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January 29, 2007

Sensitive Teeth-what can be done to relieve it

Blogged under Dental Education by DrJean on Monday 29 January 2007 at 11:49 pm

 Following up on what I wrote about the causes of sensitive teeth,there need to be an awareness that individuals with sensitive teeth actually can do something about their condition.

A very comprehensive asessment is necessary to determine the actual cause of the sensitivity.A normal routine history taking would include the chronology,nature,location,aggravating and alleviating factors that influence the sensitivity.The teeth and the soft tissue surrounding should be examined.Our diet should be discussed,because fruit juices and fizzy beverages not only have high sugar content,but also contain a considerable amount of titratable acid,which can be errosive in nature.

Once your dentist has determined the cause of your teeth sensitivity,and the diagnosis arrived is dentin hypersensitivity(ie,it is not due to decay,broken fillings,cracked tooth etc etc),then there are some self care products that can be used at home.

One of the commonest things that is presribed is a professionally endorsed desensitizing tooth paste containing active agents like potassium salts,strontium salts and various flouride compounds.

Typical examples of such toothpaste would be SensodyneF,which contains 5%potassium nitrate and 0.32% sodium fluoride.(potassiums salts work by interfering with the transmission of the stimuli to the nerve ends and the fluoride acts as a barrier to the dentinal tubules)

Another toothpaste that can be used is Colgate Sensitive which contains 5.53% Potassium Citrate and 1500 ppm fluoride.

Other products that can be used are tooth-coating creme containing Casein Phosphopeptide-Amorphous Calcium Phosphate(CPP-ACP).One such product is the Tooth Mousse,which can be purchased from your dentist.

This is a calcium compound that works by occluding the dentinal tubiules with its calcuim and phosphate salts.It also contains a safe pH where tooth errosion does not occur.The casein in the product acts by binding the calcium and phosphate to the enamel layer and the gums.Excellent product,highly recommended.

Other considerations would include changing wrong tooth brushing techniques to prevent tooth abrasion,better brushing and flossing to reduce plaque,change of diet to reduce intake of food and drinks high in sugar and acid.

January 28, 2007

Sensitive Teeth-what are the causes

Blogged under Dental Education by DrJean on Sunday 28 January 2007 at 5:52 am

Tooth sensitivity is usually presented as a short and sharp temporary discomfort or pain on taking cold food or beverage;or upon sucking on air into the mouth.Anything more intense or prolonged would mean that there is some damage to the tooth nerve and you would need to see a dentist as soon as possible.

Dentin hypersensitivity,which is the proper term to describe sensitive teeth, is actually a very common problem.A prerequisite for hypersensitivity is gum recession and subsequent exposure of dentin due to loss of enamel or cementum( a thin layer of tooth structure covering dentin below gum level).

 

The common causes of gum recession include the normal aging process,chronic gum/periodontal disease,incorrect toothbrushing habits,to name a few.When the gums are receded,the exposed root surface is prone to abrasion from aggressive tooth brushing and erosion from acidic substances in our diet.The exposed dentin layer consists of tubules through which stimuli from the oral cavity gains excess to the nervs in the pulp.Basically external stimuli will result in hydrodyanamic changes in the dentinal tubules and will be perceived as pain/sensitivity.(Too much of this information is going to bore everyone to tears!)

However,to establish that one actually has this problem of dentin hypersensitivity,there are a few other factors to be considered.You would need to rule out these causes(of tooth sensitivity).

1.Caries or tooth decay-  Decay would mean that the enamel layer of the tooth is breached and therefore dentin is exposed.You would need to see your dentist for a filling.

2.Marginal leakage of exisitng tooth filling- Old restorations or fillings may leak over time,usually from wear and tear.Again,see your dentist to have the old filling replaced.

3.Broken filling- Fillings whether new or old can fracture due to accidentally biting on hard food.In our Asian context,especially in the gloriously food-filled Malaysia,these accidents can happen quite frequently.The common culprits are crabs,chicken bones,nuts etc.

4.Cracked tooth- This is usually preceded by exisiting fine fracture lines on the tooth surface.These crack lines propagate over time and use.Once the fracture gets into the dentin layer,there will be sensitivity.This is most common amongst those who tend to chew on one particular side.It could also present in individuals who grind their teeth habitually,especially in their sleep.Usually,before the fracture propagates to a point of no return where the pulp is involved,the tooth would need to be crowned,or an onlay placed over it.

5.Other factors like post-operative sensitivity,sinusitis,other parafunctions of the jaw.

The people with high risk of tooth sensitivity/dentin hypersensitivity are those with

1.Periodontal disease,where the bacterial toxins are causing and inflamation within the dentinal tubules

2.Gum recession with root exposure

3.Parafunction habits like bruxism

4.Xerostomia or reduced salivary flow

5.Individuals with highly acidic diet,where there is a lot of enamel erosion

6.Long term use of tooth-bleaching products

Tooth sensitivity is a chronic condition which is often under diagnosed.Therefore it is essential that a comprehensive assesment is done and the appropriate treatment is prescribed to relieve the discomfort.

More about the treatment options in my next post.

January 24, 2007

Gum disease,you can do something about it

Blogged under Gum health,Oral health care,Testimonial by DrJean on Wednesday 24 January 2007 at 2:22 am

I have a friend,who is my patient at iSmile.Steven had been avoiding the dentist’s clinic for years.When he finally made it to see me,I had to give him plenty of credit for that.Unfortunately,I couldn’t do the same for him oral health at that time.

I took some pictures,encouraged him to beef up his oral hygiene and did quite a thorough cleaning for his teeth.I also taught him to floss his teeth correctly.

Well,when I reviewed him a month later,there was tremendous improvement.This time,he really deserved much credit!

  

When Steven first came to see me………….and a month after.

I must say that there is so much more motivation on Steven’s part to keep his teeth clean and more importantly,his gums healthy.Gum disease,also known as periodontitis,is increasingly becoming a rampant disease and widely linked to many systemic diseases ie heart disease and diabetes,to mention a few.More about that later.

Steven has also written a very animated testimonial for me which I am putting on this blog,with his permission.It brought a huge smile to my face when I first read it.Here it is.

The question about which part of the body is more important; the ear shall not tell the mouth that I am more important; in the same way the eye shall not tell the nose that you are not important, each part depends on one another for a integrated effort to keep the body alive and healthier.

How about my teeth?
I must confess that, I did not understand the basic principle on what I need do.
In the past I was always skeptical about making an appointment with the dentist.I still remember the pain, blood and the sound from the grinding and polishing …


Definitely  not a good idea to go to a dentist, what you get is a lot of pain, complaints about my teeth being in a very bad condition etc, and after which I still need to pay the dentist for making me feel bad and telling me all the bad news…….

In the past I mistreated my teeth without love and used them like a slave worker, with my command each of them cannot refuse to work for my eating; I did not take good care of them until I was introduced by a church friend to Dr. Jean. As usual, I missed my first appointment with her and I had to reschedule another appointment.I could recall my last time seeing a dentist was more then 5 years ago, and I choose not to remember them…..
Thank God I finally repented.
I discover that Dr.Jean is different .She is most passionate about what she does and would go to great length to take away my fears.With her gentle encouragement, I began to fall in love with my teeth again, and learning all the techniques to brush and floss my teeth…still trying very hard to change and to appreciate my teeth everyday.
I am very thankful to Dr.Jean for her gentleness, In fact I do enjoy the visits to the dental clinic now compared to the past. She provides me the best music and brings a smile to my face every time I visit  “i-Smile” dental clinic… 
 
Prepared by Steven
 
 

January 21, 2007

What I did last weekend…..and how differently I spent this weekend

Blogged under Personal by DrJean on Sunday 21 January 2007 at 11:57 pm

I had some ladies over for tea last Sunday the 14th,to chat and to just to catch up with one another after quite a while,at the same trying NOT to gossip(it’s one of the inevitable hazards when you put a bunch of ladies together!)

I baked some wholemeal buns to go with our English tea.The highlight was actually my new fine bone china tea set,given to me by a group of good friends for the occasion of the opening ceremony of my clinic last year.It took me THAT long to get the lovely set out of the box!

I had to wash them first,of course,and for a few moments there,was quite paranoid that they will slip out of my hands and shatter to smithereens on my kitchen floor.Well,I am definitely not a regular fine bone china user!!

   

Piping hot and coming out from the oven and Tada!

   

The way to drink tea from such fine crockeries,with the little finger lifted up!

Now,this weekend,the 20th and 21st,I spent the 2 days from 8.30am till 5.30pm attending lectures on Updates in Dentistry and visiting exhibition booths at the FDI-MDA Convention at the Sunway Convention Centre.It was a working weekend indeed!The hours are even longer than my clinic hours!!

     

I couldn’t resist posing at one of the booths!

Apart from the fact that I had frost bitten ears and nose(my fingers were spared as they were securedly tucked under my shawl) due to the icelandic temperature in the convention hall,I am very glad that I attended the lectures.I learnt so much from the 2 days.There is so much going on that is constantly changing in the field of Dentistry.It’s a humbling experience for me and I believe,for many others who were there.As dental practitioner,it is my responsibility to learn as much as I can.

January 17, 2007

Kids’ colouring competition results (long overdue)

Blogged under Children by DrJean on Wednesday 17 January 2007 at 11:00 pm

The children who come to iSmile for their dental treatment are usually given some colouring pages to colour on while waiting for their turn at the reception area.It keeps them occupied and entertained and at the same time,we discover the many talents in these children.

I had meant to choose a winner for each of the 2 categories;8 to 12 years old and 7 years old and below,on a quarterly basis.Well,I finally got around doing it after 2 quarters.Sigh!I must make sure I do the quarterly judging from January 2007(one of the zillions of new year resolutions that I have!)

For the 7 years and below,the winner is……..

Rosanna Wong,7 years old

And for the 8 to 12 year old category,the winner is…

Ling Qiu Lin,11 years old

We have prepared a little gift for each of the winners.I hope they will like it!

January 14, 2007

Tooth Whitening – Part 2

Blogged under Dental Education,Technology,Tooth whitening by DrJean on Sunday 14 January 2007 at 9:35 pm

Britesmile Malaysia – FAQ Teeth Whitening


There are some commonly asked questions when it comes to professional whitening,apart from the question of cost.

1.How long does it last?

As I mentioned previously,our teeth loses their whiteness over time and our lifestyle and diet would be the main things that will affect how white our teeth stay.After the Britesmile procedure,the effect lasts an average of 2 years and if you are a 3-pack-a-day smoker and compulsive coffee drinker(esp the Kopi O ‘kau” type),then you probably will lose it all in less than a year.However,there is a maintenace paint-on pen that you can use on a daily basis,and that will help your teeth stay whiter for a longer period of time.

2.Does it hurt?(VERY important question!!)

The process is actually quite comfortable as you are biting on little block throughout and therefore it is unlikely that you will suffer from a dislocated jaw or fatique.In the last 20 minutes of the procedure,as the peroxide gets into the outer dentin layer of your teeth,there may be a slight discomfort,likened to a tingling sensation.The various descriptions have been “sour sensation”,”someting is pressing on my teeth”,”clenching feeling on my teeth”,which basically describes the sensitivity that arises from you dentin being stimulated.

After the procedure,a small number of individual may get some mild pain in the next 24 hours.This is easily controlled with some mild analgesics like Panadol.

3.What can I eat and what can I not eat after that?

During the bleaching or whitening process,the pellicle layer ie a thin protein layer covering our enamel,is removed.Without this layer,our teeth will absorb stain very easily.Therefore it is of ultimate importance that you do not consume any coloured food or beverage over the next 24 hours,after which the pellicle layer will build back naturally .No oily food and no lipstick.And absolutely NO SMOKING! I heard of a case where a patient after doing whitening,rushed out form the clinic and lit up immediately(must be desperate!) and before he knew it,there was a black halo smack on his 2 upper and 2 lower front teeth!Bad mistake! That brings us to what can be consumed.Anything colourless or white,ie water,soya milk,bread without its crust,apple without skin and the list goes on.

4.Will I have Tyra Banks whiter teeth?

Well,yes! Of course!However,do not set too high expectations as the results vary from each individual.Some people have thicker enamel than others,so the effect is much better.Others have 2 different shades on the surface of their teeth ie the area nearer to the gums are much more yellowish.Again this is due to the fact that the enamel is thinner in that area.So,the area nearer to the biting edge will whiten a lot better.You should generally be able to get at least 5 shades whiter than your original shade.Anything more would be a bonus.

And I finally got around checking on what Tyra Banks is like,and ooohhh!What white teeth she has!This is one of the more decent looking pictures of Miss Banks(after screening a whole lot of not-so-appropriate photos in the internet)

January 10, 2007

Tooth Whitening – Part 1

Blogged under Dental Education,Technology,Tooth whitening by DrJean on Wednesday 10 January 2007 at 9:54 pm

Britesmile Malaysia -Teeth Whitening

It looks like Hollywood does sell,even though I do not condone that generally.I had a young lady who came to see me in my clinic and she wanted white teeth like Tyra Banks.Fortunately, I have heard of Miss Banks.She is obviously a famous Hollywood celebrity and has a set of gleaming white teeth to die for.

Another patient flashed her set of pearlies at me and asked me how white can I make them.”White?” I asked,”you mean like toilet-bowl white?”.That cracked her up and we had a good laugh together.

Tooth whitening is becoming more than a novelty nowadays.Everyone would like a set of nice and white teeth to flash when they smile.And the options are available to whiten ones teeth.Of course there are limitations.If you have tetracycline-stained teeth,the effect may not be as good because these are intrinsic stains.Whiteining gel bleach only the enamel.Which brings me to the next point.If you have fillings or crowns on your front teeth,they do not get bleached.So you may need to consider other options.

Our teeth will become yellowish from a natural aging process and also from differing lifestyles,like smoking,drinking coffee,tea,red wine etc.There is basically 2 types of teeth whitening.One is the take home tray,where you have custom-made tray with whitening gel in it to wear over your teeth for a number of hours a day.You may see some results after about 6 to 8 weeks of proper usage and usually the teeth will whiten by 1 or 2 shades.The other is done professionally in your dentist’s clinic and you get instant result in about 1 and a half hours and you get at least 5 or 6 shades whiter teeth.

This is the shade guide that I use.

I use the Britesmile Professional Whitening system in my clinic.After doing some research on my own,I realised that I wanted to use something safe above all things and it has to be fairly comfortable for my patients.The propriety gels used for whitening in the market contain between 15 to 37% of hydrogen peroxide.Naturally the higher the content,the faster the bleaching process is.However,we are talking long term effect here.I chose Britesmile because it uses a 15% peroxide gel but works excellently because the gel is activated by a cool,blue light which is shone on the teeth for three 20 minute sessions.Effectively,it is a 1 hour whitening process.The entire procedure usually takes about 1 and a half hours because I need to isolate(block out) the patient’s gums and lips before applying the whitening gel and activating it with the light.

This is the Britesmile machine.

I take a before and after picture with my Polaroid SLR-1200 along with the original tooth shade and the new shade at the end of the procedure.

My polaroid (on the right)

The results achieved have been very satisfactory and so far everyone who has gone through the procedure has been very pleased with the results they get.They go off with their own set of before and after polaroids and a whole list of dos and don’ts over the next 24 hours.

Next,I will talk about some FAQs .

January 9, 2007

My new toy

Blogged under Dental Education,Technology by DrJean on Tuesday 9 January 2007 at 12:10 am

I recently acquired a pair of magnifying loupes.These are basically telescopic lenses attached to a pair of glasses where the wearer will be able to see things enlarged to the number of times according to the magification of the lenses.

 

I do quite a substantial number of root canal cases.The molar usually has 3 or 4 roots,some even 5.In order for me to find all the canal opening through an access cavity of approximately 5 by 5 mm can be a daunting task.The loupes will help tremendously.I bought the 3X magnification lenses,so I see teeth 3 times it original size.More importantly,I will be less likely to miss any canals on a molar when I do the root canal treatment.

I am getting the hang of it,and one of the things I really like about using this is the fact that I sit at a very straight posture and therefore eliminate neck and back strain.Very ergonomic indeed.

 

Before I purchased it I had done some research found this particular brand,Surgitel to be impressive.Every pair is tailor-made to the eye specification of the user.So I had my interpupilary distance and eye-object distance measured before the specifications were sent to the US.

I am looking forward to be able to do better dentistry than ever.

January 7, 2007

New Year celebration with the iSmile family

Blogged under iSmile team by DrJean on Sunday 7 January 2007 at 10:18 pm

Last Sunday the 7th January 2007,the iSmile team with their respective spouses,who have been great and supportive, gathered at the Eastin Hotel,Petaling Jaya for the International Buffet Hi-tea.It was a time of fun and fellowship for all of us,to eat and to chat and to laugh together.

The spread was pretty impressive and we were there from 1pm to 5pm,eating,not all the time,but well….most of the time!

A toast to ourselves,for good health and enjoyment in all that we do.

We even had a clown to entertain us.

That’s Indonesian Gado-gado

and that’s Malaysian rojak

The Indian fish head curry deserves special mention.Really quite superb!

Desserts,for whatever little room left in our poor overworked stomaches.

Result of too much good food.

We had a great time.I am very blessed to have a wonderful team who have become like family to me.

Tooth-coloured filling material

Blogged under Dental Education,Technology by DrJean on Sunday 7 January 2007 at 7:47 pm

Dental restorations or fillings have revolutionised over the last couple of years.Dental material suppliers are racing to sell the latest and most technologically advanced material to dental professionals.And we are spoilt for choice.

I have 2 main things to consider when deciding on what material to use.One is the superiority of the quality of these dental material, and ther other is their cost.Logically and undoubtedly the higher the quality,the more pricey there are.

Very soon after I started my practice,I made the decision to not do amalgam fillings on my patients’ teeth.It was really quite a matter-of-fact kind of decision.There is so much hype globally about the questionable safety of dental amalgams,even though there is really no concrete proof to say that amalgams are toxic just because they contain mercury.I like to look at aesthetically pleasing things and naturally I want to be able to produce aesthetic dental fillings,besides making sure they are placed well and allow normal function.The tooth -coloured material available in the market are constantly being researched and improved upon.With that,I decided to have an amalgam-free practice.

These are a few pictures I took of my patient who had very old amalgam fillings and they were either already leaking at the margins or there were potential leakages.I replaced the amalgams with tooth-coloured high-impact  composite filling material, and you can see that there really is a great difference in how they look.I use 3M-Espe composites,which I find to be superior compared to many others.They are probably the most researched dental materials currently.Of course,composites are bonded to the teeth and more operator-sensitive,which means I have to be very careful and confident in placing the fillings to prevent microleakages and to allow them to stay functional in the mouth for a substantial amount of time.

 before    after

 before   after

 


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