|1.||Oral Diseases and Conditions|
What is dental decay?
Dental decay or dental caries is a diet related infectious disease and is the most common disease affecting teeth.
What causes dental caries?
Dental decay is influenced by how often sugar is consumed rather than the total amount of sugar eaten. Bacteria present in our mouths turn sugars and starches in our food to acid that causes dental decay.
What can I do to avoid getting dental caries?
Control sugar intake
Sugary food should ideally be only eaten with main meals as snacking greatly increases the time of acid attack in our mouths. Furthermore, the salivary flow is higher at these times. Saliva assists in clearing sugars from the mouth so there is less time for acid production. Certain foods like carbonated drinks or lemon are also very acidic. In addition to tooth decay, they may soften and wear away tooth surfaces (enamel erosion).
How do I maintain good oral hygiene
· Brush teeth thoroughly everyday with a fluoride toothpaste
· Floss daily to clean in between the teeth
· Have preventive dental check-ups at least once year
When do people get gum disease?
Gum disease can begin in childhood and may increase in severity through early adulthood to middle age.
What causes gum disease?
It is caused by plaque that accumulates between and around the necks of teeth. Plaque bacteria produce toxins that irritate gum tissues causing them to become reddened, inflamed and bleed. If not controlled, gum disease can spread to the supporting fibres and bone that hold teeth in place and eventually cause the teeth to become loose.
Why do my gums bleed when I brush my teeth?
Bleeding gums is often a sign of gum disease. This condition will usually resolve if care is given to plaque removal by daily brushing and flossing of teeth. Bleeding gums is also common during periods of hormonal changes as in puberty and pregnancy. However, rarely, bleeding gums could also be a sign of blood disorders.
Is oral cancer preventable?
Actually you can reduce your risk of getting oral cancer by adopting and practising healthy lifestyle habits.
How can I protect myself from getting oral cancer?
· Avoid the use of any kind of tobacco product (e.g. cigarettes, pipe tobacco, cigars, chewing tobacco) particularly when combined with heavy alcohol consumption.
· Avoid betel quid chewing especially with tobacco.
· Avoid heavy alcohol consumption.
· Prolonged, repeated exposure to the sun may increase the risk of cancer of the lip.
· Consume a diet with plenty of fresh fruits and vegetables that is rich in antioxidant vitamins A, C and E.
· Maintain good oral health.
· Visit your dentist at least once a year for an oral examination. · Oral cancer often starts as a tiny, unnoticed white or red spot or sore anywhere in the mouth.
· Early detection of oral cancer improves the chances of successful treatment.
· Do regular mouth self-examination. Take a few minutes periodically to examine your lips, gums, cheek lining and tongue, as well as the floor and roof of your mouth.
Take note of any of the following changes in your mouth:
· Colour changes such as white or red patches
· A lump, thickening, rough spot, crust or small eroded area
· A persistent painless ulcer/ sore that bleeds easily and does not heal
· Difficulty in chewing, swallowing, speaking or moving the jaw or tongue
· Changes in the voice
· A change in the way your teeth fit together
· Pain, tenderness or numbness in the mouth or lips
In addition, watch for other changes like drastic weight loss or a lump or mass in your neck. If any of these conditions persists, contact your dentist for an examination.
What is malocclusion and what cause the problem?
Malocclusion is essentially a faulty bite. This occurs when the size and shape of the teeth do not match that of the jaws. Jaw growth and tooth size are determined by the genetics of the parents. Premature loss of deciduous teeth causing drifting/shifting of adjacent teeth and loss of space may also result in malocclusion.
Should I be concerned if my 6 year-old has crowding of teeth?
For most children and adults crowding is the most common malocclusion. Crowding of teeth may result in future dental problems such as tooth decay, gingivitis and periodontal disease. If crowding is present by 10-11 years when all upper and lower incisors and canines have erupted, the crowding will probably not improve and you should have an orthodontist or paedodontist examine your child.
Should I be concerned when I feel pain in my mouth?
Toothache may present in several ways. It has been described as a sharp, dull or throbbing pain, pain when brushing and pain when biting. The type and nature of the pain is usually an indicator of the severity of the problem.
· Sharp pain
Sharp pain is usually due to a cavity in the tooth and is triggered by hot or cold drinks.
· Dull pain
This pain is felt without any stimulus. It is caused by bacteria invading the nerve space and causing damage to the living nerve cells. Pain may also be felt when lying in bed and night. This is due to an increase in blood pressure inside the tooth when the patient lies down.
· Sharp pain on biting
Pain may occur when you bite. Usually the molar teeth are involved. This is caused by a hairline fracture in the enamel, which allows the tooth to flex during biting.
· Sharp pain when biting near the gums
With age and wear, our gums tend to recede exposing protective cementum covering the root surfaces of teeth. The cementum layer is easily removed by tooth-brushing. When this happens pain may result.
What do I do if I experience a toothache during the night?
Taking two tabs (1000mg) of Paracetamol (Panadol) usually stops/reduces the pain. Seek dental treatment the next morning.
Halitosis (Mouth Odour)
How do I know if I have bad breath?
It is difficult to judge this yourself but if you notice people drawing away from you in a conversation, it is a good indicator that you may have halitosis.
What causes bad breath?
Over 90% of bad breath originates from the mouth and only very rarely from the stomach. There are millions of bacteria even in the cleanest mouth that have the potential to decompose microscopic food particles present taken in the mouth. These bacteria and food debris, also known as ‘plaque’ can emit odorous gases when bacteria digest food in the absence of oxygen (anaerobic metabolism). The more plaque there is in the mouth, the greater the amount of anaerobic bacterial activity, and the greater the volume of offensive gases produced.
How do I ensure fresh breath?
· Keep your mouth moist. Avoid becoming dehydrated and drink at least 8 glasses of plain water daily.
· Eat regularly and consume plenty of fresh fruits and vegetables. Avoid snacking on sugar-based products especially those containing refined sugars as these greatly increase bacterial growth in the mouth resulting in the production of greater volumes of odorous gas.
· Ensure a balanced diet with plenty of vitamin C
· Do not smoke. Smokers retain the odour of cigarettes on their breath for some time. Smoking also results in reduced salivary flow, increased adhesion of bacteria to the tongue and teeth and can cause gum disease. All these can lead to bad breath.
· Brush your teeth daily and effectively ensuring removal of as much plaque as possible. In addition, floss to ensure all food debris that can contribute to bad breath is removed.
· Brush your tongue with your toothbrush to prevent plaque from sticking to it
· Visit your dentist regularly to enhance the cleanliness of your mouth thus reducing bad odour and gum disease.
Is bad breath treatable and what is the treatment?
Most bad breath can be treated. Basic treatment such as scaling and restoration of cavities can reduce the severity of mouth odour. Understanding its causes and applying an effective method of tooth brushing and cleaning the mouth can overcome the problem of mouth odour further.
What should I do for a knocked-out tooth?
If a permanent tooth is accidentally knocked out, it is important to know the right steps to take to save the tooth. Quick action increases the tooth’s chances of survival.
Find the tooth Remember to handle to tooth by its crown, not by thr root.
Are there scholarships for postgraduate studies and what are the eligibilities to apply?
The Ministry of Health offers limited number of scholarships to our dental officers each year. The advertisement is issued by the Training Management Division , Ministry of Health and will be circulated to the whole country. Usually, officers are required to finish their compulsory service and must be confirmed in service at the time of application. Officers are also required to have good marks in their annual appraisals. Details may change each year so make sure you read the advertisement carefully before you apply.
What is a mouthguard and why do I need it?
Accidents can happen during any physical activity, more so if you take part in contact sports. A mouthguard, which is a removable rubber or polyvinyl shield worn over your upper teeth, can protect the soft tissues of the mouth and reduce the risk of injury to teeth by helping to cushion a blow to the face.
For which sports is a mouthguard recommended?
There are three types of sports when we consider the possibility of injury:
· Contact sports where contact is part of the game. These include rugby, martial arts and boxing. The use of mouthguard should be compulsory.
· Collision sports where contact often happens but it is not expected or allowed. These include basketball, hockey, water polo, netball, softball, squash, soccer, cycling, trampoline, cricket (wicket keeping or batting without a helmet) and water skiing. A mouthguard is highly recommended.
· Non-contact sports where contact is a rare occurrence. These include such sports as tennis where a mouthguard is not needed.
How do I take care of my mouthguard?
It would be good to:
· Rinse with cold water before each use.
· Clean thoroughly with soap and toothbrush after every use.
· Store the mouthguard in a firm container to prevent damage. Make sure the container is perforated for air circulation.
Pregnancy and Oral Health
Will my oral health deteriorate during pregnancy?
· Oral and general health is very important for the expectant mother.
· During pregnancy, the hormonal changes that occur cause a greater reaction to dental plaque, resulting in an increased amount of swelling, bleeding and redness of the gums.
· This condition is termed “pregnancy gingivitis” and is a condition that commonly occurs in the second or third month of pregnancy sometimes becoming more severe up through the eighth month.
· New research suggests a link between gum disease in expectant mothers and low birth weight babies.
What can I do to maintain good oral health during pregnancy?
· Since oral health is important for general health and might affect your pregnancy, it is extremely important to pay close attention to the signs of gum disease.
· It is important to maintain a proper daily oral care routine, including brushing and flossing.
· Visits to the dental clinic should be early in the pregnancy so as to enable the dental professional to identify oral health problems that might require treatment.
What sort of information should I relate to my dentist at my first dental check up during pregnancy?
Some of this information includes:
· Which month of pregnancy are you?
· Any evidence of a high-risk pregnancy?
· Any medications being taken?
· Any noticeable changes in your oral health?
Children's Dental Health
Are milk teeth as important as permanent teeth?
· Children need strong healthy teeth to chew their food easily, to speak clearly, and to look good to themselves and their friends.
· Primary teeth also help reserve space in the jaw for the permanent teeth, and when lost prematurely can pose future orthodontic complications.
· Your child’s general health can be affected if diseased and broken primary teeth are not treated early.
Do I need to clean my baby’s mouth if there are no teeth yet?
Begin cleaning your baby’s mouth during the first few days after birth. After every feeding, wipe the baby’s gums with a clean damp washcloth to remove plaque.
Can babies get cavities?
Decay can occur as soon as teeth appear in the mouth. One serious form of decay among young children is “baby bottle tooth decay” which occurs when the infant is allowed to nurse continuously from a bottle of milk, formula, sugar water, or fruit juice during naps or at night.
Is teething painful?
During teething, usually between the ages of four months and 2½ years, babies often have sore and tender gums. The pain can usually be soothed by gently rubbing the baby’s gums with a clean finger, a cool, small spoon or a wet washcloth. A clean teething ring for the baby to chew is also helpful.
When should I take my child to see the dentist?
Ideally, your child’s first dental visit should be before the first or second birthday. In addition to checking for decay and other problems, the dentist will teach you proper techniques to clean your child’s teeth as well as evaluate for any negative habits such as thumb sucking. You will also be building a lifetime of good dental habits.
When should thumb-sucking stop?
Children should have stopped thumb sucking by the time the permanent teeth are ready to erupt. Usually, children stop between the ages of two and four years old. Thumb sucking beyond the age of six may cause malocclusion. Peer pressure causes many school-age children to stop.
How can I ensure good oral hygiene for my child?
As a parent, you should:
· Establish good oral hygiene routines early in life.
· Supervise tooth brushing in children up to the age of six years.
· Use only a pea-sized amount of toothpaste to discourage excessive swallowing.
· To help children with tooth brushing, stand behind the child and tilt the head upwards so that all tooth surfaces can be brushed using the gentle scrub method.
Oral Health Of The Elderly
Should the elderly have regular dental check-ups?
· Regular examination of the mouth is necessary as it is an effective screening method to detect oral problems associated with the elderly.
· Besides checking for routine conditions such as tooth decay and gum problems, other more serious conditions such as pre-malignant lesions and suspected oral cancers which occur more frequently with increasing age can be detected, treated early and monitored.
Is self-care important for the elderly?
· Good oral health is an important part of general health and a comfortable healthy mouth is just as important for older people as for any other section of the population.
· A healthy functional mouth can benefit the elderly in terms of:
· Freedom from pain and discomfort
· Ability to eat, speak and socialise without discomfort and embarrassment
· Contribution towards well being of the patient
· Care of the mouth is a necessary part of personal daily care and dentists or primary health care providers are in a position to encourage older people to take good care of their mouths and to maintain oral health.
· It is their role to motivate, assist or provide oral care especially if the patient is dependent because of illness or disability.
How do I care for my dentures?
· If you use dentures, remove them before brushing and clean dentures separately.
· It is very important to practise good oral hygiene to ensure the health of the remaining natural teeth and gums is maintained.
· After each meal remove dentures from mouth to rinse and clean away any food debris.
· Clean your dentures carefully with a toothbrush and soap everyday.
· Soak dentures in a container of water/ denture cleanser when not in use.
· Most importantly, DO NOT sleep with your dentures in your mouth.
Oral Health Of People With Special Needs
Is my special child more prone to dental problems?
Yes, special children are often associated with:
· High levels of plaque and poor oral hygiene
· Higher levels of gum disease and tooth loss
· Having more untreated decayed teeth.
What unique problems exist that prevent this group from improving oral health?
· In a family coping with the problem of disability, oral health may be given a low priority.
· Dental care may be restricted by attitudes and difficulty in access
· Treatment may be more difficult to provide because of fear and anxiety, lack of understanding, inability to co-operate or challenging behaviour of the special child.
· Involuntary movements may restrict oral care or dental treatment.
· Difficulties with communication complicate the situation.
As a care-giver, how can I improve the oral health of a special needs child?
As a care-giver you are expected to:
· Implement simple preventive measures such as tooth brushing including the use of modified toothbrushes, effective technique, position etc.
· Carry out simple oral examination using torchlight to detect any obvious oral problems
· Implement some form of dietary control particularly with regard to the child’s sugar intake.
Where can I get more information & training to improve my child’s oral health?
Ask your dentist/dental personnel at any government dental clinic.
Oral Health Of People With Special Needs
Why is tooth-brushing important?
· Only tooth brushing and flossing can remove plaque.
· Plaque, if not removed regularly will accumulate to form calculus.
· Using fluoride toothpaste when brushing will also help to strengthen teeth and reduce dental decay.
How often should I brush?
· Brush at least twice daily with fluoride toothpaste, preferably in the morning and before going to bed at night or after the last meal of the day.
· Clean spaces between teeth once a day with dental floss or other interdental cleaning aids advised by your dentist (woodsticks, interdental brushes etc.)
What is the most effective way to brush?
· No particular method is clearly superior to others. What is important is that the brushing strokes are repeated on all tooth surfaces.
· It should be a method that suits you and cleans your teeth thoroughly in a gentle manner.
· Do not forget to brush your tongue to remove bacteria and to freshen your breath.
How do I choose the right toothbrush?
· Choose one of the right sizes for your mouth. Toothbrushes with small heads are better as they can reach difficult to clean areas near the back of your mouth and between the tongue and lower molar teeth.
· The toothbrush should have a firm and comfortable grip.
· The bristles should be round-ended and soft to medium-textured.
How often should I change my toothbrush?
After three months of use, the toothbrush bristles will start to wear and not clean as efficiently. Generally when the brush bristles become splayed it is time to change to a new brush.
How do I floss my teeth?
· Break off a length of floss and wind most of it around the middle fingers of both hands. Hold the floss tightly between thumbs and forefingers leaving a short length of floss in-between.
· Guide the floss between your teeth gently. Never snap the floss into the gums.
· When the floss reaches the gum line, curve it into a C shape against one tooth. Gently slide it into the space between the gum and the tooth.
· Hold the floss tightly against the tooth. Gently rub the side of the tooth, moving the floss away from the gum with back and forth motions.
· Repeat for all teeth.
Diet and Healthy Eating
What type of diet is best for healthy teeth & gums?
Ensure a well-balanced and varied diet daily following the Food Guide Pyramid. This includes:
· Eating a variety of foods from each level of the Food Guide Pyramid.
· Limiting intake of foods high in fats.
· Limiting total sugar intake to less than 10 to 12 teaspoons/ person/ day
· Avoid fizzy or carbonated drinks
Choose most foods from plant sources:
· Eat five or more servings of vegetables daily.
· Eat other foods from plant sources such as breads, cereals, grain products, rice, pasta or beans several times a day.
What are fissure sealants?
· Fissure sealants are special plastic materials used by dentists to seal off pits and fissures on the chewing surfaces of back teeth from bacteria and fermentable foods in the mouth.
· Usually done on children, on permanent molar teeth that are most susceptible to tooth decay. Sealants together with proper brushing and diet control help to prevent decay from starting within the deep fissures of teeth.
· The application of sealants is easy and painless. No cutting of the tooth is required. The tooth is cleaned, treated, dried and the sealant applied. When hardened, the sealant forms a protective coating over the tooth.
What is topical fluoride application?
· A solution/ gel of fluoride containing substance is systematically applied to tooth surfaces in order to strengthen those most susceptible to tooth decay.
· May be carried out during preventive dental visits.
How does fluoride protect my teeth from decay?
· Fluoride reduces the solubility of tooth enamel in acid.
· It reduces acid production by plaque bacteria.
· Fluoride also promotes repair of tooth enamel in areas that have been demineralised (dissolved) by acids.
What are the other sources of fluoride for us?
· Water fluoridation is the adjustment of the natural fluoride concentration in a community water supply to an optimum level for dental health.
· The Malaysian government since 1972 approves the fluoridation of public water supplies as a primary caries prevention programme.
· About 75.5% of the Malaysian population benefit from this public health measure.
· Community water fluoridation is the safest and most cost-effective method of reducing dental decay.
· No active participation is required by individuals or the community – just use tap water for drinking and cooking.
· It reaches every one in the community who uses public water supplies, including those in greatest need, it benefits both children and adults.
· It provides a continuous low concentration of fluoride in the mouth. This is important in preventing and controlling dental caries.
Regular Dental Visits
What treatment are provided at such check-ups?
· Routine oral examination
· Fissure sealants if necessary
· Topical fluoride if necessary
· Oral hygiene instructions and advice
Government Dental Charges
How much are dental charges at government clinics?
The cost depends on the type of treatment. The cost of dental treatment is summarized as below:
· Consultation RM 1.00
· Each filling RM 2.00
· Each extraction RM 1.00
· Scaling RM 2.00 per visit
· Root canal treatment RM 4.00
· Full dentures RM 50.00 per jaw
· Partial dentures RM 10.00 for the plate and first tooth and an additional RM2.00 for each additional tooth with maximum of RM25.00
Services rendered by the specialists are charged as follows:
Minor Oral surgery RM 50.00
Orthodontic: Removable RM 100.00 Fixed RM 500.00