Don't lose your bite

PHOTO: Don't lose your bite

If the tooth fairy paid you a visit today, she would, instead of leaving a coin under your pillow, probably tell you to get proper dental care. Beautiful teeth starts with not just good oral hygiene but also understanding the importance of orthodontic care.

Not many people can distinguish between a dentist and an orthodontist, and some wrongly assume the two are the same.

Orthodontics is a specialised field of study in dentistry that deals with the diagnosis, prevention and treatment of dental and facial irregularities. Orthodontic treatment involves the design and use of corrective appliances (such as braces, plates, head gears and functional appliances) to bring teeth and jaws into proper alignment.

Crooked teeth, abnormal bite problems, protruding teeth, jaws that are out of alignment, extra or missing teeth and cleft lip and palates are among the reasons why patients may need orthodontic care.

"Many of these conditions affect not just self-esteem but influences the quality of people's lives," says Lt. Col. Dr Shalene Kereshanan, an orthodontist attached to the Ministry of Defence.

Dr Shalene, who is also president of the Malaysian Association Of Orthodontists (MAO), says one of the potential rewards of good orthodontic care is having straight teeth that are easier to clean and therefore less prone to decay. It's also a boost to a person's self-confidence.

Clinical evidence indicates that if a person's upper front teeth protrude markedly, they are more prone to fractures. Orthodontic treatment can reduce the risk of such trauma. In some cases, speech and masticatory (chewing) efficiency can also be greatly improved.

While a general dental practitioner (GDP) is trained to provide primary dental care, orthodontists are clinically trained to take on more complex conditions, such as the aforementioned. In many developed countries, braces are fitted only by orthodontists.

A GDP does fillings, root canal therapy and extractions, basic surgical procedures as well as cleaning and polishing, veneers, crowns, bridges and dentures.

Just like in medicine, where GPs provide primary care and refer those requiring specialised treatment to specialist doctors, GDPs should refer those requiring specialised dental care to orthodontists, says Dr Noraini Alwi, immediate past president of MAO.

If, for example, a patient needs to have her teeth whitened or cleaned after orthodontic treatment, she can go back to the GDP for that service.

"Both dentists and orthodontists should ideally work well together, with each performing the functions they are trained for so patients receive the best care and treatment," says Dr Noraini.

To qualify as an orthodontist locally, a dentist has to undergo four years of training and rigorous clinical and written assessments.

Dr Noraini says it's a long road for the candidate and only the cream of the crop is selected for this postgraduate programme as places are limited.

Locally, only two universities offer this specialisation - Universiti Malaya and Universiti Kebangsaan Malaysia.

Currently, there are 120 qualified orthodontists practising in the country with one-third serving in government hospitals. On the average, there are two orthodontists in every state with the Klang Valley having a slightly higher number.

The government is working to put together a National Specialists Registry that will serve as a database of qualified and registered medical and dental specialists in the country, and orthodontists will be included in this registry, making it easier for the public to identify and locate such professionals.

The MAO also provides a list of qualified orthodontists in the country on its website and the public can search by state to find one nearest to them.

"Many Malaysians assume it's just teeth and not life threatening, so specialist care is not necessary but lose a tooth and you'll find out just how uncomfortable it is and how badly it affects the quality of life," says Dr Shalene.

Having a trained professional manage your problem is crucial as orthodontic treatment teeth may have to be removed to create space for aligning other teeth. If the wrong teeth are removed, they are lost forever. Given that patients usually seek orthodontic treatment for functionally and aesthetically pleasing results, such an outcome can be devastating.

Some patients may experience problems from improper treatment two or three years down the line while others may end up without the results they wanted or not see any improvement at all. In many cases, patients have to start from scratch again. Sometimes, the damage is irreversible and this will be hard on patients who have already forked out large sums of money.

A properly trained orthodontist will not only be able to anticipate potential problems and handle them but he would also understand the long-term implications of any procedure the patient undergoes. This is crucial as orthodontic treatment should have an end result that not only suits an individual's face but also sits well on that person as he ages.

Many people also assume that private orthodontic treatment will cost an arm and a leg but we offer one of the cheapest rates in Southeast Asia.

The cost, depending on the problem, the complexity and the duration of treatment, can be anything from RM5,000 (S$2,035) but this covers treatment running over two to three years.

At one time, many people thought braces were only for children but Dr Shalene says that of the thousands of patients undergoing orthodontic treatment, more than one in five is over the age of 21.

As the basic process involved in moving teeth is the same in adults as in children, orthodontic treatment can usually be successful at any age as long as peridontal (gum) tissues are healthy.

Today, state-of-the-art orthodontic surgeries are equipped with digital cephalometric X-ray machines and volumetric cone beam computerised tomography machines.

These, when coupled with the latest 3-D orthodontic imaging software, enable clinical information and measurements of the jaw and face to be accurately compiled. They serve as powerful tools for dental specialists to diagnose, plan treatment, document and present cases.

Orthodontic imaging software also means specialists can plan the movement of teeth and jaws prior to complex surgery and for patients to see upfront the possible outcome of their treatment.

"The crux of the matter is to go to someone trained and credible, using the right equipment and who will be accountable for his work," says Dr Shalene.