Welcome

I just came back from Salt Lake City,Utah in the United States of America after attending the Asia Pacific Key Educators Conference hosted by Ultradent Products Inc,a leading dental manufacturer in the US.

What a timely reminder for me personally,that we have only that much of tooth structure in our oral cavitites! How invasive do we want to be as dentists,in the name of practising modern,high-tech dentistry? Are we destroying more tooth structure than necessary or are we going all out to preserve as much of it as we can? 

This conference covered many topics,including latest updates and trends on whitening,root canal treatment,bonding technology in tooth restorations,aesthetic dentistry and tissue management in dentistry.However,my main take-home point was this -it confirms my conviction about wanting to keep as much natural tooth structure as possible in the mouth.Hence my occasional reluctance and refusal to do certain procedures for my patients is justified.

The man behind Ultradent is the incredibly smart yet amazingly warm and friendly Dr Dan Fischer.He started the company almost 30 years ago in the basement of his house and today it is an establishment with more than 700 employees and sits on a sprawling piece of land in Salt Lake City with a 220,000 square-foot building.

We had the privilege of hearing Dr Fischer share his passion about preserving tooth structure and how we should,as dentists be committed to respecting the tooth structure and educating our patients about it.

Ultradent was such a wonderful host to all of us delegates from Malaysia.India,Philippines,Hong Kong,China and Mongolia.We were made to feel so much at home right from the moment we arrived .The hospitality was genuine and warm,the food was great and plentiful, the programmes were authentic and fun.They even arranged a day of sight seeing for us down to the canyonlands of Southern Utah.

Great trip!! ..except for the lonnnggggg journey and the horrendous jet lag that followed……

The “in” thing currently on teeth appearance in the US is long,squarish and white,BO shade(aka toilet-bowl white) teeth.

Who knows,in a couple of years,this may change to the small,oval and not-so-white look.

This is what trends are all about.They change.Whatever it is,most Hollywood celebrities are sporting this kind of teeth.

And,I can assure you that many who are non-celebrities aspire to do likewise.

So.what are the options for a lady to look like Halle Berry or Jessica Simpson?Oops sorry,I mean to have teeth like them.What would it take for the men to have Tom Cruise’s set of pearly whites? Or even Shrek’s Chiklets teeth?

Teeth whitening,be it the one-hour professional whitening or the take-home DIY whitening kit,is a good start.As I have mentioned previously,if you are not contra-indicated for teeth whitening,then you would be able to achieve a reasonably brighter smile.

Other options include porcelain or resin-bonded veneers to change the shape and colour of your teeth.However,these treatment options may not be appropriate for everyone.Sometimes,other treatments are required as an adjunct treatment.For example,one may need some sort of gum surgery to improve the shape of the teeth.Orthodontic treatment is often a treatment of choice for poorly aligned teeth.Other lesser known options include corrective jaw surgery and more extensive gum surgery to lengthen the teeth.

Whatever the treatment of choice,my stand as a dental care-giver is that one should not attempt to have healthy tooth material removed extensively just for the sake of aesthetic and beauty.We need to manage our expectations.We are after all only blessed with one set of permanent teeth which is to last us the rest of our lives.

Hari Raya Aidil Fitri has come and gone. In the busyness of it all,we still found time to organise a Buka Puasa (breaking of fast) party during the month of Ramadhan.

Good food and good company

A commonly seen condition these days is erosion of the enamel of teeth,especially among the youth and young working adults.

This is usually seen at the outer surface of lower teeth particularly the premolars and the molars,at the gum margins.The erosion can range from mild to very severe with decay.They start with whitish patches,when enamel begin to leech its minerals due to constant and long term contact with acidic elements.They then begin to turn light brown as the enamel layer breaks down and eventually as decay sets in,the initial lesion cavitates deeper.

The most common cause for this condition is high consumption of carbonated drinks.They are not only highly acidic (ie corrosive),they also contain high sugar content.The common practice among young people these days is to sip on a can of carbonated drink throughout the day,sometimes several cans in a day.The oral cavity is constantly flooded with acid and sugar,which is a potent combination for decay to form.The cariogenic( decay -causing )bacteria in the mouth are having a ball with these individuals!

So,do be aware that not only are you heading for an early-age diabetic condition,you are also destroying your teeth unneccesarily.As my parents’ generation would advise,and wisely so,”Limit your consumption of carbonated drinks to Chinese New Year(or Hari Raya Puasa or Deepavali or other festive seasons)!”

In the Oxford dictionary,the word “cosmetic” is defined as relating to treatment intended to improve a person’s appearance.”Cosmetic Dentistry” then refers to branch of dentistry dealing with the apearance of teeth.

What exactly is cosmetic dentistry? This term has been made even more popular by the various reality TV shows with “Extreme Makeover” theme.A common scenario is where a person,usually a young working adult or a middle age woman,would tell me “I don’t like the appearance of my teeth” or “I feel ashamed to smile widely because I do not have nice teeth” or “I wish to have nicer looking teeth”.

I remembered many years ago,a lady in her 50s came to see me and in her hands she had a photo.She said,” I would like to have teeth like that” and she shoved the photo into my hands. It was a photo of Faye Wong,the Hong Kong artiste,fllashing her celebrity smile.I didn’t know whether to laugh or to cry!!

I think it is perfectly fine to want a set of teeth that is pleasing to look at.

Asthetic is definitely a very important feature of dentistry. But what is more important to me is the foundation under that beautiful set of straight and sparkling white teeth.

I constantly remind my patients that if they do not have underlying healthy gums and teeth,whatever “cosmetic” job that is done will usually not last.

In the next part of this topic we will look at what aesthetic or cosmetic dentistry constitutes and what are the current trends in cosmetic dentistry

I have been horrendously preoccupied with too many things in the past 2 months.Both physically and mentally.And blogging took a backseat

However,I managed to take a short but refreshing break with my husband ,in Bali.He was working/attending a conference half the time and I was relaxing,shopping and eating,most of the time  :)

Snapshots from Bali

Well,obviously we spent a lot of time eating!!

In the advent of new developments in material for dentistry,one of the things that we are moving more towards is the use of metal-free resotrations.

We have moved increasingly from using amalgams to resin materials like composite and glass ionomers .These new materials are not only more aesthetic,the newer reinforced ones have very superior strength.

Where crowns( http://www.ismile.com.my/patient-education/crown/) and bridges(http://www.ismile.com.my/patient-education/bridge/) are concerned,there is an increasing shift to use non-metal-based prostheses.

In a very simple way,these all-ceramic crowns are classified into low-strength and high-strength ceramic restorations.

Low strength ceramics are leucite-reinforced pressed porcelain and these are used only in very specifically indicated cases.They have very good aesthetics but low impact-strength.

High-strength ceramics are categorized based on the coping used and these copings are referred to as the core.These core material now replaces metal,hence the all-ceramic,metal-free restoration.

Alumina-core ceramics have aluminium oxide as its core material under the pressed porcelain which is fused to it.Zirconia-core ceramics will have zirconia as its core material.

Some of these crowns are done using the CAD/CAM technology.This method is capturing the photographic image of the prepared tooth model using computer technology ,a 3D restoration design is crafted to conform with all the detailed specifications,the computer will then send infomation to a milling machine where a block of core-material/ceramic will be milled to the specification.

Now,with the CEREC CAD/CAM machine,a crown can be constructed within an hour while the patient waits on the dental chair.However,there is extremely high cost involved as the CEREC machine and the material used are pretty costly

 On the first weekend of this month,my colleauge Dr Amy and I took a break from our work routine and attended the IDEM(International Dental Exhibition and Meeting) at the Suntec Convention Centre in Singapore.

There were some world-renowned speakers in the dental profession at the scientific convention and we learnt much.

It was a nice change to be able to window-shop at the mall where the convention centre was.Well,we actually did some real shopping too ,something we call “retail therapy”;something we do not get to do too often.

There are some facts that you may need to know before deciding on whether you are a suitable candidate for tooth whitening.

If you have significantly large fillings or crowns on your front teeth(this includes all the teeth that can be visibly seen when you smile widely,the you have take into consideration that these will need to be redone after tooth whitening as they WILL NOT be whitened along with you natural teeth.I am stressing on this because,most of the time we budget for something only to find out that the final cost is more than expected.So,it is vital that you check with your dentist who is going to do the whitening procedure for you.

Pigments from our food and beverages( and nicotine from cigarette smoke ,for smokers)will get absorbed into our teeth. The peroxide in the whitening gel releases oxygen ions in our teeth and these ions chemically alter the stains and eliminate them.However,our teeth will continue to absorb stains.So,tooth whitening of any kind is not a treatment that has a permanent effect .

Some professional tooth whitening systems like Britesmile have their own follow-up maintenance products.These products are to be used regularly after the chairside procedure to counter and delay the relapse process .If you want to maintain bright teeth at all times,then you may have to consider repeating the whitening procedure every 2 years or so.

Most of us do not have teeth that are even coloured where every single tooth and tooth surface is of the same shade.More often than not,we have the canines more yellowish ir darker.Some of us have a band of transluscence at the biting edge of our teeth,others have a darker band nearer to the gum margin.All these are due to the difference in the thickness of enamel and dentin on each individual’s teeth.

Therefore,in cases like these,in total effect,your teeth will become a lighter colour but you cannot expect the entire surface to be of one shade ,or all your teeth to be of the exact same shade.This is because it is mainly your enamel that gets whitened by the peroxide in the whitening gel.

I would like to mention tetracyline stains again. Depending on the severity of these stains,which are intrinsic in nature (ie,these are stains that were deposited when your teeth are in their developemental stages), your teeth can only be lightened to a certain degree and you probably have to repeat the treatment several times (ie escalated cost for you)in a short period in order to get substantial results.Even so,the brownish/greyish hue which comes from the inner dentin layer cannot be fully masked.

So if you have tetracycline stains and you still want nice white teeth,tooth whitening is really not the treatment of choice.You would have to have ceramic crowns made for all the front teeth that are visible when you smile widely.

Having said all that.most of us want a brighter smile,so if you have a reasonably healthy set of teeth n gums and you want your teeth to look brighter and whiter,then,tooth whitening is definitely an option.

I took a week off to spend time with my family over the Chinese Lunar New Year.

After last year’s horrendous experience with the “balik kampung” traffic,we decided to leave town much,much earlier.

This year,we spent Chinese New Year with my parents and siblings and their family back in Sitiawan.It was great to just relax and eat(it is after all the Chinese New Year!) and catching up with loved ones.

The atmosphere was festive and the fireworks were spectacular.The amount of “ammunition” that was used made me wonder how many truckloads of fireworks were transported to a small town like Sitiawan for the new year

We had popiah(spring rolls) for new year in Sitiawan.Practically every household would have this dish.So you can imagine that it is roaring business for the popiah skin maker.(These skins are hand-made).Here is my elder daughter demonstrating how she wraps a popiah.

On New Years Day,we went to my parents’ church for a Thanksgiving Service.And I “looked like an ang pow”(-in my children’s words) in my Chinese New Year outfit!!

We went to Pangkor Island for a short family holiday.Bad mistake! We learnt our lesson,to NEVER EVER go to Pangkor Island on a major public holiday.There were 20 of us,including children and babies,and we had to contend with the HUGE crowd of people who were also going to the same destination.The experience of queuing to board the ferry was enough to drain us all…and the thought of the queue coming back certainly did not help at all

Anyway,we(optimistic people!) decided that we would have fun.And so we did.Happy Chinese New Year!!