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FAQ

1. What is orthodontic treatment (braces)?

2. Do I need braces? Why should I have orthodontic treatment?

3. When do I need braces?

4. How long is orthodontic treatment? How long will I have my braces on?

5. What are difficult cases that usually require longer time to finish orthodontic treatment?

6. When is the best time to have braces?

7. I will be going to college for studies soon. Can I still have my braces done?

8. Am I too old for braces?

9. I have dental crowns. Am I still eligible for orthodontic treatment? Do I need to remove my crown or renew them after the treatment?

10. What is the time gap between orthodontic appointments?

11. Why does it take so long between the appointments?

12. What can I do or cannot do during orthodontic treatment?

13. Where can I get orthodontic treatment?

14. Is it painful to have braces on?

15. What is impacted wisdom tooth?

16. What happens to my impacted wisdom tooth in the long run?

17. What are the signs and symptoms that suggest removal of impacted wisdom tooth?

18. When do I have to remove my impacted wisdom tooth?

19. What is the procedure for surgical removal of wisdom tooth?

20. Will the procedure of surgical removal of impacted wisdom be painful?

21. How long is the procedure of surgical removal of impacted wisdom tooth?

22. What is expected after surgical removal of impacted wisdom tooth?

23. What is allowed after surgical removal of the impacted wisdom tooth?

24. What is not allowed after surgical removal of the impacted wisdom tooth?

25. What are the possible complications after the surgical removal of wisdom tooth? What do I do to resolve it?

26. What are dental crowns and bridges?

27. Why the need of dental crowns? What are the common indications of dental crowns?

28. What are the common indications of dental bridges?

29. How are dental crowns made?

30. How are dental bridges made?

31. Will it be painful during preparation of dental crown and bridges?

32. How long is the procedure for preparing dental crown/bridge?

33. Do I need to come back for a review after crown/bridge cementation?

34. How long do dental crowns and bridges last?

35. Why do crown fall out after few years?

36. When do I need to replace my crown/bridge?

37. What are the advantages of dental crown/bridge?

38. What are the disadvantages of dental crown/bridge?

 

1. What is orthodontic treatment (braces)?

It is usually referred to fixed dental components cemented to your teeth temporarily for leveling and alignment. The aim for orthodontic treatment is to align all of the teeth to be in optimal position for the wellbeing of the patient in terms of health, aesthetics and function. Well-aligned teeth improve the quality of oral hygiene of patients as cleaning and brushing is easier with better access. Appearance is enhanced as patients are presented with a better smile. Balanced of chewing function is achieved with elimination of stress areas.

 

2. Do I need braces? Why should I have orthodontic treatment?

Firstly, if you think you don’t need one or you have no interest in having it done more than often the answer is no. Having braces requires a lot of patience and commitment from the patient.  Consistency in attending appointments is vital to prevent delayed finishing of treatment.  Cleaning your teeth will be twice as hard as before starting orthodontic treatment. However, there are many conditions require orthodontic treatment. Consult your orthodontist for further details.

 

3. When do I need braces?

Teeth not well aligned resulting in unpleasant appearance affecting self-esteem and confidence.

Teeth out of position causing gum problems due to difficulty in cleaning.

Increased overjet or upper front teeth appears too much forward from lower front teeth. This is hazardous as it is prone to injury.

Increased overbite or deep bite where your upper teeth cover your lower teeth completely during bite. This usually result in trauma of the upper palate (roof of the mouth) and may lead to temporomandibular (jaw) joint problem in the long run.

Presence of missing teeth in certain areas and patient does not wish to have dental bridge, denture or implant placed. A rare request and limited to specific cases as it takes a longer time to close the space compared to other mode of treatment.

Accident or trauma causing mobility and out of positioned teeth.

Severe bone loss during traumatic experience requires teeth to be held on together. Collectively as a group teeth are more stable and bone remodeling (healing) is faster.

Preparation for implants, dental bridge or even denture treatment. Moving teeth to ideal position prior other dental treatment is sometimes considered to ensure longevity of those treatments.

 

4. How long is orthodontic treatment? How long will I have my braces on?

On average it takes about two years depending on cases.

 

5. What are difficult cases that usually require longer time to finish orthodontic treatment?

Missing molars. It takes easily 1-2 years (sometimes longer) just to close the missing space of a molar excluding other time taken to level and align other teeth. Having implants or a dental bridge placed is usually recommended if patient is not willing to wait.

Uncooperative patients. Failure in attending orthodontic appointments pro-longs the treatment time and delays finishing of the braces. Not using elastics as instructed sometimes results in worse condition. Poor oral hygiene leads to problems during the treatment such as cavities and breakage (or even loss) of brace.

 

6. When is the best time to have braces?

There is no fixed time to have braces. Usually early teen years present as the best time to start as all of the permanent teeth is out. Nevertheless, this is not a rule. Indicated cases vary between patients. Occasionally early loss of teeth in growing children requires orthodontic treatment for the alignment of future erupting permanent teeth. Consult your orthodontist for further information.

 

7. I will be going to college for studies soon. Can I still have my braces done?

If you are still able to attend the appointments as suggested by your orthodontist, then there is no problem. If you anticipate any difficulty such as transportation, frequent examination among many others perhaps it is best you postpone the treatment until a more convenient time.

 

8. Am I too old for braces?

No. There is no age limit for orthodontic treatment. It is recommended during the early years as bone remodeling is faster allowing faster treatment time as compared to orthodontic therapy for matured adults.

 

9. I have dental crowns. Am I still eligible for orthodontic treatment? Do I need to remove my crown or renew them after the treatment?

Yes, you are still eligible. No, you do not need to remove or renew your crown. Special hard bonding adhesive will be used to cement the brace to your crown. However, upon removal of the brace a small matt mark tend to appear. This is because the glossy layer of the initial crown is removed. It is unnoticeable if your crown is in the back region. In the case of front teeth dental crowns, crowns are usually replaced due to patient’s requests, as it is more obvious than others.

 

10. What is the time gap between orthodontic appointments?

First few sessions are generally closer from 3-7 days. Once the orthodontic wires are placed, appointments vary from 4-6 weeks apart.

 

11. Why does it take so long between the appointments?

As orthodontist likes to say, ‘let the wires cook’. The orthodontic wire is flexible and soft. Movement of teeth within bone takes time. ‘Let the wires cook’ simply means allowing the wire to take and maintain its original form from its initial bent shape as a result of adapting to the teeth’s unaligned design.

 

12. What can I do or cannot do during orthodontic treatment?

Refer to our Orthodontics Care section.

 

13. Where can I get orthodontic treatment?

Although normal general dental practitioner is able take on easy cases, patients are advised to seek treatment from qualified and trained orthodontist. They are more able to cater to difficult cases and adjust accordingly from cases to cases especially when unexpected complication arises.

 

14. Is it painful to have braces on?

Generally when your orthodontist activates the orthodontic wire, change new wire or elastics, moderate discomfort is expected the first two days following that appointment. This is because new bone remodelling is activated and taking place. Although painkillers is provided, from our experience it is quite rare that patients actually require them to reduce the pain.

 

15. What is impacted wisdom tooth?

Firstly, wisdom tooth is actually referring to the third molar. In the event of no space available for the wisdom tooth to erupt, it remains impacted within the bone. Impaction degree of the wisdom tooth may be full impaction (not visible), or partially impacted (small amount of tooth crown visible).

 

16. What happens to my impacted wisdom tooth in the long run?

Common problem faced by patients are partially erupted wisdom teeth whereby the remaining tooth structure stays within the bone. The closeness nature of the wisdom tooth to the following second molar encourages food trap. This often leads to caries (cavity) involving both wisdom and the second molar as they share surface contact. Early intervention may prevent severe damage to both teeth by having regular check-ups.

 

17. What are the signs and symptoms that suggest removal of impacted wisdom tooth?

Patients often misunderstood the presence of pain and swelling in the back of the molar area indicates surgical removal of the wisdom tooth. Although, they are usually true, some cases are not. In the event of erupting wisdom tooth, pain, swelling and even fever is expected as new tooth is emerging. As tooth eruption is a slow process, food often gets trap underneath the gum skin overlying the new wisdom tooth. This causes gum infection resulting in pain and swelling.

Severely damaged wisdom tooth due to caries (cavity), dental abscess (pus formation) due to infection of the tooth and gums usually suggests surgical removal in the nearest date following pain and swelling control.

 

18. When do I have to remove my impacted wisdom tooth?

Persisting pain and swelling after episodes of antibiotic treatment can be frustrating. Besides, frequent intake of antibiotics to control the infection is not advisable. After more than two subsequent occasions of pain and swelling related to the impacted wisdom tooth, perhaps it is time to consult your doctor and consider surgical removal.

 

19. What is the procedure for surgical removal of wisdom tooth?

The first phase is swelling and pain control. In the presence of both, patients are usually prescribed with antibiotics, anti-inflammatory and painkillers initially. Once the antibiotics regime is completed after a few days, patient is ready for the surgery.

Second phase is the actual surgery.

Local anaesthesia is administered and incision of the gum is done to create gum flaps for access to the wisdom tooth. Subsequently, bone removal surrounding the impacted wisdom is made with dental drill for further access of the wisdom tooth. The wisdom tooth is cut into smaller pieces if needed. Withdrawal of the wisdom tooth is done by dental elevator(screwdriver-like tool). Once the tooth is out, remaining bone will be filed for removal of any sharp bone edges. The previous gum flaps later will be used to close the extraction site by means of stitches.

The third phase is removal of the sutures (stitches) taking place 1 week after the surgery.

 

20. Will the procedure of surgical removal of impacted wisdom be painful?

Generally some form of discomfort is expected during the withdrawal of the wisdom tooth. This is because the pressure sensation is still experienced by the patient when the tooth is pushed against the bone. Local anaesthesia protects the patient from sharp and direct pain of the tooth but not the pressure sensation. Other components of the surgery on the other hand will be pain-free.

 

21. How long is the procedure of surgical removal of impacted wisdom tooth?

On average the surgery takes 30-45 minutes. In difficult cases, it may extend up to 90 minutes.

 

22. What is expected after surgical removal of impacted wisdom tooth?

Pain and swelling is expected from 3-7 days following the surgery. Within the first 3 days after surgery, swelling of the jaw/face will be prominent thus not fit for work/school in most places. After 3 days, gradual reduction of swelling will be visible. Antibiotics, anti-inflammatory and painkillers will be given immediately after the surgery. It is important for the patient to consume them accordingly as advised to ensure recovery.

 

23. What is allowed after surgical removal of the impacted wisdom tooth?

External ice-pack application to the surgical area. This helps to reduce the swelling.

Plenty of rest. This is your time to catch up on your sleep.

Cold beverages including ice-blended. Indulge yourself in your favorite coffee or tea drinks. You deserved it after undergoing the surgery.

Soft diet within the first two days following the surgery.

 

24. What is not allowed after surgical removal of the impacted wisdom tooth?

Traveling especially by air within the first 3 days post-surgery. The cabin pressure during take off and landing is known to break the blood clot in the healing area of surgery.

Sports activity should be prevented for at least 3 days. Active movements may promote rupture of blood clot of surgical site.

Smoking until surgical site is fully healed. Consult your doctor for this matter.

The heat from smoking is very often the reason for post-surgery infection. It promotes bone infection of surgical site.

Hot beverages should be avoided the first 48 hours after surgery for the same reason.

Touching the area of surgery with your fingers is strictly prohibited.

 

25. What are the possible complications after the surgical removal of wisdom tooth? What do I do to resolve it?

Sometimes patients experienced post-surgery bleeding later at home. Biting on towel continuously for 10-15 minutes may help stop the bleeding. If this fails, rinse the towel with saline water (available at pharmacy or optical shop) and bite again until the bleeding stops. If bleeding persists after 30 minutes, seek help at your nearest dentists available.

Infection of the bone (‘dry socket’) occurs when previous blood clot ruptures. For this you have no other choice but to seek help from your dentist immediately.

 

26. What are dental crowns and bridges?

Unlike dentures, dental crowns are not removable and are fixed to your teeth by means of cementation. On the other hand, dental bridge is a series of joined crowns to restore missing teeth.

 

27. Why do I need dental crowns? What are the common indications of dental crowns?

Severely damaged single tooth in which normal chair-side restoration would not suffice.

Replacing a large filling which is prone to fracture.

Root canal treated tooth; strength of tooth reduced due to heavy tooth removal during root canal therapy.

Discolored / poorly shaped tooth.

Patient refused to wear removable dental prosthetics such as dentures.

 

28. What are the common indications of dental bridges?

Restoration of missing tooth.

Prevention of drifting of existing teeth into gap area of missing tooth which often result in bad bite leading to temporomandibular joint problems. Additionally, risk of gum problems is higher as food stuck is likely due to increasing gap between teeth.

Single crown restoration alone is insufficient for long term chewing function due to high tooth material loss and heavy bite. Incorporation of adjacent teeth ensures longevity of damaged tooth with group function.

 

29. How are dental crowns made?

Tooth is reduced in size by means of trimming to allow adequate thickness of new dental crown.

More than often the current tooth needs to be built up with normal filling material prior reduction in size.

This may appear redundant but in fact remain vital in preparing the crown.

This is because a dental crown is not meant to restore the severely damaged tooth completely.

All dental crown/bridge has a specific size, design and thickness.

For vital (nerve still functioning) teeth, local anaesthesia is administered for patients comfort prior reduction of teeth thus treatment is pain-free.

A dental impression is later taken to create the mold for preparing the dental crown. This impression is sent to dental laboratory where dental crowns are prepared.

A temporary crown is cemented while waiting for the new crown to be ready.

When the new crown is ready, the temporary crown will be removed and the new crown will be cemented.

 

30. How are dental bridges made?

Procedure is similar to dental crowns except the increase number of teeth involved depending on the units of bridge to be prepared.

 

31. Will it be painful during preparation of dental crown and bridges?

No. Local anaesthesia will be administered at the beginning of the treatment. Some patients finds it unpleasant listening to the drilling sounds during the procedure.  They have the option of bringing their mp3 layers or even listening to their cellular phones via earphones.

 

32. How long is the procedure for preparing dental crown/bridge?

Preparation normally involves two visits; first for the preparation and second involving cementation of the new crown/bridge.

The first visit is usually the longer phase ranging from half hour to two hours depending on difficulty of cases. The second visit usually lasts about half hour.

The normal gap between the two visits is usually 1 week.

Nevertheless, emergency/fast cases are done where crown/bridge are prepared within 3 days provided the patient bearing additional charges imposed by the dental laboratory.

 

33. Do I need to come back for a review after crown/bridge cementation?

Yes. Patients are always encouraged to return the following week to examine any discomfort or ‘high bite’ of the new crown/bridge after function applied.

However, for traveling patients whom are unable to comply, they are still advised to seek consultation but in a location convenient to them elsewhere.

Review is important as minor ‘high bite’ may lead to fracture of the tooth or even joint problem in the long run.

 

34. How long do dental crowns and bridges last?

While crowns and bridges can last a lifetime, they do sometimes break, experience fracture and needs to be replaced.

Maintenance of crowns and bridges by patient is important to ensure its longevity.

The biggest cause of crown/bridge failure is poor oral hygiene. Poor oral hygiene leads to secondary caries (new cavity formation within previous restored cavity) underneath or even within the margins of the crown/bridge. Worst, periodontal problem (gum disease) occurred causing high mobility of previously restored teeth with crown/bridge. These unfortunate teeth sometimes ended up being removed.

Diet, bad habit and lifestyle influence survival of crown/bridge.

Biting or chewing on hard food/objects affects crown/bridge negatively.

Hard cookies (eg. local Muruku), ice, chicken bones among many others are strictly prohibited when chewing with dental crown/bridge.

Biting on pens or rulers at work is a common cause for crown fracture.

Sometimes, some unfortunate patients accidentally bit on small pebble stones found in their rice.

Regular check-up and good oral hygiene ensures crown/bridge to last longer.

 

35. Why do crown fall out after few years?

Incidence of dental crown/bridge being loose or even falling out completely is a social nightmare and rather embarrassing for everyone. However, this is not uncommon. This is usually due to the need of new cementation for the crown/bridge. Initial crown cement does undergo wear and tear as they not only function to adhere the crown to the tooth but also as a liner absorbing force during chewing. After new cement is applied, the crown/bridge will be as good as new.

 

36. When do I need to replace my crown/bridge?

Fracture of the ceramic component from the crown may appear unpleasant to look at and patients usually requests for ‘repair’ the broken piece by means of cementation of chair-side filling material as a quick fix. Depending on the location of the fracture, most of the time this is not possible. Even if it does work, it will only last for a short period and falls off easily.

Gum margin recession is common over the years leading to unpleasant black lines appearance at the margin of the crown. This is due to the metal base of the crown (metal fused ceramic) being visible after gum margin has receded. Although full ceramic crown may prevent this, indication for such restoration may be limited and varies from one patient to another or even varies within the same patient itself.

 

37. What are the advantages of dental crown/bridge?

Provides greater strength as opposed to normal chair-side tooth material.

Better appearance due to full coverage of tooth surface.

No staining or discoloration over time.

Ability to fully restore original tooth form and structure.

 

38. What are the disadvantages of dental crown/bridge?

Certain amount of trimming of original tooth structure is required for the design of the dental crown/bridge.

This is especially significant for preparing a bridge with fillings-free, healthy adjacent teeth.

Nevertheless, patients still has the option of dental implant to restore missing tooth without touching the adjacent healthy teeth.

Sensitivity occurs occasionally for crown restoration on vital (nerve functioning) tooth.

If the problem persists, sometimes patients are advised to seek root canal treatment for the tooth.

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