Ask A Doctor: Periodontist

Our new series, Ask A Doctor, answers all your burning questions that you may have for our heroes in the medical field.

Today, we have Dr Henry Wong, a periodontist who obtained his bachelor of dental surgery degree from the University of Singapore, post-graduate masters degree in periodontics from the University of London and has been admitted to the roll of specialists of the Academy of Medicine, Singapore.

• Are periodontists dentists?

Periodontists are dentists who specialise in the periodontium or the tissues supporting the teeth namely, the gums and bone. The etymology is peri which means around and odontos teeth.

Hence, periodontists are specialists who look after the bone and gums primarily to ensure that teeth are not lost to periodontal disease.

• Is it normal for people to lose teeth with age?

Periodontal disease is characterized by loss of bony support of the teeth which eventually leads to tooth mobility and tooth loss. If detected and treated early teeth can definitely be saved.

However, if left untreated, with time, loss of supporting bone will result in increasing mobility of teeth. The health of the periodontium is affected by systemic factors such as pregnancy and complicated by other factors such as diabetes.

The rate of loss of support depends on many factors, such as the patient’s oral hygiene, habits such as smoking, systemic factors, immunity and severity of the disease etc.

Loss of bone will be even more significant if one has short roots.

Age of the patient therefore has a bearing on the urgency for intervention. The younger the patient, the greater the urgency, if they intend to keep their teeth for life. Early detection is therefore the key.

• Is anaesthesia really effective? Many claim that they still feel pain

Local anaesthesia if administered carefully and well is painless and effective.

• How to convince young children to sit in the “dentist chair”?

Fear in children is generally not innate. Their intrepid nature explains why many children unknowingly injure and hurt themselves. They develop fear

1. If parents unintentionally share their phobia of the dentist
2. When the term “dentist’s chair” is likened to an electric chair, and is identified with punishment and pain, children will shun visiting a dentist. Intriguingly, a barber’s chair does not evoke the same measure of dread.
3. When parents instil fear in their children by using pain as a deterrent to discipline them with seemingly harmless comments such as “if you don’t behave, I will bring you to the dentist”. A visit to the dentist to the child is therefore perceived as punitive.
4. If the child’s first visit to the dentist is when he/she is in pain. A visit to the dentist is therefore an unpleasant experience. Do not wait till they are in pain before visiting the dentist.

• There are times when we brush our teeth till there’s blood when we spit the toothpaste out – is there any toothbrush to help with that?

It is not natural for gums to bleed. Healthy gums do not bleed.

Bleeding is a sign of gum disease and one should seek treatment. Brushing alone may not be effective. If left untreated, bleeding may be spontaneous with one noticing blood stains on one’s pillowcase.

• How should I calm myself down in the dentist chair?

Find a dentist in whom you trust and whose skills you trust.

Anxiety in adult patients is often associated with fear of losing one’s teeth.

A trustworthy clinician who has your interests at heart to guide you in making the right treatment choices will allay your apprehension.

• What are some common symptoms of gum diseases which most people are unaware of?

Some of the common signs are:

1. Bleeding gums with or without brushing, often erroneously dismissed as “heatiness” is a common sign. Most people are unaware of chronically inflamed bleeding gums because it is often masked with toothpaste, which one spits out. If they were to brush without toothpaste or use dental floss, they are more likely to notice the blood.
2. Halitosis or bad breath is another sign. Many people are unaware of halitosis as it is hard to detect it in oneself. It may also be culturally insensitive to alert others of their fetid breath. It is a general observation that societies who kiss and come in close proximity upon greeting each other are more conscious of odours emanating from their mouths.
3. Bad taste. Gum disease also present with a fetid taste.
4. Drifted teeth. Gum disease if left untreated results in gaps appearing as a result of teeth protruding and drifting. Patients notice how their profile has changed with age compared to photographs in their younger days.
5. Mobile teeth. In the late stages, the teeth loosen and exfoliate.

• What are some risks of dental implants that people should be made aware of?

It is important to understand that implants are not meant to substitute teeth.

They are a means of replacing teeth which have been lost, to either trauma or disease. Implants have excellent survival rates if placed in healthy mouths in which teeth are lost as a result of trauma.

Replacing mobile teeth caused by periodontal disease with implants is likened to treating polio by improving on wheelchairs. It is therefore important to save teeth before they are lost due to periodontal disease.

Before one is deemed suitable for implants, a thorough examination should be conducted as many factors have to be taken into consideration. Periodontal treatment plan differs from patient to patient in order to restore health and function.

It is erroneous to think that implants are the best and only solution, for if all one has is a hammer, every solution looks like a nail.

It is crucial for patients with implants to maintain an impeccable oral hygiene as implant failure will result in exposure of the screw threads. The patient’s motivation and dexterity in keeping the supporting structures infection free is the key to implant survival and periodontal health, for when implants fail they fail spectacularly.

Periodontal health around implants require maintenance especially if they are placed to replace teeth lost to periodontal disease.

If periodontal health is not maintained in patients with implants, younger patients are more likely to encounter complications when they get old, for the implants have a longer time in which to fail.

• How do we know when to visit a periodontist?

As periodontal disease is painless, one is unaware of its presence much as one is unaware of ailments in one’s body which are painless, till they are found upon routine examination or when problems present.

Knowing the signs and symptoms will help one identify the onset of periodontal disease. It is best to have a consultation for a baseline check as early intervention is the best prevention.

Dr Wong is at Periodontics Inc Pte Ltd, located at Mount Elizabeth Medical Centre #04-04 which is linked to Mt. Elizabeth Hospital, Orchard.

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