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.