Answering Clinical Questions Improves Patient Safety
What is dental care?
Dental care is the maintenance of healthy teeth which include Oral hygiene, the practice of keeping the mouth and teeth clean in order to prevent cavities (dental caries), gum disease, and other dental disorders
In your experience, how are Malaysians ‘general attitudes towards dental care?
Like you, I used to think the world was this great place where everybody lived by the same standards I did, then some kid with a nail showed me I was living in his world, a world where chaos rules not order, a world where righteousness is not rewarded. That’s Cesar’s world, and if you’re not willing to play by his rules, then you’re gonna have to pay the price.
How often should one see a dentist?
On average, seeing a dentist twice a year works well for most people. Others may need more frequent visits. People with very little risk of cavities or gum disease can do fine seeing their dentist just once a year. People with a high risk of dental disease might need to visit every three or four months, or more. This high-risk group includes:
• People with current gum disease
• People with a weak immune response to bacterial infection
• People who tend to get cavities or build up plaque
Some people fear of dentist. Can you tell us about your experience with this and offer some advice?
Fear of dentist is very common. Most people fear of dentist because of the needle, pain, anxiety, the invasiveness, the sound and smell, cost, poor service, bad experiences, etc.
The good news is that dentistry is more advanced and more comfortable than ever. So these days, most people don’t mind going to the dentist. To overcome fear find a dentist who understands that you are anxious. During the treatment get your self involved in decision making, have the dentists show you the tools and where the problem is and how it can be treated. The more you get yourself involved, more are the chances of yourself projecting your mind to a thought of a healthy teeth. The less vulnerable you feel, more is the comfort level.
Flossing is not common among Malaysians. Can you expand on this?
Are you a Human Being?
I agree with your above statement.
It is important to include flossing as part of a good dental hygiene in order to prevent the formation of plaque. It is required to clean in the gaps between teeth, where most toothbrushes cannot reach.
• ADA (American Dental Association) recommends flossing at least once a day. They also advise flossing before brushing, as it gives a chance to the toothpaste fluoride to penetrate the gaps between the teeth.
• It is very important to note that incorrect or vigorous flossing can cut through gum tissue, which can cause damage to the gums, and hence it is important to floss correctly.
Going beyond that, is there more one can do for a healthy mouth?
• Proper plaque control and tooth brushing
• Diet control and nutrirtion,
• Prevention tobacoo chewing, alcohol consumption, smoking
• Habits-bruxism, clenching etc
Do candy and other teeth –rottting food can affect your teeth?
Can. Candy and other sugar content food are cariogenic.
Are toothpicks safe?
Definitely no. Toothpick can traumatized the gum, teeth and can increase the gap in between the teeth. As such it may aggravate food impaction, gum disease and root caries.
What kind of simple assessment can you do at home to check your dental health?
Own assessment of their teeth, gum and other oral tissues.
• Teeth : Note for pain, sensitivity, changes of colour, movement, loosening, elongation, increase spaces in between teeth and lost of strength and ability to
• Gum : Note for change of colour and redness, bleeding when brushing, eating or spontaneously, change in texture and consistency of the gum.
• Oral tissue : Note for colour changes like any white or red lesion, painless and non-healing ulcer for more than two weeks or any abnormal growth or swelling.
Every Breath you Take
What are the common causes for bad breath ?
• Halitosis has a number of causes, both intraoral and extraoral.
• Oral disease such as caries, gum disease, dry socket and residual food deposits such as peppermint, garlic, curry, etc represent the most common cause of
• Mouth odour is common between meals, when it is associated with food stagnation and reduced salivary flow.
• Pathology of the respiratory tract, nose, sinuses, tonsils and lungs and disease of the digestive tract, Metabolic diseases, diabetes and uremia .
• Halitosis increase by age.
Which one is better –breathmints or gum?
• Sugarless chewing gum is better because non-cariogenic, prevent dental caries by stimulating salivary flow.
• Also good exercise for facial muscles.
What should you look for and look out for in breathmints?
It must be sugarless and non acidic
The concept of mouthwash is very general. Are there any less-heard of points of mouthwash we should note?
• Mouthwashes have been used for a number of purposes such as clearing the mouth of food debris, to prevent or reduce plaque accumulation, containing
anticaries agents and to reduce the activity of odour producing microorganisms.
• However some mouthwashes can cause unpleasant taste, altered taste sensation, produce staining on the teeth which is difficult to remove and affect the
mucous membranes of oral tissues and tongue.
There are many different mouthwashes, how do we find the right one?
• The effectiveness of mouthwash is based on the following criteria:
› The ability to absorb onto and bind to oral soft tissue and teeth,
› Antibacterial activity against various plaque bacteria,
› Possible anti-inflammatory effect
› Acceptable taste
› Ability to promote fresh mouth sensation.
• Some mouthwash are very strong and stay longer in the mouth. Those mouthwash such as chlorhexidine can be used to replace toothbrushing for short
period of time when this is not possible.
• On the other hand some mouthwashes are mild and does not stay long in the mouth. As such they cannot be used to replaced toothbrushing but can be used
as adjuvants to mechanical cleaning such as Listerine.
No Rush, Just Brush
Do you see a lot of patient and find that generally, people don’t brush their teeth the right way?
• YES. Not many people brush their teeth effectively.
• There are several different acceptable tooth brushing methods because each patient has different needs.
• Not all methods are perfect for all. Some may need to use more than one method.
• The majority of patients use a ‘horizontal scrub which frequently does not clean effectively around gingival margins and can lead to tooth wear. Bass technique is useful for majority of patients.
People use various methods to brush their teeth but the requirement of satisfactory methods of tooth brushing are few;
• Brush at least two minute each time and two times a day.
• The technique should clean all tooth surfaces in the particular the area of gingival margin and the interdental region. The commonest scrubbing technique will clean the
tooth convexities well and yet leave plaque in more sheltered places.
• The movement of the brush should not injure the soft tissue ( gum, check, tongue, palate) or teeth.
Are electronic brushes better than regular one?
• Numerous studies have confirmed that, for most patients, electronic toothbrushes are slightly more effective than manual brushes.
• This may be due to better mechanical cleaning, the brushhead of electric brush tend to be more compact which facilitate interproximal brushing and cleaning of the less
accessible posterior teeth.
• It has been considered advantageous for handicapped/special need, with fixed orthodontic appliances and those who are hospitalised.
• However it must be noted that all brushes, electric or manual, when used correctly are both safe and effective.
There are a lot of trendy ingredients and new revelations on toothpaste, Personally what do you recommend.
• Toothpaste helps to remove the bacteria that cause dental plaque and bad breath. As dental plaque bacteria meet with food, they create an acid that attacks
teeth and eventually causes tooth decay. A build-up of dental plaque bacteria can cause several other dental problems including gum disease.
• Toothpaste’s ingredients help control mouth bacteria and fight dental problems. The main essential ingredient is anticaries agent sodium monofluorophosphate, sodium
fluoride, stannous fluoride which help to retard enamel demineralization and promote remineralization.
• The other ingredient is antibacterial agents such as sodium lauryl sulphate, triclosan which help retard the regrowth of bacteria and plaque deposits.
Just Kidding / Children's corner
When should toddlers start brushing their teeth?
• Proper dental care begins before a baby’s first tooth appears. Running a soft, damp washcloth over a baby’s gums daily will help clear away harmful bacteria.
Cleaning his mouth at this early stage will help him get accustomed to the whole procedure meaning that he may not object too much when you introduce a toothbrush
• Parents should be advised to start tooth brushing their child teeth as soon as the first tooth erupts at around six months of age.
Any advise for parents that need to start brushing their children’s teeth?
• Sit your baby in the most comfortable position for both of you – try standing or sitting behind your baby as he looks up. This is an excellent position to adopt,
because it makes it very easy to reach all parts of his mouth.
• Around age 2, most kids can spit while brushing. Use a pea-sized (5mm) amount of toothpaste, with supervision, until around age 6 to 7. Children do not have
the manual dexterity to brush their teeth effectively about the age of 7.
• Toothbrushing should be a routine and on at least two occasions everyday.
• Many brushes and pastes have cartoon characters can be good motivator for many children.
• Teach your child to spit out as well as possible after brushing.
What kind of toothpaste should children use? Why isn’t regular ‘adult’ toothpaste recommended?
• It is not absolutely essential to use toothpaste to clean your baby’s teeth – the brushing action itself is actually the most important part of keeping them clean. If
you prefer to use toothpaste, then you should choose one that is designed specifically for infants, because they contain very little – if any – fluoride. In fact, the American
Association of Pediatric Dentistry guidelines suggest that babies under the age of 2 receive NO fluoride at all.
• Fluoride helps strengthen the enamel of teeth. However, too much of it can cause fluorosis, which is a condition where white spots can appear on the permanent teeth.
• If you use an adult toothpaste to brush your baby’s teeth, which contains the amount of fluoride recommended for adults, you run the risk of him developing fluorosis. This
is because babies tend to swallow rather a lot of toothpaste during brushing and are thereby swallowing excess fluoride which can cause many systemic problems.
Can / should young children floss their teeth?
Can but not all the children require flossing. Flossing should begin when two teeth touch each other. Daily flossing of the teeth of young children reduces caries.
At what age should you start using mouthwash?
Parents to wait until the child can definitely spit the mouthwash out. Children under the age of 6 years should not be recommended to use mouth rinses due to the risk of swallowing the product.
At what age should children start seeing a dentist?
Your child should see a dentist by the time he or she is a year old, according to the American Academy of Pediatrics