health routine as outlined in this link. Not only is it important to teach brushing and flossing, but also food habits with cutting down on sugary and starchy snacks as these foods make the saliva acidy promoting caries producing bacteria in the plaque.

This English study shows that a primary school based caries prevention program reduced caries by 35% when sugar intake was limited in the interventional group and brushing of teeth was done twice per day along with flossing.

An addition to flossing for those with narrow tooth intervals or those with braces is a waterpik system. This can be used to clean food residues from the spaces between your teeth and from gum pockets. Flossing once or twice per day is still needed to remove plaque to avoid tartar build-up. Before bedtime it is advisable to floss first, then use a waterpik, then use your electric toothbrush with a fluoridated toothpaste. During the day use the waterpik after meals followed by brushing with an electric toothbrush with non-fluoridated toothpaste.  Water Picks are also called “water flossers”; they are easier on your gums.

Other measures helpful in preventing tooth decay

Xylitol is a natural sweetener originally derived from birch. Sugarless gum often is sweetened with Xylitol. This study has shown that chewing Xylitol containing gum can effectively reduce caries. This paper describes that the increased saliva production from chewing gum provides a slightly alkaline environment for teeth. This helps to clear out sugar faster from the oral cavity after a meal, inhibits bacterial growth, neutralizes the pH in plaque that is on the acidy side after sugar consumption. The authors concluded that chewing Xylitol gum is a useful addition to the other known preventative measures of dental decay prevention, such as brushing and flossing teeth.

The techniques the dentist is using to treat plaque and dental decay have been refined by a new technique describe in this Australian publication as a minimum intervention caries prevention program.

The four methods used in minimum intervention dentistry are described here.

1. Recognition: to recognize potential caries factors early through lifestyle factor analysis and saliva testing.

2. Reduction: alter the diet and lifestyles to increase the pH of the saliva, which will reduce the risk factors for caries.

3. Regeneration: to arrest and reverse minimum lesions at the earliest stage. Use agents such as fluorides and casein phosphopeptides-amorphous calcium phosphates to achieve this.

4. Repair: when a cavity is present, a technique of “conservative caries removal” involves using bioactive materials to allow healing of the dentine layer of the tooth.

Reduction of cariogenic bacteria

I already mentioned above that alkalization of saliva by chewing Xylitol gum could significantly help prevent tooth decay. It does so by raising the pH, while chewing on sugary foods or starchy foods lowers the pH (making it more acidy). Growth of caries producing bacteria, which are called “cariogenic bacteria” is stimulated by acidy saliva and inhibited by alkaline saliva. For this reason people whose diet consists of a lot of vegetables and greens will have more alkaline saliva and are less prone to develop cavities. The worst foods to get cavities are sugar in its many disguises and starchy products (candies, bread, rice, potatoes, pasta, bagels, cookies, cakes).

What can cause bacteria from the mouth to appear in the blood? One common condition is periodontitis, which is a chronic inflammatory condition of pockets of the gums around the teeth. This originates from neglecting your teeth and not flossing. Smokers are more afflicted by this as well. Dental procedures called scaling and root planing are often done for chronic periodontitis. This study from January 2013 shows that there is about the same amount of bacteria that leak into the blood following these procedures when compared to flossing.

Sometimes a dentist will recommend using a short-term antibiotic to reduce the leakage of bacteria into the blood, particularly with people who have heart valve problems or had porcine heart valve replacement in the past. This publication from 2009 also describes that dental flossing causes bacteria to be shed into the blood (bacteremia).

Conclusion

Dental self-care should be taught to children at an early age to educate them to brush their teeth twice a day and floss them at least once per day. At the same time they need education what causes cavities in terms of food intake and that fluoride can help make teeth more cavity resistant. They should avoid sugar in pop, candies and cookies etc. Parents best teach by example! Regular visits to the dentist’s office will safe money on the long term. Regular scaling by a dental hygienist every 6-month will remove plaque from which cavities develop when bacteria thrive in them and produce acids that affects the enamel. Minimum intervention dentistry discussed above (4 methods used) can prevent your teeth from decaying. Regular flossing will keep your gums healthy and reduce the colonization of the mouth with bad, cariogenic bacteria. With all this in place you likely will keep your teeth for a long time and not need dentures or tooth implants because of lost teeth. At the same time you will prevent your immune system being overwhelmed by mouth bacteria, which could have lead to a heart attack had you neglected your teeth. As mentioned in the beginning, a CRP blood test is a useful tool to rule out chronic infection.

More information on:

1. Tooth decay: http://www.nethealthbook.com/articles/dentistry.php#Tooth_Decay

2. Heart attacks: http://nethealthbook.com/cardiovascular-disease/heart-disease/heart-attack-myocardial-infarction-or-mi/

Reference: http://www.webmd.com/heart-disease/features/your-guide-gum-disease

Last edited Nov. 7, 2014

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Mar
01
2008

The Culprits For Periodontal Disease

When people think of hazards to dental health, the first thought will be about tooth decay, lack of brushing and flossing and eating candies and other sugar-laden foods. Periodontal disease is often neglected, and yet it is just as threatening to teeth and gums. Destructive periodontal disease will lead to loss of the supporting tissues of the teeth and as a result, there will be loose or shifting teeth and ultimately tooth loss. Generally these findings were seen in older population groups. It was thought that the disease would rarely occur in patients younger than 35 years of age and the theory was that dental plaque was the likely cause. Lifestyle choices were not thought to play a large role. Recent findings told a different story. A cohort study consisting of 903 participants examined self-reported tobacco and marijuana smoking and dental examinations were also done. The authors of the study found that tobacco smoking as well as cannabis (marijuana) smoking was linked with a higher incidence of destructive periodontal disease before the age of 32 years.

The Culprits For Periodontal Disease

The Culprits For Periodontal Disease

In comparison to this dental plaque was not contributing to a higher incidence of periodontal disease in this younger age group. Another risk for destructive periodontal disease in the youngest age group (as young as 12 to 18 years of age) was impaired glucose intolerance (a condition leading to diabetes). Due to those findings it is obvious that brushing and flossing are not the only weapons against periodontal disease. Healthy eating habits and cessation of smoking are equally important for dental health. This is particularly important as heart disease, which is also an inflammatory condition is closely linked to inflammatory disease of the gums and you likely have heard that heart attacks can be prevented by brushing and flossing teeth.

More information about periodontal disease: http://nethealthbook.com/dentistry/periodontitis/

Reference: Journal of American Medical Association 2008; 299(5): pages 574-575

Last edited November 3, 2014

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Mar
01
2007

Dental Signs Indicators for Celiac Disease

Celiac disease is a condition, where a person is unable to tolerate wheat products. In other words they have a wheat allergy. It is not enough to avoid the standard foods like bread and other bakery goods that contain wheat. Wheat makes its appearance in many foods and also in taste enhancers like monosodium glutamate. Alone for this reason it is important for a person with celiac disease to carefully read labels in order to avoid foods that contain gluten, which is the offending substance. Often celiac disease goes undetected for many years, but there are early signs that can help to take action sooner rather than later.

Dr.T.Malahias, D.D.S., a dentist from Groton, Conn presented his findings at a recent international symposium for celiac disease. He pointed out that there are signs that are visible in the dental enamel, which will already be present in childhood, once the permanent teeth appear at about age 6. The bilateral symmetrical markings are defects in the tooth enamel. they can be brownish, yellow or white and are most commonly seen on the central incisors. They give the tooth a mottled, non-shiny appearance. Patients with this appearance may also have problems with the delayed eruption of the permanent teeth. These markings are permanent, and even after following a gluten-free diet they will stay, as the development of the enamel started already in the third or fourth month of life. While there may be other reasons for this abnormality, celiac disease should be considered in the context of the patient’s history.

Dental Signs Indicators for Celiac Disease

Dental enamel defects may be the only signs of celiac disease

The results are quite significant in pediatric groups: in patients less than 12 years of age who had celiac disease the rate of enamel defects ran at 90% as compared to 44% of the others without celiac disease. People who have recurrent unexplained aphthous ulcers should take notice too. Five percent have been found to have undiagnosed celiac disease as a result of the constant and chronic overstimulation of the immune system by gluten substances. Once celiac patients start with a gluten-free diet, the ulcers will occur less frequently.

More information on celiac disease: http://nethealthbook.com/digestive-system-and-gastrointestinal-disorders/celiac-disease/

Reference: Based on MD Consult News, January 31, 2007

Last edited November 2, 2014

Jul
01
2005

Tooth Implants For Better Health

Missing teeth are often just ignored -why bother? There are still all the others around to assume the necessary functions! The truth is different: missing teeth can affect us in the way we eat, speak, rest, and appear. They can influence our behavior and overall functioning. A missing tooth can also compromise the dental health of its neighbor.
In the past the only options for missing teeth was either dental bridges or dentures. Bridges and dentures still have their place now, but the benefits for dental implants are significant.
-They help to preserve remaining natural bone structure.
-They reduce the need to cut out adjacent teeth for a bridge.
-They eliminate the need for removable partials or dentures and the sores that may go along with them.
-The roof of the mouth does not need to be covered by removable partials or complete dentures.
-They look, feel and work just like natural teeth.
-They support face shape, smile and provide confidence when eating and speaking.
-A few exceptions apply: people who smoke and people who have diabetes, particularly when uncontrolled and severe, have much less success with implants, as healing is impaired. However, you may consider quitting smoking and diabetes may be able to be controlled better with the help of a specialist. Other patients who have pacemakers, artificial heart valve replacements or other implanted devices may have to stay away from implants and they may have to stick to more conventional methods such as bridges and dentures.
The dentist will do a thorough examination to decide, whether you are a candidate for dental implants. Each tooth will be examined and a medical and dental history will be taken. Special x-rays (panoramic and tomograms) are needed to determine whether there is enough bone available. This helps to decide whether the implants can be placed directly, or whether grafting more bone will be necessary. This step is very important. It also helps the dentist to identify important structures, like nerves, sinuses and adjacent tooth roots. You will discuss all the treatment options with your dentist, which also helps to clarify expectations about the final results. This comprehensive treatment plan can be compared to building the foundation of a house. The foundation has to be solid, so the final structure holds up. A properly done dental implant should be a one-time job.

Tooth Implants For Better Health

Tooth Implants For Better Health

The procedure itself is done in the dental office or in a surgical suite under a local anesthetic, and over-the-counter pain medication may be needed after the surgery. The time it takes to heal can be variable. It may take up to six months, but it is important that healthy bone develop around your implant, which is the strong bond that is needed to hold the implant in place. Once the healing is complete, your dentist takes a final impression, which is needed by the dental laboratory to create the permanent teeth.
Once the permanent teeth are placed you will receive care and a dental hygienist will instruct you in dental hygiene. Special plastic cleaning instruments are used to avoid scratching the titanium surface of the implant. Just as with natural teeth, implant-retained teeth need to be cleaned daily and need to be regularly checked by a dentist.
Looking at the overall picture it is clear, that the dental health and function of our teeth closely relates to every facet of our overall health, from speech to the function of our digestive tract and proper nutritional status, which affects cardiovascular health as well. A tooth implant involves a lot of detail work and effort, but its benefits are far reaching.

Reference: Family Health, Vol. 21, No.2, Summer 2005 (June), page 9-13; published by The College of Family Physicians of Canada

Other links re dental implants:

Association of Prosthodontists of Canada

American College of Prosthodontists

Last edited December 7, 2012