Common Problems
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Bleeding Gums and Bad Breath:
The Difference between Scaling, Polishing and Whitening
Ever so many people come in with this complaint. Many also complain of bad breath. They mostly fear seeing their dentist and avoid treatment unless they are in pain.
The most common cause is the accumulation of a hard deposit under the gums which may grow onto the tooth itself. It usually is cream-ish in colour and gets stained brown after some time. We call it calculus (No relation to Calculus in Additional Mathematics!)
The reason why the gums bleed is because the deposits are actually hardened food that was not brushed off effectively. This retained food (decaying food equals bad breath!!) hardens on the teeth due to the calcium in the saliva.
Trouble is the deposits also are mixed in with bacteria which use up the food and give off toxins which causes the gums to get swollen. Also to compound everything, the deposits no longer can be brushed off with your toothbrush!
Anything swollen has more blood supply (it’s the body’s way to get rid of germs) so when you brush your teeth, the sharp deposits scratch the swollen gums and they bleed. That’s a no brainer. huh.
So a sure sign of calculus on your teeth is if you see blood in the froth that you wash out when you brush your teeth!
The second problem is that the whole process initially doesn’t hurt and people kind of get used to seeing a little blood in the froth….. so they ignore it!
Before long the gums get more and more swollen, and the deposits get larger and sharper, and the gum bleeding is difficult to ignore! Or you start to notice people look away when you get too close because your breath could kill!
So what can you do?
Well… seeing a dentist is a good idea! We’d probably take a look and tell you that you need a scaling.
What is a Scaling?
A scaling is where the dentist examines your teeth then uses a machine that has an incredibly fast vibrating tip to knock off the deposits a.k.a. calculus. The machine makes a funny high pitched sound as it ultrasonically does its job.
There usually is a water spray that not only cools the tip but helps flush away the deposits that get knocked off the tooth. You don’t have to worry about swallowing anything as we have a vacuum tip to help you get rid of it all. I call it my power straw!!
Once we are done, the dentist will polish off any little bits still left on your teeth, together with stains that may be there with a special paste. That’s the nice part …. as you are left with a fresh feeling in your mouth and sparkling teeth!
Does it hurt? Not usually but for most people it’s awfully scary and uncomfortable. What we do for patients who have a LOT of calculus, is paint on a gel which softens the calculus so it falls away easily and fast.
The trick is to do a scaling every six months, like you bring in your car to be serviced every 5000km, then there’s very little deposits and we can get you back tip top fast and easily.
Being ‘kiasu’ when it comes to your gums really doesn’t work!! 
What is polishing?
Polishing is when the dentist uses a special paste on either a bristle brush or a rubber cup and polish off any stains off your teeth.
Polishing usually is routinely done after the scaling procedure as there may be fine deposits of calculus still stuck on your teeth making the teeth still rough (compared to the shiny slick surfaces it normally has) and retains food stuff easily.
Polishing then also gets rid of any stains: smoke stains, coffee and tea stains and yes, stains from food like egg yolk, cabbage and potatoes. There is a study that showed that certain people have a saliva composition that causes food like egg yolk, cabbage and potato to leave brown stains on their teeth!
The polishing does not harm the teeth or cause it to thin either! (Another common but mistaken belief)
Recently, there has been a special paste developed by Colgate, that claims to cause a chemical exchange on the tooth surface that makes teeth no longer sensitive for as long as 3 months after each application!
I have tested this paste and found patients do experience less sensitivity, so we now use the paste (it’s rather expensive!) when the need arises. It is not available in normal shops though … it is solely for professional use as you need to have the paste rotated onto the surface for a short period of time, so you can’t walk into your local Giant or Tesco to get a tube … sorry!
What is Whitening?
Whitening is when a gel-like substance is placed on your teeth which oxidises the surface so it appears whiter or brighter. It is actually bleaching… because the active ingredient is usually a bleach.
There are many, many types of whitening products these days. Most are professional whitening systems, which are carried out by the dentist, and there are also home-use remedies, which you can buy off the shelf and use on yourself at home.
The main difference is in the formulation of the gel-like mixture. The professional systems are of much higher concentrations than those in the home use packages.
The reason why this is so is because of several factors.
Firstly, the patient would be examined for cavities (holes), cracked teeth and leaking fillings, at the very start of the treatment as any teeth that require attention need to be attended to first! Imagine placing a bleach on an exposed tooth … it could be potentially very painful and /or damage the tooth even more!
Most people are unfortunately afraid of dentists, and avoid visiting one, so manufacturers of home-use products, very prudently, only put in a mild formulation that doesn’t have an active cycle that lasts long, (it degrades and becomes harmless in minutes) to avoid problems as much as possible.
Secondly, the home-use formulation is usually placed in a ’stock tray’, a u-shaped tray that you place the gel in, then fit in your mouth, to hold the gel onto the teeth. These trays do not exactly fit your teeth unlike those custom-made for you by the dentist, so will leak out the mixture.
Quite a bit of the home-use mixture will most probably be swallowed so has to be a rather mild concentration so be safe to sell over the counter and hence used unsupervised at home.
In the dentist’s office, the patient would be examined, then a scaling and polishing may be done first, then the initial colour of the teeth is recorded and the desired final colour is agreed upon. Only then does the procedure really start, with the patient having their gums protected by a special barrier first.
The whitening mixture is prepared and immediately placed on the teeth … this is very closely timed and the concentration of the gel mixtureis measured out exactly. The dentist then usually passes either a plasma light (a very high intensity light) or uses a UV light source, which further activates the release of oxygen from the mixture.
All this is done under very strict supervision and when the appropriate time is over, the mixture is very carefully suctioned off so you don’t swallow it.
The whole thing is repeated. Again, very strict control is exercised as to the protection of your gums from the bleach, the concentration of the mixture, the length of time it is placed on your teeth and the suctioning off of all the mixture after each application.
Once the desired shade is reached, the dentist will remove the barrier over the gums and treat the gums with Vitamin E to sooth it.
Usually we advise the patient to stay away for at least a day, from food and drink that may stain the teeth. Usually 24 hours will be more than sufficient for the teeth to remineralise from the natural saliva, after which, eating and drinking things like coffee and coke, would be fine.
In short …. whitening can be a complicated procedure and can take up to an hour or longer.
I would strongly recommend doing it in-house with a dentist supervising the whole procedure!
Linda Wahid Says:
Salam,
Dear Dr. Fauziah,
I would like to know the charges for this treatments:
1. Normal scaling and deep scaling
2. Filings for composite per tooth replacing the one with silver
amalgam fillings.
Thank you so much.
Salam.
Posted on June 3rd, 2009 at 8:05 am
Dr Fauziah Says:
Hi Linda,
Generally normal scaling and polishing is RM100.
Deep scaling is very, very, very seldom required and probably would cost more because of the xrays required (they’re RM50 each) for each quadrant. Kind of difficult to quote really because of this. I must say I last did a bona fide deep scaling years ago and had great results.
Composite fillings to replace silver amalgam usually are RM70 to RM80. These won’t break your bank!
Come in for a quick check up. I’ll draw up a treatment plan for you.
Dr Fauziah
Posted on June 3rd, 2009 at 10:03 pm
iema Says:
hi dr fauziah,
my upper right wisdom tooth is coming out and its start to hurt my jaw and i feel so uncomfortable because i cannot open my mouth widely.
plus i think my gum is swollen
does my wisdom tooth need to be remove???
and i would like to know the charges as well
thank you.
salam
Posted on June 14th, 2009 at 2:47 pm
Dr Fauziah Says:
Hi Iema,
You probably can’t open your mouth wide because of the swelling from the wisdom tooth!
I can’t tell yet if you need to take it out but you may need medication if the area is infected (probably is since it’s swollen).
Medication usually is RM40 or 50.
I doubt you need surgery, it is quite rare for upper wisdom teeth. I usually can do normal removals for upper wisdom teeth… the trick is in getting you to relax and close your mouth! Normal extraction are RM80.
But if you do need surgery (and again I doubt it) the whole package which includes the actual surgery itself, the medications, the mandatory xrays, the follow-up treatment, is RM550.
By the way did you know RTM2 ran a docudrama called ‘On Call’ a couple of years back. First they filmed me doing surgery on an actual patient. Then on a different day, my nurse and I acted in a drama specially written to explain what happens when there is an emergency. The actress/patient was in pain at home and then comes to the clinic and I was filmed, like I get a call saying there was an emergency and I drive to the clinic etc, etc. It was a whole drama with me explaining everything at the end. That was so cool!
So, don’t worry Iema … I’d just come in to be checked so we can actually see if you do need the surgery or not.
Call Idayu at 03-26917359 or 03-26911334 and we’ll slot you in for a check up.
Dr Fauziah
Posted on June 15th, 2009 at 10:01 pm
desiree Says:
Hi Dr Fauziah,
I have a lower impacted wisdom tooth growing and my jaw hurts. I want to have it removed. May i know if laser is used to remove the wisdom tooth?And i wonder if Intravenous Sedation can be given?I m very afraid of the after pain…
Thanks!
Posted on June 18th, 2009 at 12:48 am
Dr Fauziah Says:
Hi Desiree,
No I don’t use lasers to remove the wisdom teeth, nor do I give intravenous sedation. My surgeries usually are over within 20 minutes so I seldom need the patients to be sedated.
The after pain would be controlled by medication and I do believe my patients don’t suffer much. I do sometimes give Reiki treatment after the surgery if I think it is required though.
I must tell you about my last surgery patient. Hussien is an Arab who works in the Saudi Embassy as a cultural attache. I actually bumped into him in KLCC shopping with his wife and 3 kids during the evening of the surgery! He was quite, quite well and pain free.
If you like I can refer you to a Oral Maxillofacial Surgeon who does sedation. You need to drop by and I’ll do a quick examination and write you the referral letter.
Call Idayu at 03-26911334 on Monday and she’ll slot you in.
Dr Fauziah
Posted on June 19th, 2009 at 11:39 pm
Nani Says:
Hi Doctor Fauziah.. its me Noraini. Just to tell you that I’m sooo…happy with the way you treat me yesterday.
I told my husband, he doesnt have to give me any birthday present.. just pay my bill to get a “beautiful smile” … and guess what?.. he agreed. Cant wait for the next meeting with you for the makeover!
Posted on June 23rd, 2009 at 11:53 am
Dr Fauziah Says:
Hi Nooraini,
Guess what! Yet another person, like you came in today from just visiting this blog!! I’m so thrilled! Linda and her husband are from Vienna, Austria and they were so happy too.
It was just great meeting you yesterday, and yes the makeover I promise will have you smiling ….
Posted on June 23rd, 2009 at 9:19 pm
za1203 Says:
salam Dr,
saya seorang gadis berumur 23 tahun. saya mempunyai masalah pada barisan gigi atas hadapan. ini kerana ada sebatang gigi(gigi ke-3 dari tengah) yang tidak tumbuh sejak saya berumur 9 tahun.ini menyebabkan gigi saya menjadi jarang dan meninggalkan ruang yang agak besar. untuk pengetahuan doktor terdapat 5 ruang kosong yang sederhana dan 1 ruang kosong yang agak besar iaitu dikawasan gigi yang tak tumbuh itu(jarang) pada gigi barisan atas hadapan.
pada pendapat doktor rawatan apakah yang sesuai untuk masalah saya ini?
satu lagi, bolehkah saya lakukan rawatan bridge dan berapakah kosnya? harap doktor dapat bantu saya, ini kerana saya merasa kurang yakin dan segan bila berhadapan dengan orang ramai.
terima kasih.
Posted on September 29th, 2009 at 3:48 pm
Dr Fauziah Says:
Salam,
Rawatan Cosmetic memang sesuai untuk ruang- ruang sederhana dan boleh juga untuk ruang yang besar.
Cost untuk bridge tergantung pada berapa gigi yang perlu di ganti dan berapa gigi yang diguna untuk penyangkuk. Setiap gigi adalah RM750.
Saya rasa elok kalau datang untuk temujanji dan saya boleh tengok sahaja dan bagi advise yang mana yang elok untuk kamu.
Talipon Idayu di 03-26911334 dan dia boleh beri hari dan tempoh yang sesuai.
Jangan risau. Datang untuk temu janji dulu. Itukan langkah pertama!
Dr Fauziah
Posted on October 12th, 2009 at 7:30 am
amalina Says:
Salam Dr,
I just had my treatment with dr nik this morning and she advice that i’ll need to remove my lower left wisdom tooth via surgery this friday. Though she had said that the surgery will not be that long (only 1 hour and that relief me) but my concern is that i’m afraid that i will get swollen face post surgery. my best friend is getting married the other day so i hope it will not impact that much.
TQ
Posted on October 28th, 2009 at 3:03 pm
Dr Fauziah Says:
Hi Amalina,
Thank you for writing in with your concern.
I will have a word with Dr Nik and see if your surgery may need to be deferred to another date and have Hapiza call you later today.
Surgery usually involves some healing time which may include some swelling so it is normal to expect swelling, you see.
Perhaps if you are going to be very involved in the wedding, it may be a bother. The swelling is not so bad but well … since it is your best friend….
Let me speak to Dr Nik to see how complicated the surgery is going to be and she’ll get back to you, OK. I know you will be in good hands.
Thanks again!
Dr Fauziah
Posted on October 29th, 2009 at 7:25 am
nanthini Says:
hye dr fauziah.
tnx for repairing my smile! (though u forget to take a before picture)
hope to see you soon for my wisdom teeth surgery =)
Posted on November 7th, 2009 at 1:03 am
Fazillah Says:
salam dr fauziah,
saya mempunyai masalah gigi depan yang agak jarang. makin lama saya perhatikan gigi saya makin jarang dan ini membuatkan saya malu untuk berhadapan dengan orang ramai. saya ada dengar mengenai tampalan gigi palsu untuk memperbaiki gigi yang jarang. boleh saya tahu berapakah kos untuk rawatan ini?
Posted on November 30th, 2009 at 4:31 pm
sile Says:
salam.. dr fauziah.
saya penah menggunakan khidmat puan dulu. n sangat berpuas hati..teringin pulak nak menanyakan kos utk
1) pemutihan gigi.
2)mana lebih baik untuk mencatikkan barisan gigi sama ada crowning or pakai braces?dan berapa agaknya bajet. hehe. kena kumpul duit.ehe
tq.
Posted on January 27th, 2010 at 11:29 am
admin Says:
Hi Sile,
Now is the best time to do your bleaching! We now have a special until 28 Feb where the Zoom system which was RM1600 is now RM990!
As to braces or crowning … it depends on your gigi! Braces betulkan the aturan of all your teeth at one go but takes 2 years at least. It costs RM5000 in all for the braces but this cost is split over the 2 years.
You only pay RM1500 first then RM200 every time you come to change the bands every 4 to 6 weeks …. this means the cost is paid in installments and even if the appointments have to continue because your gig is ‘degil’ … there are no additional costs!
Crowning corrects individual teeth so I am not sure if braces or crowning is best for you until I see you in person.
Why not call Idayu or Hapiza for an appointment and I’ll be happy to discuss what would be best for you.
Dr Fauziah
Posted on January 28th, 2010 at 8:22 am
Chrystal Says:
Hi Dr. Fauziah,
I have yet to get a response from you. Can you kindly address the issues I mentioned as above because I would really love to get my teeth makeover from you.
Thank you very much
Posted on January 28th, 2010 at 11:54 am
admin Says:
Hi Chrystal,
I actually did reply to you three days later but you probably missed it. Here is what I wrote earlier:
Hi Chrystal,
Yes I know how frustrating it is to have a gag reflex and need to do your teeth at the same time! What makes it worse is when your gag reflex starts …. everything, especially your palate, becomes even more sensitive!!
However we have managed in the past, to work with people with gag reflex … I think the key is to take it slow and allow you to settle down and get really, really relaxed!
We even have managed to do a special child who had a gag reflex! I think treating Chee Jiun (the special needs child) was the best lesson on dealing with patients with gag reflex ever!
Why not call either Idayu or Hapiza and make an appointment
so we can sort out how to go about you getting the treatment you want.
The numbers are 03-26917359 or 03-41071591 and they will be glad to help you make the appointment.
Don’t worry OK
Dr Fauziah
Posted on March 7th, 2010 at 10:56 am
Nur Says:
Doctor,
it takes 3 days for me to drop even a comment here.
(just to give you picture how scared i am with dentist.)
i was planning to go for a check-up few years back.
like i said, i was just planning, never had the guts.
most of my friends are studying dentistry or at least something related to wearing a white coat.
the point is,am still scared of dentist.
luckily my degree year makes me extremely busy and the assignments occupied my mind-all the time. but now, am feeling guilty to my teeth. i have to do something. dont you think?
okeh, lets not think. or else ill delay another ‘few years’ before turn up in front of your door.
ps: during the procedure,is it okay if i cry? am twenty and my mom is not around. oh,,ive bite a nurse index finger before.it was never my intention tho..my jaw was tired.
menara eon is just few minutes walk from my uncle’s house. can i just drop by? ok,,ill just go.
today.tomorrow.today.tomorrow..today..
Posted on April 6th, 2010 at 1:19 pm
Dr Fauziah Says:
Nur,
Just come in and have a chat OK …
I understand scared patients! We even have a code for them so we know patients like you need extra tender loving attention by the whole Team … the code is an open secret! We mark the registration card VNP which stands for Very Nervous Patient!!!
If you fall into the very rare category of VVNP, so what! At least coming in for a chat is the start in the direction of complete health right.
I even treat Special Needs Patients though I don’t write about it. These are patients who can hardly communicate so to them the entire world is a scary place … let alone a place where they have to lie in a chair and let a stranger look into their face. All they need is a lot of patience and loving kindness. That you will find in the bucket loads at our clinics.
So come in and take your time … we want to win the War against your Fear … not just win the battle to do your teeth.
Dr Fauziah
Posted on April 13th, 2010 at 10:16 pm
Nur Says:
Hi doctor,
its me, the VNP or is it VVNP?
when i first come in to your clinic, its not the physical pain that brought me to your front door. i think, i am in denial. i called it self realization, just to make me feel better. but i have to agree with you, there’s also emotional pain. being surrounded by the future dentist as a best friend you know..THAT feeling. (though they never say anything about it)
ohwell,you’ve killed my imaginary Dentist who is wearing white coat, thick glasses,unfriendly, and armed with a dentist drill, not to mention 2 nurse on the left and the right. i am not sure if they were smiling tho, coz they wore a mask and ready to drill into my mouth.
people fear what they dont know, and i asked a lot of question when i am nervous. (if you noticed) it’s easier for me when i know what’s happening IN there. when i was in high school, once i sat on the chair, the nurse start mumbling and scolding me. And before i know,she start drilling my teeth.
if she did the counting like you, 1,2,3,4,5, (barely) 6 and then stop, ill never bite her finger. i swear.
if someone asked me, if they should go and see a dentist like you, i’d say just do it! you’ll love the feeling after-like clicking on the Refresh button. reborn.
am i winning in this war?
thank you Doctor, and the whole-friendly-team.
Posted on April 23rd, 2010 at 3:18 am
Dr Fauziah Says:
Hi Nur,
Well I think we can say you are definitely winning the war against your fear of dentists!! You certainly won the battle to do your teeth and twice too! So I guess we can drop you from VVNP (very,very nervous patient) to the VNP category! And looks like you probably won’t even fall into that category very soon!!
I think you can do away with the idea of the stereotype dentist that you picture in your head, yes? That is the typical dentist from the Mr Bean series! Ha! Ha! and certainly not the ones in our clinics.
One thing you can be assured of, the whole Team wants you to say goodbye (and good riddance!) to your fear of dentists and we’ll support you all the way!
See you soon Nur … and thanks for the great comment!
Dr Fauziah
Posted on April 27th, 2010 at 8:14 am
Lalitha Says:
Dear Dr Fauziah n Staffs,
Thank you for all you have done to do to make me feel so welcome in your office. I feel better about my smile and better about myself.
Have a good day n you surely have a lot to be proud of! Happy Birthday!
Posted on April 27th, 2010 at 6:18 pm
Dr Fauziah Says:
Hi Lalitha
I just posted your makeover and how we closed that gap! You do have a lovely smile.
Thank you for letting me do what I love best on my birthday … seeing your gleeful smile was a great birthday present for me indeed.
So keep smiling OK!
Dr Fauziah
Posted on April 28th, 2010 at 11:16 pm
zaiton khan Says:
Salam Dr. Fauziah. I am 5 month pregnant and want to have filling, scalling and polishing. Is it possible for me to have local anaesthetic before all that because i have a sensitive teeth.
thanks
Posted on June 23rd, 2010 at 8:03 pm