Yours Toothfully by Dr Chan Joon Yee

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.

Health in Algeria, according to information from a March 6, 2006 United States report, does not compare well with the developed world. Algeria has inadequate numbers of physicians (one per 1,000 people) and hospital beds (2.1 per 1,000 people) and poor access to water (87 percent of the population) and sanitation (92 percent of the population). Given Algeria’s young population, policy favors preventive health care and clinics over hospitals. In keeping with this policy, the government maintains an immunization program. However, poor sanitation and unclean water still cause tuberculosis, hepatitis, measles, typhoid fever, cholera, and dysentery. In 2003 about 0.10 percent of the population aged 15–49 was living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). The poor generally receive health care free of charge, but the wealthy pay for care according to a sliding scale. Access to health care is enhanced by the requirement that doctors and dentists work in public health for at least five years. However, doctors are more easily found in the cities of the north than in the southern Sahara region.

Describe your experience giving birth there. What type of facility did you go to? What (if any) type of pain management did you use? How long did you stay in the hospital? Was it a positive experience? Etc…



“Well, all I can say is horrible. No pain managment at all, filthy conditions…had to take my own bedding with me. You have to wait with other women in a waiting area to be processed. Lots of women screaming in pain while waiting. Then you are taken to a room full of other women giving birth. They can see you and you them. You have nurses come and hold you down by your shoulders and legs to stop you moving and then a doctors pushes down on your stomach and rolls his arms along you stomach to push the baby out. Then, you are transfered onto a bed with blood all over it from the women who was there before you then you are put into a room with blood soaked bedding, coachroaches as big as houses, no water to wash your baby or yourself as they don’t do it and even if you go private. If there is a problem with the birth you are sent back to the public hospital as cannot deal with emergencies.”

Let us all give a very big salute to our fellow citizens who are roughing it out in Algeria.