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

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


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.


Gwen Gan


Dental Bridge: Dump The Denture, Pick Up Confidence


People lost tooth for various reasons.

It could be because of a decayed tooth; it could be an accident; or it could be there wasn’t any to begin with (congenitally missing tooth or born without it).



Some may think, we have 32 teeth, so what is the big deal of losing one?

Yes, we have 32 teeth, but every single one is unique and important in its way, just like our finger. You could hold a pen like before if you lost your thumb.

Missing a tooth means altering the function of your chewing and speaking.

On top of that, what comes along with a missing tooth is missing confidence.

You could never imagine a beauty queen in pageant with a missing tooth when she smiles, neither could you imagine if she smiles, a denture falls out from her mouth.



Here I have a very pretty lady, who unfortunately lost one of her front teeth due to accident when she was at her young age.

She is a dancer, she is gorgeous, she has everything that you wish you have as a lady.

However, she has this hidden pain of not confident to laugh out loud as she is using a denture.

She longer for a change; but she was also worried that something other than denture will be worse than what she had now.

After being in dilemma for a very long time, she finally decided to find a solution to it.

We discussed about different options and finally decided that a fixed fixed dental bridge (tooth bridge) would be the best solution in her case.

The missing tooth is a right upper central incisor. She is currently using an acrylic denture.


Her upper right central incisor is a denture. Though not very visible, you could tell there are something pinkish at the side of the tooth.


As the tooth had not been there for very long, the bone above the missing tooth is very thin and look very empty.


We decided to go for a fixed fixed bridge.

It is fixed!


Now she will never have to worry that people will notice her denture , nor will she have to worry that the denture will fall out when she smiles.

She is now a truly gorgeous lady as she is born to it!


With Love,

Gwen Gan


Bleaching: How I Whiten A Single Discoloured Tooth

Single Discoloured Tooth

Do you have a friend who has a weird colour tooth?

Have you wondered why?

Or are you one of them who hopes to find a solution?




Here is the solution: Internal bleaching – a procedure to whiten the dead tooth from within.

Chris’s experience with internal bleaching

Chris had this discoloured tooth accompaniment since forever.

She always had this doubt why is it so, but she never actively looks for a solution.

Until recently when she came to me and I propose this solution and she agrees.

The whole procedures took about a month to complete.

She came about three times in between for me to carry out the procedure.

Each time when Chris came, I would put some whitening gel into the tooth, and she could go home within about 5 minutes. It is a total pain free procedure that is quick and easy to carry out.


Who are the suitable candidates for this procedure?
  1. Root canal treated tooth that discoloured.
  2. Tooth that had trauma before
  3. A tooth that without reason turn darker over time

If you have been troubled by this situation, the best is to go to see a dentist for consultation to be sure that if this could be your solution.


With Love,

Gwen Gan


Baby Teeth: Natal Teeth

Most babies are born without teeth. They look so adorable, innocent, and harmless without teeth.

When teething comes at about 6 months of age, we are all delighted with the two cute little bunny-like teeth at the lower jaw.

“SOoooooooooo cute!” That is how you feel.


What if…. Your baby is born with teeth?

“What???????? Why?????????? What should I do???????????”


Natal Teeth and Neonatal Teeth

Natal teeth are teeth that are present at birth.

Neonatal teeth are teeth that develops in the first month of life

The incidence varies from 1:2000 to 1:3500.

The most common location is the centre of lower jaw (location of lower central incisor)


How To Find Out

At birth, the paediatricians will examine the oral cavity and it includes checking for natal teeth.

Another common route is if the mother has problem with breastfeeding due to sharp structure in baby mouth, then a thorough examination is required.

In such case, a pediatric dentist will be the right person to examine your baby.

Radiograph will be required to investigate the teeth and decide what treatment is necessary.


Possible Complication of Natal Teeth

The potential complication includes:

  1. Risk of swallowing the tooth if it is very loose
  2. Breastfeeding problem as mother may be injured.
  3. Injury to the baby tongue due to the sharp structure


Management of Natal Teeth

Management is different base on the findings from the radiograph and examination by the pediatric dentist.

  1. No treatment
  2. Grinding or smoothening of the sharp edges of the tooth
  3. Extraction / Removal of the teeth

No matter which is the treatment of choice, the baby should be followed up until at least the eruption of the permanent teeth.


Myth about Natal Teeth

I have heard patients telling me that the baby is born with teeth because the mother has taken too much calcium during pregnancy.

Also, there are superstitious belief that baby born with teeth is bearer of misfortune.

The truth is multiple hypothesis have been established about the condition. These includes hormone disturbance during pregnancy, nutritional deficiency and etc.

The most acceptable theory is the location of the tooth germ that is at a more superficial level.

No matter what the reason for such condition is, the focus should always be at what to do to manage the condition and love your baby unconditionally. The paediatrician and pediatric dentist will help in such a situation and baby will grow healthily just as any other kids. =)


With Love,

Gwen Gan