Yours Toothfully by Dr Chan Joon Yee

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.

I thought I had died and gone to food heaven when my classmate Chin Leong invited me to stay at his home in Penang. Every day I was there, we went on a walk, stop and eat tour of the island. We went to Penang Hill. We went to the snake temple and many other tourist spots and at the end of each day, I would have eaten at least 3 bowls of laksa, a few pieces of grilled cuttlefish, 2 plates of char kway teow and a bowl or 2 of Hokkien mee for supper - all at roadside stalls, all of which couldn’t have gotten a D grading from our world class NEA.

Someone once joked that in Singapore, the standard of a hawker’s food is inversely proportional to the hygiene grading. I prefer to judge food quality by the rudeness of the hawker. But food hygiene is definitely no joking matter nowadays. Two people have died after eating some contaminated Indian rojak. Unlike anti-suicide barriers at MRT stations, the response to food poisoning deaths was swift.

Yes, the heat is on at hawker centres. Food hygiene is a major issue these days. To show how major it is, 80 out of 83 stalls in Geylang Serai had their hawker hygiene grading downgraded to C.

That’s interesting. But why C? Why not D? Why only 80/83 stalls? Why not all 83 stalls? Regardless of whether the stalls are “downgraded” to C or D overnight, people still need to eat and they are certainly smart enough to know that their chances of getting food poisoning at these familiar but “downgraded” stalls would not be any higher than before. The only “effective” thing about this downgrading exercise is that if anyone gets food poisoning at Geyland Serai, he can’t blame the NEA for being mistaken about the standard of stall cleanliness there.

What next? Compulsory continuing education on food hygiene for our hawkers? That’s easy to implement. What’s not so easy is for the hawkers themselves to take time off to attend these courses and keep their prices low. They may need to start looking for locums too. What’s even more difficult, is for the governing body to vouch for a hawker who has completed all his hygiene courses, judiciously implemented state of the art hygiene measures at his stall and still ends up with customers in hospital. It’s not wrong to make the hawkers take ultimate responsibilty for the safety of their own food, but if I were a hawker, I would feel a stab in my back if my stall’s cleanliness is instantly downgraded when something happens nearby.

The most reputable brand of electronics can explode. The most skillful surgeon can make mistakes on or off the operating table. Athletic people collapse and die for no apparent reason. Self-sacrificing monks can lend $50,000 in charity funds to their boyfriends. A stall that has been doing brisk business for decades may have a fatal food poisoning case. We live in an imperfect world. Accidents will happen no matter how careful you are. While it’s only right that we mourn the unfortunate people who died, taking drastic measures to prevent such things from ever happening again will not only be futile, but will make Singapore even more uniquely dull, sterile and unforgiving. I’m not a foolhardy person (and I certainly won’t tolerate a cockroach in my har gow), but I still need to live on and enjoy life. Bring on the good stuff.