This is the common question asked when someone comes to me to do teeth whitening.
I would not answer the question in this manner. I would rather compare it based on the needs and compliance of the individual.
If you are getting married tomorrow,then obviously you will need to get an “instant” whitening ie the chair-side in-house whitening.On the other hand,if you are  generally a compliant and disciplined person who is willing to listen to your dentist’s instructions ,then go for the take-home overnight whitening.
The end result?  They both give you white teeth.

Below are some before and after pictures .

The 1st picture was  taken in June 2009 .The 2nd picture was taken 2 weeks later after using the take-home whitening which was applied on the upper teeth only. This lady of 68 years old, continued with the whitening procedure for her lower teeth for another 2 weeks.(This process can be done together ie the upper and lower teeth can be whitened at the same time).The 3rd picture was taken recently in September 2010. obviously the patient is very happy with the results.

The above are pictures of a chair-side whitening patient,obviously a very happy young lady of 19 years old.

In summary,you can will get results irregardless of the type of whitening you do.

I just returned home from Singapore after attending  the FDI Annual World Dental Congress(AWDC) held at the Suntec Convention Centre there from the 2nd to 5th September. The FDI AWDC plays an important role in the advancement of dentistry. This internationally recognised event is held in a different city every year.And it was so good (and definitely so much more economical for me) that this year,it was held relatively close to home because most of the time it is held in the American or European continent.

This event comprises of scientific programmes,exhibitions and meetings by representatives from all over the world to strategize,plan and make policies for the advancement of dentistry in the future.

The scientific programme is an educational event with speakers from around the world presenting on the latest scientific topics affecting the dental profession globally. We had 4 days of lectures to attend,which covered all the various aspects of dentistry.It is quite awesome to be a part of  this huge group of dental practitioners from all over the world,who had gathered together to learn.The speakers were truly chosen from among the best.They go beyond excellence,bringing dentistry to a different level ,in the things they do,whether it be in the area of research or clinical work.

I felt  privileged to be a participant in this event as there is this increasing realisation that dentistry is moving in a direction where changes are occuring so rapidly.We are in the era of practising evidence-based dentistry.We do not just do what the textbooks say and definitely not what we learnt in dental school around 2 decades ago(well at least I am speaking for myself). Things have changed so much that it unnerves me to think that a big chunk of what I learnt in dental school is actually obsolete. Well,it just goes to prove that learning is an ongoing and a life-long process.

The dental exhibition was showcase of state-of-the-art advanced dental technology, equipment and products. Some of the products exhibited were being launched for the first time.

I guess one of the main things that I took home is the assurance that I am doing the right things in my practice and using the right materials for different cases.

Managed to take some pictures with my mobile phone…

I take quite a number of intraoral radiographs or Xrays in my daily practice.Most of the time it is the routine few that I need to take in the course of root canal treatment for my patients.I also take them very often to help me diagnose an existing  condition or when I suspect that there is a condition.It is such an essential part of my practice that it is without a doubt that a dentist cannot practice proper dentistry without an Xray facility in his or her office.

Occasionally I get the question of “Is is OK to take so many Xrays?” when I take more than a couple for one patient,which is quite normal in the course of a root canal treatment. I give them the assurance that intraoral Xrays are really extremely low in the radiation it emmits.

An intraoral Xrays emmits an estimated 0.009 mSV. (A millisievert (mSV) is a unit of measure that allows for some comparison between radiation sources that expose the entire body (such as natural background radiation) and those that only expose a portion of the body (such as radiographs). Don’t worry if you do not understand this statement,neither do I!!). Compare that to a chest Xray which emmits approximately 0.080 mSV. This is using conventional Xray films.In the advent of modern technology,we are now moving towards digital Xrays and the radiation used for digital Xrays are reduced by between 70-80%.

Dental radiographs or Xrays are images taken when Xrays pass through your mouth during a dental examination.

How it works is when the Xrays are taken,more rays are absorbed by teeth and bone,which are more dense than the cheeks and gums. The image created is called a radiograph. This can be in the form of a film or an image on the computer screen.

Teeth and bony structures will appear lighter whereas tooth decay, infections and signs of gum disease will, appear darker because of more Xray penetration. Dental fillings  may appear lighter or darker, depending on the type of material used for the particular filling.

Your dentist will be able to observe and  interpretation  these radiographs and can therefore come to a more accurate diagnosis.

Dental  Xrays can provide essential information about the condition of our teeth and our jaw. It is also imperative as a record in the event of identification of a particular individual,for example in forensic cases.

Dental Xrays can show small areas of decay between teeth or under an existing filling,which is usually not detectable by your dentist in the mouth.It can also show bone loss due to tooth infection or gum infection.Some tumours and cysts are also visible from dental XRays,and certain developmental abnormalities can be detected from them. They are also very useful for determining the position of unerupted teeth in the jaw.In cases of trauma,dental XRays play a vital role in observing possible fractures and also the position of the fracture lines.

Hence,we are able to detect and treat many dental conditions in the early stage.

I probably sound redundant,but,dental Xrays are really something we dental practitioners  cannot do without if we want to provide proper dental care to our patients.

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.

Habitual teeth grinding,also known as bruxism is quite a common phenomenon.

The tale-tell signs would be very worn down teeth,and this can occur in the front teeth or the back teeth,or in severe cases,both front and back teeth are all worn out on the biting surfaces.

What causes bruxism is still generally unknown but there has been some studies done and it can be linked to a few possible reasons,among which is,

-phsychological stress

-certain sleep disorders

-malocclusion ie unnatural bite due to missing or broken teeth or misaligned teeth

-temporo-mandibular joint related problems

-increased intake of certain medication like antidepressants

-increased intake of alcohol
etc

If you suspect that you grind habitually in your sleep,or your spouse or roommate can actually hear your night grinding,then you should see your dentist to have your teeth examined for signs of bruxism.

The usual signs are

-worn down enamel on the biting surfaces of your teeth

-tooth sensitivity especially when taking any cold food or drinks

-fracture lines on your teeth

-worn down fillings or fillings that often dislodge and have to be replaced

-aching and tired jaw especially in the mornings,at the temporo-mandibular joint area,which is situated in front of your ears

To prevent further wear and damage to the teeth ,your dentist would normally prescribe a custom night guard,to be worn at night when we are most unaware of the grinding and where we are unable to control the grinding

At the same time,you may need to address any  causes of phsychological stress that may lead to the bruxism.The stress may come from work or family or a particular  situation  you are going through.

If you have some sort of malocclusion that may be the underlying cause,then get your dentist to advise you on the various options for treatment to correct the problem.

You may need to be referred to a jaw specialist if it is a joint-related problem

In summary,if you think you grind habitually,talk to your dentist and get some advise and treatment where necessary.

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.

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.