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July 12, 2009

Teeth grinding

Blogged under Oral health care by DrJean on Sunday 12 July 2009 at 7:04 am

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

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.

April 29, 2009

Tooth decay -how preventable is it?

Blogged under Dental Education,Oral health care by DrJean on Wednesday 29 April 2009 at 4:58 am

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.

September 11, 2008

Teeth erosion

Blogged under Dental Education,Oral health care by DrJean on Thursday 11 September 2008 at 7:13 pm

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)!”

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!

September 5, 2007

“To save or not to save,that is the question”

Blogged under Dental Education,Oral health care by DrJean on Wednesday 5 September 2007 at 7:15 am

If you read Shakespeare or have watched Hamlet(by Shakespeare),you would have read about or heard perhaps the most famous soliloquy in literature;”To be or not to be,that is the question“.It was Hamlet,the Prince of Denmark ,having found out that his father has been killed by his uncle who now sits on the throne of Denmark and has remarried his mother within a month of his father’s passing,was desperate and contemplating suicide.

Now,I am not about to tell you the story of Hamlet.I am not a literature expert.I have only read a children’s book on this title when I was a schoolgirl.However,everytime Shakspeare is mentioned,inevitably,you hear this famous  quote.

Can we say that for our teeth,”to save or not to save…” in the same desperation and urgency? We are in the age where we do not advocate extraction of the permanent teeth(even milk teeth,we allow them to come out in their own time) unless it is absolutely the last resort or in some cases,the tooth is absolutely non-functional.

We are all aware of the fact that we have only one precious set of permanent teeth which will emerge by the time we are around 12 years old,and they are meant for us to take care and use them till we meet our Maker.

It is imperative that you ask your dentist for options when a tooth is in bad shape and you may potentially need to have it removed.Take your time to think carefully before agreeing on extraction.Almost all the time,when a tooth is saveble,it is more economical to keep it (by having a root canal treatment done followed by a crown) then to have it removed.Once removed,you would need to plan to have it replaced either through a fixed or removable prosthesis.This is because everytime a tooth is removed,there is a space,and the other teeth will start to move.

Unless you opt for a denture,which is removable,any fixed prosthesis that is used to replace a missing tooth will almost always cost more.Examples of fixed prosthesis to replace missing teeth would be a bridge or an implant.

So do think thoroughly before deciding to extract a funtional tooth in your mouth.

July 17, 2007

“I enjoy my visits to the dentist”

Blogged under Oral health care by DrJean on Tuesday 17 July 2007 at 10:06 pm

Say that again??” This is a rare statement.Usually I get things like “I am very afraid of coming to the dentist” or the downright ,straight-in-the-face “I don’t like dentists!”.

I do have a few patients who actually tell me that they like coming for dental checkups and regular scaling.These are the ones who really care for their teeth and I must say that they have excellent oral hygiene.I make it a point to commend them for doing a good job in brushing and flossing.This brings much satisfaction for me as an oral health giver.

This patient of mine who said that she enjoys her dental visits,told me that she likens it to going for a facial treatment,where she relaxes while her teeth(or face) is being cleaned by someone she trusts,who will ensure that she has good oral health.Hmm..sounds very logical.

Actually,I have also noticed that my the majority of my children patients are less fearful compared to the adults.This,I realise,is the result of their parents,after having gone through horrendous experiences at the dentist when they were younger and do not want their children to go throught the same,very diligently bringing their children for regular dental check ups.And usually,the parents look a lot more stressed than their children even though it’s their child and not them on the dental chair!

The conclusion is,bad experiences in the dental clinic(or in any other situation,for that matter) during childhood, leave a tremendous effect on an individual.Conversely,good experiences will bring pleasant memories and will positively impact an individual in similar future experiences.

So,do bring your children to the dentist when they are young and impressionable,even when they do not have any potential problems and ensure that they have a pleasant visit,especially the first one.


July 16, 2007

Lesson from Sweden

Blogged under Oral health care,Personal by DrJean on Monday 16 July 2007 at 10:55 am

A number of years ago,I had the privilege of visiting the Sweden.And I was invited by a friend,Dr Sofie Hybels, to visit the Eastman Dental Institute in Stockholm,where she works as a Pediatric Dentist.This is teaching dental hospital for postgraduates as well as a clinic for children under the public dental services.


In Sweden,children and young people up to 19 years of age are offered organised dental care free of charge provided by the National Dental Service.Adults 20 years of age and above come under a general dental care insurance,where the adults are given compensation for preventive care,extractions,endodontic/root canal treatments and fillings.The dental insurance will cover a substantial percentage of the cost of dental treatment.

In Sweden,apparently 8% of the total governmental spending on healthcare is spent on dentistry.That is a lot!!There is a Dental Act there which states that all Swedish citizens are entitled to good quality dental care.Note GOOD QUALITY.

Why am I talking about Sweden dental health care? Because I think we have much to learn from them.

When I was visiting Eastman,I was brought on a mini tour around the place and I was so impressed at the quality of work and materials used.That was year 2001.It left quite an impact on me.

Then about 2 years ago,my husband TC and I visited Sweden again,to visit some of our very dear Swedish friends.This time,one of our friends,Goran,arranged for me to visit his dentist,who is in private practice.This was in the town of Linkoping,north of Stockholm.


I was deeply inspired to see a thriving private practice with so many happy and smiling staff.They all seemed to be thoroughly enjoying themselves,and I made a mental note that when I start my own practice, I want my staff to be as happy,if not more.

Why am I writing about this? I believe there is much we can learn from the way this country manages her citizen’s oral health care.Yes,they are a very developed country,but we in Malaysia are catching up in leaps and bounds.We should not be lagging behind.I believe every single Malaysian should be well informed about the importance of their oral health,and encouraged to take proactive measures to take care of their teeth.And dentists both in the public and private sector,as oral health care givers,must rise up to provide good quality dental treatment for our patients.

June 17, 2007

“A lifetime of Healthy Smiles”

Blogged under Oral health care,Personal by DrJean on Sunday 17 June 2007 at 8:44 am

That is the tagline and vision statement for the National Oral Health Plan(NOHP) 2010 for Malaysia.

I just attended the MDA/FDI Scientific Convention(MDA stands for Malaysian Dental Association and FDI is short for Dentaire Internationale or federation of National Dental Associations) over the weekend and attended a number of lectures,some more educational than others.Well,if you want to see many,many dentists(shudder!) all at the same time(yikes!),in the same place,these kind of conventions would be the place to be in. 🙂 


Amongst the many lectures/sessions,there was one which was presented by the Oral Health Division of the Ministry of Health of Malaysia.Dr Choo Yoke Yuen,who is the Principal Assistant Director of Oral Health Division,presented an update on the NOHP 2010.The NOHP was initiated in year 2001 to improve the oral health of the nation and recently there was a review to track the progress and achievements of this plan thus far,hence the NOHP 2010 of Malaysia.

I sat there listening to someone passionately sharing about objectives and goals of the nation to improve the oral health of individuals,from children to adults.She talked about successes thus far as well as goals yet to be achieved.Strategies to achieve these goals were mentioned.

And for some moments there,I just felt a little sad.Here I was,in a convention hall with a small group of dentists,of whom I was probably one of the very few from the private sector.Most of those attending this particular lecture were from the public services.The rest of the world(ie private practitioners,were either attending another lecture running concurrently,or busy buying dental products from the host of dental exhibitors there).The Health Ministry may be achieving their oral health goals in the last 6 years and aiming for more in the coming years;but what are the dental practitioners in the private sector doing to help? By this I mean,there need to be a lot more done to educate the public and preventive measures done intentionally.Prevention is after all better than cure.There is still so many out there who are not aware of the importance of proper oral health care.

However,on a positive note,the general public are becoming more discerning and are increasingly willing to be educated about their oral and dental health.And parents are beginning to bring their children for dental checks at a young age,before any problem sets in.And children are generally being exposed to dental clinics and dentists at a younger age,where the environment is non-threatening.So,hopefully,we will have a next generation of people with not only much better teeth,but also not fearful of the dentist! Yay!

April 18, 2007

Tooth erosion and decay

Blogged under Dental Education,Oral health care by DrJean on Wednesday 18 April 2007 at 10:04 pm

I recently saw a young man in my clinic who had not visited a dentist for a substantial period of time.He was persuaded to come to see a dentist because he had bleeding gums and “black stains” on his teeth.

When I did the initial examination,I asked him a couple of questions and discovered that he is a smoker,he is not very diligent in his tooth-brushing(and obviously does not floss) and he drinks a lot of Coca Cola.That,by the way is one of the potent combinations for dental disaster.

I spent a rather long session cleaning his teeth and teaching him how to brush and floss correctly and advising him against his high-sugar and high-acid diet.

This picture was taken 2 weeks later after his swollen and bleeding gums had healed considerably and he had been brushing his teeth much more carefully.The black patches are due to erosion  and decay.He also had extensive decay in between all his front teeth.

The erosion is due to his long-term relationship with Coca Cola.Dental erosion is a process whereby the tooth stucture (enamel  and sometimes,dentin)is destroyed by the long-term exposure and action of acid on it.This is an external cause ie from his diet.The decay is also a contribution from Mr Coke plus the fact that he was not careful with his tooth brushing.Decay is a process where the tooth structure is destroyed  by acid-producing bacteria,Streps Mutans.

The process of dental erosion is irreversible and requires treatment to arrest the situation, and also a drastic change in dietary and oral hygiene habits.Decay is a progressive disease which needs to be dealt with as soon as possible before it progresses to reach the pulp of the teeth.

There was much to be done for this young man.He had taken a tremendous  step to improve his oral hygiene and to visit the dentist more regularly.He also promised to cut down on,if not stop all his fizzy and sweet beverages.One of his front teeth is already non vital,due to the decay reaching and destroying the pulp of the tooth.And he would require a root canal treatment for that tooth.

As a first line of treatment,now that he is able to manage his oral hygiene reasonably well,I did some direct composite veneers to his 4 front teeth,after removing all the decay present.

He was rather pleased that he can now smile confidently after such a long time.

Just to mention a bit more on dental erosion,young people especially teenagers and young working adults are most susceptible because of the high consumption of fizzy or soft drinks.The diet version may be lower in sugar content,but the acidic effect is actually much worse.Pure fruit juices which are acidic like citrus juices,are just as bad in its errosive abilities.

There need to be a more acute awareness about this problem.I see an increase in dental erosion and decay amongst the growing affluent society.When I walk along the aisle of the supermarket where drinks are being sold,I see rows and rows of soft drinks,juices of all sorts,not to mention a whole load of sweetened drinks like cultured milk,soya milk and the list goes on.

Apart from your dentist advising you or your child about this problem,parents and care-givers play a crucial role.Watch what your children are drinking and take them for regular dental check up,so that if there is an inherent problem,the situation can be quickly diagnosed and delat with accordingly. 


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

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