Why the long wait for dental care at govt clinics?

This letter appeared in today's Straits Times forum page.

"Why does it take so long to receive specialist dental treatment at government clinics?

The process starts with trying to make an appointment for a referral letter from a dental clinic, usually located within a polyclinic. When I called last month, the earliest date I was given was next February - four months away.

The next step can be interminable too. Once you get the referral letter, be prepard to wait for at least three to four months for an appointment with the specialist at the National Dental Centre. The actual treatment, such as making dentures, for example, can take another six months.

In my mother's aborted attempt, we tried to shorten the wait when she tried her luck by waiting at the clinic the entire day for an untaken slot. She was lucky as a scheduled patient did not turn up and it took her only a full day's wait to obtain a referral to the specialist.

But when we subsequently discovered how long it would take for my mother to see the specialist and then have her dentures fitted - almost a year in all - we gave up, and I paid private rates for her treatment at the National Dental Centre.

The result: my mother had new dentures within a month.

I worry now about myself. When I grow old, I may not be able to afford to pay private rates. I am single and my CPF-linked medical savings do not cover most dental treatments.

Singaporeans who need subsidised dental care may also be unable to receive treatment in time. What if I had a toothache, or a gum infection? Must I wait for a year for treatment, or as in my mother's case for gum infection, some six months? What will be left to treat?

Paying private rates does not guarantee earlier treatment either. Last month, I made and confirmed as appointment with the National Dental Centre for Nov 19, only to reciev a letter on Monday changing the appointment to almost a month later, on Christmas Eve. Reason: the dentist would be unavailable for my original appointment.

Ho Suit Keng (Ms)"

Arica's Mishap

Arica fell down the stairs and broke her leg last night. She was admitted to the hospital and the last we heard, she was due to go for surgery to reset her leg. It looks like she would be on extended medical leave and she will not be able to walk. The pain must be excruciating.

Arica, our prayers are with you and we hope that you get well soon.

Patient inspired to be an Orthodontist

When Raphy's orthodontic adjustment was completed today, we debriefed her mother as to what we achieved today and what we expect to see when she is next in for her orthodontic adjustment.

It was then that Raphy's mother revealed that we have inspired her 13 year old daughter to become an orthodontist.

Mum has booked this year's family holiday to New Zealand to check out the dental schools for her as both patient and mum feel that it is almost impossible to enter dental school in Singapore and they hope that New Zealand will be much easier.

It is still early days yet but it is amazing to see what parents would go through for their children.

We have offered Raphy an intern position as this would stand her in good stead in her application to dental school.

Good luck and you knwo that we will be here for you.

Pulling out all lower teeth

We had a patient come in asking to have all her lower teeth extracted so that she could have lower full dentures. She did the same thing on her upper jaw and was happy to get rid of her teeth because they were too troublesome to look after!

Lower dentures are very different from upper dentures because they are inherently unstable due to the presence of the tongue. A fact that many patients do not take into account. This gives rise to much unhappiness with the resulting dentures and the problem is more profound in patients that have never worn a lower denture before. Such patients will not know how to control their tongue to aid the stability of that lower full denture.

When patients are told of this problem,they would usually not go through with their original plan of removing all their lower teeth. However, there are some who insist of going ahead with the extraction of all their lower teeth. We make sure that these patients are fully aware of the consequences of their decision so that they do not end up blaming the dentist for their troublesome lower full dentures.

Some of these patients regret their decision and end up having implants placed so that they can have a more stable lower denture.

Looking forward to see the dentist!

One of our patients recommended her friend to bring her 4-year-old to come and seek treatment with Dr Lim.

On her first visit to the dental clinic, the dentist went out to the reception area and asked the child to open her mouth, which the child promptly refused. The dentist told the patient to make an appointment. During the scheduled appointment, the child again refused to open her mouth and the dentist gave up.

When the child came and saw Dr Lim last week, Dr lim started by building a relationship with the child. By the end of that appointment, not only did Dr Lim persuade the child to open her mouth but she also managed to polish the child's teeth. At that visit, the child was found to have 4 cavities.

It was encouraging to note that the patient came back for her restorations four days later. When she arrived, she was happily playing in the office. This time, she even brought her own DVD to watch during her dental treatment. Dr Lim managed to restore two of the cavities and scheduled her to complete the last two cavities.

Retainer or Nightguard

One of our patients who completed his orthodontic treatment about 5 years ago came in with his retainers chewed to bits. This latest set of retainers has only been in use for less than a year. He acknowledged that he has been very stressed lately and that he has been grinding his teeth intensely in his sleep. This has resulted in his retainers breaking into several pieces.

In view of his current situation, we prescribed a full coverage nightguard to serve both as a retainer and as protection for his teeth. As the cost of the full coverage nightguard cost more than a retainer, the patient was unsure as to whether he should spend the additional money.

We told the patient that night time grinding (bruxism) generates more force on his teeth than he could possibly produce when he is awake. We have seen teeth snap in two as a result of bruxism.
With the full coverage nightguard, he would be grinding against acrylic (which is softer) instead of against his own natural teeth. The nightguard will ultimately fail under such abuse. However, in the long term, it would be much cheaper to replace a nightguard than to replace a fractured tooth (greater than 1:8 ratio).

In light of this information, the patient decided to go ahead with the nightguard.

Implant problems?

One of our orthodontic patient's mother took the opportunity to ask us about implants:

Her friend had his implant done in Germany and he encountered the following:

His implant crown came out eating peanut butter.
We asked if the crown that dislodged was a temporary crown but she was not sure. It should be noted that sticky materials similar to peanut butter is sometimes used to remove crowns. Therefore, such food should be avoided for patients who have crowns in their mouths.

There was a need to remove implant to clean.
We told her that as the implants are fused to the jaws, they cannot be removed for cleaning. Even during a profession scaling and polishing at the dental office, the implant superstructure is not normally removed for cleaning.

In fact, in order to scale around any implants, we use very special graphite instruments to do the procedure. This is because the regular dental instruments will leave scratch marks on the smooth implant surface, unlike these special graphite instruments. Scratched implant surfaces tend to accumulate dirt and plaque more easily.

Despite these issues, implants are currently still the best replacement for missing teeth. If you have questions or are thinking of having implants done, call our office for an appointment to consult one of our specialist in prosthodontics.

I have been very busy...

Eleanor is one of our orthodontic patients and she last visited our clinic in November 2008 to have her braces adjusted. Nothing has happened to her teeth since then, i.e. no change in her tooth position.

When we asked her why she has not been back since then, she replied that as this is her first year in University, she has been very busy and had no time to come back.

We told her that she had to make the effort to return for regular adjustments if she wants her treatment completed before her graduation and she has promised to do so for her own sake.

This is one of the reasons why orthodontic treatment takes longer that usual. Fortunately, Eleanor takes responsibility for her shortcomings and accepts that her treatment has been delayed by her own action. Not all patients are like that.

ADHD Braces Patient

We did braces for a Attention Deficit Hyperactivity Disorder (ADHD) child many years ago. He always enjoyed coming to our dental practice and interacting with the staff here.

Orthodontic treatment was completed and retainers were given to him. Due to his condition, he was not able to follow our instructions on wearing his retainers. As a result of his parents enormous efforts to get him to wear his retainers, his relapse was minimal.

However, he has been obsessing about the slightly crooked teeth every time he came to our office, asking when he could have his braces put back on.

We have not seen him for quite a while but his mother came back yesterday with a toothache. While mum was getting her condition attended to, dad caught up with us. He told us that his son still wanted to have his braces but his ADHD condition has worsen and he has not been out of the home for several months.

We told his dad that we would be happy to put his braces back for him once he feels better!

I want a Nice Smile as I am a Public Person

Last week, we had a Russian husband and wife come from Vladivostok for dental treatment. Apparently, the husband is a prominent public figure from that area and he wanted a more aesthetic replacement for some of his missing teeth and his failing bridge.

He needed a prosthesis that consisted of 11 crowns and bridges and it involved his upper front teeth as well.

Conventional crowns have a metal substructure, which tend to lack the translucency of natural teeth. For this patient, Dr Lim opted for crowns and bridges with a zirconia substructure. Zirconia is also used in the manufacture of synthetic diamonds. This material is hard, optically flawless and usually colourless, which makes it highly suitable for areas of the mouth that require aesthetic, naturally looking teeth.

However, the hardness of this material makes it very difficult to adjust and thus the crowns and bridges must be cast very high accuracy and precision. As with all laboratory fabricated dental prosthesis, zirconia crowns need to have their bite adjusted in the patients mouth after fitting and cementation. Thus, such crowns take a lot of clinical time to fit well.

Today, we delivered the crowns and bridges to the patient and both his wife and him were delighted with the result.

If you have crowns on your front teeth that you would like improved, call us and make an appointment to see our specialist prosthodontist.

To veneer or not to veneer...

We have a patient who wanted to straightened her slightly crooked two front teeth without having to go through braces. Dr Lim suggested that she had a veneer done about 5 months ago but the patient kept putting off the appointment.

This patient comes back on Friday with only one front tooth veneered, which had to be thickened considerably in order to align with the other front tooth. Composite material was used as opposed to Dr Lim's preferred ceramic veneers.

Ceramic veneers are a superior choice for the following reasons:

• the colour palate is wider, making shade matching more accurate. This would give a more natural look to the veneered teeth.
• the colour is more stable when compared with composite, increasing it's lifespan.

Apparently, the patient did it at one quarter of Dr Lim's fees and as can be seen, yhou get what you pay for.

Well, patient is not happy with the look and feel of the result and that is why she returned to see Dr Lim to have the veneer redone on one front teeth and to add another veneer to the adjacent front tooth as originally suggested.

If you would like to see what veneers can do for you, make an appointment to see Dr Lim today.

...100% success!

Our endodontist did a root canal for a patient 6 months ago.

At the first consultation, our endodontist informed the patient that the success of root canal treatment for back teeth was about 90%. This patient said that if it was not 100% success, he would not do the treatment.

The patient came back subsequently and decided to proceed with the root canal treatment despite it being reiterated to him that success rate will not be 100%. His treatment was completed 6 months ago and the patient was told repeatedly that after the completion of the root canal treatment, the tooth needed to be crowned to prevent it from form cracking or splitting.

Compounding his problem was the fact that the gums around that tooth in question had also receded and trapping food. As we all know, when food get wedged in our gums, there will definitely be some sensitive sensation.

Unfortunately, the patient kept perceiving the wedged food sensation as a sign that the root canal was not successful. He was even instructed on how to floos between his teeth to dislodge the food and at the same time reminded to get his crown done immediately.

The patient refused to floss his teeth and kept insisting that if the root canal was not 100% successful, he would not get his crown done.

Finally, he returned yesterday because the tooth had split.

If you have a root canal tooth at the back of your mouth that is not crowned, please come and see us immediately so that we can assess if a crown is necessary in order to save your tooth.

Excuse me, are you the patient...

One of our orthodontic patient came to the practice with the braces on one of her lower front teeth dislodged. This resulted in that tooth slipping its contact with the neighbouring tooth and going crooked again. We showed her the problem and reinforced the need to keep the braces intact.

We removed the broken bracket and replaced it with a new bracket. We then gave her an appointment one week later so as to minimise the loss of treatment time due to the broken bracket. The intention was to tie in the repaired bracket and this was communicated to the patient. The patient was also given a 6-week adjustment appointment on 30 October 2009.

That evening, the patient showed her mother the crooked tooth and wondered why that tooth was not tied in to the bracket.

The next day, over anxious mum calls and insisted on talking to the dentist despite the clinician being in the midst of treatment. When mum's call was returned, she claimed that her daughter's upper tooth was crooked. She continued to insist that the problem was the upper tooth despite being reassured that the breakage was on the lower tooth. She refused to accept the dentist's explanation and wanted to have her daughter seen immediately and not at the stipulated appointment. She was afraid that if the teeth were left unattached to the wire, the tooth would get worse.

The attending dentist then asked the patient where she perceived the problem and she replied that it was her lower tooth!

When the appointed time came for the patient to return for attaching the tooth to the wire, the patient failed to attend and did not even call until after the event. The patient then insisted on getting another appointment the very next day, which she was given.

Again, the patient failed the second appointment and again she insisted on a next day appointment. She failed the third appointment and was given an appointment within four days of the third failed appointment.

The patient failed her fourth appointment and was gievn an appointment 1 week later. This gets even better. She fails her fourth appointment and gets a fifth appointment 1 week later (which she finally attends). This is barely 2 weeks from her 6-week adjustment appointment, which means that her teeth did not move in the mean time and treatment has been set back by about one month.



The failed appointments add up to 50 minutes that could have been given 5 other patients. Inconsiderate patients like this rob others of an earlier appointment.

What options do we have? Charge patients for not showing up for their apointments?

I am on my way

One of our orthodontic patients had an adjustment appointment and she arrived 15 minutes late. That was despite a reminder call which she personally answered one and a half hours before the appointment. She said that she was on her way.

As she was already late, there was no time for us to carry out the planned treatment. On top of that, she broke two braces which caused a gap to open between her lower front teeth. The consequences of being late in this instance in addition to not doing the planned treatment:

• no time to repair the broken braces to enable treatment to progress
• inability to correct the gap due to the absence of braces in that area

The patient had to be given another appointment just to address the above problems and as circumstances would have it, the next available appointment was 4 weeks away.

Thus treatment would have been delayed by at least two months if not more. It would be rather unrealistic for this patient to expect her treatment to be completed within the estimated time.

You probably cannot recognise us!

We had a new orthodontic patient today.

This 12-year-old girl just completed her last PSLE paper today and mum and dad had already booked an appointment with us so that she can get her braces fixed at the beginning of the upcoming school holidays.

When mum and dad saw me, their first reaction was you probably cannot recognise us but I did. I remembered dad but mum is now wearing contact lenses, which threw me off a little. They had originally accompanied their eldest son for his orthodontic adjustments. He last saw us at least 5 years ago and we have not seen the family since. Mum and dad updated us that he will be completing is National Service soon. Wow! How time flies!

At the end of the visit, mum and dad decided to bring their second son to see us as well for gaps between his teeth.

Welcome back. It's nice to see old friends again.

Why is my friend's braces so slow?

We started orthodontic treatment for a 22-year-old young lady in the middle of last year. By the year end school holidays, she introduced us her 13-year-old younger brother to have his teeth straightened.

Last week, both brother and sister came for their orthodontic adjustment. As we treated the younger brother, the young lady related that her classmate started her braces at about the same time as her brother but her friend's extraction spaces are still very visible as compared to her brother's extraction gaps. She commented that her brother's treatment was progressing very rapidly.

We told her that yes, her brother's treatment was going smoothly. However, to compare her brother's treatment with her friend's treatment was like comparing apples with oranges.

Firstly, her friend's dental condition may be different from her brother's condition.

Secondly, the age difference would partially account for the discrepancy in treatment progress.

Thirdly, the treatment objectives may be different.

As such, casual comparisons like this may give rise to unnecessary misunderstanding regarding treatment. We must always remember that each patient is an individual and treatment is customised for each patient.

4 New Patients

Today, Dr Lim saw 4 new patients:

• a mother (implant) and son (whitening) pair
• one for orthodontic treatment
• one whose crown was dislodged.

In the first case, the mother had multiple loose teeth which is indicative of a periodontal (gum) disease. She complained that her last dentist extracted her two front teeth although they were "perfectly good and healthy". The only problem with them, according to the patient, was that they were loose.

It appears that the patient did not understand that she has gum disease and she wanted to go ahead to have implants to replace her missing front teeth. We will have to make it very clear to her that if she has gum disease and she still insist on having the implants done without addressing the gum problem, there is a high chance that the implants will fail.

The second patient was rather straight forward. The patient's elder sister had her braces done with us and she recommended him to see us. Now it's his turn to straighten his teeth. Dr Lim took the necessary x-rays, photos and impressions so that we can present the treatment plan at the patient's next appointment.

The last patient was also recommended to see us by our patient. This last patient had his crown done in Taiwan. The crown that he dislodged was a plastic temporary crown and according to him, the dentist did not tell him that it was only temporary and that his second appointment with the dentist was to fit the permanent crown. If he had known, he would not have chewed gum on the crown. In addition, although he grinds his teeth in his sleep, he did not wear his nightguard to bed.

Dr Lim relined his temporaryt crown and recemented it with a stronger cement as the patient has to visit several other countries before returning to Taiwan for his dental appointment. Dr Lim also cautioned him that his dentist may have some difficulty removing the temporary crown because of the stronger cement.

Hopefully, with proper communication with our patients and understanding by our patients, we will be able to serve our patients better.

My filling broke after 6 months!

Dr Lim saw a patient which we have not seen in 10 years. The patient had relocated to Shanghai and came home to Singapore during the Chinese National Day. Today, the patient brought her whole family along with her!

Her husband told Dr Lim that he had a filling done in Shanghai 6 months ago but that filling had dropped out. When Dr Lim examined his teeth, she found that his teeth were worn down with numerous crack lines on each tooth. According to the patient, he also grinds his teeth in his sleep (bruxism).

Besides restoring the broken filling, Dr Lim also prescribed a nightguard for the patient. The function of the nightguard is to protect the patient's teeth and restorations. When the patient grinds his teeth in his sleep, he would be grinding against a softer material than his teeth. Furthermore, as he grinds, he will be wearing off the nightguard and not his teeth.

In the event that his nightguard gets worn down, it can simply and cheaply be replaced as compared with a worn or broken down tooth. In addition, the nightguard can extend the lifespan of the fillings and crowns in his mouth.

It is a worthwhile investment, especially for patients who grind their teeth in their sleep (bruxism).

How long more?

We have come across several patients who were in a hurry to get their braces off.

For us, we believe in doing a good job for the patient, no matter how long it takes. However, there seems to be a mismatch between the patients and us about how perfect the teeth should be before the braces are removed.

Thus, our procedures have evolved to the point where patient can have their braces off once they are satisfied with the results. It does not matter whether we, as clinicians, are satisfied or not. Most importantly, patients must realise that if they are not happy with the end result after the removal of the braces, they must be prepared to have the braces put back on.

One of our patients is a dentist working in a public dental institution. We saw him last week to adjust is orthodontic appliances. At the end of the session, we told him what changes we expected to see by his next visit and we also said that we will try to expedite his treatment. His reply astonished us.

He told us to take our time to complete his orthodontic treatment, which was the total opposite of what our patients expected of us. We probed further and found out that at his workplace, he had seen many cases where the braces were completed very rapidly. He observed that such cases tend to relapse or go back towards their previous conditions very rapidly as well. In some instances, when the patient returned one week later to collect their retainers, the retainers no longer fit due to the replase of the teeth.

We have also seen cases from other clinicians who finished their cases quickly. Some of these patients were not happy with the end result and complained that they were not given the option as to when they should have their braces off. They felt that their treatment was not complete and wanted us to fix the problem, i.e. a second round of braces with the associated time, effort and cost.

So, you have to make the decision as to whether speed or end result is more important to you as it looks as if you cannot have both.

Flowers for Dr Lim

Dr Lim spent an hour doing a veneer mock up for a patient today.

The patient was so delighted with the mock up that she decided to proceed with the veneer impression on the spot.

As the teeth to be veneered were slightly rotated,

• there was no need to cut healthy, sound tooth structure


• however, the patient had to accept an increase in the bulkiness of the teeth

Later in the afternoon, Dr Lim was pleasantly surprised with a lovely bouquet of roses!

That just made Dr Lim's day for her. Thank you so much.

My last adjustment was 9 months ago

On Saturday, we attended to one of our orthodontic patients who last came for an adjustment of his braces in December 2008.

He told us that he was very busy with work and could not come for his monthly adjustment. When he realised that he was due for an adjustment, he would forget to call for an appointment. Finally, we managed to schedule an appointment for him and he turned up.

Fortunately for him, none of his brackets were broken and we could continue treatment without having to back track.

He is aware and understands that his orthodontic treatment will take longer than usual.

Individuals to Couples to Families

Today, Dr Lim treated members of three very special couples.

All six of them were her patients of our dental practice before they got married and now, they all have children of their own. The older kids have started to see Dr Lim while the younger ones are still awaiting the eruption of their milk teeth before they start seeing Dr Lim.

Thank you for giving us the privilege and honour of caring for you and your families.

Is it necessary to Scale and Clean after Braces?

At the end of orthodontic treatment, the standard procedure would be to remove the brackets, take an impression of the aligned teeth and the necessary x-rays and photographs.

What we found was that those patients that did not brush properly invariably end up with:

• calculus coating the surface of the teeth
• some decay

So what are the consequences of leaving these two conditions alone and take the impression for the fabrication of the retainers?

Firstly, the impression is an accurate reproduction of the tooth positions at the end of braces. This impression is used to make the retainers which fit the straightened teeth accurately to prevent the teeth from going crooked again.

Now, imagine what happens if we do not scale away the calculus coating. We will be taking an impression of the coated teeth and the retainers are made to fit the calculus coated teeth. When the calculus is removed later on or it breaks off, a space will form between the retainer and the teeth. This space allows the teeth to move and the results in crooked teeth even though you have worn your retainers faithfully.

In the next scenario, imagine having your decay treated after the retainers are made based on the original shape and contour of your teeth. Filling the teeth almost never restores the original shape and contour of your teeth. This will result either with a gap between the retainer and the teeth (under-contoured) as discussed above or it may end up with an over contoured restoration which will prevent the retainer from fitting.

These are the reason why we encourage and do an examination, scale and clean when we remove the braces and before we take the impression for the retainers.

As this is an optional step, it is not part of the orthdontic fees.

Patient in Pain

One of our orthodontic patients called on behalf of his friend whose wisdom tooth was causing him pain and urgently needed to be seen as he is flying off on Monday.

An arrangement was made for our oral and maxillofacial surgeon to see the patient after office hours on an emergency basis. The patient arrived early for his appointment but our oral surgeon was held up in the operating theatre and did not arrive until 7 pm.

The removal of the wisodm teeth was completed and resorbable sutures was placed in view of the patient's travel plans. The eliminated the need for the patient to change his plans just to remove the stitches. The patient had his dental problem resolved and left by 7.30pm.

By special prior arrangements we are able to accommodate our patients at a time that suits their schedule.

What you can do to reduce wait time

Having to wait for your treatment is a very common gripe amongst patients.

It must be stated that your time is as important as our time. Thus we can both help each other to reduce the need for waiting.

1. Be Punctual
We tend to attend to patients who come on time because we also respect their time. If you come late for your appointment, you may find that those who arrive after you may be seen before you. Under such circumstance, by seeing you when you arrive will result in the others having to wait. If you come on time, surely you would want us to see you on time and not the other person who came late.

2. Do not ask to be squeezed in
When you are squeezed in, you are taking away time from some one else. If something unforseen occurs in that person's treatment, you will end up having to wait unnecessarily.

3. Do not insist to have more treatment than what has been scheduled
This often results in the next patient having to wait for quite some time before being seen. No one wants to be on the receiving end of this problem.

Just yesterday, one of our orthodontic patients came for the application of fissure sealant on her tooth. She came on time and she was immediately shown into the treatment room. As soon as she finished her fissure sealant procedure, she was shown into the orthodontic operatory where she had her braces adjusted.

She spent no more than 20 minutes in the practice and she was pleasantly surprised. She kept exclaiming "Wow, everything is going very smoothly today and there's no need for any wait!"

We would want you to have the same experience as well, so help us to help you!

What will my smile look like?

We saw a patient today, who was very bothered with the look of her upper front teeth. She was very conscious of how those front teeth looked especially in photos. She came to consult us in search of a solution that would fit her lifestyle.

This patient was reluctant to proceed with any treatment option without first being able to see a simulation of what her smile would look like at the completion of her dental treatment. Together with the patient, we decided to mock up several treatment options for her to visualise the end result. The patient was willing to accept the following:

• the mock ups will be done one at a time rather than simultaneously
• there will be a time lapse before treatment is carried out
• it would require several visits to the practice
• there is costs involved

We have planned a prosthodontic mock up session for veneers and crowns (requiring about one hour) and another session for an Invisalign simulation approximately 4 weeks later if she was not comfortable with the prosthdontic option.

The patient was extremely happy that we could visualise her treatment to assist her make an informed decision regarding her smile.

Long Distance Braces

We had a patient who started her orthodontic treatment towards the end of last year. As she was going to further her studies in Australia earlier this year, her parents wanted brackets that did not require her to visit us as often as if conventional braces were used.

We chose to use the Damon bracket for her because this bracket design requires an adjustment every 8 to 10 weeks compared with 4 to 6 weeks in conventional brackets. This allowed the patient to come back to Singapore for her orthodontic adjustments during her Australian school holidays.

Having her come back about every 2 to 3 months for her orthodontic adjustment also worked out very well for both the patient and her parents. She did not have bouts of homesickness and her parents did not miss her as much.

The patient flew in on Saturday and she will be going back to school in Australia on 10 October. We will be seeing her again in December and she should be finishing her braces by February of next year.

Why is there a black line under my crown?

Today, our orthodontic patient told us that her friend's front tooth has a black line at the gums, just like in the picture. She asked if anything could be done for her friend.

The black margin occurs, usually as a result of the use of non-precious metals in the crown. These crowns are cheap but by the very nature of the metal, they show a black margin under the gums.

This issue can be addressed by using dental gold for the metal base in the porcelain fused to metal crowns as gold does not corrode. However, we all know that gold is costlier and thus the crown would not be cheap.

Another alternative is the all ceramic crown. These crowns are ideal for the aesthetics of the front teeth. They look very natural and they address the black margin issue better than other options. Again, this option would cost more than the non-precious metal crowns.

If you have the black margin problem under your crown and you would like to correct it, call our office today to get a consult with one of our specialist prosthodontists.

Another Birthday in our Team

Today, we gave Dr Cheong a surprise birthday celebration at the end of her clinical session.

On behalf of all of us at the practice, Arica took the trouble to buy a really delicious chocolate fudge cake for her. We even managed to pack some takeaway cake for her husband and her daughter.

Happy Birthday Dr Cheong!

The Next Appointment

Last week, one of our orthodontic patients was happy with her results and wanted her braces out.

For the removal of braces, patients are usually given two appointments:

1. The first appointment to remove the braces, take post treatment x-rays and photos, clean the teeth and do any necessary restorations. Finally, we take a mould of the teeth and this is used to make the retainers. The mould is taken at the end of the appointment to ensure a good fit of the retainers because if we take the mould before restoring the teeth, the mould will not be accurate and the resulting retainers will not fit well.
2. One week later, the retainers are fitted for the patient

For patients that are having their braces out, we try to give them an appointment the following week.

However, in this case, we were not able to co-ordinate the appointments between the orthodontists and the other clinicians. The orthodontist was available but the other clinicians were booked out till the third week of October. Mum was not too thrilled about that and she made that very clear to us.

We reassured mum that we would explore the following options for the patients:

1. we would possibly have a last minute cancellation but this would mean that the patient was going to get a rather short notice of her appointment.
2. we could ask one of the off duty clinicans if they could come in specially just for this patient.

Well, yesterday, as we were confirming patients for Friday's appointments, two patients who had one-hour appointments cancelled. This is usually not acceptable but in this case, it worked in this particular patient's favour.

Our front office contacted the orthodontic patient and arranged for her to come in on Friday to remove her braces. Mum is now satisfied.

I'm getting married, what can you do for me?

She did her braces with us when she was still in school at least 10 years ago. She has been a regular patient since then and she even introduced her fiance to have his dental treatment done with us. She is getting married in October and she wanted to look her best on her special day.

Back then, when we finished her orthodontic treatment, she had some gum shrinkage which resulted in several "black holes" just under her tooth contacts. The shape of her teeth also did not help.

We are looking at several treatment options to make her the radiant bride on her big day!

Is that me?

One of our patients who finsihed her orthodontic treatment about a year ago asked to see the pre-treatment models of her teeth. Although she has straight teeth now, she could not remember how far she has come since she started treatment.

When she saw original condition of her teeth, she was amazed at her transformation from duckling to swan.

Apparently, her mother did not think that her condition was that serious and told her not to bother about having her teeth fixed. But now, she is happy that she did have her teeth done.

She asked and was presented with her models which she says will be taking pride of place in her room. With that, all she needs to do to remind her that her orthodontic treatment was well worth her effort is to look at her original teeth.

Instant Teeth?

We had a patient who last saw us 7 years ago.

During this last 7 years, she did not get her gum disease (periodontitis) treated, which resulted in 9 of her teeth being very shaky in her mouth. She remembered that when we did her last denture for her, we had the denture ready before we extracted her teeth. By doing it that way, she did not have to suffer the embarrassment of going without her teeth.

She went to a dentist near her home and she was told that having the dentures ready before extracting her teeth was not possible. So she decided to return to us to have her dental problem resolved.

Unfortunately, this time, instead of having all her teeth done, she only wanted to have her four front teeth done despite us advising her otherwise. This means that when the other 5 teeth need to be removed, she would need to redo her dentures again.

Well, we can only do what our patients allow us to do and nothing more.

University of Sydney Alumni Singapore

The University of Sydney held their annual Alumni Day celebration yesterday for its Singapore Alumni. This year, Professor Eli Schwarz, the Dean of the Faculty of Dentistry, University of Sydney was also among the 40 strong delegation who flew in from Sydney.

We spent the evening catching up with Prof Schwarz, who updated us on our professors and lecturers from when we were studying there. We also spoke on the future direction of the Dental Faculty in Sydney.

Prof Schwarz then discussed the state of dentistry in Singapore with the opening up of the local dental profession to ASEAN and Indian graduates. Prof Schwarz related Australia's concern about the adverse effects of foreign trained dental professionals and its decision not to allow them free access to the Australian public.

We finally touched on how Singapore patients compare with Australian patients. Prof Schwarz, seeing the size of Singapore commented that it our patients would most likely not need to travel too far to get treatment as compared with Australia where he has known of patients driving 1000 km to seek dental help!

That reminded me of the time when I was in the New South Wales' State Orthodontic Service and I had to fly out to Wagga Wagga once a month to provide orthodontic treatment to the people of the Riverina Area. I had patients drive 5 hours just to see me at the Wagga Wagga Bae Hospital!

All in all, it was a fruitful event and we look forward to the next edition of the University of Sydney Alumni Day.

How many cavities can a Baby Bottle cause?

Yesterday, Dr Lim saw a 3 year old patient who goes to sleep every day sucking his baby bottle.

Mum and dad brought him in to "manage his decay" because they saw many holes in his front teeth when he smiled. This condition is known as baby bottle syndrome.

Dr Lim found that 13 of his teeth had decay on them, with each tooth having two cavities for a total of 26 holes! One of the teeth even had the decay spread into the root of the pulp chamber. In order to spare the child of the psychological trauma of multiple visits to the dentist to have the teeth treated, his parents are contemplating having all the treatment done under a single general anaesthesia procedure.

To prevent nursing bottle cavities, parents can do the following:

• do not leave a bottle in a child's mouth when he or she is asleep.


• begin cleaning your child's teeth as soon as they come into the mouth with a toothbrush or a wet cloth.


• bring him to see the dentist by his first birthday.

Save your child from the unnecessary pain of baby bottle syndrome.

Slow and Easy...

One of our orthodontic stragglers finally came in today for his adjustment. He was last in our dental office in March 2008, which was one and a half years ago! We have been chasing him regularly during that all time to no avail. The reason why he came in today was because he has been extremely busy for the last one and a half years. However, today he is clearing his leave (14 days in a row!) in preparation for Hari Raya Puasa.

When we looked in his mouth and lo and behold, his braces were still intact after all this time! This reasonable condition of his braces facilitated his treatment for two reasons:

1. All of his teeth were firmly being controlled by the braces, i.e. no teeth going haywire.
2. Treatment could progress from the time we last left off without having to backtrack due to breakages of braces.

As such, he is very close to finishing his orthodontic treatment.

When we completed today's adjustment, we tried to make another follow-up appointment for him but he claims to still be very busy. We even suggested that he cleared his leave on a monthly basis, instead of 14 days at one go, just so that he could come and complete his treatment quickly. He told us that the earliest that he could try to come for an appointment would be in December of this year, three months from now.

His infrequent visits to have his braces adjusted would have delayed the completion of his treatment dramatically. The silver lining in all this is that he accepts his situation and he is willing to live with having to take a much longer time to complete his treatment.

Dr Cheong wins NUS Teaching Award

Dr Cheong has won the Best Lecturer Award in the Faculty of Dentistry, National University of Singapore. This award is based on the students' votes. This is the second year in a row that she has won this award. What is more remarkable is the fact that she is only a part-time lecturer.

We would like to congratulate Dr Cheong on her commendable achievement.

Well done and keep up the good work! The future dentists of Singapore are in your very capable hands.

Money or your LIFE?

Yesterday, we had a patient come in complaining of gum pain on the left side of his lower jaw. This ex-smoker started having pain in that area for the past several days.

When we examined him, the area in pain did not have a tooth present as it was extracted "a long time ago". However, the area was pain to the touch. We took an x-ray for him to make sure that there wasn't a tooth remnant lying beneath the gums in that area. The x-ray did not show anything buried underneath the gums.

The gums on the other hand had an unusual pattern on the surface and we suspected that it may be pre-cancerous so we referred the patient for a biopsy. If it proves to be cancer, at least, treatment can be started early to save this patient's life.

We made an urgent appointment with the oral and maxillofacial surgeon and prepared the referral documents for the patient. We also dispensed some symptomatic oitment for the patient to tide him over until he is seen by the specialist for the definitive treatment.

The patient took the ointment but refused to pay for both the ointment and the referral. He also did not want to have the biopsy done because he claims to have no money despite being informed that the biopsy was covered by Medisave.

Looks like a mobile phone means more than a LIFE!

Another Wedding Photo Shoot

Twice in two days. This is just amazing.

Today, one of our Invisalign patients came in for her orthodontic treatment. Her teeth were tracking well but she has some way to go before she completed her Invisalign treatment.

Well, she's getting married in November and she asked us whether she could have her tooth coloured attachments removed for her big day so that they do not show in her wedding photos. We told her that we will definitely do that for her and in addition we will do it at no charge for her as a token wedding gift!

Congratulations!

A Wedding Photo Shoot

Dr Lim did not have a schedule for today but she did something special for a very special patient today.

This patient is flying off to London on Monday to take her wedding photos but she did not like the grey/silver shade of her amalgams. She opted to have tooth coloured restorations so that she could look as perfect as possible for her once in a lifetime photos.

Due to the limited time available, Dr Lim came in to the clinic today just to see the patient. She replaced the visible amaglams with Cerec Computer Aided Design and Manufacturing (CAD/CAM) restorations so that the patient could get the treatment done within the same day.

The patient was very impressed with the technology and the end result that could be achieved with it. She now has her desired tooth coloured restoration and she can now smile confidently for her wedding pictures!

Patients who care!

Last week, Dr Lim was sharing issues about bone health with a patient suffering from Rheumatoid Arthritis. This patient's condition is rather severe with the disease causing her fingers to bend. Her pain is so severe that she walks with the aid of a walking stick.

When she found out that Dr Lim also had some bone issues, she went out of her way to buy an additional box of the health supplement she was taking just for Dr Lim.

Today, she got her husband to bring the box of health supplements to Dr Lim when he came for his dental appointment.

We are very fortunate to have such caring patients. Thank you for thinking about us and we will always keep you in our thoughts.

Wisdom teeth

SL completed her braces with us in 1999. She was then awarded a government scholarship to study at an Ivy League university in the US. After spending 8 years completing her bachelors and masters degrees, SL returned to Singapore to serve out her scholarship bond.

Upon her return, SL resumed her orthodontic retainer and dental follow-up with us in 2007. Just this year, her wisdom tooth started to cause problems and it was decided that the wisdom tooth had to go.

Her appointment was scheduled for today and our oral and maxillofacial specialist removed the tooth in under 30 minutes. Both she and her mother were all smiles at the end of the procedure. She did not need to take painkillers (analgesics) because according to her, there was no pain. Furthermore, her fees were mostly covered with her parents' Medisave.

My friend didn't need...

This is a very common statement that we encounter.

"When my friend did his braces, he did not need to extract teeth."

"When my friend did his braces, he did not need to do both jaws."

"When my friend did his root canal, he did not need to crown his tooth."

Sometimes, we wonder why patients would ask this question.

To us, each patient is an individual and we treat them as individual. Many times, we simply ask our patients, "Do you look like your friend? If not, what makes you think that your friend's treatment plan would work on you?"

As an example, let us look a two patients that have the same pattern of crooked teeth. That is what we all see on the surface. However, underneath this appearance, one patient's jaws may be wider than the other or his teeth are smaller in size than the other. These factors can tip the decision between needing extractions or not when the braces are done. That is why we have to customise each patient's treatment to specifically suit his unique circumstances.

Patients deserve to be treated as individuals unless they do not want to be treated that way! We treat each and every patient of ours as individuals

The OTHER Role of Saliva

When saliva is mentioned, most would associate it with the digestion of food. That is what we were taught in secondary school biology.

However, saliva has an even more important role, i.e. to protect our teeth from decay. Saliva's buffering capacity has a moderating effect on the acids that we ingest on a daily basis. This prevents an acid attack which can soften the surface of our teeth.

For example, if we have our customary breakfast orange juice and brush our teeth after that, we would be brushing away some of our teeth. Over time, we would have removed enough tooth substance to expose the nerves in our teeth. Not a pleasant experience.

As dentists, we need to determine the cause of the decay before we treat the cavity otherwise the decay would recur. This would involve the use of salivary test to determine salivary pH and salivary flow rate.

Salivary pH can be reduced when there is a shift in fluid balance as a result of execrise. A lack of hydration on the other hand would reduce salivary flow.

Sometimes, the medication that we take would also affect our salivary flow. In patients being treated for Rheumatoid Arthritis, one out of three would suffer from dry mouth. It is more likely to occur in female Rheumatoid Arthritis patients. This would inevitably lead to numerous teeth having decay, especially on the roots of the teeth, which is the most difficult to treat. Patients with Hepatitis C and diabetic patients would also suffer from dry mouth and up to 50% of patients would be affected. Dry mouth from these conditions is the result of Secondary Sjogren's Disease.

Conversely, with orthodontic (braces) treatment, there would be an increase in salivary flow. There is also a related change in the bacterial colonies in the mouth and an increase in bacterial count.

Thus, it is important for the dentist to regularly to assess the patient's caries risk and to tailor treatment to address those needs. Patients who suffer from Rheumatoid Arthritis, Hepatitis C and diabetes should visit the dentists more frequently so that any dental problems can be detected and treated early to prevent further adverse consequences.

Advances in Gum Treatment

Periodontal (gum) disease progresses steadily if not treated. It starts with bleeding gums before progressing to shrinking gums and finally loose, shaky teeth.

Previously, conventional wisdom was that there was no cure for gum disease. The only thing dentists could do was to stop it from progressing and preserving what was left of the gums.

Today, there are numerous ongoing research into the holy grail of gum treatment, i.e. the cure for severe gum disease. The latest research is able to regenerate the lost bone destroyed by the disease but the best news to date is that scientists are able to regenerate the gums themselves.

There is also research into how dentists can block the disease process and ultimately shut it down as well.

For the patients, it would mean being able to save their undecayed teeth and eliminate the need for dental prosthesis. It is a shame to lose perfectly healthy teeth just because they have no foundation (the bone) to hold them.

Changing Concepts in Dental Treatment

Professor Mark Wolff of New York University School of Dentistry presented the results of various research carried out in his dental school:

1. The lifespan of dental restorations in the US is on average 8 years.
2. The more frequently a patient changed dentist, the more frequently their restorations change. Changing restorations invariably lead to larger restorations.
3. The more a tooth is cut, the more it is weakened.
4. In the 1960s, 2/3 of adults over 65 had no teeth. Today, 2/3 of adults over 65 have on average 17 teeth.
5. Enamel (outermost layer of the tooth) dissolves at pH 5.5 while dentine (inner layer of the tooth) dissolves at a less acidic pH of 6.2. Contrast this with the pH of Coke Lite (pH 3.2), Sprite (pH 3.2), Red wine (pH 3.0) and White wine (pH 3.2).
6. The latest tooth decay management strategy include (in order of preference):

• Home care instructions
• Dietary counselling
• Fluoride toothpaste
• Supplemental fluoride (at home and in-office)
• Calcium products (dental formulation)
• Antimicrobials
• Restore tooth

As can be seen, having to do a restoration on decayed teeth is the least preferred choice of treatment. All the other strategies are designed to heal the tooth. So don't be surprised if the next time a dentist tells you that you have a decayed tooth, the dentist may not even restore your tooth. Instead he may adopt the strategies as outlined above.

We hope that this information is useful for our patients.

FDI World Dental Congress

The FDI World Dental Congress commenced its main programme today.

One of the topics presented this morning was Advancing Dentistry with Advancing Technology. It discussed the latest uses of laser technology in dentistry:

1. Calculus (tartar) Detection
2. Hardening of tooth surface to prevent tooth decay
3. Repair of initial decay
4. Laser induced analgesia which could possibly replace pain-killers
5. Whitening tough stains e.g. tetracycline stains
6. Root Canal disinfection
7. Coating tooth surface

The Er:YAG laser is the most used dental laser. With the laser, there is no need for the use of the dental motor and the bur. In a research done in Germany, 83% of the patients in this study liked the laser compared with the bur and 88% of the patients in this same study expressed that they would do laser treatment in future.

Currently, the are about 400 practices in Australia that are equipped with lasers. There is still some way to go before lasers are accepted by Singapore patients and become mainstream here.

Future of Facial Reconstruction

Terrorism is a major threat to modern society.

It not only kills but worse still, it maims many innocent bystanders.

Most of these victims suffer horrific hand and neck injuries with the loss of bone, teeth and flesh. They have to endure multiple opeartions in an attempt to reconstruct their faces. However, there are limitations as to what modern surgery can achieve at this stage.

New research is being carried out in the field of scaffolding where the donor cells are removed, leaving behind the scaffold structure and the host cells are then cultured onto these scaffolds. Replacing missing bone structure is also being investigated to give structure to the face with the objective of returning the face to its original form and shape.

In addition, there are ongoing studies into better tooth replacement options.

The major obstacle to facial reconstruction at this point in is the ability to replace lost muscles and the horizon for this is much further than the rest.

With advances in these fields, it is hoped that the impact of facial wounds will not be as devastating as before.

Dental Diplomacy

In recent years, Singapore has increasingly been involved in dental missions, especially to neighbouring countries.

The nature of dental disease makes dental missions an ideal diplomatic tool. Dental patients have pre-existing conditions whereby the institution of treatment would resolve the problem. There is usually no need for complicated follow-up and long-term care.

Medical patients, on the other hand, need time to heal. Example, a diabetic patient or a hypertensive patient would need long-term medication and a regular follow-up to monitor their condition.

The SAF's deployment of a Dental Project Team to Bamiyan Province in Afghanistan as part of the Provincial Reconstruction Team is a good example of the use of dental missions as a diplomatic tool.

CSI Forensics

CSI and its offshoots CSI Miami and CSI New York are all very popular TV programmes.

CSI or Crime Scene Investigation would involve some dental input. When there is an unidentified victim or the presence of bite marks on a victim, dental expertise is frequently required to process the data to identify the victim or the perpetrator.

DVI or Disaster Victim Identification also involves some dental input. Here, the forensic dentists are involved in the identification process where the effects of the incident, e.g. tsunami, accident (aircraft crash or ship sinking) or terrorist attack renders visual identification impossible. They compare previous dental records with the dental remains.

As the dental examination is very involved, it is usually the bottleneck in the DVI process during mass casualty scenario.

It is therefore important that our patients' records are regularly updated.

NatGeo - Inside Afghan ER

According to the U.S. Department of Defense’s Directorate for Information Operations and Reports, during World War II, the likelihood of surviving battlefield wounds was 69.7 percent; by the end of the Vietnam War it had improved to 76.4 percent; and survival of those wounded in the current Iraq (and Afghanistan) War has increased to an astounding 90.4 percent.

The reasons for this include the new state-of-the-art, bullet-proof vests that soldiers are equipped with and the fact that military combat hospitals are equipped with the best technology available.

Improved soldier body armour has resulted in distinctly new patterns of combat injuries. Unprotected areas of the body account for the majority of injuries. Bullet-proof vests may protect the heart, but not even Kevlar helmets can offer complete protection for the head. Shrapnel can make its way into the brain via the face, the forehead or the nape of the neck. Such wounded soldiers are quickly evacuated to the combat hospital, usually by medevac helicopter.

This documentary, broadcast at 8 pm last night, is about the US military's combat hospital at Camp Salerno located 90 miles from Kabul. This four bed trauma facility is one of only three US combat hospitals in Afghanistan and it appears no different from any well equipped ER in the developed world.

The type of injuries that the modern soldier sustains in the head and neck area frequently involves the mouth and teeth. Thus the skills of the dentist is increasingly becoming more of value in the modern combat hospital.

How long must I wait?

In Bamiyan, Afghanistan, patients are known to walk two hours to reach the only dental clinic in the province. Then it is a one hour wait in line just to get to the front of the queue so that a hospital administration staff can determine whether the patient gets to see the dentist. If that staff decides for administrative reasons that tthe patient cannot see the dentist, the patient would just take another two hours to walk home. No fuss and no complaints.

In Wagga Wagga, Australia, patients are known to drive five hours just to see the orthodontist. Again, if for unforseen reasons, the orthodontist runs late, the patients would sit and wait in the reception area. Again no fuss and no complaints.

We are acutely aware that our patients' time is very important and we constantly strive to see all our patients on time if they come on time. However, things sometimes happen and the dentist would run late. We ask for your understanding in such situations. At the same time, we will endeavour to keep all waiting patients updated about the estimated time of when they will be seen.

A Tale of Two Patients

We had a patient the other day a patient came in early in the morning complaining of pain. He had a tooth in his mouth that was broken 3 years ago. He endured the pain by stuffing panadol into the stump of a tooth. Finally, he came in because the panadol was not working any more.

We gave him the specific injections to numb the broken tooth and all the gums and neighbouring teeth were numbed but the broken tooth could not be anaesthetisised. The reason is that because he left the tooth untreated for so long that his body had form a protective barrier around the borken tooth to prevent the infection from that tooth from spreading. This protective barrier is also barrier to the anaesthetic medicine from penetrating into the infected area.

The patient insisted that we take the tooth out despite the lack of anaesthesia on the broken tooth.

As the tooth was badly broken down, we were not able to grip the tooth with our forceps. We had to cut the tooth into three before we were able to take the tooth out.

On the same day, we had another patient whom we had earlier diagnosed as unsaveable. We had a set of dentures made before hand so that on that day, when we extracted the tooth we could give her a new set of dentures and she did not need to go a day without her teeth.

This is the result that you can get if your treatment is properly planned and executed unlike the earlier example which resulted in unnecessary pain and aesthetic issues with missing teeth.

One became two became three!

When I arrived at the office today, I saw this little girl playing with the fountain in our reception area and mummy watching protectively over her 17 month old. They are Daniel's wife and daughter.

I first met Daniel when I was an orthodontic registrar at the National Dental Centre. When I left to set up Omni Dental Centre, Daniel followed me out. That was in 1997 and Daniel was just a 19 years old recruit in the SAF.

Daniel has stayed with us all these years, coming regularly for his dental check ups. Along the way, he introduced his then girlfriend (now wife) to see us. When his baby daughter started having teeth, he brought her to see us. And that made three.

Shortly after coming in to the office today, I met Daniel along the corridor. He had just finished his treatment and he introduced his daughter to me. He said, "Next time, when she grows up, she's going to see you to have her teeth straightened!"

Team Member Wanted

We are looking for new Mandarin speaking members to join our friendly and talented team.

We have a beautiful modern hi-tech office, a wonderful patient population, an enthusiastic team, and dentists dedicated to quality care.

So, if you are a team player with a positive, caring and sincere personality, we are looking for you. Previous dental experience would be helpful, but a great attitude and a strong work ethic are our first priorities.

Call us for an interview appointment today. Our application form can be downloaded from our website at www.omnidental.com.sg/career.htm under "Forms".

Treating Strawberries

According to Wikipedia, the strawberry generation (草莓族) is a term coined in Taiwan to designate people born in the 1980s (between 1981 and 1991).

The general perception is that these people, having grown in a protected environment and with economic prosperity, are less able to withstand pressure or to do hard work. The term is linked to the fact that persons from this generation are generally supposed to have grown in a protected environment (e.g. being overprotected by their parents), just as strawberries are grown in greenhouses and command a high price compared to other fruits.

In the words of Dr Chong Yeh Woei, President of the Singapore Medical, they look good on the outside, are soft on the inside, and bruise easily.

From our observation, the strawberry generation could possibly extend to those born in the 1990s as well.

We just saw a patient that was suppose to come for his braces adjustment two weeks ago but his mother called to cancel on the day of the appointment because he was sitting for a paper in the national examinations on yesterday.

He came for this appointment after his national examination paper because he broke off one of his brackets but for this appointment, he only wanted to have the broken bracket replaced and his mother specifically instructed that we do not activate his braces because he was sitting for his trial examination the following week.

Every time breaks his braces, it's never this princeling's fault but our glue is not strong enough to sustain his abuse!

Every time he cannot come, he has a reason e.g. headache but we have to understand and accommodate our schedule to his whims at the expense of other patients. Mum demands that we give him an appointment that suits his convenience regardless of whether there are other patients scheduled to come at that time.

Whenever he comes, his mother would sit in the operatory to watch what we do and she is always questioning us about what we were doing. She would also question our front desk about payment and appointments.

Fortunately for us, not all parents are like this and most of our patients are a joy to treat. To all these patients, thank you for making our work "peachy".

Braces for Faces - You Handsome Devil, You!

Yin's mother came in yesterday one of her children. It took several takes before both Siti and Arica realised that it was Yin! He looked completely different from what we remember him to be. His face appears to be shorter and more proportionate than before. According to him, even his long time friend walked right pass him without recognising him.

Mum was all smiles yesterday and she kept asking whether he looked more handsome post surgery. Arica commented that he looks much better now, despite some residual swelling. In fact, she added that he now looks more like his mother now! Mum seemed pleased.

Yin revealled to us that he has been on a soft diet for the last three weeks and yesterday, the surgeons removed his surgical wafer, allowing him to have his first decent meal in weeks. He also intimated that there was some pain and discomfort but overall he had not regrets and would happily do it again.

Singapore is a Food Paradise!

On Wednesday, we went to Ion's Food Opera for lunch. It was very crowded and we ended up sharing our table with two Caucasian ladies and their Singaporean friend. The two ladies were so excited with the wide variety of food available and they kept leaving the table, only to come back with another type of food. We overheard them comment that Singapore is such a food heaven and they wondered why our Singapore Girls remain so slim despite having such good food to enjoy.

Well, I have had the experience of eating with an orthodontic retainer and I can tell you that food does not taste that great when you have some of your taste buds covered, either by a retainer or a denture.

Therefore, if you want to enjoy the culinary delights on offer in our country to the fullest, make sure that your dentition is in good working condition!

Hard food, Hard luck!

Yesterday, a patient who last saw us one year ago introduced his girlfriend to see us for her dental problem. When we first saw him last year, he had broken his tooth eating compressed crispy Thai pork floss, a very popular snack. In order to save his tooth, we had to perform a root canal and crown the treated tooth (which is still outstanding) to protect it from fracturing.

Well, her girlfriend presented yesterday with exactly the same problem, only on a different tooth. We had to relief her pain and rebuild the missing part of her tooth before giving her an appointment for the root canal.

We would have been expected that after his original mishap, he would have advised his girlfriend to be more careful when eating hard food.

Finally, the Retainer

When we first saw Wendy at the start of her orthodontic treatment, she was shy about her smile. Normally the upper front teeth are in front of the lower front teeth (overjet) by between 1 to 3 mm. Hers were at 11 mm which made her a candidate for a combination of orthognathic or jaw surgery and braces in order to correct her problem. Alternative, she could accept a compromised result and omit the surgery.

Wendy decided to go the non-surgical route despite the extended treatment time.

She used to be very shy about her smile, covering her mouth in embarrassment every time she smiled. Perhaps due to this, she was never proud of her deportment. She used to come sloppily dressed, usually in her pajamas, her unkempt hair and her spectacles.

After several years of orthodontic treatment, her overjet was reduce to within the normal range, i.e. 1 to 3 mm. She was delighted with the result and we removed her braces last week. She also aksed for her smile to be whitened, which we did.

Today, she returned to collect her retainer and my, what a change! She was all glammed up, sporting a new hairstyle, make-up, fashionable attire and contact lenses! This time, she flashed her new smile repeatedly with lots of self confidence.

Thank you Wendy for giving us the chance to be part of your metamorphosis into a butterfly

Braces for Patient from 9 years ago!

Ashley's mum started orthodontic treatment with us when our practice first started many years ago. She brought Ashley to see us in 2000 when he was in Primary 2 and we have not seen him since until today. In the mean time, we did braces for his two older brothers and dad also had his teeth looked after by us.

Today, Ashley is back to have his orthodontic treatment done with us. He is starting his braces at this mature age because he has a jaw discrepancy which requires him to have completed his adolescent growth spurt before a surgical option can be considered with is orthodontics.

Welcome back Ashley!

Happy Birthday Daniel!

Well, it's finally Daniel's turn to celebrate his birthday. Daniel is our IT go-to guy whose tireless effort to keep the IT systems in our office chugging along has enable us to operate smoothly on a daily basis. He looks after the scheduling software, the patient entertainment software and the digital radiography (x-ray) hardware and software. Last but not least, the maintenance of our practice website and the setting up of these practice blogs would not have been done without the help of Daniel.

The dark chocolate cake from Bakerzin was just heavenly!

We would also like to take this opportunity to thank Daniel for all his assistance in our time of need. Once again, Happy Birthday Daniel and here's wishing you many more to come.

From All at Omni Dental Centre.

Penny wise, pound foolish

A patient came in today having spent a sleepless night enduring the pain of a toothache while waiting to seek treatment to rid him of his excruciating pain. Some have described the pain as the most severe pain after child birth.

He had previously had multiple extractions with no tooth replacement because he refuses to pay to look after his teeth. Although he would have huge cavities, he would normally wait until he was in pain before he sought a remedy. By that time, a small, easy to fix cavity has grown into a full blown acute inflammation of the tooth with nerve involvement and a costly and time consuming rehabilitation process.

We told him that because he has never had is extracted teeth replaced, it would be very difficult for him to have the replacement later on. We have seen patients who waited until all their teeth were extracted before they even considered having the worst of all options - dentures. They all complained of the horrid experience they went through to get used to their new dentures.

The lower dentures would be swimming around the mouth because of the presence of a tongue which got in the way of the denture.

The upper denture would drop when they talk, very embarassing in a social context!

Over time, the bone in the jaw would shrink and the dentures get loose and need replacement. Finally, when the jaws are completely stripped of their ridges, no dentures can be retained on the jaws and implants would need to be considered.

At this stage, in order to place the implants, some patients would require a rib to be grafted onto the jaws in order to carry the implants!

Initailly when he heard this, he asked if we could save his tooth for him. After reading an x-ray of his dental condition, we told him that the tooth was savable and how much it would cost him. Again, he chose the cheaper option of the extraction, forgetting the consequences of this option.

After removing the tooth, we had to tell this one-packet-a-day smoker to refrain from smoking for 24 hours to facilitate wound healing.

The cost of replacing that tooth with an implant (without the rib graft) would have been approximately equivalent to between 60 to 80 times that of the tooth extraction!

I remember what my lecturer once told me:

Dentistry is not expensive,

the neglect of your teeth is.

GEP Tales

One of Dr Lim's recent patients is a Gifted Education Programme (GEP) teacher in one of the top primary schools in Singapore.

She related that she had a student who transferred into her school to attend the GEP. For the first six months, that student coped well with the very demanding programme. This student was very industrious but despite her hardwork, she started to flounder subsequently. Fortunately for her, she managed to make it to the Primary School Leaving Examination (PSLE) and got average results. The reason why she struggled to cope with the GEP was because she was hot housed into the GEP and was not of the same calibre as her fellow contemporaries and hardwork alone may not be enough for the GEP.

In another encounter, Dr Lim was introduced to a GEP student while accompanying her son for his chess competition. Dr Lim was very impressed with this girl's achievements and decided to inquire further. She asked this 11 year old what her academic results were and the GEP student replied, "Didn't your parents teach you not to ask such questions?!"

I wonder what kind of a patient this 11 year old would make.

Pets love our NTIs

Today, one of our patients came in with his mangled NTI nightguard or splint. This device acts to protect your teeth and dental work against the harmful effects of grinding your teeth in your sleep (bruxism). According to him, his dog found the NTI and chewed it to pieces! Must have been delicious! We had to make a new one for him.

Some time back, we had another patient, who saw her NTI in her cat's mouth! She tried to pry it out of her cat's mouth, only to have the feline run into the the garden with the NTI in her mouth. By the time our patient found her cat, it was under a bush and the NTI was nowhere in sight. Another mystery of the missing NTI which need to be replaced.

The moral of the story is that our pets love our NTIs just like they love our homework! So, keep your NTIs in a secure place to prevent your pets from getting access to it. They don't need it as much as we do!

Have a Little Compassion

Yesterday, my son fell during physical education in school and injured his left ankle.

When he got home, we noticed that he was limping around the house and applied cold compress on his ankle. We also instructed him to go to bed early in order to rest his ankle. Yesterday, when he woke up for school, he found that he was unable to get out of bed. His ankle had swollen to the size of an orange and we had to get him a crutch to give him some mobility, no matter how limited. We waited till the doctor's office opened and brought him straight to see the orthopaedic surgeon.

As we were walk-in patients and had no appointment due to the nature of the injury, we expected to wait. However, we did not know how long we had to wait. As such, I thought it only prudent to postpone my only patient's appointment to another day so that she did not have to put up with any uncertainties.

When she was contacted, the patient said that she had taken a full day of leave to get her teeth done and she was upset that we had to postpone her appointment. She gave the ultimatum that "by hook or by crook" she expected to be seen today. She even told us that we must understand that she had taken leave for her dental appointment

Here's my dilemma:

1. Should I have left my son alone in the hospital to manage his own affairs so that I could give this patient a good customer experience and be branded as a "bad father"?

2. Should I have stayed with my son until his situation is resolved and disregard the patient's demand and be accused of giving "bad customer service"?

3. Is the customer always right?

I invite comments, feedback and suggestions as to how I should have managed this situation.

Thank you.

Tooth Brittle

We had a patient today who presented with a tooth that was completely decapitated at the gum level. The nerves and blood vessels that nourished that tooth were dead. It was just not viable to resurrect that tooth even if we wanted to.

Under such circumstances, we would give all patients the following information for the purposes of facilitating an informed decision:

When you fold a fresh green leaf, it does so without any damage to the leave. However, if you try to fold a dead, brown leaf, it will crumble into many small pieces. The same applies to a dead or non-vital tooth. They are very brittle and difficult to extract in one piece. Often, a surgical procedure is required to completely remove such teeth.

The patient understood the analogy and consented to the removal of the tooth. The moment we applied the forceps to the dead tooth, it immediately crumbled. This process of forceps application and tooth crumbling repeated itself several times until the forceps had no more tooth structure was available for the forceps to grip. We had to switch to a surgical procedure to remove the tooth in several pieces. In the end, it took over 90 minutes to completely remove the tooth.

Thus, never wait until the tooth is so badly broken down before you seek treatment. It's very traumatic experience!

What an inspiration! A Dr Lim wannabe!

We have a family of patients who take pride in how their smiles look. Both parents had the teeth straightened with Invisalign at our dental office.

The parents even believe in ensuring that their children have a healthy set of teeth and brought the kids in since they were two years old.

Today, mum shared this story with Dr Lim:

The other day, their 4-year-old girl told mummy that when she grows up she wanted to be a dentist just like Dr Lim. Mum and dad were overjoyed that their little tike aspires to be a dentist. However, that sentiment was short-lived. Their daughter also wanted to be addressed as Dr Lim when she became a dentist!

Mummy said, "But that is not your surname. You should be addressed by your surname."

She replied, "But I want to be just like Dr Lim and be called Dr Lim!"

Kids say the darnest things!

Halimeter

We just received our halimeter back from the agent.

So, just what is a halimeter?

Well, it's an instrument to measure the level of volative sulphur compunds in the mouth. These sulphur compounds are associated with bad breath or halitosis.

We now have the means to determine your baseline halitosis score and the ability to monitor its progress over a period of time. The score should improve with your decrease in bad breath as treatment is carried out.

Our dental team went through some comprehensive training on the workings and use of the halimeter so that we are proficient with it.

Do call us for a consult now and get rid of the embarrassment of bad breath! Be socially acceptable again.

Appreciation or Expensive????

Polly spent the last few days as an observer in an animal clinic. This was one of the more interesting "human" stories that the veterinarian related to her:

One day, she was performing a delivery for an expecting dog when suddenly, the dog went into labour distress as she was about to give birth to her last puppy of the litter. The vet immediately performed an emergency caesarian in order to save both puppy and mother. The procedure was successful and all the dogs were safe and well.

When the owner returned to collect her dogs, she was presented with the bill and she exclaimed, "Wah, why so expensive!" She even commented that had she known the cost involved, she would have bought another new dog instead of having the vet save her pet!

Throughout all this, there only criticism, angst and unhappiness expressed over the bill and not a word of thanks for the efforts put in by the vet.

Patient had two teeth knocked out

Today a medical clinic that we work with referred a patient who had a traumatic experience.

This 12 year old girl's schoolmate whipped her in the mouth with a bicycle chain, resulting in her two front teeth being knocked out (avulsed tooth) of her mouth. She came in still bleeding and holding a cold compress to her wound. She was sobbing quietly at the loss of her tooth and the laceration of her upper lip.

When our team of doctors asked her for the teeth that were knocked out, she replied that she did not have them and she did not look for them. The doctors then proceeded to check her for any broken bones in her mouth, stitch her laceration and stop the bleeding.

Our team was rather upset that such an incident could have happened to this pretty girl who had straight teeth.

Omni Nurses' Day 2009 Celebration

Omni Dental Centre celebrated Nurses' Day 2009 for our team today with a sumptuous lunch in appreciation for their dedication & professionalism.

In addition, we celebrated Polly's birthday (which happens to fall on 02/08/09)

Many happy returns of the day, Polly.