General Topic : Dental Examination

“Doctor, I brush my teeth twice a day. Why do I still get problem with my teeth?”

Does this sound familiar to you? Is this one of your doubts as well?

Most of us in Malaysia have the habit of brushing twice per day.

However, how effective is your brushing?

Are you brushing using the right tool?

Are you brushing using the right way?

How do you know if you are brushing well?

Chances are you won’t know until a dentist examine you and tell you about it.


Whenever patient come for dental check up, I like to examine the teeth, the gum, the arrangement of their teeth and any other potential problem that is present.

Let’s look at this patient teeth together.


Case Study: a lower tooth that is difficult to clean

This young gentleman came requested for a scaling.

Interestingly, all the teeth in general are very clean; except for one tooth that was totally covered by calculus.

Immediately, I knew that something wasn’t quite right there.

When I looked again, I realised that the teeth next to it are not align with it.

It means that when he place his tooth brush there, the bristle of the tooth brush won’t be touching this tooth. No matter how hard he tried, he won’t be able to clean the tooth.

I discussed with him what is the challenge, and taught him how to angle his tooth brush in brushing this tooth.

Also, I suggested other tools that could help him in cleaning this particular tooth.

He was delighted to learn about the way of cleaning his teeth as he was always troubled by a rough feeling over this tooth.

Before he left, of course I cleaned his teeth so that he could start fresh from there.


In a nutshell, everyone has different teeth.

There is no one size fits all method of cleaning teeth.

If you have trouble cleaning your teeth, or you would like to know how to clean your teeth effectively, feel free to contact me for a personalised plan for you.

Thank you.


Dr Gwen Gan

Mandibular Tori (Torus Mandibularis)


Mandibular tori or torus (plural)  is a common harmless bone growth that develops at the lower jaw, at the side near to the tongue.

This condition normally does not have any significant impact to life as it does not disturb speech, eating or how the person looks.

Hence, most people never realise they have this excessive bone growth in their mouth until they were pointed out; or they just never know its existence.


Clinical Features

The mandibular torus present as a bony structure along the inner aspect of the lower jaw near to the premolar region.

It can be either  a single nodule or a bilateral growth (growing on both left and right side of the jaw)

The color of the tissue covering the bony structure is of the same color like the gum, and the surface feel smooth.

In rare circumstances, the bilateral tori can grow so big that the almost meet in the midline.



No treatment is necessary generally.

The only time that a treatment is considered is when a denture is required at the site, and the presence of tori makes it hard for a denture to be placed.

In such a case, a surgical removal is required to accomodate the denture.


My Experience With Mandibular Tori

It is a very common condition among Asian and I see it quite often in my practice.

Recently I was approached  by my patients raising concern about this as they were worried that it is something cancerous.

The first lady was a 80-ish lady and she was very concerned since she had lived so long and she never realised of its existence. I assured her that this is a harmless condition and we took photos to record it in case it grows bigger.

Another patient rushed in with a sudden panic attack worrying that her torus had grown. (We have discussed about her torus two years ago, radiograph and record was taken). This is a very young lady at her twenties. For her, I too make sure that the record is well taken and we measured it so that we can be sure if it grows.

The experience with these two ladies actually made me reflect on myself that something that is common in a dentist eyes, may not be something that patient is cool about.

The best is to inform patient whenever I see such condition and make sure they understand about it.

If you have a similar condition and you are wondering what is this, the best thing is to schedule and appointment with a dentist for a check up.

Else, you can send me a picture and if it is clear enough, I am happy to help diagnosing it.

Hope you learn somethin from this post.

Have a good day.


Thank you.

With Love,

Dr Gwen Gan

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


Smile Makeover For Lily – Part 2


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






Smile Makeover For Lily – Part 1


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.


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.



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…..