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Oral health in Singapore: Tips and treatments from the island’s top dental professionals

By: Verne Maree

Luckily for us, 21st-century technology allows us to maintain a full set of beautiful gnashers right through into old age. And Singapore offers the whole gamut of dental professionals, from dental hygienists to periodontists and oral maxillo-facial surgeons.

 

Teaching good brushing habits to the young'uns goes a long way
Teaching good brushing habits to the young’uns goes a long way

 

Your smile says a lot about you. Until not so many years ago, it was easy to pick out British actors in a movie: so many of them had dull and crooked teeth. At the other end of the scale, the brilliance of a Hollywood smile – so bright, so white, so even that it hardly looks real – marked you out as unmistakeably North American.

Some are simply born with good teeth, courtesy of good genes. I’ve met people in their 40s who barely floss, yet don’t have a filling in their head – and neither do their children. Others, like me, have a mouth full of horrible amalgam by the age of 10, and are due for a total dental overhaul before their 30th birthday.

You’re fortunate if your medical insurance covers dental work: ours won’t pay a cent. Be that as it may – a strong set of teeth that functions properly is a vital part of good health, and if you neglect them you will end up paying one way or another. For one thing, poor digestion, compromised nutrition and gum disease pave the way for just about every life-threatening condition you can think of.

Aesthetics count, too. Having an attractive smile – whether God-given or courtesy of a highly skilled dental professional – is important for self-confidence. On the other hand, the fear of revealing crooked, discoloured or even missing teeth can be enough to make one too embarrassed to smile… and what a pity that would be.

 

Baby's first little chompers
Baby’s first little chompers

 

#1: Get off to a Good Start

Caring for your baby’s teeth is essential, says Dr Ong Yean Sze from Kids Dental World, and establishing correct dental habits in young children will stand them in good stead for the rest of their life. “Most of your child’s dental care can simply be carried out at home,” she adds, “along with regular six-monthly checkups by your dentist.”

While it’s true that some are more susceptible than others to dental decay, there’s a lot you can do to prevent it. A combination of several factors is required for dental decay to begin, such as:

• bacteria that are conducive to decay, and a diet that encourages the growth of such bacteria;

• susceptible tooth structure and surfaces;

• availability of fluoride, and so on.

Sugar and acid
Dr Ong’s key advice is to strictly limit not only the amount of sugary and acidic foods your child eats and drinks, but the frequency with which he or she consumes them. Fruit juice and soft drinks need not be completely avoided, but should be consumed during mealtimes to reduce the exposure time between acid and sugar and teeth. Sweets and ice cream should be considered party treats.

Snacks between meals should be savoury or sugar-free.  Remember that even sparkling water and fizzy diet drinks that don’t contain sugar have an acidic reaction: the carbonation that makes the drink bubbly will erode tooth enamel.

Brushing and flossing
Thorough pre-bedtime tooth-brushing is essential, so parents need to help with this until children have developed the necessary dexterity; Dr Ong suggests that supervision should continue until the age of seven or eight. Plaque-disclosing dyes are a fun way to show up areas that have been missed.

Most young children are not good at flossing, so you’ll need to do this between all the baby teeth that make contact with one another: between the baby molars is a primary site for decay. But if your child has natural spacing, simple brushing is enough.

Fissure sealant
Tooth fissures – the deep pits and grooves on the chewing surfaces of the back teeth – are so narrow that even toothbrush bristles cannot clean them, so they tend to attract bacteria. To prevent the onset of decay, your dentist can apply a fissure sealant: a special material, white in colour, that bonds directly to the tooth enamel and forms a protective coating over the tooth. This is most effective when it’s done as soon as practicable after the eruption of the tooth.

How does fluoride work?
• First, it works on the yet-to-erupt adult teeth that start to form at birth, helping them to grow strong and healthy. Second, it works on the exposed teeth that have already erupted.

• Singapore tap water is fluoridated, and toothpastes are another good source of fluoride for children.

• For those who are too young to expectorate, but who already show signs of early tooth decay, a small amount of fluoridated toothpaste (the size of a rice grain) smeared over affected surfaces can prevent the decay from going further.

• Children who are very susceptible to decay may benefit from additional applications of topical fluoride by the dentist.

 

Say "aaaahhh"....
Say “aaaahhh”….

 

#2: Get Over It!

Dental anxiety is a common problem that can plague even the most rational and intelligent person, says Dr Brendan Gin from Smilefocus. Often, it is caused by a childhood experience.

There are varying degrees of dental anxiety, but even a low level of anxiety can cause one to indefinitely put off visiting the dentist for preventive care. Some may force themselves to visit the dentist – crying, sweating and trembling all the while.

Others may completely refuse to go, opting to live with gum infections, pain or even broken and unsightly teeth until the pain is more unbearable than the fear and the patient is forced to visit the dentist. Often, says Brendan, this means that a problem which could have been diagnosed and treated easily, requires much more complex treatment.

Beating Anxiety
• Find a dentist who communicates well, is patient, genuinely caring and makes you feel comfortable.

• When scheduling your appointment, let the clinic know you are nervous and they will allow a longer time for your appointment. Choose a time when you’ll be relaxed; not before an important meeting.

• Arrive early so you’re not in a rush, and bring along a friend for moral support.

• Your dentist can discuss with you a number of relaxation techniques such as administering nitrous oxide (laughing gas) or playing relaxing music through headphones.

You’ll discover that modern techniques and technology are less intimidating than in the past, and that most treatments – including injections – are virtually pain-free.

“A Very Nervous Lady”
“A very nervous lady attended our practice with a severe toothache,” recalls Brendan. “She had walked past our front door over 20 times before having the courage to enter, whereupon she broke down in tears.”

Having had a very bad childhood experience, she had stopped going to the dentist and even neglected dental homecare. “As a result, her teeth had suffered both aesthetically and functionally. Although a well-groomed and successful businesswoman, she avoided smiling, laughing and close conversation.”

After many visits to acclimatise her to the dental environment and build her trust and confidence, Dr Gin was able to resolve her immediate toothache problems, restore good function and organise a good preventative home programme.

“The change in her attitude to dentistry was astounding,” he recalls. “In time, she decided that she needed ‘a new smile to suit her new attitude and regained confidence’, in her own words; so we used the latest porcelain materials to rebuild and restore her smile. Today, this formerly very nervous patient comes for a check-up every six months.”

 

When left to their own devices, wisdom teeth can cause plenty of pain
When left to their own devices, wisdom teeth can cause plenty of pain

 

#3: Wisen Up!

Wisdom teeth removal doesn’t have to be a painful and unpleasant experience, says Dr Ho Kok Sen, dental specialist in oral and maxillofacial surgery at Specialist Dental Group. “Most patients are able to resume their normal activities soon after they have done the procedure. In fact, some patients attend business dinners that same night!”

What are wisdom teeth?
Also known as third molars, wisdom teeth emerge during early adulthood. A panoramic dental radiograph (x-ray) will confirm the number of wisdom teeth in a person’s mouth and indicate whether there are any buried teeth. In certain cases, detailed 3D scans (known as cone beam computed tomography) may be done to pinpoint their exact position in relation to important structures like the dental nerve and maxillary sinus.

When are they a problem?
Wisdom teeth often do not properly erupt and can grow sideways, emerge partway out of the gum, or remain trapped beneath the gum and bone, causing chronic pain, migraines, headaches and facial pain. When wisdom teeth do not grow properly, the adjacent teeth are more likely to decay; a tooth can become so badly decayed that root canal therapy may be the only way to salvage it, or it may even have to be replaced by a dental implant.

Even when the wisdom teeth erupt properly, there is a chance that there will be a tight fit at the back of the mouth, making it a challenge to clean the teeth properly, which may lead to tooth decay.

When should they be removed?
Generally, it is recommended that wisdom teeth be removed in one’s teens or young adulthood, when recovery is faster because the bone is more elastic and the roots shorter. After the age of 30, you may be at greater risk for gum disease in the surrounding tissues.

How is it done?
Surgical options include:

Local anaesthesia, which is how most minor oral surgery is performed.

Sedation, where the oral surgery is performed while the patient is in a light sleep. This can be done in the clinic with the assistance of an anaesthetist.

General anaesthesia, usually administered in a hospital or day surgery centre, which increase the cost of treatment. Recovery from anaesthesia is a little slower than with sedation.

“Whichever you select,” says Dr Ho, “rest assured that you will receive the utmost care and attention to ensure your safety and comfort both during and after the procedure.”

 

Keep your pearly whites sparkling with whitening treatments
Keep your pearly whites sparkling with whitening treatments

 

#4: Lighten Up!

Tooth whitening is a popular dental technique to rejuvenate the colour of teeth that have become dull and yellow after years of accumulating internal stains, says Dr Thean Tsin Piao from Aesthete Smilestudio.

Did you know?
Unlike simple scaling and polishing, which is a purely mechanical process that removes surface stains caused by substances such as coffee, tea and red wine, tooth whitening removes internal stains through an oxidation process. The most common ingredient used for whitening teeth is peroxide gel.

Home or away?
• The take-home whitening system usually involves a customised tray filled with peroxide gel in a 10- to 20-percent concentration. You wear this tray for 30 minutes every day, for 14 days.

• The in-office system is a one-off treatment that uses a much higher concentration of peroxide gel – 30 to 40 percent – and takes from 30 to 60 minutes. The higher the concentration of gel, the faster the whitening process.

What can you expect?
You can look forward to teeth that are six to eight shades whiter – usually to the colour of your teenage teeth. Teeth may be sensitive during the whitening procedure, but the effect is transient. When using the take-home system, take great care to ensure that the gel does not come into contact with the gums, says Dr Thean, or it will burn them.

 

If only all kids looked this thrilled to brush
If only all kids looked this thrilled to brush

 

#5: Early Does It!

Dr Catherine Lee of Dr Catherine Lee Orthodontics believes that major orthodontic work can be avoided, or at least minimised, by treatment at an early age, before the facial bones and jaws have fully developed. What’s more, problems often run in families, so if you needed orthodontic work, it’s more likely that your children will, too. In line with the American Association of Orthodontists, she recommends an initial assessment between the ages of five and seven.

Dr Lee identifies two phases of orthodontic care for children:

Phase I – 5 to 10 years old
By monitoring and modifying jaw growth with early interceptive care, when their first permanent teeth start to appear. you’re taking advantage of a child’s natural development in order to improve his or her smile, facial shape and even profile. Early intervention reduces the need to remove good, permanent teeth during Phase Two, the teenage years, and brings down the overall cost, especially in complicated or difficult cases.

Phase II – the teenage years
The purpose of orthodontic treatment is not merely to straighten the teeth – which may be relatively easy to do – but also to achieve a good, functional occlusion, or “bite”. Repositioning bones, jaw and teeth will improve facial balance and help ensure that teeth last a lifetime.

Smile! Wearing braces should be a happy experience, Dr Lee believes. They don’t need to hurt in order to work properly. You can choose between silver, tooth-coloured, or “invisible” braces (like Invisalign Teen), and even add vibrant colours if you like.

For adults, says Dr Lee, the phrase ‘healthy mouth, healthy you’ really is true, and it’s backed by growing scientific evidence. If you’ve had orthodontic treatment in the past, but have found that your teeth have drifted over the years, you can have some refinement done to perfect your teeth again. Invisible braces like Invisalign easily fit into a busy lifestyle.

Many adults choose to have their teeth corrected, not because their teeth aren’t straight, but also to correct a “bad bite” that is causing early wear and decay. It’s never too late for orthodontic braces – one of Dr Lee’s patients was 71 years old at the time of treatment.

 

There's no shame in being a brace face!
There’s no shame in being a brace face!

 

#6: Which Braces?

Traditional metallic, self-ligating, ceramic or even invisible – the type of brace you choose should suit your needs and lifestyle, believes orthodontist Dr Vicpearly Wong from Orange Orthodontics and Dental Orthopaedics. In the end, they all work to move teeth into their ideal positions by applying steady pressure over time.

Traditional braces comprise three main components: the bracket (placed on the tooth), the archwire that runs through the brackets and applies the required pressure, and elastic or metal ties (ligatures) that connect the brackets to the archwire.

Self-ligating braces don’t have ties; they use a permanently installed, moveable component to trap the archwire. Not only are they smaller and more aesthetic, but they’re more comfortable than traditional metal braces. Food is far less likely to be trapped in them, so patients find it easier to maintain good oral hygiene during treatment.

Ceramic braces have an obvious aesthetic appeal, as they match the colour of your own teeth. This is orthodontic treatment “minus the metal look”, as Dr Wong puts it. They’re both made from aluminium oxide, and you can choose between polycrystalline and monocrystalline; the latter are noticeably clearer. Within these options, you can choose between two systems: modular ligation (Radiance Plus), or self-ligation (Empower Clear).

Invisalign, or invisible braces, is a modern approach to straightening teeth, says VicPearly – and it really is almost invisible.

• A computer software program projects the required movement of the teeth to achieve the desired results, after which a custom-made series of aligner trays is created especially for each patient.

• Wearing the aligners gradually and gently shifts your teeth into place, based on the exact movements your dentist or orthodontist has planned out for you.

• About every two weeks, you simply switch to the next set of aligner trays in the series.

This isn’t just for adults who don’t want their braces to be visible; in fact, the 14-year-old daughter of one of my colleagues recently underwent Invisalign treatment, with a very good result.

 

Remember to look out for any signs of gum trouble
Remember to look out for any signs of gum trouble

 

#7: Healthy Gums, Healthy Teeth

According to the people at PHSC Dental, our teeth should last us our lifetime – and maintaining healthy gums is all-important. That’s because gum disease is one of the major causes of tooth loss. But, if periodontal disease is largely preventable, why is it so common?

Signs of gum disease
• Red, swollen or tender gums

• Bleeding while brushing, flossing or eating hard food

• Receding gums, where the teeth appear longer than they used to

• Loose or separating teeth

• Pus between the gums and teeth

• Mouth sores

• Persistent bad breath

• A change in the way your teeth fit together when you bite

• A change in the fit of partial dentures

Risk factors
Some people have a higher risk of developing periodontal disease. Smoking is a major risk factor. You’re also more at risk if you’re stressed, pregnant or diabetic, or taking on various medications.

What’s more, it is also well documented that periodontal infections may have an impact on systemic diseases or conditions such as diabetes, pregnancy, and infective endocarditis. There is even preliminary evidence associating periodontal infections with lung disease and other remote site afflictions such as colorectal cancer.

4-Step Prevention
• Visit your dentist at least every six months.

• He or she should check the condition of your gums, take x-rays to help diagnose periodontal health issues, and give your teeth and gums a professional clean.

• You should tell your dentist about any predisposing conditions or diseases you may have, and any medications you are currently taking.

• Remember! The onus still falls on you to properly brush your teeth at least twice a day and to floss every day.

The link between gum inflammation and heart health
A number of studies show that oral health can have a significant impact on cardiovascular health, according to mercola.com:

• Researchers at Columbia University in New York found that improving dental care slows down the build-up of plaque in the arteries, reducing your risk of heart disease.

• Another 2010 study found that those with the worst oral hygiene had a whopping 70 percent higher risk of developing heart disease than twice-a-day brushers.

 

Could she be more proud of her gleaming gnashers? We doubt so...
Could she be more proud of her gleaming gnashers? We doubt so…

 

8: Straight White Teeth!

Everyone wants straight white teeth, says Dr Ernest Rex Tan from Smile Inc., but not everyone is prepared to undergo the long and relatively arduous process of orthodontic correction. The good news is that it’s possible to achieve straight, white teeth in a visit or two.

“We don’t need to shift your teeth to give you a beautiful Hollywood smile,” he explains. “But we can resolve a wide range of issues – missing teeth, discolouration, gaps, disproportionately shaped teeth, crookedness and much more – all in a single procedure over two visits. Even protruded, retruded or collapsed front teeth can be restored to perfection. In fact, full mouth reconstruction is a regular part of what we do.”

Straight white teeth is an integral part of the Smile Inc. makeover, he says, “It is the advanced application of dental techniques to align and beautify the teeth, including the selective contouring of the teeth by means of applying materials such as porcelain and resin to them. Because no two mouths are the same, the treatment is highly individualised.”

“Best of all,” he adds, “excellent results can be achieved in as few as one or two visits, as opposed to a number of years.”

Many adults cannot contemplate spending years with braces in their mouths (plus the long-term wearing retainers after that), either because of the perceived pain and discomfort, or because they feel that it would be awkward or inappropriate in their professional lives – or perhaps just because it takes too long. If you want to look your best for your upcoming wedding, or for a career-making presentation, you may not be able to afford that kind of time.

What’s more, as straight teeth allows your mouth to retain its original shape, there’s no need for the kind of retainers that orthodontics patients have to wear for years to stop their teeth drifting out of alignment.

 

 

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