Hi… How are you doing? Heartiest welcome to our blog and we do hope you will enjoy reading our refreshed blogs for comprehensive dental services provided here. Our prestigious dentists here have come out with this infomational blog for the oral health of our current and potential patients. If you want to know more, you can send a message or WhatsApp us here!
In intravenous sedation, a cannula is placed into a vein and a drug is administered directly into the patient’s blood stream with the patient in supine position.
A cannula (thin plastic tube) will be put into a vein in the back of one of your hands.
The primary goal of IV sedation is to reduce your anxiety, make you feel relaxed and less aware of the dental procedure.
The use of intravenous sedation is indicated in the management of patients with high level of dental anxiety or patients that unable to tolerate stress (epileptic, stroke patient).
During the procedure, adequately sedated patient is demonstrated by expressionless face, drowsiness, and slow speech but they will still be able to understand and respond to verbal contact. However, this patient may not be able to recall events that occurred during the procedure after the treatment.
The major side effect with midazolam sedation is respiratory depression. Thus, the use of a pulse oximeter (device attached to your finger to measure oxygen level and heart rate) is mandatory to monitor patient from this potentially dangerous side effect during the procedure.
Patient who is allergy to benzodiazepines is an absolute contraindication but is extremely rare. IV sedation should be aware in pregnant patient, patient with kidney, liver and heart disease, elderly patient, and children.
Before intravenous sedation
Take your routine medicines at usual times and discuss your medical history and the medicines you took with your dentist
Inform your dentist if you think you may be pregnant
Have a light meal 2 hours before your appointment
Do not take alcohol in any form
Bring an adult that can bring you home and take care of you afterwards
After intravenous sedation
You will need to stay in our recovery room for at least one hour before you leave the clinic.
The effects of sedation can last up to 12 hours, thus during this period:
Do not drive any vehicle, or operate any machinery, or travel alone
Do not take alcohol in any form
Do not use internet and social media
Do not return to work
Do not make any important decisions or sign any legal documents
When compared to general anaesthesia, intravenous sedation is simpler, easier to administer, faster onset with fewer complications and contraindications, patient remains conscious and can breathe on their own throughout procedure.
In general anesthesia (GA), drugs are administered by intravenous or inhalation routes which makes the person to be unconscious and do not feel or remember anything during the surgery. This patient is not wakened even by painful stimulation. General anaesthesia currently can only be performed in the operating room under the hospital setup where the sleep doctor (anaesthesiologist) will be the one to make the patient sleep.
GA is recommended for:
Complicated, extensive, and prolonged treatment to be performed
Working in difficult or multiple areas in the mouth
Patient with special needs
Patient with extremely dental anxiety – only if other form of sedation are ineffective
The patient is unconscious – allows the dentist to perform surgery without concern of constantly moving, uncooperating or anxiety patient.
Patient do not feel pain
Patient cannot remember events occurred during the surgery
Longer operating time
The patient is unconscious – can be life threatening
Higher risk of complications – higher risk of airway obstruction because patient unable to cough
Patient cannot control the situation – do not respond to sound and touch
Require assistant to maintain a patent airway – patient cannot breathe on his own
Very expensive – require special equipment
Patient must fast at least 8 hours before surgery
Requires adequately and specially trained doctor (anesthesiologist) to perform
Time consuming procedure – long recovery period
Before administering GA, the patient should be assessed thoroughly by the anesthesiologist by taking detailed medical history, drug history, physical test, and extensive laboratory test. The patient should be explained about the procedure and informed consent form should be signed by the patient. Patient must fast at least 8 hours before the procedure.
Then, GA drug administered intravenously or by inhalation to induce general anaesthesia.
After GA is induced, the doctor will secure your airway by placing a tube into your lung via the nose, mouth or a opening in the neck to ensure sufficient oxygen to reach your lung before dental treatment begins.
When dentist has finished the dental treatment, the doctor will stop the administration of GA drugs and begins to bring the patient back to consciousness. The patient should be monitored for 1-2days before discharging.
The uses for general anesthesia in dentistry have decreased over the years as other less invasive sedation techniques have evolved. Nevertheless, there are still many situations that require the use of GA.
Minor oral surgery is a field in dentistry that involves surgical treatment that performed within the mouth. This surgery can be done under local anaesthesia with or without sedation. In most situations, it requires only a relatively short recovery period. Types of Minor Oral Surgery
Removable appliance is an appliance that is not fixed to teeth but can be removed by the patient. It usually contains spring, screws, clasps and acrylic base plate. This appliance is often used in situation whereby simple teeth movement are needed only and it can allow patients to perform better oral hygiene by removing it. However, this appliance requires compliance from the patient to wear it.
Fixed appliance is probably the most common type of orthodontic appliances in use today. They consist of small brackets that are attached onto the front surface of the teeth and a thin wire which is often held in place by elastic loops.This appliance allows multiple tooth movements simultaneously and more effectively as compared to removable appliance. The treatment usually lasts from 6 months to 30 months depending upon the severity of the problem. It is very important to maintain an excellent oral hygiene and dental health throughout the orthodontic treatment
A procedure to correct the gum shape and contour thus improve the smile line. Gingivoplasty surgery is usually done on the upper front teeth (can be up to the premolar region) where the gums here can be seen when smiling.
Most of these gum defects are usually caused by gum diseases (eg. periodontitis). However, in certain cases, the gum recedes due to over brushing or probably just because the gum itself is thin (thin biotype).
In gingivoplasty, a gum graft can be done where the tissue is taken from the roof of the mouth (this is called a graft) and then stitched into place on either side of the tooth that is recessed.
Here, is a case of a young male presented with receded gum due to over brushing…
He didn’t like his teeth and gum for a few aesthetic
The teeth are uneven
The gums on his left are simply too high!!
We found out that he was a right-handed person, using his toothbrush to brush his left teeth too hard!! That causing the gum to shrink upwards.
Secondly, his gums were thin biotype and the previous dentist had over-filled his abrasion cavity with composite preventing the gum from ‘coming down’
Objectives of treatment:
Correct his over-brushing technique
Modified the over-filled composite restoration
Correct the Shape of his teeth
Gum surgery to thicken his thin biotype gum and bring his gum down at the same time
Digital dentistry refers to the use of dental technologies or devices that incorporates digital or computer-controlled components to carry out dental procedures rather than using mechanical or electrical tools. The use of digital dentistry can make carrying out dental procedures more accurate, efficient than using mechanical tools, both for restorative as well as for diagnostic purposes.
Digital dentistry can be use for:
Fabricating a veneer, crown or bridge in just ONE DAY. So, patient can have a crown done and cemented in his/her mouth on the same day, without the need of 2 visits or multiple injections or temporary prosthesis.
Planning of teeth movement in orthodontic patient. After planning, a series of teeth models will be printed out where the vacumme-formed aligners will be fabricate for patient to wear. This aligners will move the teeth as planned and achieve final result.
Planning and creating a new smile for patient in digital smile design. By changing the teeth colour and alignment in the computer, both clinician and patient can immediately appreciate the outcome of the smile design. From there, clinician can give several treatment options for the patient to achieve the final result.
Surgical guide for implant placement – making implant surgery safe and precise
Digital dentistry basically involved 3 basic steps:
data manipulation and analysis; and finally
We need to collect data or information from patient to start the outflow in the digital dentistry, for example:
Dental and Face images. Good image of the teeth or oral cavity region, patient’s smile or portrait picture of patient are essential data for planning digital smile design (DSD). These information can be obtained using a SLR Camera in the Photo Studio environment.
Intra-oral 3D scan. With a Intra-oral scanner (such as 3hape scanner), 3D images of the oral cavity region can be record and save in the computer.
CT-scan or 3D image of the teeth and jaw bone of patient mouth. Cone Beam CT (CBCT) is the radiograph unit acquire the data. With CT-scan
DDS (UKM), MFDS RCS( Edinburgh), MSC ORTHO(The Uni of Manchester), MORTH RCS (England)
Dr. Cheok Chieh How’s Duty Roster
SetiaWalk By Appointment
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Summary about Dr. Cheok
Dr. Cheok is a consultant specialist orthodontist. He obtained his basic dentistry degree in 2006 from University Kebangsaan Malaysia. He has found his keen interest in orthodontics after he started working. He was lucky to have secured a government full scholarship in 2010, whereby he pursued his master in orthodontics at the University of Manchester, United Kingdom. In 2013, he has possessed the Membership of orthodontics by Royal College of Surgeons (England). He is very much passionate and dedicated to aligning straight teeth.
Dr Eddy Loo is a dental surgeon who has special interest in Endodontics, Orthodontics and Dental Implantology. He obtained his Doctor of Dental Surgery (DDS) from Universiti Sains Malaysia (USM). He completed his compulsory government service and was previously attached to the Oral Maxillofacial Surgery (OMFS) and Pediatric Dentistry department in Hospital Raja Permaisuri Bainun (HRPB) in Ipoh. As an avid learner, he often attends courses and conferences locally and internationally.
He is currently pursuing a 3 years Orthodontic Programme by Dr Derek Mahony which will qualify for a Postgraduate Diploma in Orthodontics from the University of City London Dental School.