Teeth for the toothless

PHOTO: Teeth for the toothless

Dentist Dr Chow Kai Foo wants to ensure that it is not just 'the rich and the brave' who can afford dental implants.

BO geh, bo geh, chiak taugeh!" Literally translated as "No teeth, no teeth, eat beansprouts!", this Hokkien rhyme warns children about the dangers of toothlessness, among which is the inability to eat solid food.

As retired civil servant JS Lim, 80, can testify, not being able to enjoy your favourite foods can be downright depressing.

The steak-lover had been suffering from what he calls "dancing dentures" for the past two to three years, ever since his remaining natural teeth started to become loose.

Lim shares that he started losing his teeth around the age of 45. "It started with my molars. Last time, there was no such thing as (dental) implants, you just had to make do with what you have."

Like most of us, Lim only visited the dentist when he developed cavities and had to remove the affected tooth or teeth. Dentists recommend that we go for regular dental check-ups twice a year.

Over the next couple of decades, Lim continued losing a tooth here and there, until he finally had to get a dental bridge to replace his upper front teeth around the age of 60, and another one for the increasing gaps between his remaining natural teeth at 65.

"These lasted me for a long time. Then, in the last two to three years, my anchor teeth started to become loose, and the dentist said they could not be saved, and had to be removed.

"After that, I became totally toothless," he shares.

While he still attempted to utilise his dentures for eating, the lack of teeth to anchor them made them move around too much during the process, although it was still slightly better than just gumming his food.

"The dentures, even without the anchor, could still help a bit - no veggies, but still can eat fish, (and) if you confine yourself to soft things, then you can still cope with the 'dancing dentures'."

He adds with a wistful laugh: "At that time, you can only remember how good steak and lamb chops taste."

During that time, Lim sought treatment at a public hospital, which had a programme offering two free dental implants to eligible patients. However, there was such high demand that the waiting time was very long.

In the meantime, he decided to write in to The Star, highlighting the high cost of dental implants in Malaysia, after reading about Health Minister Datuk Seri Liow Tiong Lai's announcement that his ministry would look into improving dental care in government clinics and hospitals, and increasing the number of dentists and orthodontists in the country (Health Ministry wants better bite for the people, The Star, May 5, 2012).

Made in Malaysia

Oral surgeon and oral implantologist Dr Chow Kai Foo read his letter (Help those who are totally toothless, The Star, May 7, 2012), and approached this writer to help get in touch with Lim.

He shares: "One of the most exciting things in my life as a dentist was when I first put in an implant more than a dozen years ago.

"It was hard to believe, but there it was, a new tooth almost as good as new standing in my patient's mouth.

"It not only looked good, it could bite well, and after a few years, I realised that such implanted teeth can also last a long time. In fact, most of them last for life."

However, he eventually came to believe that those who manage to get dental implants are "the rich and the brave".

"The rich" because dental implants, being generally made out of titanium and imported from abroad, can cost between RM5,000-10,000 (S$1,996-3,992)  per implant; and "the brave" because the patient has to endure the outpatient surgery, which includes drilling into the jawbone.

With this in mind, Dr Chow decided to source for more affordable implants.

The implants, which are called Minimised Osseointegrating Screw Titanium Dental Implants (Mostdis), are of smaller size compared to the more popularly-used ones. These mini-implants have been increasingly accepted over the past few years by dentists around the world as a valid and effective tool to stabilise loose dentures.

As one of his main goals is to help as many patients as possible, Dr Chow decided to embark on a CSR programme called Teeth for the Toothless to help deserving Malaysians with loose lower full dentures who are unable to eat properly.

Those eligible would receive a significant subsidy on the implants and surgery they needed, which is in turn, funded by the profits made by selling the implants.

"The CSR project will depend on our bottomline. We foresee that there will be patients who are able to pay the full price, and those who can't, so we will try to balance them," he says.

The programme also allows Dr Chow a way to help train other dentists in the procedure of putting in the implants, as he can invite a few of his colleagues to observe the surgery.

Only about 5 per cent of dentists in Malaysia are specialised in implant surgery, he says; but Dr Chow and his fellow specialists believe that with advancing technology and dental techniques, the procedure can be made simpler and less invasive, and thus, within the capabilities of general dentists.

"When we saw the letter to The Star from a pensioner saying that dental implants were beyond his ability to pay, even though he needed them to stabilise his lower false teeth, we felt that we should do what we can," he shares.

Lim underwent the surgery to put in four implants in his lower jaw last September. He was so pleased with the results that he persuaded Dr Chow to do the same for his upper dentures recently.

"Frankly, the bottom ones were very good, very firm. Now, with the upper ones as well, I can finally enjoy eating again this Chinese New Year," he says with a laugh.

"I can vouch that anyone who pays this price and goes through this experience will find it worthwhile."

It's the gums

According to Dr Chow, the National Oral Health Survey of Adults 2010 revealed that 7 per cent of adults in Malaysia are edentulous, or have lost all their natural teeth.

The survey also found that a whopping 90 per cent of Malaysian adults have gum disease.

With the incidence of dental caries plummeting due to the national fluoridation programme, the dental specialist believes that gum disease is now the main cause of tooth loss in the country.

"Gum disease is very slow; it can go on for 10 to 20 years without the patient discovering it, versus tooth decay, which hits acutely," he says.

"After 10 years, they might start to realise one or two teeth are loose, and they try not to bite down so hard with them. After 10 more years, the tooth will start to come out."

He adds that unlike tooth decay, which affects one or two teeth, gum disease affects many teeth because it hits the foundation holding the teeth up - the gum.

Although most affected people start to seek dental help by the time they are around 30- to 40-years-old, Dr Chow says that it is already quite late by then.

"I'd advise everyone to go for regular check-ups starting from age 10, because gum disease can be treated and cured when caught early enough," he says, adding that by the time the patient is 30 to 40 years old, the bacterial infection can only be controlled, not cured.

"We know, among the profession, that 30 per cent of people who have lost their teeth don't wear dentures," he says.

"There are various reasons. Price is one. Second is accessibility - many of them are in rural areas with no easy access to dental care.

"Third is resilience - they just live with it; and perhaps also ignorance (of the treatment options available)."

He adds that about half of those wearing dentures have problems with it. Those who have the most problems are those with lower dentures, as these tend to become quite loose after a few years, due to bone loss.

The main worries with these patients are the prospects of compromised nutrition, as they find it very difficult to eat properly, and psychosocial effects, as the loose denture affects their appearance and speech, leading them to avoid socialising and decreasing their self-confidence.

Replacing your teeth

For those who have lost their teeth, there are three treatment options.

The simplest, quickest and most affordable, are removable dentures, or false teeth.

However, most people tend to find it difficult to keep these in place - just like Lim with his "dancing dentures", and hard to maintain as food tends to frequently get lodged under it while eating.

Over time, it can also cause the loss of more teeth as the dentures rely on natural teeth to keep them in place.

"The next best thing are bridges," says Dr Chow.

As its name implies, the denture is fitted into a metal frame that is anchored onto the two natural teeth on either side of the toothless gap, therefore, bridging the gap.

The advantages of a bridge is that it is fixed in position, looks presentable, and can be used to eat easily.

The downside is that the natural teeth anchoring the bridge have to be trimmed in order to fit the bridge onto them, and after around 10 years, 30 per cent of these teeth will develop cavities, leading to the eventual failure of the bridge.

The third treatment option are dental implants.

These are described by Dr Chow as "very functional, very strong - almost as good as natural teeth, because nothing is ever as good as your own natural teeth".

As the implants are anchored into the jawbone, the dentures affixed onto them can stand by themselves, and do not affect any remaining natural teeth.

"They look quite nice, and statistically, will last a long time, with only a 10 per cent failure rate over 10 years," he says, adding that dental implants are expected to last a lifetime, although that cannot be guaranteed for various reasons.

However, as previously stated, dental implants are expensive, and they require a certain amount of surgery, which is a scary thought for some patients.

Dr Chow hopes at least, to address the question of affordability.

"We hope to bring this form of treatment to everyone in Malaysia who complains of a loose lower denture," he says.

Those interested in joining the CSR project, and dentists interested in being trained by Dr Chow in his minimised dental implant procedure, can email their enquiries to teeth4toothless@gmail.com. His blog smalldentalimplants@blogspot.com shows many images useful to the professional and informative to the layperson.