Archive for July, 2009
This post on dental assessments is especially useful for those who are about to undergo cancer treatment (radiation or chemotherapy) or a major surgical procedure (e.g. organ transplantation, heart bypass, etc).
There is increasingly more research suporting the link between oral health and overall health. In the situation where the body’s immune system is down, it is even more important to be aware of how to avoid oral complications in the middle of treatment or post-surgery.
Oral Complications
Oral complications are present in:
(1) Almost all patients receiving radiation for head and neck cancer;
(2) Up to 75% of blood and marrow transplant recipients; and
(3) Nearly 40% of patients receiving chemotherapy.
Effects of Oral Complications
The effects of oral complications on the patient include:
(1) Seriously compromising the patient’s health and quality of life;
(2) Affecting the patient’s ability to complete the course of treatment;
(3) Resulting in tolerance of a lower and less effective dose of therapy;
(4) Postponing scheduled treatments;
(5) Stopping treatment; and
(6) Developing potentially life threatening systemic infections.
Thus, oral care before, during and after cancer treatment is critical in the prevention or reduction of the incidence and severity of oral complications, with the net result that patient survival and quality of life are enhanced.
Here is how the dental specialist team can work together with the medical team in these special cases:
I. Pre-Treatment Dental Assessment
Sending cancer patients for a pre-treatment dental assessment prior to undergoing radiation therapy or chemotherapy:
(1) Reduces the risk and severity of dental complications developing during the course of treatment;
(2) Allows early detection and treatment of existing infections and other problems;
(3) Increases the likelihood that the patient will successfully complete the treatment;
(4) Minimizes oral infections that could lead to potentially fatal systemic infections;
(5) Prevents or reduces later incidence of bone necrosis;
(6) Prevents, eliminates or reduces oral pain;
(7) Improves the quality of life; and
(8) Decreases the cost of care.
A dental assessment enables the identification and treatment of problems such as infection, fractured teeth or restorations, and gum disease that could worsen oral complications once cancer therapy is started. Baseline data can also be established in order to compare the patient’s status in subsequent examinations.
The identification of any pressing dental treatment needs, including gum swelling, loose or decayed teeth, and any other lesions in the oral cavity would indicate dental treatment should be provided before the patient undergoes chemotherapy or radiotherapy.
II. On-going Dental Treatment Needs
Continued follow-up by the dental specialist is important during the course of cancer treatment to prevent, detect, and treat oral complications in a timely manner.
For more information on Dental Assessments, please click here.
Electric toothbrushes have been used for a long time. The earliest electric toothbrushes were initially developed for patients with limited motor skills and orthodontic (braces) patients.
Basic Designs
There are a few basic designs in electric toothbrushes. Most of them have a certain pattern of brush head movements. Others may have specific types of brush bristle moving cycles, unique frequency of movement, or discharge certain ions to facilitate cleaning. One brand even features an auto-stop function when excessive pressure is applied onto the teeth.
Effectiveness of Electric Toothbrushes
Regular toothbrushes require reasonable manual dexterity to adequately clean our teeth on a regular basis. Therefore, incorrect brushing technique may reduce the effectiveness of optimal cleaning. Successful manipulation of the toothbrushes may also not be possible when the individual is too young, too old, having a disability, or wearing some form of dental appliance (such as braces or dentures). Incorrect brushing techniques not only lead to ineffective cleaning, it may even harm the teeth and gums by exerting excessive pressure.
Some studies have shown that electric toothbrushes are more efficient at cleaning teeth than manual toothbrushes. In the case of the rotation-oscillation type brush heads, there is less room for incorrect brushing. As a result, the effectiveness of tooth-brushing is enhanced. This is one reason why some dentists also recommend electric toothbrushes for children. Electrical toothbrushes are also helpful when regular dental care is provided by a third party such as a nurse in a nursing home.
Selection of an Electric Toothbrush
When one is choosing an electric toothbrush, it is important that the size of the toothbrush is correctly chosen. Usually the brush head should be less than 2cm in length and 1cm in width. A toothbrush that is too big is simply not agile enough to reach all surfaces especially the back teeth.
In general, soft bristles are kinder to the teeth and reduce the chance of traumatising the gums. Some types feature round end bristle filaments. These microscopic tooth bristle tips are also less abrasive to the gum and dental enamel.
Pricier models may not necessarily the best for your budget or dental condition.
Electric toothbrushes occasionally require technical maintenance or replacement of parts, such as the brush head. It is therefore important to purchase an electric toothbrush that has a local retailer who carries the parts. Check to see if the manufacturer has a local warranty program in case fixing or repairing is needed.
Consult your dentist for some practical tips on your electric toothbrush selection process.
Many adults suffer from temporomandibular joint (TMJ) disorders or jaw joint pain, sometimes referred to as chronic facial pain. TMJ disorders affect mostly women but men also suffer from it.
Symptoms
Common symptoms of a TMJ disorder include pain on the sides of the face or head, noise in the jaw joints, uneven bite and problems with jaw movements such as closing the mouth and moving the jaw side wards. In some cases, one might experience neck and/or shoulder pain, clicking and popping sounds in the jaw joint, and difficulty in moving the jaw joint which in turn affects talking, eating and even smiling.
Causes
Factors such as traumatic injury to the jaw joints and ill-fitting dental fillings can trigger TMJ problems. A poor bite or multiple missing teeth could be a triggering factor too. Occasionally, if one attempts to open the jaw too wide and dislocates the jaw joint, this may damage the cartilage in the jaw joint and cause TMJ problems in the future.
One of the most common characteristics amongst patients in big cities is stress. We know that bruxism is related with day time stress. When a person is highly stressed, he or she is more likely to grind his teeth during sleep – it is not surprising that the jaw muscles are tired in the morning, resulting in jaw pain during the day. This is called myofascial pain and is one form of a TMJ disorder.
Treatment
Diagnosis is an important step before treatment. Part of a clinical examination includes checking the joints and muscles for tenderness, clicking, popping or difficulty moving. A patient’s complete medical history may be reviewed, so it is important to keep dental office record up-to-date. The dentist may make a model of your teeth to see how your bite fits together. Your dentist may also take specialized x-rays for the TMJ.
Treatments for TMJ disorders may include stress reducing exercises and muscle relaxants. Bruxism can be easily treated with dental appliances such as a mouth guard. If the patient is experiencing a locked jaw (a type of TMJ disorder) which is an inflammation of the jaw joint, he might benefit from an injection of steroids or painkiller into the jaw joint. In case where missing teeth or a poor bite is the reason for the symptoms, then a dental rehabilitation using crowns, denture or dental implants may be the solution. In situations where the pain condition is difficult to pinpoint, a visit to a neurologist or a specialist dealing with pain may be needed.
TMJ treatment typically requires more than two months to show some results. This is simply due to the fact that healing of jaw joints, the associated cartilage and muscles requires time. Occasionally, fixing and repairing the bite/teeth may be needed to ensure predictability
Prevention
Preventive measures include choosing regular-sized food items if possible and cutting food into small pieces before eating. Dietary supplements for the joint such as glucosamine will also strengthen the jaw joints’ cartilage as well as speed up the healing process.
TMJ Disorders are a multi-factorial clinical problem. A lot of people have had it or are suffering from it. Do not let it go and suffer in silence. The key is to sort it out and treat it early.
For more information on Jaw Joint Treatment, click here.
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A beautiful smile is an asset. Facial proportion, dental health and aesthetics contribute to creating that unforgettable smile. Some are blessed and born with good looks, and others can enhance what they have.
Benefits of Straight Teeth
Straight teeth contribute significantly to an attractive smile, and can do wonders for one’s self-esteem and self-confidence. For some, it can even alter their attitudes on life and lifestyle.
Aesthetics are not the only reason for straightening teeth. Crooked teeth are often difficult to clean and maintain. They are susceptible to dental decay and gum disease. This can make treatment extensive and costly if delayed until much later.
Speech can also be affected in some instances where the teeth are poorly aligned, or when the upper and lower jaws are not in correct alignment with each other.
Trauma of dental tissues can also result from a bad bite. Protruding front teeth are prone to accidental injuries. Sometimes, a deep bite (excessive overlap between upper and lower teeth), crossbites (single tooth reverse-bite), or jaw discrepancies create a traumatic bite. For some people, there may be gum trauma where a bad bite chews at the gums, causing gum recession or ulcerations and loose teeth. For others, a bad bite or jaw positions can put additional strain on the jaw joints, resulting in joint pains and tension headaches.
Children and the Orthodontist Visit
The American Association of Orthodontists recommends that all children have an orthodontic check up not later than 7 years old. Although it is unusual to start treatment before the age of 7, early orthodontic consultation allows potential problems to be identified and preventive measures taken, e.g. discouragement of a thumb-sucking or pacifier habit, or the prevention of early loss of primary teeth due to poor oral hygiene.
Interceptive orthodontics may be indicated in some children between 7-12 years old if they have traumatic bites or jaw discrepancies. Comprehensive orthodontics usually commences around the time when all the permanent teeth have erupted. This involves the use of fixed braces to straighten and align teeth.
It is a misconception that braces are only suitable for children or teenagers. Braces can still work for adults. With advancements in technology and orthodontics, there are also options for more aesthetic orthodontic devices to straighten teeth.
Types of Braces
The conventional type of braces is stainless steel. There are also braces more aesthetically appealing than their metal predecessors, such as ceramic braces which are tooth-coloured so they are less obvious. Lingual braces, or braces that adhere to the back of the teeth instead of the front, are also available. Another option is Invisalign. It makes use of a series of transparent aligners to gradually straighten the teeth. These ‘invisible’ aligners are comfortable to wear and are removable.
Every individual is unique and every face is different. The treatment plan and objectives may differ for each. Discuss with your orthodontist your concerns and expectations, and find out about the treatment, alternatives, risks and benefits, as well as costs and payment plans before you decide.
For more information on solutions to straighten your teeth, click here
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Wisdom teeth, also known as third molars, 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 any of these teeth are buried or unerupted. It also allows full radiographic examination of the upper and lower jaw architecture and all the teeth present.
Due to our smaller jawbones, wisdom teeth often do not properly erupt and can grow sideways, emerge part-way out of the gum, or remain trapped beneath the gum and bone. As maintaining their cleanliness is difficult, gum and bone infection is very common. Wisdom teeth and their adjacent teeth can also become decayed. Chronic pain, migraines, headaches and facial pain can result. The adjacent teeth can also become so grossly carious that root canal therapy may be the only way to salvage the tooth. In some circumstance, the adjacent tooth may be replaced by a dental implant.
Even when the wisdom teeth erupt properly, there may be a tight fit in the back of the mouth, making it very hard to clean them properly – leading to decay.
The younger one is, the easier the removal of the wisdom teeth, as the bone is more elastic and the roots are shorter. With proper management, the procedure is smooth and seldom causes any significant swelling or discomfort afterwards.
The procedure can be performed under local anaesthesia alone, or together with intravenous sedation, which puts patients in a relaxed state of mind and significantly reduces any anxiety factors. Sedation can be done in the clinic with the assistance of an anaesthetist who will administer the sedation and monitor the patient’s vital conditions. General anaesthesia usually takes place in a hospital or day surgery centre and increases the total cost of treatment. Whichever method selected to remove wisdom teeth, with proper expertise, wisdom teeth removal can be accomplished under an hour for all four teeth or under 30 minutes for two teeth.
Delaying treatment may increase the likelihood of pain, infection and problems associated with the wisdom teeth. Researchers have found that patients aged 30 years and above may be at greater risk for gum disease in the tissues surrounding the wisdom teeth and adjacent teeth, which can, in turn, affect general health. It is also unwise to delay removal of wisdom teeth until pain and infection set in as healing may be complicated and more prolonged. It is better to remove the wisdom teeth preventively before they become infected as infected wisdom teeth are more complicated and more expensive to treat.
Research has shown that the overall dental condition improves after the removal of wisdom teeth. Prevention is cure and early removal avoids all the associated problems stated.
For Singaporeans and those with Singapore Permanent Residency, wisdom teeth surgery may also be covered by Medisave. Click for more information on wisdom teeth surgery
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With the large number of dentists and dental clinics available in Singapore, the challenge is in selecting a dentist that is appropriate for the dental needs of you and your family. Some factors to consider in selecting a dentist include (in no particular order):
Objectivity and Communication Skills – Is the dentist willing to listen, give you some alternatives to treatment and explain the benefits and risks of such treatment? Is he or she willing to answer your questions about the procedure?
Clinical skills – are you comfortable with the clinical skills of the dentist, either based on your personal experience or the experience of friends and family members?
Training and qualifications – are the dentist’s training and qualifications important to you? All Singapore general dental practitioners have basic training in routine dental procedures. However, if you are considering more specialized treatment, you may wish to consult a specialist (or more than one specialist) to determine if you are suitable for the particular procedure.
Experience – how much experience does the dentist have with a particular procedure? Is the dentist a newly minted one, or has he or she been in practice for an extended period of time?
Continued professional development – Does he or she attend Continuing Dental Education courses to keep current on clinical developments and innovations? Does the dentist teach at their local dental school or contribute scientific publication to professional journals?
Dental Team – if several different dental procedures are required, can they all be provided in the same clinic, or would you have to go to several different clinics to complete the procedure? This would be a consideration in terms of multiple appointments with different clinics, travel time and communications between treating/referring dentists and familiarity with the dental team and staff.
Accessibility – how accessible is the dentist? Is an emergency number provided? What other means of communication are there with the clinic or dentist?
Staff friendliness – how friendly and helpful are the dental staff?
Responsiveness – how responsive is the dentist and the dental staff? Are your calls or emails returned promptly?
Confidence level – how comfortable are you with the dentist and the staff? Is this a dental team that you can trust to take good care of you and your family’s dental needs? Remember, that since twice yearly visits to the dentist is important to maintain dental health, you will be visiting the dentist on a regular basis. It is important to have confidence and trust in the dentist as this is a long term relationship.
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Trailers for
“Putting the Sparkle Back into your Smile: A Dental Seminar that Bridges Function & Aesthetics” started airing on Channel NewsAsia today. The seminar, organized by Specialist Dental Group™ and Channel NewsAsia, will be held on Saturday, August 1, 2009 at the Suntec Convention Centre in Singapore from 2pm to 5:30 pm. More information on the Seminar can be found at
http://www.specialistdentalgroup.com/events.php. The trailer for the event can also be viewed at the link.
“This is the first time that Specialist Dental Group™ is embarking on such a major public education program. We thought that this was a great way to commemorate the 30th anniversary of our clinic,” said Dr. Neo Tee Khin, Partner and Prosthodontist with Specialist Dental Group™.
Specialist Dental Group™, formerly known as Henry Lee Dental Surgery, was founded by Dr. Henry Lee, a well-respected oral surgeon. Dr. Lee also placed the first titanium dental implants in Singapore more than 20 years ago and this strength in dental implants has continued to be reflected in the multi-specialty team at Specialist Dental Group™.
According to Dr. Ansgar C. Cheng, also a Partner and Prosthodontist with the clinic, six leading specialists from the clinic will be sharing their expertise with seminar attendees on the following topics:
· The Mouth & Body Connection;
· Restoring your Sparkling Smile;
· The Straight Truth about Braces;
· Dental Surgery Now Pain-Free; and
· Filling Gaps & Brightening Smiles
Tickets for the event can be purchased from SISTIC at http://www.sistic.com/
Major Sponsors of the Seminar include Nobel Biocare, Invisalign, Ezyhealth & Beauty and Cosmetic Surgery & Beauty.
Goody Bag Sponsors include Parkway Health, Lion Corporation, Sensodyne, Listerine, SA Dental Supply, Clorets, Vicks, Hisamitsu and Philips.
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