Saturday, March 15, 2008

Scaling & Polishing

Today I thought of writting something about one of the most basic preventive treatment in dentistry i.e. SCALING & POLISHING.

Scaling is removal of calculus from tooth surface. Why is this important?

Calculus builds up on our tooth surface over time and becomes an ideal breeding ground for bacterial colonies. Calculus also "eats" into our gums causing swelling of gums and infection at the gum pockets.

Left unattended, these calculus forts on our tooth becomes the starting point of decay and loosening of our tooth from its pockets.

Scaling is to remove the excessive build up of calculus and to ensure a healthier tooth-to-gum interface.

What about polishing, is this a cosmetic affair? Well no. Polishing removes stains from the surface of the tooth. Tooth is abraded daily by our chewing and munching activities. As the surface becomes overly rough, it becomes more dificult to clean effectively and stains develop easily.

Polishing removes the unwanted stains and brightens the tooth surface. Of course it looks and feels a lot better too!

Friday, March 14, 2008

Layman's guide to dental treatment

Before I go on writting some jargon and twisting tales about your teeth, let me just attach here a very simple layman's guide to dental treatment:

By: Dr Joon
32-1 Jalan USJ 10/1, Taipan Triangle, 47620 Subang Jaya
Disclaimer: Information and opinion given here are provided in good faith for educational purposes only. For a specific professional diagnosis and recommended treatment, please consult a dental surgeon.


There goes a saying that politicians hate dentists because they will have to keep their mouth open and don’t talk.

An Egyptian scribe named Hesy-Re who died in 2600 BC is often referred to as the first “dentist.” After almost 46 centuries, the phobia (or hatred?) towards dental treatments is still very fresh amongst the general public.

Maybe this is because it is very clear that even a mummy normally has its teeth intact and what’s so great about visiting a dentist to keep your teeth huh? Egyptian kings never used floss too?

Remember, Egyptian kings never used to eat like us too. Today our diet, general lifestyle and environment have changed tremendously. We need a conscious effort to keep our teeth for life to enjoy the kerepek and keropok.

Before we talk about the phobia of visiting a dentist, let us ask – do we really understand what a dental check-up can reveal? And do we know what can be done to prevent the loss of a valuable tooth?

Are we taking an informed decision or a panic-stricken decision on our dental treatment?
This article seeks to reassure readers of the importance of good preventive habits and the options available to keep their teeth for life. We hope that through this article readers will understand dental treatments and their relevance towards making an informed decision.


Step 1: Check, ask & understand
Understand that check-ups are non-intrusive with no pain. Tell your dentist that you need a check-up and a feedback on the status of your oral health … and that’s it for today!

You don’t have to reach a dental chair with a definite need to do a treatment. You can choose to find out and leave; to mentally digest the diagnosis.

Also understand that you have every right to seek a check-up, get an opinion, get a second opinion if necessary and then make an informed decision before you do anything with your teeth or gums.

Step 2: Scaling & polishing
Ask how much it would cost and what you expect to achieve.

If you have not heard the word “dentist” since Primary 6; you still think dental chairs look like barber chairs and you are crossing 38, you would probably require scaling and polishing.

“Why polish my teeth? … No need for shining teeth lah!” … You are right; polishing removes stains, improves the feel of your breath and makes you smile better. And if you are a lion trainer who needs to spot a seasoned look with obvious stains, then you may not need polishing!

“Scaling? You mean our teeth got scales one ah?” Well no – your teeth would have built-up calculus that is the perfect foundation for bacterial colonies to build squatter homes! You have the choice to provide them with ‘Temporary Occupancy Licenses’ until your teeth give way or remove the calculus and deny the bacteria a chance to eat into your teeth.

See … with just 30 minutes of time you could take the first step towards knowing how is your oral hygiene, remove calculus and polish your teeth. You can now arrive in style with a better smile.

Now what happens if your dentist said that you have a chipped cavity on the front tooth that does not look cute at 38?

Step 3: Tooth-coloured filling
“What can I do” … Options? You can do a filling using tooth-colored composite material. And you thought composites were used only in construction? Your dentist can prepare the tooth and fill the cavity.

… Isn’t it cute now?

Tooth-colored filling can be done using several materials ranging from composite resin to glass ionomer. But then what if the tooth is so badly broken and looks like a weathered lighthouse?

Step 4: Crown
If the roots of your teeth are healthy, not mobile and the tooth has some intact structure – we can re-establish the function by using a crown. It is like using a cap to hide balding hairline but with one difference; a crown sits firmly on the tooth and you could start biting almost like the original tooth.

Crowns would be made to match your tooth colour and is made of very durable material. You need not smile with a gold tooth shining in the morning sun!

“My tooth broke when my son hit me with the basketball. Now look like old volcano. Can do crown meh?” … Now you need to plant a “bakau piling” before we pour the cement! This is called “post crown”, where you plant a post and then place a crown on top of the tooth.

This comes after the root is treated accordingly i.e. root canal treatment – which we shall discuss later.

What can make a difference in price when making a crown? The main subject is the type of material eg. Acrylic, pure porcelain, porcelain bonded to metal (non-precious, semi-precious, precious metals) or full metal.

In a post crown, the material of the post can be stainless steel, gold-plated metal, titanium or carbon fiber.

Do ask about the pros & cons; durability, applicability to your case and of course, the price indication.

When all else fails, are there any last choices before abandoning the rescue mission? What if the tooth has infected root?

Step 5: Root canal treatment
Given the right ‘environment’, the dentist can attempt root canal treatment to restore an infected root to restore its function before doing a crown.

“If the tooth can goyang also can treat ah?” … If the tooth is too mobile, of course it has to be extracted and thrown away (Oopps!).

“Then what happens?” … Then we can keep the tooth in a jar of oil or donate to a university for research!! Oh man! Then we have reached the last frontier … lost tooth.
Now there are not many choices except to find a way to put in a artificial ‘solution.’

Step 6: Bridge
If there are some adjacent good teeth available (like two banks of a river!) then we can build a bridge in between. If the contractor is good and the concrete is strong, a bridge can last very long … same principle here – if the adjacent teeth are not mobile, they can form a good anchor for the bridge.

With the two anchors, we can restore the few lost teeth in between. And you know what? This gives you a very natural look, natural bite and original feeling!

“Like this sure expensive one!” … Well depends on what is meant as expensive. After messing with the teeth to the extent of losing it completely and then to put it back to almost it’s original shape cannot be the price of a Coke!

The usual material used for a bridge is porcelain fused to metal (non-precious, semi-precious or precious metal).

“Got any cheaper solution or not?” … Oh yes! Cheapest is to live with it and count on the savings made on the food bill! Next is making a denture.

Step 7: Dentures
Just before we talk of dentures – there is one treatment called “implants.” This is where artificial ‘roots’ are surgically planted and crowns built on top of it. This is a slightly more expensive treatment compared with dentures.

Partial dentures replace one or more missing teeth while full dentures are made when no teeth is present in the patient’s mouth.

“But denture very leceh lah! Must open, soak and clean. Sometime break, very susah!” … Naturally removable appliances will have to be ‘maintained’ properly since there are ample gaps and crevices where dirt and foodstuff can get trapped causing infection and decay on remaining teeth.

Dentures made with a chrome-cobalt base would be costlier than a plastic base. Again choice is based on preference, affordability and application.


Even pisang goreng can have a range of price from stall to stall. But the easy part is we can judge by taste. Dental treatments have several factors that are relevant when considering price:

  1. The type of materials used (affecting durability, aesthetics & application)
  2. The quality of materials used (whether they are from tested & proven manufacturers)
  3. The dentist (whether the dentist exercises skill in handling patient anxiety, pain, discomfort and takes an informed approach to the diagnosis & treatment)
  4. The technology used in treatment (right equipments for the right job; proper sterilization, right choice of finishing tools)
  5. The quality of examination and diagnosis (whether all factors have been fairly considered when making a diagnosis & recommendation)

Therefore, it is not easy to compare equally between two clinics. However, the onus is on the patient to ask for an explanation or consider a second opinion if in doubt.


There are no rules on this subject. Treatments costs are not related to body weight or age! So there would be a base cost to work from and there are clinics that offer special rates at their own discretion.

The golden rule is - ask.

As even machines are out on preventive maintenance programmes to prevent undue breakdown; so are our teeth. If you stick to a regular check-up habit; many problems would be detected early and can be addressed well before it hits the critical zone.

Dentists are just as human as any other professional and the “Code of Professional Conduct” set by the Malaysian Dental Council governs their practice.

Do not wait until the pain is unbearable before seeking help. Get a professional opinon.

What can be revealed in a Dental check up?

By doing a check up, just like a blood test, we get a summary of the condition of your oral hygiene.

Main areas covered are:
  • Overall oral "map" i.e. existing tooth, missing tooth, decayed tooth, loose tooth, calculus level etc
  • Any abnormal conditions such as chipped tooth, crooked tooth, growth, gum condition etc

After mapping the condition, then you normally get a "report card" with options

The list of items can go on and on. But the bottom line is after you understand what is required, the next question is COST. How much it may cost? Always get an estimate. If it is within your budget, well and fine. If you feel you are not convinced - there are always other clinics around for you to get another opinion and estimate!

As a patient, you have to exercise your prudence in asking for the options available.

FREE Dental Check up

Make a note in your calendar: 1st - 30th April 2008
Organised by the Malaysian Dental Association with Colgate Palmolive.

BE TRUTHFUL TO YOUR TEETH and make it a point to go to the nearest participating clinic to have your free check.

This is organised by MDA and sponsored by Colgate for the benefit of all. So DO NOT start thinking that this is a business gimmick to get you to undertake expensive treatments!! We Malaysians are always vary of marketing gimmicks where we are frequently taken in for some hidden spending.

This campaign is to raise the public's awareness and is entirely FREE (for a full check up excluding X-rays). After you hear the "story about your teeth" and the possible issues; you can always choose to have a 2nd opinion.

Prudence is to be with you to check options available before agreeing to any treatment.

So stop ignoring your valuable teeth and check them out. You won't know what is hidden in between waiting to "explode"!

Thank you to my mentors

Before I go on writting my comments, I certainly wish to thank all those mentors in my career who contributed one way or another in broadening my perspective in my profession.

My first few drops of knowdlege was from my government posting in the Johor Bahru Dental Clinic. Under the supervision of Dato Tan Nam Ho (a maxilo-facial surgeon) and Dr Chen Swee Lian (an Oral Surgeon) my days at the clinic was filled with challenging experience and I must say I gathered an ocean of practical exposure to various dental treatments.

The JB clinic was one of the busiest with many many emergency cases each night when we are on standby. And that also means that we end up treating many cases.

Next was my posting to the Tangkak Dental Clinic as the Dental Surgeon in Charge. I had an excellent DSA (Dental Surgery Assistant) called Navamani who was a senior person and had an ocean of information to learn from.

I must say I had a good time working with the many staff of the Tangkak Dental Clinic before I moved on to the private sector. The government days were an eye opener, contrary to popular believe, government clinics actually have among the best equipment and medication.

My private practise experience reached a stage where I figured I should run my own clinic and here I am in Klinik Pergigian Joon.

My cyberspace of dental information

I created this blog as my own cyberspace of dental information. In Malaysia, we do not find a high level of awareness on dental (oral) health. I say this because every year we have FREE dental check up campaigns organised by the Malaysian Dental Association, which is not heavily patronised.

Many Malaysians do not see regular monitoring of oral hygiene as a means of maintaining a good set of teeth and healthy gums for life.

Our teeth is among the strongest parts of our body. Yet we frequently allow tiny bacteria to attach and crash our "defense"! If we understand the logic behind regular dental check up we will realise that it will help us spend much less to upkeep what we already have.

So in this blog, I hope to write some of my experience and the knowledge I gained over the many years of being in this field for the benefit of interested browsers.

Welcome to my dental forum


As the cyberspace community is growing I too decided to join in and contribute my small bit of opinion and information.

Hope you enjoy my blog!

Dr. Joon