The year has gone past so fast and looking back,again,I am thankful for the many people,relationships and happenings in 2008.

We have had lots of fun and laughter here at iSmile.I am so thankful for and proud of my team.They have worked hard and showed much dedication in their daily responsibilities.Without them,I would be quite incapacitated.

We took time off recently to go for a holiday together with our respective families,to Langkawi.

Here’s the gang at the Langkawi International Airport,all raring to go.

Of course,feasting,err I mean eating is a priority!

We did some touristy stuff like going on the boat ride to the mangrooves to visit the fishing villages,the bat caves and watch the famous eagles of Langkawi .We also took the cable car up to the highest point in Langkawi.Quite awesome!

HAPPY NEW YEAR!!

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.

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……

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.

Good food and good company

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)!”

What exactly is cosmetic dentistry? This term has been made even more popular by the various reality TV shows with “Extreme Makeover” theme.A common scenario is where a person,usually a young working adult or a middle age woman,would tell me “I don’t like the appearance of my teeth” or “I feel ashamed to smile widely because I do not have nice teeth” or “I wish to have nicer looking teeth”.

I remembered many years ago,a lady in her 50s came to see me and in her hands she had a photo.She said,” I would like to have teeth like that” and she shoved the photo into my hands. It was a photo of Faye Wong,the Hong Kong artiste,fllashing her celebrity smile.I didn’t know whether to laugh or to cry!!

I think it is perfectly fine to want a set of teeth that is pleasing to look at.

Asthetic is definitely a very important feature of dentistry. But what is more important to me is the foundation under that beautiful set of straight and sparkling white teeth.

I constantly remind my patients that if they do not have underlying healthy gums and teeth,whatever “cosmetic” job that is done will usually not last.

In the next part of this topic we will look at what aesthetic or cosmetic dentistry constitutes and what are the current trends in cosmetic dentistry

However,I managed to take a short but refreshing break with my husband ,in Bali.He was working/attending a conference half the time and I was relaxing,shopping and eating,most of the time  :)

Snapshots from Bali

Well,obviously we spent a lot of time eating!!

We have moved increasingly from using amalgams to resin materials like composite and glass ionomers .These new materials are not only more aesthetic,the newer reinforced ones have very superior strength.

Where crowns( http://www.ismile.com.my/patient-education/crown/) and bridges(http://www.ismile.com.my/patient-education/bridge/) are concerned,there is an increasing shift to use non-metal-based prostheses.

In a very simple way,these all-ceramic crowns are classified into low-strength and high-strength ceramic restorations.

Low strength ceramics are leucite-reinforced pressed porcelain and these are used only in very specifically indicated cases.They have very good aesthetics but low impact-strength.

High-strength ceramics are categorized based on the coping used and these copings are referred to as the core.These core material now replaces metal,hence the all-ceramic,metal-free restoration.

Alumina-core ceramics have aluminium oxide as its core material under the pressed porcelain which is fused to it.Zirconia-core ceramics will have zirconia as its core material.

Some of these crowns are done using the CAD/CAM technology.This method is capturing the photographic image of the prepared tooth model using computer technology ,a 3D restoration design is crafted to conform with all the detailed specifications,the computer will then send infomation to a milling machine where a block of core-material/ceramic will be milled to the specification.

Now,with the CEREC CAD/CAM machine,a crown can be constructed within an hour while the patient waits on the dental chair.However,there is extremely high cost involved as the CEREC machine and the material used are pretty costly

 On the first weekend of this month,my colleauge Dr Amy and I took a break from our work routine and attended the IDEM(International Dental Exhibition and Meeting) at the Suntec Convention Centre in Singapore.

There were some world-renowned speakers in the dental profession at the scientific convention and we learnt much.

It was a nice change to be able to window-shop at the mall where the convention centre was.Well,we actually did some real shopping too ,something we call “retail therapy”;something we do not get to do too often.