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Dental caries or tooth decay is a disease.It involves a process where the enamel of the teeth loses minerals( a process called demineralisation) due to an acidic environment in the mouth causing the surface to become more permeable to bacteria. (Our mouth is loaded with them,if you are not aware!) .Once bacteria gains entry into the tooth structure,they continue to proliferate by metabolizing the sugar (glucose,sucrose,fructose,lactose etc) in our diet.The by-product of this process is more acid that continues to destroy more tooth structure.
To treat tooth deacy,you basically need to have fillings done.

However,we are now looking at diagnosing a pre-decay condition and taking steps of prevention.
Before that,just a bit of chemistry of the disease:-
Acid dissolves tooth structure.The source of acid can be extrinsic (bacterial and deitary/environmental) or intrinsic(stomach acid reflux) or a combination of both.
A process called demineralisation occurs.What is seen on the tooth surface is white patches called white spot lesions,which when left unattended ,will deteriorate to a cavity.
Now we are looking at how to neutralise the oral environment and remineralise the tooth surface.
As long as the tooth surface is still intact ,bacterial molecules are too big to penetrate enamel layer,therefore there is the opportunity to remineralise.
Firstly,we have to stop the demineralisation by raising the pH in the oral cavity.

Normal salivary flow is usually sufficient as a buffer to neutralise the normal acid levels in the oral cavity.In situations where salivary flow is reduced due to certain reasons(consumption of certain medication/post radiotherapy/certain systemic diseases),some form of ph-raising oral rinse is required.There are also some products that stimulate salivary flow.
Personal habits like use of nicotine,alcohol,caffiene etc can also cause lower salivary output .These substances act as a diuretic .Our body’s natural reaction is to conserve fluid,therefore it will produce less saliva in the presence of high levels of these substances.

We start by eliminating sources of acid in our mouth.
Dietary habits need to be noted and changes made where necessary ,for example,we should halt consumption of food and drink that have high sugar content and with low pH/how acidity.
If there is a problem with instrinsic acid where gastric reflux is a problem,then one should seek the advise of a physician.
For bacterial acid,there are antibacterial treatment options that your dentist can recommend.

Of absolute importance is of course ,good tooth brushing with a fluoride-containing toothpaste and proper flossing .
In conclusion,we should aim to modify the chemistry of the oral cavity to one of non-acidic nature.

I have always wished that teeth whitening was more affordable so that it is accessible to most people.The fact of the matter is that most of us wish we had whiter and brighter teeth but the main damper is the cost of the whitening.

I have been doing in-house professional whitening for my patients for more than 2 years now and yes,we do get satisfying results,in various degrees.However,in Malaysia,any kind of in-house or chair-side whitening will cost quite a bit ,especially where light-activation whitening is involved.

When I went to US last October to listen to some of the gurus of whitening, they were talking about whitening treatment that is growing exponentially in the US over the last 2-3 years.And interestingly, the type of whitening they talk about is that of dentist-supervised take-home whitening.

Take-home whitening as opposed to in-house whitening is where your dentist makes custom trays to fit your teeth and dispenses whitening gel for you to wear the trays with the gel in it overnight.The downside to this is ,you have to be compliant in wearing your trays and to do it as instructed by your dentist.And it takes at least 2 weeks or more before you see good results.Now,if you REALLY want whiter teeth,and you do not want to pay a lot for it,you would be compliant and you would be patient,right??

Well,here was an option to whiten at a much lower cost and most importantly,it works.In fact, more than that,the product that was presented to us contained PF,a term used to describe a combination of potassium nitrate and fluoride.(Potassium nitrate is the ingredient used in desensitizing tooth pastes and fluoride in safe amounts, has been proven to reduce tooth decay when used in tooth pastes as well as when it is topically applied on the teeth by your dentist.) So here we have not just a product that whitens but also reduces tooth decay and provides desensitizing effect during the process of whitening.It has also been proven to harden the enamel of the teeth over the period of use.

 
Take-home whitening is something that has been around for a long time.However it has obviously not lost its effectiveness with the development of newer and more superior products.

 
In this society where everyone wants things FAST,it may not sound very appealing.However,it is most definitely an option and take-home whitening has been proven to give better results when used long term because the rebound (to the oirignal colour) is a lot slower compared to chair-side whitening.

We just recently celebrated the Lunar Chinese New Year of 2009.

This year,to my great relief,we did not need to travel out of town.The vivid visual memories of traffic jams of the worst kind still flashes through my mind every now and then.So ,to my delight,my parents,siblings and in-laws graciously agreed to come to Kuala Lumpur/Petaling Jaya to celebrate the New Year with us.

It mattered not that I had more than 20 persons staying at my home throughout the period.I was more than happy to house everyone.

Here are some snapshots of all the food and fun

Lots of food preparation .

What is Chinese New Year without the giving of ang pows and mandarin oranges!

We even got a chocolate fountain going! Yumm!!

I just realised that I have not blogged for over 2 months(just posted one a moment ago ),and before you know it,the year 2009 is just hours away.

The year has gone past so fast and looking back,again,I am thankful for the many people,relationships and happenings in 2008.

We have had lots of fun and laughter here at iSmile.I am so thankful for and proud of my team.They have worked hard and showed much dedication in their daily responsibilities.Without them,I would be quite incapacitated.

We took time off recently to go for a holiday together with our respective families,to Langkawi.

Here’s the gang at the Langkawi International Airport,all raring to go.

Of course,feasting,err I mean eating is a priority!

We did some touristy stuff like going on the boat ride to the mangrooves to visit the fishing villages,the bat caves and watch the famous eagles of Langkawi .We also took the cable car up to the highest point in Langkawi.Quite awesome!

HAPPY NEW YEAR!!

I am not too fond of showing “before and after” pictures as they inevitably give the very wrong impression that with a snap of the finger and “Tada!”,you get an instant makeover.I am merely showing them because I want to get the message across that more often than not,we can use direct veneers as an alternative to crowns.

Direct veneers are composite material bonded directly on to the enamel of the teeth.It is unlike indirect veneers which is usually done with porcelain which is fired in the laboratory and then bonded onto the tooth with a bonding agent or luting cement.

Direct veneers are actually a very good and far more economical option when correctly indicated.However,as I said,the indications has to be right ie it is nor a magic potion for every and anyone.

I do quite a bit of veneers because there is minimal removal of tooth structure as compared to full coverage crowns where a lot of tooth structure has to be take off in order for the crown to be fitted on to the tooth.

This is a simple case where the patient has fractured his front tooth and there was no pain nor sensitivity over a long period of time.I did some tests to ensure the tooth is still healthy and proceeded to do a veneer for him.

The following person had whitening done followed by veneers over his 2 front teeth which had brown streaks on them since they came out in the mouth.

This other individual had very heavily restored 4 front teeth and the restorations tend to discolour and chip off every now and then.Instead of crowning them,I just placed some veneers over them and at the same time giving them a whiter shade.

This is a young person who has small front teeth and some of them pegged shaped.As a result,she has spaces between her front teeth.I just bonded the veneers on to make her teeth look wider and longer without removing any tooth structure at all.

They are really quite nice and durable.Again,I want to stress that it is not THE solution for everyone.

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