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After the age of 35, gum disease or periodontitis is the major cause of tooth loss in adults, far more so than tooth decay. In fact, about 80% of tooth loss can be ascribed to periodontal disease in this age group. A lot of time and money could be saved by early detection and treatment of the disease and many more people would keep their teeth if they were aware of this fact.

Sequela of gum disease
Sequela of gum disease

Periodontal disease affects the support structures of the teeth: the bone, gums and ligament (Click here for Dental Anatomy). It is long-term and slow-moving disease: painless in its initial stages, but later presenting as a chronic inflammation that damages both the gums and bone holding the teeth in place. Bacterial plaque is the main culprit here, and only fastidious daily brushing and flossing can effectively remove it.
The most common form of periodontitis is adult periodontitis. It can be localized or generalized and appears to progress episodically. During periods of exacerbationthere is advancing loss of epithelial attachment, increase periodontal pocket depth, increased gingival crevicular fluid, loss of alveolar bone and connective tissue attachment and gingival bleeding.
The predominant species associated with adult periodontitis ace Actinobaccillus actinomycetemcomitans (25-30%), Actinomyces naeslundii, Bacteriods forsythus, Campylobacter rectus, Eikenella corrodens, Eubacterium species, Fusobacterium nucleatum, Peptostreptococcus micros, Prevotella intermedia, Prophyromonas gingivalis, Selenomonas sputigena, Streptococcus intermedius and Treponema species

Types of periodontitis

Adult periodontitis can be devided into  3 types base on severity:

i) Mild (Early) Adult Periodontitis

Mild periodontitis. From Colour Atlas of Common Oral Disease
Mild periodontitis. From Colour Atlas of Common Oral Disease

Clinical features:

  • 3mm epithelial attachment loss or less (gum recession)
  • periodontal pocket depths of 3-5mm (determine by using a periodontal probe)
  • class I furcation involvement
  • alveolar bone loss of 2mm or less (Alveolar bone loss is determined by vertical periapical bitewing radiograph)

ii) Moderate Adult Periodontitis

Moderate periodontitis. From Colour Atlas of Common Oral Disease
Moderate periodontitis. From Colour Atlas of Common Oral Disease

Clinical features:

  • 4-5mm epithelial attachment loss
  • periodontal pocket depths of 4-6mm
  • alveolar l bone loss of 3-5mm
  • gingival exudate and bleeding
  • horizontal, vertical  bone loss and osseous defects
  • mobile teeth and class II furcation involvement

iii) Advanced Adult Periodontitis

Advanced periodontitis. From Colour Atlas of Common Oral Disease
Advanced periodontitis. From Colour Atlas of Common Oral Disease

Clinical features:

  • At least 6mm epithelial attachment loss
  • periodontal pocket depths exceed 6mm
  • alveolar crestal bone loss is more than 5mm
  • gingival recession
  • significant tooth mobility and class III furcation involvement (A through-and-through bony defect)

 Other types of periodontitis

  • Early-onset periodontitis which can be prepubertal periodontitis and juvenile periodontitis
  • Rapidly progressing periodontitis
  • Necrotizing ulcerative periodontitis (HIV periodontitis)
  • Responsiveness to therapy (refactory periodontitis)


Treatment depends on the causal factors but generally involves:

Dental Scaling
Dental Scaling

  • the removal of plaque, calculus and diseased cementum by scaling, curettage and root planing
  • Topical antibiotics, short-course therapy with systemic antibiotics (tetracycline and metronidazole)
  • periodontal surgery


More info


Treatments of gum disease:



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Researchers have found that people with gum disease are almost twice as likely to suffer from coronary artery disease. – American Academy of Periodontology

Heart Disease

Several theories exist to explain the link between periodontal disease and heart disease. One theory is that oral bacteria can affect the heart when they enter the blood stream, attaching to fatty plaques in the coronary arteries (heart blood vessels) and contributing to clot formation. Coronary artery disease is characterized by a thickening of the walls of the coronary arteries due to the buildup of fatty proteins. Blood clots can obstruct normal blood flow, restricting the amount of nutrients and oxygen required for the heart to function properly. This may lead to heart attacks.
Another possibility is that the inflammation caused by periodontal disease increases plaque build up, which may contribute to swelling of the arteries.
Researchers have found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease as those without periodontal disease.
Periodontal disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures.


Additional studies have pointed to a relationship between periodontal disease and stroke. In one study that looked at the causal relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group.

When you have heart disease, maintaning goor oral health is important. Remember:

  • Make sure your dentist and hygienist know you have a heart problem
  • Have regular dental checkups
  • Maintain good oral health by brushing and flossing twice a day
  • Eat healthily, exercise, and if you smoke, quit


More info


Treatments of gum disease:



Dental intra-oral radiographs a.k.a X-rays. Dentists use radiographs for multiple reasons: to find hidden dental structures, malignant or benign masses, bone loss, and cavities.


How does x-ray of your teeth formed?

X-ray of your teeth is formed by a controlled burst of X-ray radiation which penetrates oral structures at different levels, depending on varying anatomical densities, before striking the film or sensor.

  • Teeth appear lighter because less radiation penetrates them to reach the film.
  • Dental caries, infections and other changes in the bone density, and the periodontal ligament, appear darker because X-rays readily penetrate these less dense structures.
  • Dental restorations (fillings, crowns) may appear lighter or darker, depending on the density of the material.

Should Patients Have Concerns About Radiation Exposure?

The dosage of X-ray radiation for dental is typically safe, around 0.150 mSv for a full mouth series, according to the American Dental Association website. It is equivalent to a few days’ worth of background environmental radiation exposure, or similar to the dose received during a cross-country airplane flight (concentrated into one short burst aimed at a small area).

Incidental exposure is further reduced by the use of a lead shield, lead apron, sometimes with a lead thyroid collar. Operator exposure is reduced by stepping out of the room, or behind adequate shielding material, when the X-ray source is activated.

Types of intra-oral radiographs

  1. Bitewing
  2. Periapical

Bitewing radiograph


Bitewing radiograph designed the placement of the film packet to reveal the coronal halves of the maxillary and mandibular teeth, inter-proximal contacts and portions of the interdental septa.

It is indicated primarily to detect or monitor interproximal caries if the proximal surfaces of the teeth cannot be visually or tactilely examined.

Occlusal caries, crestal alveolar bone level and secondarily for eruption patterns, caries and restoration proximity to pulp spaces, primary molar furcation pathology and developmental anomalies may also be detected with bitewing radiographs.

Periapical Radiograph

PA radiography describes intra-oral techniques designed to show individual teeth and the tissues around the apices. Each image usually shows two to four teeth and provides detailed information about the teeth and the surrounding alveolar bone.

Anterior PA

Posterior PA

Indications for PA radiograph are:

  • Detection of apical infection/inflammation
  • Assessment of the periodontal status
  • After trauma to the teeth and associated alveolar bone
  • Assessment of the presence and position of unerupted teeth
  • Assessment of root morphology before extractions
  • During endodontics
  • Preoperative assessment and postoperative appraisal of apical surgery
  • Detailed evaluation of apical cysts and other lesions within the alveolar bone
  • Evaluation of implants postoperatively.
Other Radiograph Modalities…



Why do we have to clean our teeth?

Tartar (calculus) are deposits that have built up on the teeth over time. Dental cleanings involve removing plaque (soft, sticky, bacteria infested film) and tartar (calculus) deposits that have built up on the teeth over time. Your teeth are continually bathed in saliva which contains calcium and other substances which help strengthen and protect the teeth. While this is a good thing, it also means that we tend to get a build-up of calcium deposits on the teeth. This chalky substance will eventually build up over time. Usually it is tooth coloured and can easily be mistaken as part of the teeth, but it also can vary from brown to black in colour.

If the calculus (or tartar, as dentists like to call it) is allowed to accumulate on the teeth it will unfortunately provide the right conditions for bacteria to thrive next to the gums. The purpose of the scaling and polishing is basically to leave the surfaces of the teeth clean and smooth so that bacteria are unable to stick to them and you have a better chance of keeping the teeth clean during your regular home care. Also it leaves your teeth feeling lovely and smooth and clean, which is nice when you run your tongue around them.

10 Reason why you need to have Dental Cleaning


How are dental cleanings done?

Dental surgeon or dental hygienist uses specialized instruments to gently remove these deposits without harming the teeth.

1) Ultrasonic instrument (Scaler)

Ultrasonic Scaling

Commonly used first is an ultrasonic instrument or scaler unit which uses tickling vibrations to knock larger pieces of tartar loose. It also sprays a cooling mist of water while it works to wash away debris and keep the area at a proper temperature. The device typically emits a humming or high pitched whistling sound. This may seem louder than it actually is because the sound may get amplified inside your head, just like when you put an electric toothbrush into your mouth.

The ultrasonic instrument tips are curved and rounded and are always kept in motion around the teeth. They are by no means sharp since their purpose is to knock tartar loose and not to cut into the teeth. It is best to inform the operator if the sensations are too strong or ticklish so that they can adjust the setting appropriately on the device or modify the pressure applied.

With larger deposits that have hardened on, it can take some time to remove these, just like trying to remove baked-on grime on a stove that has been left over a long time. So your cleaning may take longer than future cleanings. Imagine not cleaning a house for six months versus cleaning it every week. The six-month job is going to take longer than doing smaller weekly jobs.

2) Air polishing

After the dentist has done scaling using the ultrasonic scaler, he will proceed with polishing either using air polishing or polishing cup. Air polishing is an alternative more advance method  than the polishing cup and paste method. It requires a special ultrasonic unit (e.g. Air Flow from EMS) that allows use of this insert in the handpiece.

EMS Air polishing unit
EMS Air polishing unit

Air polishing uses medical-grade sodium bicarbonate and water in a jet of compressed air to “sandblast” the surface of the enamel leaving your teeth smooth and clean.

Indications for air polishing

  • Heavily smoking stain on the teeth
  • Staining due to coffee or tea
  • To remove fine tartar that are still attached to the teeth surface after scaling
Tobacco and coffee stain

Video: Air polishing method with EMS Air Flow®

Advantages of using air polishing

  • There is no physical contact with the tooth, therefore thermal injury is of no concern.
  • It is ideally suited for teeth separated by wide diastemata and considerable in shape and size.
  • Particularly good for cats where teeth are so small that standard cups can create gingival damage.
  • They are very efficient at removing stains from teeth.

Is scaling & air polishing going to be painful?

Most people find that cleanings are painless, and find the sensations described above – tickling vibrations, the cooling mist of water, and the feeling of pressure during “scraping” – do not cause discomfort. A lot of people even report that they enjoy cleanings and the lovely smooth feel of their teeth afterwards! There may be odd zingy sensations, but many people don’t mind as they only last a nanosecond.

Be sure to let your dentist/hygienist know if you find things are getting too uncomfortable for your liking. They can recommend various options to make the cleaning more enjoyable.

Painful cleaning experiences can be caused by a number of things: a rough dentist or hygienist, exposed dentine (not dangerous, but can make cleanings unpleasant), or sore gum tissues.

In case you may have had painful cleaning experiences in the past, switching to a gentle hygienist/dentist and perhaps a spot of nitrous oxide can often make all the difference. You could also choose to be numbed. If you find the scaling a bit uncomfortable because the gum tissues (rather than the teeth themselves) are sensitive, topical numbing gels can be used.

More info


Treatments of gum disease:




Full porcelain crown


  • Intro..
  • What is a crown
  • Indications for full porcelain crown
  • The procedure
  • Cases of Full Porcelain done in our clinic
  • Advantages of full porcelain


Full porcelain crown is a crown frabricated for highly aesthethic demand patient as people today want to see their crown to be as natural as possible and bleanch to the rest of his/her teeth.

This is where full porcelain material comes in!! It is made mostly of Zirconia or E-Max (lithium disilicate) material. The conventional porcelain is made of porcelain layer fused to a metal surface which make is less transucent and greyish.

With zirconia or E-Max material , no metal use, therefore, no greyish appearance and more natural!!

What is a crown?

A crown is a replacement of the outside casing of your teeth that is permanently fixed to the tooth below.  They are few types of crown depends on the material used:

  1. Full porcelain (highly aesthetic  crown)
  2. Porcelain fused to metal (commonly used)
  3. Full metal crown (either precious/non-precious metal crown)


Because full porcelain crown is highly aesthetic, it is used to improve the appearance of the front teeth. For those that are insecure about the appearance of their teeth or their smile, porcelain crowns can be a one-fix-for-all-problems solution.

Full porcelain crown mainly used :

  • to  brighten teeth
  • to make the tooth slight translucent thus making it more natural
  • indicated for the front teeth where aesthetic demand is higher
  • close gap narrowing
  • fix teeth that stick out
  • reduce crowding in the mouth

The procedure

To fit the crowns, a thin layer is shaved off teeth that are to receive treatment, and this prepares them for the crowns. On the patient’s first visit of the treatment a mould is taken of their teeth in order to get the perfect shape for the next session. The crowns are then bonded onto the teeth using a bonding material of some sort. Once the bonding has taken place, which will normally take one session at the dentist, the patient’s can eat as normal.

Cases of Full Porcelain done in our clinic

Case 1


This young lady presented with a discolour right lateral incisor and her right central slanting inwards. Two full porcelain crowns were fabricated to change the colour of the lateral incisor as well as to change the shape of the right central incisor (below).


Case 2

After tooth preperation

A case for prepared tooth (right lateral incisor) for impression taking. A full porcelain crown was fabricated and cemented onto the tooth (below).

Full porcelain crown cemented onto the tooth

Case 3


This young gentleman presented with poorly restore filling material on his front teeth. The fillings were removed  and the front teeth were prepared for porcelain crown.

Full porcelain crowns fabricated on the model

The full porcelain crowns were constructed on the model and finally cemented into patient’s mouth (below).


Case 4


Another case of discolour tooth which was treated with full porcelain crown.


Case 5


This man had a non-vital tooth (left central incisor) which was root treated had showed badly discolouration. The tooth was treated with porcelain crown.


Case 6


Another case of discolouration which was treated with full porcelain crown


Advantages of full porcelain

Crowns are very popular because they have an excellent history of fixing dental issues, and their track record is proven to work in all countries in the world. Up until quite recently, crowns were bonded to the tooth using a metal-based framework (porcelain fused to metal) so that the crown could withstand the pressures involved with daily chewing of food in the mouth. Today, most of the time the metal framework is not required, since modern technology has advanced up to the point where pure porcelain is strong enough even for use on hard working molar teeth. The metal framework had an issue – after a few years the gum line of a patient would recede with age, revealing an ugly grey line at the top of the crowned tooth. Due to the color of the metal showing through, it was difficult to make crowned teeth look natural for more than a few years.

The advantage of using pure porcelain is that the crowns are near identical in color to the existing colors of the patient’s teeth, making it nigh on impossible for others to discern a crowned tooth from a real one. A dentist will match the color of the crown to the tooth color already in the mouth, and then they will place an order with a lab to create the tooth with the perfect color and shape, taken from the previously mentioned mold, and patients are very happy with the results, and their new smile.

Read More




Prestige Dental Care


  • To read on dental bridge click here
  • Crown – What is it?
  • How do we do it?
  • Picture on cases done in our clinic
  • Maintenance

Crown – What is it?

A crown is a replacement of the outside casing of your teeth that is permanently fixed to the tooth below. In other words, the decayed or damaged area of your tooth is removed and replaced by synthetic material, such as porcelain, to create a new ‘tooth’ with permanent results.

A crown is a replacement of the outside casing of your tooth

Crowns are often used after a root canal treatment, because the removal of a nerve causes a tooth to discolour. However, there are other reasons your dentist might crown one or more of your teeth: to restore a damaged or fracture tooth, to protect a weakened tooth so that it does not fracture under stress or to reinforce a large filling where there is not enough tooth structure left below.
Crowns are also made out of various material: gold or non-precious alloy, porcelain or ceramics, acrylic or composite resin, or even a combination of porcelain on metal. Obviously the material chosen will be in line with what will work best for your particular problem.

Gold crown

Non-precious Metal Crown

Porcelain fused with metal crown (PFM)

Full porcelain crown

Currently, most dentist use porcelain fused to metal crown or full porcelain crown as both crowns produce good aesthetic result

How do we do it?

When crowning a tooth, your dentist starts by filing away away between 1mm and 2mm on every surface of your teeth, and then the entire surface is smoothed. Next, an impression is taken of the prepared tooth by syringing an impression material into the space around the tooth and holding an impression tray in position until the material has set. This gives the laboratory a perfect negative copy of your tooth, which allows them to make up the permanent crown. The dentist also ensures he sends the laboratory details of what the colour porcelain to use, to ensure the crown looks natural.

1) Tooth are prepared and smoothen

2) Impression material is syringed into the space around the tooth to get the copy of the tooth

3) Negative copy of the teeth produced by impression material which is hardened on the impression tray

4) The crowns are fabricated on the model by laboratory technician

5) Finally, the crown is cemented onto the prepared tooth

Your are then fitted with a temporary crown, which is really just a rough space-filler, while you wait for the laboratory manufacture the permanent fixture.
At the following appointment, the dentist will have taken delivery of the permanent crown. The temporary crown is then removed, and the prepared tooth below thoroughly cleaned and dried. Then the new, permanent crown is cemented onto the tooth below. Any excess cement is removed, and the treatment completed.

Picture on cases done in our clinic

Here is a example of a discolour tooth that is replaced with a full porcelain crown (E-Max)

The young gentleman dislike his front discolour right central incisor

His tooth discolouration was due to old filling and the tooth is non-vital

After the tooth is prepared, colour of the porcelain crown is chosen to match his neighbour teeth

The full porcelain crown is cemented onto the tooth

Final Result – natural looking crown!!  (Treatment done by Dr. H.W.NG)


You do need to take care of your crown and not overstress it by biting or chewing very hard food. You can also floss normally around a crown. If at a later stage, your crown should break, you need to see your dentist as soon as possible, especially if the tooth inside becomes sensitive. Save the fractured piece if you can, as this can be glued back on temporarily until a new crown is made.

Read more

More info on General Dental Treatment


Having to deal with a dental emergency is not something people think about. However, being prepared can make the difference between saving or losing a tooth. And in the case of a toothache, if it involves a bacterial infection, it can be a life-threatening situation.
Here are a couple of common dental emergencies and what to do about them.

A lost filling

Rinse out the cavity with warm water. Apply a temporary filling product such as Dentemp® which can be made into a ball and pressed firmly into the cavity. This can alleviate immediate pain, but it is important that you call your emergency dentist and arrange to have your filling replaced before the situation worsens.

Temporary filling

Lost Crown / Cap


Even though a missing crown is not immediately painful, it can become painful in a short period of time as food and other debris gather in the cavity. Unless the cavity is sealed up again, decay and infection can cause the tooth to ache. It is important that you visit your emergency dentist within a few days of losing your crown or cap.

You’re suffering with a toothache

Toothaches can be more dangerous than any physical trauma to a tooth. Rinse your mouth out with warm water and place some kind of cold compress against your cheek for twenty minutes to reduce the swelling. Then let it warm up for 20 minutes and then back to the cold compress.
Don’t put any kind of pain medication against the gum. The pain medication could burn the gum and cause more problems. The greatest risk comes if the toothache is from a bacterial infection. If left untreated, this could become life threatening. See an emergency dentist ASAP.
Shamblott Family Dentistry

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