An interesting video on how laser can be used on the soft tissue in the mouth. The source of the video is from Biolase, the company that produce Waterlase. Personally, I have been using Waterlase mostly for gum contouring, gum depigmentation/gum whitening, frenum attachment removal and tongue tie release.
Soft Tissue With Waterlase Laser video link
Hopefully, the video can provide some idea into what Laser Dentistry is able to achieve in the Dentistry.
The theme this year has been pretty much COVID(still), Dentistry and cycling. An invitation for a lecture is a good break from a bullet train like year.
In the upcoming lecture, I will be covering on how we can manage dark gum caused by hyperpigmentation. Excessive melanin is the most significant contribution to dark gum. Personally, I have been using dental laser to treat dark gum for several years. In the upcoming lecture, I will be sharing with participants on how dental laser can be a predictable and safe way to remove the excessive pigment in the gum. Also on what to look out for during initial consultation and during the procedure itself.
The other portion of the lecture will be on managment on patchy teeth. Quite often, some patients are concerned about patchy teeth. It normally manifest as white or brown patches that cannot be removed even with professional scaling and polishing. In the lecture, we will be covering what are the conservative ways, without trimming the teeth, to remove the patchiness on the teeth to give patient a more uniform, “healthier” and nicer looking teeth.
Until then, more Vitamin D and Vitamin C!
2020 has been a disruptive year and the new decade may possibly be define by remote technology? Many things have shifted online. At a clinic level, I have been using more remote communication with patients.
On the lecturing front, many dental conferences have moved online as well. Denstply Sirona which I started my lecturing journey with has also moved their “DS Solution Week Singapore” online as well.
This time, I will be sharing on how I manage my Class II restorations to make it predictable. Class II restorations is one of the most common procedure performed by a dentist. Normally it is caused by decay in between teeth and a composite resin/ceramic restoration is then needed. Occasionally, sensitivity or dislodged restoration may occur after the procedure. In the lecture, I will be sharing how I attempt to reduce occurrence of sensitivity or dislodged filling after performing a Class II restoration as a clinician.
Click here to sign up!
Most people perceive a nice smile as a set of straight white teeth. Some may go a step further and describe a nice smile is also about nicely shaped teeth with certain anglulation to the face and that a right amount of gum is shown.
Those are about right, just that a nice smile is also beyond that. For a start, a nice smile is not just about a set of straight teeth but also having a nice smile arc.
Let’s discuss the science behind a nice smile. We can broadly categorise this into 3M which are macro, micro and mini aesthetics.
Macro: looking at the face in general with focus on the relationship of the teeth to the face.
Mini: focus on the smile framework like the gingival and tooth display on smiling, gummy smile, buccal corridors, alignment and colour.
Micro: analyse the shape of the teeth and tooth proportion like height, width, gingival shape.
At each level, there are parameters that are used to look at a component objectively. A clinician should be able to identify the variation from the ideal or desired parameter and come up with a treatment option to address that.
The downside of 3M is that it can be too detailed for most clients during their first dental visit. When speaking to most clients I will normally use ABC instead of 3M for communication.
Alignment: Where we look at the arrangement of the teeth. Often Invisalign can be used to address this.
Brightness: Where we look at the colour of the teeth. Often teeth whitening or veneers can be used to address this.
Contour: Where we look at shape of teeth if its too squarish, too round etc. Often, the treatment can range from ceramic veneers or composite bonding or laser gum contouring.
ABC facilitates understanding for the clients about their dental issue but doesn’t provide the clinician with the parameters to improve the smile. More often, as a clinician I would normally rely to the 3M analysis for treatment planning.
Of course a nice smile is more than science, sometime I do need to use gut feel or clinician’s hunch to make some decision, sometime, not too often fortunately.
Having said that, with advancement in technology we can create a simulation of the possible outcome(s) that can help both parties to see the desired outcome. With that, the workflow will be for the clinician to reverse engineer dentistry to produce the outcome desired.
Currently, most things are happening at home or from home. We are studying at home, working from home, exercising at home and dining at home. You get the trend. So we are starting a new trend! Smile From Home
In fact, there are a few options so you are pretty much spoilt for choice.
Take a photo of you smiling and upload here and once we create a simulation on how an ideal smile could look like, we will send you the simulation and arrange Zoom video call to explain how it can possibly be achieved.
Email
If you are camera shy, then just click here and send me an email and the team will reply to you.
Let’s do our part and stay at home and flatten the curve! Save life by staying at home. Try an option to #Smilefromhome
*This is not a virtual dental consultation as a consultation should require an in person examination with appropriate radiographs with diagnosis for treatment planning. The main objective is to provide generic discussion on dental concerns during the circuit breaker period, since you are supposed to stay-home-anyway.
Currently, Singapore and several countries are on circuit breaker mode in respond to the COVID19 outbreak. While some countries have started lifting restriction of dental practice to see patients, here in Singapore we are very much only seeing patients for emergency/urgent cases in pain with minimum treatment. With the spare time on top of going through treatment planning for existing patients, I have recorded a lecture on Digital Dentistry in Daily Practice.
For dentists who may be interested, do email me with your DCR number and I can send you the link for the 1hr lecture. Meanwhile, I have uploaded a 7 minutes preview on the page.
In this lecture, we will talk about how we can use digital dentistry to acquire information to enable us to plan and produce treatment for patients.
Learning objectives:
- Using digital dentistry for single unit ceramic crown or ceramic onlay or even for smile makeover cases with veneers.
- Using digital dentistry for implant planning and fabrication of surgical stent for precise implant placement and restoring implant crown using digital dentistry
- Using remote monitoring to monitor progress of patients and using digital dentistry for alignment of teeth
- Using digital dentistry in multi disciplinary cases
Traditionally, images of pain has been associated with dentistry and those images has often been passed down for generations. Fortunately, dentistry has advanced tremendously over the past one or two decades such that dental treatment can be made more comfortable for patients.
Topical numbing gel before using a finer needle with a distractor when administrating local anaesthetic to achieve profound numbness on the treatment area is sufficient for most patients.
However, there is still a small group of patients whose dental anxiety still prevent them from seeking dental treatment even if profound numbness can be achieved with local anaesthetic. Sometime, this procrastination to seek dental treatment may lead to more serious dental problem. That in turn lead to a downward spiral where dental treatment required can be more extensive.
Patients with dental anxiety may prefer not to be aware of what happens during the treatment and may request for a treatment modality that is completed when they are awake.Such treatment modality normally include general anaesthetic (GA) or IV sedation. Most people would have heard of GA where patients are completely unconscious, such that the body’s normal automatic functions, like breathing, heartbeat and circulation of blood are suppressed.
IV sedation is normally used for minor surgeries or shorter, less complex procedures when local anaesthetic is not sufficient but deeper general anaesthesia is not necessary. When a patient is under IV sedation, they are still breathing on their own with oxygen supplemented. IV Sedation like the name suggest, is where sedative medication is given via IV (intra venous) by an anaesthetist.
Some of the more common procedures that IV sedation are used for in a dental clinic include procedures like extraction, wisdom tooth removal, implant placement. Some patients have also requested for IV sedation for procedures like root canal treatment, ceramic crowning and even direct composite restoration. In some procedures that are not surgical in nature like root canal treatment, ceramic crowning or direct composite restoration alternatives to IV sedation like nitrous oxide or oral sedation are also possible.
Nitrous oxide is commonly known as laughing gas. When inhaled, it gives a calm and euphoric feeling and can provide a mild sedative effect. Do note that when administrating the nitrous oxide, it needs to be administrated with oxgyen. A key element to a safe and good nitrous oxide experience is on the titration of nitrous oxide and oxygen. Nitrous oxide can be used for even simple procedure like routine scaling to allow the patients to have a clam experience.
With local anaesthetic, nitrous oxide, IV sedation and GA it gives us a scale to control the pain and consciousness for different patients for different procedures. Sedation can be used to overcome dental anxiety that some people may have. Often, a conversation with the patient will allow us as clinician to know what type of sedation and analgesia is needed for the individual based on the procedure and the dental anxiety that they may have.
The following are 2 videos with regards to measures taken during the current COVID 19 in Singapore.
The 1st video on top highlight the our role as a dental clinic during the circuit breaker period in Singapore and also the measures taken the circuit breaker period.
The 2nd video which is below covers some changes that the clinic has done since COVID 19 outbreak as of 26th March 2020.
COVID 19 maybe one of the most popular googled word at this moment. Essentially its a virus that has infected more than 1million worldwide. Based on current evidence, generally population with some underlying condition like hypertension, diabetics, lung disease, kidney disease and autoimmune disease tend to get it worse. COVID 19 works like a chain, in that, a healthy individual may be a carrier without even knowing and spread the virus to a contact who is a higher risk to die from the virus.
In a respond to that, Singapore started our circuit breaking measures from 7th April 2020 and the population is urged to stay home unless they are working in essential services or going out for essential errands like buying food and grocery. Dental clinic is classified as an essential services and I will be working during this circuit breaking period to ensure that dental needs for my existing patients are addressed if deemed suitable to carry out dental treatment according to MOH guideline. Also, we will be there for emergency or urgent dental treatment for new patients as well, subjected to suitability based on MOH guideline.
While we are opened, prepared and well equipped to see patients, I would like to urge people to stay at home and I will use this circuit breaking opportunity to share some home care dental tips.
Brushing twice a day and floss once a day.
Airfloss, waterpik and small interdental brush are possible alternative if you may find flossing difficult to ensure you can clean in between teeth.
Mouthwash maybe a good alternative if you are experiencing mild swollen gum at this moment. Swollen gum maybe a sign of something more serious so do contact your dentist.
if you are experiencing dental pain, do contact your dentist to check if its an urgent condition that may require urgent attention.
Given the present situation, it is prudent to wash your hand with soap before carrying out any dental hygiene procedures.
For my Invisalign patients who are working at home, aligners in, food out!
Keep the aligners in to snack less! You have a good barrier to cut down snacking!
Do also, wash your hand with soap before removing and taking out the aligners.
Stay at home, stay safe and stay healthy!
Concluded the lecture at MDA Scientific Convention and Trade Exhibition in KLCC, Kuala Lumpur, Malaysia.
It was a lecture of similar topic that I have talked on several times in the past 2 years. Bulk of the lecture was on management of gummy smile with digital planning and then executing it with dental laser.
To add another dimension to this lecture, we discussed more on how digital planning for gummy smile can be incorporated into smile makeover cases. In addition, I shared several cases that were slightly more complicated, where the patients wanted to change the shape and colour of the teeth together with addressing their concern about gummy smile.
1st post of 2020.
Looking forward to lecturing in Kuala Lumpur at Malaysia Dental Association (MDA) Scate in February 2020. I will be talking about management of gummy smile with laser dentistry again. To ensure that the participants has something refreshing to bring back, I will be sharing cases of smile makeover with digital smile design and veneers will be taken with a focus on the gum on top the the conventional focus on teeth only.
I will also also be covering on multi disciplinary cases like using clear aligners or Invisalign to combine with laser dentistry to improve gummy smile. Hopefully, this will be a refreshing perspective for the participants. New year, new perspective!
More often we will hear people talk about nice white set of teeth than pink set of gum. Words like pearlie white, sparkling white teeth are often associated with a nice colour for the teeth. There is less attention to the colour of the gum. To be exact, the occurrence of “dark gum” or “black gum” is seen less than yellow teeth. However, for those with “dark gum”, it may bother them but treatment for it can be hard to find.
The colour of the gum is contributed from cells like melanin, carotene and haemoglobin. All of us have some degree of pigments on the gum, unless one is born congenitally without pigment. However, typically 2 main groups may find themselves having “darker gum”
Habits like smoking may contribute to the “dark gum” condition.
Some ethnic groups like Asian, African and Mediterranean populations may have higher pigment activity which result in darker appearance of the gum.
Often, “dark gum” is only a variety of gum colour and not pathological, so no treatment is needed. Occasionally “dark gum” may be caused by endocrine disease, heavy metals, medication, inflammation and cancer. If there is no pathology that causes “dark gum”, treatment is only needed if it bothers the individual.
Roshni and Nandakumar in 2005 classified the treatment for “dark gum” into 9 treatments methods including treatment like scalpel, radiosurgery, gum graft and laser to name a few.
Personally, I have been using laser for removal of the pigment on the gum for individuals who are bothered by the “dark gum”. According to research, laser has been recognised as one of the effective, pleasant and reliable technique [1]
In one of my lectures to fellow dentists titled “Shades of White”, where the main focus was on teeth whitening and removing white and brown stain on teeth, I also shared a case on using laser for the management of laser gum depigmentation to achieve a lighter toned pinkish appearance on the gum. The reason for sharing that was to create awareness to fellow dentists that “dark gum” can be addressed if it bothers the individual.
[1] M. Prabhuji, S. Madhupreetha, V. ArchanaTreatment of gingival hyperpigmentation for aesthetic purposes using the diode laser Laser, 2 (2011), pp. 18-191
This is the furthest speaking engagement for me so far. A lecture in Seoul during Asia Pacific Dental Congress 2019. It was held in conjunction with Korea Dental Association Scientific Congress.
Again, the lecture is on Gummy Smile and how I combine laser dentistry and digital planning to carry out laser gum contouring to manage my gummy smile cases. This time, I did share more multidisciplinary cases where we also carried out Invisalign or veneers to combine with laser gum contouring to obtain the results that the patients wanted.
With all unfamiliar faces in the lecture hall, I had no one who could send me the photos from the lecture.
With a few hours before flying back, wandered into the COEX library which was a contemporary architecture.
It was an intense month in January with 3 lecture engagement. Kick starting the month was giving a lecture on teeth whitening and management of stain on teeth for College of General Dental Practitioners’ GP Series. It was a great opportunity to share with fellow dentists on my protocol on teeth whitening and how we can manage some of the more difficult cases. The other aspect that is interesting in the lecture would be sharing with them how using newer techniques, some of the brown or white stain on the teeth can be eliminated to give patients more uniform white teeth.
Then it was to Cambodia on the invite from Cambodia Dental Association to share on my pet topic, digital planning with laser dentistry to manage gummy smile. On top of that, I used the chance to share some of the smile makeover cases where patient’s smile is enhanced with porcelain veneers.
2 days later, it was back in Singapore to the Aesthetics Dentistry Society of Singapore’s Annual Forum where I was sharing with fellow colleagues on digital planning with laser dentistry to manage gummy smile.
The reason for repeating the lecture in the short span of 3 days in 2 countries is because both theme are on digital transition in aesthetics dentistry. It is latest trend in dentistry and glad to have the opportunity to share how with digital planning the outcome can be better forecasted and with laser dentistry the healing is more comfortable for patients.
The past few months have been busy preparing for 3 more lecture in Janrary 2019. A throwback to the recent dental conference where again I had the chance to share on my protocol for management of gummy smile.
A link, hopefully it works, to a short video from the organiser on the talk.
11th WCLI Asia Pacific Laser Symposium just concluded in Singapore last weekend. I was given an opportunity to share how I have been combining digital dentistry to assist in the planning for my laser gum contouring cases. This has allowed patients and dentists to have a simulation of how the outcome of the laser gum contouring will be. Using dental laser for gum contouring has made recovery much faster compared to traditional methods. I also shared how I used other treatment options like Botulinum Toxin for management of gummy smile.
As one of the 2 local speakers, I hope I had made a good impression to the overseas delegates who were here as well. Back to preparing more lectures in October 2018 and Janurary 2019.
Have the honour to be invited to speak in WCLI Asia Pacific Symposium on Laser Dentistry. The Symposium will be held in the weekend of 22-23 September 2018 at Sofitel Hotel.
I will sharing with the participants on my experience of using Dental Laser to manage my aesthetics cases. During the lecture, I will also be sharing with the participants how by combining Digital Dentistry with Laser Dentistry can enhance patients experience to obtain more predictable, less painful, quicker treatment outcomes for patient's with gummy smile.
For dentists who are keen to learn more about laser dentistry, do sign up here.
Fortunate to be sitting on the Youth Guild Task Force in National University Singapore Society (NUSS). The Youth Guild was formed to engage the under 35 years old members in NUSS.
If you are under 35 years old, is a NUSS member or looking for a place to have activity exclusive to under 35 years old, look out for activities by NUSS Youth Guild!
E-copy of the article here
Concluded my first overseas lecture 2 months ago. Had the opportunity to share on posterior composite and digital smile design (DSD).
Always great to see that dentists are passionate about learning.
It was an interesting experience for me as it was an overseas lecture. A good take away is to have a packing list! Almost forgot my mac adapter.
Now back to work to prepare for a 1.5day composite workshop to be held in March 2018!
