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September 3, 2009

Intraoral Xrays

Blogged under Dental Education,Technology by DrJean on Thursday 3 September 2009 at 9:05 am

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.

May 20, 2007

Tooth coloured fillings-nano filler composite resin

Blogged under Aesthetic Dentistry,Dental Education,Technology by DrJean on Sunday 20 May 2007 at 10:03 pm

Materials used for fillings are constantly being researched and upgraded.Composite resins has been around for a long time,as a more esthetic option to the silver amalgams.

Over time.with technology and much R&D,composite resins has evolved to be a material with high quality esthetics.The size of the fillers particles used in composites will determine the polishibility and therefore the quality of esthetics in the results produced.Particle size has evolved from 1 micron(1000nm) in the 80s to around 20nm in today’s modern dentistry.Hence the nano-technology in tooth-coloured fillings.

For front teeth,we can get really good results with these new materials.Here are some examples of before and after pictures.We no longer have to live with ugly and unesthetic looking fillings on our front teeth!






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

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


January 6, 2007

One happy patient

Blogged under Aesthetic Dentistry,Technology,Testimonial by DrJean on Saturday 6 January 2007 at 9:21 pm

Dental treatment has moved towards aesthetics and cosmetics in the recent years.Dental material have also revolutionised to enable us as dental professionals to produce very aesthetically pleasing restorations on our patients.And for me,it is always most satisfying when my patients return to me or write to me to tell me how pleased they are with their new smile.

This is the case of Aireen.She has been walking around over the last few years with a badly discoloured front tooth which was previously root-canal treated.And she has some unaesthetic restorations placed on her two front teeth.

This was Aireen,before

And this is Aireen,after

The smile on her face was priceless.Aireen emailed me a picture of her taken with her friends over the Christmas season and this is what she wrote,”Hello Dr Jean,now I can smile like I used to.Thanks again.Regards,Aireen”

Aireen is seated 2nd from the right.Hey,Aireen.You look lovely!


June 15, 2006

A little bit of advanced technology to stay ahead

Blogged under Technology by DrJean on Thursday 15 June 2006 at 7:14 am

I have invested in some technology for my clinic,with the vision that it is the way to go in the future.

I attended an international dental conference in March this year and was very inspired by the topics covered about advancements in technology.To stay on the cutting edge,we cannot be lagging behind when everyone is moving forward.

So,I made a decision that I WILL stay in the front while advancing with the new technologies and materials in dentistry.

This is my digital X-Ray system.They are a lot safer and environmental-friendly.Radiation is reduced up till 90%,compared to conventional dental X-Rays,and by going digital,I eliminate the use of toxic chemicals(developing solutions) in my clinic.They show up on my computer screen in seconds and I can enlarge the image to see the details of it.

And this is an example of a radiograph taken with my digital X-Ray system

This is my intra-oral camera,which takes superb pictures of teeth magnified many times.

They are excellent diagnostic tools,apart from being a great way of educating every discerning patient who comes along.It takes very good before and after pictures too.

I believe that the society today is slowly but surely becoming aware of the need for good dental and oral health.Ignorance is no longer an excuse.It is therefore every dental practitioner’s responsibility to educate the public on how to achieve high levels of dental health.And I am convinced that the knowledge and understanding that is gained will be passed on to the next generation and the next.

Having said that,I still believe that the 2 most important things any dentist who wants to make a difference should have,is competence and compassion.Competency means knowing how to do my job well,ie always striving for excellence .Being compassionate means having the commitment to care for every person who comes to me to seek dental treatment . High callings, but I believe standards,just like visions,should be set high and not just at mediocre levels.


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