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July 12, 2009

Dental trauma-what we need to know

Blogged under Children,Dental Education by DrJean on Sunday 12 July 2009 at 7:59 am

Children in their early years will inevitably be prone to some kind of knocks or falls.

In these early years,the milk teeth are very closely related to the permanent teeth which are forming within the jaw bone.

Any injury to the milk teeth,usually the upper front teeth, during these formative years can affect the development of the permanent teeth.The result can vary depending on the severity of the trauma to the milk teeth.The permanent teeth will possibly be affected aethetically ,usually in the form of some changes in the colour or surface texture .This will only be visible when they erupt in the mouth of a child around the age of 7 or 8.

More serious injuries are where the milk teeth become embedded into the gums or where the milk teeth completely avulse from their socket.

Milk teeth that are completely knocked out should not be replaced.

What we need to be even more aware of is ,when the permanent teeth (usually the front teeth)suffer some sort of traumatic injury,we need to know what to do.This often occur in children between the age of 7 to 12.

The most important thing to do is to consult a dentist IMMEDIATELY after the incident occurs. The sooner,the better.It is of utmost importance that any traumatic injuries to the permanent teeth be examined,diagnosed and treated conservatively in the first few hours following the injury as it will affect the long term prognosis of the the tooth/teeth. Following the initial treatment,your dentist will need to folow up on the treated tooth for a number of years to prevent future complications.

The International Association of Dental Traumatology has come up with some simple guidelines and diagrams to help us understand the basics of what need to be done in the event of an injury to a child’s permanent tooth.

Recover the broken piece or pieces of the child’s tooth and place it in a cup of milk or clean water and bring it to the dentist for it to be repositioned,which is the most conservative option.

In the event that the tooth is completely knocked out,pick up the tooth by holding the crown portion and not the root portion and rinse any debris off it under running water. Then try to put the tooth back in its socket and bite down on it with a hanky or tissue paper and go to the dentist immediately.

If you are unable to put the tooth back in its original position,place it in a cup of milk or saline to keep it moist and go the dentist immediately, If you are unable to find milk nor saline,the tooth can be held in the child’s mouth but please ensure that he or she does not swallow it!

The key message is,GO TO THE DENTIST IMMEDIATELY following a traumatic injury to the permanent teeth.

September 28, 2007


Blogged under Children,Oral health care by DrJean on Friday 28 September 2007 at 10:25 pm

In June last year,I wrote about Cheyenne,the 4 year-old girl whom I saw for dental fillings.(

Recently,I saw Cheyenne again for her regular dental check up.She has grown and is now a vibrant and talkative 5-year-old.She is no longer fearful to sit on the dental chair.She chats incessantly with me and she willingly opens her mouth for me to check her teeth.

All of Cheyenne’s 8 fillings are intact with no signs of marginal leakage around them and she has no new decay in her other teeth.Her oral hygiene is good,and I complimented her mother for putting in the effort to help Cheyenne maintain her oral health.Of course,Cheyenne was showered with loads of praises.

It brings tremendous satisfaction for me to see that when child and parent take the right advice and put it into action,the end result is always good for all.And in this case,I believe Cheyenne will continue to keep a good oral hygiene,will not have any major problems with her teeth in the future and the best thing of all,she will grow up with the knowledge that she needs to take good care of her teeth and she does not need to fear the dentist!

May 7, 2007

Fissure Sealants

Blogged under Children,Dental Education by DrJean on Monday 7 May 2007 at 1:44 am

 What is that??

Sealants are actually flowable resins/plastic material which are placed on biting surfaces of molars/back teeth,to seal up the pits and fissures of these surfaces.These sealants will bond to the grooves on the teeth and prevent food and plaque from sticking on them,and therefore preventing decay.

Fissure sealants are usually recommended for permanent molars of children from the time the molars erupt till their early teenage years.These are the crucial years where the children in this age group will be prone to decay.Generally,children in this age group are usually not very dilligent in brushing their teeth and their diet can be quite cariogenic,ie high sugar/acid diet. 

This is a preventive treatment.In other words,the sealants are placed on teeth that are not yet decayed.The process is quite simple and painless.The tooth requiring sealant will be cleaned by the dentist and a mild acid gel is painted on the fissures to etch the tooth surface.This is then quickly washed off and the tooth dried before the sealant is placed on the grooves.A blue light or sometimes and LED light is shone on to the sealant to set and harden it.


The sealants usually last for quite a number of years.However,over time,due to wear and tear,your dentist might need to repair some of them.Your dentist will check on the sealants during the 6 monthly dental check up.

Having said that,it does not meant that your child can be slack in his tooth brushing.The sealants will however make it easier to clean their teeth,as the grooves on the biting surfaces are now all covered up. 

April 5, 2007

Kids’ colouring competition Q1/07

Blogged under Children by DrJean on Thursday 5 April 2007 at 6:19 pm

The 1st quarter of 2007 has passed.How time flies!

The level of enthusiasm among the children who come to iSmile to do colouring is phenomenal.Especially after we gave away prizes at the end of last quarter.

We decided to give away more prizes this time.Yay!!

Below are the winners in no particular order.Congratulations!!


 Ling Xuan Xi,7                                             Elicia Yap,9


Timothy Hiew,6                                           Pang Hsin Yi,8

Lee Yong Le,7

April 1, 2007

Brushing your children’s teeth

Blogged under Children,Dental Education by DrJean on Sunday 1 April 2007 at 9:08 am

When do we start brushing our children’s teeth? The moment their teeth erupt.It’s never too early to start.The sooner you get your child familiar with the habit of brushing,the less problems you will have in getting your child to cooperate.

What if our child refuses to let us brush their teeth? This can be very stressful and frustrating to parents.Allow your child to play with the toothbrush but always supervise.You do not want any untoward accidents.Then tell your child that you will finish up the brushing for him or her.Again,this may take some time before your child actually cooperates and allows you to help.So,do be patient.

Children below the age of 7 generally do not have the manual dexterity to brush their teeth well.Therefore,it is important for parents to be aware that the child needs to be assisted when they brush their teeth.

You will need to select a suitable toothbrush for your child.The brush should be small enough to fit comfortably into your child’s mouth and its bristles should be soft.There are so many varieties in the market,so we are really spoilt for choice.

A children’s toothpaste can be used once the child is able to gargle and spit properly.Again,there are several brands of children’s toothpaste available,and if a fluoride toothpaste is used,it should contain not more than 500ppm of fluoride.Use only a pea-sized amount.As much as we are concerned with fluoride ingestion,it does provide good protection to our children’s teeth.

The best position to brush your child’s teeth would be to stand behind or beside your child with your other arm gently holding the jaws.

How long should we brush?The recommended duration to brush is actually 3 minutes,which is a LONG time.It can be extremely challenging if your child is the normal active,can’t-keep-still type.So,I would suggest you sing a little song,one of those children songs which should take you about a minute or slightly more.You could have one of your child’s favourite songs sung during toothbrushing time.

Start by brushing the back teeth,focusing on the biting surfaces where it is usually most prone to decay.Brush the outer surfaces followed by the surfaces in the palate area.Then move to the front and finish up by brushing the front teeth both outside and inside.Use short circular motions to give a scrubbing effect.

Get your child to rinse thoroughly by gargling some water and spitting it out.Inevitably,they may swallow some toothpaste in the process,but it is alright as long as they are using children’s toothpaste with very low fluoride content.

You can try to floss your child’s teeth from young.Again stand behind your child,or let your child lie on your lap while you floss the teeth which are touching one another.

Finally,compliment your child on being so good and cooperative.Tell them how clean and shiny their teeth look.Constant encouragement and praise will raise their self esteem and they will be more interested and aware of their oral health as they grow up.

March 4, 2007

Children’s teeth

Blogged under Children,Dental Education by DrJean on Sunday 4 March 2007 at 6:02 am

When does a baby gets his or her first tooth?The age actually varies.

Sometimes,rarely though,babies are born with one or two teeth in their mouth.These are called natal teeth .There are also incidences where the tooth appears about a month after birth and these are called neo natal teeth.There is really no cause for concern except that if these teeth are loose,they should be removed to prevent the child from swallowing or aspirating it.

Some children only get their first teeth at around 18 months old.So,the range is quite variable.However the average age of a child’s first tooth eruption would be at around 6 month of age and by the time the child turns 3,he/she will have a full set of 20 milk teeth.

Below is the eruption schedule for milk teeth based on the average statistics.You would notice that usually,the 2 lower front teeth will be the first to appear,


This Celine Yong,at 5 month old,showing signs of her 2 lower front teeth erupting.Girls generally precede boys in tooth eruption.

There may be some discomfort associated to the teething process like excessive drooling,gum sensitivity,irritbility and the child refusing food.Usually,by giving the child something to chew on,like a teething ring or teething crackers,like help ease the problem,or you can just rub a clean finger over the gum area.

Around the age of 4,the jaw and facial bones of a child begin to grow,and there will be spaces between the milk teeth.This is a natural growth process,to provide the necessary space for the larger permanent teeth to erupt.

In spite of the fact that the milk teeth will eventually fall out and replaced by the permanents,they do play a very important role.They reserve space for the permanent teeth,they help in development of clear speech and they enable the child to eat properly(missing or decayed milk teeth will cause children to reject food).

Around the age of 6,the permanents start to appear.In some children,the permanent molars start to appear behind the last milk molar,and in some others,the lower front teeth come out first.It is important to be aware of this because sometimes the permanents appear behind the milk teeth before they fall out.Usually at this point,the milk teeth in front would be rather loose.

Below is the eruption schedule for the permanent teeth,again based on average statistics.


This Tjia-Yi,aged 6 and the half.She has lost her 4 lower and 2 upper milk teeth,and she has 2 lower permanents out and the 2 adjacent ones on their way out.

By age 13,most of the permanent teeth will be in place.The 4 3rd molars or wisdom teeth will emerge between age 17 and 21,bringing the total number of permanent teeth to 32.

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!

December 11, 2006

The brave little ones! Children vs Dentist

Blogged under Children by DrJean on Monday 11 December 2006 at 11:10 pm

Dental Treatment for Children – Getting Small Kids On The Dental Chair

Children loves outings.However,and outing to the dentist can pose as a challenge if they have not been familiarised to the dental clinic environment.The situation is even more challenging is they have had some kind of unpleasant experience in the past with their dentist.

I personally believe that children are generally good on the dental chair if their parents have played the important role of explaining and preparing them,and NOT threatening or frightening them regarding their visit to the dentist.

I have seen many child patients and I must say that,generally, they are all fairly well behaved and are quite willing to have cleaning,fillings and even extractions done without kicking up a fuss.My compliments to their parents!

Here are some of the braver ones:

Cheyenne Woon,4
Evangelina Peh,6
Benjamin Lim,6

July 23, 2006

Bringing your child to the dentist

Blogged under Children by DrJean on Sunday 23 July 2006 at 10:07 pm

It’s been a while since my last update.I have been rather busy with the clinic and balancing my time to spend with my family.I have to remind myself that in spite of the long hours spent at the clinic,my family still come first .

Speaking of families,I want to share a little about this lovely family who came last month with their youngest daughter Cheyenne,who is four.


Cheyenne had never been to a dentist and she was a little apprehensive.This little girl had decay on almost every single tooth in her mouth.Not quite uncommon in children who have a regular diet of sweets and candies.

Anyway,Cheyenne had many fillings to be done.Her parents had explained to her as much as a 4-year-old could understand that she would need some dental treatment.And this is the right thing to do.Many children are terrified because they do not know and they do not understand why they are placed on a foreign-looking chair and asked to open their mouth,not to mention having unfriendly-looking instruments poking at their teeth!Parents play a vital role in preparing their children before coming to the dentist.Explain to them about having their teeth examined.Be truthful and do not attempt to tell half lies.The worst thing to do is to deceive your child that you are bringing him or her somewhere else,and the next moment he or she is shoved into the dental surgery.No wonder they re-act and resist!Of course,the ultimate damage that can be done is to threaten and frighten your child with horror stories about the dentist.I have seen the lasting impact of such inflicted fear,all the way into adulthood.

Coming back to Cheyenne,after a thorough examination on her teeth,we embarked on a treatment plan which would span over the next few weeks.As apprehensive as she was,I managed to coax her to start with one filling on her first visit.Subsequently,I have completed her planned restorations,which totaled 8, in 5 separate visits.

The reason why I am writing about about Cheyenne is because she has a wonderful family who gives her incredible support.On her first visit,her parents ,together with her older brother and sister,were all present with her in my dental surgery.I thought that was a very endearing thing for the whole family to come along and give her the moral support.And on subsequent visits both her siblings were always accompanying her,and they are only 10 and 8 respectively.

After practising dentistry for so many years and having encountered a whole variety of different personalities,I am convinced that the “fear of dentists” is a universal condition,and it transcends all ages,gender,ethnicity and nationality.And,I also discovered that having someone close,perhaps a family member or a good friend,to go along for a dental appointment,will help take away some of the fear and apprehension,provided the support-giver is encouraging and not equally as fearful.

Therefore,I truly commend the Woon family for their relentless support and encouragement towards Cheyenne.With many reminders not to take candies regularly and to brush her teeth well(actually I reminded her parents that they play an important role in managing the candies,and they have to help brush Cheyenne’s teeth as she does not have the dexterity to brush her own teeth well yet),she will have a better dental condition from now on,and she will hardly have any problems coming to the dentist in the future.Well,I am looking forward to seeing her in 6 months’ time,and I wouldn’t be surprised to see her entire entourage!


July 5, 2006

Tooth injury in children

Blogged under Children,Dental Education by DrJean on Wednesday 5 July 2006 at 9:17 pm

Lets talk a little bit about children.Those of us with small children often fear injury on our little precious ones.And it is immensely stressful when they fall and hurt themselves,especially when the injury is on their faces(including their mouth and teeth).

 I saw an 11 year-old child recently,who had a fall and broke her 2 front permanent teeth.I felt for her mother as she told me about how freaked out she was when she saw her daughter’s condition.The little girl was in pain,but was very brave about it. Anyway,she had her teeth restored and now we are waiting to see whether the pulp of the teeth recovers.I will be seeing her next week to review her condition.

That’s her restored teeth,note the swelling on her lower lip.The tooth on the left was severed up to almost a third of its original,something like this:

 and the one on the right had a diagonal fracture.I would have taken a “before” picture,but the child was quite distressed when she came in,so I did the “after” instead and she was a picture of happiness after that!

Here are some tips,to be more informed whenever you encounter a child with tooth injury.

Types of Tooth Injuries:

• Loosened tooth – may bleed a little from the gums

• Displaced tooth (usually pushed inward)

• Chipped or fractured tooth

• Avulsed (knocked out) tooth — a dental emergency for permanent teeth

When to Call Your Doctor for Tooth Injury

Call Your Doctor or Dentist NOW if:

• You think your child has a serious injury

• Permanent tooth knocked out (Reason: needs reimplantation ASAP; 2 hours is the deadline for tooth survival). First Aid Advice: Transport the tooth in some milk or saliva (milk is best). If over 30 minutes away, try to replace the tooth in the socket before coming in

 • Permanent tooth is almost falling out

• Bleeding won’t stop after 10 minutes of direct pressure

• Tooth is greatly pushed out of its normal position

• Tooth that’s pushed out of its normal position interferes with normal bite

 • Severe pain

Call Your Doctor or Dentist Within 24 Hours if:

• Baby tooth knocked out by injury. (Reason: can’t be reimplanted but dentist will check for damage to permanent tooth)

• Tooth is slightly pushed out of its normal position

• Can see a chip or fracture line in the tooth

• Tooth sensitive to cold fluids

• Tooth feels very loose when you try to move it

Home Care (Read “Call Your Doctor…” first):

Local Cold

For pain, apply a piece of ice to the injured gum area for 20 minutes.

Pain Medicine

If it still hurts, give acetaminophen (e.g. Panadol) .

 Soft Diet

For any loose teeth, offer a soft diet for 3 days. By then, it should be tightened up.

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