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When Raphy's orthodontic adjustment was completed today, we debriefed her mother as to what we achieved today and what we expect to see when she is next in for her orthodontic adjustment.
It was then that Raphy's mother revealed that we have inspired her 13 year old daughter to become an orthodontist.
Mum has booked this year's family holiday to New Zealand to check out the dental schools for her as both patient and mum feel that it is almost impossible to enter dental school in Singapore and they hope that New Zealand will be much easier.
It is still early days yet but it is amazing to see what parents would go through for their children.
We have offered Raphy an intern position as this would stand her in good stead in her application to dental school.
Good luck and you knwo that we will be here for you.
Thursday, October 29, 2009
Wednesday, October 28, 2009
Pulling out all lower teeth
We had a patient come in asking to have all her lower teeth extracted so that she could have lower full dentures. She did the same thing on her upper jaw and was happy to get rid of her teeth because they were too troublesome to look after!
Lower dentures are very different from upper dentures because they are inherently unstable due to the presence of the tongue. A fact that many patients do not take into account. This gives rise to much unhappiness with the resulting dentures and the problem is more profound in patients that have never worn a lower denture before. Such patients will not know how to control their tongue to aid the stability of that lower full denture.
When patients are told of this problem,they would usually not go through with their original plan of removing all their lower teeth. However, there are some who insist of going ahead with the extraction of all their lower teeth. We make sure that these patients are fully aware of the consequences of their decision so that they do not end up blaming the dentist for their troublesome lower full dentures.
Some of these patients regret their decision and end up having implants placed so that they can have a more stable lower denture.
Lower dentures are very different from upper dentures because they are inherently unstable due to the presence of the tongue. A fact that many patients do not take into account. This gives rise to much unhappiness with the resulting dentures and the problem is more profound in patients that have never worn a lower denture before. Such patients will not know how to control their tongue to aid the stability of that lower full denture.
When patients are told of this problem,they would usually not go through with their original plan of removing all their lower teeth. However, there are some who insist of going ahead with the extraction of all their lower teeth. We make sure that these patients are fully aware of the consequences of their decision so that they do not end up blaming the dentist for their troublesome lower full dentures.
Some of these patients regret their decision and end up having implants placed so that they can have a more stable lower denture.
Tuesday, October 27, 2009
Looking forward to see the dentist!
One of our patients recommended her friend to bring her 4-year-old to come and seek treatment with Dr Lim.
On her first visit to the dental clinic, the dentist went out to the reception area and asked the child to open her mouth, which the child promptly refused. The dentist told the patient to make an appointment. During the scheduled appointment, the child again refused to open her mouth and the dentist gave up.
When the child came and saw Dr Lim last week, Dr lim started by building a relationship with the child. By the end of that appointment, not only did Dr Lim persuade the child to open her mouth but she also managed to polish the child's teeth. At that visit, the child was found to have 4 cavities.
It was encouraging to note that the patient came back for her restorations four days later. When she arrived, she was happily playing in the office. This time, she even brought her own DVD to watch during her dental treatment. Dr Lim managed to restore two of the cavities and scheduled her to complete the last two cavities.
On her first visit to the dental clinic, the dentist went out to the reception area and asked the child to open her mouth, which the child promptly refused. The dentist told the patient to make an appointment. During the scheduled appointment, the child again refused to open her mouth and the dentist gave up.
When the child came and saw Dr Lim last week, Dr lim started by building a relationship with the child. By the end of that appointment, not only did Dr Lim persuade the child to open her mouth but she also managed to polish the child's teeth. At that visit, the child was found to have 4 cavities.
It was encouraging to note that the patient came back for her restorations four days later. When she arrived, she was happily playing in the office. This time, she even brought her own DVD to watch during her dental treatment. Dr Lim managed to restore two of the cavities and scheduled her to complete the last two cavities.
Monday, October 26, 2009
Retainer or Nightguard
One of our patients who completed his orthodontic treatment about 5 years ago came in with his retainers chewed to bits. This latest set of retainers has only been in use for less than a year. He acknowledged that he has been very stressed lately and that he has been grinding his teeth intensely in his sleep. This has resulted in his retainers breaking into several pieces.
In view of his current situation, we prescribed a full coverage nightguard to serve both as a retainer and as protection for his teeth. As the cost of the full coverage nightguard cost more than a retainer, the patient was unsure as to whether he should spend the additional money.
We told the patient that night time grinding (bruxism) generates more force on his teeth than he could possibly produce when he is awake. We have seen teeth snap in two as a result of bruxism.
With the full coverage nightguard, he would be grinding against acrylic (which is softer) instead of against his own natural teeth. The nightguard will ultimately fail under such abuse. However, in the long term, it would be much cheaper to replace a nightguard than to replace a fractured tooth (greater than 1:8 ratio).
In light of this information, the patient decided to go ahead with the nightguard.
In view of his current situation, we prescribed a full coverage nightguard to serve both as a retainer and as protection for his teeth. As the cost of the full coverage nightguard cost more than a retainer, the patient was unsure as to whether he should spend the additional money.
We told the patient that night time grinding (bruxism) generates more force on his teeth than he could possibly produce when he is awake. We have seen teeth snap in two as a result of bruxism.
With the full coverage nightguard, he would be grinding against acrylic (which is softer) instead of against his own natural teeth. The nightguard will ultimately fail under such abuse. However, in the long term, it would be much cheaper to replace a nightguard than to replace a fractured tooth (greater than 1:8 ratio).
In light of this information, the patient decided to go ahead with the nightguard.
Saturday, October 24, 2009
Implant problems?
One of our orthodontic patient's mother took the opportunity to ask us about implants:
Her friend had his implant done in Germany and he encountered the following:
His implant crown came out eating peanut butter.
We asked if the crown that dislodged was a temporary crown but she was not sure. It should be noted that sticky materials similar to peanut butter is sometimes used to remove crowns. Therefore, such food should be avoided for patients who have crowns in their mouths.
There was a need to remove implant to clean.
We told her that as the implants are fused to the jaws, they cannot be removed for cleaning. Even during a profession scaling and polishing at the dental office, the implant superstructure is not normally removed for cleaning.
In fact, in order to scale around any implants, we use very special graphite instruments to do the procedure. This is because the regular dental instruments will leave scratch marks on the smooth implant surface, unlike these special graphite instruments. Scratched implant surfaces tend to accumulate dirt and plaque more easily.
Despite these issues, implants are currently still the best replacement for missing teeth. If you have questions or are thinking of having implants done, call our office for an appointment to consult one of our specialist in prosthodontics.
Her friend had his implant done in Germany and he encountered the following:
His implant crown came out eating peanut butter.
We asked if the crown that dislodged was a temporary crown but she was not sure. It should be noted that sticky materials similar to peanut butter is sometimes used to remove crowns. Therefore, such food should be avoided for patients who have crowns in their mouths.
There was a need to remove implant to clean.
We told her that as the implants are fused to the jaws, they cannot be removed for cleaning. Even during a profession scaling and polishing at the dental office, the implant superstructure is not normally removed for cleaning.
In fact, in order to scale around any implants, we use very special graphite instruments to do the procedure. This is because the regular dental instruments will leave scratch marks on the smooth implant surface, unlike these special graphite instruments. Scratched implant surfaces tend to accumulate dirt and plaque more easily.
Despite these issues, implants are currently still the best replacement for missing teeth. If you have questions or are thinking of having implants done, call our office for an appointment to consult one of our specialist in prosthodontics.
Thursday, October 22, 2009
I have been very busy...
Eleanor is one of our orthodontic patients and she last visited our clinic in November 2008 to have her braces adjusted. Nothing has happened to her teeth since then, i.e. no change in her tooth position.
When we asked her why she has not been back since then, she replied that as this is her first year in University, she has been very busy and had no time to come back.
We told her that she had to make the effort to return for regular adjustments if she wants her treatment completed before her graduation and she has promised to do so for her own sake.
This is one of the reasons why orthodontic treatment takes longer that usual. Fortunately, Eleanor takes responsibility for her shortcomings and accepts that her treatment has been delayed by her own action. Not all patients are like that.
When we asked her why she has not been back since then, she replied that as this is her first year in University, she has been very busy and had no time to come back.
We told her that she had to make the effort to return for regular adjustments if she wants her treatment completed before her graduation and she has promised to do so for her own sake.
This is one of the reasons why orthodontic treatment takes longer that usual. Fortunately, Eleanor takes responsibility for her shortcomings and accepts that her treatment has been delayed by her own action. Not all patients are like that.
Wednesday, October 21, 2009
ADHD Braces Patient
We did braces for a Attention Deficit Hyperactivity Disorder (ADHD) child many years ago. He always enjoyed coming to our dental practice and interacting with the staff here.
Orthodontic treatment was completed and retainers were given to him. Due to his condition, he was not able to follow our instructions on wearing his retainers. As a result of his parents enormous efforts to get him to wear his retainers, his relapse was minimal.
However, he has been obsessing about the slightly crooked teeth every time he came to our office, asking when he could have his braces put back on.
We have not seen him for quite a while but his mother came back yesterday with a toothache. While mum was getting her condition attended to, dad caught up with us. He told us that his son still wanted to have his braces but his ADHD condition has worsen and he has not been out of the home for several months.
We told his dad that we would be happy to put his braces back for him once he feels better!
Orthodontic treatment was completed and retainers were given to him. Due to his condition, he was not able to follow our instructions on wearing his retainers. As a result of his parents enormous efforts to get him to wear his retainers, his relapse was minimal.
However, he has been obsessing about the slightly crooked teeth every time he came to our office, asking when he could have his braces put back on.
We have not seen him for quite a while but his mother came back yesterday with a toothache. While mum was getting her condition attended to, dad caught up with us. He told us that his son still wanted to have his braces but his ADHD condition has worsen and he has not been out of the home for several months.
We told his dad that we would be happy to put his braces back for him once he feels better!
Tuesday, October 20, 2009
I want a Nice Smile as I am a Public Person
Last week, we had a Russian husband and wife come from Vladivostok for dental treatment. Apparently, the husband is a prominent public figure from that area and he wanted a more aesthetic replacement for some of his missing teeth and his failing bridge.
He needed a prosthesis that consisted of 11 crowns and bridges and it involved his upper front teeth as well.
Conventional crowns have a metal substructure, which tend to lack the translucency of natural teeth. For this patient, Dr Lim opted for crowns and bridges with a zirconia substructure. Zirconia is also used in the manufacture of synthetic diamonds. This material is hard, optically flawless and usually colourless, which makes it highly suitable for areas of the mouth that require aesthetic, naturally looking teeth.
However, the hardness of this material makes it very difficult to adjust and thus the crowns and bridges must be cast very high accuracy and precision. As with all laboratory fabricated dental prosthesis, zirconia crowns need to have their bite adjusted in the patients mouth after fitting and cementation. Thus, such crowns take a lot of clinical time to fit well.
Today, we delivered the crowns and bridges to the patient and both his wife and him were delighted with the result.
If you have crowns on your front teeth that you would like improved, call us and make an appointment to see our specialist prosthodontist.
He needed a prosthesis that consisted of 11 crowns and bridges and it involved his upper front teeth as well.
Conventional crowns have a metal substructure, which tend to lack the translucency of natural teeth. For this patient, Dr Lim opted for crowns and bridges with a zirconia substructure. Zirconia is also used in the manufacture of synthetic diamonds. This material is hard, optically flawless and usually colourless, which makes it highly suitable for areas of the mouth that require aesthetic, naturally looking teeth.
However, the hardness of this material makes it very difficult to adjust and thus the crowns and bridges must be cast very high accuracy and precision. As with all laboratory fabricated dental prosthesis, zirconia crowns need to have their bite adjusted in the patients mouth after fitting and cementation. Thus, such crowns take a lot of clinical time to fit well.
Today, we delivered the crowns and bridges to the patient and both his wife and him were delighted with the result.
If you have crowns on your front teeth that you would like improved, call us and make an appointment to see our specialist prosthodontist.
Monday, October 19, 2009
To veneer or not to veneer...
We have a patient who wanted to straightened her slightly crooked two front teeth without having to go through braces. Dr Lim suggested that she had a veneer done about 5 months ago but the patient kept putting off the appointment.
This patient comes back on Friday with only one front tooth veneered, which had to be thickened considerably in order to align with the other front tooth. Composite material was used as opposed to Dr Lim's preferred ceramic veneers.
Ceramic veneers are a superior choice for the following reasons:
Well, patient is not happy with the look and feel of the result and that is why she returned to see Dr Lim to have the veneer redone on one front teeth and to add another veneer to the adjacent front tooth as originally suggested.
If you would like to see what veneers can do for you, make an appointment to see Dr Lim today.
This patient comes back on Friday with only one front tooth veneered, which had to be thickened considerably in order to align with the other front tooth. Composite material was used as opposed to Dr Lim's preferred ceramic veneers.
Ceramic veneers are a superior choice for the following reasons:
- the colour palate is wider, making shade matching more accurate. This would give a more natural look to the veneered teeth.
- the colour is more stable when compared with composite, increasing it's lifespan.
Well, patient is not happy with the look and feel of the result and that is why she returned to see Dr Lim to have the veneer redone on one front teeth and to add another veneer to the adjacent front tooth as originally suggested.
If you would like to see what veneers can do for you, make an appointment to see Dr Lim today.
Friday, October 16, 2009
...100% success!
Our endodontist did a root canal for a patient 6 months ago.
At the first consultation, our endodontist informed the patient that the success of root canal treatment for back teeth was about 90%. This patient said that if it was not 100% success, he would not do the treatment.
The patient came back subsequently and decided to proceed with the root canal treatment despite it being reiterated to him that success rate will not be 100%. His treatment was completed 6 months ago and the patient was told repeatedly that after the completion of the root canal treatment, the tooth needed to be crowned to prevent it from form cracking or splitting.
Compounding his problem was the fact that the gums around that tooth in question had also receded and trapping food. As we all know, when food get wedged in our gums, there will definitely be some sensitive sensation.
Unfortunately, the patient kept perceiving the wedged food sensation as a sign that the root canal was not successful. He was even instructed on how to floos between his teeth to dislodge the food and at the same time reminded to get his crown done immediately.
The patient refused to floss his teeth and kept insisting that if the root canal was not 100% successful, he would not get his crown done.
Finally, he returned yesterday because the tooth had split.
If you have a root canal tooth at the back of your mouth that is not crowned, please come and see us immediately so that we can assess if a crown is necessary in order to save your tooth.
At the first consultation, our endodontist informed the patient that the success of root canal treatment for back teeth was about 90%. This patient said that if it was not 100% success, he would not do the treatment.
The patient came back subsequently and decided to proceed with the root canal treatment despite it being reiterated to him that success rate will not be 100%. His treatment was completed 6 months ago and the patient was told repeatedly that after the completion of the root canal treatment, the tooth needed to be crowned to prevent it from form cracking or splitting.
Compounding his problem was the fact that the gums around that tooth in question had also receded and trapping food. As we all know, when food get wedged in our gums, there will definitely be some sensitive sensation.
Unfortunately, the patient kept perceiving the wedged food sensation as a sign that the root canal was not successful. He was even instructed on how to floos between his teeth to dislodge the food and at the same time reminded to get his crown done immediately.
The patient refused to floss his teeth and kept insisting that if the root canal was not 100% successful, he would not get his crown done.
Finally, he returned yesterday because the tooth had split.
If you have a root canal tooth at the back of your mouth that is not crowned, please come and see us immediately so that we can assess if a crown is necessary in order to save your tooth.
Thursday, October 15, 2009
Excuse me, are you the patient...
One of our orthodontic patient came to the practice with the braces on one of her lower front teeth dislodged. This resulted in that tooth slipping its contact with the neighbouring tooth and going crooked again. We showed her the problem and reinforced the need to keep the braces intact.
We removed the broken bracket and replaced it with a new bracket. We then gave her an appointment one week later so as to minimise the loss of treatment time due to the broken bracket. The intention was to tie in the repaired bracket and this was communicated to the patient. The patient was also given a 6-week adjustment appointment on 30 October 2009.
That evening, the patient showed her mother the crooked tooth and wondered why that tooth was not tied in to the bracket.
The next day, over anxious mum calls and insisted on talking to the dentist despite the clinician being in the midst of treatment. When mum's call was returned, she claimed that her daughter's upper tooth was crooked. She continued to insist that the problem was the upper tooth despite being reassured that the breakage was on the lower tooth. She refused to accept the dentist's explanation and wanted to have her daughter seen immediately and not at the stipulated appointment. She was afraid that if the teeth were left unattached to the wire, the tooth would get worse.
The attending dentist then asked the patient where she perceived the problem and she replied that it was her lower tooth!
When the appointed time came for the patient to return for attaching the tooth to the wire, the patient failed to attend and did not even call until after the event. The patient then insisted on getting another appointment the very next day, which she was given.
Again, the patient failed the second appointment and again she insisted on a next day appointment. She failed the third appointment and was given an appointment within four days of the third failed appointment.
The patient failed her fourth appointment and was gievn an appointment 1 week later. This gets even better. She fails her fourth appointment and gets a fifth appointment 1 week later (which she finally attends). This is barely 2 weeks from her 6-week adjustment appointment, which means that her teeth did not move in the mean time and treatment has been set back by about one month.
The failed appointments add up to 50 minutes that could have been given 5 other patients. Inconsiderate patients like this rob others of an earlier appointment.
What options do we have? Charge patients for not showing up for their apointments?
We removed the broken bracket and replaced it with a new bracket. We then gave her an appointment one week later so as to minimise the loss of treatment time due to the broken bracket. The intention was to tie in the repaired bracket and this was communicated to the patient. The patient was also given a 6-week adjustment appointment on 30 October 2009.
That evening, the patient showed her mother the crooked tooth and wondered why that tooth was not tied in to the bracket.
The next day, over anxious mum calls and insisted on talking to the dentist despite the clinician being in the midst of treatment. When mum's call was returned, she claimed that her daughter's upper tooth was crooked. She continued to insist that the problem was the upper tooth despite being reassured that the breakage was on the lower tooth. She refused to accept the dentist's explanation and wanted to have her daughter seen immediately and not at the stipulated appointment. She was afraid that if the teeth were left unattached to the wire, the tooth would get worse.
The attending dentist then asked the patient where she perceived the problem and she replied that it was her lower tooth!
When the appointed time came for the patient to return for attaching the tooth to the wire, the patient failed to attend and did not even call until after the event. The patient then insisted on getting another appointment the very next day, which she was given.
Again, the patient failed the second appointment and again she insisted on a next day appointment. She failed the third appointment and was given an appointment within four days of the third failed appointment.
The patient failed her fourth appointment and was gievn an appointment 1 week later. This gets even better. She fails her fourth appointment and gets a fifth appointment 1 week later (which she finally attends). This is barely 2 weeks from her 6-week adjustment appointment, which means that her teeth did not move in the mean time and treatment has been set back by about one month.
The failed appointments add up to 50 minutes that could have been given 5 other patients. Inconsiderate patients like this rob others of an earlier appointment.
What options do we have? Charge patients for not showing up for their apointments?
Wednesday, October 14, 2009
I am on my way
One of our orthodontic patients had an adjustment appointment and she arrived 15 minutes late. That was despite a reminder call which she personally answered one and a half hours before the appointment. She said that she was on her way.
As she was already late, there was no time for us to carry out the planned treatment. On top of that, she broke two braces which caused a gap to open between her lower front teeth. The consequences of being late in this instance in addition to not doing the planned treatment:
As she was already late, there was no time for us to carry out the planned treatment. On top of that, she broke two braces which caused a gap to open between her lower front teeth. The consequences of being late in this instance in addition to not doing the planned treatment:
- no time to repair the broken braces to enable treatment to progress
- inability to correct the gap due to the absence of braces in that area
The patient had to be given another appointment just to address the above problems and as circumstances would have it, the next available appointment was 4 weeks away.
Thus treatment would have been delayed by at least two months if not more. It would be rather unrealistic for this patient to expect her treatment to be completed within the estimated time.
Tuesday, October 13, 2009
You probably cannot recognise us!
We had a new orthodontic patient today.
This 12-year-old girl just completed her last PSLE paper today and mum and dad had already booked an appointment with us so that she can get her braces fixed at the beginning of the upcoming school holidays.
When mum and dad saw me, their first reaction was you probably cannot recognise us but I did. I remembered dad but mum is now wearing contact lenses, which threw me off a little. They had originally accompanied their eldest son for his orthodontic adjustments. He last saw us at least 5 years ago and we have not seen the family since. Mum and dad updated us that he will be completing is National Service soon. Wow! How time flies!
At the end of the visit, mum and dad decided to bring their second son to see us as well for gaps between his teeth.
Welcome back. It's nice to see old friends again.
This 12-year-old girl just completed her last PSLE paper today and mum and dad had already booked an appointment with us so that she can get her braces fixed at the beginning of the upcoming school holidays.
When mum and dad saw me, their first reaction was you probably cannot recognise us but I did. I remembered dad but mum is now wearing contact lenses, which threw me off a little. They had originally accompanied their eldest son for his orthodontic adjustments. He last saw us at least 5 years ago and we have not seen the family since. Mum and dad updated us that he will be completing is National Service soon. Wow! How time flies!
At the end of the visit, mum and dad decided to bring their second son to see us as well for gaps between his teeth.
Welcome back. It's nice to see old friends again.
Monday, October 12, 2009
Why is my friend's braces so slow?
We started orthodontic treatment for a 22-year-old young lady in the middle of last year. By the year end school holidays, she introduced us her 13-year-old younger brother to have his teeth straightened.
Last week, both brother and sister came for their orthodontic adjustment. As we treated the younger brother, the young lady related that her classmate started her braces at about the same time as her brother but her friend's extraction spaces are still very visible as compared to her brother's extraction gaps. She commented that her brother's treatment was progressing very rapidly.
We told her that yes, her brother's treatment was going smoothly. However, to compare her brother's treatment with her friend's treatment was like comparing apples with oranges.
Firstly, her friend's dental condition may be different from her brother's condition.
Secondly, the age difference would partially account for the discrepancy in treatment progress.
Thirdly, the treatment objectives may be different.
As such, casual comparisons like this may give rise to unnecessary misunderstanding regarding treatment. We must always remember that each patient is an individual and treatment is customised for each patient.
Last week, both brother and sister came for their orthodontic adjustment. As we treated the younger brother, the young lady related that her classmate started her braces at about the same time as her brother but her friend's extraction spaces are still very visible as compared to her brother's extraction gaps. She commented that her brother's treatment was progressing very rapidly.
We told her that yes, her brother's treatment was going smoothly. However, to compare her brother's treatment with her friend's treatment was like comparing apples with oranges.
Firstly, her friend's dental condition may be different from her brother's condition.
Secondly, the age difference would partially account for the discrepancy in treatment progress.
Thirdly, the treatment objectives may be different.
As such, casual comparisons like this may give rise to unnecessary misunderstanding regarding treatment. We must always remember that each patient is an individual and treatment is customised for each patient.
Saturday, October 10, 2009
4 New Patients
Today, Dr Lim saw 4 new patients:
It appears that the patient did not understand that she has gum disease and she wanted to go ahead to have implants to replace her missing front teeth. We will have to make it very clear to her that if she has gum disease and she still insist on having the implants done without addressing the gum problem, there is a high chance that the implants will fail.
The second patient was rather straight forward. The patient's elder sister had her braces done with us and she recommended him to see us. Now it's his turn to straighten his teeth. Dr Lim took the necessary x-rays, photos and impressions so that we can present the treatment plan at the patient's next appointment.
The last patient was also recommended to see us by our patient. This last patient had his crown done in Taiwan. The crown that he dislodged was a plastic temporary crown and according to him, the dentist did not tell him that it was only temporary and that his second appointment with the dentist was to fit the permanent crown. If he had known, he would not have chewed gum on the crown. In addition, although he grinds his teeth in his sleep, he did not wear his nightguard to bed.
Dr Lim relined his temporaryt crown and recemented it with a stronger cement as the patient has to visit several other countries before returning to Taiwan for his dental appointment. Dr Lim also cautioned him that his dentist may have some difficulty removing the temporary crown because of the stronger cement.
Hopefully, with proper communication with our patients and understanding by our patients, we will be able to serve our patients better.
- a mother (implant) and son (whitening) pair
- one for orthodontic treatment
- one whose crown was dislodged.
It appears that the patient did not understand that she has gum disease and she wanted to go ahead to have implants to replace her missing front teeth. We will have to make it very clear to her that if she has gum disease and she still insist on having the implants done without addressing the gum problem, there is a high chance that the implants will fail.
The second patient was rather straight forward. The patient's elder sister had her braces done with us and she recommended him to see us. Now it's his turn to straighten his teeth. Dr Lim took the necessary x-rays, photos and impressions so that we can present the treatment plan at the patient's next appointment.
The last patient was also recommended to see us by our patient. This last patient had his crown done in Taiwan. The crown that he dislodged was a plastic temporary crown and according to him, the dentist did not tell him that it was only temporary and that his second appointment with the dentist was to fit the permanent crown. If he had known, he would not have chewed gum on the crown. In addition, although he grinds his teeth in his sleep, he did not wear his nightguard to bed.
Dr Lim relined his temporaryt crown and recemented it with a stronger cement as the patient has to visit several other countries before returning to Taiwan for his dental appointment. Dr Lim also cautioned him that his dentist may have some difficulty removing the temporary crown because of the stronger cement.
Hopefully, with proper communication with our patients and understanding by our patients, we will be able to serve our patients better.
Friday, October 9, 2009
My filling broke after 6 months!
Dr Lim saw a patient which we have not seen in 10 years. The patient had relocated to Shanghai and came home to Singapore during the Chinese National Day. Today, the patient brought her whole family along with her!
Her husband told Dr Lim that he had a filling done in Shanghai 6 months ago but that filling had dropped out. When Dr Lim examined his teeth, she found that his teeth were worn down with numerous crack lines on each tooth. According to the patient, he also grinds his teeth in his sleep (bruxism).
Besides restoring the broken filling, Dr Lim also prescribed a nightguard for the patient. The function of the nightguard is to protect the patient's teeth and restorations. When the patient grinds his teeth in his sleep, he would be grinding against a softer material than his teeth. Furthermore, as he grinds, he will be wearing off the nightguard and not his teeth.
In the event that his nightguard gets worn down, it can simply and cheaply be replaced as compared with a worn or broken down tooth. In addition, the nightguard can extend the lifespan of the fillings and crowns in his mouth.
It is a worthwhile investment, especially for patients who grind their teeth in their sleep (bruxism).
Her husband told Dr Lim that he had a filling done in Shanghai 6 months ago but that filling had dropped out. When Dr Lim examined his teeth, she found that his teeth were worn down with numerous crack lines on each tooth. According to the patient, he also grinds his teeth in his sleep (bruxism).
Besides restoring the broken filling, Dr Lim also prescribed a nightguard for the patient. The function of the nightguard is to protect the patient's teeth and restorations. When the patient grinds his teeth in his sleep, he would be grinding against a softer material than his teeth. Furthermore, as he grinds, he will be wearing off the nightguard and not his teeth.
In the event that his nightguard gets worn down, it can simply and cheaply be replaced as compared with a worn or broken down tooth. In addition, the nightguard can extend the lifespan of the fillings and crowns in his mouth.
It is a worthwhile investment, especially for patients who grind their teeth in their sleep (bruxism).
Wednesday, October 7, 2009
How long more?
We have come across several patients who were in a hurry to get their braces off.
For us, we believe in doing a good job for the patient, no matter how long it takes. However, there seems to be a mismatch between the patients and us about how perfect the teeth should be before the braces are removed.
Thus, our procedures have evolved to the point where patient can have their braces off once they are satisfied with the results. It does not matter whether we, as clinicians, are satisfied or not. Most importantly, patients must realise that if they are not happy with the end result after the removal of the braces, they must be prepared to have the braces put back on.
One of our patients is a dentist working in a public dental institution. We saw him last week to adjust is orthodontic appliances. At the end of the session, we told him what changes we expected to see by his next visit and we also said that we will try to expedite his treatment. His reply astonished us.
He told us to take our time to complete his orthodontic treatment, which was the total opposite of what our patients expected of us. We probed further and found out that at his workplace, he had seen many cases where the braces were completed very rapidly. He observed that such cases tend to relapse or go back towards their previous conditions very rapidly as well. In some instances, when the patient returned one week later to collect their retainers, the retainers no longer fit due to the replase of the teeth.
We have also seen cases from other clinicians who finished their cases quickly. Some of these patients were not happy with the end result and complained that they were not given the option as to when they should have their braces off. They felt that their treatment was not complete and wanted us to fix the problem, i.e. a second round of braces with the associated time, effort and cost.
So, you have to make the decision as to whether speed or end result is more important to you as it looks as if you cannot have both.
For us, we believe in doing a good job for the patient, no matter how long it takes. However, there seems to be a mismatch between the patients and us about how perfect the teeth should be before the braces are removed.
Thus, our procedures have evolved to the point where patient can have their braces off once they are satisfied with the results. It does not matter whether we, as clinicians, are satisfied or not. Most importantly, patients must realise that if they are not happy with the end result after the removal of the braces, they must be prepared to have the braces put back on.
One of our patients is a dentist working in a public dental institution. We saw him last week to adjust is orthodontic appliances. At the end of the session, we told him what changes we expected to see by his next visit and we also said that we will try to expedite his treatment. His reply astonished us.
He told us to take our time to complete his orthodontic treatment, which was the total opposite of what our patients expected of us. We probed further and found out that at his workplace, he had seen many cases where the braces were completed very rapidly. He observed that such cases tend to relapse or go back towards their previous conditions very rapidly as well. In some instances, when the patient returned one week later to collect their retainers, the retainers no longer fit due to the replase of the teeth.
We have also seen cases from other clinicians who finished their cases quickly. Some of these patients were not happy with the end result and complained that they were not given the option as to when they should have their braces off. They felt that their treatment was not complete and wanted us to fix the problem, i.e. a second round of braces with the associated time, effort and cost.
So, you have to make the decision as to whether speed or end result is more important to you as it looks as if you cannot have both.
Tuesday, October 6, 2009
Flowers for Dr Lim
Dr Lim spent an hour doing a veneer mock up for a patient today.The patient was so delighted with the mock up that she decided to proceed with the veneer impression on the spot.
As the teeth to be veneered were slightly rotated,
- there was no need to cut healthy, sound tooth structure
- however, the patient had to accept an increase in the bulkiness of the teeth
Later in the afternoon, Dr Lim was pleasantly surprised with a lovely bouquet of roses!
That just made Dr Lim's day for her. Thank you so much.
Monday, October 5, 2009
My last adjustment was 9 months ago
On Saturday, we attended to one of our orthodontic patients who last came for an adjustment of his braces in December 2008.
He told us that he was very busy with work and could not come for his monthly adjustment. When he realised that he was due for an adjustment, he would forget to call for an appointment. Finally, we managed to schedule an appointment for him and he turned up.
Fortunately for him, none of his brackets were broken and we could continue treatment without having to back track.
He is aware and understands that his orthodontic treatment will take longer than usual.
He told us that he was very busy with work and could not come for his monthly adjustment. When he realised that he was due for an adjustment, he would forget to call for an appointment. Finally, we managed to schedule an appointment for him and he turned up.
Fortunately for him, none of his brackets were broken and we could continue treatment without having to back track.
He is aware and understands that his orthodontic treatment will take longer than usual.
Saturday, October 3, 2009
Individuals to Couples to Families
Today, Dr Lim treated members of three very special couples.
All six of them were her patients of our dental practice before they got married and now, they all have children of their own. The older kids have started to see Dr Lim while the younger ones are still awaiting the eruption of their milk teeth before they start seeing Dr Lim.
Thank you for giving us the privilege and honour of caring for you and your families.
All six of them were her patients of our dental practice before they got married and now, they all have children of their own. The older kids have started to see Dr Lim while the younger ones are still awaiting the eruption of their milk teeth before they start seeing Dr Lim.
Thank you for giving us the privilege and honour of caring for you and your families.
Friday, October 2, 2009
Is it necessary to Scale and Clean after Braces?
At the end of orthodontic treatment, the standard procedure would be to remove the brackets, take an impression of the aligned teeth and the necessary x-rays and photographs.
What we found was that those patients that did not brush properly invariably end up with:
- calculus coating the surface of the teeth
- some decay
Firstly, the impression is an accurate reproduction of the tooth positions at the end of braces. This impression is used to make the retainers which fit the straightened teeth accurately to prevent the teeth from going crooked again.
Now, imagine what happens if we do not scale away the calculus coating. We will be taking an impression of the coated teeth and the retainers are made to fit the calculus coated teeth. When the calculus is removed later on or it breaks off, a space will form between the retainer and the teeth. This space allows the teeth to move and the results in crooked teeth even though you have worn your retainers faithfully.
In the next scenario, imagine having your decay treated after the retainers are made based on the original shape and contour of your teeth. Filling the teeth almost never restores the original shape and contour of your teeth. This will result either with a gap between the retainer and the teeth (under-contoured) as discussed above or it may end up with an over contoured restoration which will prevent the retainer from fitting.
These are the reason why we encourage and do an examination, scale and clean when we remove the braces and before we take the impression for the retainers.
As this is an optional step, it is not part of the orthdontic fees.
Thursday, October 1, 2009
Patient in Pain
One of our orthodontic patients called on behalf of his friend whose wisdom tooth was causing him pain and urgently needed to be seen as he is flying off on Monday.
An arrangement was made for our oral and maxillofacial surgeon to see the patient after office hours on an emergency basis. The patient arrived early for his appointment but our oral surgeon was held up in the operating theatre and did not arrive until 7 pm.
The removal of the wisodm teeth was completed and resorbable sutures was placed in view of the patient's travel plans. The eliminated the need for the patient to change his plans just to remove the stitches. The patient had his dental problem resolved and left by 7.30pm.
By special prior arrangements we are able to accommodate our patients at a time that suits their schedule.
An arrangement was made for our oral and maxillofacial surgeon to see the patient after office hours on an emergency basis. The patient arrived early for his appointment but our oral surgeon was held up in the operating theatre and did not arrive until 7 pm.
The removal of the wisodm teeth was completed and resorbable sutures was placed in view of the patient's travel plans. The eliminated the need for the patient to change his plans just to remove the stitches. The patient had his dental problem resolved and left by 7.30pm.
By special prior arrangements we are able to accommodate our patients at a time that suits their schedule.
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