04/Mar/2020

First Visit

It is recommended that every child has an introductory dental visit within 6 months of eruption of their first tooth. As parents, you might think this is too early- even more so when there is no “problem” with your child’s teeth yet. However, starting dental visits early has many advantages:

We can assess each child’s risk of developing tooth decay.
We can suggest preventive steps that is special to each child’s needs
We can have the opportunity to show your child that dental visits can be fun, hence reducing chances of dental anxiety in the future

Quite often, it is a child’s first visit to the dental clinic but he/she is having pain. We understand that it can be stressful and anxious for both parent and the child. For younger children, parents can be present in the treatment room. For older children, it is best that we can see the child by themselves, but if parents are not comfortable with that, parents can be passive observers- allowing us a chance to interact and explain in simple terms that your child can understand. Many studies have shown that when parents are anxious themselves, their child will also tend to be anxious as well.

Depending on the your child’s reaction to his/her dental visit and what treatment needs to be done, we will try our best to provide your child with the best care possible. It is however important for parents to understand that treatment should not be forced or rushed onto a child. We understand that parents are busy and prefer treatment to be done all in a single visit, but it takes a lot of patience and time for us to build a trusting relationship and bond with your child. This is how dental visits can become stress free and fun for your child.

Our services includes

Standard Cleanings and Check ups

The care we provide is the best we can for each child. This means that the cleaning frequency we recommend can vary from individual to individual. Your child might benefit from cleanings every 3 months, or every 6 months.

What happens during a standard cleaning and check up?

A standard dental examination
Scaling, polishing and flossing
Dental x-rays (if needed)
Fluoride varnish treatment

Fluoride Varnish Treatment

What is Fluoride? Fluoride helps to strengthen teeth and prevent decay. It is also able to remineralise teeth that have early decay (seen as white patches on teeth). Fluoride can be found in fluoridated toothpaste, and are available in various amounts and concentrations.

Fluoride varnish contains a higher than normal amount of fluoride and it comes in the form of a thick sticky paste that adheres to teeth to minimise swallowing. It is very well tolerated as well. Varnish is proven in many ways to slow, stop and even reverse the formation of cavities. Everyone is at risk of developing cavities, from the young infants to young kids to teenagers. Here are some risk factors:

Infants still bottle feeding past one year of age.
Infants sleeping with a bottle containing liquids other than water (eg. milk, juices, sweetened drinks like Milo)
Frequent breastfeeding without proper mouth cleaning afterwards, especially at night
Constant consumption of sugary or starchy foods and beverages
Dental history of cavities
Developmental disabilities

Fluoride varnish may be unfamiliar to many patients, so here are some information for parents and children:

It will make your child’s teeth look dull and yellowish when leaving the dentist. Their teeth will return to normal as the varnish wears off, usually in 1 day.
In order for the varnish to have the most benefit, it needs to remain adhered to the teeth for as long as possible. For that, your child should not brush or floss until the next morning.
To prevent early removal of the varnish, avoid abrasive or hard foods for the rest of the day. Soft diet is ideal for the day.
Fluoride varnish should be done every 6 months for most children. For children who have a higher risk of cavities, we may recommend 3-monthly application of fluoride varnish.

Tooth coloured fillings

These are white fillings that look beautiful and blend in with the natural color of the tooth. Placement of fillings is fairly quick and easy. First the decayed part of the tooth is cleaned and removed, then the tooth is dried and filled.

Happy Gas

What is Happy Gas? Happy Gas is also known as nitrous oxide/ laughing gas. In our clinic, we use it as a mild analgesic. It works by filling the patient with a feeling of happiness, which helps them feel relaxed and less anxious about dental treatment.

How do we use Happy Gas? We apply the gas through a tube and nose piece that fits over your child’s nose. All he/she has to do is breathe through his/her nose

Why use Happy Gas? Happy Gas is fast acting and wears off quickly. Its effects can be felt within 5 minutes, and when the gas flow stops, those effects wear off within another 5 minutes of breathing oxygen. It is safe, easy to use and can be adjusted easily for your child’s comfort. The only thing that stops it is a stuffy nose. If your child can’t breathe through his/her nose, it won’t work.Children’s Primary Teeth

More Info…

More info on General Dental Treatment

Dr. Tham

03/Mar/2020

Digital crown- What is it and how does it work?

With our new Rainbow-Mill Clinic machine, we can now produce natural and functional ceramic indirect restorations (crowns, onlays, inlays) within a day!

The creation and placement of indirect restoration is one of the most commonly performed procedures in dentistry today. Like traditional crowns and onlays, digital crowns and onlays are ideal for teeth which are badly decayed or broken and commonly used as routine finishes for procedures like Root Canal Therapy.

However, anyone who has had a standard crown or onlay done will know that it can be a time consuming process which takes a minumum of 1 week or more for it to complete.

The crown that was millerd out from the hybrid-ceramic block

Normally in the case of traditional crowns, impressions are taken and sent off to a dental lab for crown fabrication. It may take a week or two for the lab to receive the impression, make the crown and send it back to us. The waiting time and having a temporary crown in the mouth are the drawbacks of this method.

With Digital crowns/ onlays, we can shorten the entire process significantly. The biggest advantage of digital crown is that it can be designed and milled right here in our clinic. Using the latest CAD/CAM technology and state of art equipment, patients receive a perfect crown/onlay in just one day! In addition to that, the crowns are incredibly accurate as we scan your tooth instead of taking impressions.

So how does a Digital Crown work?

Your dentist will prepare your tooth for a crown as per usual and instead of having you bite down on gooey plasticine like impression materials which are messy and uncomfortable, your tooth will be scanned with our intra oral scanner that takes a 3D image of your tooth, which is then fed into a computer programme. After designing your crown, we will use our milling machine to cut out or “mill” the exact crown that was designed out of a ceramic block. Once milled, the crown is then fitted, polished and bonded to your tooth- all on the same day.

A Digital crown fabricated from the unit

So there you go.. now that you know about Digital crowns that can be milled (cut out) in our own clinic, you can consider giving it a go next time to save an extra visit to the clinic! Talk to your dentist about this if you have more questions or make an appointment to find out more.

Dr. Tham

30/Jan/2020

If you are thinking of straightening out your teeth but not looking forward to having fixed metal braces on your teeth, we can help you achieve that with Invisalign at Prestige Dental Care!

Invisalign is a set of custom-fitted aligners that fit over your teeth that slowly pull all your teeth into alignment. With Invisalign, you will be given a set of custom-made aligner trays that are made of BPA-free thermoplastic material.

They are removable, flexible, smooth and almost invisible- this means that you can remove your aligners while eating, avoid the painful monthly tightening needed for metal braces, and the best yet: you no longer have to put up with having ulcers or metal wires poking into your sensitive mouth tissues, or getting food in your braces and subsequently bad odour from areas that are difficult to be cleaned.

How is it done?

At Prestige Dental Care, we will examine your teeth and take the necessary records needed before starting treatment, such as: photos of your teeth and facial profile and dental X-rays. Our clinic is also equipped with the 3-shape intra-oral scanner. Unlike traditional methods of taking moulds of teeth, we use this intra-oral scanner to take digital pictures of your teeth which gives our dentists a very high definition, 3D image of your smile and teeth. This can then be used to custom make your aligners very accurately.

More info

Dr. Tham

23/Mar/2019

What is interceptive orthodontics?

In interceptive orthodontics , we identify and treat crooked teeth as soon as they are detected. According to the American Academy of Orthodontics, all children should have an orthodontic assessment no later than 7 years old.

How is interceptive orthodontics done?

Every child’s condition is different and treatment will be different too. Treatment can be done with at least ONE or a combination of the following:

Removable appliances (eg. expansion screws, springs, labial bows)
Oromyofunctional therapy ( Myobrace + oral exercises to train good oral posture. Read below for more information on oro-myofunctional therapy)
Braces (Depending on suitability, braces can be started earlier to gain more space for teeth in the jaws hence avoiding the need for pulling teeth out in the future)

1. Upper removable appliances (URA)

As it’s name implies, this treatment typically uses a plastic appliance that can be worn on and removed from the teeth. There are many types of removable appliances available and they are custom made according the child’s teeth. Often, we use springs or expansion screws to move teeth. Below are some examples of removable appliances.

2. Oro-Myofunctional Therapy (OMT)

How does Oro-Myofunctional Therapy (OMT) work?
OMT is a pre-braces treatment suitable only for growing children. The treatment aims to improve growing children’s cranial and jaw development by treating the underlying causes of crooked teeth and poor oral posture.

OMT can also improve a child’s general health and prevent Sleep Breathing Disorders.

This treatment involves using a series of removable intra-oral appliances (Myobrace) that are worn for 1-2 hours each day plus overnight while sleeping.

OMT also requires a child to do several oral exercises to train the strength of their lips and tongue and improve their nasal breathing. These exercises are very fun and parents are encouraged to get involved too!

The intra-oral appliance works by correcting poor oral habits that cause negative impacts on the development of face, jaws and teeth, such as mouth breathing, incorrect tongue position, thumb sucking, bottle feeding and swallowing incorrectly.

What Causes Crooked Teeth?

Many Malaysian children are growing up with crooked teeth. This is evidence of poor development of craniofacial structures. Traditional orthodontic treatment such as extractions and braces after waiting for all permanent teeth to come through actually focus on moving teeth without treating the underlying cause for crooked teeth.

Modern research has shown that crowded teeth, incorrect jaw development and other orthodontic problems are not caused by big teeth and small jaws or genetic factors. Rather, it is due to poor myofunctional habits (poor oral habits) like mouth breathing, tongue thrusting, reverse swallowing and thumb sucking that can be evident since the first years of life.

The craniofacial structures develop correctly only when children have the following 4 patterns for straight teeth:

1. Lips together at rest

2. Tongue resting at the roof of the mouth

3. Breathing through the nose (NOT the mouth!)

4. Correct swallowing method (No lip/cheek movement)

Here at Prestige Dental Care, we provide early intervention options for children that improve the underlying cause of crooked teeth with Oro-Myofunctional therapy.

What Oro-Myofunctional therapy does:

Corrects poor oral habits
Develops & aligns the jaws
Straightens the teeth
Optimises facial development
Improves overall health
Promotes healthy eating habits

How does it do this?

By helping the child:

Breathe through the nose
Swallow correctly
Correct his/her tongue posture
Keep lips together

Oro-MyoFunctional Training Exercises

How to wear MyoBrace Appliance/MRC Trainer?

Training 1 – Resting Position, Correct Swallow, Breathing Awareness

Training 2 – Drinking, Paces, Remembering game

Training 3 – Lip training, Continuous drinking, Nose opening

Training 4 – Yawning, Water seal, Tongue clicks

Training 5 – Squirt water bottle, Skinny Tongue

Training 6 – Kick, Gargling, Straw drinking

More info

..

Dr. Tham

02/Nov/2011

Why it is important?

Improper oral hygiene leads to plaque build-up
Plaque formation can lead to gingivitis, an early form of gum disease
If left untreated, gingivitis can progress to periodontitis, a more severe form of gum disease
Recent evidence indicates that periodontitis is associated with certain medical conditions

That is why it is important for your overall health to understand the importance of good oral hygiene.

Plaque

What is plaque?

A colourless film of harmful bacteria that sticks to your teeth
It is constantly form on the tooth surface.
Combination of saliva, food and fluids produce these deposits that collected on teeth and where teeth and gums meet.

Why prevent it?

Plaque build-up can lead to gum irritation, gingivitis, periodontal disease, cavities, and even lead to tooth loss
Plaque build-up may also harden into tartar

Tartar

Tartar trapped between the teeth and gum

Tartar or calculus is a crusty deposite that can trap stains on the teeth and cause discolouration.
It creates a strong bond to the tooth surface, making it difficult to be remove by using dental floss or brushing
Tartar formation may also make it more difficult to remove new plaque and bacteria
Tartar can only be removed with dental scaling by a dental professional

Calculus — Tartar attach on the extracted teeth

Plaque and Tartar will lead to dental problem such as:

Gingivitis

Periodontitis and tooth loss

Dental Caries

Poor Oral Health Could Mean Poor Overall Health

Oral health is integral to general health – from the Surgeon General’s Report on Oral Health, 2000

What is the association?

The mouth is directly connected to the body by the bloodstream and the digestive system
Left untreated, plaque and inflammation can lead to gingivitis
Untreated gingivitis may progress to periodontitis
Recent evidence suggests that periodontitis is associated with systemic diseases such as heart disease (eg. heart attack, stroke) and diabeties.

Prevention is better than cure

Daily Oral Care: Cleaning In Between

1. Dental Floss

Step One:
Take about 18 inches (50cm) of floss and loosely wrap most of it around each middle finger (wrapping more around one finger then the other) leaving 2 inches (5cm) of floss in between

Step Two:
With your tumb and index fingers holding the floss taut, gently slide it down between your teeth, while being careful not to snap it down on your gums.

Step Three:
Curve the floss around each tooth in a “C” shape and gently move it up and down the sides of each tooth, including under the gumline

How to floss your teeth – source Mouth Healthy (ADA)

2. Interdental Brushes and Threading Floss

For people with widely spaced teeth, braces, bridges or implants, they may benefit from an interdental toothbrush.

Daily Oral Care: Brushing Teeth

Video: How to brush your teeth – source Health Education England (NHS)

Twice yearly: To visit a dentist for dental check-up & dental scaling

More info

Treatments of gum disease:

Scaling and polishing
Air Polishing – A way to eliminate staining due to smoking, coffee or tea
Root Planning
Gum Surgery
Fear of Dental Treatment? How to overcome it..?

Dr. Tham

20/Feb/2011

Lateral cephalometric is a radiograph of the head taken with the x-ray beam perpendicular to the patient’s sagittal plane. This radiography image is useful for studying the dental and facial growth of a patient.

LatCeph01 — Position of patient from the X-ray source to produce a standard Lateral cephalometric radiograph

In orthodontic treatment, clinician/orthodontist use this radiograph to identified dental and skeletal deformity; the relationship between upper and lower teeth and jaw bone. By doing so, he can create a treatment plan to correct the teeth misalignment. This radiograph is also useful in monitoring the progress of braces treatment and to compare before and after treatment.

Cephlo — Patient’ head is in ‘natural head position’

During radiograph taking, the patient’s head is positioned in the most relax position — natural head position — is a standardized orientation of the head that is reproducible for each individual and is used as a means of standardization during analysis of dentofacial morphology both for photos and radiographs.

Lat-Cephalo — An example of a standard Lateral Cephalometric Radiograph

Cephalometric Tracing

Cephalometric tracing is an overlay drawing produced from a cephalometric radiograph by digital means and a computer program or by copying specific outlines from it with a lead pencil onto acetate paper, using an illuminated view-box. Tracings are used to facilitate cephalometric analysis, as well as in superimpositions, to evaluate treatment and growth changes.

The landmarks on the radiograph are identified and marked.

Lines are made to join the markings and the angles where the lines intercept will be recorded. The values of the angle will be compared to the norm value according to the patient’s race. And finally, a conclusion will be depends on the deviation of the patient’s value to the norm value.

Sometimes, lateral cephalometric radiograph can be use to compare before and after treatment or the growth pattern of a child. For example, in the image below, the green line represent before treatment and the black will be after treatment. From here, we can appreciate how the teeth and jaws move during treatment. Doctor use this radiograph to evaluate if he has achieve his treatment objective!!

Other Radiograph Modalities…

Dr. Tham

22/Jan/2011

Primary teeth or Deciduous teeth, otherwise known as reborner teeth, baby teeth, temporary teeth and primary teeth, are the first set of teeth in the growth development of humans and many other mammals. In some Asian countries they are referred to as fall teeth as they will eventually fall out, while in almost all European languages they are called milk teeth as they exist when the child is still mainly drinking milk. They develop during the embryonic stage of development and erupt—that is, they become visible in the mouth—during infancy. They are usually lost and replaced by permanent teeth, but in the absence of permanent replacements, they can remain functional for many years.
Deciduous teeth start to form during the embryo phase of pregnancy. The development of deciduous teeth starts at the sixth week of development as the dental lamina. This process starts at the midline and then spreads back into the posterior region. By the time the embryo is eight weeks old, there are ten areas on the upper and lower arches that will eventually become the deciduous dentition. These teeth will continue to form until they erupt in the mouth. In the deciduous dentition there are a total of twenty teeth: five per quadrant and ten per arch. The eruption of these teeth begins at the age of six months and continues until twenty-five to thirty-three months of age. Usually, the first teeth seen in the mouth are the mandibular centrals and the last are the maxillary second molars.
The deciduous dentition is made up of central incisors, lateral incisors, canines, first molars, and secondary molars; there is one in each quadrant, making a total of four of each tooth. All of these are gradually replaced with a permanent counterpart except for the first and second molars; they are replaced by premolars. The replacement of deciduous teeth begins around age six. At that time, the permanent teeth start to appear in the mouth, resulting in mixed dentition. The erupting permanent teeth causes root resorption, where the permanent teeth push down on the roots of the deciduous teeth causing the roots to be dissolved and become absorbed by the forming permanent teeth. The process of shedding deciduous teeth and the replacement by permanent teeth is called exfoliation. This may last from age six to age twelve. By age twelve there usually are only permanent teeth remaining.
Teething age of deciduous teeth:

Central incisors : 6–12 months
Lateral incisors : 9–16 months
Canine teeth : 16–23 months
First molars : 13–19 months
Second molars : 22–33 months

Primary teeth care

Proper care of deciduous teeth is very important and starts at early stages even prior to their eruption. At the earliest stage, a child’s mouth and gums are to be wiped with a clean damp cloth, gauze pad, or especially designed teeth wipes. Wiping the baby’s teeth and gums after each feeding, and particularly at bedtime, helps prevent baby bottle tooth decay. This practice also helps reduce premature decay caused by harmful plaque-like film and bacteria that builds when babies ingest juices or any food containing sugar. Moreover, to reduce the possibilities to develop baby bottle tooth decay is it better to give the baby only plain water at bedtime or during the night and avoid juices, sugar water, milk or any other liquid containing sugar.

first-teeth-toothpaste — Non-flouride toothpaste

Once the first primary teeth come in, brushing starts. Warm water is normally used in these cases or a non fluoride toothpaste. The market offers special toothbrushes or finger toothbrushes for babies that help protect tender gums and gently clean baby teeth and gums. Other toothbrushes are specially designed for toddlers to easily grip them. They also come in catchy designs that encourage toddlers to use them. Toothbrush designs vary according to age, therefore, it is better to check the age recommendation on the package to obtain the most convenient one. Toothbrushes should be replaced every two to three months. It is also important to brush children’s teeth after giving them medicine as their acids may affect the tooth enamel. Early brushing helps reduce harmful bacteria, remove plaque, sugar, or any other kind of food that may cause tooth decay.

Reduce high sugar food can reduce dental cavity significantly — Reduce intake of high sugar food

Parents are advised to take their children to the first dentist visit when they are 12 months old. During this visit, the dentist can define dental care plan. Two possible ways to prevent tooth decay are the use of fluoride and sealants.

Treating patient [1600x1200] — It is important to bring your children for dental check-up regularly

Fluoride makes teeth stronger over time which then prevents the initiation of dental caries and tooth decay. Also, it re-mineralizes those areas of the teeth which have been weakened by acid. Fluoride can be included in one’s diet. Other ways of obtaining fluoride are in toothpastes and mouth rinses that are normally used at homes. The dentist can provide it through gels and foams he applies during dental visits.
To add to the benefits of the fluoride, dentists also apply sealant in order to preserve the teeth even more. Sealant is applied in some locations of the teeth that smooth their surface. Therefore, food and plaque are less likely to get trapped in those areas.
Children can start flossing when they are about 3-4 years old. However, at this age they might still need help and will be able to floss by themselves when they are 8-10 years old.