With the trend towards healthier lifestyles, running and other sports, the consumption of sports drinks, power bars and gels has also risen. One of the things to be mindful about when consuming these too frequently, is the impact of these drinks and food on your teeth.

Sports Drinks

According to Dr Elvin Leong, Prosthodontist with Specialist Dental Group, the important thing to remember with sports drinks is, like all other foodstuffs, to take them in moderation. The frequency of drinking and the time that teeth are exposed to the acidic drinks will affect the severity of erosion.

Athletes who are involved in endurance events usually get re-hydrated every few kilometers. In a typical marathon or triathlon competition set up, seldom do professional or amateur participants drink continuously over their event. Furthermore, athletes only take part in these events several times in a year. Therefore, considering all these factors, the impact of the sports drinks on those athletes is not an issue.

Some recommendations are:

• Drink in moderation, i.e., only if you need to and not on a daily/regular basis;
• If possible, plain water is still the best thirst quencher without risk of acid erosion to teeth
• Rinse the mouth with plain water after drinking the sports drinks

 At present, there is very little scientific research to validate the number of times one should drink such drinks or if drinking from a straw would be more beneficial than sipping or drinking at one go.

 Power bars and Gels

Power bars and gels are meant to be a last minute energy supply during long drawn endurance type sports events that typically last more than a few hours. For shorter events, there is simply insufficient time for the body to digest, absorb and utilize them as energy source. Power bars and gels are not meant to be regular meal substitutes on an everyday basis.

There are many brands of power bars or gels. In general, power bars and gels contain high levels of simple sugars, which are easily absorbed and utilized as an energy source. Power gels tend to be simpler in terms of nutrient formulation. The gel form is meant to be swallowed faster. Many power bars contain significant levels of fat and nuts which take longer to be digested and absorbed as an energy source. Power bars are meant to be well chewed up before they are swallowed. The key difference is the duration that the contents stay in the oral cavity. According to Dr Ansgar Cheng, Prosthodontist at Specialist Dental Group, the shorter that these stay in the oral cavity, less harmful to the teeth they may be.

It is natural to relate high sugar content to dental caries. On a regular basis, athletes practice at a fraction of the distance of their favorite long event, and thus the need for consumption of these last minute supplements is low. In Singapore, due to the hot weather, athletes tend to consume a lot of fluids during and after their training, which may neutralize the harmful effect of the sugar content.

Currently, the relationship between dental caries and supplement consumptions is not very well established.

Some people smile with a little bit of their gums showing but for some others, a significant amount of gums can be seen when they smile. Their teeth appear short in proportion to the rest of the gums, giving rise to the term “gummy smile.”

Although people with gummy smiles may have healthy teeth and gums, they may be self-conscious about smiling, and thus reluctant to smile. The good news is that there are options available to correct gummy smiles.

Causes of Gummy Smiles

Gummy smiles may arise due to a number of factors including:

• Excessive display of gums due to the abnormal eruption of the teeth;
• Hyperactive lip muscles which causes the upper lip to rise higher than normal when smiling, showing more gum tissue;
• Prominent upper jaw;
• Prominent position of upper front teeth; or
• Severely worn teeth, resulting in the teeth looking shorter relative to the gums.

Benefits of Treatment

The main benefits of gummy smile treatment are an improved and enhanced smile which in turn, boosts self-confidence and social acceptance.

Treatment for Gummy Smiles

There are several treatment options for those with gummy smiles:

• Crown lengthening: procedure which adjusts excessive gum tissue and the underlying bone. This may be combined with crowns or veneers to give the teeth the final aesthetic look;
• If the cause of the gummy smile is due to front teeth that are set too far forward, orthodontics (alignment of the teeth), crowns and/or jaw surgery may be required

The most important aspect of treatment for gummy smiles is clear communication between the dentist and the patient. Gum surgery itself takes about one hour to complete and the stitches are removed after one week.

If crowns are indicated, then there is a waiting period of about 1-3 months before the final crowns are attached. Where braces and/or jaw surgery is required, the treatment period will take longer, depending on the dental condition of the patient. You will always have teeth and look normal during the whole treatment period.

Gum surgery is NOT a temporary solution – with careful planning and execution, the result will last for a years and years. Proper maintenance and professional follow-up will be essential for successful long term treatment outcome.

Where to Find Treatment

A dental professional trained in gum surgery (periodontist) would be involved in the correction of gummy smiles. As treatment of this nature usually involves other specialty areas of dentistry, e.g. prosthodontists (for crowns or veneers), orthodontists (for braces) or oral surgeons, you may want to consider looking for a dental clinic which can offer access to all these other specialists under one roof.

About 180 children, parents and teachers from the Nanyang Kindergarten made a field trip to visit Specialist Dental Group last week. This was a first for our clinic and our dental team/clinical staff were excited to host the children. To ensure that everyone was able to fit into the clinic, the children visited us over a two-day period in different groups.

We saw this event as a wonderful opportunity to introduce  the children to the dental clinic and the dental team/staff in a positive manner. We wanted the Nanyang children to have good memories of the experience, so that subsequent trips to the dentist would be seen as a routine event, and not something to be feared.

The children were able to have a ride in the “magic chair” while dressed up in a blue bib and cool sunglasses.  Our friendly staff explained what each instrument was used for and they had an opportunity to help count each other’s teeth.

They also felt the spray from the triple syringe and experienced the blue light that is used for hardening fillings and learned that the drill (although a little noisy), did not hurt – in fact, it was rather ticklish…

Dentists from our team also showed them how to brush properly and some of the children volunteered to brush the teeth on our demonstration model and they eagerly raised their hands to answer our dental quiz. The little prizes were specially made and decorated glove balloons !

We want to thank Madam Cheng, Vice Principal of Nanyang Kindergarten for helping to organize this field trip, and also to Kodomo for their sponsorship of the event.

We hope the children had as great a time as we had fun planning the event ….

If you are experiencing sensitivity in your teeth or have experienced it in the past, you are not alone. Globally, about 33% of the population experience tooth sensitivity. In Singapore, two studies conducted by GlaxoSmithKline in 2009 indicated that between 23-25% of Singaporeans suffered from sensitive teeth.

People may report sensitivity to a variety of stimuli including cold drinks, hot soups, sweet or sour food and tooth brushing. This sensitivity may be transient or lingering. Transient sensitivity may not bother the person much, but lingering, high intensity sensitivity is more debilitating.

Causes of Sensitivity

Normal, healthy teeth have an outer layer of enamel protecting the sensitive underlying layer of dentine. The roots of normal teeth are also covered by bone and gums. No dentine is exposed, so there is no sensitivity to normal stimuli during eating and drinking.

Possible causes of the increased incidence of sensitive teeth include:

• Gum disease – As people are keeping their teeth for a longer time due to a reduction in dental caries, more of these teeth may be exposed to periodontal disease. Gum disease is often a silent, slowly progressing, inflammatory process that causes loss of the bone and gums around roots of teeth. When the roots are exposed, sensitivity will be felt. 
• Wear and tear of teeth – Whether through function or through excessive grinding of teeth (bruxism), the enamel on the biting surfaces is worn down and underlying dentine is exposed. Over time, fillings may be worn or teeth cracked. This can also result in sensitivity.
•  Overbrushing or Type of Toothbrush used – People who brushing their teeth too frequently and who use a hard-bristled toothbrush or brush aggressively will end up scrubbing away the thin gum covering the root surfaces. The exposed roots can also be subsequently abraded by aggressive brushing and lead to sensitivity.
• Decayed teeth – As the decay progresses, the sensitivity increases in intensity and duration (lingering). If there is a painful reaction to hot stimulus, then the tooth is likely to be irreversibly damaged and will require more extensive treatment.
• Consumption of carbonated drinks - Younger people are also experiencing tooth sensitivity perhaps due to increased consumption of drinks with acidic levels which may cause the erosion of the tooth enamel over time. 
•  Hormonal changes – Women who are pregnant are more predisposed to gum problems due to hormonal changes which may also result in sensitivity of teeth.
•  Teeth whitening – in some cases, teeth whitening procedures may also result in sensitive teeth. Thus, it is important to ensure that consultation with a dentist is done before undergoing this procedure to minimize sensitivity issues. The degree of shades by which the teeth are whitened may also affect sensitivity.  

Treatment Options

Treatment for sensitive teeth depends on the reason for sensitivity and the extent. Thus, treatment can range from using a desensitizing toothpaste, to professional application of certain gels and varnishes, or even fillings to cover the exposed surfaces.

Several companies have toothpastes and other oral care products targeted at sensitive teeth sufferers – these include Systema, Sensodyne and more recently, Colgate.

One little-known treatment possibility is the use of gum grafting to cover the exposed roots and bring the gum level back to the original position. This is a specialized surgical procedure that may benefit a small percentage of people with receding gums and exposed roots. You can find out more about this procedure by speaking with a periodontist (gum specialist).

Practical Tips

Some practical preventive tips include the following:

• Brush with a soft-bristled brush with gentle strokes. (Ask a dentist to teach you correct techniques).
• Floss between teeth;
• Don’t use a toothpick.
• Visit your dentist at least once in 6 months for thorough check-up and scaling (professional cleaning to remove hardened deposits of calculus).
• Rinse after consuming soft drinks or eating acidic food

 The key for treating sensitive teeth is to determine what the source of sensitivity is – during the consultation, our dentists will try to determine the type of sensitivity the person experiences and from the responses, address the situation and find a resolution to the problem.

A Tradition of Excellence

Specialist Dental Group™ has been established at the Mount Elizabeth Medical Centre in Singapore since 1979 and celebrates its 30^th anniversary this year. The Group is one of the largest multi-specialty dental clinics in Singapore and has nine treatment rooms in two clinics served by a team of seven leading dental specialists.

“Not many dental practices in Singapore have the distinction of being around for such a long time,” says Dr Neo Tee Khin, Managing Partner of Specialist Dental Group™. The late Dr. Henry Lee, founder of the clinic, was a well established oral surgeon who placed the first titanium dental implants in Singapore more than 20 years ago. This strong foundation in dental implants has continued today with Specialist Dental Group™ being one of the leading dental implant providers in Singapore.

According to Dr Ansgar C Cheng, Co-Managing Partner of the Group, the clinic was renamed Specialist Dental Group™ in 2008 to reflect the breadth and depth of the comprehensive dental solutions under one roof provided by its internationally trained/ qualified multi-specialty team.

The clinical team at Specialist Dental Group™ includes dentists with specialty training in prosthodontics (teeth replacement), periodontics (gum treatment), orthodontics (braces) and oral & maxillofacial surgery. Signature dental solutions include Teeth-in-an-Hour implants, Instant Implants™, conventional dental implants, Invisalign®, braces, oral surgery, gum treatment and crowns.

“The idea of a multi-specialty practice arose due to the higher demand and expectation of our patients. Having all our specialists in one place improves communication among them resulting in an excellent standard of care and convenience for our patients,” adds Dr. Neo. Patients benefit with reduced waiting times and can access dentists from different specialty areas with one appointment.

Another convenience is that due to the location of the clinic in a premier medical centre, patients can also schedule their medical and dental visits on the same day in the same building, minimizing the need to take extra time off their busy schedules.

The dental team at Specialist Dental Group™ is also experienced in treating patients with medical conditions such as cancer, stroke, diabetes and heart problems. One of the services offered to patients prior to undergoing cancer treatment (e.g., radiation or chemotherapy) or a major medical procedure (e.g. organ transplantation or heart surgery) is a Dental Assessment. Dental Assessments minimize the risk of oral complications developing in the middle of cancer treatment or post-surgery as a result of a pre-existing dental condition such as an infected tooth or gum disease. The significant cost savings and avoidance of physical and emotional trauma are some of the benefits of having a dental assessment.

Contribution to the Professional Community and to Public Awareness

Most of the dentists at Specialist Dental Group™ have taught or are currently teaching at the National University of Singapore and other international universities. They are also active contributors to international scientific journals and sit on the editorial boards of such publications. As opinion leaders in their respective specialty areas, they are regularly invited to speak at local and international dental conferences.

On the public awareness front, the dental team at Specialist Dental Group™ is passionate about educating the public about oral health, innovations in dentistry and the connection between good oral health and a healthy body. In conjunction with the 30^th anniversary of Specialist Dental Group™’ this year, the clinic organized a public seminar with Channel NewsAsia – Putting the Sparkle Back Into Your Smile – A Dental Seminar that Bridges Function & Aesthetics, which was very well received with an audience of almost 600 people attending to learn more about oral health.

Getting Connected

In addition to the comprehensive information on dental procedures on the Specialist Dental Group™ website, patients are also able to make appointment bookings and enquiries as well as view videos. Specialist Dental Group™ also has a Blog, Facebook Fan Page and a Twitter account in order to be more accessible to patients.

Dentistry used to be associated with dental cleanings, fillings, extractions and dentures. In recent years, its scope has expanded to include smile makeovers. An often overlooked but important aspect of dentistry, however, is the treatment of special needs patients.

This unique branch of dentistry is defined by the Royal College of Surgeons of Edinburgh, a UK specialist board, as “the specialty of dentistry concerned with the oral health care of patients with special needs for whatever reason including those who are physically or mentally challenged.”

Dentistry for Medically Compromised Patients

Medically compromised patients include:

• those who have medical problems such as cerebral palsy and stroke;
• those who are taking immunosuppressive medication;
• those undergoing radiation and chemotherapy; and
• those who are scheduled for major surgical procedures such as organ transplantation.

Patients with cerebral palsy usually have involuntary movements, making surgical procedures and fine precision work dental work a challenge.  A combination of special techniques and sedation can ensure that these patients are efficiently, safely and predictably treated.

Severe stroke patients are usually wheelchair bound with impaired mobility. Most of them also take blood thinning medication to enhance blood flow which may complicate certain dental procedures, e.g. cause prolonged bleeding after a surgical procedure. Close coordination between the dentist and the patient’s medical specialists and a clear understanding of the clinical impact of these medications forms the foundation of safe treatment. This type of patient should be best treated by a specialist team which regularly encounters these clinical issues.

Transplant patients (for example, organ transplants or bone marrow transplants) commonly take immunosuppressive medication which impairs their body’s ability to fight off infections in the oral cavity and other areas.  These patients usually have abnormally swollen gums and are best managed by regular dental assessments before and after the organ transplant procedure.

Some dental conditions that may not bother a healthy individual may become a significant problem for cancer patients during treatment. Conditions such as gum disease or tooth infections, can be cost-effectively managed if properly diagnosed and attended to promptly before the initiation of the cancer treatment. Should these pre-existing dental problems flare up later, they tend to result in complications and are expensive to manage. Most importantly, a dental complication may interrupt the overall treatment strategy and potentially compromise the overall success of treatment.

Dentistry for the Elderly and Physically Challenged

Elderly patients usually have multiple medical conditions and have been prescribed a long list of medications. Thus, familiarity with treatment goals, side effects and interaction of those medications and how they impact on the clinical condition of these patients is important. Patients who are physically challenged face barriers to accessing dental care such as issues in mobility. Patients with functional handicaps, such as visual or hearing impairments, will require the dentist to use skills such as Braille or sign language for communication and gaining of trust.

To ensure good oral health for special needs patients:

1. Brushing of teeth should be done at least twice a day, to reduce the amount of food deposits and build-up of bacterial plaque.
2. Sugar consumption should be restricted or as advised by the patient’s medical doctor.
3. Consider the use of an electric toothbrush. Patients with limited hand mobility may find it easier than using a regular toothbrush.
4. Regular visits to the dentist are advised. The specific time interval will be designated by the dentist, customised to the individual needs of every patient.

Dental management is an integral and crucial part in the overall health equation. Patients with special needs can share the same healthy life style and dental health as everybody as long as proper care and attention is given in their everyday living.