How often should you visit the dentist?

SINGAPORE - The best way to see less of your dentist is, ironically, to see him regularly.

Most people avoid seeing the dentist until they get a toothache or other dental problems, said Dr Fu Jia Hui, a registrar in the discipline of periodontics (treatment of the gums and bones that support teeth) at National University Hospital (NUH).

They may end up having to spend more time with him and seeing him more often for their dental problems, she said.

Regular check-ups are important because some oral problems, such as early decay and gingivitis, do not have obvious symptoms at the beginning until the diseases are in their late stages, said Dr Fu.

When diagnosed and treated early, these oral problems can be reversed.

Gingivitis is the early stage of periodontal (gum) disease when the gum tissue becomes swollen and may bleed easily.

If it progresses, severe gum disease can develop.

Gum tissue will pull away from the teeth, allowing the bacteria to destroy the underlying bone supporting the teeth.

Most importantly, regular dental checks not only maintain the health of the mouth, they also maintain the health of the body, Dr Fu said.

Evidence is emerging of the connection between the mouth and body.

Research has shown that oral bacteria can travel from the mouth into the bloodstream and injure major organs.

For instance, gum disease, which is marked by inflammation, has been linked to other chronic illnesses such as heart disease and diabetes.

Just how often should you pay a visit to your dentist?

This depends on your medical and dental health, said Dr Marianne Ong, a senior consultant at the periodontics dentistry unit at the department of restorative dentistry at National Dental Centre Singapore.

She gives a rough guide.

Dental care for children

Parents are advised to take their child to the dentist six months after the first tooth erupts, which usually occurs around the age of one.

This is the recommendation of the American Academy of Paediatric Dentistry.

Doing so allows the dentist to prevent and anticipate problems before they arise, said Dr Tan Wee Kiat, senior consultant and head of the paediatric dentistry unit at the department of restorative dentistry at the National Dental Centre Singapore.

Dental diseases progress faster in children's teeth because their teeth are smaller and have less enamel to protect them from decay, she said.

In fact, an aggressive form of decay, called early childhood caries, is on the rise here and now affects about four in 10 children aged three to six.

The rise has been blamed on parents' ignorance about dental disease.

Letting a child fall asleep with a milk bottle in his mouth can make matters worse. This is because sugar that occurs naturally in milk makes a perfect environment for bacteria to multiply.

The bacteria convert the milk sugar, called lactose, into lactic acid.

The acid attacks the tooth enamel, making it easier for bacteria to reach the nerve of the tooth.

The decay-causing bacteria usually first attacks a young child's front teeth, sometimes as soon as they erupt.

The decay can spread rapidly, and the tooth can rot right down to its roots between six months and a year.

Left untreated, it may lead to pain, swelling, loss of appetite and sleep, and damage the developing permanent teeth.

Children are at risk of getting the problem if they are frequent snackers, do not brush their teeth regularly or habitually suckle a bottle of milk to sleep.

Parents should be alerted to the problem if a child complains of pain when biting food, of sensitivity to hot or cold food, or has swollen gums.

The National Dental Centre Singapore runs an infant oral health clinic, the first in Singapore with a preventive oral health programme for mothers and their infants. For more information, call 6324-8802.

Dental care for adults

For people with good dental health, including those well-controlled medical conditions such as heart disease and diabetes

Frequency: Once every six to 12 months.

Why: Brushing and flossing the teeth alone cannot get rid of plaque in teeth which are tilted and in the harder-to-reach areas, such as the back of the molars.

During a dental visit, the dentist can remove plaque in these areas with the help of dental equipment.

Plaque is a sticky bacterial film that forms constantly on the teeth and can contribute to tooth decay and gum disease.

It contains bacteria which, following a meal high in sugar, can release acids that attack tooth enamel, which is the outer layer of the tooth.

Repeated attacks can cause the enamel to break down, eventually resulting in cavities or dental caries (tooth decay).

Plaque that is not removed can eventually harden into calculus or tartar. This makes it more difficult to keep the teeth clean.

When tartar collects above the gum line, the gum tissue can become swollen and may bleed easily, leading to gingivitis and, in those who are susceptible, to periodontitis (advanced stage of gum disease with bone loss around the teeth).

For healthy people with oral diseases, such as dental caries or gum disease, due to poor oral hygiene

Frequency: Once every three to six months.

Why: This is to ensure that oral diseases are nipped in the bud. When picked up early, dental caries and gingivitis can be reversed.

Regular dental visits also keep oral diseases under control by minimising the level of bacterial plaque build-up in the mouth.

For people with poorly controlled medical conditions, such as diabetes, especially if they also have poor dental health

Frequency: Once every two to four months.

Why: People with diabetes that is not well-controlled are more likely to have gum disease than those without.

This is probably because people with poorly controlled diabetes are more likely to contract infections, including gum disease.

Conversely, periodontal disease may make it more difficult for people who have diabetes to control their blood sugar levels.

Severe periodontal disease can increase blood sugar, contributing to increased periods of time when those levels are elevated in the body. This puts people with diabetes at increased risk of complications such as kidney failure.

For people, often older, with multiple medical conditions and on multiple drugs

Frequency: Once every two to four months.

Why: Those who are on multiple types of medication are more prone to developing xerostomia (dry mouth). Dry mouth results from an inadequate flow of saliva, which is the mouth's primary defence against tooth decay.

It washes away food and other debris and neutralises acid produced by bacteria in the mouth.

Thus, it limits the growth of bacteria and bathes the teeth with disease-fighting substances.

A reduction in saliva can increase the risk of developing dental caries.

Sources: www.mouthhealthy.org, www.perio.org/consumer/diabetes.htm and Dr Marianne Ong, senior consultant at the periodontics dentistry unit at the department of restorative dentistry at the National Dental Centre Singapore

During a dental visit

A typical dental examination involves visual examination and clinical examination of the teeth and oral soft tissue.

Visual examination

The dentist examines the colour and contour of the gum tissue for signs of infection or inflammation.

He checks for any obvious cavities and broken or defective fillings.

He also looks for any abnormal lumps or bumps, or non-healing ulcers in the oral soft tissue. These could indicate an abnormal growth or a tumour.

Clinical examination

A tool, called a dental explorer, and another, called a periodontal probe, are used to check for cavities and gum disease respectively.

The explorer, a pen-like metal device with a sharp hook at one end, is used to check the biting surfaces and the sides of the teeth for cavities.

It can also be used to tap on the teeth to check how sensitive they are.

The dentist can also use it to pick out any loose debris in between the teeth or gums.

The periodontal probe, which is also a pen-like metal device but with a blunted hook at one end, is used to check how firm the gum is around the tooth.

There are markings inscribed on this blunted hook to measure how deep the pocket around a tooth is. This helps establish the health of the gums.

If needed, the dentist may sometimes order radiographs (X-rays) of the teeth and jaw to be done.

The dentist will also check the integrity of the dental prosthesis, if the patient has one.

For removable dentures, the fit of the prosthesis is also checked. After several years of use, these may need to be changed if they do not fit well, as the soft and hard tissue over the denture-bearing area will shrink over time.

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