Scaling & Polishing
Whether you eat to live or live to eat, every drink or food you consume has bacteria that stick to your teeth and gums within 48 hours! This build up of bacteria also known as plaque and tartar can cause gum disease to manifest most commonly as “bleeding gums”.
No, bleeding gums are not normal.
Bleeding gums are the first sign of gum disease known as gingivitis. Gingivitis is basically a bodily response to the unwanted bacteria that is trapped for prolonged periods of time (more than 48 hours) due to the lack of personal and professional cleaning!
The main difference between the types of gum disease is that gingivitis is reversible, but periodontal disease is not. Gingivitis affects the soft tissues, ie the pink meaty gums you see. Periodontal disease on the other hand, affected the soft tissues (gums) as well as the hard tissues ie the bone underneath that hold your teeth in place.
Gum disease is a silent disease and pain is usually only experienced when things are severe and too much bone has been lost, causing teeth to become loose and wobbly or flared with gaps.
Scaling and polishing ensure that all the plaque and debris that we cannot reach on our own, is regularly, professionally removed to maintain a healthy oral cavity!
A big plus is that teeth can look whiter/cleaner since coffee and tea stains are polished off during this process.
The biggest upside to all of this is that you would probably stand a better chance at having all your teeth to a lovely ripe old age.
Scaling is the mechanical process of removing plaque of all kinds hard and soft from the crevices of your teeth and gums. We use hand and ultrasonic instruments. Hand instruments are specifically shaped for an accurate reach under the gums to scrape out any unwanted bacteria laden dirt that is trapped. Ultrasonic instruments on the other hand are powered by sonic vibrations which produce a humming sound and pressurized water to give a good painless flush out of bacteria. This procedure can be done under local anesthetic for tough areas that are more inflamed or just for a peace of mind.
The benefit of scaling is to produce a smooth tooth surface that gums can happily attach themselves to, to keep teeth firmly rooted in their positions.
The healthier your gums, the more painless the process. Why? Because healthy gums are tight and bouncy, so when a scaling is done, it feels like water and a light vibration rather than blood, pain and drowning frustration.
Dental polishing is to mechanically remove external stains picked up from dark coloured foods and drinks such as curries and red wine.
Two main ways to go about dental polishing is using a cup and polishing paste, similarly to a automated shoe shine buffer. The second way would be to use a pressurized water jet that spurts out polishing power which contains baking soda that helps to absorb and remove stubborn stains.
Polishing can help to uncover white teeth buried under caffeine stains but it does not whiten teeth.
A scaling and polishing procedures takes about 20 – 30 minutes. Costs $80 – 120 before GST.
It goes in this sequence: Ultrasonic scaling – flossing – hand scaling – polishing, then presto, job well done.
If it is your first visit or there are multiple fillings, we routinely take dental full mouth xrays once every two years for a complete check up to avoid any blindspots such as decay starting within the tooth that the naked eye cannot see.
Veneers & Crowns
Veneers – A porcelain layer of tooth to change the colour and shape of your front teeth!
Crowns – a full tooth cap version that comes both in metal and porcelain styles to protect the entire tooth. Its like wearing a cap, except your tooth is the head and your crown is the cap, cemented in permanently.
Veneers – Calling all ladies who gets manicures, this one is for you! Just like acrylic nails, the same concept applies. When our natural tooth shape limits the aesthetic potential of the final smile results, veneers are porcelain shells cemented on your front teeth to give the best possible smile.
Crowns – More for function. When a root canal is done or a tooth is cracked, the tooth becomes weaker. So a crown encapsulates and hugs the entire tooth to protect it from the dangers of further damage especially when we are enjoying a good packet of almond nuts!
Veneers – Lasts 5 – 7 years theoretically ( will link literature article) however it really depends on your lifestyle and diet! If you are a teeth grinder in your sleep, veneers are not such a good idea because the chances of them chipping or having hairline cracks are much higher.
Crowns – Lasts 10 years theoretically (will link literature article) however if lots of sticky sugary foods are taken and there is no flossing to remove these acids, chances are the crowns may not last as long because decay will creep in from underneath.
Moral of the story – Floss and brush well to optimize the longevity of your crowns and veneers!
There are no hard or fast rules with which is a better material but instead, we evaluate based on aesthetic demands, functional demands and also location! For example, unless you were snoop dog you probably would not want a gold front tooth. Or if you do then good for you, gold is historically proven to be the best dental material known to mankind.
Veneers – Two main materials include porcelain and composite veneers.
Porcelain ($$$$$) is far superior in aesthetic shine, contour and overall longevity in comparison to composite veneers due to the nature of the way it is glazed and heated in a furnace.
Composite ($$) is a good tooth coloured material that can be blended in to look natural though it loses its shine quickly and relies on regular polishing to maintain a natural glossy appearance.
Crowns – Three main materials included zirconia (all ceramic), porcelain fused to metal and metal crowns.
Zirconia and pure ceramics ($$$$$) such as EMAX porcelain are metal free. Zirconia is extremely opaque and hardy good for back teeth, while emax porcelain is more translucent good for front teeth. However the biggest downside to ceramics is that they tend to wear down the natural opposing tooth over time due to their abrasive nature.
Porcelain fused to metal crown ($$$) is the most popular choice. Why? Because it is semi aesthetic with porcelain on the outside to match its neighbouring teeth, as well as functional with metal on the inside which helps to protect the tooth within. The main draw back is that porcelain and metal are not cut from the same cloth, and as such over time the porcelain can chip off, exposing parts of the metal within the crown which some might mistake as decay or dirt.
Full metal crowns ($$$ – $$$$$) are the least popular choice due to their aesthetics. However, metal is known to be the most lasting crown material to put in the mouth. Stainless steel and gold are the 2 main metals used. However stainless steel can tarnish and rust over time. Gold is still the gold standard.
It takes 2 – 3 visits depending on how many veneers are being done.
For example, for a single tooth veneer, it would be more straight forward and simple if the goal was to create symmetry and match the tooth beside it. However, for multiple teeth such as front 6 to 8 teeth, more time would be spent to create the correct shape and tooth dimensions so that the final product is tailored to your aesthetic goals.
Visit 1: Mock up – We do a trial version using temporary material to show what the shape of teeth with veneers could look like. A physical illustration per se, so that both dentist’s and patient’s goals are aligned.
Visit 2: Tooth preparation – This visit typically takes 45 minutes to 1 hour for 2 teeth, and can take longer if needed for more teeth. The top outer layer (enamel) of teeth is shaved off under local anesthetic to create space for veneers to be fitted on. To be exact, 0.5mm to 0.8mm of tooth tissue is shaved off because this is the amount of space required for porcelain to be aesthetic yet retentive.
A mould or 3D scan of your teeth is taken to be sent to the lab so that customized veneers can be created. A temporary version of the veneers are cemented on.
Visit 3: Veneer cementation – Local anesthetic is given (yes an injection) so that the rest of the procedure is painless. Temporary veneers are removed, and porcelain veneers are cemented in. Bite and contacts are checked, and viola, your smile is complete.
It takes 1 visit and is done chairside, ie freehand by the dentist. Sometimes we also have pre-fabricated veneers that can be used depending on shape and size desired.
Typically takes 30- 40 minutes per tooth. The composite material is a soft layer bonded to the tooth, and then hardens with a blue light that activates the hardening process. We then adjust and polish till an ideal smile is achieved.
It takes 1 – 2 weeks to get used to veneers. Sensitivity to hot and cold drinks and foods is normal for the first 2 weeks but it should not get progressively worse. You really should not be biting into apples or doing anything to put unnecessary stress on your veneers because they are a THIN layer. No matter what the textbook says, environmental and habitual factors are the biggest determinant to the longevity of any dental work done.
2 – 3 visits.
Visit 1: Tooth preparation – This visit typically takes 45 minutes to 1 hour for 1 tooth. The tooth is shaved to become smaller, to create space for the crown to be fitted on. To be exact, 0.5mm to 0.8mm of tooth tissue if its metal, and 1.5 to 2mm if its ceramic. This is the amount of space required for porcelain and metal to be lasting and retentive.
A mould or 3D scan of your teeth is taken to be sent to the lab so that a customized crown can be fabricated according to your bite. A temporary crown is cemented on.
Visit 2: Crown cementation –Temporary crown is removed, and the final crown is cemented in. Bite and contacts are checked, and viola, your smile is complete.
Generally a crown would take 1 – 2 weeks to get used to.
Theoretically, a gold crown can last for up to 20 years in the tooth and on average porcelain fused to metal crowns can last for up to 10 years. However many components are at play to the success of keeping a crown in place. Several of these components include diet, oral hygiene habits and medical health. Having a dry mouth due to side effects from medication or smoking can lead to a higher risk of decay underneath the crowns. Flossing enables the surrounding gums to be healthy, and prevents the risk of food trap that can cause further decay even in a crowned tooth. Having a high calcium low acid diet can help to create a friendly pH netural environment for crowns to live an inert and hopefully indefinite life in your mouth.
No they will not because teeth whitening depends on a process that takes place to breakdown the molecular structure within living tooth tissue while crowns and veneers are inert substances.
Root Canal Treatment
If you have had a nasty toothache, you would have heard of this. Root canal treatment is a procedure done under local anesthetic to remove the irreversible, infected nerve from within the tooth.
When a tooth is badly decayed or has hard a hard knock / trauma, the nerves within the tooth can become inflamed due to the bacteria that creeps in, causing a condition called “irreversible pulpitis” or “pulpal necrosis”. This leaves you with 2 options: 1. Save the tooth by doing a root canal treatment 2. Extract the tooth forever.
Decay (Caries) to me is a biological response to the lifestyle we have. A combination of diet and oral hygiene habits, your teeth can tell a whole life story.
In Singapore, we live with fluoridated water which theoretically helps to mineralize the enamel (outer layer) of teeth. If the environment is primed for healthy teeth, why do we still get decay?
It is mostly about our diet and oral hygiene. Consuming sugary drinks and foods or sticky foods, can lead to a higher risk of decay due to the acidic oral environment that these sugars create. If the frequency of consumption is high, for example snacking on chocolates, that makes the chance of decay even greater because the acidic levels in our saliva cannot neutralize with a constant supply of fresh acid. Couple that with the lack of flossing, it’s a lethal recipe for an eventual toothache.
As with all things bodily related, there is always a genetic predisposition for some more than others to have softer enamel or “hypoplastic” enamel which basically means that the teeth are weaker and more prone to decay.
The most common areas of decay are in between teeth and also on the grooves of molars. Think about where we ingest our foods and drinks. It would make sense that the little pits and grooves on our molars are more likely to lock in sugars and trap sticky foods because those are the surfaces we use to chew, pressing and packing in whatever we ingest right into the grooves of these teeth. As for decay in between the teeth, that is self explanatory if flossing is not a part of your everyday routine. Brush as hard as you like, it ain’t going to get the food bits stuck in between your teeth, out. Leave it there long enough and it will not only be a source of unhealthy bacteria irritating your gums, but also a source of acid which will slowly but surely, demineralize the enamel causing holes to form.
Once a root canal treatment is completed and all infected nerves have been eradicated, then yes the tooth is officially dead.
Google will tell you 10 – 15 years. However, a crowned dead tooth can improve those odds and also, good hygiene practices can help to create a sustainable environment for the crown and root canal treated tooth to last a long time.
Not putting a crown over the tooth is not a good idea. Crowning a root canal treated tooth helps the tooth to be protected from unintended biting pressure points that can cause the tooth to crack and split into two. After that happens, an extraction is the only option.
Price range $500 – 1250 depending on front, premolar or molar tooth.
1 – 2 visits on average. Lots of disinfectant liquids, noise, bright light and a green sheet to cover your entire mouth and isolate the tooth. Perhaps a tired jaw but a more pain free tooth by the end of the first visit.
Sometimes a root canal treatment can be done in 1 visit and sometimes it may take 3 – 4 visits. The reason for this range is due to the complexity of the roots within the tooth, and also how many roots there are. For example, a front tooth only has 1 straight canal, while a back molar tooth has 3 – 4 canals and can be curved which would be more challenging to clean right down into the ends of the roots. Bear in mind that an infection takes several months to build up, so don’t expect an infection to last that long to be fixed in 1 sitting.
Visit 1- 2: Cleaning and disinfecting. Local anesthetic (injection) is given so that the rest of the procedure is numb and painless. The tooth is first opened up using real diamonds, yes I said real diamonds because diamonds are the hardest material that can cut through hard enamel ie the top layer of teeth! Once an access path has been created, special thin files and instruments are used to tunnel through your teeth and create smooth tunnels that allow the trapped bacteria to purge itself, as well as remove the infected tooth tissues at the same time. After the shaping is completed, the tooth is dressing internally within the tunnels with antibiotic medication and left inside the tooth with a temporary filling to disinfect and eliminate any residual bacteria.
Visit 3 – 4: Disinfecting and sealing. Once the tooth has settled down after approximately 2 weeks, the tunnels or rather canals, are cleaned out, then sealed with an inert material called gutta percha. This material is meant to occupy the space where the nerves used to be, to prevent any new bacteria from creeping back in. After which a filling is placed to cover the access point of the tooth, then we plan for a crown another 2 – 4 weeks later once the tooth has completely settled down.
I always encourage patients to be careful with what they eat after a root canal before a crown has been placed as the tooth is still in a vulnerable state. However soft foods should still be playing it safe. If you bite into crabs or have a whole container of nuts, chances of cracking the already compromised tooth are very high and would lead to a complete tooth fracture.
Clear Aligners
A digitized way to straighten teeth using computer simulations. Based on a series of predictable tooth movements, plastic trays ie clear aligners are produced in sequence to straighten teeth!
Price range $2400 – 7500 before gst.
After several decades of hearing friends struggling through the pains of poky wires and unaesthetic metal braces, technology has advanced to make straightening teeth with plastic, possible and predictable! Many who are working adults, or play contact sports for example, may prefer a removable option for teeth straightening that is semi – transparent, aesthetic and cost friendly.
Having straight teeth adds value to every life the same way a drummer is key to a band. Not in the front of the stage, but blazingly obvious when missing in action. Similarly, having straight teeth may not be the first facial feature a person would notice, but it is a key feature to complete the face. Sometimes having crooked teeth can also cause teeth to grind and chip against one another, or even cause gum issues due to food trap from crowded teeth. Using clear aligners, the form and function of an ideal smile are achieved in the most subtle way possible, clearly, some may say.
There is nothing like a great set of teeth to smile confidently or sweetly with. And it is proven that straighter teeth are easier to maintain and clean.
Wear the aligners full time, 20 – 22 hours per day and only remove during eating and brushing teeth or flossing. Each aligner is worn for 7 – 14 days.
The workflow of aligners is simple.
Visit 1 – Consultation. We discuss your objectives, what teeth bother you and whether it can be corrected with clear aligners. We go through the variety of aligners available from Zenyum ($$) for mild correction to Invisalign ($$$$) for moderate to complex cases.
A full mouth xray, 3D scan and photos of your teeth are taken.
Visit 2 – Treatment plan discussion
All this data is then processed to generate out a treatment plan to simulate how your teeth will look like after a series of aligners are worn.
This process is vastly different from braces for this very reason which is that you get to see the final outcome before treatment even starts.
Of course, as with all things computer predicted, a 100% guarantee is not possible but we always aim for 100% and if needed, a second round of aligners for minor adjustments can be done.
Visit 3 – Clear aligners fitted
Once the treatment plan is confirmed, the entire series of aligners are 3D printed and placed in a box ready for you to wear them sequentially! Instructions on how to wear, care and optimize your aligners are discussed and the journey of teeth straightening begins.
Subsequent visits
The monitoring process is dental visits eveyr 6 – 8 weeks if you are on Invisalign and if you are on zenyum, you are mostly monitored via their app.
Sometimes, attachments which are tooth coloured bumps are placed on teeth to create artificial pressure points on teeth so that certain movements can be done efficiently.
These attachments are later polished off after they have served their purpose, either during or at the end of treatment.
No you only have to wear retainers to sleep at night once treatment is completed. Recommended retainer wear is for 5 years post treatment.
This is a myth more than a fact. Many a time, clear aligners take longer to straighten teeth because patients drag out treatment time by wearing the aligners less hours in a day, but for more days. This is not recommended as there should be a constant pressure from aligners all the time except for eating and brushing your teeth, if you want your teeth to move according to the plan!
It is totally understandable that life still goes on, and sometimes its not the most convenient to wear aligners during a client meeting or a court hearing. However, pick a treatment that works best for your lifestyle and just remember that the process of wearing aligners is not forever! The more we stick to the plan, the better the chances we have of getting to an ideal smile.
Smoking will cause the aligners to discolour and also cause teeth to pick up nicotine stains more quickly, so it is recommended to take out aligners during smoking.
Yes, you can! Provided the teeth have no attachments on them, otherwise it is best to wait till the attachments are removed to avoid patchy teeth.
No, that is not a good idea because eating with your aligners on will firstly, cause your aligners to get dirty, yellow and cloudy very quickly. Secondly, it can also cause your back teeth to start spreading apart and when you take them off, they cannot meet and bite together.
Yes! Acceleratory devices such as Acceledent are add ons that can cause the process of bone remodelling during the teeth straightening process to quicken, thereby shortening treatment time!
Wisdom Tooth Extraction
The removal process of bothersome wisdom teeth. Wisdom teeth are not mandatory to remove, however if they are impacted and creating a painful riot in your mouth, its best to get it looked at.
Wisdom teeth are the last teeth in the mouth to emerge. So more often than not, they grow in awkward ways that cause pain and discomfort. Most of the time they are also nonfunctional i.e. you can’t use these guys to chomp down your meals.
Sometimes we also take them out to create more space for teeth straightening plans.
Usually a full mouth xray is taken to locate and determine whether wisdom teeth should be removed. If they are slanted, impacted, trapping food and causing the gums to swell then yes you should probably think about taking them out.
The procedure depends on the type of extraction required. Mainly surgical or non-surgical. Please eat before you have your wisdom teeth taken out so that if you need to take any medication after, you’re not taking it on an empty stomach and causing a gastric whirlpool to start.
Non-surgical removal of wisdom teeth including time taken to numb up the area may take 20 – 30 minutes in total. A dry and quick process for the actual removal which takes 30 seconds to 5 minutes for a straightforward case.
Surgical removal of wisdom teeth may take 30 – 60 minutes because this is a more complex procedure where the gums have to be sectioned and separated from the tooth in order for the slanted wisdom tooth to be accessed and removed in sections. You will hear a lot of noise, taste salty water and have to open wide the entire time. It is a good idea to bring something to listen to, be it headphones or airpods to listen to music or listen to a podcast. The main idea is to zone out and remain relaxed the entire time.
Once the tooth is fully removed, a dissolvable sponge is placed to help the blood clot and stitches are sutured in to close up the gums and allow the healing process to take place.
For a non-surgical case, 1 -2 days of rest should suffice. The socket would take approximately 2 – 3 weeks to fully close.
For surgical cases, we recommend 5- 7 days of rest. The gums take 1 – 2 weeks to fused back together and heal. However, the first 4 days post op can be the most heavy going, with facial swelling and jaw discomfort or limited mouth opening due to the long procedure that just took place. We recommend drinking lots of water and having ice cream for a cooling effect. Soft diet for the first week is recommended.
Yes, if its is a surgical removal. For surgical extraction of wisdom teeth, medisave claimable amount is $350 or $950 depending on case complexity.
Non surgical removal is NOT claimable by medisave. It usually ranges from $150 – 250 depending on the difficulty on the day itself. However, CHAS subsidies can pay for part of the procedure.
Teeth Whitening
Teeth whitening is a process of changing the colour of your teeth through the use of an active agent called peroxide. Peroxide causes a process of oxidation which releases oxygen into your teeth, cause the compounds to reorganize and produce a visibily whiter colour.
When we eat and drink darker colours such as coffee and curries, the colour gets absorbed into our enamel. This can cause teeth to look yellow and ‘dirty’.
Teeth whitening is a purely cosmetic procedure that aims to brighten and improve the colour of teeth to make a smile look clean, healthy and younger.
Short term use of certified FDA or HSA approved, teeth whitening gels are effective and safe. There are no long term studies to show that teeth whitening gels with peroxide can cause teeth to become weaker, or have any negative impact on gums.
Temporary side effects include heightened sensitivity and gum irritation. It is normal to feel some sensitivity during the process due to the nature of the reaction happening within the teeth to cause the colour change. Rest assured that for most cases, the teeth sensitivity or any mild gum discomfort should go away within 24 – 48 hours of removing the gel. Gums can get irritated when strong concentrations of peroxide are used, causing the gums to feel sore or even ulcerate. It is important not to overload the whitening trays and wipe off any excess gel around the gum line during teeth whitening process.
If you have a big occasion coming up such as a wedding, its best to plan for this!
How fast your teeth whiten depends on which mode of teeth whitening you choose. The same results can be achieved with lower concentrations of peroxide over longer exposure time and vice versa.
Chairside teeth whitening is a procedure done in the dental office, where a stronger peroxide base e.g. 15- 40% of hydrogen peroxide is applied to the teeth for 1 hour, sometimes with or without a light activated add on depending on the manufacturer. This can produce teeth 4- 6 shade white according to Philips ZOOM whitening. However, if teeth have been whitened before or the base shade is already quite white, then it may not have such a big difference.
Take home kits are a procedure done at home, where a milder peroxide based whitening gel (hydrogen peroxide 4 – 8 % or carbamide peroxide 10 – 22%) can be used over a period of up to 2 weeks. Depending on the manufacture’s guidelines and the concentration of the gel, you could be wearing the gel for 20 minutes per day or overnight, for up to 2 weeks before you see visible results. However, this is the most popular mode of whitening due to the convenience and milder side effects of sensitivity and gum irritation.
Usually we recommended to do chairside whitening ($800 – 950) to kickstart the process, then do the take home whitening kit ($350 – 500) for maintenance every 3- 6 month after.
When peroxide is in contact with your teeth, the oxidation and colour change is pending. That means that while it is not an absolute no no, it is best to avoid dark coloured foods and drinks such as coffees, teas, red wines or curries. Smoking should also be minimized. If absolutely necessary to ingest, then be sure not to prolong the duration of consumption. For example, have your coffee with a straw, within a 30 minute window rather than sip it throughout the day. Once youre done with consuming, have lots of water to wash down the colour change so that your saliva is not brown, because that too can cause the whitening process to be slightly jeopardized.
Whitening toothpastes are a hit and miss. Many of them claim to be whitening because there are ingredients that are highly abrasive, so that stains can be scrubbed off. However, prolonged use of abrasive toothpastes can lead to thinning of the enamel and outer layer of the teeth. When this happens, the inner yellower layer of dentine is exposed. So, be wise and careful not to be counterproductive with over the counter products!
