Dental Reflections 006

how many factors can you think of that will mess with good matrix band placement and hence hinder the interproximal contour of a Class II restoration? here's a short and by no means exhaustive list...

1) insufficient tooth structure to band securely and still touch the adjacent tooth/teeth
2) weird concavities in the root surface that prevent the band from adapting well despite attempts at wedging
3) unusual coronal morphology/the cusp of Carabelli
4) long-standing cavitation into which the abutting tooth has drifted
5) a diastema whereby even furious burnishing will not stretch the band far enough to allow a contour that prevents food trapping

and how to overcome them?
1) euuhhh... work in CR. freehand yourself some buccal and mesial structure, then band from there.
2) with crappy wooden wedges, not a lot a man can do. prepare to stuff a fine diamond or an EVA into the interprox region...
3) this is actually, strangely enough, not too bad if you work in CR. you can shape the tooth bit by bit and respect the original structure. if you work in amalgam... fat hope
4) enamel mod *hack up coughcough* the offending neighbour!
5) this is counterintuitive... leave the gap big enough so that any food which makes its way in comes out easily. and teach the patient the joys of the interprox brush.

Prisoner of Love - Utada Hikaru

Under A Warm Sky

just when i was least expecting it, an email plopped itself into my mailbox, and now i know that i have my marching orders. to Queenstown it is then. i guess this isnt the place to dissect exactly why i've been sent there, but i dont feel too much of a wrench. after all,
1) am i not the most junior employee, and a maggot amongst the maggots? if i got everything i wanted and word was sweet and easy, it would be called fantasy and not a job.
2) wherever i go, God has a plan.

went to Cedele with Peijun for lunch. now, i think my views on priorities in food are well known. flavour and quantity are the 2 pillars of a good meal, in my opinion. secondary considerations include service, ambience (whereby i mean good seats and lighting and decent music) and costing. Cedele was established on the principles of providing alternative food choices. to whit, they concoct egg-free desserts and gluten-free mains. all very noble, of course, but how does it all match up? after all, the proof of the pudding is in the eating...

Cedele did not get off to a good start with its surly front-door dude. but we persevered (on the uncomfortable front-door purgatory seats, no less) and were rewarded with a table near the window. within a few seconds it became apparent that the outlet (apparently the Wheelock branch is newly opened) was having staffing problems. a full house, and many staff running around like headless (but stylish, mind) chickens, bussing tables, pouring water and doing every damn thing but actually taking orders. finally a nice young man *yay* came to our aid and took the orders for our mains, as well as our drink orders. while our mains did arrive, the drink orders fell through the cracks. i mean... one warm water and one iced water, and a reminder is needed? severe work flow problems. and down to the mains...

Peijun ordered what basically amounted to a mushroom and bacon fettucine carbonara. i felt adventurous and had some fusion-sounding thing that basically said steak and pasta. firstly there really wasn't much to say about Peijun's food. it was competent but... meh. if you can screw up a pasta with cream and cheese and bacon in it, you should be hung from the nearest crossbeam available. my food... was weird. firstly, if the menu promises medium-rare pieces of beef, i most certainly do not expect the pieces well-done in the style of a boot sole. and squeezing lime juice on it most certainly does not help things. damn tree hugger chefs. disappointment was written on my face, enough for my dearest lunch partner to see.

so after that fiasco we had a quick look over the dessert menu. they were offering a free scoop of icecream for orders totalling over $25 *handily achieved*. the Honey Nut was rather good, a base flavour of vanilla given life by a hint of honey and some nice bits of nuts. we also ordered a Cranberry Scone, enticed by the purported hot scones and cranberry jam. alas, this was not to be. half an hour of waiting later, we politely called for the bill and cancelled the scones. not 2 minutes later, the prodigal scones finally arrived. we stuck our ground and the scones were taken away and we caught a glimpse of them being binned... *tragedy in freefall*

so yeah... Cedele. not going back there in hopes of a good square meal. this is the kind of place girl gangs go to gossip over cakes and coffee. lime my beef steak? *unmentionable* you!

Back Again

so i return to stick my head into the grind once again. i really hope that all i've gained over the week will not fade from me as sunsets collect. its been a rare and precious experience, something to be treasured for a lifetime.

so there i was, a new church camp looming on the horizon. school had precluded any attempts at attending for the last four years, and i was really wondering what this camp would turn out to be like. it didnt help expectations to have, as its theme and song, 'A Passion for Thee'. i have to confess, i truly cannot stand that song. hearing makes me feel as if heat-plasticised treacle is being poured into my head via a hole trephined by a squad of upset monkeys. nothing to do with the words, guys, its the tune and chord work. if the tune gives me the musical equivalent of an MSG headache, i will have trouble liking it. but that's just me...

getting there and starting to do stuff, this camp exceeded all expectations. it was good to be playing again. even despite all the difficulties of an ad-hoc gang of noisemakers which were often-times difficult to round up. i was also blessed to have as a discussion group a fellowship of people who could open and talk about the things of life. it wouldn't have been the same without them. people to laugh with, cry with, and do nonsense with. valuable beyond belief.

at this point i'd also like to make a shout-out to Debbie and Norman, Tapir-boy and Angel-girl, dynamic duo, partners-in-crime and life and soul of our gang. they've been a literal blessing to ACTS (and i say blessing because every other word is inadequate) and the camp really wouldn't have been the same without them.

and finally i'd like to remember the camp speaker. Pastor Richards delivered the Word simply and truly. i just wish more people could have had the chance to hear him *brandishes sermon VCDs* best. camp. messages. ever.

back into the real world, i'll be waiting to see what's on my plate for monday. going to be reorganising my life a bit to give me more prayer and bible time. hope that all i've seen and heard doesn't get swept away in the rush of life...

Heart of Worship - Matt Redman

Dental Reflections 005

amongst my experiences in NDC i can now add the WWF Pulpect. i have performed WWF SAP before, whereby when i really need to get a patient cleaned up in a hurry (think pack-a-day smoker, never been cleaned in his life and radiotherapy looming in a month) i will head-lock the patient in the crook of my left arm and get the job done. not my favourite maneuvre, but i do seem to be using it a lot more than i would like to have to. but today, i had to use the same headlock to do a pulpectomy...

pt was scheduled for CAP #47(d).

hx of an impacted #48, causing the caries for which i was scheduled to spend a leisurely hour digging out. NRMH, NKDA

and so there i was, with the patient in the chair. EPT -ve but cold ++ve, non-lingering. this was probably a sign of trouble to come, but as i was checking the tooth over it didn't seem terribly out of the ordinary. 2 carts into the IDN and some initial caries free later, i was greeted by the sight of a mass of hyperplastic, hyperaemic strawberry-red tissue bursting out of the distal cavity. and IDN be buggered, it was sensitive to manipulation.

one quick scream to Dr Lui and some prodding later, and it seemed that my only option would be for the patient to grin and bear it while de-roofing the pulp chamber to allow for a good intrapulpal. the sheer irony of of hyperplastic pulp is that the tissue that you want desperately to anaesthetise is blocking the line of sight for you to get your needle into position to do the intrapulpal. damn. and so i had to headlock the patient and rip a diamond bur across the occlusal, and then stuff in a big-head round bur to slash out the pulp from the chamber, all the while apologising profusely and sweating in the deficient air-conditioning. to compound matters, when i sent the patient in for a PA to make sure i was digging in the right direction, and not to china, the radio auntie didn't have the faintest idea how to handle a PA for a patient with dam on! gwaaaaaaaaargh... ended up grabbing an EndoRay from Dr Kuah and aiming it meself.

upon returning from the PA queue, the pulp stumps were still gushing fantastic amounts of blood (hyperaemia ftl) and so another shoutout to Dr Lui later i was witnessing my first live demo in the use of Ledermix. Dr Lui qualified that Ledermix is not a good thing to use in infected cases in general, but due to the sheer amount of inflammation in this case, closing up after splorking Ledermix onto the pulp stumps would prove helpful and allow me to finish up the case in 1-2 weeks with much less bleeding.

hope it all works out...

Dental Reflections 004 and some spleen

so there i was, with an upset patient in my chair...

pt c/o swelling R face for 7/7:
on 290408 i did a PSA block for cons purposes. after that the patient noted swelling and ecchymosis.

o/e: R lower cheek area presented with ecchymosis, tender on palpation of the bruised region. posterior to the ecchymosis was a region of inflamed skin. pt reported using a muscle ointment on the bruise to cope with the pain. no abnormalities intraorally; buccal sulcus normal. adjacent teeth nttp/pp and vital except for the one with the prior RCT. stetson's duct was patent, with clear fluid expressed.

everything basically pointed towards me having nicked a vessel or something. blood then tracked down the fascia and pooled in the lower end of the buccal space. so what's to be done? AB cover and review, plus some Piriton for the skin irritation that seemed to be connected to usage of an oil of wintergreen-containing ointment. pretty standard stuff, management is basically to make sure that the dead space is taken care of using antibiotics to minimise risk of ending up with a cellulitis.

now at this point the blog will leave didactics and move into full-blown rant mode...

for this patient there is also an incidental finding of acute malignant shit-for-brains. the patient was remarkably ungracious about the whole incident. yes, youre upset because you have a big-ass bruise on your face. yes, you acknowledge it's your bloody fault that when i bent over backwards to give you a fast review you didnt show up because you thought it was getting better, and couldnt be arsed to come down and grace my chair with your presence. but for goodness sake, checking you up one more time costs money too! x-rays don't come free! and medications certainly don't come free either. if you don't want to eat medications and still want to be seen, what do you want me to do? we already bent over backwards to waive all the clinical stuff and x-ray fees, now be a good hippopotamus and eat your medication! no point coming up with stupid excuses about 'i fear medications' (this doesn't translate well from the mandarin) or 'antihistamines make me sleepy'. how do you expect things to happen if you don't eat medications? and when you casually mention the fact that a dentist in your church told you it was just a nicked vessel and not to worry, it identifies you as a person of the book and destroys testimony, not to mention the snide remarks about God blessing you with a haematoma. shit for brains! truly shit for brains...

and i have to review her again on thursday. i am so looking forward to this...

Dental Reflections 003 + some other stuff

when a patient has hope, he always does better than the patient who doesnt have hope. the patient who believes what you say and acts on it will also perform better in the long run.

so what do you do with the patient who
1) has a Hx of NPC with all the problems of
1a) xerostomia
1b) a 1 3/4 finger opening of DOOOOOOM!
2) doesnt use his F- gel
3) is still ACTIVELY SMOKING ~20/day?

doing his CAPs felt like an exercise in self-punishment. there was smoker's breath, exposed dentine blackened, not by foodstuff and caries, but by the assortment of noxious chemicals from the ciggies, bad-ass caries (ever seen distal upper 7 look as if a rat has chewed it?). amazing. hope my little preventive talk got into his thick head...

Kenneth managed to get me hooked on another anime series. Macross Frontier tells the story of a colony fleet, its inhabitants, a group of civilian military contractors who defend said fleet and in particular one particular, well, for want of a better description, reluctant bishonen. i think my general tastes in anime tend towards exploding things and series which have fun and don't take themselves too seriously, notable exceptions being Monster and Gunslinger Girl. this series kinda fits the mould, and they know that they have rabid fanboys amongst the viewers! expect frog abuse, micronisation errors and the ever-loved Macross Missile Massacre(tm) a-plenty!

My Boyfriend's A Pilot - Ling Minmei

Dental Reflections 002

got to review a case today after a pulpect, thought this one was worth writing up.

pt walk-in c/o lingering sensitivity on #12

o/e: #12 barrel morphology, AR (o) intact (and yes the barrel was that big), nttp/pp and perio normal but lingering to cold, EPT positive

dx: #12 irreversible pulpitis, normal periapex

so there i was with a pulpect of a #12 in a tooth with an old AR which i suspected to be a dens invaginatus. hacking out the AR yielded.... no pulp chamber or canal. gentle exploration at the base of the invagination yielded nothing either. and so, one consult later, my answer appeared in front of me... the canal, by very very careful staring at the PA, was in fact mesial to the dens invaggie chamber, and had i gone on a quixotic dig-to-china spree on the base of the chamber i may well have done a mid-root perf. heng ah!

lesson learned... in the dens invaginatus the pulp chamber proper may not lie in the middle of the tooth!

Dental Reflections 001

what i learned this week:

1) fear is a very powerful motivator and must be managed well. or else patients will go and do stupid things and make stupid choices.

2) the people who have dental anxiety tend to have heightened gag reflexes and strong circumoral and tongue muscle tone. truly trouble never comes singly.

3) never underestimate the trouble in matrix banding a lone-standing tooth and trying to get good contour from the outset. it's not going to happen.

4) the person who smokes a pack a day is smoking just over $10 bucks of noxious chemicals every day. this means that the SAP visit he claims is too expensive could be afforded by, oh, say, stopping smoking for 5 or 6 days. the single unit chrome partial by not smoking for, oh, 2 months. and then imagine the patient who smokes 2 packs a day...

4a) truly, smoking is a great social evil that keeps the poor poorer. and yet it is a self-inflicted poverty that strikes in 2 phases; the first when the person spends his hard-earned Yusof Ishaks on smokes, and second when he lands his posterior on the NCC treatment list...

Luminosity Is Levity/ And Levity, Luminosity

its been a very long time since i put finger to keyboard for this blog. far too long. but i guess after recent turns of events one should take the time to put ones mind to the written word as an exercise in focus. sorry boss; there ain't not patients present on worklist or in-tray...

it finally happened on sunday. ibu myra decided to postpone the orthognathics for PJ because of a persistent, nasty, phlegmy URTI. in a dispassionate way, one could well reflect that it was for the best. who wants to do elective ops on a patient who isn't ASA 1? and in a way that allows one to be gripped in emotion, this has been something that she's quite literally been waiting for; and end point to her ortho tx. and this has taken four whole years, probably twice the duration of your average pt. but all in, long term management of a disappointment situation must be one whereby disappointment gives way to acceptance and a willingness to move forward. failure to recognise a closed door and an acceptance of a new path will only need to unhappiness and depression.

so what's my take on the whole thing?

- the good Lord closes doors according to his will and timing, and it is definitely not in the christian's best interests to either whine at the door which he closes, or to try to breach the door.

- at the same time, the door which he will surely open instead of the closed door will be a door that will prove beneficial compared to the closed door.

- true peace comes from acceptance of guidance when one's will is subordinate to, and guided by, the divine hand.

so yeah... time to apply leave for the 12th of may!

a second thing ive been wanting to do is start a series of blog entries on what i've learnt at work so far. i'd hate to forget any of the lessons that i've learnt while i've been here, and there are so many of them...

as a closing note, watch Bamboo Blade. a recent work of anime, this short series focusses on a high school kendo club and its members. and thats probably all i can say without blowing the plot, after all its classic slice-of-life genre stuff. the brilliance lies in how this series has fun, advances plot and yet doesn't take itself too seriously. there's emotional development, yet not too treacly and emo, great shinai-work, and they even created a whole faux Super Sentai show for the lead character to idolise! enough blurb! get thee to Veoh!

Star Rise - Bamboo Blade Seiyuu

And Now, For Your Entertainment And Vilification Pleasure...

this over the class mailing list: a debate in the country-over-the-bridge re implants. anyone who's known me for a while is probably familiar with my opinion of the state of politics there. sadly, showboating and unsubstantiated rhetoric seems to extend to the helathcare sector as well. on with the show:

*****

Wednesday February 13, 2008

Dental visits a pain in the pocket

ACCORDING to statistics, about 10% of people who are 55 years and older will begin to lose their teeth. Whatever the cause attributed to each individual, age is the single biggest factor. Because of our ageing population, the number of people who would become edentulous would be a substantial number. The market is huge.
Many old folks are at the mercy of dental surgeons, especially the ones who now describe themselves as implantologists.
Many of them wear doctor’s coats, carry stethoscopes and insist on being called doctors. They charge by the tooth for every implant. Current prices range from RM7,000 to RM9,000 for the implantation of a tooth. This does not include the cost of the replacement parts, surgery, X-rays, etc.
Hence, for about four to five teeth to be implanted in the average elderly person, the price can come up to RM45,000. This is more than the cost of a complex angioplasty, bypass operation, or a hip replacement.
There seems to be no regulation to control these prices. It is a free market, with dentists, specialists, as well as GPs competing and charging whatever the market can take.
Most older people are poor and have to depend on their relatives. And few family members want to pay these exorbitant charges.
Government specialists, curiously, do not provide teeth implants for most of these unfortunate victims. If they do, it is to learn the technique before leaving government service.
While the cost of private medical care is now regulated and there are guidelines provided by the MMA, implantology is a wide open field with no control. Even the Malaysian Dental council has not tried to exert any control.
The patients who cannot afford implants are given cheap dentures or a mix of implant and a bridge (if they can afford the latter).
Having watched the implantation procedure, I think this is really a simple procedure, most of the time done under direct vision. There are no special tools required.
Most surgically trained medical GPs should be able to learn this procedure very quickly. There will, of course, be some difficult cases which can be left to the specialists.
Dental surgeons, whether specialists or GPs, work in a very narrow field of the human body. From experience, I have learnt that they know little or nothing about the wider spectrum of medicine.
The number of antibiotics they are familiar with is very few.They ask for a history of diseases that the patient may have but do not know how to assess how bad these diseases are or how they should be treated.
They have no idea about emergencies that may occur with surgery or with drugs.
They do not know anything about cardiopulmonary resuscitation.
Because of these weaknesses, I would suggest the following remedial actions:
> The Malaysian Dental Council should investigate and control prices in this dog-eat-dog business. They must impose some discipline to care for poor old people.
> The dental surgeon who calls himself an implantologist should give a written bill to the patient before he starts treatment. He should list all his immediate charges as well as charges for subsequent visits.
> It should be possible to train technicians to do single implants. These technicians should be licensed and also given guidelines on charges. Prices would come down in a free market once you increase the supply.
> Medical emergencies during a dental implant are rare but can happen. Hence it should be mandated that an anaesthetist should be on standby during any implant or surgical procedure done by a dentist.
> The dentist should buy and place in his clinic emergency equipment. This would include a defibrillator, a heart monitor, a pulse oxymetre and an ECG machine.
> The implantologist should be certified, which means going before a panel of peers who will verify if he has the knowledge and skills to perform large volume implantation.

MEDICAL DOCTOR,
Kuala Lumpur.

*

Thursday February 14, 2008

Get your facts right, doc

MEDICAL Doctor in his letter “Dental visits a pain in the pocket” (The Star, Feb 13) does not even know the duties of a dental surgeon and a dental technician.A dental surgeon graduates with a “Bachelor of Dental Surgery” degree and is conferred with the title Doctor while a dental student studies anatomy, physiology, biochemistry, dental materials, pathology, microbiology, pharmacology, medicine, surgery and all other dental subjects in a dental college.The RM7,000 to RM9,000 fee is still cheap for a single dental implant. The cost to set up a dental surgery with implantology varies from RM500,000 to RM1mil or more. The material costs and laboratory charges are equally high.The procedure for doing a dental implant is not simple. It is a high precision procedure and needs lots of training before the dental surgeon can provide such treatment. It is not just a case of cut and fix.All dental surgeons providing dental implant treatment have undergone intensive training and attended courses and meetings like the latest Osstem Meeting 2007 at KLCC on Nov 25 last year.

Here are my replies to some of the suggestions raised in the letter:

> The Malaysian Dental Council together with the Health Ministry have set the range of dental charges for basic dental treatment under the Private Healthcare Facilities and Services Act. Dental specialist charges have not as yet been imposed.

> All dental surgeons providing dental implants and any other dental treatment quote the treatment charges prior to starting the treatment and patients are forewarned of any other charges that may occur during the procedure should any deviation of treatment arise.

> Technicians are not surgeons. They only fabricate the implants, crowns, bridges, dentures and splints in their laboratories.

> All dental surgeons doing dental implants are fully aware of any medical emergencies that may arise and are well prepared for it. So far, not a single emergency has occurred for a dental surgeon to require a defibrillator, a heart monitor, a pulse oxymeter or an ECG machine.

> Should such a need arise, the dental surgeon will either call for medical help or take the patient himself to the nearest medical centre.

> A dental surgeon providing dental implant treatment has attended courses and is proficient in his expertise. Not all dental surgeons provide dental implant treatment.Medical Doctor should get his facts correct before alarming the public unnecessarily. If you cannot afford an expensive car, you should buy a cheaper car according to your budget.The Malaysian dental surgeons are doing a very good service to the public.

DR JASPALL SINGH,

Vice-President, Malaysian Private Dental Practitioners Association,

Kuala Lumpur.

*

Saturday February 16, 2008

What a dentist can do only a dentist can do

I REFER to the letter ‘Dental visits a pain in the pocket’ (The Star, Feb 13). The dental treatment charges in Malaysia are well regulated by the Medical Practice Division, of the Health Ministry under the Private HealthCare Facilities and Services Act 1998 (Act 586).This act is well supported by Malaysian Private Dental Practitioners’ Association and Malaysian Dental Association.Dental practitioners’ in the private sector whether they are GPs or Specialists are well trained in this aspect and are supposed to adhere and practise dentistry according to these guidelines.The healthcare clients (new terminology for patients) have their own rights. Under the Act, they have all the rights to know about the charges and treatment procedures.If they do not feel satisfied with the dentist, there is the “Grievances Mechanism” in clinics to address the issue under the Act.The writer also said that the dental surgeons were not well versed in drugs.The second year of dental course covers pharmacology.In fact, dental surgeons can treat Upper Respiratory Tract Infection (sore throat) that is a common disease treated by medical practitioners.The third year covers subjects of general surgery and general medicine.The syllabus clearly shows that dental surgeons are on par with their medical counterparts.Another accusation by the writer is that implantologists are not well trained and medical GPs can place implants.This is a joke!My sincere advice to him is, please look at your backyard.There are a lot of illegal and incompetent medical practitioners. Try to rectify that.We have our own professional body to regulate competency.In conclusion, I feel the writer was wrong in all his statements and figures.He was too emotional in expressing his opinion and created an increase in dental phobia among dental patients.One important phenomenon that everyone must realise is that: “What a dentist can do only a dentist can do.”

Dr NEDUNCHELIAN VENGU,

President, Malaysian Private Dental Practitioners’ Association.

*

Monday February 18, 2008Cheaper to do dental implants here AS A practising oral implantologist, I read with alarm and concern the polemic “Dental visits a pain in the pocket” (The Star, Feb 13).
To clarify matters and to set the record straight, I would like to address certain inaccuracies that were unfortunately passed off as facts:
> To qualify as an oral implantologist requires vigorous practical and theoretical grounding on par with medical doctors: a five-year basic degree in addition to a further two to four years of specialisation.
During the course of the training, many modules are identical to those undertaken by medical students, including management of medical emergencies and performance of cardio-pulmonary resuscitation (CPR).
> The current prices of implants in Malaysia range from RM5,000 to RM9,000, which is substantially lower than those in other countries. For example, implants in Singapore easily cost in excess of S$6,000 (RM13,662); in the UK, more than £2,500 (RM15,788); in the US, more than US$2,500 (RM8,050).
In fact, many foreign patients of mine have performed multiple dental implants in Malaysia specifically due to the equivalent level of professional competence but at a fraction of the price back home.
> Implants are not necessarily the final word in tooth restoration (even though the procedure ranks as the best among the options available in terms of comfort, function and aesthetics).
In the interest of cost, cheaper options such as dentures and bridges are available. On this note, no right-minded dental practitioner will force a patient to have implants done if affordability is an issue.
> The Malaysian Dental Association does provide a list of recommended fees for dental implants. However, as the writer pointed out, it is a free market; therefore each patient has the right to find the practitioner that he is most comfortable with.
> Government specialists have been providing dental implant services for some time now at lower rates compared with private fees. The writer seems to be ignorant of this fact.
> The implantation procedure is not as simple, nor as straightforward, as claimed by the writer.
As stated in the foregoing points, an oral implantologist has to undergo lengthy clinical and hands-on training to become an expert in the field.
There are many serious complications and adverse effects that can arise should the procedure be done incorrectly: for example in the case of guided bone regeneration procedure, sinus lift and bone harvesting.
I hope I have clarified some of the misconceptions that the writer has generated in his letter.
AN ORAL IMPLANTOLOGIST,
Petaling Jaya, Selangor.

*

> Sunday February 24, 2008>

> Dental implants have the best bite

> THE ideal standard of care for replacing teeth is not a denture or even a bridge anymore, but dental implants. >

> Dental implants are now used to replace missing teeth, stabilise loose dentures, straighten teeth and rehabilitate patients who have lost parts of their jaw and face due to cancer or accidents.

> We refer to the letter “Dental visits a pain in the pocket” (The Star, Feb 13) and wish to express our sadness over the misconceptions of a colleague whose profession we highly respect and admire.

> Dentists or dental surgeons are part and parcel of the healthcare providing medical profession and work hand in hand for the betterment of our patients.

> We do empathise with his concern for the older members of the population who due to inadequate dental care in the past now require dental implants.

> However, the main cause of teeth loss in older people is not aging as stated by medical doctor, but gum disease.

> This means that a healthy adult who takes proper care of their teeth and gums will enjoy a full set of teeth for life.

> Hardly 10% of dentists practice implantology and also because implants are all imported and costly, the cost of providing the service is still relatively expensive.

> Research and development of dental implantology took a lot of time, effort and expenditure on the part of university researchers and implant manufacturers.

> The cost of training is still very high because it involves highly trained lecturers, logistics and material costs.

> Implantology is not as simple as it looks.

> Such treatment can range between simple to highly complex procedures that involve bone grafting, gum grafting, specialised imaging, detailed planning and a thorough understanding of occlusion which may take years of experience to understand and successfully manage.

> Special dedicated tools, equipment and materials are needed in implantology.

> Dental implantology usually does not incur any more trauma than an ordinary extraction of a tooth, and therefore does not require any extra safety measures that are not already in place in all dental clinics.

> Dental implants have helped countless people around the world to enjoy their food again. They are the best replacement for lost teeth.

> Though expensive currently, the price will keep coming down due to free market forces.

> Like in all professions, some dentists charge more and some less. Find one you can afford.

> After all, dentists here in Malaysia are highly trained and yet are still among the most affordable in the world.

> The cost for dental implants in Malaysia is one of the lowest in Asean.

> This has led many from overseas like Australia, Europe, America and Japan coming to Malaysia to enjoy the benefits of dental implantology at international standards and yet at half the price or less in their home countries.

> Dental implantology has placed Malaysia on the map as a major destination for health tourism in this region.

> DR FIRDAUS HANAPIAH & DR CHOW KAI FOO,

> President and Honorary Secretary,

> Malaysian Oral Implant Association (MOIA).

*

*had enough? more to come*

*

Saturday February 23, 2008

Implants cost too much

I REFER to the letter Cheaper to do dental implants here in The Star, Feb 18. Implants in Malaysia costs between RM5,000 and RM9,000. Let us say it is RM7,000 on the average, which is the equivalent to 7,000 cups of coffee or three months' pay of a government medical officer’s salary here.
In Britain, it is £2,500 which is about 1,500 cups of coffee there or less than a month's salary of a government medical officer.
In the United States, it is US$2,500, which is about 1000 cups of coffee there or much less than a month's salary of a government medical officer. In Singapore, it is S$6,000, which is about 2000 cups of coffee there or less than a month's salary of government medical officer.
A baby delivery by Caeserean section here - which includes general anaesthesia and few days stay in a private hospital - would cost less than a tooth implant in Malaysia.
So dental implants here are among the most expensive in the world.
Suggesting other alternatives like dentures and bridges is like telling a patient with a bone fracture not to have nailing and plating and just to have plaster casts, as it will heal anyway.
Just as there is government control over food items and other products, there must be a price control over dental procedures. Dental health must be available and affordable to the rakyat of Malaysia.
As can be seen from above, a reasonable charge for an implant would be around 1,500 cups of coffee or RM1,500 by comparing the different prices of several countries. A root canal should not cost more than RM300 and crowns not more than RM300.
Technicians here should be taught to perform implants as there are other more difficult procedures that are also done by technicians. For example, there are midwives doing a good job with examinations, investigations and the delivery of babies.
Ultrasound and echo (for heart patients) are done by technicians, medical assistants are doing examinations, investigatings and treating patients while dental nurses are doing fillings and extractions. In addition, anaesthetic assistants are giving general anaethesia in rural areas.
Medical doctors should be taught to do implants as they have basically learnt all that the dentists have learned such as oral anatomy, physiology, pathology, bone regeneration, bone harvesting etc.
In my rural posting I was taught to extract teeth and do fillings. Implants have now become a common part of dental procedures, just as root canal treatment.
If there is a shortage of oral implantologists then we should recruit medical doctors. I am sure doctors here will fulfil their Hippocratic Oath to serve the public.
Dentists are also bound by Hippocratic oath to serve the public.
*
ANOTHER DOCTOR,
Kuala Lumpur.

Monday February 25, 2008Dental implants an expert’s job WE REFER to the ongoing discussion on dental, medical and healthcare costs in Malaysia. In Implants cost too much (The Star, Feb 23) oral implants were likened to treatment for bone fractures.
Comparing the cost of dental implants to the local price of a cup of coffee does not make sense. This is because a major cost of a dental implant is the cost of the imported prosthesis itself.
More than just the cost of materials, oral implantology is a multi-stage multi-disciplinary treatment procedure. The surgical component (i.e. the placement of the implant within the bone) is performed by the implantologist/ oral surgeon.
In fact, we invite interested medical surgeons to equip themselves with the proper training and accreditation that enable them to perform this surgical procedure.
The demand for oral implants is far higher than what dentists in this country can cope with. Having well-trained medical surgeons to help out in the surgical process will be a welcome bonus.
The next step involves designing an artificial tooth over the implant. When a patient requests an implant, this tooth component is the one he or she will see and use every day.
Therefore, this stage is best carried out by a dentist properly trained in treatment planning, dental occlusion, function and aesthetics.
Based on the dentist’s exact specifications and detailed instructions, the prosthesis (tooth) is custom-made in the laboratory by a dental technician. Finally, this prosthesis is precisely attached to the implant.
Function and cosmetics are examined clinically. This multi-stage, multi-disciplinary approach is important to ensure that each stage is done by an expert in that field, to ascertain the best possible treatment outcome.
The dental implant of today is by no means the ultimate replacement for missing teeth. Further research and development (R&D) is required.
Currently, essential/basic dental treatment like extraction, pain relief, fillings, scaling, and infection management are already affordably priced. These procedures are cheaper than most medical surgical treatment.
We are working towards a time when dental implants are no longer an optional luxury but a common affordable treatment alternative, just as cars were once exclusive to the rich but are now commonplace.
We can achieve all this and more only with the understanding and cooperation of our medical colleagues and the public.
Who knows, with support from all parties and sufficient funds for R&D, the option of replacing a missing tooth with a new one grown from stem cells may soon be available.

DR FOO CHI CHEAN, President – Malaysian Academy of Cosmetic Dentistry.
DR MELISSA FOO SUYIN, Oral & Maxillofacial Surgery Department, Hospital Sungai Buloh.

*****

really, to sum up, it does look like a bad case of doctors with itchy backsides and a poor understanding of what other people do. it doesn't mean that a well-rehearsed procedure is effortless just because it looks to be so. also, healthcare should be based on needs, not wants.

Now I Know

i finally understand the fuss about tuna-based sushi. this is a bit of an overdue blog, but anyway me and PJ went out over last weekend to celebrate her birthday. it involved going for a play and then a good dinner.

Chesty Nutty Bang Bang: The Hairspray of the Phoenix was quite literally 2+ hours of cheap shots. very good ones too, mind. the comedy crew opened up mercilessly spoofing the now-infamous MDA rap (youtube for it, you lazy buggers!), followed by skewering such subjects as Ribena ads, Beauty World, Heroes, 881... excellent. you have not lived until you have heard people sing Umbrella in hokkien. catch the next one when they get back on the stage! also ran into Lor, long-unseen JC class rep. good catchin up w her, wonder when our gang will next assemble...

the evening's laughter was followed up by a meal at Sushi Yoshida. we always passed by the place on the walk from Cine to PJ's place, and saw head chef Yoshida-san standing with the valet parking dude of the bar next door watching the world pass by every time. this reached the point where we dubbed the place 'Valet Sushi'. original plan was to check out a restaurant up the hill for dinner, but a great urging for a dinner of the raw fish variety struck PJ. i thought to myself, what the heck? expensive raw fish, here we come!

Sushi Yoshida is located in a small corner next to Bar Stop on Devonshire Rd, they possess a common entrance so dont walk past wondering where it is. ambience is cosy, slightly darkish in terms of lighting for my taste but alright otherwise. serving staff are generally friendly but still rough around the edges. the sushi, however, is excellent. this will be remembered as the place where i had my first Chu Toro Nigiri. its not just any old Magurozushi, mind you. a completely different animal, and another excellent proof that without fat of some kind food has less flavour. it tasted like fish in a good way, darker than salmon. it literally made me wish i had another hundred bucks to splurge on O-Toro. i must admit PJ was less blown away than i was, but now if i can get good tuna cuts i'll get some over the more generic local favourite salmon. in japan noone eats shake-sashimi anyhow...

Umbrella - Mandy Moore

O Muse! Sing in me, and through me tell the story...

after having discovered the wonders of the disc borrowing service at Gramophone, there are a couple of movies that we've watched that warrant a mention. in particular, go check out 'O Brother, Where Art Thou?' by the Coen brothers. in terms of comedy, this is one fun movie! 3 men escape from a chain gang to go get some treasure, and the rest would be spoiling the movie i guess. definitely worth the rental fee!

I Am The Man Of Constant Sorrow - The Soggy Bottom Boys

How To Fly A Kite

or... the life of a DO after 4 and a half working days. seems as if the old saying about sheer boredom punctuated by moments of abject terror really is true. i've had irritating pulpectomies, angry patients, and a panic-attack-in-the-chair from a heart patient. ive scaled, root planed, done TDs, CRs ARs, and too much GIC to count. but i still need to be faster. and learn how not to irritate the consultants. bleah.

Deconstruction

seems like i havent had terribly much time to write, but its a damn good procrastination tool. right now i need a few moments to regather my thoughts before i head off back to do some work.

i've been meaning to write for the longest time about the concept of the boyfriend corner. every boutique should have a boyfriend corner. this is a little space where the tired boyfriend may rest a moment while his girlfriend sacks the racks, looking for that elusive new buy. while shops must consider their merchandise, advertising and product layout, the presence of a boyfriend corner shows how much a shop cares, in a very literal way. improvised boyfriend corners are couches or benches commandeered away from their original use as places to perch while slipping on new shoes. poor boyfriend corners are those made up of stools stuck in a corner next to the winter coats that will never sell well in our sunny island. better boyfriend corners have adequate seating for the weary multitude of boyfriends/batmen who are on duty during sale time. excellent boyfriend corners have a commanding view of the changing room entrance to facilitate our giving useful comments on apparel that is being tried on by the girlfriend. and to this end, i have to say that the best boyfriend corner i have seen to date is located in the Giordanos in the basement of Takashimaya. it has 2 spacious couches, next to the atrium leading to the changing room. more storekeepers should take note...

The Night Santa Went Crazy - Weird Al Yankovic

Please Hold

so the Registrar's Office cocked up my bloody transcript. don't you love wild goose chases of an administrative nature? there are a whole bunch of things i could be doing right now that would be a more intelligent use of time, such as cutting my toenails or watching glue dry...

bloody hell.

Finally

just like to take the opportunity to congratulate my brother who will be having his graduation ceremony this evening. here's to the late bloomers of the Ee family!

Heartbreak Hotel

"Love is patient; love is kind; love is not envious or boastful or arrogant ⁵or rude. It does not insist on its own way; it is not irritable or resentful; ⁶it does not rejoice in wrongdoing, but rejoices in the truth. ⁷It bears all things, believes all things, hopes all things, endures all things."

-1st Corinthians 13

as i take stock of the way things have been and turn out, i see my shortcomings shouting back at me. God give me the grace to improve...

Peons In The Mist

sitting in the Engineering Canteen, an empty cup of joe next to me and a slight jiggle in my extremeties as i type up a long-overdue blog. having taken up this part-time job, i find spare time to do personal things even more fleeting and precious. after work and picking Peijun up to send her home, i just want to get horizontal and let the tension ease from my body. not so easy when there's so much to do.

been just over a week of part-time work. i think organising Prof Foong's research stuff was a major success, measuring virtual OVD on Lit Teen's projections was pretty decent. but tracing MRIs makes me want to run screaming for my bed to lose consciousness. should have discovered Engin coffee earlier, though, it tastes pretty good and seems to be loaded full of caffeine goodness. just can't wait for it to be all over. its a cold-lonely lab in Engin, with no company. occasionally, 2 girls from VJC are in my area to do their colaboration with Prof Foong and Hsiao Piau. theyre about as friendly as rotting tree stumps, and ignore my presence except when i open the door for them after they go for pee breaks. assholes... where i come from being polite enough to say hi is required!

on the Anime front, Arts Central's latest import, Monster, seems to be really good stuff. not the usual blow-stuff-up shonen adventure, Monster deals with horror and moral dilemmas, centred around a killer with no morals who was saved by a doctor years before. and i guess thats all i can throw up without utterly spoilerising it.

seems like the little plans Peijun and me had to take a small regional break may not be happening, too short notice, not enough resource. but there's always next year, when we have more coin in the pocket, and the op is over.

one round of practice achieved for Terence and Lishan's wedding. even though this time only half of us will be Ejects and Rejects (or voluntary withdrawals) but the music looks like it'll be good. the small but acoustically decent venue will also help immensely. auditoriums suck! and because the runway is so short, whatever we play of Canon in D will not have a chance to hit the funky bit. plus point or minus point, take it as you wish...

Selfish Love - Miyavi

I Get To Hear Their Delightful Screams Again Today

so there i was, quite literally looking for something to do while waiting for epoxy to cure. my new anime entertainment is Sayonara Zetsubō Sensei, which may be the most freaking funny, twisted series ever! basically about a teacher with a pessimistic view on life, who tries to commit suicide at least once an episode, and his weird class, this has to be seen to be believed.

i wonder if the epoxy is done...

絶世美人 - Ai Nonaka, Marina Inoue, Yū Kobayashi, and Ryōko Shintani

A Gamer's Perspective

so there i was, killing time talking to Darren in PI this afternoon, reminiscing about the wonders of big stompy robots and blowing stuff up. one of his friends popped by, being a bit early for a gathering to organise the gameplay for a huge WH$40k promo in the store. this lead to a little discussion about perceptions of the gamer by friends, family and prospective life partners. in essence, this was sparked off by him asking what game i played. after finding out i'm a CBT player, he made a remark about not having the resources to dive into more minis-based games, and since he started with $40k he's been essentially married to it. this lead on to how he has a honking great collection of minis (GW huge army lists ftw), and how people (= girlfriends) react when they pop by his house. essentially, once the girl gets over the shock of how much plastic and metal she is seeing (think big-ass glass-fronted display cabinet), variations of a few standard questions will come out...
1) don't you have a life?
2) wah! you love me more or those figurines more?
3) once we get married will you sell them?
question 1 is an ignorant bigoted narrow-minded attempt at passing a comment via a rhetorical question. of course we have a life. it's just different from yours. while you choose to spend your time doing things to relax and switch off such as shopping or cycling or watching a movie, every so often we like to engage our brains. stops the atrophy from setting in.
question 2... quite succinctly answered by Darren's friend. 'wait... this is the 3rd time we're meeting up, i hardly know you and you're asking me this?' why does it turn into a me-or-them thing? its ridiculous. what kind of insecure females are we breeding to feel threatened by minis...
and the 3rd question... to the non-gamer, it seems as if games are things that one discards as one ages so as to move on to more 'matured' things. what if we like it this way? what if our little escape provides us the much-needed stress relief from the mature lifestyle you happen to be touting? why is gaming considered childish anyway? because we imagine? ban the fantasy stock market then! ban Rowling, Tolkien and Gaiman! ban singing in the shower even!
in short, give gamers a break. i truly hate feeling marginalised because i carry dice and am proud of it. because i chose to use my brain in my free time instead of vegetating. because i chose to let little fantasies of big stompy robots seep out of my head and onto the table from time to time.
but then again, the people who most need to re-think their attitude towards their gamer friends, family and loved ones will never read this, because they simply dont care, being an apathetic majority secure in their 'normalness' and 'conventional social behaviour'. they live out their white-bread lives, happy to trudge the same paths and so ready to criticise the harmless variations from their comfortable middle road.
disgusting.