Economic Downturns

A person who sounded like an expert confidently declared that the economy is recovering. That’s because he has noticed that ordinary folks in T-shirts and bermudas are flocking to new property launches like a Singapore Idol audition. In the same breath, the expert thinks that dentists are not affected by economic downturns. He’s not alone. Many of my friends are surprised that dentists’ incomes are affected by a recession because they are still under the impression that dentists treat toothaches and nothing else.

Sure, dentists are trained to extract or fill up painful teeth, but how often do people have toothaches and need extractions? In fact, most progressive practices today do very few extractions. Even when a tooth is dead and infected, the treatment of choice is root canal. Educated, cooperative and motivated patients are expected to turn up regularly for hygiene visits even when they do not have any toothache. In the developed world, preventive dentistry (scaling, polishing, filling early cavities, mouthguards, removing impacted wisdom teeth) keeps many general practices busy. Yet, we often see people walking around with teeth encrusted with barnacles, oozing with plaque and bad breath. From the dentist’s point of view, it is extremely important that patients clean up the tartar on their teeth and arrest any early gum disease. From the average Singaporean’s point of view, it’s: no pain, no need to see dentist.

What else do dentists do? There is denture construction, crown and bridge work, implant dentistry. Again, in the developed world, people change their dentures every few years. They do crowns and bridges to restore broken or missing teeth. They also go for dental implants. All these procedures come under the field of restorative dentistry. From the dentist’s point of view, most people who have lost some teeth will require restorative dental treatment. It restores the person’s smile and function. However, we often see people walking around with missing teeth. Those who have lost back teeth often don’t bother to replace them, resulting in the remaining teeth drifting everywhere. From these people’s point of view, restorative dentistry is not necessary. Why? No pain, no need to see dentist.

A combination of preventive and restorative dentistry form thee bulk of the average general dental practitioner’s income. Both fields of dentistry can be rather recession prone. Take implant restoration for instance. An economic downturn of this magnitude will have a very drastic impact on patient acceptance of procedures like implants, crowns and bridges. For many practitioners who have upgraded themselves and acquired new skills to perform sophisticated procedures, the bulk of their income will come from these procedures and the handling of nasty toothaches. Tooth whitening and other cosmetic dental procedures form the bulk of treatment rendered in many upmarket practices.

But the “experts” are right in thinking that someone suffering from the intense pain of acute pulpitis will not hesitate to see a dentist regardless of economic situation. By the same token, they should also realise that only a nasty toothache will force a person to see a dentist regardless of economic climate. While it’s good that dentists are doing more root canals, more preventive and restorative treatment, these treatments may end up working against dentists by reducing the number of toothaches in a population which still cannot accept preventive dentistry as a necessity.

Wisdom Tooth Surgery

Wisdom Tooth Surgery is Medisave claimable at our Medisave Accredited Day Sugery Centre

The wisdom tooth is the third molar. Most people have one in each quadrant of the mouth. However, it is not uncommon to find individuals with less than 4 wisdom teeth.

Because this tooth usually erupts when the person is about 18-21 years of age, it is called the wisdom tooth. In reality, the tooth is often non-functional or even problematic.

When there is insufficient space in the jaw for the tooth to emerge fully, the wisdom tooth may get trapped under the gum and bone. Partial eruption makes the tooth susceptible to gum infection which may result in recurrent bouts of pain and swelling. Left alone for long periods, chronic gum infection can lead to fibrous growths or cyst formation.

In certain cases, the tooth may be slanted against the next tooth - the second molar. The resulting gap between the two teeth traps food and promotes bad breath as well as decay.

Wisdom tooth surgery is usually carried out to save the second molar or stop the recurrence of gum swelling. In some individuals, the eruption of their wisdom teeth coincides with the appearance of their front teeth being pushed together. Wisdom tooth surgery is also performed to allay fears of crowding/overlapping front teeth, though there is no strong evidence to prove that the crowding front teeth is the direct result of pressure from erupting wisdom teeth.

There are various categories of wisdom tooth impaction. Below are some of the most common positions that impacted lower wisdom teeth may end up.

Vertical impaction

Mesio-angular impaction

Horizontal impaction

Disto-angular impaction

The depth of the impaction will affect the degree of difficulty in removing the tooth, but angulation also plays a part. Generally, vertical impactions are easy to deal with while horizontal and disto-angular impactions are challenging. I have successfully removed wisdom teeth in all the above categories.

Most wisdom teeth in the upper jaw can be extracted without surgery. Wisdom teeth in the lower jaw are usually more troublesome. Most dental practices are only equipped to provide local anaesthetic. For relatively simple cases, local anaesthesia, delivered by injection, is usually sufficient.

What is "Alamak"?

"Boy, lots of food here. Come down with Papa and your brother. I'm not buying dinner tonight, faster huh ."


Alamak Patient (in Hokkien or Teochew): "Nay, this one is the pull teeth one lor."

"I warn you first huh. (pointing finger at dentist's nose) I very scared of dentists one huh. You better don't frighten me huh."

It may surprise some people, but many heartlanders in developed and progressive Singapore still treat a visit to the dentist like a visit to the barber. They don't bother to bring any identification or make any appointment. They also may not co-operate in history taking. What's more, they often think that dentistry is a craft no more complex and demanding than changing tyres. In fact, they think that teeth are much easier to handle because they're smaller than tyres. Not to belittle mechanics, such unfair comparisons give patients the impression that we are always "overcharging".

The word "alamak" probably originates from a Malay slang meaning "oh dear". It is used here to describe a boorish, ungracious and kiasu heartlander who has no respect for dentists as professionals practising a complex and diverse form of healthcare that requires a tremendous investment in many years of education and training.

All the cases depicted below are real. Some are even typical and recurring. We are happy to note that our clientele has evolved over the years and currently, the majority of our patients are not alamak. This website has helped us a lot in our effort to upgrade ourselves to a cosmetic dental centre.

Secret To Get Rich???

Most self help books are useless and some are more useless than others, so when I read a self help book, I’m not looking for any real help. Instead, I look for honest opinions and insights on the topic being dealt with. This book does contain many good and honest insights into what makes a business as successful as the author’s.

Dominating your niche means going all the way to stand on top of your competitors. Sounds fierce? Well, the author begins with an intro for newbies on what entrepreneurship is all about. You must:
1. Have a reason to go into business
2. Think big and aim high
3. Be obsessive about it
4. Focus on profits
5. Burn bridges and don’t think about turning back

It’s only in Chapter 3 that the author starts talking about niche markets. How does one find a profitable one and avoid making the mistake that Crazy Horse in Singapore made? The answer lies in market research. The author went into pest management after finding out that most hospitality establishments in Singapore changed their pest control companies like the way people change their underwear. That’s because the service provided by most of these companies fall way below standards expected of them.

The author chose this niche because there was a desperate demand for better service and corporate clients were willing to pay a premium for it. The author gives us examples like Charles & Keith and Song of India restaurant - which I think are not totally appropriate as far as niche domination and providing something desperately needed are concerned.

Printed in large font at the beginning of Chapter 4, is the statement:

The bigger and more serious the problem, the more valuable your solution.

That’s very easy for us to agree with. Problems are everywhere. We identify those problems and solve them. We differentiate ourselves by doing things differently and better, charging more for it. To be a leader, one must also charge leading fees and provide top notch service. Not only that, one must dress and act like the industry leader, also making sure that employees are well-groomed and company vehicles well-polished.

The next few chapters further support the author’s belief in going all out to stand on top of all competitors. Networking is important. It’s not just who you know but who knows you. Get testimonials. Get awards. Overcome customer resistance with guarantees. Be a good leader to your staff. Scout for and retain talented people. Empower them. Implement new technology and ride on the next wave.

Even long before the book finishes, the astute reader should have realised that there are not too many secrets in this book. It may make him wonder why he’s spent $32.55 (before discount) on it. One of the reasons for the author’s success in his niche must have something to do with his less well-educated competitors. Better able to upgrade himself and acquire new skills and technology ahead of his competitors, it’s less difficult for him to outwit, outsell and outperform his competition.

Well, I guess even this “secret” is an open one. We are seeing more and more graduates engaged in businesses traditionally handled by the academically challenged. I know a temple medium who speaks fluent English. With so many intelligent competitors who have as much access to cutting edge technology and an equal ability to learn new things from developed countries, it won’t be long before it becomes impossible for to rise above a level playing field unless someone has an unfair advantage (e.g. rental-free father’s shop) to begin with.

This book has not been a waste of time for me. I don’t expect too much from self help books these days, but the author’s long road to success is an inspiring one. I admire what the author has done even though very few of those who have read the book will be able to achieve the same.

“Student Promotion”

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Crown Lengthening

Ask : Jan Schuneman

before making additional veneers the gum has to be operate (reductio, lift up the gum), after a couple of weeks the ceramics. Yes indeed she very beauty and I'm sure with a perfect treatment she will be a model! Those are cases what we do nearly every day....

Answer : Dr Chan

Using conventional crown lengthening techniques, the gum level takes 2 months to stabilise. With laser, you may be able to get away with 2 weeks, but I wouldn't take the risk, especially when bone is involved. One month perhaps.

"adjust denture"

I made a set of dentures for an old lady a month ago. It was a challenging case. Yes, that dreaded bilateral free end saddle again. I took care to design a chrome denture that would not move too much whenever the patient bites. But as free end saddle dentures go, there would always be a dragging effect in the saddle area.

As a rule, I warned the patient not too have such high expectations. As usual, the patient agreed and as usual again, the complaints keep coming in. This time, the one relaying the complaints were none other than her American-accented daughter. The Hokkien-speaking patient was nowhere in sight.

“Just trim the denture here and here.” she said, pointing to the appliance.

“I need your mother to be here to ascertain where the trouble spots are.” I said.

“Let me tell you. They’re here and here.”

“We need to be more precise than that. It’s useless for me to trim the denture without any reference to sore spots in the patient’s mouth.” I tried to explain.

“How do you know it wouldn’t work? You haven’t even tried.”

Well, suffice to say that even people who speak with an American accent may not know how dentures work.