Yours Toothfully by Dr Chan Joon Yee

Yesterday evening, visitors at a playground at Punggol watched as this uncle pounded his way round and round the running track with ankle weights and all. How does this old man do it? Most people don’t bother to ask the old man. No surprises. I’m no health guru. People wishing to be healthier and fitter normally resort to the myraid self-help books on the shelves of bookstores and libraries. I’ve read more than a few of such publications myself.

A cynic once said that if you want to get healthier with today’s health books, just eat them, don’t read them. The fibre in these books will do you a lot more good than the advice given. Another claimed that she ties up her books in 2 bundles, uses them as weights for weight training and that has done her a lot more good than following the advice given in the books.

The most popular self-help books on health are weight loss, diet and other anti-aging programmes. There are literally thousands of titles out there and almost inadvertently, we are drifting back to our topic on information overload. The sitaution follows the laws of demand and supply. There is a demand for “secrets” in a population that feels insecure about its waistlines and wrinkles. The supply of such “secrets” is then provided by gurus and experts (real and fake). Thus, the industry fluorishes. And the expert advice given in these books range from common sense practices to extreme regimes characterised by strict vegan, sugarless, alcohol-free, pleasureless diets and ascetic lifestyles.

Many of the fans of these self-help books will soon discover that they are still fat and still lethargic; unable to drag themselves from the TV set to the jogging track. The reason? Most diets, especially the extreme ones, are extremely difficult to stick to. With sufficient motivation, many educated, health-conscious people will eat and live healthy and make it a way of life - provided it’s not a radical change in lifestyle. However, not everyone can be permanently converted. Reading a new book may motivate you for a few weeks, but once the fascination wears out, you’re back to square one. So what do you do? Read another book? Will yourself to remain converted? Have somebody police over you? Let’s get real. American comedian Johnny Carson once said: “I once knew a man who gave up smoking, drinking and sex. He was healthy right up to the day he killed himself.”

I personally do not believe that there are that many “poisons” in the environment and our food. Life is fragile and vulnerable, but we don’t have to go tho such extremes to lead a long, healthy life. A few of those self help books on healthy living are actually quite informative. But read one and you might have read them all. Some give downright harmful or potentially dangerous advice. Some are just publicity efforts for health products that the authors sell. Reading them all will certainly result in confusion and possibly suicidal information overload.

I eat healthy most of the time, but I don’t stay away from laksa, roti prata and char kway teow. I even drink quite a bit on festive occasions. Will those things kill you? Of course not if taken in moderation. In fact, “unhealthy” stuff like chocolates contain the same antioxidants found in red wine. Not being athletes, the key to health and fitness for normal folks like us is not really to follow a strict diet but to live a more active lifestyle. Get out of that couch. Go for a job or a bike ride. Go hiking. Go swimming. Sell your car and terminate your cable TV subscription.

So give me that laksa with hum any day. And if the hum is free, I don’t mind having it in my mee siam too. Your self help books are a torture to follow and definitely no fun to swallow. Just be sensible about your diet and exercise adequately.

Somebody suggested that we can consider reintroducing non-air-con buses. Unthinkable? Not so. The only problem is, our public transport system does not always let the market decide. Peanuts can tip the balance. Let me illustrate.

Just yesterday, at some old coffeeshop at Hougang, I decided to have an unhealthy char kway teow for lunch. The last time I ate at the stall, the char kway teow was priced at $2 and $3. Obviously, the $3 plate had a larger serving of noodles and cockles. And to make myself feel less guilty about eating such an unhealthy dish, I would always order the $2 plate. The $3 serving was almost 2 times larger. Apparently, the $3 plate was not very popular.

A surprise awaited me at the stall when I went there yesterday. There was no more $2 char kway teow. Instead, it was either $2.50 or $3. Yep, I fell for the trap. $2 is now $2.50. $3 is still $3. Which one would I order? $3 of course. The hawker may not have really increased the price of his $3 char kway teow. However, by increasing the price of his $2 char kway teow by 50 cents, thus closing the gap between “regular” and “large” to only 50 cents, he has definitely increased the demand for the $3 “large” plate. How ingenious.

Now we go back to the topic of non-air-con buses. Will there be any takers? I’m sure there will be. Some old folks, some foreign workers, backpackers etc. But what about the fare? How much less than the air-con buses? Half the price? Wait a minute. The public buses in Singapore don’t have windows that can open. They can’t just use the vehicles whose air-cons are not working to run the non-air-con services. They’ll have to buy new buses or import old buses from neighbouring countries. Either way, it means spending money which in turn means that the fares can’t be too low. Being unprofitable is a death sentence in Singapore, even though some companies that are far from unprofitable continue to squeeze their customers who have little or no choice. If there is little difference between fares charged for air-con and non-air-con buses, which type will our wise consumers go for?

Somebody said that it isn’t fair for me to just reject people suffering from information overload. I’ve got to show people how I handle information overload.

The information overload coming from the mailbox is easy to take care off. There is a nice row of recycling bins lying between Tangs and Lucky Plaza. Sometimes, a look at the envelope can help me decide whether it’s better off in the recycling bin.

As for information overload from the internet, that’s even easier to switch off. I sometimes do a “negative search”. What’s that? When a salesperson comes to me with a new product … let’s call it Bestooth. I’ll listen to what the salesman has to say, then I go online and enter “Bestooth sucks”. I’ll see all the negative reviews. Of course, some of these negative reviews are written by idiots who have axes to grind. But not that many idiots have the time to grind them. What if I miss out on an opportunity to try an excellent product? My experience in dental practice tells me that exisiting materials and instruments are quite adequate for almost all procedures that are performed in any regular dental practice like mine. New is not always good. Just take a look at the new nano composites. Expensive and no big deal at all. Give me good old microhybrid any day.

A few years back, I attended a continuing education course where the speaker compared several brands of of adhesives in the lab. The conclusion, a certain brand (the one his company is selling) came up top in all the tests. But what is the significance? I have used the worst performing adhesive (according to his tests) and it has worked well in most cases. I have used his brand of adhesive (proven to be the best) and a few cases didn’t turn out well. So which is the best one of them all? I have no answer. But that does not mean that I don’t know which ahesive to use. They all work well with the proper technique! The trouble is, when a patient asks me which adhesive is best, he/she may be expecting the answer that will show that I know what I’m doing?

We dentists are all bound by the system. We have no choice but to get involved in continuing education. This puts us at great risk of information overload. The way to prevent this overload is simple. Just switch off. It takes a little practice to know when to sign in for points and then just switch off, but it shouldn’t be too difficult.

The patient who has overdone his/her research and listened to 100 opinions too many should understand that it’s more than sufficient to read up on some basics, enough to choose a good dentist. Once a dentist has been chosen, one should probably stop asking others for their opinions. I get rather cross when someone under another dentist’s care wants me to comment on a colleague’s management of the case halfway through the treatment. Interestingly, some patients get rather cross when they get different treatment plans from different dentists. They expect all dentists to handle a case in exactly the same way. The truth of the matter is, there is no single “best” way to treat a patient. By seeking different opinions, these patients are generating their own information overload. Shop by all means, but if you drop, then it’s your own fault.

Life is short and I think we can all do with a little more sleep.

I’ve heard some middle aged people lament that if only they had online dating during their time, they would have had a far wider choice of partners. Presumably, dating would have been a lot more fun and they would have married someone far better than their tormenting spouses. The power to shop and choose from a global pool of potentials is indeed tempting. But does that guarantee us a better choice?

Let’s look at something simple. You want to buy a toothpaste. Brand X says that they are the brand most dentists use. Brand Y says that they are the brand Miss Singapore uses. Brand Z says that they are the brand a certain actress uses. Each brand says that they are best when it comes to preventing tooth decay, reducing sensitivity etc. So which brand of toothpaste should you use? Personally, I would use the brand that most dentists use. Why? Because this would be the brand that gives out the most free samples to dentists. Should you use it? Well, why not? Unless of course, the brand that Miss Singapore uses runs a contest that gives you a chance to have dinner with her.

Frankly, dentists won’t be any worse off using the toothpaste used by their denture patients. And don’t be surprised if a patient who has a very bad gum condition could be using the same toothpaste that Miss Singapore uses. He could even be using the same toothpaste that most dentists use - except that he didn’t get his for free.

Meanwhile, the precision thinkers may swear that they won’t buy any toothpaste until they have figured out which toothpaste is the best. They surf the net, interview dentists over the phone, plough into the literature for and against each brand. They continue researching for months without finding a clear winner. In all likelihood, they won’t. They’d be better off just brushing their teeth well.

Apart from cosmetic dentistry, I also practise “reality dentistry” and reality dentistry has a lot to do with 2 levels of patient education 1. To educate them to a sufficient level of dentla awareness and 2. Like reality TV, let them go behind the scenes and see how tough it is to be a dentist. Both levels of patient education are sorely lacking in our general population.

Dentistry is a boring subject. Unless you have the talent to make it interesting, nobody will visit dental websites just for the fun of it. However, there are some curious individuals who absorb information like a sponge and they seem to enjoy learning about dentistry even more than the dentists themselves. Is this to be encouraged? What if instead of something simple like toothpaste, these folks are considering implants?

Yes, for an exciting topic like implants, there is probably enough info out there to fill up all the libraries in Singapore. Each system has its series of sub-systems. Each system boasts of high success rate, excellent aesthetics … Even entertaining a sales person from each implant system can take up a lot of precious time. It is easy to choose the cheapest system. It’s easy to choose the system with the longest history. It’s easy to choose the leading system in the US, in Europe, Korea, Japan … Which practising dentist has the time to go through all the systems and choose “the best”? I certainly can’t be bothered. Why? Am I not interested in finding out which implant system is the best? The fact is, no single implant system has only advantages. The principle of osseointegration is basically universal among all the systems. It’s only a question of which system the practitioner is more comfortable with, what sort of bone condition the patient presents with and which style of restoration is more suitable for a particular case.

It’s quite rare, but once in a while, an atypically well-informed patient steps into my office and begins an intellectual discussion. This frightens me because like all practitioners (not academics), most of my time in the office is spent working on patients and not reading the literature. I normally welcome inquisitive patients because it gives me a chance to show what I know.

However, patients who come in already very well-informed can be a problem if they don’t know when to stop. This week, they have been reading about System A and they want a System A implant. Then, when they go back to surf the net, they find System B to be more impressive. They ask you if they should have System B instead. Another week later, they read somewhere that System C is the best. Then, they hear that a relative who has System C didn’t have a good experience. Digging further into the endless internet jungle reveals more anecdotes that speak for or against A to Z. Where does one begin? Where does one end?

And as if systems are not abundant enough, these patients are also spolied for choice when it omes to dentists. Should Dr A do it? Wait a minute, he’s not a specialist. What about Dr B? But he only does the surgery and will refer me to Dr C for the crown. Is Dr C good? Or should I go to Dr D for the crown. But Dr D does surgery too? Should I find out if he charges less that Dr B?

Nothing much I can say to these people except: happy shopping.