health MEDIA COVERAGE: TODAY, Tuesday, November 17, 2009, Pg 44 Missing teeth can lead to a host of health problems

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1 TODAY, Tuesday, November 17, 2009, Pg 44 health IN COLLABORATION WITH: TUESDAY NOVEMBER 17, TODAY ORAL CARE It s nothing to laugh about WHAT S SHOWING ON TELEVISION 46 Missing teeth can lead to a host of health problems EVELINE GAN eveline@mediacorp.com.sg MORE THAN JUST A PRETTY SMILE AFP FILLING THE VOID

2 The Business Times, Tuesday, December 22, 2009 www. b i o -s c a ffol d.com

NTUC Lifestyle, March Edition, 2010 36 wellness The whole tooth When it comes to looking good, our smiles are one of our greatest assets. A beautiful smile comes with neatly-aligned front teeth.

There is no doubt that our teeth work very hard chomping, shredding and grinding our food. Losing our teeth, whether through old age, decay or an accident, can be a traumatic experience.

Imagine not being able to chomp on crab claws or chew spicy spare ribs? Or even crunch on an apple if you re vegetarian?

The gaps left by missing teeth are not only unsightly but eventually, the adjacent tooth may shift into the gap, creating aesthetically ugly gaps in front of and behind it.

3 NTUC Lifestyle, March Edition, wellness The whole tooth When it comes to looking good, our smiles are one of our greatest assets. A beautiful smile comes with neatly-aligned front teeth. People who have lost teeth might feel too self-conscious to smile or talk. It s no wonder Hollywood celebrities spend a fortune to preserve their dazzling smiles! There is no doubt that our teeth work very hard chomping, shredding and grinding our food. Losing our teeth, whether through old age, decay or an accident, can be a traumatic experience. As well as bringing about unattractive changes in facial appearance, missing teeth can have a negative effect on confidence and self-esteem. Not to mention missing out on your favorite food. Imagine not being able to chomp on crab claws or chew spicy spare ribs? Or even crunch on an apple if you re vegetarian? Our teeth are exposed to a tremendous amount of wear and tear and of course, we are all aging. But losing teeth has far more serious effects apart from just affecting one s smile. The gaps left by missing teeth are not only unsightly but eventually, the adjacent tooth may shift into the gap, creating aesthetically ugly gaps in front of and behind it. Additionally, biting irregularities caused by tooth loss can have a negative effect on eating habits and this can lead to secondary health problems like malnutrition. Even the loss of one tooth can be harmful and have a lifelong effect. A smile is an inexpensive way to change your looks. ~Charles Gordy There are many reasons why we lose our teeth. Tooth decay, root canal infections, gum disease (Periodontitis), congenital defects and accidents are some examples. tooth or FALSE Besides wiping that smile off your face, losing a tooth or several teeth can be a traumatic experience. Dental surgeon, DR EMILY WONG tells us the consequences of missing teeth, and also how with advances in dental techniques like socket preservation, solutions are available. Teeth start shifting into adjacent gap Opposite missing teeth For example, when you bite, your top tooth bites with the opposite one on the lower jaw. Missing either tooth makes the opposite one useless, so it is the same as missing two teeth, functionally. Our back teeth (molars) work hard at grinding our food and we have four on each side of our mouth (except the third molars). When one molar is missing, the opposite molar will be non functional. More importantly, the bone tissue at the gap will start to degrade and melt away once no tooth is there. It is estimated that the jaw bone can lose as much as 1mm to 1.5mm of height within three months of tooth loss or extraction. Furthermore, the thickness of the jaw bone can reduce by half within a year. Two thirds of the thinning of the jaw bone will occur within three months after the tooth is lost. The thinning of jaw bone will also weaken the adjacent tooth support.

NTUC Lifestyle, March Edition, 2010 38 wellness The whole tooth Missing teeth can also cause secondary problems like headaches or neck ache.

The excess use of one side of the mouth, greatly stresses the jaw and neck muscles on that side, causing aches and pains which feel like headaches.

4 NTUC Lifestyle, March Edition, wellness The whole tooth Missing teeth can also cause secondary problems like headaches or neck ache. For example, losing a molar makes chewing difficult at that side, forcing you to use the other side of your mouth. The excess use of one side of the mouth, greatly stresses the jaw and neck muscles on that side, causing aches and pains which feel like headaches. When multiple teeth are lost, the imbalance in the mouth places some stress and strain to the jaw joints. This pain can radiate downwards towards the neck and shoulders. Also, due to the proximity of our upper back teeth to our sinuses, loss of teeth in this area can cause the sinus cavity to be exposed, which could lead to problems like sinusitis and fistulae. The effects mentioned above will be multiplied in the case of more than one missing tooth. Therefore, it is important to replace missing teeth at the earliest opportunity. After a tooth is extracted, dentists will screen the patient and advise them on how the missing tooth can be replaced. Part of this screening process involves checking the condition of the patient s jaw bone. As mentioned earlier, extraction or loss of a tooth results in bone loss, which could be quite dramatic within a year. This makes it difficult to insert implants in a socket (space from where the tooth was extracted). Problems like these can be overcome by procedures such as bone grafting or socket preservation. What is socket preservation and why do we need to preserve the socket? Socket preservation is a procedure in which bone graft material or a scaffold is immediately placed in the socket of an extracted tooth to preserve bone ridge and density. It can greatly increase the chances for successful dental implants, especially for delayed implants. Careful management of extraction sockets after tooth extraction prevents unsightly bone loss and provides a better cosmetic outcome for tooth replacement. Socket preservation with granules, Courtesy: Socket preservation following tooth extraction appears to offer several clinical advantages in preparing the ridge for future implant placement as well as other restorative tooth structures like fixed bridges, dentures etc. It may also play a part in prolonging the life of an implant. There are a few techniques and materials available for socket preservation and a dentist will usually discuss these with the patient. Traditionally, dentists have used bone grafts when there is inadequate bone material in the patient s jaw. Examples of bone grafts are Autograft (the patient s own bone), Allograft (bone from another Human Being) or Xenograft (bone from animal, usually porcine or bovine origins) and Alloplast (synthetic materials which come in various forms such as granules, scaffolds, injectable pastes etc). Autograft, is the best choice but it has its limitations plus the disadvantage of involving surgery and pain in order to harvest bone from a secondary site, not to mention the associated costs. Allografts use bone graft material from human cadavers. Xenografts obtain bone graft material from tissue of animal origin, which includes bovine (cow) or porcine (pig) bone. With allograft and xenograft, there is a very small chance of disease cross-transmission or rejection of the graft by the recipient s immune system. For many patients, using cadaver or animal bone material may be offensive on religious or cultural grounds. However, with the advance of technology, new materials are now available which are bio-inert and will not be identified by the host tissue as a foreign body. Such materials are known as Alloplast. All materials have their own key benefits but generally, synthetic materials are preferred as they are inert and carry no animal or dead human remains. Synthetic materials are also free from cross genetic contamination. Some recent advances in technology have produced synthetic scaffolds which are affordable and can provide a mechanical support for the socket walls to prevent collapse, without affecting the natural healing process. These scaffolds can also encourage the natural growth of one s own bone tissue, reducing the loss of jaw bone material.

NTUC Lifestyle, March Edition, 2010 lifestyle Mar 2010 39 People seldom notice old clothes if you wear a big smile.

As bone loss occurs rapidly after tooth extraction, the end result will always be insufficient bone volume if the natural bone loss process is not immediately arrested after tooth extraction.

5 NTUC Lifestyle, March Edition, 2010 lifestyle Mar People seldom notice old clothes if you wear a big smile.~lee Mildon There is also the important aesthetic element that can no longer be ignored. Naturally, all patients want to look good after their dental procedures. As bone loss occurs rapidly after tooth extraction, the end result will always be insufficient bone volume if the natural bone loss process is not immediately arrested after tooth extraction. This could cause inwardsinking of the gum lines, thus rendering a poor aesthetic appearance. Extensive bone loss can cause the face to sink in as well as other undesirable effects. Gaps from missing side teeth can cause our cheeks to fall into the gap, giving a sunken appearance to the face. Losing one s front teeth causes the lips to fall inwards, giving the mouth a loose, wrinkled appearance. And if you have the misfortune to lose all your teeth, your whole face profile will change, giving you a concave, crescent moon face with wrinkles and a very old appearance! Collapsed face with missing teeth on the left. (Courtesy of www. drmartz.com) So maintaining a good set of teeth into old age and preserving our jawbones goes far beyond conserving our smile. It could make the difference to our overall health, wellbeing and self-esteem. LINKS: Preservation_of_alveolar_ridge_height Dr Emily Wong is at Rapha Specialist Clinic (Clementi), Tel:

6 PRIME, May/June Edition, 2010

7 PRIME, May/June Edition, 2010

8 The Business Times, May 04, 2010

Ezyhealth, August 2010 ADVERTORIAL t Your jaws the backbone of your smile! here is a lot of attention on the prevention of tooth loss but very little on the prevention of jaw bone loss.

When we smile, the first thing catches the eyes are the beautifully aligned teeth, followed by the supported lips and cheeks and then the whole face.

It also supports the soft tissue which builds the aesthetic for the beautiful smile.

A simple loss of one tooth can alter the total aesthetic of the smile and face. Teeth - An Important part of the Structure Teeth are important for jaw bone health.

Natural teeth are embedded in the jaw bone and attached via a root Bridging the Gap By Dr Hui Chee Wah, Flozz Dental Surgery structure which, depending on the location and size of the tooth, varies

When teeth are missing, the alveolar bone the portion of the jaw bone that anchors the teeth in the mouth no longer receives this physical stimulation and starts to resorb, or break down, leaving a

There is no doubt that someone who has lost several teeth will appear more aged than someone who has a full set of teeth.

of it. Missing either tooth makes the opposite tooth useless, so it is the same as missing two teeth, functionally.

9 Ezyhealth, August 2010 ADVERTORIAL t Your jaws the backbone of your smile! here is a lot of attention on the prevention of tooth loss but very little on the prevention of jaw bone loss. However, there is a clear link between healthy teeth and a strong jaw bone, so pay attention to both! When we smile, the first thing catches the eyes are the beautifully aligned teeth, followed by the supported lips and cheeks and then the whole face. Our jaw bone not only carries our teeth but it also holds them strongly in place for all the chewing and biting we do. It also supports the soft tissue which builds the aesthetic for the beautiful smile. Once our jaw bone is affected due to loss of the tooth, it affects everything around it including the rest of the teeth and the gums and cheeks. A simple loss of one tooth can alter the total aesthetic of the smile and face. Teeth - An Important part of the Structure Teeth are important for jaw bone health. As with muscle or any other tissue in the human body, bone tissue needs to be used to maintain its shape and overall health. Natural teeth are embedded in the jaw bone and attached via a root Bridging the Gap By Dr Hui Chee Wah, Flozz Dental Surgery structure which, depending on the location and size of the tooth, varies in size, shape and complexity. Activities such as biting and chewing stimulate the root structure, which in turn stimulates the bone that the tooth root is attached to. When teeth are missing, the alveolar bone the portion of the jaw bone that anchors the teeth in the mouth no longer receives this physical stimulation and starts to resorb, or break down, leaving a space or defect. The breakdown and rebuilding of bone is a natural, ongoing process that maintains normal, healthy bone where it is needed and removes bone where it is not needed. When teeth are lost, the body no longer needs this bone, and it subsequently goes away. One s facial appearance is affected as there may be a collapse of the facial profile and reduced lip support. There may also be increased wrinkling of the skin around the mouth and distortion of other facial features. There is no doubt that someone who has lost several teeth will appear more aged than someone who has a full set of teeth. Ageing effect on face with toothless thin jaw A Gap-ing Problem Gaps left by missing teeth are unsightly and may cause the adjacent tooth to shift into the gap, creating ugly gaps in front and behind of it. Missing either tooth makes the opposite tooth useless, so it is the same as missing two teeth, functionally. More importantly, the bone tissue at the gap will start to degrade and melt away once no tooth is there. It is estimated that the jaw bone can lose as much as 1 mm to 1.5 mm of height within three months of tooth loss or extraction. Furthermore, the thickness of the jaw bone can reduce by half within a year. Two thirds of the thinning of the jaw bone will occur within 3 months after the tooth is lost. Other problems include jaw pain, headaches and difficulty in communicating. Dentures and bridgework may appear to correct the problem of missing teeth, at least in terms of appearance and function, but most are not designed to mimic a natural tooth s ability to stimulate bone in the jaw. Some dentures are supported and held in place by implants that may provide sufficient stimulation for preserving bone health. Similarly, unanchored dentures rest on top of the gum line and provide no direct stimulation of alveolar bone. This type of denture depends on support from the gums and the underlying bone structure to keep it in place. As bone resorption progresses, patients often report that their dentures become progressively looser and do not fit as well as they did when they first started wearing them. After several years, bone and gum tissue may shrink to a point where new (or relined) dentures and even denture adhesives cannot provide adequate retention. After a tooth is extracted, dentists will screen the patient and advise them on how the missing tooth can be replaced. Part of this screening process involves checking the condition of the patient s jaw bone. As mentioned earlier, extraction or loss of a tooth results in bone loss, which could be quite dramatic within a year. This makes it difficult to insert implants in the jaw. Some of this bone loss can be alleviated with procedures such as bone grafting or prevented with socket preservation, which is the most effective way. Socket Preservation What is socket preservation and why do we need to preserve the socket? Socket preservation is a procedure in which bone graft material or a scaffold is immediately placed in the socket of an extracted tooth to preserve bone height, width and density. It can greatly increase the chances for successful dental implants, especially for delayed implants. Careful management of extraction sockets after tooth extraction prevents unsightly bone loss and provides a better cosmetic outcome for tooth replacement. Socket preservation following tooth extraction appears to offer several clinical advantages in preparing the ridge for future implant placement as well as other restorative tooth structures like fixed bridges, dentures etc. It may also play a part in prolonging the life of an implant. Some recent advances in technology have produced synthetic scaffolds which are affordable and can provide a mechanical support for the socket walls to prevent collapse, without affecting the natural healing process. Traditionally, dentists use bone grafts when there is inadequate bone material in the patient s jaw. Examples of bone grafts are Autograft (the patient s own bone), Allograft (bone from another Human Being) or Xenograft (bone from animal, usually porcine or bovine origins) and Alloplast (synthetic materials which come in various forms such as granules or scaffolds). Autograft is the best choice but there is still the need to undergo surgery, pain in order to harvest bone from a secondary site and the associated costs. With allograft and xenograft, there is a very small chance of disease cross-transmission or rejection of the graft by the recipient s immune system. For many patients, using cadaver or animal bone material may be offensive on religious or cultural grounds. Technology Brings Newer Materials However, with the advance of technology, new materials are now available which are bio-inert and will not be identified by the host tissue as a foreign body. Synthetic materials are preferred as they are inert and carry no animal or dead human remains, and are free from cross genetic contamination. Some recent advances in technology have produced synthetic scaffolds which are affordable and can provide a mechanical support for the socket walls to prevent collapse, without affecting the natural healing process. These scaffolds can also encourage the natural growth of one s own bone tissue, reducing the loss of jaw bone material. Maintaining a good set of teeth and keeping your jawbone healthy will help conserve your smile. And this will have an impact on your overall health, wellbeing and self-esteem. Be aware of the signs and symptoms of oral diseases and get them treated in time to prevent tooth loss. Keep up those regular visits to the dentist! For more information on bone and socket preservation, please visit. Dr Hui is the current President of the Society of Periodontology (Singapore) 38 ezyhealth&beauty. aug 2010 aug ezyhealth&beauty 39

Patient's Guide to Dental Implants. an investment for a lifelong smile

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