She had a tumour successfully removed from her jaw but Meena was left with a severely collapsed cheek. Requiring expertise not available in her native India, she decided to come to Singapore.

 By Keith G Emuang (keithg@emuang.org)

“My mouth was a warzone! I couldn’t chew, swallow or speak properly at all. It was distressing,” recalls Meena, a 62-year old homemaker from New Delhi.

This was after she had surgery in June 2007 to remove a malignant tumour in the left side of her jaw. Meena had to undergo two months of chemo-radiation therapy thereafter. Although she had won the battle with cancer, there was a casualty – her upper jaw bone – or precisely the 25 per cent of what was left of it.

Even though the initial promise of oral rehabilitation had lifted her spirits somewhat, several months later, it became clear that her recovery was not progressing as she had expected. In fact, it had not progressed at all.

“My mouth was simply useless and I told my husband that this cannot go on. He agreed and that’s when we decided to do something about it.”

Only the best

Meena’s husband, a medical doctor, decided to speak to his colleagues whilst combing through several renowned medical journals. After a studious search, he identified the specific dental expertise that his wife required. However, the challenge was finding it.    

He shares, “There are many prosthodontists but not many have a super-speciality in maxillofacial prosthodontics. Moreover, we wanted a specialist with experience and who was recognised in the field.”

Prosthodontists are dental specialists who are skilled in the replacement of missing teeth and the restoration of natural teeth. Maxillofacial prosthodontists, on the other hand, treat patients who have defects of the head and neck (maxillofacial) region due to cancer, surgery, trauma, and/or birth defects.

Eventually, a shortlist of five maxillofacial prosthodontists was made and following an exchange of email and phone queries, he settled on one from Singapore. 

“Dr Cheng was very prompt with his replies and they were good responses too. Besides, his work had been published in several journals which mattered to me,” Meena’s husband says.

In late November 2009, the couple arrived in Singapore to meet Dr Ansgar Cheng, a Prosthodontist at Specialist Dental Group.

Straight to work

“Meena was distraught when I first met her. Although the combination of surgery and chemo-radiation therapy was effective in treating her cancer, there was not much meaningful work done to restore function to her mouth. Even the denture prosthesis she was given did not fit well,” outlines Dr Cheng.

According to him, Meena only had five functional teeth in her upper jaw. The rest, many of which had root canals done on them, were badly decayed as a result of the cancer therapy. Moreover, the dental bone on her upper jaw was completely gone, leading to another major concern.

“She was missing a seal between her nasal and oral cavity and this caused the accumulation of secretions which was hampering her speech and swallowing abilities. We had to give her a new platform to support the reconstruction of that seal, and new teeth too,” explains Dr Cheng.

A day after she arrived, Dr Cheng began work on restoring Meena’s mouth. By the time he was done in early December, some 17 days later, she had a functional rehabilitation on her upper jaw, five teeth reinforced by titanium posts, three root canals redone and 10 Zirconia crowns for protection and good aesthetic effect.

Meena also had a palatal obturator fitted which covered the hole in the roof of her mouth that leads to the nasal cavity. This obturator replaced the missing 75% upper jaw bone and the missing teeth.

A new beginning  

Dr Cheng remarks, “She was not just missing teeth. Meena was literally handicapped when she came in and her speech was unintelligible. Fortunately, we have managed to give her back significant function to her jaw and teeth, and within a reasonable time frame.

For almost two years, Meena had not been in the right state of mind to enjoy most things. Unable to bite and speak properly, her social life was affected. Today, she is a different woman and is quick to point out where her gratitude lies.   

“I was apprehensive when I first met Dr Cheng but his calm and patient demeanor put me at ease very quickly. By the second day, I had put my full trust in him.”

Dr Cheng adds, “The trust between doctor and patient is vital. So when a patient trusts in their doctor, it makes it very easy for the doctor to carry out treatment.”

According to him, Meena is expected to recover well. He even suggested she put her new jaw and teeth to the ultimate test, which Meena gladly complied. A day and a few pieces of chicken later, she was reassured.

On 16 December 2009, Meena flew back to India – definitely more confident, clearly more excited and audibly more vocal than when she first arrived. Her mouth had been restored and judging by her future plans once she gets home, so too was her lifestyle. 

   Name:             Belle Luer

   Nationality:      Malaysia

   Procedure:      Root Canal Treatment/Crowns

Belle Luer, a Malaysian, had made plans to celebrate Christmas and New Year’s in Cologne, Germany, with her husband’s family. Little did she know that in a matter of days, she would be cutting short her holiday celebrations to fly 10,000 kilometres to Singapore for emergency root canal treatment.

Belle had seen a dentist in Kuala Lumpur for a root canal and crown a few months earlier. However, it turned out that the root canal had been done on the wrong tooth as she had been pregnant at that time, and her obstetrician had recommended that she avoid a dental x-ray. The problematic tooth was left untreated and flared up on Christmas Eve when she was in Europe.  

Saddled with a 9 month old baby and a 6 year old son during the freezing winter, Belle was unable to see a dentist in Germany since the clinics were closed for the Christmas Eve, Christmas and Boxing Day holidays. She was in so much pain that she was on painkillers every couple of hours. She decided to cut short her German vacation and flew to Singapore to see Dr Ansgar Cheng of Specialist Dental Group, her family’s dentist. He opened the clinic to see her on an emergency basis on New Year’s Day.

Belle had a root canal procedure done and was relieved of her agony at the end of the one hour appointment. She was able to return to Kuala Lumpur the next day. Shortly afterwards, Belle returned to Singapore to have a zirconium crown fitted over the root canal treated tooth. She was very satisfied with the results and was amazed at how quickly her tooth healed and the relatively painless procedure.  Dr Cheng also fixed an old crown which was not fitted properly. She was so impressed with Dr. Cheng’s work that she later opted to do all her dental work at Specialist Dental Group, and visited the clinic recently for teeth whitening.

Specialist Dental Group’s comments:

One of the common mistakes in root canal-treated teeth is the failure to provide a well-made dental filling. Research has shown that a reinforced foundation and a well-fitted dental crown are crucial in protecting a root canal-treated tooth and regaining function. We opted to make a CAD-CAM zirconium based dental crown because of its superior precision, excellent hardness and life-like appearance, which we believe is essential for a young lady with a busy work schedule and an active social life.

Root canal treatments are performed using a microscope. Research has shown that clinical outcome improves with high power magnification. Also, the surgical instruments that we use for root canal treatments are all electronically controlled with high precision. A combination of all these clinical aids and clinical expertise results in more predictability in the treatment outcome.

In recent years, the words “medical tourism” and “dental tourism” have become a popular buzzword, particularly on the internet. According to Wikipedia, the phrases above refer to individuals who are seeking medical or dental care outside their local healthcare systems.

It may surprise people to know that dental tourism is not a new phenomenon in Singapore. In fact, Specialist Dental Group, formerly known as Henry Lee Dental Surgery, has been seeing international patients for over 30 years. Most of our foreign patients in those days were from the neighboring countries of Indonesia and Malaysia. 

Why do people travel for dental services?

There are generally several reasons that patients would travel out of their home countries for dental treatment in another country:

1)      Access to more advanced facilities/equipment or specialists that can manage complex cases; or

2)      Quicker access to treatment, i.e. longer waiting list in their home country;

3)       Lower cost of treatment in another country; or

4)       A combination of the above factors.

While Singapore may not top the list for being the lowest in fees for medical or dental care, Singapore has a solid reputation for excellent healthcare facilities and expertise with complex procedures in the Asian region.

In some countries, it is not uncommon for a patient to shuttle from one clinic to another to see several types of dentists during the course of a particular procedure. This inevitably leads to a longer treatment period and time spent travelling from one location to another. In other countries, there is a waiting list before much needed dental treatment can be received.

At our clinic, it may be possible for patients who have undergone their initial consultation on their suitability for a procedure, to start off the procedure during the same visit…. as long as there are no outstanding dental treatment that needs to be done ahead of time, e.g. gum treatment or extractions.

It is also possible for patients to access different types of specialists with one appointment, if the appointment booking is made ahead of time – this is a savings of time and costs for patients. For example, a patient with gum problems who also had missing teeth, could have an appointment with a gum specialist (periodontist), prosthodontist (teeth replacement specialist) and oral surgeon during the same visit.  In the same way, a patient who need a consultation for crooked teeth and a protruding jawline could see both the orthodontist (braces specialist) and oral maxillofacial surgeon) at the same visit.

Why has dental tourism become popular?

Dental tourism has seen a surge in growth in recent years due to several reasons:

1)      Increased number of budget airlines making it affordable to travel overseas for dental treatment;

2)      Increased access to the internet  – more people are able to use the internet to search for healthcare providers via internet cafes, mobile internet access, etc

3)      Increased media coverage of medical tourism and dental tourism – with more news stories on people who have travelled to another country to obtain medical and dental treatment, the interest (and demand) in becoming a dental tourist has also increased

4)      More advertising and online marketing by healthcare providers as well as online word of mouth referrals /reviews by patients and their families

Considerations for dental travelers/dental tourists

If you are considering scheduling in a dental makeover on your next vacation / business trip, do your research ahead of time.  Most clinics will have a website with information on the services provided and qualifications of their dentist.   

• what is the standard of dental care in the country you are thinking of having your dental work done?
• Do you know anyone who has had dental work done there? How did it turn out?
• What is the qualification of the dentist who will be performing the procedure? Is the training/qualification recognized in your home country?
• Is he or she a specialist dentist or a general dentist? A dental specialist may charge more for a procedure but he or she also has had more extensive training/experience in a particular area, and will be more equipped to handle complex or difficult cases.
• Where was he or she trained, and how much experience does he or she have with the procedure in question?
• What methods of communication are available with the clinic/dentist – e.g. email? Telephone? How prompt is the response?
• How detailed is the clinic about the cost of the procedure and what to expect? Do you feel comfortable about the amount of information that has been provided?

 Once the research has been done, the tickets booked and the bags packed, bring out the sunglasses and enjoy your dental vacation. You will find that it is a life changing experience !!!

                      Patient:              Kristin Thompson

                      Nationality:        American

                     Procedure :        Crowns

“If I didn’t know better, I would absolutely think that these teeth are my original teeth.  The color is perfectly matched to my teeth; the texture is identical to the original teeth; and the placement, size and position with the gums is 100% real.”   -          Kristin Thompson 

Kristin Thompson had been wearing a dental bridge since she was 15 and had never been able to eat an apple off the core or corn-on-the-cob since that time. She was also limited in what she could eat and playing sports was sometimes risky.

When Kristin was based in Indonesia, she decided to get dental implants done in Singapore. After asking around, she was recommended to see Dr Ansgar Cheng of Specialist Dental Group and flew in for an initial consultation.

A surfing incident shortly after resulted in an emergency visit to Singapore. Kristin had felt her dental bridge shift while surfing and a few days later, experienced excruciating pain in her teeth. It was Thursday night at 8pm in Jakarta. She was unable to sleep through the night and called the clinic first thing in the morning. Specialist Dental Group staff were able to squeeze her into the tight schedule at the last minute and by 9 am, Kristin was on a flight to Singapore.  A few hours later, she was in Dr Cheng’s dental chair. Two teeth and the bridge were removed and an abscess was drained.

As Kristin had rushed to Singapore so quickly that morning, she had not had a chance to book a hotel room.  Numb from the anesthesia and tired from the early morning flight over, she was not sure where to go.  Without prompting, the clinic staff quickly offered to arrange a hotel for her that was within walking distance.  Within 20 minutes she was resting comfortably at the hotel.  The clinic expedited the fabrication of a temporary denture and she was able to return to Indonesia within three days.

She later returned to Singapore to have implant surgery under Dr Myra Elliot at the Mount Elizabeth Medical Centre and had her crowns made by Dr Cheng. Kristin was delighted that the crowns looked and felt like natural teeth.

One of the first things that she did after leaving the clinic was to bite into an apple – something that she had not been able to do for so long, and which she never thought she would be able to do again.

Specialist Dental Group’s Comments:

Dental crowns cover the teeth and restore them to their natural size, shape and colour. Crowns are used to strengthen teeth that are mechanically weakened, e.g. teeth that have had root canal treatment. In addition, crowns can be used to modify the colour or position of the teeth. Crowns are also used together with dental implants to restore function to the teeth.

Teeth that have been crowned should be cared for just like regular teeth – this means that regular maintenance of the crowns is necessary. Crowns can be made from different materials including ceramic and zirconia. Zirconium-based dental crowns are superior in structural strength reinforcement and aesthetic quality.

When 69-year old Australian Janet Ho was faced with dental problems, her quality of life took a nosedive. Determined to find a solution, she ended up in Singapore for treatment.

Article written by Keith Emuang (keithg@emuang.org)

                Name:               Janet Ho

                Procedure:       Dental Implants

                Nationality:        Australian

Bite, chew and swallow – three simple steps to eating. How difficult can it possibly be? Most of us don’t even give it a second thought. However, for those with a problem in any of these steps, every meal can be a challenge. Just ask retired teacher Janet Ho.  

“I was having chewing difficulties which eventually led to me developing a stomach problem, possibly from being unable to digest my food properly.” 

For a long time, the fillings in her lower back tooth kept falling off every few months. Although she religiously saw her dentist to get it replaced, her patience reached a hair’s end after one occasion when the fillings lasted for just three weeks. A second opinion was in order, the Melbourne resident thought to herself. 

Janet recounts, “I saw a general dentist who recommended I consider having root canal treatment and a dental crown placed over my problem tooth. He then referred me to root canal specialist.”

Bad to worse

Though initially uncomfortable with the fee, Janet eventually underwent root canal treatment after managing to obtain a price reduction. She returned for a follow-up not long after and it was at that point Janet’s flame of discontentment ignited.

“The dentist was too busy to see me and so referred me to a junior one instead. He examined me, said I had 40 per cent bone lost in my jaw and requested I do another X-ray. He also said I needed further treatment. I’d already taken X-rays two weeks earlier but nonetheless agreed to the inconvenience of going to another diagnostic clinic to have them done, “Janet relates.     

However, her subsequent experience left her frustrated and disgruntled, and Janet lost her patience and confidence in dentists for some time.

“Luckily for me, a friend suggested that I go to Singapore for dental treatment. My niece, who works in the healthcare industry there, recommended that I see Dr Ansgar Cheng at Specialist Dental Group. I readily agreed because I knew Singapore has an excellent and solid reputation for its medical treatment,” shares the mother of three.     

Making the difference

In April 2008, Janet arrived in Singapore and met with Dr Cheng, a prosthodontist at Specialist Dental Group. After a thorough examination, he brought in his colleague, periodontist, Dr Helena Lee.

“She was very reassuring and puts one at ease immediately. She explained in detail everything she intended to do in a way that a lay person like me could understand. That really assured me that everything would turn out well.”

Janet adds, “I was also highly impressed that all the specialists were under one roof, which saved me time travelling from one place to another. In this Singapore clinic, you have one dentist as the key person and receive follow-up treatment with other specialists at the same clinic. It’s a great arrangement.” 

Over the course of a few hours, Janet was attended by both Drs Cheng and Lee who took turns to treat her infected teeth. Janet had the necessary extractions and teeth implants fitted to solve her long-standing chewing problems.

“I’m very happy and satisfied with the treatment I received at Specialist Dental Group. In fact, my dentist in Australia never even told me I had three infected teeth. I was under the impression that I had only one bad tooth.”

“Besides the expertise and sub-specialization at the clinic, and high quality of technology used, there were no hidden charges as everyone was very transparent and upfront. It really cuts down on stress and time wasting. Best of all I can go back to enjoying my meals once again.”

Specialist Dental Group’s Comments

Dental implants look, feel and function just like natural teeth. The procedure allows one or more teeth to be replaced without affecting neighbouring teeth (unlike the case with dentures) and is a long term solution for teeth loss.

One of the benefits of having several types of dental specialists in one location is that patients are able to consult with, and obtain treatment for different dental problems without having to travel between clinics or arranging additional appointments.  Patients benefit from time and cost savings. Communication between the various specialists is also seamless as all the patient’s records are in one clinic.  An added convenience is that patients can have their digital x-rays and CT scans taken at the clinic without going to a separate facility and waiting in line.

          Name: Stephen Houston

          Procedure: Emergency Oral Surgery

          Nationality: Canadian

“I am extremely thankful this sort of thing happened when I was within a reasonable distance of such professional, high quality care. I am well aware that without such, things could have been very unpleasant indeed”   – Stephen Houston

Stephen had been suffering from an infected wisdom tooth that resulted in breathing difficulties and impaired his ability to swallow. The Canadian was working with the Indonesian government’s tsunami and earthquake reconstruction and rehabilitation agency in Banda Aceh at the time. With the side of his neck beginning to swell, he searched the internet for help and came across Specialist Dental Group’s website.

It was Good Friday evening, a public holiday in Singapore. Stephen emailed the clinic to request for an appointment the following morning. Minutes later, he received a call from Dr. Ansgar Cheng asking for more details on his symptoms.  Dr Cheng instructed Stephen to go directly to the clinic upon arriving in Singapore and he would be seen on an emergency basis.

Dr Cheng, a maxillofacial prosthodontist with Specialist Dental Group (SDG), initially examined Stephen and called in his colleague, Dr Ho Kok Sen, an oral maxillofacial surgeon to assist with Stephen’s case. Stephen was admitted to the Mount Elizabeth Hospital immediately and put on intravenous antibiotics and anti-inflammatory medications. Surgery was scheduled for 9pm that same evening.

Dr Ho and the attending anaesthesiologist explained to Stephen what would be done and ensured that he understood and was comfortable with the proposed treatment. Shortly after, Stephen was back in the hospital bed with the wisdom tooth and much of the infection removed. He was also able to breathe and swallow again. Stephen was discharged a few days later and returned to Indonesia to work.

 Specialist Dental Group’s Comments:

Infections resulting from impacted wisdom teeth, deep cavities requiring immediate root canal treatment or decayed teeth can sometimes cause swelling of the gums and mouth. This can result in difficulty in eating or swallowing. Pain is also experienced. In some instances, the airways can become so swollen that a person can experience breathing difficulties. When this happens, getting prompt dental treatment is critical.

Antibiotics are usually prescribed to reduce the inflammation from the infection. If the situation is non-urgent, the patient will be instructed to return to the clinic a few days after taking the medication to have the tooth treated. In emergency situations, immediate treatment is required.

Prevention, in these types of situations, is always better than treatment. Regular visits to the dentist will make early detection of potential dental problems such as cavities and decay possible. In addition, wisdom teeth that are not well-positioned and which are likely to cause problems can be identified and extracted before they become an issue. Treatment costs would be lower in non-emergency situations and patients 

               Name: Anne Howe

               Procedure: Dental Implants and Bridges

               Nationality: Australian

“I couldn’t be happier with both these doctors, the work they carried out, the detailed care they took, and the friendliness they showed towards me was above and beyond.”                                                                                                         -  Anne Howe

Anne played golf and tennis regularly and listed scuba diving and sky diving as some of her outdoor activities.  Based on Norfolk Island, she actively volunteered for the past 20 years in rescuing and raising injured or orphaned Australian native birds and animals. She also volunteered for an organization that cared for children with cancer.

When it came to her dental well-being, Anne decided to take matters into her own hands after being told by her Australian dentist that her jaw was going out of alignment.  She consulted with an Australian specialist and obtained a quote for the treatment involved. Finding the fee rather steep, she researched the internet for dentists in Asia after hearing that high quality dental work could be done less expensively there.

After comparing information on dental surgeons in Thailand, India and Singapore, she finally decided on Dr Myra Elliot, an oral maxillofacial surgeon based at the Mount Elizabeth Medical Centre in Singapore. Anne had visited Singapore several times previously and felt safe in the country. Singapore also had a reputation for high standards of work and honesty. Dr Elliot, in turn, recommended Dr Neo Tee Khin, prosthodontist at Specialist Dental Group (SDG) to assist with the prosthesis treatment for Anne.

Anne’s treatment involved having teeth removed and dental implants placed to support a bridge. She also had general dental treatment.  According to Anne, the overall cost of her dental treatment was about the same as having the work done in Sydney by the time she paid for airfares, accommodation and sundry expenses. However, she enjoyed 3 excellent trips to Singapore, which was starting to feel like a second home, and that was a bonus.

Specialist Dental Group’s Comments:

Dental implant treatment has been long documented to be an effective and lasting solution for replacing missing teeth. Teamwork and coordination between the oral surgeon and the prosthodontist is important for a successful outcome. Implant teeth can be supported with dentures, crowns or bridges.

The best treatment option will be recommended after a thorough examination and consultation with the dental specialist. Many patients have reported significant changes in their confidence level after completion of dental implant treatment and are able to enjoy a wider variety of food and social activities. The new teeth look, feel and function just like natural teeth, and should be cared for in the same way as one’s natural teeth 

Specialist Dental Group was recently featured in a Kaltim Post article (newspaper based in Kalimantan, Indonesia) about healthcare in Singapore. You can read the full article in Bahasa Indonesia by clicking here.

For the convenience of our blog readers who do not understand Bahasa Indonesia, we have summarized the relevant portion of the article in English below.

ACCURACY: 3D X-rays are used to ensure that the installation of dental implants is accurate at Specialist Dental Group

Apart from visiting the restructured hospitals in Singapore, we also visited several private hospitals in Singapore, such as Raffles Hospital, Thomson Medical Center, Specialist Dental Group in Mount Elizabeth Hospital, and Pacific Healthcare at Paragon Mall. In Singapore, the hospital is not just a place for treatment but also to beautify yourself or as a lifestyle enhancer.

At Specialist Dental Group, there is a method to straighten your teeth by using transparent aligners (Invisalign). According to Dr. Ansgar C Cheng, these aligners are very useful especially for those who may feel shy in wearing braces. Invisalign uses 3-dimensional computer technology to plan a comprehensive treatment, and consisting of a series of specially personalized aligners for the patient. Each aligner is used approximately 2 weeks before being replaced by the next, and gradually straightening your teeth until the final pair of aligners are used.

“You will not know that a person is wearing the aligners, because Invisalign is transparent (clear),” he said. 

Invisalign treatment takes about 1-3 years to complete, and may require an average of 10-50 pairs of aligners. Invisalign treatment is suitable to close gaps between teeth, or teeth that are mild to moderately crowded. “The benefits of using Invisalign, are because the aligners are not as obvious as conventional metal braces, and it is very easy to install and remove, which makes it easy to clean the aligners and the teeth,”  said Dr. Cheng.

In addition, Specialist Dental Group also provides dental implants in a single day. “Most dental implants take weeks, while it just takes a day here,” he said.