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Smile! Eight great reasons to show off your pearly whites

By: Verne Maree

Where does smiling come from, and why do we do it? You’ve probably heard the theory that our ancestors – monkeys and apes – developed a sort of manic, fear-based grimace that was supposed to indicate to rivals or predators that they were harmless. Since then the whole business got a lot more subtle, of course: nowadays we have at least 50 shades of ivory, including the conspiratorial grin, the sarcastic smirk, the lustful leer, the winsome simper and many more.

Here’s another question: Do we learn to smile, or is it something we’re born with? Newborns have been known to smile soon after birth, even before they’ve had a chance to clock their parents’ infatuated grins. Sceptics call it wind, but who really knows? (Or cares?)

Surely, the important thing is that we do smile – often, widely and with joyous confidence in a mouth that’s attractive and teeth that are healthy, straight, white and beautiful. That’s not to be taken for granted.

You might count yourself among the lucky few who’re genetically blessed with shiny, even teeth that resist decay. I’ve known a handful of people who sail through life with a full mouth of perfect pearly-whites, in spite of below-average care and only rare visits to the dentist.

Sadly, I’m not one of them – both of my parents were, shall we say, dentally challenged, and I’ve had more than my fair share of troubles, from multiple cavities during childhood to an ongoing “bad bite” that broke all my fillings: it was only corrected by spending two years in orthodontic braces in my thirties.

The message here is that neither you nor I are stuck with our crappy DNA, thanks to modern technology that’s continually advancing. Isn’t that a good reason to smile? Well, here are eight more.

1 You can prevent decay!

Teeth are strong, of course, but how strong are they really? According to Dr Teodora Kent of Smilefocus, the enamel of your tooth – that’s the visible white portion – is the hardest material in your body, even stronger than your bones.

Enamel is actually harder than either iron or steel, because it was designed to last a lifetime. Teeth can even survive temperatures up to 1,000 degree Celsius!

So why do our teeth decay? Unfortunately for us, mighty enamel has its own kryptonite – acid!  Acid can be found in the foods and drinks we consume, some of the most common culprits being sweets, fruit juice, wine and vinegar. Eating foods that contain sugar or simple carbohydrates causes acid to be produced from the oral bacteria (or plaque) that is present. This acid weakens enamel, leading to a loss of minerals that over time causes dental decay.

Understanding the causes of tooth decay means you can do what’s required to prevent it as far as possible.

A dental sealant is a thick layer of plastic resin that’s placed over the biting surface, usually of molars or pre-molars near the back of the mouth. By covering the deep grooves in these surfaces, which can make them hard to clean, you are protecting them from decay. They are quick and simple to place, says Dr Kent.

Last but not least, seeing your dentist every six months for an examination and professional cleaning will help safeguard your teeth and correct any minor concerns such as small cavities, before they become more difficult and costly to correct.

Six DIY Ways

  1. Brush your teeth twice a day with fluoridated toothpaste; this cleans 60 percent of the tooth surfaces.
  2. Floss daily. A significant portion of dental decay occurs in-between the teeth of both children and adults.
  3. Limit the intake of soft drinks, juices, wines, beers, sports drinks and especially dried fruit.
  4. Avoid snacking on sugary, refined or acidic foods. Give your teeth at least a two-hour gap between snacks or meals so they can remineralise.
  5. Drink water. It provides a buffering effect and helps keep your mouth hydrated.
  6. Ask your dentist about dental sealants.

2 It doesn’t have to hurt!
In the past, the phrase “pain-free dentistry” was an oxymoron, says Dr Nijam Latiff of Coast Dental – serendipitously located right next to Awfully Chocolate, opposite Katong 112 shopping mall. Nowadays, of course, there’s a great emphasis on preventing pain arising in the first place, and on minimally invasive techniques. Pain-free dentistry has become a reality.

Most dental disease that occurs in the enamel or dentine layer doesn’t cause any pain, he explains. Treatments focused on this layer tend to be simpler and often can be performed without any form of anaesthesia at all; they are truly pain-free.

But it’s a different story when disease involves the pulp layer, which has numerous nerves, explains Dr Nijam. “In these cases, treatment is often both more complicated and more invasive.  So, if we can prevent a patient from getting a tooth decay or needing an extraction or a root canal then we have done well as professionals.”

Fortunately, he says, there’s much we can do to reduce the risk of dental disease. The first step is to teach our children good dental habits from a young age; and the American Academy of Pediatric Dentistry recommends that parents take their children for their first visit to the dentist at the age of one.

“This allows us to monitor the growth and development of the facial structures and educate parents on the use of pacifiers, milk bottles and so on.” Of course, it’s important that the first dental visit is a pleasant experience. It makes sense that future dental experiences are more likely to be comfortable for a child who is relaxed about going to the dentist: it’s well known that the perception of pain is reduced when fear and anxiety are eliminated.

Three degrees

  • Many dental procedures are done under local anaesthesia. A topical gel is applied to the gum area before the anaesthetic is injected. Once it has taken effect, the entire procedure – be it wisdom tooth surgery, a root canal or a tooth restoration – is literally pain-free.
  • Sedation is where the patient is placed in a semi-conscious state before dental treatment, through the use of a combination of drugs.
  • Another option is general anaesthesia, a state of unconsciousness.

Missing a tooth? You can get a new one!

Anyone can lose a tooth, at any age. And there’s every reason to get it replaced as soon as possible, advises Dr Neo Tee Khin of Specialist Dental Group’s implant team of prosthodontists, periodontists and oral & maxillofacial surgeons.

It’s a misconception that losing a tooth or two is an inevitable result of ageing, or that it does not matter when the missing tooth is at the back. Serious functional problems can arise: eating, chewing and even speech can be affected.

“You may also be more susceptible to cavities, bite problems and periodontal (gum) disease,” explains Dr Neo. “When teeth are missing, the gums that support teeth recede with time and bone loss occurs. The adjacent teeth will start moving and given enough time, this will cause gaps between your other teeth.”

Dental implants are an excellent solution for a single missing tooth, or multiple missing teeth, with a success rate of between 95 and 99 percent. Best of all, they look, feel and function just like your natural teeth.

Fast facts

  • A dental implant is a titanium screw that is placed into the jawbone to replace the root of the missing tooth. It serves to anchor the new permanent tooth, or implant crown.
  • Traditional dental implants may be placed on the same day as your initial consultation and are suitable for a single missing tooth, or multiple missing teeth. Temporary teeth are fabricated and attached on the spot. Once the implants are fully integrated with the jawbone, the permanent implant crowns can be attached.
  • The NobelGuide Teeth-in-an-Hour procedure is suitable for patients with multiple missing teeth, or no teeth at all in either jaw. The dental implants and permanent teeth are placed in the same day, within an hour.
  • The All-On-4 dental implant procedure allows people missing a full set of teeth to have their teeth replaced on the same day, supported by only four implants.

You can look ten years younger – with a smile makeover!

Dentists like Dr Thean Tsin Piao of Aesthete Smilestudio use crowns and veneers to reconstruct missing tooth structure and give you a total smile makeover.

He explains that veneers, as thin as contact lenses, are usually placed on the front surface of the tooth, whereas crowns cover the entire surface of the tooth, front and back.

Both crowns and veneers are made of porcelain, ceramic, composite resin or a combination of these materials. “The most beautiful veneers are handcrafted, layered porcelain,” says Dr Thean. “The strongest crowns are ceramic, often made with layered porcelain for a 3D effect that looks very real, even from close up!”

If your teeth are not well positioned or aligned, before proceeding with veneers he may recommend treatment with braces, or Invisalign, to minimise the removal of tooth material.

Minimally invasive dentistry involves the placement of porcelain veneers, either without any removal of tooth structure or with only a minimal removal of tooth structure. This is usually possible for people over the age 40, as erosion, wear and tear usually remove one or two millimetres of tooth structure over the years; eating acidic food and drinking wine, fizzy drinks and so-called power drinks accelerate the process.

Smiles makeovers can be life-changing, he says. And that’s because having a healthy, attractive smile affects all areas of your life, from enhancing interpersonal relationships and helping you to connect well with your colleagues and the wider community, to optimising your self-confidence and self-actualisation.

You can say no to amalgam!

Worried about having a toxic mouth? Dr Jerry Lim of Orchard Scotts Dental believes you can better protect your long-term wellbeing by opting for composite fillings or ceramic restorations instead of amalgam ones.

Amalgam or “silver” fillings – which contain 50 percent mercury – can affect our health, says the International Academy of Oral Medicine and Toxicology (IAOMT). That’s because the mercury in them is released, albeit at very low levels, as mercury vapour. Absorbed into the bloodstream, it is stored in organs such as the brain, kidneys and liver, and is thought to affect their functioning over time. However, as other studies have shown amalgam to have no effect on the body, this is still debatable.

What we do know with certainty is that amalgam fillings expand and contract due to changes in temperature, which can increase the incidence of tooth fractures and cause permanent and irreparable damage to the tooth structure. In addition, amalgam fillings corrode over time in the harsh environment of the mouth, leaking metallic ions that can stain the tooth. And because this discolouration makes it difficult to identify decay and treat it timeously, the tooth may end up requiring root canal treatment, crowning or even extraction.

Mercury amalgam fillings can be replaced with composite or ceramic restorations, assures Dr Lim. These restorations are bonded onto the tooth structure, making it stronger. What’s more, they look good because they match the colour of your teeth, and they last just as long when done correctly. Larger mercury fillings can be replaced with stronger ceramic or prefabricated resin for added strength and protection.

Protocol for removing amalgam safely
Is your dentist practising safe amalgam removal?

  • A rubber dam is an expandable plastic sheet that covers the teeth from which the amalgam is being removed, helping to prevent the ingestion of loosened mercury particles.
  • High-vacuum suction removes mercury particles plus any mercury vapour that may be released.
  • Copious water-cooling of the amalgam during the process reduces mercury vapour; this water is removed with the high-vacuum suction.
  • Using an electric hand-piece reduces the air turbine effect of traditional turbine hand-pieces that rely on high air-pressure, which displaces mercury vapour and chips.
  • An alternative source of oxygen is provided, too.

Early orthodontic treatment saves both money and hassle in the long run!
There’s good reason why the American Association of Orthodontists (AAO) recommends that all children should be checked by an orthodontic specialist no later than age seven, says Dr Vicpearly Wong of Orange Orthodontics – though, as she points out, the AAO doesn’t advocate comprehensive orthodontic treatment at this age.

Facial growth is rapid in children and slows down as we age, she explains. Any growth problems, if picked up early, can be corrected by orthodontic and dentofacial orthopaedics. If early interceptive treatment is indicated for any reason, any further treatment at a later stage is likely to be less complicated, have a shorter duration and be less expensive. The reason interceptive treatment is so effective is that it utilises the child’s growth potential to achieve a better outcome than fixed braces alone would be able to do.

That’s not all. To help increase the size of a restricted upper airway, orthodontics can help by modifying the upper arch expansion, and this is usually done in partnership with an ear, nose and throat specialist. Speech problems from a habitual tongue thrust can be modified with a fixed orthodontic device to the palate in conjunction with a speech therapist. And to avoid the need for surgical correction later in life, modifications can be made to facial growth patterns to correct problems such as a too-short or too-long lower jaw, or even facial asymmetry.

Why before age seven?

Permanent teeth often start to erupt around the age of six or seven. Where alignment problems are caused by extended sucking of thumbs or pacifiers, or in the case of lower lip trap, early treatment with preventive devices may help to lessen the habit and prevent more serious problems from developing.

Seven to nine years

This is the mixed dentition stage, where children lose their primary teeth and gain their permanent ones. It’s also been called the ugly duckling stage, due to the loss of the central incisors.

Nine to 12 years

Some children have attained their full set of permanent teeth by the age of 12. Detected early, orthodontic problems may be easier to correct – but it’s not always easy for parents to tell if their child has an orthodontic problem.

Signs your child may need an orthodontic exam:

  • Baby teeth taking longer than expected to drop out
  • Difficulty in chewing or biting
  • Breathing through the mouth
  • Finger- or thumb-sucking
  • Teeth that are crowded, misplaced or blocked
  • Jaws that shift or make sounds
  • Biting the inner cheeks
  • Teeth that meet abnormally
  • Jaws and teeth out of proportion to the rest of the face

With lingual braces for adults, no one has to know!

Getting married? Graduating soon? Lack the confidence to flash a full smile? There’s no need to envy others their Hollywood smiles, says Dr Lim Hong Meng of Mount Elizabeth Orthodontic Clinic.

Noticing that your teeth are looking worse with each passing year, but still holding off on deciding to undergo treatment? Perhaps you want to have your teeth straightened, but cannot bear the thought of having braces peeking out of your mouth?

In his 21 years of orthodontic practice, says Dr Lim, many of his adult patients have answered “yes” to the above questions. “Most of them did not have the opportunity to have treatment when they were younger,” he explains. Others had experienced a relapse after earlier treatment.

For adults who want comprehensive correction of their malocclusion or misalignment, but don’t want to be seen with a mouth full of bonded braces, he can offer two options: lingual braces or clear aligners.

  • Lingual braces – braces bonded on to the inner side of the teeth – are the truly invisible option. Though they’ve been available since the late 1970s, not many people know about them, because only a handful of orthodontists use and offer this treatment technique. Contrary to what some might claim, he says, in the hands of orthodontists experienced and skilled with the technique, lingual braces can be used to treat most cases with good results, predictably and with minimal inconvenience to patients.
  • Treatment with clear aligners involves a series of removable plastic appliances and is widely offered by both general dentists and orthodontists. Aligners are not a complete replacement for bonded braces, notes Dr Lim, as not all types of tooth movement can be achieved as effectively as with bonded braces.

For patients with simple alignment problem, says Dr Lim, he would offer either Invisalign or lingual braces. “For those with complex malocclusion, lingual braces are better, as they give me more control in executing tooth movements predictably and there is less reliance on patients’ compliance than there is with aligners. And in cases where treatment with aligners has not been successful, lingual braces can step in.”

And the final reason to smile… there really is a tooth fairy!

Transforming lives through her work in the tricky field of cleft lip and cleft palate therapy, orthodontist Dr Catherine Lee is the Patron and Health Director of the Cleft Care Indonesia Foundation, a non-profit charity organisation in Surabaya, Indonesia, that provides care to underprivileged cleft children. She simultaneously runs her own busy practice, Dr Catherine Lee Orthodontics, providing orthodontic care to both mainstream and cleft-lip and cleft-palate patients.

Tell us about the Cleft Care Indonesia Foundation.
Run by a group of international volunteers and four full-time local Indonesian staff, it locates and treats underprivileged cleft children from city slums, small villages and remote areas of Java. Homecare visits are primarily targeted at the mothers of cleft newborns, who need immediate information about their condition, such as how to take care of their child and how to seek treatment.

What is your role in this foundation?
An estimated 85 to 90 percent of cleft infants are born into the lowest socio-economic level, so our core aim is to ensure that the child survives has the cleft surgery needed. My job as a healthcare advisor is to establish the programmes, work the protocols and ensure that each child is well taken care of.

How soon can treatment for cleft lip or cleft palate begin?
In a first-world country like Singapore, it can start as soon as the child is born. In this pre-surgical treatment, an orthodontist like myself, who has specialised in cleft work, helps the surgeon to move the displaced lip, gum and nose tissues into the correct position before the first round of surgery at the age of about three months. Cleft lip repair surgery is only the beginning of a cleft child’s surgical journey, and his or her overall development needs to be closely monitored all the way to adulthood.

In third world countries, where no orthodontist is available, the child will be operated on at about three months of age if healthy. However, if he or she is sick, malnourished, underweight or has any other medical condition (like a heart condition or TB), the first surgery can be delayed up to the age of one, two or even later — or it may never be done at all.

How do you combine your cleft palate and cleft lip work with your mainstream orthodontic practice?
In our Singapore clinic, my team and I try to make each patient feel as normal as possible, and just like any other children. As for my outreach work, I have to take time out of the practice to do it.

This story first appeared in Expat Living’s July 2015 issue.