Yours Toothfully by Dr Chan Joon Yee

Like many impoverished Hakka people in Guangdong Province, my grandparents fled from a turbulent China and settled down in a little village near Ipoh. With hardly any formal education, they worked as tin miners, toiling in the sun and the mud from dawn to dusk. Seeing little future in Malaysia, my parents came to Singapore to work during the 50s. Having found better job opportunities in Singapore, they decided to settle down here. I was born into the “State of Singapore” in 1964. A year later, Singapore became a republic. As my parents maintained their close ties with Ipoh, we never really lost touch with our uncles and cousins in Ipoh. Over the years, some of my cousins in Ipoh followed my parents’ footsteps and came to Singapore to work. Some started their own businesses, married and had children here. Most of them were happy as permanent residents of the lion city.

Just recently, a member of our family surprised everyone with a heroic deed. My nephew, Kok Khew Fai, better known as the legendary LTA Kok Khew Fai, saved the life of a recruit at a grenade throwing range. He received an award for his bravery. He later applied for and was awarded an SAF scholarship. He is now studying in the UK. We are all very proud of him.

The guy with the moustache is my cousin. We used to go fishing together and we called him by his nickname Ah Chin. You may be able to tell that Cousin Chin is not the sort who is comfortable with neckties. In fact, he and his wife felt a bit out of place sitting with the well-heeled parents of the other SAF scholars. Well, who cares? My only concern is that it’s going to be hard on Khew Fai to keep up the poster boy image. He is going to be brought out repeatedly during important speeches, as a foreigner who not only did his NS to become a citizen, he even saved some Singaporean asses while doing his NS. I’d like to believe that heroism runs in the family. I just hope Khew Fai knows where and when to stop playing hero when he returns from his studies and joins the establishment.

We know exactly what a poster boy ought to and ought not to do or say just by looking at Uyghur poster girl Rebiya Kadeer. One mainland Chinese supporter argued that the very fact that Rebiya Kadeer managed to become one of the richest women in China shows that Uyghur oppression is nonsense. But did this fellow realise that when Rebiya was doing well in China, she was vice chairwoman of the Xinjiang Autonomous Region Federation of Industry and Commerce, and vice chairwoman of the Xinjiang Association of Women Entrepreneurs as well as member of the National People’s Consultative Conference? She not only lost all these posts, she was even imprisoned the moment she spoke out against the Party’s policies.

Poster boys/girls are meant to be there to prove something that the authorities want to show. They are not meant to be heroic and speak their minds.

From poster boys/girls, we move to local innovations. As a Singaporean, I’d be proud of local inventions that make a difference. Earlier on, while commenting on Singapore women’s success on Everest, I’ve said that I’d be very proud of our girls if they had managed to do something that no other women’s team managed to do.

If there’s a dental product developed by Singaporeans and if it is something that no one else managed to do or sell at an agreeable price, I would buy tonnes of the product and use it exclusively. Some time ago, the manufacturers of Alvelac pushed a box of the socket preservation thing as a consignment in my clinic. I didn’t turn them down. One of the researchers who came up with this concept was a senior of mine in dental school. That ought to give me another reason to feel proud.

Looks impressive? Well, just how useful is it? The manufacturer mentioned quite casually that the scaffold must be inserted in the socket, near the edges of the buccal and lingual walls. This means that in order for the product to work, the socket must be completely surrounded by bone. How often do we get extraction sockets which are like that? Make no bones about it, most teeth are extracted because of gum disease nowadays. With gum disease, you will almost never get perfect bone walls suitable for Alvelac.

What if you do get perfect walls? Well, a socket that is perfect for Alvelac would also be perfect for immediate implant placement. Why bother to preserve the socket with something that prepares it for implantation when you can implant and preserve the socket immediately, saving the patient time and money?

Sorry, guys. I would love to support this local product and I would still keep my consignment just in case a patriot decides to insist on the placement on Alvelac, but I will keep patients informed of the much better option of immediate implantation.

A person who sounded like an expert confidently declared that the economy is recovering. That’s because he has noticed that ordinary folks in T-shirts and bermudas are flocking to new property launches like a Singapore Idol audition. In the same breath, the expert thinks that dentists are not affected by economic downturns. He’s not alone. Many of my friends are surprised that dentists’ incomes are affected by a recession because they are still under the impression that dentists treat toothaches and nothing else.

Sure, dentists are trained to extract or fill up painful teeth, but how often do people have toothaches and need extractions? In fact, most progressive practices today do very few extractions. Even when a tooth is dead and infected, the treatment of choice is root canal. Educated, cooperative and motivated patients are expected to turn up regularly for hygiene visits even when they do not have any toothache. In the developed world, preventive dentistry (scaling, polishing, filling early cavities, mouthguards, removing impacted wisdom teeth) keeps many general practices busy. Yet, we often see people walking around with teeth encrusted with barnacles, oozing with plaque and bad breath. From the dentist’s point of view, it is extremely important that patients clean up the tartar on their teeth and arrest any early gum disease. From the average Singaporean’s point of view, it’s: no pain, no need to see dentist.

What else do dentists do? There is denture construction, crown and bridge work, implant dentistry. Again, in the developed world, people change their dentures every few years. They do crowns and bridges to restore broken or missing teeth. They also go for dental implants. All these procedures come under the field of restorative dentistry. From the dentist’s point of view, most people who have lost some teeth will require restorative dental treatment. It restores the person’s smile and function. However, we often see people walking around with missing teeth. Those who have lost back teeth often don’t bother to replace them, resulting in the remaining teeth drifting everywhere. From these people’s point of view, restorative dentistry is not necessary. Why? No pain, no need to see dentist.

A combination of preventive and restorative dentistry form thee bulk of the average general dental practitioner’s income. Both fields of dentistry can be rather recession prone. Take implant restoration for instance. An economic downturn of this magnitude will have a very drastic impact on patient acceptance of procedures like implants, crowns and bridges. For many practitioners who have upgraded themselves and acquired new skills to perform sophisticated procedures, the bulk of their income will come from these procedures and the handling of nasty toothaches. Tooth whitening and other cosmetic dental procedures form the bulk of treatment rendered in many upmarket practices.

But the “experts” are right in thinking that someone suffering from the intense pain of acute pulpitis will not hesitate to see a dentist regardless of economic situation. By the same token, they should also realise that only a nasty toothache will force a person to see a dentist regardless of economic climate. While it’s good that dentists are doing more root canals, more preventive and restorative treatment, these treatments may end up working against dentists by reducing the number of toothaches in a population which still cannot accept preventive dentistry as a necessity.