18 Jun
Beautiful Smile, Children Dentistry, Smile Makeover

Children Dentistry: Anterior Cross Bite Correction

 

This is one of the cases that I am really proud of.

I feel proud, not because it is a bombastic treatment.

I feel proud, because a small gesture that I did make a difference for his entire life.

In other word, it is impactful!

 

Interceptive Orthodontic Treatment

Most parents do not realise the need of an assessment for interceptive treatment at young age;

and will only seek orthodontic treatment (braces)  after all the permanent teeth have erupted.

In most of the cases, it works; but not all.

The trusth is : any problem that involve jaw development is best to be corrected at young age.

Once the jaw has been fully developed, the most likely way to treat it will be surgery in adulthood.

Interceptive orthodontic treatment is treatment that help to remove any obstacle in jaw development and helps the jaw to develop in a natural and correct way.

So the most important take home message from this post is :

Do an orthodontic evaluation at about age 7 and 8.

 

Case Study

Anterior Cross Bite

This is a little boy at age 7 when his mum brings him for a cleaning of his teeth.

When I see kid at this age, my routine is that I will assess their bite and eruption of the teeth to make sure everything is going the right way.

The two front teeth were trapper by the lower teeth. Take note also that the two lower teeth appears much longer than others.

 

For him, his upper front teeth were trapped by the lower front teeth.

His mother never realised about this.

To be fair, it wasnt obvious at all as it only involved the two front teeth which just erupted not long ago.

If not because I was checking his bite, I most likely would have missed it as well.

So, parents please check your kid’s bite from time to time to be sure that their bite is correct. The upper teeth should be in front of the lower teeth.

If this condition was left behind, he will become a true class III (reverse bite where the lower jaw become much longer than the upper jaw)

Why is that so?

Jaw Development

At his age, the upper jaw was developing but it can’t continue to grow as the lower teeth were stopping it from growing. It was trapped and limited his upper jaw to grow.

At this point, the lower jaw wasn’t growing as much and hence most people wont notice it.

When he reaches his puberty age, at about 10-13 years old, the lower jaw will start growing.

By then, there is nothing from the top to make sure that the lower jaw grows according to his correct profile. The lower jaw will keep on growing and finally become much longer than the top.

When this happens, depending on the severity of the jaw discrepancy, could be difficult to solve. Worst case scenario is that a major surgery would be required to correct it.

Other problem

On top of the restriction of the upper jaw, another problem happens together with anterior cross bite.

As the upper jaw tries to grow, the upper teeth will push the lower front teeth forward in an abnormal rate.

The lower teeth could be pushed until that not much bone is encircling the lower teeth and hence cause bone lost if the relevant teeth.

In long term, this can become a serious gum problem and cause premature of losing these two lower teeth.

From the picture above, you can tell that the two lower front teeth are much longer than other teeth.

This is because the teeth were pushed to the border of bone and some of the bone that were supposed to encircling the teeth were lost.

In other word, less bone is holding these teeth and hence weaker.

 

Orthodontic Appliance

After discussion with the mother, I made an removable appliance for him.

The design of the appliance is Z-spring with posterior bite plane.

The Z-spring was used to push the two teeth forward and the posterior bite plane was to make sure that the lower teeth were not in a way when the Z-spring pushed the teeth forward.

 

This is a photo taken half way through treatment. One of the tooth has successfully cross over, but the other not totally yet.

 

Six months down the road, finally the bite was corrected.

Bite corrected! Hooray!

 

I am glad that now his upper jaw is no longer trapped and it can grow naturally.

Would he still need to do braces in the future?

Maybe yes, maybe no depending on his other permanent teeth growth.

At least what I can assure is his jaw development is now normal and any minor correction of his teeth alignment could be solved very easily through simple braces.

Honestly, I am very proud of what I have done for this case.

Like I say, it is a small gesture but it impacts his whole life.

 

How do I not love being a dentist?

With Love,

Gwen Gan

 

17 Jun
Beautiful Smile, Composite Veneer, Dental Bridge, Root Canal Treatment, Smile Makeover, Whitening

Smile Makeover For Lily – Part 2

THE BEFINNING OF SMILE MAKEOVER

Step 1- Composite Veneers

The first thing I did for Lily is four composite veneers for her upper front teeth.

Why did I choose to do so?

Lily was going to join a new workplace in two weeks time. I needed to do something that had the most impact of her smile.

Base on the smile analysis, people could hardly notice that she had two missing teeth.

The teeth that would affects her smile and image were the four front teeth and hence must be treated first.

Due to the time constraint, her discolored upper right central incisor that needed root canal treatment and internal bleaching (whitening of single tooth from inside the tooth) would be carried out later on.

 

Step 2 – Root Canal Treatment and Internal Bleaching

Base on the investigation results, two teeth required root canal treatment.

It took us about 3 weeks to finish the root canal treatment. Lily was very determined and she came in consistently for her treatment.

From there, we sterted internal bleaching for the discolored upper right central incisor.

Step 3 – Dental bridge

Once the necessary treatments to manage infection were carried out, we moved on to restorative phase.

Lily had two missing premolar, one on the left and one on the right.

After discussion about the treatment options available, Lily prefered to restore the missing teeth with dental bridge.

 

 

We made two fix-fix porcelain bridge for her, just in time for her engagement ceremony.

That was what I promised her, to have the best smile on her engagement ceremony. =)

My heartiest congratulation to Lily!

 

With Love,

Gwen Gan

 

 

 

 

 

17 Jun
Beautiful Smile, Composite Veneer, Dental Bridge, Root Canal Treatment, Smile Makeover, Whitening

Smile Makeover For Lily – Part 1

INTRODUCTION

This blog post is specially dedicated for Lily – a girl who is happy, determined and never give up.

How we met was nothing special, she is a patient and I am a dentist.

She came for dental check up and I was her dentist.

She probably did not expect that our meet up would change her smile and life; and I definitely would not expect that her story would remind me once again how my job could impact someone life.

I want to write this down to remind myself never to forget to be a kind dentist.

THE FIRST MEET UP

Lily had been to many different dentists before seeing me. Her appointment with me was an appointment for scaling.

She is a regular patient in the clinic that I work for but we have never met, she was seeing other dentist all the while.

Looking at her appointment, I did not have a second thought and thought that this is just another patient coming for a regular dental check up and scaling.

However, when I looked into her mouth, I started to frown.

She is a pretty and young lady, and it was very obvious that she had some dental problem but why nothing had been treated despite being a regular patient to the dental clinic. I felt sorry for her.

After the scaling, I sat her down and explain her about her oral condition.

I prepared a long list of what were the problems, what were the treatments required, what are the prices and how long she would need to complete all these.

I reassure her that she would be fine as what she was lacking is someone to guide her and do a good treatment plan for her.

I was running out of time that day, in fact I was overtime as I was only given half an hour with her, but I felt the duty to make sure she understood what is her oral condition and what types of treatment she needed. Hence, I kept her longer to feed her with as much information as I could.

Before she left, I told her that she must make an appointment to come for a discussion again and I did not really have faith that she would return as she was quiet and did not show much interest.

At least I did my part. That was what I thought.

 

THE STRUGGLE IN LILY

Little did I know that, that time she was actually frustrated looking for a dentist.

She had been to many dentists hoping someone could help her, but all she got was blaming her for such bad teeth and never told her what to do.

After we completed everything only she told me that she was taking me as her last chance to fix her teeth.

If I failed her as everyone else, she was ready to give up already.

I am really glad that I took the initiative to explain her oral condition and the treatments that she needed even though she did not ask actively.

I am really grateful that I could be there to help her in making a decision that would impact her life.

I am glad that I still keep my pure heart being a dentist to help people in need. =)

 

to be continued…..

 

17 Jun
Beautiful Smile, Uncategorized

All About Your Regular Dental Scaling

As a dentist, I am glad that more and more people are now aware of the importance of regular dental scaling.

If you are one of them who goes to check in at the dental clinic regularly, congratulation and well done!

If you are yet to be one of them, I hope this post will remind you that it is time to do so.

 

WHAT IS DENTAL SCALING?

Dental scaling is a procedure performed by the dentist to remove calculus that had been built up along the gumline. (In Malaysia, there is no dental hygienist and dentist is the one who performs the procedure).

A polishing will be performed also to help removing stain and smoothen the rough surface following dental scaling.

Hence, you always heard the name Scaling and Polishing.

In short, these two procedures help to keep your mouth clean, prevent gum problem and give you a beautiful and confident smile. =)

 

WHAT TOOL IS USED?

Dental Scaling

Ultrasonic scaler is used during the procedure.

The ultrasonic handpiece typically uses either magnetostrictive (elliptical motion)or piezo-electric (back-and-forth motion) technology. Magnetostrictive inserts operate at 25,000 to 30,000 cycles/second and, Piezo-electric inserts operate at 28,000 to 36,000 cycles/second.

The high vibration energy works effectively to knock the calculus and hence detach from the surface of your teeth.

The water comes together with the scaler also serve a few purposes during the procedure. First, of course it helps to flush away the debris. At the same time, it works to cool the tip of the ultrasonic scaler so that the heat created is not transmitted to the teeth. The tiny bubbles that are created also helps to disrupt the and rupture the bacteria, and changed the environment that is not suitable for bacteria to live.

Polishing

Traditionally, polishing is performed using prophylaxis cup and prophylaxis paste. It works to smoothen the rough surface following dental scaling. It also works to remove stain (not all, but to certain extend). It also contains fluoride that helps strengthening the teeth.

A newer way of doing polishing is through air polishing which use high pressurised water and fine sodium bicarbonate to blast on the plaque and stain to remove them. It is more gentle to the enamel layer yet more effective in removing stain compared to the traditional way of polishing.

 

ANY AFTER CARE TO TAKE NOTE?

Teeth sensitivity

One of the most common side effects that follow after dental scaling is teeth sensitivity.

Avoid taking very sweet and cold food or drink as it can trigger more sensitivity. Once the biofilm is built up again (typically takes a few days) then your teeth will feel normal again.

You can also consider using a sensitive toothpaste to ease the problem

Gum Bleeding

If there is any bleeding from the gum, it will normally stop within a day.

However, if you notice any unusual bleeding please refer back to your dentist to be sure.

Mouthrinse

Antibiotic mouth wash may or may not be prescribed depending on the condition of the gum.

Discuss with your dentist if you need a mouthwash to further clean up your mouth.

Oral hygiene

Do your best to minimise the deposition of calculus again.

Even though it is inevitable to have calculus, but keeping a good oral hygine helps to minimise it.

Discuss with your dentist if you are not sure if your oral hygine is good.

In a nutshell, flossing daily, brush twice a day with fluoridate toothpaste is necessary.

 

HOW FREQUENT SHOULD I DO THIS?

A general answer is 6 months. However, it depends on the overall condition of your mouth.

Someone that has calculus build up faster will need more regular check up , e.g. 4 months.

Someone that hardly has calculus build up can wait for 6 months or 9 months before seeing a dentist.

On top of how fast calculus built, someone that easily get dental caries will be called back for check up earlier than someone who never has any caries or filling.

The best thing is to work together with you dentist to decide what is the suitable timeline for your regular dental check up.

With Love,

Gwen Gan

 

14 Jun
Beautiful Smile, Whitening

Beautiful Smile: In-Office Teeth Whitening

What Is In-Office Teeth Whitening?

In-office teeth whitening means to have your teeth whitten at a dental clinic.

It is a procedure that can only be carried out in a dental clinic by a dentist.

The procedure is safe and result is immediate.

 

How Is The Procedure Like?

There are a few steps involved :

  1. The dentist will first perform scaling to remove plaque and calculus on the teeth.
  2. Photograph will be taken to record the shade (color) before teeth whitening
  3. Cheek retractor and cotton rolls will be inserted in your mouth to protect the soft tissues (to protect your lip, cheek, gum and etc)
  4. A special gel to protect the gum near to the teeth will be applied.
  5. The dentist will then apply the whitening gel on your teeth.
  6. A special laser light is used to shine on your teeth for 15 minutes.
  7. Step 5 and 6 are repeats for 3 or 4 times.
  8. Admire your new smile!

 

How Does It Work?

The whitening gel contains an active whitening ingredient (either carbamide peroxide or hydrogen peroxide) that penetrates the outer layer of your teeth to the deeper layer of your teeth.

When it gets to the discolored molecules , the Oxygen molecules from the whitening agents react with the discolored molecules , breaking the bonds that hold them together.

As the discolored molecules became atom, your teeth now are whiter.

 

Is There Any Side Effect?

Most people experience different level of teeth sensitivity after the procedure.

The effect could last from 2 hours to about a day.

There isn’t any damage to the structure of the teeth as it is a chemical reaction that works to lighter the shade of the teeth.

 

How White Can My Teeth Become?

Nobody can answer this question as the procedure only works to break down the discolored molecules.

It could only at best return your teeth to the color before staining due to food consumption, but it could not give a new color to the teeth.

Imagine that you are bleaching your white shirt, and you will most likely get back the color when you first bought the shirt, but not any whiter.

It works the same for teeth whitening.

How Long Can It Last?

Depending on individual’s diet, it can last up to three years.

 

Do I Need To Avoid Any Food After Whitening?

For the first few days, try not to consume any food that stains.

Example, tumeric,black coffee, marinara sauce, wine, blueberry and etc.

 

I hope I have covered most of the concerns about in-office teeth whitening.

Feel free to leave a comment if you have any other question.

 

With Love,

Gwen Gan

 

13 Jun
Children Dentistry

Baby Teeth: Space Maintainer for Early Tooth Loss

Timeline of Baby Teeth Shedding

Most babies get their full set of baby teeth/primary teeth at around three years old.

At about age 6, they start to have the permanent teeth growing and gradually replace the primary teeth.

This process of replacing baby teeth takes about 6 years to complete.

Early Lost of Baby Tooth

In certain circumstances, a kid could lose a primary tooth before the permanent tooth is ready to grow.

It could be an accident, or it could because of a dental cavity with serious infection.

When such situation occurs, there will be concern if the premature tooth loss will cause misalignment of the remaining teeth and hence cause problem to the eruption of permanent teeth.

 

Challenge of Premature Baby Tooth Lost

When a baby tooth lost too early, two problems arises:

  1. The permanent tooth lose a guide as of where to come out
  2. The neighbour baby teeth lose the support and move into the space. The jaw is now smaller and the narrower space is insufficient for the permanent tooth to come out properly and hence become crowded.

 

Space Maintainer

As the name suggested, a space maintainer is a custom made appliance fitting into the space to keep the space.

It makes sure the neighbor teeth keep still and help to keep sufficient space for the permanent tooth to grow properly.

The design of the space maintainer comes in different forms, depending on the number of missing teeth and the location of it.

A most common space maintainer design is called Band and Loop where a metal band circumference the molar tooth and a metal wire keep the space of the missing tooth.

 

Maintainence of Space Maintainer

There isn’t any additional thing with regards to maintainence, just make sure that the oral hygiene is good (brush and clean the mouth well) to avoid plaque forming around it.

A regular dental check up and follow up is important to make sure that the space maintainer is not in a way when the permanent tooth is coming out.

 

Must a Space Maintainer be Issued Whenever a Baby Tooth is Lose?

No. it depends on the location and timing of the permanent tooth eruption.

A dental radiograph may be required to help making the decision.

 

With that, I hope you get some insight about space maintainer.

Love,

Gwen Gan

 

12 Jun
Periodontal / Gum Problem

Gingivitis/Periodontitis: How to Stop Gum Bleeding?

What I Used to Think About Gum Bleeding

Have you ever experienced bleeding from gum during brushing and flossing?

Before I became a dentist, I panic whenever I saw this.

What I did was I tried to brush very carefully and gently so that I do not hurt my gum further.

In most of the time, the bleeding would go away sometime later.

 

What I Know About Gum Bleeding

After becoming a dentist, I learnt that bleeding gum is a sign of inflammation of the gum.

(Sign of inflammation: redness, swelling, heat, pain and loss of function.)

What causes inflammation of gum is the plaque and tartar on the teeth and gum.

 

 

 

 

 

 

 

 

 

How Can I Help My Body to Fight the Infection?

The most effective way to stop it is by getting rid of the bacteria.

This can be done by brushing away the plaque and scaling to remove the calculus by a dentist.

 

The Simple Steps to Stop Gum Bleeding

  1. Brush twice daily. Make sure that the bristle of your toothbrush cleans the junction between gum and teeth.
  2. Floss once daily
  3. Dental scaling every 6 monthly or as recommended by your dentist
  4. Have a dental check up to rule out if there is any other cause of the bleeding gum

 

With that, I hope you won’t be panic when you see your gum bleeds like I used to be.

Now when I see bleeding from gum, I will say,

“Okay, got it, is time to have a spa at dental clinic. Thank you for reminding me!”

 

With love,

Gwen Gan

05 Jun
Children Dentistry

Baby Teeth: Pacifier Teeth

 

If you are a mother like me, I am sure this topic is not something new to you.

In fact, all of us, at some point of time, wonder if pacifier is the solution for our cranky baby who just cannot be soothed.

However, at the very last moment, you always wonder if it will do more good than harm as you heard stories about pacifier teeth.

 

WHAT ARE PACIFIER TEETH?

Pacifier teeth are misalignment in teeth caused by prolonged usage of pacifier.

The dental problems can be open bite, overbite or crossbite.

Once the problem is developed, it is not going to be solved on its own and intervention is required to solve it.

 

IS IT GOING TO CAUSE DENTAL PROBLEM FOR SURE?

It depends on how long your baby been using the pacifier.

If the habit is carried on until the grow of the permanent teeth, then the effect is sure.

 

WHEN SHOULD CHILDREN STOP USING PACIFIER?

The use of pacifier should be stopped as early as 6 months and not later than 4 years old, the earlier the better.

 

CONCLUSION

Though pacifier has its benefit, the prolong use of it will cause dental problem.

It is recommended to stop using pacifier as early as possible

 

With Love,

Gwen Gan