Yours Toothfully by Dr Chan Joon Yee

Yes, it should be “how would I know?” in English, but a direct translation from proper Chinese 我怎么知道?, Singaporean Hokkien: “wa mana ei zai?” or Thai : “ja roo dai yung ngai” would be “how I know?”.

Like “how would I know?”, all the remarks above are often made in indignance or denial of responsibility. Sometimes, such denial is fair. For instance:

“How would I know you would come visit me if you didn’t call beforehand?”

“How would I know there is an appointment if you didn’t tell me?”

“How would I know you were standing behind the curtain?”

“How would I know you were sleeping under the car?”

When you do things or make plans that others cannot reasonably expect to do or plan, “how would I know?” is a reasonable response from them when something undesirable or disastrous happens.

But there are also instances where “how would I know?” is unreasonable. There are too many of such examples in my daily activities and encounters. Indeed “wa mana ei zai” is not a good excuse when such things are common knowledge. Of course, we can’t know everything; not even if it’s common knowledge. When these gaps are identified, the best thing we can do is to acknowledge our lack of knowledge, learn it, remember it and move on.

Of course, issues concerning “face” and “ego” affect everyone. We all feel good when our egos are stroked. We all feel unpleasant when we are embarrassed. Such feelings are universal. Not so universal, however, is the typical response from people whose egos are bruised. In some societies, including certain levels of our own society, shocking violence may greet a person who has not show respect for someone’s “face” or “ego”. Identifying and bringing someone’s mistake or shortcoming to light is sometimes viewed as an unforgivable sin. Simply criticising someone or forcing him to admit a mistake can result in extreme violence.

When dealing with these individuals, it would be wise to just walk away when they say “how I know?” when their mistake has been pointed out. Pursuing further for an apology may result in the scene above.

On a milder yet no less extreme and unreasonable note, there are cases where the ignorant control freak decides and dictates what everyone can do or can’t do and then turns around to shirk all responsibility when it turns out that their decisions have not been that good.

“This is your plan. Your idea. Look what’s happened.”

“How I know?”

“You insisted on this and that, threatening when it’s not done according to your wishes. Look what has happened?”

“How I know?”

Huh? Shouldn’t you be listening to others and not throw tantrums at people who may know better because they have been in the business for decades?

“How I know?”

Push it at your own risk.

I survived 2 days of lectures at a dental symposium held over the weekend at a hotel in Orchard. Usually, the best parts of such seminars are the food, the comfortable chairs and the chance to catch up with members of the fraternity.

Of course, I have already attended many seminars, conferences, meetings, symposiums or whatever the organisers call them. To be fair, this is not the worst and most time-wasting. Why am I talking about it in my blog? Because this particular symposium brought out a big irony of “updating” ourselves at compulsory continuing education seminars.

The whole rationale of making continuing education compulsory is to ensure that dentists don’t become dinosaurs. We need to be updated on the latest technology. Very few members of the public would argue against that. We are bombarded by new technology every day. Almost without thinking, we accept that the latest #$%&* Plus as superior to #$%&*.

Many people wonder what dentists use to “glue” their crowns on prepared teeth. The material you see above is one such cement. When I was a student, I cemented all my gold inlays with this cement. However, many young dentists would not have seen this cement, let alone use it. Of course, I don’t expect them to be very familiar with gold inlays either. Of course this cement can be used to cement other types of crowns. It’s just that newer, sexier, hi-tech and much more expensive materials came into the market and everybody forgot about zinc phosphate. In some developed countries, you shouldn’t even tell people you have used zinc phosphate cement if you don’t want them to know how old and oudated you are.

In the first lecture of the symposium, the elderly speaker spoke on the development of dental cements over the decades. It was an enlightening history lesson. Some cements worked well. Some didn’t work so well, but dentists later found out why and managed to solve the problems. Some gave disastrous results. Dentists also found out why, but the they didn’t manage to solve the problems. Some of these disastrous innovations, strongly touted by some of the biggest and most reputable dental material manufacturers as the best cements during their time, quickly got pulled off the shelves when crowns broke and teeth fractured.

Dentists have been conned. Patients suffered and sued. I can’t say that I find the speaker very objective, but he does share some of my thoughts. If something has been working well for years, why change to something new and untested? Frankly, I have not even heard of some of the cements the speaker mentioned. And it’s certainly a case of ignorance is bliss. My patients ought to feel so fortunate that continuing education wasn’t compulsory back then. I would have attended one of those seminars, got conned into using those new products and done my patients a great disservice.

The big irony here, is that the “update” we’re getting here is telling us that all the cement “updates” we have been receiving all these years are not really “upgrades”. We wouldn’t have lost much if we had ignored them all and stuck with good old zinc phosphate.

The conclusion? Our speaker strongly advocates gold restorations and zinc phosphate cement. Some of these combinations have lasted 40 years in the speaker’s patients’ mouths. As a practitioner of cosmetic dentistry, I wouldn’t want to have any gold inside my patients’ mouths and I’m sure they won’t get mad at me if their crowns don’t last 40 years. But this speaker made a very valid point which the organisers and administrators of continuing dental education should take note of.

Not all “updates” are “upgrades”. Many, or should I say too many new dental products simply don’t work as well as their ancestors. Such guided evolution panders to the public’s insatiable appetite for new technology. As discerning professionals, we shouldn’t be so obsessed with the latest tabloid news. We can already see a confusing explosion of information and misinformation on the internet. How much of what is released is worth listening to? With a rigid 70 point criteria to be fulfilled in a 2-year period before your dentist can renew his practising certificate, are you not worried that he pays his way to be fed with misinformation which will cost you in more ways than one?

Dr L (a senior consultant at a well known local hospital) and I were neighbours. We virtually grew up together in the old neighbourhood of Queenstown. We had a lot in common as our parents were neither well-educated nor wealthy. We were athletic, but unlike the other boys, the two of us just didn’t like football and marbles. Our folks were good friends, especially our mothers. Once, the two ladies travelled to Australia together. They visited the outback and some beautiful farms and vineyards. Mrs L’s impression of Australia?

“It’s such a backward country. You drive for miles and can’t even find a single NTUC. Trees, grass and sheep. So backward. Not like Singapore where everything you need is within a shuttle bus ride.”

At first glance, Mrs L’s remarks are laughable and perhaps not even worth mentioning. You may not believe me now, but there is actually a lot that we and our esteemed decision makers can learn from Mrs L’s remarks.

According to one CNA report:

Singapore has only 1,300 dentists in active practice and the Ministry of Health (MOH) wants to increase this number by between 60 and 80 per cent over the next 10 years.

It is studying a proposal to allow foreign dentists from the region to practise and train here under an accreditation scheme.

There is one dentist for every 3,400 people here in Singapore, a figure that has lagged far behind developed countries.

Singapore produces 40 dentists a year and MOH hopes to ramp this up. It is considering accrediting private training centres to allow registered foreign dentists to treat patients while undergoing training.

A dentist to population ratio of 1:3400 is too low for Singapore because developed countries have a “healthier” ratio?

First of all, let’s consider Mrs L’s remarks about Australia where you can drive for miles in the outback and not come across an NTUC, let alone a dentist. Can you drive for miles off the expressway from one housing estate to another in Singapore and not be able to find a single dentist with an empty waiting room? Is dentist to population ratio a good guideline for what is excess and what is deficient?

The logic behind looking at absolute numbers is obviously flawed. Many established dentists have more than 5000 patients on record, many of whom are seen once in 10 years. In the developed countries, old folks must have dentures. And they do change their dentures every now and then too. Over in the developed countries, it’s also not too difficult for dentists to convince their patients to do root canals and crowns. A lot of such treatment is considered basic necessities and are covered by insurance.

Over here, our thrifty old folks make one set of dentures and try to make them last a lifetime and many young, educated people have not heard of crowns and root canals. There are numerous indications for crowns, root canals and implants, but indications are just indications. What is the reason for all that undone dentistry which dental practitioners encounter on a daily basis? Not enough dentists? Or just a lack of interest and/or knowledge on the part of the patients?

Still trust the numbers?

Unlike mom and pop shops, solo dental clinics are still able to survive because as far as dentistry and hairdstyling go, many people still value that personal touch from someone familiar. Apart from that, the small practices have little advantage over the big boys who often get free publicity by making news. Many existing small practices are already facing great challenges against the big boys. Increasing the number of dentists will only shrink the pie further and make things worse for small practices which are already struggling regardless of the favourable theoretical conclusion that can be drawn from the 1:3400 ratio.

The world is flooded with self improvement books. Each one of them acts like a coach to guide the reader on his path of success both professionally and socially. There is one common denominator as far as self improvement or self help books are concerned. Another “selfish” word - self esteem. Since the “self help movement” started a couple of decades ago, the experts authoring these books came to the rather unscientific conclusion that people are obnoxious losers because they lack self esteem. It may have something to do with an unhappy childhood, but the gurus felt and so many still subscribe to that “you’ve got to love yourself before you can love others” myth.

How do we know it’s a myth? Because after an entire generation of self help books with thousands of titles published and billions of dollars spent on all the “non-fiction” bestsellers, America is still the same old country full of unhappy and unloved people. And Singapore is not spared this rip-off. Some years ago, two of my buddies in the army used to snap up every single self help book in the local bookstores. They were single, unhappy and not rich enough. After spending thousands on these books, they were still single, lonely, unhappy and a few thousand dollars poorer. Have the gurus thought of preaching a diametrically opposing doctrine?

Who are the people who are often unhappy and usually unloved; with few friends and even fewer successes in life? Who are the losers? Personally, the losers that I see around me are typically self-centred spoilt brats with poor emotional control. Is there a problem with their self esteem? Do they love themselves too little? Hell, no. In fact, they often have too much self-respect and too little respect for others. They turn hostile when others merely express impatience in repeating something to them. On the other hand, they don’t seem to realise that all the while, others are being very tolerant to their impatience and rudeness which they can’t see. Of course the spoilt brat may choose to live in denial and accuse the whole world of being against them. The objective indicator for who is right and who is wrong lies in the number of friends they and the people they criticise have. The genuine spoilt brats have few friends and even more telling is their propensity to blame the very nature of the environment for their unhappiness.

Like the yin and yang theory in Chinese medicine, boosting the self esteem of these individuals will merely upset the balance of yin and yang further. And without self help books, the parents of these spoilt brats are already doing a very good job perpetuating their self-centredness. These helpless folks agree with everything the spoilt brat says because they fear that disagreeing will trigger a round of tantrums. This way, the spoilt brat will never learn his/her mistakes. Certain cultures actually consider this as appropriate action in the face of unreasonable people/behaviour. I beg to differ. The more we give in to unreasonable behaviour, the more we encourage it.

No country can progress without peace and stability. No personal achievements can be made without hardwork, patience and a calm, peaceful mind. Glitches and mistakes are sometimes caused by our own carelessness. Sometimes they is caused by others’ carelessness or a breakdown in communication. They are intolerant to any glitches in life, getting angry and throwing tantrums whenever things don’t turn out right. By blowing up and blaming everyone instead of staying calm to resolve the matter amicably with people who are not impossible to work with, they effectively set bridges on fire, cutting off opportunities for future interaction and cooperation. Do we still need to add the oil of self esteem on those burning bridges?

The majority of people are able to deal with spoilt brats simply by avoiding them. Not when it happens in your family. Some parents continue to pamper those spoilt brats all the way to adulthood, soothing their already fiery ego on a daily basis. Ironically, that is meant to stop these grown ups from throwing tantrums or issuing malicious threats. What else can the aged parents do?