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.