Introduction

For most of us, thorough daily oral hygiene lays the groundwork for a healthy smile. Just a simple routine of brushing and flossing, in addition to regular dental checkups, can be enough in most cases to help prevent tooth decay, gum disease and bad breath. The article seeks to suggest some techniques such as brushing and flossing and dental hygiene practices, and provide you with some basic information on dental care.

It is important to always remember that regular visits to your dentist will help you to maintain a healthy set of teeth. I have often reminded my readers that having a good set of teeth does wonders to your self confidence and personality. But it takes self pride and discipline to maintain your general and dental wellbeing.  You want a charming and attractive smile, well it is not impossible. All you have to work hard at perfecting your daily routine of brushing and flossing. And at the first sign to a dental problem, please see your dentist

BRUSHING UP ON TECHNIQUE

Since there are various techniques for brushing your teeth, it’s a good idea to ask your dentist which one to use .Here are a few tips to help you develop a good brushing routine:

Brush at least twice a day.

Use a fluoridecontaining toothpaste to help prevent tooth decay. Place your brush at a slight angle toward the gums when brushing along the gum line.Use a gentle touch—it doesn’t take much pressure to remove the plaque from your teeth, and a vigorous scrubbing could irritate your gums.Concentrate on cleaning all the surfaces of the teeth.
Brushing your tongue gently can help remove bacteria that cause bad breath.

THE IMPORTANCE OF FLOSSING

Cleaning between your teeth is every bit as important as brushing. Since brushing can’t effectively clean between teeth, it’s important to use floss to get to those areas.

Other items also are available to help you clean between your teeth. Ask your dentist which ones to use.Clean between your teeth once a day. As with brushing, use a gentle touch to avoid injuring your gum tissue.

INTERDENTAL BRUSHING

Interdental Brushes – are used for cleaning by using the interproximal brush with medical solution to clean and treat between teeth. Interdental brushes are usually very small and specially designed brushes for cleaning between the teeth. Interdental brushes are best when the spaces between your teeth are too wide to use floss. Interdental brushes come in different widths to match the space between teeth.

Interdental brushes are easier to use than floss. The Interdental brushes should be used by pushing gently back and forth between the teeth and the gumline. The Interdental brush should never be forced into the space between the teeth as this can cause trauma to the teeth and gum. Your dentist or hygienist will advice and show you how to use Interdental brushes.

IT’S YOUR CHOICE

Sometimes just walking down the oral health care aisle in your local drug store is enough to make your head spin. With so many choices, how can you choose which products are best for you? Ask your dentist to help you select the best products for your needs. Because there are distinctive oral hygiene routines and techniques, some products seem to work better for some individuals than for others. The best brush or interdental cleaner you can buy is the one you will use regularly and properly.

Talk to your dentist or dental dental assistant about your home care routine and technique— he or she can help you get the job done properly.

WANT TO KNOW MORE?

There is a wealth of information on dental care at your fingertips.
Here are some quick and easy ways to narrow your selection:
Just go to the  Dental Web site or blog such as mine.(www.drkamsiah.com)

Conclusion

You will realise it is not rocket science to maintain a good set of teeth. All you have to do is to establish a good daily routine of brushing and flossing your teeth after every meal. This article give you a general idea that good oral hygiene practices can be learned easily. But it will take constant application of the techniques to anchor your habit of brushing and flossing. If you are determined to have a beautiful smile, you must work hard for it.

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Introduction

Many people think of periodontal disease as an adult problem. However, studies indicate that nearly all children and adolescents have gingivitis, the first stage of periodontal disease. So periodontal disease can be a problem for all children and young adults.Generalized juvenile periodontitis which includes early onset adult periodontitis, recurrent necrotizing ulcerative periodontitis and the true generalized form of juvenile periodontitis.

Periodontitis in systemically diseased individuals can be divided into three subgroups: juvenile periodontitis associated with primary neutrophil disorders, juvenile periodontal disease in which neutrophils are secondarily abnormal, and juvenile periodontitis associated with other diseases. Juvenile periodontitis is perhaps the best understood form of periodontal disease. As always, it should be accepted practice not only for adults but also for children to visit the dentist at least once every six months.

Juvenile periodontitis.

A degenerative periodontal disease of adolescents in which the periodontal destruction is out of proportion to the local irritating factors present on the adjacent teeth; inflammatory changes become superimposed, and bone loss, migration, and extrusion are observed. Two forms are recognized: localized, in which the destruction is limited to the incisors and first molars; and generalized, involving all the teeth.

Juvenile periodontosis is defined as a disease of the periodontium occurring in otherwise healthy adolescents (onset as low as 11 and as high as 20 years of age) and characterized by rapid alveolar bone loss in one or more permanent teeth (2:73). The disease has been classification” (3:268) and usually occurs in young adults, though much earlier onset, around puberty, has been observed (1:58).

Localized Juvenile Periodontitis (LJP)

LJP is different from all other periodontal infections, as it is not associated with plaque accumulations or calculus (in fact the absence of such led early investigators to consider it as a degenerative condition), is localized to certain anterior or front teeth and first molars, and is seen following puberty. It is a rather rare entity, occurring in about 0.1 to 0.5% of teenagers, but when found, is often clustered within families.

This familial background suggested a genetic predisposition, which subsequently has been identified as a neutrophil defect associated with reduced chemotaxis. Bacterial examinations of subgingival plaque from affected teeth and adjacent healthy teeth, revealed that the diseased teeth were colonized by an essentially Gram-negative flora dominated by organisms subsequently identified as various Capnocytophaga and Wolinella species and Actinobacillus actinomycetemcomitans. It is A actinomycetemcomitans that appears to be the etiologic agent of LJP, and the arguments for its involvement are illustrative of the arguments made to implicate other species in other forms of periodontitis.

Once LJP has been recognized clinically, most of the tissue damage has already occurred, thereby permitting only a retrospective diagnosis of an A actinomycetemcomitans infection. A actinomycetemcomitans is found at a higher prevalence in tooth sites associated with LJP and at a lower prevalence in healthy sites in the same mouth, or at sites in periodontally healthy individuals.

It is often found among other family members in a household with an LJP individual, and indeed among siblings at risk to LJP, there is suggestive data that colonization by A actinomycetemcomitans precedes the development of a pocket and subsequent bone loss. But what has been the most important reason for implicating A actinomycetemcomitans as a periodontopathogen, is its killing effect on neutrophils.

A actinomycetemcomitans produces a leukotoxin that kills neutrophils in vitro. It is clear that this leukotoxin is expressed in vivo, because patients with LJP have developed circulating antibodies which can neutralize this toxin in vitro. From this finding, a scenario can be developed that explains the localized nature of LJP.

Children with a neutrophil chemotactic defect become colonized by A actinomycetemcomitans in early life, presumably by contact with infected household members. The colonization spreads to those permanent teeth that erupted at ages 5 to 7, but remains quiescent as an infection during the time that the primary or baby teeth are lost, and new permanent teeth appear at about ages 11 to 13. The individual entering puberty, has a dentition composed of first molars and incisors that are colonized by A actinomycetemcomitans and newly erupted teeth that either are not colonized or only minimally colonized.

Something then triggers the relative overgrowth of A actinomycetemcomitans in the subgingival plaque, and some of these organisms invade the gingival tissue and cause attachment and bone loss in the absence of an obvious inflammatory response. The latter can be explained by both a sluggish neutrophil response to the bacteria and by the leukotoxin inhibiting the neutrophils, and thereby preventing a protective host response in the pocket microenvironment. The leukotoxin is antigenic and elicits an antibody response which may neutralize the leukotoxin at other tooth sites, thereby limiting the infection to the originally colonized molars and incisors.

This scenario, while incomplete, does explain the localized nature of LJP, partially explains the absence of an inflammatory response in the tissue, and demonstrates the dynamic role of neutrophils and circulating antibodies in defending the periodontium. Presumably, this theme is operating in the more commonly found cases of adult periodontitis. Certainly, the central role of the neutrophils in host defense is unquestioned, as individuals with neutropenias, chronic granulomatous disease and various leukemias often present with advanced forms of periodontal disease.

Generalized juvenile periodontitis

Generalized juvenile periodontitis which includes early onset adult periodontitis, recurrent necrotizing ulcerative periodontitis and the true generalized form of juvenile periodontitis. Periodontitis in systemically diseased individuals can be divided into three subgroups: juvenile periodontitis associated with primary neutrophil disorders, juvenile periodontal disease in which neutrophils are secondarily abnormal, and juvenile periodontitis associated with other diseases. Juvenile periodontitis is perhaps the best understood form of periodontal disease. A major infecting organism, Actinobacillus actinomycetemcomitans, is strongly associated with the disease, and may be an exogenous pathogen since it is not found in healthy individuals or in healthy sites in LJP patients. It is virulent with marked leukaggressive properties and it induces a marked antibody response in infected patients. Eradication of Actinobacillus actinomycetemcomitans requires attention to the fact that it invades the tissue and hence systemic antimicrobials or surgical excision of the tissues is necessary for eradication. Marked suppression of the organism from subgingival sites is associated with healing. Host responses in LJP have also been well described and most immune functions studied appear to be normal. The notable exception is neutrophil chemotaxis which is depressed. Associated with depressed neutrophil chemotaxis is a reduction of neutrophil receptors for several chemotactic factors including C5a, the fifth component of complement.

Conclusion

Many people think of periodontal disease as an adult problem. However, studies indicate that nearly all children and adolescents have gingivitis, the first stage of periodontal disease. Advanced forms of periodontal disease are more rare in children than adults, but can occur.

Types of periodontal diseases in children

Chronic gingivitis is common in children. It usually causes gum tissue to swell, turn red and bleed easily. Gingivitis is both preventable and treatable with a regular routine of brushing, flossing and professional dental care. However, left untreated, it can eventually advance to more serious forms of periodontal disease.

Aggressive periodontitis can affect young people who are otherwise healthy. Localized aggressive periodontitis is found in teenagers and young adults and mainly affects the first molars and incisors. It is characterized by the severe loss of alveolar bone, and ironically, patients generally form very little dental plaque or calculus.

Generalized aggressive periodontitis may begin around puberty and involve the entire mouth. It is marked by inflammation of the gums and heavy accumulations of plaque and calculus. Eventually it can cause the teeth to become loose.

Periodontitis associated with systemic disease occurs in children and adolescents as it does in adults. Conditions that make children more susceptible to periodontal disease include:

• Type I diabetes
• Down syndrome
• Kindler syndrome
• Papillon-Lefevre syndrome

It is good practice for adults as well as children to make regular visits to their dentist (at least once every six months).  The problem of juvenile periodontitis can be eliminated through good oral hygiene habits and dental care.

Introduction

drkam

Diabetic patients are more likely to develop periodontal disease, which, in turn, can lead to  blood sugar and diabetic complications.

People with diabetes are more likely to have periodontal disease than people without diabetes, probably because diabetics are more susceptible to contracting infections. In fact, periodontal disease is often considered the sixth complication of diabetes. Those people who don’t control their diabetes are especially at risk.

A study in the Journal of Periodontology found that poorly controlled type 2 diabetic patients are more likely to develop periodontal disease than well-controlled diabetics are.

Research has emerged that suggests that the relationship between periodontal disease and diabetes goes both ways – periodontal disease may make it more difficult for people who have diabetes to control their blood sugar.

Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts diabetics at increased risk for diabetic complications. Thus, diabetics who have periodontal disease should be treated to eliminate the periodontal infection.

This recommendation is supported by a study reported in the Journal of Periodontology in 1997 involving 113 Pima Indians with both diabetes and periodontal disease. The study found that when their periodontal infections were treated, the management of their diabetes markedly improved.

Other Mouth-Body Connections

Inflammation and Periodontal Diseases

Journal of Periodontology Supplement on Inflammation

In January 2008 the Academy held a workshop on inflammation, inviting a select group of medical and dental experts on the subject of inflammation. The proceedings from the supplement were published in August 2008, and are available online at the links below.

• Journal of Periodontology Supplement Inflammation and Periodontal Diseases: A Reappraisal
• Dr. Robert Genco’s paper, which appeared in the supplement, discusses the clinical implications of managing inflammation and periodontal diseases.
• Press Release announcing the supplement “Inflammation and Periodontal Diseases: A Reappraisal” supplement

Gum Disease and Osteoporosis

Researchers have suggested that a link exists between osteoporosis and bone loss in the jaw. Studies indicate that osteoporosis may lead to tooth loss because the density of the bone that supports the teeth may be decreased, which means the teeth no longer have a solid foundation. However, hormone replacement therapy may offer some protection.

Gum Disease Links to Heart Disease and Stroke

Researchers have found that people with gum disease are almost twice as likely to suffer from coronary artery disease.

Heart Disease

Several theories exist to explain the link between periodontal disease and heart disease. One theory is that oral bacteria can affect the heart when they enter the blood stream, attaching to fatty plaques in the coronary arteries (heart blood vessels) and contributing to clot formation.

Coronary artery disease is characterized by a thickening of the walls of the coronary arteries due to the buildup of fatty proteins. Blood clots can obstruct normal blood flow, restricting the amount of nutrients and oxygen required for the heart to function properly. This may lead to heart attacks.

Another possibility is that the inflammation caused by periodontal disease increases plaque build up, which may contribute to swelling of the arteries.

Researchers have found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease as those without periodontal disease.

Periodontal disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures.

 Stroke

Additional studies have pointed to a relationship between periodontal disease and stroke. In one study that looked at the causal relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group.

Gum Disease and Pregnancy Problems

Pregnant women who have periodontal disease may be seven times more likely to have a baby that is born too early and too small.

For a long time we’ve known that risk factors such as smoking, alcohol use, and drug use contribute to mothers having babies that are born prematurely at a low birth weight.

Now evidence is mounting that suggests a new risk factor – periodontal disease. Pregnant women who have periodontal disease may be seven times more likely to have a baby that is born too early and too small.

More research is needed to confirm how periodontal disease may affect pregnancy outcomes. It appears that periodontal disease triggers increased levels of biological fluids that induce labor. Furthermore, data suggests that women whose periodontal condition worsens during pregnancy have an even higher risk of having a premature baby.

All infections are cause for concern among pregnant women because they pose a risk to the health of the baby. The Academy recommends that women considering pregnancy have a periodontal evaluation.

Gum Disease and Respiratory Diseases

Bacteria in your mouth can be aspirated into the lungs to cause respiratory diseases such as pneumonia, especially in people with gum disease.

Bacterial respiratory infections are thought to be acquired through aspiration (inhaling) of fine droplets from the mouth and throat into the lungs. These droplets contain germs that can breed and multiply within the lungs to cause damage.

Recent research suggests that bacteria found in the throat, as well as bacteria found in the mouth, can be drawn into the lower respiratory tract. This can cause infections or worsen existing lung conditions. People with respiratory diseases, such as chronic obstructive pulmonary disease, typically suffer from reduced protective systems, making it difficult to eliminate bacteria from the lungs.

Scientists have found that bacteria that grow in the oral cavity can be aspirated into the lung to cause respiratory diseases such as pneumonia, especially in people with periodontal disease. This discovery leads researchers to believe that these respiratory bacteria can travel from the oral cavity into the lungs to cause infection.

Chronic obstructive pulmonary diseases (COPD) cause persistent obstruction of the airways. The main cause of this disease is thought to be long-term smoking. Chemicals from smoke or air pollution irritate the airways to cause obstruction. Further damage to the tissue and working function of the lungs can be prevented, but already damaged tissue cannot be restored – untreated or undetected COPD can result in irreversible damage.

Scientists believe that through the aspiration process, bacteria cam cause requent bouts of infection in patients with COPD. Studies are now in progress to learn to what extent oral hygiene and periodontal disease may be associated with more frequents bouts of respiratory disease in COPD patients.

Conclusion

Untreated gingivitis can advance to periodontitis and eventually lead to tooth loss and other health problems.

Periodontal (gum) diseases, including gingivitis and periodontitis, are serious infections that, left untreated, can lead to tooth loss. The word periodontal literally means “around the tooth.” Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth. Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes the gums to become inflamed.

Gingivitis

Gingivitis is the mildest form of periodontal disease. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional treatment and good oral home care.

Periodontitis

Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.

There are many forms of periodontitis. The most common ones include the following.

• Aggressive periodontitis occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction and familial aggregation.
• Chronic periodontitis results in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss. This is the most frequently occurring form of periodontitis and is characterized by pocket formation and/or recession of the gingiva. It is prevalent in adults, but can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur.
• Periodontitis as a manifestation of systemic diseases often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis.
• Necrotizing periodontal disease is an infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression.

Find a Periodontist

Periodontists are experts in the diagnosis and treatment of gum disease and can help you keep your teeth for life!

 

Introduction

It is a widely accepted view that the more you know about a particular topic, the better you are prepared when it comes to  sharing  your perspective, experiential knowledge and research with others  through of dialogues and discussions. The basic  observation also applies in  the area of dental health.  It follows then that  some general knowledge of dental health  enables  us to  understand why it is important for our general health. At the same time, it will motivate us to care of our teeth so that they can last a lifetime so that we  do not experience severe toothaches and weak gums .  Did you know that your teeth were intended to last a lifetime?

Here are some fun facts about teeth that you might find interesting.  50% of people say that a smile is the first feature they notice about someone. This article attempts to share a interesting and useful information when it comes to the care and maintenance of  our teeth.

How people take care of their mouths is often a reflection about how they feel about themselves.  At  birth the only fully developed organ is the tongue.  It is needed for sucking.  For the first two months of life our mouth is our primary organ.  We use it for survival, to express ourselves and to explore our new world.  Because of this it is my opinion that how we take care of our mouths is a reflection of how we feel about ourselves.  People who feel good about themselves take good care of their mouth and people who have a poor self image generally do not take good care of their mouth.

Here are some interesting facts:

Chewing gum may not be so bad, yes, you read that right, if  it is of  the sugarless variety. Even then, we cannot  say  that  chewing a piece of gum for hours on end  is good, even when it was found that chewing gum may help after every meal to remove food particles caught in the teeth are and in the production of saliva, which prevents plaque.

Recent surveys  showed that men and women feel guilty if they forget to clean their teeth; apparently, most people feel that brushing is a kind of obligation. About 80 per cent of respondents  say that they brush their teeth, because it is something that they have been asked to do in their lives.

The reality is that most people do not actually do so since  over 75% (three out of four people) of these respondents do not change their toothbrushes as often as they should. It is recommended by dentists that  for reasons of good hygiene, we should replace our toothbrushes every two to three months. Most of us  apparent do not  adopt this practice.

Smoking is hazardous to our health, yet most of us who smoke  ignore  this. Oral cancer occurs twice as often in men than in women and  smoking one pack of cigarettes per day and with smokeless tobacco, the risk of developing oral cancer is expected to increase by four times.

You get 2 sets of teeth in your lifetime.

The first set is your baby teeth. You will start to lose your baby teeth at around 6-7 years of age. By the time your 21 years old, you will only have one set of permanent teeth.

Always replace a toothbrush after you had a cold, sore throat or some bad infections. The bacteria planted on the toothbrush can lead to reinfection.

Replace toothbrush

The swallowing of a fluoride containing toothpaste can cause many harmful effects such as fluoride toxicity. (Hence kids below 5years should be given non fluoridated toothpastes)

Toothpaste

• Vigorous brushing does more harm than good. Overzealous brushing can lead to eroded enamel which never grows back causing teeth sensitivity along with other oral problems.

More people use blue toothbrushes than red ones.

Like fingerprints, everyone’s tongue print is different.

The average toothbrush contains about 2,500 bristles grouped into 40 tufts per tooth brush. The tufts are folded over a metal staple and forced onto pre-cored holed in the head and fused into the head with heat. The handle is made of at least two materials, using plastic and rubber. The grip used for the handle is: precision, power, spoon and distal oblique.

The average woman smiles about 62 times a day!

A man? Only 8!

Kids laugh around 400 times a day. Grown-ups just 15:-(

Smilers in school yearbooks are more likely to have successful careers and marriages than their poker faced peers

Tooth decay remains the most common chronic disease among children ages 5-17 with 59% affected.

More than 51 million hours of school are lost each year by children due to dental related illness.

Employed adults lose more than 164 million hours of work each year due to oral health problems or dental visits.

Just 40% of children in poor or near-poor poverty level had a preventive dental visit in the past year.

44% of dental care expenditures are paid out-of-pocket.

Conclusion

Some general knowledge of dental health  enables  us to  understand why proper dental hygiene and care are  important for our general health. At the same time, it will motivate us to care of our teeth so that they can last a lifetime .  We  do not experience severe toothaches and weak gums .  Do you know that your teeth were intended to last a lifetime?

In order to have your teeth for a lifetime it is essential that you take good care of them by cleaning your mouth and brushing and flossing your teeth regularly, particularly after every meal. This habit will enable you to have both clean teeth and healthy gums. You should also make it a personal duty to visit your dentist on a regular basis. The dentist will be able to treat cavities and inspect our mouth and gums. Prevention is always better than cure.

For patients with chronic and disabling conditions, it is mandatory that they see their dentist regularly. This is a good habit because several diseases can be identified  and can be successfully treated in their early stages . A dentist screens for health problems such as eating disorders, diabetes, drug abuse, and HIV infection.

Source: Issue Briefs on Challenges for the 21st Century

Comment:

drkam

It is shocking to learn from this Bernama report which stated that only six percent of Malaysians (total population of 28 million) are utilising dental services available in our country. Given rising living standards, one would have expected adults would be conscious of good oral hygiene and dental care. Children are setting the good example, given that free dental care is provided by clinics on wheels that come to our schools regularly.

The Ministry of Health Dentistry Division Director  Datuk Dr. Norain Abu Taib attributes the low turnout of adults at dental clinics, both government and private clinic, to their not being able to “understand the importance of dental health”. Blogs like mine have been spreading the message that apart of considerations of personality of having a good set of teeth, oral hygiene habits must be inculcated early in our young Malaysians preferably at school. Obviously, Datuk Dr. Norain and her team are  doing their best  in this  regard.  But more needs to be done to ensure that a higher percentage of  Malaysians see their dentists regularly.

Parents too have a critical role to play and should be example of good practitioners of oral hypiene, encouraging their children to see their dentist at least once every 6 months. Adults too can be encouraged to take preventive measures to ensure that they can enjoy having good teeth throughout their lifetimes. It pays off if they undertake preventive measures like proper brushing and flossing of their teeth and going off to see their dentists at the slightest sign that they have cavities or swollen gums.

Early attention saves lots of cost and inconvenience. The visit to dentist should be liken to a visit to a beautician, hair stylist or a masseur. But then, all attempts to look good would come to naught if one carries a poor set of the teeth.  A good set of teeth enhances one’s personality and does wonders to one’s self confidence.  Furthermore, one must not compromise on one’s health, including dental health–drKam.

KUALA LUMPUR, Nov 15 (Bernama) — Only six per cent of Malaysia’s 28 million population are utilising dental services and half of them are schoolchildren, Health Ministry Dentistry Division director Datuk Dr Norain Abu Talib said on Sunday. She said the small percentage was mainly due to the fact that most of the people in the country would only seek dental treatment if they were having dental problems. “They will only go to the dental clinic when they have toothache. That will be too late because by then you have to extract the tooth.” She said this after opening the 20th Convention and Science Exhibition of the Malaysian Private Dental Practitioners Association here. She said although the country was facing a shortage of dentists, it was not the main reason why most Malaysians did not seek dental treatment. “The main reason is that most of the people are not aware of the importance of dental health,” she said.

Nevertheless, Dr Norain said the ministry had targeted to have a ratio of one dentist for every 4,000 patients by 2020 to ensourage more people to visit the dental clinics. “Although we aim to achieve that target by 2020, with 11 institutions of higher learning offering dentistry, we are confident that the target can be achieved by 2018,” she said, adding that the current ratio was one dentist for every 7,800 patients. — BERNAMA

November 16, 2009

Introduction

Many of us have these amalgam fillings. Too many people feel that they have amalgam toxicity. A lot of times, people need to have these fillings removed because it is chipping or is just wearing down from many years of use. Many years ago, getting an amalgam filling was no big deal but today, people wonder whether mercury based fillings are safe.

Mercury is a highly toxic metal associated with damage to the kidneys and central nervous system. Mercury vapor is emitted from volcanoes, coal-burning power stations, and municipal incinerators and returns to the earth through rain contaminated with metallic mercury. Metallic mercury is methylated to methyl mercury in oceans and lakes and enters the food chain via fish and other seafood. Long-lived predator fish such as shark, swordfish, tilefish, king mackerel, and pike and bass in fresh water are the main sources of methyl mercury. Dental amalgams are an important source of mercury vapour and the vaccine preservative thimerosal is a significant source of ethyl mercury.

Today we have a choice: Avoid using amalgam

Actually,in those bygone days, there was no choice; if you needed to get a cavity filled, you just got amalgam or gold. Now, you have a choice. A lot of dentists are not even using amalgam anymore and instead, erring on the side of prudence, they use  safer materials, such as  composite resins.

Go to a Prudent Dentist

If you are like many of us and need to get an amalgam filling replaced, the best advice is to go to a dentist  who takes extra precautions in the removal. If a dentist is just going to go in and take it out as if he was just filling it, then run and run fast. Go to a dentist who believes that it is dangerous to remove these fillings. When a filling is being removed, mercury is leaked out ,and you are breathing it in. During the removal, a patient can be exposed to mercury vapor. Sometimes, the patient can even swallow some.

The increase in mercury in a person’s body can cause many different problems. Illness, memory problems, and chronic fatigue are a few of the possible problems. If a few extra precautions are taken on the dentists part, it does not have to amount to all of those problems. It is not recommended to have amalgams removed while pregnant or breastfeeding unless there is no other option. The mercury vapor would be passed on to the fetus or in the breastmilk. There have been studies that link mercury to autism. It is best to just wait until after you give birth or stop breastfeeding, for your baby’s sake.

Safe Removal of Amalgam Fillings

Dentists all over the world remove millions of amalgam fillings every day, with no regard for the possible mercury exposure that can result from grinding them out. Much of the time, a new amalgam filling goes back in place of the old one. The dental establishment claims that amalgam is a stable material, that emits little or no mercury, but then turns around and blames the mercury-free dentists for “unnecessarily exposing patients to excess mercury” when removing amalgams electively. Well, which is it? Stable, or mercury emitting.

However, please bear in mind that the material presented here is intended strictly as a set of suggestions. A licensed practitioner must make up his or her own mind concerning specific treatment options.

Cut and Chunk, Keep it cool

Most of these suggestions are simple and obvious, common sense physical means of reducing exposure. If you remove an old amalgam by slicing across it and dislodging big chunks, you will aerosolize less of the contents than if you grind it all away. If you keep it under a constant water spray while cutting, you will keep the temperature down, and reduce the vapor pressure within the mercury.

Suction!

Your best tool for removing mercury vapor and amalgam particulates from the operating field is your high volume evacuation (HVE). Keep it going next to the patient’s tooth until you are finished with the removal and clean-up process. But check to see where in your office it discharges! If the vacuum pump discharges into an open trap or through its own base, you could be pumping mercury vapor into your utility room or lab. A highly effective HVE adjunct is the “Clean-Up” suction tip, which has an enclosure at the end that surrounds the tooth you’re working on. It dramatically reduces the spatter of particles, directing them efficiently into the suction tube.

Rubber dam or no rubber dam?

Some dentists hate rubber dams, while others can’t live without them. Reduced exposure amalgam removal can be done either way. A rubber dam will help contain the majority of the debris of amalgam grinding, among its many other benefits.

Berglund and Molin8 demonstrated, as a follow-up to Molin’s 1990 study, that the use of a rubber dam eliminated the spike in plasma mercury one day after amalgam removal, as well as the spike in urine mercury ten days afterward: evidence of its protective benefit. Of course both amalgam removal groups, dam or no dam, showed 50-75% reduction in mercury levels a year later.

But you must know that mercury vapor will diffuse right through the dam, and some of the particulates will often sneak past it. So:

• Always use a saliva ejector behind the dam to evacuate air that may contain mercury vapor.
• Rinse the dam well as you go, because amalgam particles left on it will emit mercury from your garbage can. (If you wipe your dirty mirror on a gauze square or the patient’s bib, that gray smear also emits quite a lot of mercury vapor!)
• As soon as the amalgams are out, remove the dam and thoroughly rinse the patient’s mouth before placing the new restorations. It can take as much as sixty seconds of rinsing to fully remove the mercury vapor. Search for gray particles. If there are particles on the back of the tongue, have the patient sit up and gargle them out.

If you don’t use a rubber dam, you must be vigilant with the HVE, and take frequent breaks to thoroughly rinse the field. Either way, the “Clean-Up” suction tip reduces the dispersion of particulates in the area.

Cover the Skin

Covering the patient’s face with a barrier will prevent spattered amalgam particles from landing on the skin, or the eyes. The barrier can be as simple as a moist paper towel, or as elaborate as a surgical drape.

Rubber gloves

Mercury vapor will diffuse through latex and vinyl gloves, just as it does through latex and vinyl rubber dams. Nitrile material is a more effective diffusion barrier, and while there are no nitrile rubber dams available, nitrile rubber gloves appear to better protect the dentist’s hands from a concentration of mercury vapor.

Controlling the Breathing Space

However efficient your HVE technique is, the air surrounding the operative field will fill up with a mercury vapor and amalgam particulate aerosol. Keeping the breathing space of the patient and dental staff free of contamination is the next priority.

Supplemental Air

Provide the patient with piped–in air, so they do not have to breathe the air directly over the mouth during amalgam removal. A positive pressure respiration device such as a nitrous oxide nose hood, or a similar ventilation device, is probably the best way to provide clean air. A nasal cannula that admits ambient air won’t help.

Respirators for the Staff

The typical paper hygienic masks that are in everyday use are of no benefit whatsoever for removing either amalgam particulates or mercury vapor from the air we breathe. The best protection for the dental staff, from an industrial hygiene point of view, would be a positive pressure respirator. This kind of system is certainly available from safety equipment suppliers. Much simpler to set up would be a Bureau of Mines certified, “half–mask” respirator with mercury rated filter cartridges. However, the cartridges need to be fitted with a “P-100” rated particulate filter, which will remove particles as small as 0.3 microns.

Conclusion

Amalgam filling should be carefully removed. It is prudent for you to visit a dentist who takes special effort and use proper procedure to have them removed. Although studies have yet to make definite conclusions about the effects of amalgam on our health, we now have knowledge  about the toxicity of mercury and its effects on the kidneys and central nervous system. You may be well advised to see a good dentist who will be able to advise you on what can be done with your amalgam fillings. Be sure to ask your dentist how he would deal with the removal of those fillings. As this article tries to show, special removal procedures are required before amalgam fillings can be safely removed.

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Safety of Mercury-containing fillings

Introduction

University of Saskatchewan research team found that surface forms of mercury in older “silver” fillings (also known as amalgams) may be less toxic than previously thought. But due to the significant mercury loss over time, human exposure to mercury lost from fillings is “still of concern” and that further research is needed to determine when, how and in what form mercury is lost from fillings.  Despite the fact that their finding is far from conclusive, we still should have our old fillings checked during our routine visits (at least once every 6  months) to our dentist.

Dental Amalgam ( Mercury) Fillings may be less toxic than previously thought.

by Graham George, B.Sc., D.Phil., et.al

Amid the on-going controversy over the safety of mercury-containing dental fillings, a University of Saskatchewan research team has shed new light on how the chemical forms of mercury at the surface of fillings change over time.

Their work, just published in the American Chemical Society journal Chemical Research in Toxicology, shows that the surface forms of mercury in older “silver” fillings (also known as amalgams) may be less toxic than previously thought.

“The dental amalgam on the surface of an old tooth filling may have lost as much as 95 per cent of its mercury but what’s left is in a form that is unlikely to be toxic in the body,” said U of S Canada Research Chair Graham George who led the study.

But the team cautions that due to the significant mercury loss over time, human exposure to mercury lost from fillings is “still of concern” and that further research is needed to determine when, how and in what form mercury is lost from fillings.

Mercury-based fillings have been used by dentists to repair teeth for well over a century. But in recent decades, their use has become controversial due to concerns about exposure to potentially toxic mercury.

“Mercury can potentially exist in several different chemical forms, each with a different toxicity,” said George. “Prior to our work, little was known about how the chemical forms of mercury in dental amalgam might change over time.”

The team used a special X-ray technique at the Stanford Sychrotron Radiation Lightsource to probe the amount and chemical nature of mercury at the surface of both freshly prepared metal fillings and aged fillings (about 20 years old) obtained from the U of S dental clinic’s tooth bank.

While the fresh fillings contained metallic mercury, which can be toxic, aged fillings contained a form of mercury called beta-mercuric sulfide or metacinnabar which is unlikely to be toxic in the body. For this reason, grinding or polishing during dental cleaning is unlikely to cause any toxic effects.

But of potential greater concern is the nature of the surface mercury lost from fillings. This may be due to evaporation (with subsequent inhalation and leaching of mercury into saliva), exposure to some kinds of dental hygiene products such as those containing peroxides, exposure to certain sulphur-containing foods (such as onion and garlic or coffee), or other factors.

“Possibly this missing mercury is in the less toxic form of mercury (metacinnabar) abraded from the surface of the filling. Or alternatively, it may be mercury lost prior to formation of the metacinnabar through various types of exposures,” said George.

In North America, the traditional view is that the advantages of mercury-containing amalgam outweigh any possible health risks, and for this reason, mercury-containing dental amalgams are still widely used.

Other members of the team include Satya Singh, Jay Hoover, and Canada Research Chair Ingrid Pickering. This project was supported by a grant from the Canadian Institutes of Health Research.

Conclusion

Because of its durability, dental amalgam (mercury based) are still widely used in North America and other developed countries. With new types of tooth colored fillings, most dentists are gradually phasing out its use. In the case of Dr Kamsiah, she has never used dental amalgam for fillings in her private practice (since 1997).  This is a matter of her personal choice to ensure that her patients are not exposed to unnecessary health risks.

by Dr Kamsiah binti Gulam Haider

Introduction

When children loose a tooth, there is celebration and joy. When adults loose a tooth, there is usually concern and dismay. Children replace their own tooth by growing one anew. Adults require assistance from their family dentist. The first job of the dentist is to assist their patient  with the decision of how to replace that tooth.

There are many options available to replace teeth. When a front tooth is lost in an accident, such as when playing a sport or in a car, time can be a major concern. Dentists can replace a tooth very quickly by fabricating a single tooth denture . This kind of denture is much like an orthodontic retainer with one or two teeth; it may have a couple of wire clips that hold it onto other teeth. Dentures are easy to wear and care for, and they repair the patient’s appearance. Most people are not happy with their ability to chew with the denture in place, so they remove it when eating. Some have trouble talking with the denture at first, but speech improves with practice. This is the least expensive way to replace a tooth. Some patients will live with a denture for years before replacing it with a more permanent false tooth or another denture.

There are three basic ways to fix a missing tooth or teeth.

• A fixed bridge
• A removable appliance
• A dental implant

A fixed bridge

Having a bridge is like having three crowns. The teeth on either side of the missing tooth are prepared for crowns, an impression is made, and the case is sent to a dental laboratory. The laboratory then makes the crowns and fastens a false tooth between the two crowns – this is a bridge.The advantages of a bridge are that it is fixed, stable, and feels like your own teeth. In most cases it can be made to look just like you never had a tooth missing. The disadvantage is that you have to treat two teeth besides the one that was extracted – these teeth may otherwise be perfectly sound with nothing wrong.

A Maryland bridge is the least expensive type, but has some esthetic and mechanicalproblems.Usually used as an interim treatment during implant treatment in 2 stage implant procedure.

Using the ovate pontic technique with a dental bridge can create the illusion that the false tooth is growing out of the gum.

A Removable Appliance.

Something removable can be used to replace a missing tooth. This can be anything from a budget “denture” (a piece of plastic with a false tooth attached) or a Cobalt Chromium, to a more sturdy metal and acrylic removable partial denture.

The advantages of the removable partial denture appliance are that it is a more economical way to replace missing teeth than a fixed bridge. Also, you can replace multiple teeth with one appliance. If the span of missing teeth is three or more, or if there are not solid teeth on both sides of the missing teeth, a fixed bridge may not work.

The disadvantages are that it may not be as esthetic as a bridge. Clasps will be required to retain the removable partial, and it may not be possible or practical to entirely conceal those (though that problem can be avoided often with a “precision attachment” partial). Also, there may be some discomfort with wearing removable hardware in your mouth, and it is not as stable as a bridge.

A dental implant

A dental implant is an artificial “root” that is implanted in your jaw after a tooth extraction, and then a tooth is placed on it. Biologically, it is like placing an entirely new artificial tooth in your mouth.The advantages of an implant are: No teeth on either side have to be prepared for crowns, so there is no grinding on “good teeth” – you just fix the missing tooth. Implants can also span the space of multiple missing teeth. There is no limit to the span they can cover, as long as the patient’s health is good and there is healthy and adequate bone to support the implant. An implant also is fixed and feels just like your own teeth. Read our more thorough discussion of implants, plus see before-and-after photographs, on our cosmetic dental implant page.

The disadvantages of implants are that they can cost more and be more and time-consuming, and the cost may not be covered by dental insurance. You will likely have to deal with two dentists – the dentist who does the surgery to place the implant, and the dentist who puts the false tooth on top of the implant. There is also a delay in getting the false tooth or teeth – a healing interval of several months may be required before the artificial root can have a tooth placed on it. There is also surgery involved with its attendant discomfort and healing period.

However, if you are missing multiple teeth or all your teeth, there is a strong advantage to dental implants in that they will preserve the jawbone. Sometimes dentists don’t explain the negative long-term consequences of missing teeth, which are that your jaw gradually shrinks until you can’t wear any removable appliance. To read more about this, please see our page about facial collapse. So if you want to still be able to eat when you’re 80, you may want to consider investing in dental implants to replace those missing teeth.

Conclusion

Removable partial dentures have metal clasps that clip onto teeth to hold the device in the mouth. Patients need to take these in and out for cleaning after eating. Tooth supported bridges rely on the adjacent teeth for support. The teeth next to the missing tooth space are ground down and the bridge is cemented onto them. This bridge does not come in and out and relies on the integrity of the adjacent teeth for support.

The final method of tooth replacement is the dental implant, which is a replacement for the root of a tooth. The implant is placed where the root of the missing tooth used to be. The replacement root is then used to attach a replacement tooth.

There is significant loss of adjacent teeth (ranging from 12%-19%) if the missing tooth is not replaced.Tooth supported bridges improve the survival rate, with abutment tooth loss from 7%-10% at 6.7 and 8.6 years. Removable partial dentures increase abutment tooth failure rate ranging from 17% to 30% at 4.2 to 7 years. There is no significant difference in the statistics of the various studies.When an individual loses a tooth there are important decisions to be made.

Patients who do not replace missing teeth may experience shifting of teeth, spaces opening between teeth (resulting in food impaction), collapse of the bite, alterations in their chewing ability, TMJ pain, and trauma to the remaining teeth. People sometimes don’t replace teeth that are “in the back” of the mouth because no one sees them. The back teeth are needed to support the bite and grind up food. We can all swallow food that is not chewed thoroughly, but this compromises the nutrition we extract from our diet.

Dental care for those above 6 year old

Dental Treatments
 
Filling
 
If you suffer from dental caries, you have to see a dentist for filling to prevent the caries from getting worse.

Why do we need filling？

*To stop pain caused by decayed tooth.
*To restore the shape and functions of the tooth, such as chewing, articulating, aesthetics,  and etc.
*To keep the carious deciduous teeth to prevent alignment problem in permanent teeth due to  early loss of deciduous teeth.
*Overview of filling process

-Remove the decayed tooth structure.
-Place the filling material into the cavity.
-Trim off and polish the filling material.
-How many filling materials do you know?

Composite resin fillings
Colour: similar to natural tooth colour

Glass Ionomer Cement
Colour: similar to natural tooth colour
Compomer
Colour: similar to natural tooth colour

Stainless steel crown
Colour: Silver. It has different sizes, and it is often used on deciduous molars.

Feeling uncomfortable after filling?
- It takes a few days to adapt to the newly filled tooth. If situation hasn’t gradually improved, or has even slowly got worse, you need to see the dentist for a detailed examination.

  
Temporary Denture
If a child loses his/her permanent tooth due to an accident, his/her dentist needs to fabricate a temporary denture for him/her.

Purpose
To improve aesthetics by filling the gap left by the missing tooth. To wait until the child’s jawbones are fully developed (around 18 years old) to insert a permanent denture/bridge/implant.

Material
Plastic and stainless steel wires.

Procedure

Impressions of the teeth are taken, and the occlusion is recorded
The temporary denture is fabricated in the dental laboratory
The temporary denture is fitted
Points to note

After fitting a temporary denture, extra attention should be paid to the oral hygiene in order to prevent dental caries and periodontal disease.
Thoroughly clean the denture and teeth every morning and before bed at night.
When the temporary denture is not worn, it must be soaked in plain water.
If severe discomfort is felt when wearing the temporary denture, you must bring your child to the dentist immediately.
   
Pulp Treatment (Root Canal Treatment)
What is pulp treatment?
Pulp treatment is necessary if the pulp of a tooth is infected or became necrotic because of trauma or dental caries. The treatment involves partial or complete removal of the pulp and application of filling material to fill up the area.

Knowing more about pulp treatment

Pulp treatment requires a few visits to complete. Remember to revisit on schedule!

If the filling material has fallen off during the treatment period, you must ask the dentist to refill the material in order to avoid infection caused by bacteria in the saliva.

Local anaesthesia may be required during the treatment. Remember not to bite your lips or tongue before the anaesthesia has worn off. 
 
Leong’s Premolar
What is Leong’s Premolar?
Some permanent premolars have a projected portion of the tooth structure which is fragile; this kind of premolar is called ‘Leong’s Premolar’. If the projected portion fractures, the pulp inside the tooth may become necrotic from bacterial infection, or even results in abscess.

If I have a Leong’s Premolar, what should I do?

To avoid the projected portion to fracture, the dentist will use the preventive treatments below according to individual need:

Method 1: Strengthen the projected portion
Method 2: Remove the projected portion and apply filling to the cavity
If you think you have a Leong’s Premolar, you should ask your parents to take you to a dental clinic for a detailed check-up and receive appropriate treatment as soon as possible!
 
 
Orthodontic Treatment
What is orthodontic treatment?

Orthodontic treatment is a series of processes to move poorly aligned teeth to a desirable position.

Orthodontic treatment can：

Improve aesthetics
Improve the occlusion and chewing function. 

Types of orthodontic appliances

Fixed orthodontic appliance

Procedure
Placement of orthodontic brackets.
The orthodontic wire and orthodontic brackets are connected by elastics and stainless steel wires (ligatures).
Regular dental revisits are needed according to the instructions of the orthodontist.
After the teeth have moved to favourable positions, a retainer is used to hold and stabilize the teeth in these positions.

How long does a fixed orthodontic treatment take?
The overall duration lasts for about one and a half to three years. The actual time needed depends on the complexity of treatment.
Removable orthodontic appliance

It is suitable for simple orthodontic treatments.

Procedure
Impressions of the teeth are taken.
The removable orthodontic appliance is fabricated in the dental laboratory.
The appliance is fitted in the mouth. It is also activated.
Regular dental visits to check the tooth movements and adjust the appliance.
How long does a removable orthodontic treatment take?
The overall duration lasts for about 6 to 12 months. The actual time needed depends on the complexity of treatment.
 

Points to note on orthodontic treatments

When you are wearing an orthodontic appliance, extra attention towards oral hygiene is needed to prevent dental caries and periodontal disease.

When you are wearing a removable orthodontic appliance, the appliance and teeth must be thoroughly cleaned every morning and evening before wearing it again. Leave the appliance in a cup of water when it is not worn.

If severe discomfort is felt when you are wearing an orthodontic appliance, consult your orthodontist immediately.
Consult the dentist to see whether or not it is necessary for you to undergo orthodontic treatment. Allow him to check your oral situation and explain the treatment to you in detail.
  
Extraction
Why do we need to extract a tooth？

Caries is found on a tooth where we cannot or do not need to repair it.
For the needs of orthodontic treatment.
Procedure

Apply local anaesthesia to let the teeth and oral tissues to get numb.
Use dental tools to take the tooth out.
Tightly bite on a piece of gauze or cotton roll to help stop bleeding.
Points to note after extraction
For the next 24 hours, you should :

Not rinse your mouth vigorously
Not disturb the wound with your tongue or fingers
Not use alcoholic beverages
Not do heavy exercise
Not smoke
Take pain control medication as recommended
Generally speaking, the wound will gradually heal in 3 to 4 days after the extraction. If discomfort persists even after 4 or 5 days, you should ask your parents to bring you to the dentist for a detailed check-up.
 
  
Fissure sealant
Under what circumstances are fissure sealants needed?

Fissure sealant is a composite sealant; it requires a dental professional to apply it for us.

If there are deep fissures on a tooth, dental plaque can easily accumulate in these areas where toothbrush bristles cannot access to and clean these areas.

In order to prevent these teeth from dental caries, we need to apply fissure sealants to seal these fissures.

Procedures for applying fissure sealants

First use diluted acid to etch the surface of the tooth so that the sealant can adhere onto the tooth.

Use water to wash away the acid, blow-dry the tooth, and then apply the fissure sealant onto the fissure.

Use curing light (a dental light source) to harden the fissure sealant in the fissure. 
 
Scaling and Polishing
Why do we need scaling and polishing?

Scaling removes the accumulated dental plaque, calculus, and stain from the surfaces of our teeth, which can prevent periodontal disease.

Treatment procedure

Use dental instruments or ultrasonic scaling machine to remove calculus.
Polish the surfaces of teeth to remove stain and keep the surfaces smooth.
Points to note after scaling
There may be slight discomfort and minor gingival bleeding in the first few days after scaling. Please do not worry. You only need to thoroughly clean your teeth daily, and the discomfort and gingival bleeding will gradually disappear. The gum will become healthy as well.

Prophylaxis is designed to preserve health and prevent the spread of disease.  The purpose of polishing tooth surfaces is to make these surfaces smooth which makes it more difficult for plaque and debris to accumulate on your teeth to cause decay or gum disease 

Dental polishing or prophy, is rarely done at the first appointment due to restrictions applied by patients dental plans and is only done after completing the clinical exam if there is no presence of gum disease.

It is professionally defined as a procedure that includes scaling and polishing procedures to remove coronal plaque, calculus and stains deposits that are coronal only (which rarely exist) and is a scaling and polishing procedure for patients in a healthy oral state.

 Professional polishing removes plaque, tartar, and stain from the teeth. It is a cosmetic procedure that removes surface stains on the crown part of the tooth or above the gumline so they will look and feel cleaner.  However, this procedure is not a procedure that cleans infected, diseased gum tissue and root surfaces. This is only a superficial cleaning and will not eliminate disease or get it under control. 

 This cleaning may be done by your dentist, dental hygienist, and/or a licensed professional who performs this polishing in the dental office along with education in the proper care of your teeth and gums.

It’s main purpose is to improve the appearance of your teeth by making them look cleaner and brighter.

As consumers we all like to have options.  In fact, I remember a psychology course in college where we examined a vending machine study.  The study, among other things, determined that they would sell more Snickers bars when there were Snickers bars and some other option, than when there was nothing but Snickers bars. 

The same hold true for any purchase we decide to make.  Often, increasing case acceptance is simply a matter of allowing that patient to feel like they have choices.  Especially when it comes to payment plans.  Sometimes the anxiety of letting go of that money, or making that commitment today is just too much to stomach.  Thoughts of a leaky roof, a broken down car, or the possibility of a losing a job leave a patient wondering if this treatment can wait…because, what if something bad does happen.

Payment plans are nothing new, but patients will frequently reject them because they know what it likely entails:

·        Applying for a new credit card

·        Having an “introductory/promo rate” with retroactive interest

·        Another open line of credit on their credit report (even after it is paid off)

·        One more credit card to stick in your wallet

In order to overcome some of these aversions, many practices choose to offer in-house financing.  It certainly helps increase case acceptance when the patient knows you’ll offer 90 or 180 days to pay their bill, but how quickly time passes and they soon forget the wonderful treatment they received.  Unfortunately, you simply can’t go repo the tooth…not that it would help you pay your bills but might serve as motivation for them to pay theirs. I’m only kidding–it would be quite spiteful indeed.

Accounts receivable balances, however, can become a serious issue for the health of your practice.  They can become a small cancer that quickly grows undetected until it is a serious problem. They can be difficult to reduce and hard to manage and the time and money involved in properly managing them can have you feeling more like a collections agency than a dental practice.

Again, I am not recommending the elimination of either, but rather pointing out that by giving your patients options (in addition to the 2 mentioned here), they will say “yes” more often than if they feel they only have the Snickers bar to choose from.  Just a simple way to help patients feel comfortable and more in control of their treatment plan.  Don’t fall into the trap of thinking that Care Credit and in-house financing are your only options.  Dentists like having options other than Snickers too, right?