Sunday, November 16, 2008

mind that gap!

beauty is in the eye of the beholder. some people think mocha-skinned people are exotic. some people think hairy-chested guys are macho. i think tall men are sexy. i also think i look sweet in purple (eceh! perasan!) although all my sisters think purple is a boring colour..

those gaping hole between your two front teeth has been bugging you lately? you actually have several choices in improving it, if it's that what you are after.

1. braces
spacing in between your teeth can easily be corrected with braces. the good thing is it doesn't involve extracting any of your teeth. but, though this is the easiest solution, you still have to wear it for quite a long time for the result(1-3 yrs). the good thing: it doesn't involve cutting any of your tooth structure or any foreign material. its your natural teeth minus the gap.

2. filling
if the gap is small, you can always have the space filled. we usually will take the colour of your teeth first to suit the colour of the material that we are going to use. the procedure will take about half hour and voila! no gap no more. but it does come with a hitch: you cannot eat hard stuff with your front teeth or those filling will break. you should also refrain yourself from taking too much coffee/tea/coloured food because that filling are easily stained. but then, its cost is much much lower than wearing braces, so if it breaks, or if the colour has changed, or if you want the tooth shape done differently... you can always repeat this treatment. no problem there.

3. crowning / veneering
because it is lab-constructed, doing crown or veneer will eliminate all the problems that you might have with a tooth filling. meaning; it doesn't break easily, it doesn't stain and it looks really good and natural. the downside of it: its cost. it may cost lower than braces, but it is about 10 times higher than if you do a simple filling. crowning also involves cutting some structure of the teeth- so you might have sensitivity problem later on. veneer doesn't have this problem, but its cost is double the cost of crowning.

4. or else

or else... leave it alone!!
beauty is in the eye of the beholder. some people may think that gap in your teeth make you look sexier..

Tuesday, October 28, 2008


to all parents with children age 4 years and below, you are welcome to visit us at our clinic and get a Pureen Kids Toothpaste sample for free!!!

Term and conditions:

free sample only for children age 4 and below. dental check up should be done prior to determine whether your child is suitable to use a non-fluoridated toothpaste.
available flavour: mint, strawberry, orange. While stock lasts.
one sample per child, please. on first come first serve basis.

Sunday, September 14, 2008

rawatan pergigian dan hukumnya dalam islam

mungkin belum terlambat untuk saya mengucapkan selamat berpuasa kepada saudara2 saya. saya juga terpanggil untuk menjawab kemusykilan pesakit2 saya yg saban hari datang bertanyakan perkara berkaitan topik ini, terutama semasa kita dalam bulan mulia ini. saya akan cuba meng-clarify-kan persoalan2 ini, tetapi kalau boleh jangan lah menganggap saya sebagai seorang yang expert dan arif tentang hukum agama kerana saya sekadar saudara biasa yang masih memerlukan banyak panduan.

soalan 1: apakah hukum memakai braces/pendakap gigi?

Memakai pendakap gigi dibolehkan kerana ia bukanlah dalam kategori mengubah ciptaan Allah. Mengubah ciptaan Allah adalah apabila seseorang itu mengubah sesuatu yang sememangnya normal. Pendakap gigi dipakai untuk membetulkan gigi yang bentuknya kurang normal, maka ia dibolehkan.

soalan 2: apa pula hukum membuat implant/bridge/crown? oleh kerana ia mengcover gigi kita, bukankah air wudhuk tidak akan dapat melalui gigi tersebut?

Islam membenarkan kaedah “crowning” dilakukan kerana ia dilakukan untuk tujuan perubatan dan bukan kecantikan. Gigi bukanlah salah satu anggota badan yang wajib dibasuh memandangkan ia didalam tubuh dan bukan diluarnya. Wudhu’ tanpa berkumur-kumur masih sah. Menggunakan implan gigi bukanlah dalam kategori mengubah ciptaan Allah kerana ia adalah menggantikan apa yang sudah rosak atau tiada. Islam membenarkan penggunaan implan gigi seperti Islam membenarkan implan organ lain yang sudah tiada lagi.

soalan 3: bolehkah kita mendapatkan rawatan gigi dalam bulan ramadhan? tidakkah terbatal puasa kita? (soalan favourite pesakit).

list ini saya ambil dari terjemahan buku Puasa, Hikmah dan Hukum oleh: Syeikh Abdul Majid Aziz Az-Zindani yang mempublish Keputusan Majlis Perhimpunan Fiqh Islam Berkenaan Benda-benda Yang Membatalkan Puasa Di Dalam Bidang Perubatan. (terima kasih PERMAYA)

perkara yang TIDAK membatalkan puasa dalam perubatan adalah seperti:

1. Menebuk gigi, atau mencabut geraham, atau membersihkan gigi, atau bersugi dan memberus gigi, sekiranya dielak menelan apa yang sampai ke halkum.
2. Membilas mulut, berkumur, dan semburan ubat yang diletakkan pada mulut, sekiranya dielak menelan apa yang sampai ke halkum.
3. Suntikan ubat pada kulit atau otot atau urat, kecuali cecair-cecair dan suntikan berzat nutrien.

saya harap ini dapat membantu mengurangkan kemusykilan saudara2 saya supaya boleh mendapatkan rawatan gigi dengan lapang hati, terutama dalam bulan ramadhan ini. namun mungkin harus saya nyatakan di sini sekiranya kita masih was-was, contohnya kita takut tertelan air semasa scaling, maka eloklah delay rawatan scaling itu sehingga selepas waktu berbuka.

maklumat yang saya gunakan pada post ini saya dapat dari:
- website MUIS (majlis ugama islam singapura)
- website Unit Penterjemahan & Penyelidikan PERMAYA (persatuan pelajar Malaysia Yaman)

mohon betulkan saya sekiranya ada maklumat yang saya dapat disini adalah salah.
Selamat Berpuasa Dan Menyambut Aidilfitri. :)

Monday, August 25, 2008

what's under the umbrella?

(green alert for the sweet-toothed)


the sinful pleasure of that rainbow-coloured delight. go on, have it. this one dentist won't say you can't.

are you serious???

sure i am. (why so serious, by the way?)

eating sweets and chocolates will cause rotten teeth.

and hands down to the oldest, most misplaced and misunderstood statement of all time. here i am, the saviour of you sweet-toothed people (including me, i should say) and let me modify that statement a little bit:

eating sweets and chocolates WITHOUT cleaning your teeth will cause rotten teeth.

yes, you read me. sugar alone will not cause that hideous blackened teeth we often see. sugar (and formula milk) are the ones bacteria fed on, so everytime we take sugar or give our children that bottled milk, the bacterias that cause rotten teeth will be jumping in glee because they are also being fed their favourite food. but, if after that we brush our teeth, that food source those bacterias indulge on is not there any more and the bacteria will die out of starvation... so no rotten teeth!

you will now argue that magnanimous sugar consumption are still bad for our general health, and i will not debate with you on that. high sugar taking will make you a good candidate of having diabetes (high sugar level in your urine) especially if you have your closest family members that also have diabetes and if you are pregnant. now, let me introduce you to a new icon:
called 'The Happy Tooth', it is licensed to mark all confectionery, sweets, chewing gums, bonbons, lollipops, etc which have been demonstrated to be safe for teeth (check out their website here). these effort was started by the swiss people in 1982 to create awareness of oral health and the logo was introduced internationally in 1989. the logo was introduced here in south-east asia in 2003.

in Malaysia, unfortunately there are not many products with the happy tooth that is available here, i suspect (but i do not regret) because of the 'halal' issue, since from the info i have gathered, it is upmost difficult for non-halal products to have retail rights here in our country. anyhow, some of those with the logo are:

chupa chups cremosa lollipop, retail rm0.98 at guardian pharmacy. also available at hypermarkets in packs of 6.

fisherman's friend lozenges range, retail rm3.90.

ricola fresh pearls range, retail rm3.90.

smint mints range, retail rm3.00.

what's need to be reminded, however is not all sugar free products are marked with the happy tooth, example mentos, wrigleys, dentyne, etc. sugar free products are meant for diabetic-conscious and weight-concerned people , and these brands are probably either not tested or fail in their toothfriendly testing. so to the manufacturers: go, guys! go get that logo! and to the rest of Homo sapiens: indulge yourself, guilt-free! life without indulgence, is no life whatsoever.(just don't forget to brush afterwards, okay..)

++++++whoooping gleefully while eating lollipop :D

Wednesday, August 13, 2008

us, unique.

13 august 2008-

Happy Lefties Day to lefties around the world.

not many people were aware that i practice with my left hand. i take that as a positive output: it means they are comfortable with me even though i am somewhat 'different'. but some who notices often ask me the oldest question: how do you adept? i do not know how, i just do. some of my left-handed colleagues do their work with their right hand (i applaud them- their practice makes them ambidextrous) but for me, i like being different; and if practicing dentistry with my left hand makes me unique, so be it.

does being left-handed affect the outcome of my work? i would like to believe absolutely not. i trust it is who we are, not which hand we use, that determines the outcome of what we do.

there are dental chairs that can be set for left-handed dentists, but i am comfortable with the right-sided settings. besides, all my locum dentists are right-handed. i wouldn't want to trouble them unnecessarily. it used to be awkward for my nurses to adapt with me, since i do my work from the left side; but by now i am pretty sure they are getting used to it.

to all lefties out there: celebrate our uniqueness!

Wednesday, July 23, 2008

bracing matter

the question of the week: berapa cost nak buat braces?

braces (or pendakap gigi, or besi pada gigi, or medically known as orthodontic treatment) has somehow becoming a trend among youngsters now. usually this type of treatment is done under advice of our dentists, but there are some cases in which the patients themselves request for it for various causes, example for self esteem, aesthetics reasons, because its cool and also because all their friends have it.

the cost of wearing braces varies from one clinic to another, but on average it is between rm3500-rm5000. no no no, you are not paying this amount in one shot. most of the payment you will have to put down is on your bonding appointment, in which your dentist cements the braces onto your teeth. on that appointment only you will pay about rm1500-rm2000. after that, you will have appointments on monthly basis, up to two years or more, to change or tighten the wires. those appointment costs about rm150-rm200. easy said, consider the initial rm1500-rm2000 as down-payment, and rm150-rm200 as monthly payment. so, for example, if you pay rm1500 as your initial payment and rm200 consequently on every monthly visit, and your dentist charge you rm4300 for the whole treatment course;

(rm4300 - rm1500) /rm200 = 14 months
you will finish paying in a little over one year. its not bad, isn't it?

okay, those rm4300 does not include the consultation before you start wearing braces, the treatment you need before you put on the braces and also the follow up after you remove them. specialist will charge you around rm50 for consultation. scaling or filling or extraction prior to putting on the braces will be charged accordingly. and x-ray cost is around rm100.

minor malalignment- non-specialist case

general dental practitioners do provide orthodontics treatment. we do this after we attend some short courses that enable us to provide those services to our patients; but only for simple cases such as minor malalignment of the teeth or spacing of the teeth (gigi jarang). we tend to charge lower for our services.

moderate-severe crowding: specialist's case

orthodontists, on the other hand are specialists that specializes in correcting major malalignment such as jongang (pardon my word, but i need to be blunt) and severe crowding of teeth, so their charges will be a little bit on the costly side. my advice is: always get a second or several opinions before you decide. get these dentists to tell you whether yours is a simple or a complicated case.

wearing braces is no ordinary or simple matter. a lot of failed cases attributes to lack of discipline and knowledge. so make sure you do your research and mentally well-readied before deciding on flaunting them. good luck!

Tuesday, July 8, 2008


'saya nak putihkan gigi saya...'


'saya nak macam orang kat hollywood sana...'

untuk rawatan tuh kita charge rm500 untuk satu session yea...

'ape pulak... kawan saya buat hari tu rm60 aje!!'

yg rm60 tu cuci gigi lah dikk..

our teeth is naturally yellowish white in colour. the intensity of the colour yellow very much depends on the thickness of our enamel (the outer layer of our teeth) and dentine (the inner layer of our teeth). this thickness, in turn, believe it or not, depends on our genes. those who has thicker enamel will have whitier teeth and those with thicker dentine will have teeth that appears more yellowish. that is why dark-skinned people (indians, african-americans) seems to have whitier teeth whilst those with fair skin (chinese, eurasian) have more yellowish teeth. malays? we are somewhere in between (as always).

what do we mean when we say ' cleaning' or 'cuci' our teeth? simply means we are removing the plaque (or in our world better known as tahi gigi) and calculus (i.e tahi gigi yang dah keras macam batu). plaque and calculus will appear as yellow depositions along our gum margins, and they easily irritates our gum. the simplest sign that you have plaque and calculus deposition is when you have bleeding gums while brushing.

plus, if you frequently indulge yourselves in heavily coloured food (example: coffee, tea, fizzy drinks, chocolates, liquor, etc etc) and of course, if you smoke, these depositions will be coloured as well, and we call them staining of teeth. the older you are, the more apparent these staining will become as our dentine will become thicker hence teeth become yellower and stains become darker.

brushing alone, be it 5 times a day, will not enough to remove plaque if you do not accompany them with flossing. calculus, on the other hand, can only be removed by your favourite person (the dentist). this is the main reason we encourage dental check ups. just do it on your own accord, be it thrice a year or once in three years. but do it routinely.

while teeth cleaning is a routine treatment need, teeth whitening on the other hand is completely for cosmetic purposes, just like a makeover. i am of course referring to here in Malaysia. Do not compare ourselves with them in Tinseltown where they seem to suffer without collagen injection and whitens their grins routinely.

there are all range of whitening options, from rolls royce level to motor kapcai. the most expensive is the laser treatment, which can cost about rm2k per session and the result is very satisfying. you can achieve that 100 watt smile, no argue there. the cheapest would be the take-home toothpaste ones you get over the counter anywhere between carrefour and kedai runcit abu. the result? you tell me. i'm sure everyone have tried it before one way or another.

for me, just like you do those makeover once or twice for that extra-special occasion, you can also whitens your teeth for the same purposes: engagement, wedding, graduation... but let me also suggest, that if you opt for the lower-middle or higher-middle range (which costs from rm100-500 per session) that you try it once about 3-6 months before the purported time. because incidentally, the result of these mid-range type varies to different types of teeth. some lucky ones can get up to 5 shades whiter than their original shade, but others cannot see the difference at all. even if you choose the laser treatment, you should also try it once before, see whether it suits you and whether you can control yourselves afterwards (in your smoking and eating habits, i mean) because whitened teeth are super-easily stained and there are reports of hypersensitivity in some patients. you do test drive the car first before you buy, right?

and oh, yes. you do have to have your teeth cleaned first before you even think of whitening them.

Monday, June 16, 2008


i have not been able to write anything for this past few weeks due to a lot of distractions; one involving some very disturbing yet appealing changes that have been waited upon; the other depriving me of sleep and making my eyes wary by forcing them to follow one ball chased upon few guys in shorts on the coloured box.
between here and there however i have been collecting some contents that might interest young parents: lets hope azzuri goes through and the good mood will flow into good article.

forza italia! :)

Tuesday, May 20, 2008

in too deep

choices, choices, choices.

pumps: red? blue? purple?
football: man u? liverpool? chelsea?
cars: toyota? mazda? honda?

teeth: cabut? cabut? cabut? *huh?*

we do have choices when it comes to the health of our teeth. all the choices available is to eliminate whatever discomfort that we have. be it just a small hole, or major pain in the (ermm..) oral cavity... YES! we have!

a small to medium-sized hole on our tooth will present itself as a slight discomfort: during eating, drinking... especially hot or cold or sweet. its solution is simplest of all: filling! because the cavity is small, only involves the enamel and a little bit of dentin and very far away from the nerve, pain during this type of treatment is zilch!

a medium to large-sized cavity will cause a more apparent discomfort. added to that is the feeling that there's always some food stuck at that area whenever we eat, and it is becoming more and more difficult for us to take the food out. the other sign would be, whenever we floss, the floss gets stuck. the solution again, is filling. but apart from the normal filling material, we will also add a medication (a calcium hydroxide material) that will stop the caries from going deeper and nearer to the nerve by promoting the production of secondary dentin, which is a harder, stronger layer as compared to our primary dentin.

a large cavity may well has your pulp (the chamber housing our nerve) involved already. you will have: - hell of a pain, accompanied by swelling of gum, and the occasional facial asymmetry. Solution: root canal treatment. basically we will take out all the nerve and blood capillary that supplies that particular tooth; clean the canal area and fill it up with a type of rubber. it is almost the same process as mummification: we embalm the tooth so that the tooth is dead, no sense whatsoever, but still can remain in the mouth and still can be used to chew.

if all these fail, then you can consider extracting the tooth. but, you can also consider redoing the treatments.

choices, choices, choices. its all up to you. how much value do you put to your teeth? or should i say, how much value do you put in comfortably and without worry eating the satay kajang.. pizza... nasi dagang... soto ayam.. mee bandung muar... roti canai... lamb chop... strawberries and vanilla ice-cream... lobster thermidor... cupcakes....

choices, choices, choices.

euro: italia! italia! italia! :D

Thursday, May 15, 2008

the very first time

I hate horror movies. When i become a dental surgeon, that hate evolves to despise. I totally despise horror movies, one in particular. Why can’t they make gross movies about lawyers? Engineers? Accountants? Why can’t they produce ‘DrakuLawyer’ or ‘The Engineer of Death’ or ‘Ledger of Blood’? First impression always counts, doesn’t matter what anyone believe. And the first impression the world population got about a dentist is horror.


Enough babbling. Seriously, going to the dentist is NOT excruciating anymore. Pain during dental treatment is an outdated perception, an old story (just like the movie). Modern technologies, updated equipments, improved techniques; all with the same aim:- to lessen, if not eliminate, pain. Do you remember your first visit to the dentist? is it bad? do you want your child to have that same bad experience?

So, how are we going to wipe off the phobia? Especially to our children? When the whole world practically is against us?

  1. Make your child’s first visit a very comfortable one. Instead of scaring them away, we can always give the impression that a trip to the dentist is a joyful one; just like a trip to the zoo. Be positively enthusiastic; children can always sense if we are fearful.
  2. Bring them early in their life, and bring them often. They will easily get use to the clinic’s surrounding. Bring them as early as their first tooth erupted. Bring them whenever you yourself or your spouse or your sister has dental appointments.
  3. Bring all family members. Children always like to copy their siblings, and they always like to do things in groups. It is a family trip, after all.
  4. Do NOT mention the word ‘pain’, ‘needle’, ‘jab’ or anything similar before the trip. They will chicken out even before the war begins.

We will also try to make your child’s first visit be as comfortable as possible. We do not usually do any treatment right away; we will just introduce the instruments to them. We will usually show them that our tools are not going to cause any pain, that it is just water and air. We will also let them experience our ‘robotic’ chair- boys always love it.

Nowadays, dental clinics are designed to be very people-friendly and comfortable. We always have children’s section where they can play with toys and further ease their minds. Clinics are now devoid of that ‘hospital-ly’ smell, thanks to ambi pur and aromatherapy. We ourselves do not like pain. We certainly do not want our patients to experience pain.

Ease your minds, don't believe the propaganda. Dentists don’t bite. Seriously.

Monday, May 12, 2008

to be or not to be

I have been pondering on this subject for quite some time, trying to figure out the best way to subtly and carefully going through this sensitive issue without offending anyone, to no avail. Therefore, first and foremost, I am inexpressibly sorry if I offended any of you, but, seriously, there’s just no other way for me to directly confront the subject except for, well, being direct.

While we constantly being reminded everywhere: the television, the adverts, the billboards; about the effect of smoking to our general health, the little known and often ignored, but otherwise extremely important effect of smoking is to our oral health (or should I say oral pain?).

And me, being ever always an obsessively organized person, will list down all the effect of smoking to our mouth and teeth in one, two, three.


Do you always notice that some people have brownish teeth? Especially the lower ones. What happen was, the white plaque and food remnants that stick to our tooth surface and everybody has it, for smokers, is being ‘painted’ brown and yellow by the nicotine. Your dentist can remove the staining on the tooth surface (with backbreaking and neck-paining effort, seriously) but for staining in between the teeth, it is upmost difficult. Dentists have some special polishing material to remove it, but patients always complains of hypersensitivity afterwards, because those materials will actually also remove a little bit of our natural tooth surface, not to mention patients will have to do it regularly… unless if you quit.


The nicotine and the smoke will cause dry mouth. Lame effect, huh? Dry mouth, so what? So, the effect of dry mouth are:

- bad breath. Believe it or not, our saliva plays important role. Lack of saliva will cause bad breath. That is why we have bad breath in the morning because during sleep, our salivary production is also at ‘rest’. Add that to the smell of smoke, and here I wonder how your partner feels when you guys are smooching.

- hypersensitivity. Our saliva actually provides a protective layer on our tooth surface, giving extra protection to our tooth nerve from stimulation by extra cold, extra hot or extra sweet food.dry mouth sufferers will complain of teeth hypersensitivity. Clue: you feel sharp, stinging pain all over your teeth, and you cannot quite pinpoint exactly which tooth is the problem.

- gum and mucosa pain. If you have a minuscule ulcer for example, maybe because you poke yourself with your toothbrush or fishbone, dry condition will exaggerate the pain and prolong the healing. Usually it will take three days for an ulcer to heal, for smokers, about 10 days. And the symptoms are the same as hypersensitivity (the you cannot pinpoint part). And worse, sometimes there’s no wound whatsoever and yet you still have the gum pain. Worse still, if you have pus at your gum area, the pain will make you feel like you want to cabut all your teeth, even though there’s nothing wrong with them. Your teeth are innocent!! Why blame them?!

- difficulties in swallowing. Saliva provides lubrication while swallowing. Lack of lubrication equals to ‘burning sensation’ while you are eating.

.. and that’s just a small part of the effects of dry mouth. Lame, you say. If you do smoke and you have not experience any of these, you will. Soon. Unless if you quit.


Smoking, besides burning a hole through your pocket, can cost you your teeth. One of the reasons of loose teeth is loss of bone, and smoking can cause just that: periodontal destruction and loss of bone. Periodontal tissue is the tissue that is holding our teeth at its place, located inside our bone. Roughly 90% of patients with periodontal problem worldwide are smokers. You are interested in wearing dentures, is it? Of course, unless if you quit.


This will be under the heading - other effects of smoking:

- altered taste sensation, means that sweet lollipop is not so sweet anymore, and that yummy curry is not really that 'kick'. Unless if you quit.

- notice an ever growing dark space in between your two upper front teeth? That is caused by gum recession, which in turn, caused by smoking. That space will be ghastly darker, noticeably bigger, and will be at point of not returning to normal… unless if you quit.

- oral cancer. THE point of no return. Unless if you quit.


Thursday, April 24, 2008

black or white

It is generally known that there are 2 types of tooth filling: the black silverish ones (or amalgam) and the white tooth-coloured ones (composite). But the thing that we always wonder would be, which one is better? Is it the black ones, because it has been used as tooth filling material for more than a century now; or is it the white ones, simply because it looks better?

Let the competition begin, and I will let you be the judge. ;-)

Round 1: strength

Amalgam is known for its high strength; it can stand up to 350MPa of pressure (even higher than natural teeth – 250MPA). It is also not affected by surrounding factors such as saliva and blood. Problem is, its strength can only be achieve in bulk; means the filling must be at least 1.5 mm thick (or the hole must be 1.5mm deep) or it will easily fell.

Composite, on the other hand, has similar strength with our natural teeth (260MPa). It can be used on a shallow cavity, but its strength can easily be altered by surrounding factors. For example, if it is mixed with our saliva or blood, its strength will become low. Also if composite is exposed to the dental overhead light for too long, its composition can also be altered.

Round 2: cost

Cost of amalgam is about 30% less as compared to composite. Also, a relatively greater amount of time and skill is needed for your dentist to place a white filling as compared to an amalgam filling. Your dentist has to make sure the cavity prepared is free of blood and moisture. Also, composite cannot bond itself to tooth surface. It needs extra help, a bonding agent; which equals to extra cost.

Round 3: bonding strength

Amalgam bond itself to our tooth surface via mechanical retention, means your dentist has to prepare a ‘lock’ or an ‘undercut’ before amalgam is placed. Think ‘lock and key’. Composite, on the other hand, depends on chemical retention. Your dentist has to place the bonding agent first before your tooth can be filled with composite.

Round 4: aesthetics

Hmm.. its pretty obvious, don’t you think? Composite is tooth coloured, it even has different colours so your dentist can match the shades with your exact tooth colour. We can even do it in layers you know, if the neck of your tooth has different shade than the tip of your tooth. Amalgam is… well..

Round 5: composition

This might be new for some of you. For your info, amalgam consists of mixture of metal alloy and mercury, on a 1:1 ratio. Mercury, as is generally known, is a highly unstable element. A little bit of mercury is released when tooth is being filled, or when amalgam filling is removed, and even during chewing. Side effect of mercury ingestion includes personality change, memory loss, psychological distress and a lot of others. However, rest assured, there are no scientific evidence that shows dental amalgam does affect our general heath. Our Health Ministry has produced a Position Statement on use of dental amalgam in 2002. Ask your dentist for a copy of you want to read it.

Composite on the other hand is pretty safe. Manufacturers of dental composite upon producing new composite product has to comply with American National Standard/American Dental Association Document No 41 for Recommended Standard Practices for Biological Evaluation of Dental Materials, 1982 before it can be distributed. This evaluation consists of Cytotoxicity, Mutagenicity, Sensitivity and Carcinogenicity test. So no worries.

Round 6: life span

Generally, amalgam has longer life span as compared to composite. Van Nieuwenhuysen in 2003 and Forss in 2001 conducted a comparison study between dental composite fillings and dental amalgam fillings. They found an average life span of 12 to 12.8 years for amalgam fillings and 5 to 7.8 years for composite fillings. However, composite is an evolving material. Every year dentists are introduced to composite that has better strength, durability, polishability, aesthetics.. so I am pretty sure its life span and strength will improve with time.

And the winner is…

Tuesday, April 22, 2008

the power to choose

As parents, we always wants the best for our children, and we always wonder whether the things we did is the best for them. We always choose the best milk formula ‘with highest content of AHA,DHA, so forth’; the best diapers ‘that can stand up to 7-8 wets’, the best shoes that ‘allows the feet to grow’,.. the list goes on. Same goes when it comes to choosing dental products. The best toothpaste for our toddler must be the one with highest concentration of fluoride, since fluoride can help fight tooth decay, right?


The actual fact is, while fluoride does help in fighting tooth decay, our body (also our children’s) only need about 0.05-0.07mg fluoride /kg body weight. This can easily be achieved by drinking plain water or eating food cooked using water. In Malaysia, water fluoridation (putting fluoride into our water supply) started in Johor in 1966 and becomes a nationwide policy in 1972; and it has been significant in reducing tooth decay by strengthening the enamel (the outer layer of the tooth).

The fluoride level in our commercially available toothpaste are being regulated in between 550 – 1500 ppm (parts per million) and it is safe to be used by us, adults, for 2 reason:

- the fluoride will act as a topical supplement; i.e. it will only makes contact to the tooth surface since we do not swallow the toothpaste

- our average body weight (50-70kg) can sustain up to 0.10mg of fluoride/kg body weight, and one pea-sized toothpaste contains about 1mg of 1000 ppm fluoride. Confused? Let’s just say it’s safe for us to swallow one whole tube of toothpaste without risking any side effect.

Unfortunately, both reason is exactly why our children (age 6 months to 6 years) should not use fluoridated toothpaste. Pray tell, how can you confirm your child would not ‘accidentally’ swallow the yummy orange-flavoured toothpaste? Even though we have told them not to?

The next question you would ask would be: how does excessive fluoride consumption affects our children?

Let me introduce you to a new vocabulary:

It is a damage in tooth development, occurs between the ages of 6 months to 5 years, from the overexposure to fluoride. It will present itself as intrinsic (read: internal) staining of the permanent teeth, so the teeth will have whitish specks (mild fluorosis) up to brownish black (severe fluorosis).

Besides fluorosis, which is a known and proven side effect of excessive fluoride intake, the less known side effect is more worrisome, such as effects to their IQ and also to the kidneys and liver function in children. However, these side effects are very much debatable and more questionable. We should just leave the issue to the experts, I guess.

Trouble is, there is not many kids toothpaste that does not contain fluoride. I can introduce some brands that are available commercially, but please share with me if you know of others.

Pureen fluoride free kids toothpaste, retail at RM3.50

First Teeth A Natural Enzyme Baby Toothpaste, retail at RM35.00, available only at selected pharmacies (and a tad too expensive, if I may add)

ProdentalB children’s toothpaste, retail at RM4.00 though it’s really difficult to get this in stores. I have no idea why, maybe their distribution is limited.

Don’t get me wrong here. I’m not saying that you should ban fluoridated toothpaste from your household, okay. Fluoride is extremely important in remineralizing (strengthening) tooth surface that might have early signs of decay, and the side effects are relatively small compared to the positive effects. Plus, there are treatments available for those who have fluorosis. But prevention is much better, isn’t it?

For me, I keep both fluoridated and nonfluoridated toothpaste for my daughter. I use the nonfluoridated one daily and the fluoridated one like once in 2-3 weeks. Besides that you can always monitor or help your children while they are brushing their teeth, make sure they did not swallow any of the toothpaste if you are using the fluoridated ones. Also your dentist can give your child what we call ‘fluoride therapy’- which can be done once every 3-6 months, and very beneficial for sweet-toothed children. For babies, you can opt for the First Teeth toothpaste, or your dentist should be able to prescribe your child a suitable alternative. Or you can always not use anything, the wet towel can already do wonders.

Sunday, March 30, 2008

its there, its not there


hmmm why does this nasik feels like batu??
whhooppss.. its my tooth filling!!!


i just did that filling about a week ago!!!!!!!


trust me, its a dentist's worst nightmare.. having to face your patient again after you've just filled his teeth just one week before. worse still, now he's complaining of pain that has not been there before..

and now i feel obliged to explain how can a filling become loose. it might because of one or multiple reasons. but first and foremost, please dont come banging on the clinic's counter... at least go inside and let your dentist have a look at the tooth and explain to you, okay.. we are also human, we really dont like to let our patient feels dissatisfied, really we dont,.. so satisfy yourself by hearing our explanation.

so my preaching today would be aptly titled-
why does and how can tooth filling become loose/fallen:

1. the filling has probably become too large for the tooth to handle. the tooth will be unable to withhold the filling, the tooth structure becomes weak, and after slight pressure onto the tooth while we are eating, the filling become loose. there are cases in which the remaining tooth structure is fractured. the solution: crowning. for this type of problem dentist will always suggest crowning for that tooth. just like our socks will cover our feet, the crown will cover the whole tooth structure so the tooth will become stronger and able to withheld great pressure (i.e chewing/biting).

2. there might be a secondary infection/caries underneath the old filling. tooth filling is bonded to a cleaned surface, but when the area become infected it will become soft, causing the filling to dislodge. this will usually accompanied by pain because the infection will further deepen the previously restored tooth. your dentist will have to remove the old filling, scoop out the infection until no more is left and refill the tooth. when needed some type of medication will be placed so that the floor of the filling is stronger and void of further infection.

3. our material is very sensitive to moisture. if ever our saliva is mixed with the material, the material itself will become weak. so please avoid putting your tongue whilst having your tooth filled, okay. that's the need of the suction, and some dentists resort to using rubber dams (rubber sheet placed over your mouth to prevent any water/saliva into entering the tooth preparation, but some people claim its really uncomfortable). but contrary to popular believe that expensive material will bond better, well, it wont. the price of material depends more on the polishability/cosmetic/colour/strength, not how they bond to tooth surface.

4. there is one condition called abrasion cavity, this is caused by usage of hard or medium-bristled toothbrush that is just too harsh for tooth surface. the cavity is triangular shaped, situated at the neck of your tooth near the gum, and it will cause sensitivity. your dentist can fill it easy, with one really important condition: change your toothbrush!! your naturally hard enamel tooth surface itself cannot withstand the harsh effect of hard/medium-bristled toothbrush, let alone tooth fillings. preferably change it into a supersoft/extrasoft-bristled toothbrush. you might have to change your toothbrush more frequently, but i supposed that is so much better than to have your teeth filled repeatedly!

5. erm... you might accidentally bite on a really hard thing i.e small stone or chicken bone that may have caused the filling to break. i encountered one patient with his whole, unfilled, healthy back tooth split straight into two after he indulged in his favourite snack during a man u game: kacang cap tangan. i assure you the pain is terrible, i really feel sorry for him. i had to extract his tooth, there was no other choice. :( . anyway, if a healthy tooth can break, so can filled tooth..

mmm.. i'm pretty sure your eyelid will become heavy if i continue droning on this subject. so that's it. the important ones, that is. there are more to these, of course, but they are less important and less frequently happen.

if ever your tooth filling become loose after only a few weeks having it filled, please visit your dentist a.s.a.p. its never good to leave your tooth unfilled, because it may lead to more problem. and as a normal practice, dentist will usually charge you nothing if you come back (to the same dentist) within 30 days to redo the less than a month old filling.
its free! so why delay??

Tuesday, March 11, 2008

what about me?

and what about the rest of our children? those in primary and secondary school?

i used to work in the government for almost 4 years before i resign, and i know for sure they do have a solid dental program for schoolchildren. basically the program involves dental check ups and simple treatments for all schools.

this is how it works:

every start of the year the klinik kesihatan in the constituency (for example klinik kesihatan in sec 3 bandar baru bangi) will draft a schedule as to where and when they will pay a visit to each of the schools within that area. the program will be two tiered: they will first call all students class by class to do a general check up. then the next step they will call, also class by class, only those who needs treatment. usually before they call the student for the second time students are required to get consent from their guardians. the involved personnels are generally divided to two teams:

teams for primary school consists of
- 2-3 dental nurses
- 2 attendants
- and occasionally a dentist will accompany them whenever needed
teams for secondary school
- 1-2 dentists
- 1-2 dental assisstants

their coverage for each area is quite thorough although for secondary schools its quite difficult for them to cover all schools; the reason being
1 they're almost always lacking in numbers of officers.
2 usually schools dont allow the program runs on exam period i.e pmr/spm/midterm exams

for example in bandar baru bangi the klinik kesihatan dental teams will cover
primary schools
- sek jalan 2 - sek jalan 4
- sek jalan 3 - sek chung hwa in kajang
- sek jalan 6 - sek convent in kajang
- sek integrasi - those that have slipped my mind
secondary schools
- sek jalan 2 - sek maahaad hamidiah
- sek jalan 3 - sek jalan reko
- sek jalan 4 - sek al amin
so you see its pretty thorough, but i have to mention that schools with the best cooperation given during my working year in the government (2004-2007) (from the children as well as teachers) are sek men jalan 4 and maahad hamidiah.

i also do understand your concern.

i do always hear complaints from parents and students that the dental service given at school left much to be desired. that doesnt give you an excuse so that you can run away when the dentist starts calling your class. the first tier (the general check up) is the one which plays the most important role and also the simplest: to determine whether you need any treatment or not. if you dont, good for you. if you do....

actually you have 2 choices- 1. let the dentist do her job... its not bad actually. we usually try to do the best that we can. it just the time constraint. just imagine.. we are to do up to 100 dental fillings from 8.30 am to 12.30 pm.
move on to no.2. you can always decline treatment. tell your dentist that you want to have treatment at nearby clinic. or for parents, you can always inform the dentist that you dont want your child to have dental treatment at their school. the dentists are always glad when you tell them that. it will take a little bit off their shoulder, u know.

just dont run away when they call you the first time, okay. its nothing, they wont do the treatment right away. its just check ups, but an important one, so that you'll know whether you need a dental treatment or not.

Thursday, March 6, 2008

for parents and would-be s

fact 1 -

yes, milk tooth is rrreeeeeaaaaaallllyyyyy easy to have holes on it. its minuscule, plus the fact that our child almost all the times doesnt want to hear us...

no sweets!!
but i want it!!
go brush your teeth!
but i dont want to!!

they always seems to LOVE contradicting us!

fact 2 -

but they can also brush their teeth fine! yeah... they also can eat fine by themselves... but theres always mounts of nasik on the table and floor...

so lets fast forward to lesson number 2:

routine dental check up for your child (age 2-6 yrs)

as i mention earlier, milk tooth is too easy to become rotten, because
1. they take their milk often, and milk are like vitamins for bacterias.
2. their size is small, so however small the hole might be, it can straight away become big the next week.
3. their motor control (i.e their control of their toothbrushes) are still not very good (thus the nasik on the floor) so no matter how loong/short they take to brush their teeth its still not thoroughly clean..
4. not to mention the amount of sugar they take... (i do wonder whether mine can get juvenile diabetes with her granny/grandpa/aunties/uncles feeding her all sorts of tidbits every half hour or so...)
5. and because of no. 2, all in a sudden before you realize there's a hole in your child's tooth, he's already crying, not able to sleep, not able to eat, and worse- now you see his face is asymmetrical- because the swelling becomes so big, one of his cheek becomes extra ermm.. 'comel'....

so please bring your child to dental checkups as early as at the age of 2... the earlier the better.. so that anything can be detected early... early intervention also means less pain and less cost..
and if your child is below 6 yrs old please dont let him brush his teeth only on his own. of course you can encourage him, its better that way,but also make sure you yourselves help him brush everytime..

its just so sad to see children as young as 2 years old crying their hearts out because the pain is unbearable.. we ourselves cannot stand toothache, let alone a 2 year old... no wonder dental treatment is such a phobia..

so let your dentist help them. small lesions/holes can easily be filled, but large ones will be a completely different story altogether.

the reason behind

why this blog

the basis of this blog is my passion towards my work. i believe i have a lot to offer to my patients. first of all, of course, pain-free dental treatment. which, strangely, is like an alien subject in this part of the world. but being a human first and a dentist, much much later...

i am no stranger than us ordinary people. i used to be terrified whenever i have dental appointments. i will feel like cringing, my heart beats thousand times more, i'll be sweating like.. ermm.. the sound of the drill makes me want to run faster than you can say 'drill'..

when i become a dentist (only about 4 yrs ago..) i set myself a life long goal:

i want all my patients to feel comfortable when they are with me
- i want my patients to be able to tell me their fears and expectations
- i want to provide dental treatments with littlest pain possible
- i want my patients to be satisfied with the service i give, they feel that that is the best that they could get
- i want me to be satisfied with the service i give, i feel that that is the best that i can give

reality hits me like buckets of icy cold water. malaysians... their take on their dental health... i would estimate only about 20% keeps their biannual dental checkups, and about 95% of that 20% are in kuala lumpur. so for me, practicing in bandar baru bangi.... only 1 out of 10 patient i saw come for their routine check ups.



The last epidemiological survey of adults in Malaysia in year 2000 revealed that only 25.2% of adults (aged 15 years and above) had a dental check-up in the past year while 15.3% had one in the past 1 to 2 years.

its really frustrating. usually when they come to me... its too late for me to do any minimally invasive (= minimal pain) treatment anymore. instead we were left with either one of two: root canal treatment or extraction. in which.. both of course we can try and do it as pain-free as possible, but for sure both are really invasive procedure...

so lesson number 1:

try and keep your routine dental check up. it doesnt have to be biannually or annually, keep it at your own time but do it regularly. the advantages would be:
- small caries lesion can be detected early. you may not feel anything, just a stinging during eating sweets.. but its there. so if we can find it early, the restoration process (the treatment) would truly be pain-free.
- your calculus or staining or karang gigi is at minimal level so the removal will also be minimal and again, pain-free. try imagining removing a 5 years old calculus vs 1 year old calculus. or try this: imagine how hard we have to scrap 5 year old dirt vs 1 year old dirt. go figure.
- start your child's check up early. say around 2-3 yrs old. that way they will get used to the surrounding hence, eliminate the phobia.
- consider the cost, my friend!! routine check up will cost you about rm10-15, simple filling rm50-60. so at most, per visit you will pay.. say about rm120 for check up and 2 simple fillings with no pain.. IF u hv holes in your teeth.. only IF... compare it with.... when its too late.. your tooth already need root canal treatment... which will cost you more than rm200... and multiple visits.. with the toothache that you might have to endure before that because you left that hole in your tooth for much too long.. not to mention the meds you have to take... oh did i mention the hideous swelling that might accompany the pain??

think about it....

Wednesday, March 5, 2008

the newcomer

and that's me

truly a newcomer in everything; the internet, blogs, googles and yahoos.. the world that i conveniently ignored since my husband is in THIS world. i used to even ask him to .. set my mail, check my mail, compose my mail, search something or anything from the www, ... well you get the drift. not until i accidentally found out about HIS blog. how i did that? well i googled his name of course... i bet he is still knocking his head off that simplest mistake since i was not supposed to find out about it. sorry honey.
you would not believe how ignorant i am. i didnt even know the meaning of the word 'blog'.

blog (blŏg) Pronunciation Key
n. A weblog.

intr.v. blogged, blog·ging, blogs
To write entries in, add material to, or maintain a weblog.

thats from the american heritage dictionary. sorry i cannot help to look for it. its just so strange for me.

from blog history in blogstar:
Early 1999: Peter Merholz
coins the term blog after announcing he was going to pronouce web blogs as "wee-blog". This was then shortened to blog.

thats like almost 10 yrs ago. so .. i've been snubbed for the past 10 yrs.. no wonder all my younger sisters rolls their eyes. my husband complains i'm a slow writer (or is it typer? mmm not sure about that) and my friends look at me like i'm out from another world when i told them ' but i dont really know how to email..'

well here's the weird truth:
1. i've never had an online chatting (except for recently of course)
2. i've never manage my own email acc.
3. i dont have a friendster/facebook/whatever
(mb i'll hv it soon... i dont know.. )

what's lasting is not what resists time, but what wisely changes with it - peter muller

so i have not been wise for the past 10 yrs... its never too late isnt it??