Confessions of a procrastinator

A procrastinator explains how it feels after finally having gone to the dentist:

Sometimes it is only when the niggling pain goes away that you realise just how irritating and distracting it had become.

A sore tooth can sit for weeks just beneath the threshold of consciousness before you finally decide to do something about it, and you leave the dentist full of optimism, hope and love for all humanity now that you can think clearly.

Well, like a man who bangs his head against a brick wall because it feels so good to stop, I've finally given up procrastinating and visited my dentist.

And life is good.

The toothache has been sorted. The ringing in my ears has stopped. I can breathe freely and that sharp pain whenever I bend over sideways has finally cleared up. I can be at peace whenever and wherever I want to be, and life is good.

Dental schools in Malaysia

University of Malaya Faculty of Dentistry
Prof. Dato' Dr Ishak Abdul Razak, BDS (Malaya), DDPHRCS (England), MSc (London), PhD (Malaya)
Dean, Faculty of Dentistry
University of Malaya
50603 KUALA LUMPUR
Malaysia
Tel: +603-7967 4800 / 4801, +603-7956 5143 (Dean's DL)
Fax:+603-7956 1607 / +603-7967 4809
Emails: queryfq@um.edu.my, dekan_dental@um.edu.my


Universiti Kebangsaan Malaysia Faculty of Dentistry
Professor Dr Ghazali Mat Nor
Dean, Faculty of Dentistry
Universiti Kebangsaan Malaysia
Jalan Raja Muda Abd Aziz
50300 KUALA LUMPUR
Malaysia
Tel: +603-4040 5799 / +603-4040 5700 (Dean's DLs)
Emails: dkfdent@dental.ukm.my, ghazali@medic.ukm.my
http://pkukmweb.ukm.my/~FPerg/MALAY/laman%20utama.html
http://www.ukm.my/english/fgigi.htm

Universiti Sains Malaysia School of Dental Sciences
Assoc. Prof. Dr. Hj. Abdul Rashid Hj. Ismail
Dean, School of Dental Sciences
Universiti Sains Malaysia
Kampus Kesihatan
16150 KUBANG KERIAN
Kelantan, Malaysia
Tel: +609 766 3700
Fax: +609 764 2026
e-mail: dental@kb.usm.my
http://www.kck.usm.my/ppsg

Universiti Teknologi MARA Faculty of Dentistry
Prof Dr Mohamed Ibrahim Abu Hassan, BDS (Malaya) MDSc (Leeds), PhD (Bristol)
Founding Dean, Faculty of Dentistry
Universiti Teknologi Mara
40450 SHAH ALAM
Malaysia
Tel: +603-5543 5802, +603-5543 5801 (Dean's DL)
Fax: +603-5543 5803
Email: mibrahim@salam.uitm.edu.my
http://www.dentistry.uitm.edu.my

AIMST University School of Dentistry

AIMST University Semeling Campus:
Senior Professor Dr Frederick Charles Smales, BSc Dunedin, BDS Newcastle, PhD London, FDSRCS England and Edinburgh, FHKAM (Dental Surgery), FCDSHK (Periodontology)
Dean, School of Dentistry
AIMST University
Jalan Bedong - Semeling
08100 Bedong
Kedah Darul Aman
Tel: +604-429 8000 / 8038
Fax: +604-429 8007 / 8008 / 8009
Email: chooseaimst@aimst.edu.my

KL Office:
AIMST University
No. 10-1st Floor
Jalan SS15 / 8
47500 Subang Jaya
Tel / Fax : +603-5636 3688
http://www.aimst.edu.my/facultiesn/facultiesdetails/denintro.asp


Penang International Dental College (campus is under construction in Kepala Batas, Bertam, Penang)
Administration Office:
Dr S. Sharavanan, MBBS., M.D., (Radiology)
Pro-Chancellor – VMU, Salem, India.
Managing Director and Chief Executive Officer – PIDC
Suite 3A-05, Block-E
Phileo Damansara 1
Jalan 16 / 11, Off Jalan Damansara
46350 Petaling Jaya
Selangor Darul Ehsan., Malaysia
Tel: +603 7665 3333,
Fax: +603 7665 3323
E-mail: info@pidc.edu.my
Website: http://www.pidc.edu.my

International Islamic University Malaysia Kulliyyah of Dentistry
Dean, Kulliyyah of Dentistry
International Islamic University Malaysia
P.O Box 141
25710 KUANTAN
Malaysia
Tel: +609-571 6441 / 6444
http://www.iiu.edu.my/prospective/faculties.shtml#faculties

Universiti Sains Islam Malaysia (USIM) Faculty of Dentistry
Dean : Dato’ Dr. Wan Mohamad Nasir bin Wan Othman
Secretary: Ms. Firdaus binti Alwi
Assistant Registrar: Mr. Mohd Azli bin Mohd Nizah
Faculty of Dentistry
Islamic University of Malaysia
Level 13, Tower B, MPAJ Building
Pesiaran MPAJ, Jalan Pandan Indah
55100 KUALA LUMPUR
Malaysia
Tel: +603-4289 2566
Fax: +603-4289 2408
e-mail: ddwan818@admin.kuim.edu.my
http://www.kuim.edu.my/english/index.php?option=com_content&task=view&id=96&Itemid=85

Prevention is better than cure

Prevention is vital to avoid tooth decay

To ensure you look after your teeth properly, you should routinely spend at least two minutes every morning and night and after meals brushing and flossing your teeth.

Controlling what you eat can help reduce your risk of tooth decay, too. Limiting your intake of sugary and starchy foods helps to prevent tooth decay and the need for dental treatment. Some of the bacteria in our mouths love the sugars and starches found in foods. They turn these into acid, which causes decay.

Help your children brush their teeth twice a day and after meals, and take them for regular check-ups at the dentist. Also, cut down the amount of sweet snacks your child is allowed (including acidic fizzy drinks). Luckily in Malaysia, our water supply is fluoridated, so it is not necessary to take fluoride supplements.

Why have a dental check-up?
Get in the habit of seeing your dental surgeon as often as they recommend, so that complicated and unpleasant treatments can be avoided. Most problems could be detected early, helping you steer clear of extensive treatment. There are good reasons besides toothache, for seeing your dental surgeon. They can often diagnose and prevent diseases of the tongue, lining of the cheeks (mucosa), palate and jawbones. As well as checking gums for disease, they may also spot the first signs of oral cancer (although only about seven percent of cancerous tumours occur in the mouth).

Your dental surgeon will give you a personal recommendation of how often you should have a check-up. Current guidelines recommend that for under-18s check-ups should be between 3 and 12 months, and for adults between 6 and 18 months.

This will:

• Ensure your teeth and gums are in good shape
• Allow the dental surgeon to remove any plaque which contributes to cavities and gum disease
• Enable the dental surgeon to spot serious oral health problems early when they can be treated successfully
• Enable you to learn how to brush and floss your teeth properly
• Build your confidence if you’re nervous, as you’ll get to know your dental surgeon and know what to expect at each visit

Oral Health Survey of Malaysian Adults 2000
According to the results from the Oral Health Survey of Malaysian Adults 2000, less than half of those surveyed cited making a dental visit within the last two years, and more than 50% of them did so only because they had dental problems.

Only about 13% made self-initiated ‘preventive visits.’

Only about 60% of those with problems of the oral cavity perceived a need to see a dental surgeon. In fact, about 50% of those with problems of the oral cavity did not make a dental visit within the last two years, the large majority perceiving their dental problems as ‘not being serious enough.’

It is pertinent to note that cost of treatment was not a barrier to dental treatment for a large majority of Malaysians; dental fees in Malaysia being among the lowest in the Asia Pacific region.

Public dental facilities seemed to rate quite highly by a substantial number of those surveyed. More than half of subjects attended a public facility, yet if given a choice of facilities, more than two-thirds would actually prefer to use a public facility.

The reasons for preference of public facilities were ‘reasonable charges,’ ‘good facilities and equipment’ and ‘convenient location.’ Those who chose private facilities did so mainly because of the ‘short waiting time’ and ‘convenient hours.’

Government poll results
Another poll asking “Where do you go for your dental treatment?” conducted by the Oral Heath Division, Ministry of Health found that 49% of Malaysians frequented Government dentists, 36% went to private dentists and an amazing 15% avoided dentists at all costs!

Afraid of the dentist?
Many people feel anxious at the prospect of seeing the dental surgeon and, for some, their fear prevents them from visiting for years. However, most practices are sympathetic and various methods of help are available.

Why we’re afraid
An unpleasant experience in the past may be the cause of the anxiety. Other common concerns include fear of injections, the anaesthesia not working, concerns about unnecessary treatment and anxiety about cross-infection.

Fear of the Fee
It’s not always fear of physical pain that makes people anxious about a dentist’s visit; in many countries, particularly the USA and UK, it’s also fear of the fee. As dentist Robert E Kroeger explains in his book How to Overcome Fear of Dentistry:

Because many fearful patients have not visited a dentist in 5-10 years or longer, they may have memories of dental fees from their last dental visit many years ago. When they are informed of the current fees for treatment, they experience ‘sticker shock’. The dental phobic may need some time to accept that his or her mouth deserves the best dentistry and that may cost a substantial amount.

There are ways to lessen this trauma to the back pocket. In Europe, the British, Germans, Austrians and Swiss are taking dental holidays in Hungary and Poland, where dentists charge a third to half of Western prices for similar quality dentistry performed with the latest high-tech equipment.

Americans with rotten teeth can take their families on a dental excursion to Costa Rica where you can shop and sightsee between visits to US-trained dentists who charge a fraction of the prices elsewhere.

The good news for Malaysians is that we have some of the lowest dental fees in the Asia Pacific region. So much so that dental tourism is fast gaining ground as an industry here in Malaysia with patients coming from Singapore, Indonesia and even as far away as Australia, Europe and Ecuador for affordable world-class dental treatment.

What can be done?
Don’t be embarrassed about expressing your concerns and talk to your dental surgeon. If you haven’t been for a while, you may wish to contact a number of practices first and explain your concerns over the phone.

If you need treatment, ask plenty of questions and make sure you understand exactly what will happen, which should help you to feel more in control. You may also wish to take a friend or relative with you for support.

If the thought of a long treatment session is worrying you, discuss it with your dental surgeon and work on a coping strategy, such as a hand signal if you need to take a break for a few moments.

Sedation
Fear of dentists is not a uniquely Malaysian experience. In 1998, the American Dental Association found that over 23 million Americans delay dental care solely out of fear. All of these dental patients have some sense of nervousness when it comes to going to the dentist.

Sedation provides an option for these patients who want to get their teeth fixed but are fearful of the process. Sedation ~ the use of anesthesia during dental procedures ~ may diminish the fear in these patients, but will not obliterate the pain.

The candidates for sedation have one or more of the following characteristics:

• Dental anxiety
• Dental phobia
• Inability to control movements due to conditions like Parkinson's Disease or cerebral palsy

There are several different methods of sedation as applied in dentistry. Dentists may choose to use only one, or, several of the following methods in combination:

• Nitrous oxide
• IV sedation
• Oral sedative

Dental Implants

Tooth extraction is quite common due to poor dental health and gum disease. Leaving the missing tooth space empty may not sound too serious, but the consequences of not filling in the space from the missing tooth can include:

• The teeth adjacent to your missing tooth can change position to fill the gap;
• The loss of your missing tooth’s root can cause your jawbone to shrink, making your face appear prematurely older; and,
• A missing tooth in the front of your mouth can affect your smile and your self-confidence.

In many situations, a dental implant is the most pleasingly aesthetic solution for replacing the missing tooth. An all-ceramic dental crown or dental bridge, secured to a dental implant, provides a complete and beautiful solution for improving your smile. A dental implant takes the place of the missing tooth’s root and helps prevent the above consequences.

What are dental implants?
Dental implants are artificial teeth roots that are surgically anchored into the jawbone. Most implants today are endosteal implants— these are surgically implanted directly into the jawbone. Usually made of titanium alloy, they are securely positioned into the jawbone beneath your gums. Once in place, they allow your dental surgeon to mount prosthetic (replacement) teeth (called crowns or dentures) onto them.

Once the surrounding gum tissue has healed, a second surgery is needed to connect a post to the original implant. Finally, an artificial tooth (called crown) is attached to the post individually, or grouped on a denture.

In “flapless implant” surgery, however, this second surgery is unnecessary as the crown is fitted immediately. This surgical procedure is also known as immediate loading.

A removable full denture secured by two implant-borne clip-in retainers: even one or two implants dramatically increase the stability. Photo Credit: Straumann

A single replacement tooth called a crown is finally affixed onto an individual dental implant. Sometimes, when many teeth need to be replaced, a group of artificial teeth called dentures are affixed onto two or more dental implants.
How do dental implants work?
Because implants securely fuse to your jawbone (by a biological process medically known as osseointegration), they provide extremely stable support for replacement teeth. Crowns and dentures mounted to implants won't slip or shift in your mouth — an especially important benefit when eating and speaking. This secure fit helps the dentures — as well as individual crowns affixed over implants — feel more natural than bridges or conventional dentures.

For some people, ordinary bridges and dentures are simply not comfortable or even possible due to a number of reasons such as poor ridges, sore spots or gagging. In addition, ordinary bridges must be attached to teeth on either side of the space left by the missing tooth. A distinct advantage of dental implants is that no adjacent teeth need to be prepared or ground down to hold your new replacement tooth/teeth in place.

To receive implants, you need to have healthy gums and adequate bone mass to support the dental implant. You must also commit to keeping these structures healthy. Meticulous oral hygiene and regular dental visits are critical to the long-term success of dental implants. Usually a course of antibiotics is prescribed when an implant is placed to prevent the occurrence of infection. It is important to take and complete this course of antibiotics to avoid complications due to infection.

Dental implants are usually more expensive than other methods of tooth replacement but the many advantages of dental implants far outweigh this added one-time investment in your oral health.

How long do dental implants last?
Dental implants generally last a lifetime ~ certainly between ten to twenty years ~ depending on the location of the implant in the mouth and on patient compliance with oral hygiene and dental visits. Because molars are used for grinding food, they receive more stress than other teeth. Due to this heavy wear and tear, the crowns on these implants typically do not last as long as those located at the front of your mouth.

In general and barring complications, dental implants that are carefully chosen and placed by your dental or oral surgeon can be safely regarded as a one-time investment in a permanent dental solution that also provides accompanying psychological and social benefits.

Are you a good candidate for dental implants?
Patients must undergo a medical evaluation to determine whether the implant placement procedure poses any health risks, and whether any factors exist that may affect the healing capacity of either their bones or their associated soft tissues.

Who can receive dental implants?
Patients who are medically fit to participate in a general oral surgical procedure.

Who should carefully consider dental implants?
Patients who have medical or other conditions that may interfere with the healing process of either their bones or soft tissues (e.g. connective tissue disorders, steroid therapy, bone infections, cigarette smoking) must carefully evaluate, with their dentists, the potential risks and benefits of using dental implants.

Precautions for implant treatment
Dental implants should not be used in patients that have inadequate amounts of bone to permit placement of implants in sufficient size and numbers to support their biomechanical loads. Mechanical failures, including fatigue fracture of implants, prosthetic screws, and/or abutment screws, may occur if dental implants are insufficient in size or number to support their biomechanical loads, or are not properly positioned. To reduce the risk of overload or fatigue failure, dentists must place the implants and design prosthetics to accommodate the physical or medical conditions of their patients, such as bruxism (i.e., grinding or clenching of teeth) or unfavourable jaw relationships.

Further information:
More information about dental implants may be obtained from the Malaysian Oral Implant Association (MOIA):
http://geocities.com/malaysian_oral_implant_assn

The Phenomenon of the inciDental Tourist

It all began in the UK
British dental patients are flocking abroad to avoid long queues for access to dentists back home. Cheap flights and bargain prices for treatment are additional incentives.

Some dentists in England and Wales are reporting they have to turn away National Health Service (NHS) patients because local health authorities have run out of money to pay them. The dentists blame changes in government policy introduced in April 2006 designed to improve access to NHS dentists and make fees fairer. However, many dentists were unhappy with their new terms and conditions and it is estimated that some 2,000 dentists (one in 10) consequently left the NHS.

As a result, in that year alone more than two million Britons were unable to get dental treatment, so it is no surprise some are resorting to extreme measures to care for their teeth.

Many dental tourism agencies have mushroomed in the UK offering cut-price treatment combined with a holiday break. Prices are so much lower in Eastern Europe that it is economical for patients from the UK to fly out, undergo surgery, take in a sight seeing tour and return home. Besides dental tourism agencies, British patients are increasingly using the internet and budget airlines to seek out cheaper alternatives to private dentistry at home.

Flocking to Poland and Hungary
To do the same dental treatment in a private dental practice in Great Britain would be three to five times more expensive than in Warsaw. Polish dentists are expecting a boom - the number of dental tourists is expected to increase by 20% in 2008.

Dentists in Hungary are used to dealing with foreign teeth. Austrians, Germans and other Europeans for decades have been crossing the former Iron Curtain to get their teeth fixed, often at jaw-droppingly low prices, literally for a fraction of the price at home. A dental industry has emerged in towns along the border and an estimated one in three Austrians now use Hungarian dentists. The emerging market of British patients is concentrated on Budapest due to its accessibility by three budget airlines.

The Americans join in
Now, a small but growing number of Americans, prompted by soaring medical costs and dwindling insurance benefits at home, are following suit of the Austrians, Germans and British. They're contributing to the rising popularity of dental tourism, a relatively young trend, but part of a fast-growing global phenomenon in which travelers, typically from wealthier countries, visit less-developed nations for dental care mixed with vacation — all at cut-rate prices.

The price factor
One 52-year-old patient’s dilemma was that her teeth were falling out due to a hereditary gum disease and she did not want dentures. She was told the alternative was to have dental implants done privately which would have cost her £52,000 in the UK.

"No way could I afford £52,000," she lamented. Eventually she found she could get the same treatment for £16,500 in Budapest - a 3,360 km round trip that took 12 hours. "It just seems so stupid to get in the car and drive all the way to Luton and catching a flight for a check up and going to another country but I had no option.”

Another patient was quoted £17,000 by a private practice in Edinburgh for root canal work, four implants and 12 crowns. A British dental tourism agency arranged his treatment in Budapest for around £7,000.

Most of British patients who go abroad for dental treatment need extensive work done: bridges and implants, which are not usually available on the NHS. However, with NHS dentists becoming increasingly scarce - just four for every 10,000 people in England - clinics in Hungary are expecting more patients who need routine work such as crowns.

A single dental implant - a metal screw placed into the jaw bone to hold a replacement tooth or bridge - costs £1,000 - £2,000 at a dentist's in north London. In Hungary, they're putting them in for £580. The same London dentist charges more than £800 for root canal treatment and a crown. In Budapest, the price is around £250. Even with the cost of flights, accommodation and return visits, the savings are considerable.

How can they keep costs down? “One reason: the manpower is very cheap,” says a dentist who moved his practice to Hungary five years ago from his native Germany. There, he says, most of the cost goes to lab technicians and salaries. Here, he uses the same materials, pays his staff better-than-average wages and still makes a bigger profit.

A word of caution
The British Dental Association (BDA) urged those thinking of traveling abroad for treatment to be cautious. They warned that if any complications develop when patients are home they may find local dental surgeons reluctant to take on responsibility for extensive treatment that was done another dentist, particularly one overseas.

As for calibre of care, the American Dental Association similarly offers caution. The concerns are not for the quality of dentistry received... but for the patient when it comes to long-term follow-up and possible complications. The term 'buyer beware' is very much in play here, as you may have fewer options after treatment if you feel it has not gone well.

That is one of the potential problems, finding aftercare in the home country for treatment that was done abroad. However, many patients are not worried about that as they are confident in the quality of the work they have received and believe the effort involved in traveling abroad is less stressful than the inconvenience of waiting for treatment in the UK.

All's well that ends well
Dentistry and tourism seem an ideal match. Patients are delighted, for example, to get all of their work done in one fell swoop. And once the major part was out of the way, stopping back for brief fittings left ample time for sightseeing.

Dental Caries

What are dental caries?
Tooth decay, known technically as dental caries, is one of the most common health complaints in the world.

It is a disease of the teeth that affects individuals of all ages, although it is particularly common in children and young adults.

Dental caries affect individuals of all ages, although it is particularly common in children and young adults. Photo Credit: Nobel Biocare

Its incidence has been fueled by an increase in sugars in the diet, and poor dental hygiene. Dental caries occurs when the tooth enamel is destroyed.

Decay begins at the tooth's hard external surface, and may advance to internal structures of the tooth including the dentin and pulp. The earlier decay is treated, the better chance of saving the tooth.

What causes tooth decay?
The bacteria that are normally present in the mouth change the food (primarily sugars and starches) we eat into acids. Over a period of time, the bacteria and acids form a sticky deposit called dental plaque that clings to the teeth.

Tooth decay is caused by dental plaque that collect, in particular, around the gum line, the edges of fillings and the grooved surfaces of the teeth. Plaque is made up of food debris, saliva and the bacteria that are normally present in the mouth. If plaque is allowed to collect over time it will harden into a substance called tartar. Both tartar and plaque contain acids which, over time, can dissolve away the protective, hard enamel coating of the tooth, resulting in holes or cavities.

Most cavities slowly form over a period of months, or even years and are usually painless, but they can grow very large, and damage the much softer internal structures of the tooth such as the dentin and the pulp, which is found at the core.

If left untreated, cavities can lead to a serious complication such as the development of a tooth abscess - the build up of pus resulting from a bacterial infection of the centre of the tooth. Infection may spread out from the root of the tooth and to the bones supporting the tooth. Tooth infection can kill the nerve and blood vessels of the tooth, and ultimately the tooth itself.

Plaque and tartar also irritate the gums, and lead to a gum disease called gingivitis. Children's teeth primarily decay in the grooves. In addition to the grooves, older adults decay in other areas, including the roots of the teeth, which may be exposed as a result of receding gums.

What are the symptoms?
The most obvious sign of tooth decay is toothache, particularly after hot or cold foods or drinks. However, pain may not be present until decay has reached an advanced stage.

Pits or holes may also be visible in the teeth.

Most tooth decay is discovered at an early stage during a routine check up.

Is diet a factor?
Yes, sugar and starches (such as candy, cakes, cookies, milk and fizzy soft drinks) are responsible for much of tooth decay, but sour or acidic foods (such as lemons and fruit juices), also contribute to decay because they change the pH (acidity level) in the mouth. Eating a diet rich in sugar and starch therefore increases the risk of tooth decay, and sticky foods can be a particular problem because they are more likely to remain on the surface of the teeth.

Frequent snacking also increases the amount of time that acids are in contact with the teeth.

In the absence of good oral hygiene, it doesn't take long for damage to begin. The acids generated by the breakdown of food stuff in the mouth can begin to attack the tooth enamel within 20 minutes of a meal.

How do you prevent tooth decay?
The best way to keep your teeth in healthy condition is to ensure that you clean them regularly to get rid of any plaque build up. Eating nutritious foods and visiting the dentist on a regular basis will also help prevent cavities.

Dentists provide these guidelines for preventing tooth decay:

• Brushing your teeth at least twice a day. Using a toothpaste containing fluoride is recommended as this provides the teeth with added protection from the effects of acid.
• Cleaning between the teeth daily with floss
• Rinsing out your mouth after eating sticky foods
• Eating well-balanced meals and limiting snacking
• Visiting the dentist on a regular basis for check-ups and cleanings
• If brushing is not possible, the next best thing is to rinse the mouth with water to neutralize the acids and change the pH level in the mouth, which may curb tooth decay.

How often should you visit your dentist?
It is also important to have a regular check up at the dentist - most dentists suggest once every six months to a year for a cleaning and a thorough examination. You should never hesitate to consult a dentist if you experience any problems or need emergency care.

How is tooth decay treated?
Unfortunately, even good oral hygiene does not prevent decay as the bacteria congregate in areas inaccessible to brushes and floss. Therefore regular visits to the dentist are important so that your dentist can remove the inaccessible plaque and tartar using a technique known as scaling.

Once the structure of a tooth has been damaged by decay, there is no way to repair it. However, if decay is picked up at an early stage its progression can be blocked. Decayed material can be removed, and replaced with a restorative material known as a filling.

If the decay is more extensive, then another option is a crown. The decayed or weakened area is removed and repaired and a covering jacket - the crown - is fitted over the remainder of the tooth.

If the nerve in a tooth has died, either from decay or a blow, then a dentist will consider root canal work. This involves removing the centre of the tooth, including the nerve and blood vessel tissue. The root is then filled with a sealing material, and the process is completed with a filling or, possibly, a crown.