Dr Ho Kok Sen of Specialist Dental Group was recently interviewed by Daniel Martin of “Body & Soul” on 938LIVE FM Radio. The interview was part of a series of events to launch the Sjogren’s Syndrome Club in Singapore. Dr Ho, an Oral Maxillofacial Surgeon, was one of the speakers at a public seminar, and spoke on “Managing Dry Mouth (Xerostomia) for Sjogren’s Syndrome patients.
For your convenience, we have uploaded the radio interview and selected slides from Dr Ho’s presentation on YouTube, Facebook and our website.
I am a regular reader of Sumiko Tan’s columns in the Straits Times – she is a good writer and always has an interesting perspective on issues of daily life.
Sumiko’s recent May 2, 2010 article in the Straits Times on her experience with Invisalign certainly grabbed my attention (and I am sure, the attention of many Invisalign patients and dentists/orthodontists). Titled “In Dental Prison”, she recounted her negative experience wearing the Invisalign aligners for her upper teeth and her trepidation on wearing braces for her lower teeth.
Readers may have come to the general conclusion after reading the article that braces and Invisalign are uncomfortable and restrictive and that one has to decide whether the cost of being subject to such treatments is justified, particularly if it is for aesthetic reasons alone. Having recently completed Invisalign treatment myself (and having worn braces many years ago), I wanted to suggest a few pointers for those considering Invisalign or braces treatment
Knowing what to expect ahead of time would be helpful in psychologically and practically preparing oneself for the procedure. Any treatment where teeth (and bones) are being moved will inevitably result in some level of discomfort but having an idea of what is involved will usually smoothen the transition.
Having a positive frame of mind and a good understanding of the treatment also goes a long way in reducing anxiety. The experience of the Invisalign patients (myself included) at Specialist Dental Group has largely been nothing less than good - in fact, many eagerly awaited the appointment with the orthodontist to have the Invisalign aligners issued for the first time. I certainly couldn’t wait to start my treatment.
From a personal perspective, I actually found that wearing Invisalign was rather liberating. There were no restrictions on the types of food or drinks consumed as long as one removed the aligners prior to eating. I could still enjoy coffee/tea (just let it cool down first) and also soft drinks – I just had to make sure to rinse later.
Putting on and taking off the aligners was something that became routine. Just discretely use your hand to shield your mouth when you remove the aligner… or get an “Outie” tool to help make removing the aligner easier.
Ideally, one should brush one’s teeth after eating and before putting the aligners on again. I was really good about it for the first couple of months… and then I confess, I became a little less diligent and just rinsed well after meals… that was OK too. I guess I was lucky.
Any sharpness in the edges of the aligner can easily be corrected at the dentist’s office. I had no issues with this for my aligners.
In terms of payment of fees, when it comes to Invisalign, check with your clinic on their payment policy. Our clinic generally collects a deposit when treatment is confirmed, and subsequently, patients can pay in installments at each review appointment. Some clinics may also have arrangements with credit card companies where the treatment fees may be spread out over a longer period of time.
Apart from the cosmetic reasons to have one’s teeth straightened, there are also functional reasons why orthodontic treatment may be necessary, and not just for vanity’s sake. 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.
Finally, if one is considering braces or Invisalign treatment,
Speak with others who have gone through the experience and obtain practical tips from them.
General dentists and specialist orthodontists have different training and experience. Find one that you are comfortable with who is able to discuss the various treatment options for you.
Some patients may be told that they need to have extractions in order for optimal results. While no one would like to lose teeth that are otherwise healthy, do consider your dentist’s/orthodontist’s expert advice carefully – he or she is experienced in doing many of these procedures and your teeth may need to have the extra space in order to be aligned properly.
Know yourself and your habits – if you lack discipline to faithfully wear the Invisalign aligners, you may want to consider having fixed braces instead.
The two dental specialists summed up the biggest dental issues of the 21st century as being:
Tooth decay;
Gum disease;
Root caries; and
Bruxism
I. Tooth Decay (Dental Caries)
At Specialist Dental Group, we have noted a rising trend in the number of teenagers with multiple tooth decay (dental caries). This was not previously seen due to the existence of fluoride in our water which imparts a certain degree of ‘protection’ against dental decay.
Possible reasons for the rise in tooth decay include:
The increased tendency to skip regular meals and resort to frequent snacking while working, studying or surfing the internet.
Snacks are usually high in refined sugar which results in a high concentration of caries-causing bacteria in the mouth and hence increased incidence of tooth decay.
Such food may also be sticky, thus lengthening the time the sugar is in contact with the teeth.
People increasingly have less time for tooth brushing and some teenagers have been known to fall asleep after eating.
Tooth brushing is important in removing food that sticks to the teeth and also reduces the caries-causing bacteria count in the mouth. When a person is asleep, salivary flow reduces and is therefore less effective in flushing out the sugars in the mouth.
II. Gum Disease (Periodontitis)
The lack of proper tooth brushing may also cause gum disease or periodontitis. Periodontitis is an infection of the gums, bone and supporting tissues that holds the teeth in place. The disease progresses slowly and is often not noticed by the lay person because it is painless in the early stages.
Left untreated for many years, the supporting bone and fibres around the roots are lost and teeth become loose. At the more advanced stages, tell-tale signs like frequent gum abscesses occur and gums bleed easily. Perfectly good teeth are thus lost through gum disease. Gum disease is also increasingly found in younger people and not just the older generation. This could be attributed to the changing lifestyles as mentioned above.
Only 43% of the population was aware of the cause of gum disease and that gum disease could lead to tooth loss.
The practice of dental flossing was reported by only 33% of those surveyed.
Only 46% of the adults visited the dentist at least once a year.
Gum disease has been linked to general body health issues such as heart disease, diabetes and stroke. A patient who has uncontrolled gum disease may also find his diabetes difficult to control. Diabetes also has a slow and silent onset. In the untreated diabetic, the destruction of gum disease is more aggressive and progresses faster. Getting gum disease diagnosed and treated also contributes to better management of blood sugar levels in diabetics.
Prevention is always better than cure; this preventive care is best started during childhood.
III. Root Caries
With people living longer and keeping their natural teeth longer than ever before, elderly adults will have more teeth that are susceptible to root caries (in addition to gum disease as described above). Root caries progress quickly due to the relatively soft nature of the root surface.
Risk factors associated with the high prevalence of root caries among older adults include:
decrease salivary flow or xerostomia,
exposure of root surfaces due to periodontal (gum) disease,
chronic medical conditions,
radiation treatment for head and neck cancer,
physical limitations, and
diminished manual dexterity due to stroke, arthritis, or Parkinson’s disease,
cognitive deficits due to mental illness, depression, Alzheimer’s disease or dementia,
Sjögren’s syndrome (an autoimmune disease),
diabetes,
poor oral hygiene,
multiple medication use, and
changes in dietary habits.
One or more of these risk factors or life changes, which are more common among older adults, can increase root caries in an individual who has not had dental caries for many years.
IV. Bruxism
In a fast-paced, highly stressed population, there are also increasing numbers of people who brux (grind) and clench unconsciously. The teeth show signs of wear that is advanced for the person’s age.
Fillings may also break off more often. With excessive bruxing, some teeth may fracture. If the fracture stretches deep through the nerves and roots of the tooth, it will have to be extracted.
Bruxism can also cause chronic problems with the temporomandibular (jaw) joint leading to TMJ or TMD problems. This is characterized by unresolved facial pain. Common symptoms include pain in or around the ears, tenderness of the jaw, clicking noises when opening the mouth, and headaches or neck aches.
Implications
Dental caries and gum disease can result in tooth loss with resultant difficulty in chewing food. With fewer teeth, eating healthy food like fruits and vegetables will be a challenge, leading to preference for a diet that is high in sugar and low in nutrition (e.g., cakes and mashed potatoes).
A group of dental experts concluded in 2002 that elderly patients with no teeth that are wearing ill-fitting dentures may be at risk for malnutrition. They recommended regular dental visits to the dentist and in some cases, the use of dental implants to restore chewing function.
Tips on Prevention
Gum disease and dental caries are both painless in their early stages. The symptoms may be relatively mild e.g. discomfort or sensitivity on biting and drinking cold fluids. When pain occurs, the destruction of tooth, gums bone and its supporting structure may be irreversible resulting in ultimate tooth loss. Therefore, it is beneficial to take some basic steps to prevent dental problems
Brush twice a day with a fluoride toothpaste;
Floss or use an inter dental cleaner once a day;
Eat a balanced diet;
Limit eating and drinking between meals. If there is a need to eat, choose nutritious food such as fruits instead of snacks high in refined sugars;
Visit your dentist regularly every six months;
In children, dental sealants may be useful to prevent decay on adult teeth.
Due to the proactive measure by our dentists, dental associations and the Health Promotion Board, public awareness about dental problems is on the rise and will continue to increase. Hopefully this will translate to a reduction in the number of teeth lost due to tooth decay, gum disease and root caries.
For more information on options to replace missing teeth, click here. To find out about gum treatment, click here.
Dr Ho Kok Sen from Specialist Dental Group was recently interviewed on 938LIVE radio on the Body & Soul show about a dry mouth condition known as Xerostomia and is currently available on Youtube. You may listen to it at http://bit.ly/9bBKbd. Read on to find out more about Xerostomia.
What is Xerostomia?
Xerostomia is the medical term for dry mouth. It is also known as salivary gland hypofunction. Dry mouth as the name refers to a subjective feeling of oral dryness due to a lack of saliva. It is not a diagnosis but a symptom. For this symptom to appear, the person’s unstimulated and stimulated salivary flow rate must be depressed to a certain level.
How does Xerostomia impact dental care?
Xerostomia is not a normal condition. Other bodily fluids like blood, urine and even tears have been widely used as indicators of health and disease. Saliva, however, has been largely ignored. Saliva protects our teeth and oral tissues. It also aids in digestion, taste and speech and is also a sensitive indicator of serious systemic conditions and diseases. Having a dry mouth is not normal and the general public needs to recognize this condition and bring it to the attention of their doctors and dentists.
Patients with dry mouths who do not seek preventive dental care in the early stages will usually present with severe dental caries (decay). This may be accompanied by mucositis or general inflammation of the oral tissues. Saliva with its immunoglobulins and other protective enzymes helps with food clearance thus preventing tooth decay. It also lines and protects the oral mucosa thus preventing recurrent oral infections.
How do you know that your Xerostomia is getting worse?
Our salivary glands are like factories. They need raw materials, machines and electricity to function and produce the end-products. If there is any disruption in this production line, the end-products get affected. Applying this to our salivary glands, we know that if there is any interference in the supply of metabolites including water, damage to the glands or failure in neural transmission can result in a reduction in the synthesis of saliva.
Xerostomia may present early with little or mild symptoms. Symptoms worsen when there is increased difficulty in speech and eating, This may be coupled with halitosis or bad breath. To determine if xerostomia is getting worse, we can test the salivary gland function. This can be done by collecting saliva and determining the amount produced in a five minute period. Other objective evidence of salivary gland involvement is tested through ultrasound examinations and/ or a parotid sialography.
Studies have shown that 1 in 4 adults complained of dry mouth and its associated symptoms. This coupled with the fact that about 40% of the elderly complained of dry mouth goes on to show that it is quite a common condition.
What can you do prevent and treat Xerostomia?
Treatment involves finding any correctable causes and fixing those if possible. In many cases it is not possible to correct the xerostomia itself, and treatment focuses on relieving the symptoms and preventing cavities.
Tips for patients with Xerostomia
avoid the use of decongestants and antihistamines,
pay careful attention to oral hygiene.
Sipping non-carbonated sugarless fluids frequently, chewing xylitol-containing gum, and using a carboxymethyl cellulose saliva substitute as a mouthwash may help.
The use of an enzymatic product such as Biotene toothpaste, mouthwash, and dry mouth moisturizing liquid has been proven to reduce the rate of recurrence of dental plaque resulting from dry mouth.
Ensure that you see your dentist regularly for check-ups to maintain your oral health
What is Sjogren’s Syndrome?
Sjögren’s syndrome is an autoimmune disorder in which immune cells in our body system attack and destroy the exocrine glands that produce tears and saliva. The exocrine glands concerned are the tear or lacrimal glands and the salivary glands, It is named after Swedish ophthalmologist Henrik Sjögren (1899–1986) who first described it.
The hallmark symptoms of the disorder are dry mouth and dry eyes. In addition, Sjögren’s syndrome may cause skin, nose, and vaginal dryness and may affect other organs of the body, including the kidneys, blood vessels, lungs, liver, pancreas, and brain.
Public Seminar on Xerostomia and Launch of Sjogren’s Syndrome Club in Singapore
If you have xerostomia / Sjogren’s Syndrome or know of someone who has xerostomia/Sjogren’s Syndrome, Dr Ho will be speaking on “Managing Dry Mouth in Sjogren’s Syndrome”
Date: Saturday, April 24, 2010
Venue: Marina Mandarin Hotel (Taurus Ballroom)
Time: 2pm to 4pm.
Fee: Registration fee is $12 (Goodie bag worth $70 will be provided). Payment by cheque or credit card only.
See below for more details or contact: Shawn Chong at (65) 6232 8335 / 9227 1771 or email shawn.s.chong@gsk.com.
Dr. Ansgar Cheng, Director and Prosthodontist with Specialist Dental Group, was profiled in Ezyhealth & Beauty’s March 2010 Issue. The article was entitled “Dr. Ansgar C Cheng, The Dental Specialist who Reconstructs Faces”. Dr Cheng is a Hong Kong-born Canadian who moved to Singapore 6 years ago and is one of the leading prosthodontists in the country. He is also trained in the sub-specialized area of maxillofacial prosthetics.
Prosthodontics and Maxillofacial Prosthetics
Dr Cheng elaborated that the work he did was like building, designing, and being the overall architect for a house. In the US, prosthodontics actually leads to the sub-specialty of maxillofacial prosthetics which includes the rebuilding of not just teeth, but also the jaw and facial parts, for patients who need extensive reconstruction as a result of trauma or head and neck cancer.
Creating Smiles and Function
During the interview, Dr. Cheng brought up a case of a patient from Indonesia, who had a sizable tumor removed in his upper jaw. The tumor was surgically removed. The functional factor was important in managing this case, as the patient was a professional speaker and it was very important for him to speak clearly.
Dr. Cheng’s principle in treating patients is that dentistry is not just about creating a beautiful smile – it is important to create a smile that is functional at the same time.
Contributing to the Professional Boards and Societies
He mentioned that he feels that he needs to pay back to the society which has contributed so much during his study time through meaningful training. Dr. Cheng makes his contribution by being on the Dental Specialists Accreditation Board, sitting on the committee of the Prosthodontics Society (Singapore) and also as an Adjunct Associate Professor at the National University of Singapore, teaching the graduate specialty students there.
“Hopefully we can pass on our knowledge to the next generation, because whatever we have, we owe it to our teachers as well,” he said.
Living in Singapore
Dr Cheng’s impression of Singapore after living for the past 6 years is that Singapore is a fantastic country with a world class airport, a government that really works, a system that is efficient, and great weather. On top of that, geographically, staying in Singapore offers easier access to his extended family in Hong Kong and Malaysia.
Being Healthy
Dr Cheng shared that being healthy was not just about physical well-being but also psychological well-being. Physiological well-being is partly constituted by how healthy you are and how many people love you.
Read the complete interview in the March 2010 issue of Ezyhealth & Beauty
Dr Marzella, Dr Neo Tee Khin, Richard Soh, Dr Ansgar Cheng and Dr Ho Kok Sen
A team of dentists from Specialist Dental Group and Universitas Trisakti performed the NobelGuide Teeth-in-an-Hour Live Surgery procedure before a group of approximately 200 dentists in Jakarta on Saturday, February 20, 2010. This revolutionary procedure enables dental implants to be placed in one hour, and was the first time that this procedure was performed in Indonesia.
According to Dr Neo Tee Khin, Prosthodontist with Specialist Dental Group, “With this Nobelguide Teeth-in-an-Hour procedure, people who have missing teeth can get new teeth that look, feel and function just their natural teeth – all in an hour.”
The Live Surgery event was part of a workshop organized by the Indonesian Society of Implant Dentistry with the collaboration of Universitas Trisakti and sponsored by NobelBiocare. Dr Neo and Dr Ho Kok Sen, Oral Maxillofacial Surgeon with Specialist Dental Group, were instrumental in planning and providing clinical expertise for the procedure together with Dr Marzella Mega Lestari from Universitas Trisakti.
The patient, Richard Soh, 56, is from Singapore and previously lived in Jakarta for a few years. Mr Soh had been wearing dentures for many years on both his upper and lower jaw. He found the dentures uncomfortable and he could not fully enjoy his food. After the NobelGuide Teeth-in-an-Hour procedure, Mr Soh was able to eat almost immediately – and he enjoyed a full lunch that afternoon and was able to eat as normal the rest of the time.
Patient eating watermelon minutes after the surgery
“The NobelGuide Teeth-in-an-Hour procedure is minimally invasive – there is no swelling or pain, and the recovery is very quick,” added Dr Ho Kok Sen.
Professor Ansgar Cheng of Specialist Dental Group also provided a briefing on the NobelGuide Teeth-in-an-Hour procedure. “Our clinical experience shows that the success rate of this procedure is about 99%”, said Dr Cheng.
Nobel Biocare is the world leader in innovative restorative and aesthetic dental solutions. It has the largest share of the global dental market and has developed numerous advancements in dental implants over the past 40 years. The company is the leading innovator of computer-aided design and manufacturing as well as computer-aided implant treatment planning and guided implant installation. For more information, visit www.nobelbiocare.com
Specialist Dental Group is the leading multi-specialist dental clinic in Singapore. Based at the Mount Elizabeth Medical Centre, the clinic celebrated its 30th anniversary in 2009. Its founder, Dr Henry Lee, placed the first dental implants in Singapore over 25 years ago. The dental team consists of 7 internationally trained/qualified specialists in different areas of dentistry. Specialist Dental Group offers comprehensive specialist dental solutions under one roof. For more information visit www.specialistdentalgroup.com
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.
Specialist Dental Group’s resident Oral Maxillofacial Surgeon, Dr Ho Kok Sen, was profiled in the December 17 issue of Mind Your Body (Straits Times) today. For those of you who are unable to access the paper, read on below to have an idea of what the story was about.
I decided to specialise in oral-maxillofacial surgery because…
I get to disassemble and reassemble stuff which is something I’ve enjoyed since I was a small kid. I remember spending hours on my airfix models and WWII toy soldier models. When i did not have the funds to purchase new models, I would take the existing models apart and put them back together again.
Similarly, in the oral cavity, I get to take out broken or decayed teeth and replace them with dental implants. In the facial region, I get to move the jaws around and put them together to give new form and function. I also get to fix the various jaw segments together when patients fracture them during a road traffic accident or traumatic fall.
The jaws are fascinating because…
It is such an integral part of the body. It gives form (and function!) to the face. People in the fashion industry talk about jaw lines. People in the food industry talk about jaw strength! But remember, jaws without teeth on them neither give you any form nor function. So maintaining a good set of teeth sets the stage for a fabulous smile and nice jaw line.
If I were to give an analogy for what I do, I’d be a…
Handyman. I piece together things and fix people’s teeth so that they can function again. I also make sure things are working as they should be.
I have come across all types of cases…
…ranging from a little child engaged in child’s play getting a thumbtack stuck in his tongue to big jaw cysts requiring removal and reconstruction. I have also had cases where patients have come in straight from the airport to be admitted into the hospital due to airway obstruction caused by the swelling of an infected tooth. In between, I take care of impacted wisdom teeth, place dental implants and perform jaw surgery.
A typical day for me would be…
I wake up at 7am to play with my 2.5 year old daughter before she heads to playschool. I then spend some time with my 5 month old son before I leave and reach Specialist Dental Group at 830am.
The rest of the day is divided between consultations and surgeries. General anaesthesia procedures are done in the hospital operating theatre while sedation procedures are performed in the clinic.
I hold a teaching appointment as an adjunct senior lecturer at NUS and I spend one morning or afternoon a week teaching dental undergraduates and graduate dentists.
My day usually ends around 6pm and I head home to spend time with my 2 kids and wife who is an obstetrician and gynaecologist at KK Hospital. I may be called upon some nights to attend to emergency cases at the A&E of the Parkway Group Hospitals.
I love patients who are…
Appreciative of what I am trying to do for them. Many of them have become friends. The doctor-patient relationship has no hierarchical levels. It is one forged on mutual respect and understanding.
Patients who get my goat are…
Patients who have genuine dental needs but choose to listen to “overly concerned” relatives and friends who convinced them otherwise. In doing so, they are not giving themselves the opportunity to have treatment that would improve their lifestyle and health.
One little known fact about wisdom tooth surgery is…
It can be a painless procedure. With proper management, the procedure and post-surgery recovery can be smooth and pain-free. And yes, you can eat after surgery, in fact, ice cream and other cold desserts are encouraged …..
Things that put a smile on my face are…
When a patient’s smile is restored successfully and you can see the change in their confidence level and attitude to life at subsequent visits. Another thing that makes me smile is the relief on anxious patients’ faces when their surgical experience was more positive than they had initially expected.
It breaks my heart when…
Patients do not know that there are solutions available now for virtually any debilitating dental conditions that they may have. As a result they experience a less-than-optimal quality of life or suffer pain in silence.
We live now in a highly advanced and high tech society and this has allowed scientists and researchers to come up with new techniques and solutions that our forefathers had no access to.
I wouldn’t trade places for the world because…
This career gives me the satisfaction of taking out what is not salvageable and replacing them with state of the art artificial teeth while seeing the tremendous positive impact it can have on a person’s life.
I also enjoy working together with the multi-specialty team at Specialist Dental Group because we are able to take a comprehensive approach based on our different areas of training and experience. This not only enables cutting edge dental treatment to be done, which is fulfilling on a professional level, but also enables the patient to access comprehensive treatment in one place.
My best tip…
Remove your wisdom teeth before they start to give you problems. Prevention is better than cure. Take care of your teeth well and they will be with you longer.
