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Root Canal Treatment All root canal treatments at Braces and Faces are done by post-graduate trained dentists using a dental microscope for absolute detail. Root canals are done under local anesthesia and should be painless. They can however be technically challenging and require thorough cleaning and patience for success.

Oral Hygiene Program We cannot underestimate the importance of this service. At routine dental appointments, often the focus is on treating dental issues, leaving little time to review brushing and flossing or discussing oral hygiene aids. We therefore offer a complementary service for children and adults to participate in this program with our hygienist at non-peak hours to go through oral hygiene practices and products in detail. Clinical photos and disclosing agents that temporarily stain unclean areas will be applied on teeth to help patients visualise where they can improve. Please let us know if we can help.

Outreach Services Our dentists and specialists are happy to give oral health advice to schools or community groups. We offer fun and interactive educational presentations and experiments for children. Email us if we can help at info@bracesandfaces.co .

Dental Cleaning (Scaling and Polishing) Cleanings are usually recommended every 6 months and are performed by our dentists or hygienists. Prior to a first cleaning appointment, a thorough check up by the dentist is required to ensure the teeth and gums are healthy. ​ Cleanings help to remove plaque, tartar and stains that build up over time. Appointments typically take 30 minutes for children and 45 mins for adolescents and adults. Fluoride varnish may also be recommended as an anti-cavity and anti-sensitivity treatment. For orthodontic patients with fixed braces, we recommend the cleanings can be done during a routine adjustment appointment when the wires are removed prior to the cleaning for a more thorough and comfortable clean. ​ For stubborn stains that often occur between the teeth or on surface grooves, we recommend using a salt or xylitol power spray that is effective yet gentle. ​ For patients who have aggressive or severe periodontal (gum) disease, we would recommend the cleanings to be done by the periodontist (gum specialist) and certain follow ups can be done by the general dentist or hygienist.

Sedation We offer nitrous oxide (laughing gas) sedation as a safe and effective means of light sedation to help reduce anxiety in children and adults. For deeper sedation we offer Monitored Anaesthesia Care (MAC) or Intravenous (IV) Sedation carried out by an anaesthetist in our sister practice, Central Smile. Deeper sedation may be recommended for more complex procedures or for anxious children with multiple cavities.

Teeth Whitening Teeth Whitening In-Office Zoom!®️ We offer three bleaching options: (a) In-office blue light bleaching done in the practice for 45 mins over 1-2 visits (b) Home bleaching using customised trays with varying concentrations of bleaching gel to be used for a couple of hours during the day or overnight for around 2 weeks (c) Take home bleaching products like the Snow whitening system for around 4 weeks Perfect for busy people due to its efficiency and convenience, in-office Zoom!®️ teeth whitening can deliver dramatically whiter teeth in only one office visit. The whitening formula contains hydrogen peroxide and is activated by a special light. This potent combination oxidizes years of stains away—often revealing results up to ten shades whiter! The entire Zoom!®️ process is simple. First, our teeth whitening Specialist will place protective retractors and a napkin to protect your lips, followed by a special rubber coating to form a barrier over your gums. The Zoom!®️ whitening gel is then applied directly onto the surface of your teeth, and the powerful light is used to activate the gel for deep penetration of the bleaching agents. Throughout treatment, you’ll be able to sit back, relax, watch TV and listen to music—and multiple rounds will be done until your desired whiteness is achieved. After using Zoom!®️, your teeth will always be whiter than they were before you started because the enamel and dentin of your teeth is lightened. Over time, you will likely pick up new stains, but you can always touch up your smile with our take-home whitening trays! Teeth Whitening Q & A What is Zoom! teeth whitening? Zoom! is a bleaching process that lightens the discoloration of enamel and dentin. How Long Do Teeth Whitening Results Last? The longevity of teeth whitening results is highly variable based on numerous factors, but most of our patients are able to enjoy their brightened smile for anywhere from 12–24 months before they might desire a touch up treatment. ​ Recommendations for helping to extend your teeth whitening outcome include remaining cognizant of the foods and beverages (with dark stains such as coffee, tea and wine) you regularly consume, as well as refraining from smoking cigarettes or using other tobacco products. Of course, maintaining a proper oral hygiene routine and receiving routine dental cleanings at least twice annually also help to prolong results. Should the time eventually come that you feel you need to consider whitening again, our teeth whitening Specialist will be happy to help you decide between an in-office treatment or take-home trays based on your unique needs and smile goals. What can cause tooth discoloration? There are many causes. The most common include aging and consumption of staining substances such as coffee, tea, or tobacco. During tooth formation consumption of tetracycline, certain antibiotics, or excessive fluoride may also cause tooth discoloration. Who may benefit from teeth whitening? Just about anyone can benefit from tooth whitening. However, treatment may not be as effective for some as it is for others. With an oral exam, BRACES AND FACES Doctors or Teeth Whitening Specialist can determine if you are a candidate for this procedure, including a shade assessment. Is teeth whitening becoming more popular? Absolutely! A bright, beautiful smile can make a big difference. The Zoom! Whitening System makes it easier and faster than ever before. Is teeth whitening safe? Yes, research and clinical studies indicate that whitening teeth under the supervision of a dentist are safe. In fact, many dentists consider whitening the safest cosmetic dental procedure available. As with any tooth whitening product, Zoom! is not recommended for children under 13 years of age and pregnant or lactating women. Do the results last a long time? By following some simple post whitening care instructions, your teeth will always be lighter than they were before. We recommend flossing, brushing twice daily with Zoom! Whitening Toothpaste, and touch-ups with Zoom! take-home gel. These are professional formula products designed specifically to keep your teeth their brightest. They are available through our office. Is there any difference between over-the-counter tooth whiteners and Zoom! Yes! Consulting BRACES AND FACES Doctors or Teeth Whitening Specialist is always the first step to whitening your teeth safely. Over-the-counter tooth whitening strips, brush-on gels, and toothpaste take weeks or months to whiten your teeth in just a few shades. Zoom! is clinically proven to whiten your teeth eight shades* in one hour or six shades* in just one weekend. How does the Zoom! In-Office System work? The Zoom! light-activated whitening gel’s active ingredient is Hydrogen Peroxide. As Hydrogen Peroxide is broken down, oxygen enters the enamel and dentin, bleaching any colored substance while keeping the structure of the tooth unchanged. The Zoom! light aids in activating the Hydrogen Peroxide and helps it penetrate the surface of the tooth. Is the Zoom! In-office procedure painful? No. During the procedure, patients can actually watch television or listen to music. Many fall asleep. Are there any side effects? Some people experience temporary increased tooth sensitivity to cold during treatment. These symptoms disappear within 1-3 days after interruption or completion of the treatment. How long does Zoom! Take-Home Whitening take? The Zoom! take-home gel is designed to be worn between four and eight hours per application. BRACES AND FACES Doctors or Teeth Whitening Specialist will advise you on how long you should wear each application. A recent study showed that you can achieve an average improvement of six shades* after just three nights of use. BRACES AND FACES Doctors or Teeth Whitening Specialist will help you determine how many applications are right for you. How is the Zoom! Take-Home System different from the Zoom! In-Office System? The main difference between the two systems is that you use Zoom! Take-Home System in the convenience of your own home over a few nights. The Zoom! In-Office System is performed entirely in the office.

Cosmetic and Restorative Dentistry Carefully crafted composite fillings or veneers can greatly enhance the appearance of the front teeth. In general, composite fillings require no or minimal tooth preparation (grinding) and can be used to reshape, lengthen or fill in spaces between teeth. ​ Porcelain veneers or fillings usually have superior long term results but may require more tooth preparation. We offer three bleaching options. ​ In-office bleaching done in the practice for 45 mins ​ Home bleaching using customised trays with varying levels of bleach concentration to be used either during the day for a couple of hours or overnight ​ ​ Take home bleaching products like the Snow home whitening system. ​ ​ To help you make decisions on how to improve your smile, we use the latest digital planning software such a Digital Smile Design or Smilemate to let you see the projected results before it happens. We love making smiles!

Instructions to snap on and off the floss head

Braces Tips and Care Top things to do before you get braces These tips will help you feel prepared and ensure you get the best result for yourself and your smile. Don’t forget to ask us any questions you may have during your consultation, we recommend writing down a list of questions or concerns before the appointment and feel free to ask us any questions you like. Remember we are here to service you. Preparing for braces It imperative teeth are healthy before starting orthodontic treatment. We may suggest seeing your own dentist or one of our own dentists for a check up and/or hygienist for a cleaning to ensure there are no cavities or gum disease prior to starting. It’s important we move healthy teeth otherwise moving teeth with active infection may lead to worsening of dental health, more discomfort or ceasing orthodontic treatment until the health issues are addressed. Also, be sure to thoroughly brush your teeth and floss in the lead up to your appointment so that your teeth and gums are in the best possible condition on the day your braces are applied. What foods should you avoid with braces? Some foods are not good for braces. They can pop brackets and bend wires, which will lead to unexpected trips to the office. Please: Avoid very hard foods like nuts Other hard healthy foods likes apples, carrots, hard crust pizza, please cut up into small bite size pieces. Biting a whole apple and tearing it away from your teeth puts a lot of strain on the braces. Avoid bubble or chewing gum that contains sugar. The occasional sugar-free chewing gum is acceptable as this promotes saliva flow to flush food/bacteria between the braces. Careful when biting into popcorn. As unsuspecting kernel seed can easily break the braces. Please avoid or reserve for special occasions high sugar or acidic beverages such as fizzy drinks or energy drinks. They cause decalcification of the enamel and can leave very unsightly permanent scars on the teeth when braces are removed. What to do the day you get your braces fixed Bonding braces are straightforward and there really shouldn’t be anything to worry about. It’s a painless procedure that takes 30 to 45 minutes. However we kindly request you: Clean your teeth thoroughly In order to have the cement adhere to your teeth correctly, we need a plaque-free surface, so it’s best to gently clean your teeth before your appointment. Take a before selfie When we’re feeling self-conscious about our teeth, we tend to smile with our mouth closed, but before we head intakes a photo with our teeth on display. You’ll enjoy looking back on your teeth before treatment and seeing how much your smile is changing along the way. Run your tongue over your teeth While the temptation is strong, you’re going to want to avoid poking around your braces with your tongue. After cleaning your teeth take a moment to run your tongue over your teeth to feel the smoothness – it will also be the first thing you do once your braces come off. How do you put braces on? The bonding of braces typically takes 30 to 45 minutes. The steps to bonding the braces are: We will clean the bonding surface using a sandy paste called pumice A sour gel is applied to prepare the tooth surface for the braces. The bonding cement is applied to the braces and a tasteless bonding liquid is applied to the teeth. A powerful blue light will shine on each tooth for roughly 10 seconds to harden the glue. After the braces are bonded, the patient takes a rinse and chooses their braces colour (O-rings) until their next adjustment appointment in about 6 weeks time. A thin flexible Nickel Titanium alloy wire is inserted to give a “tight” feeling. This is not painful but will feel “weird”. You are ready to eat and drink straight away. But please be mindful about avoiding hard, sticky or sugary foods. A mild dull ache usually starts 24 hours after the braces are bonded and typically lasts for 3 to 5 days. Do you need to get cavities filled before braces? All cavities should be filled before braces. However, sometimes your dentist may suggest monitoring a potential cavity. In these circumstances, please let us know and continue to see your dentist as scheduled. Please inform us who your dentist is and we will send them treatment reports before, during and after to keep them up-to-date with your treatment progress. If you are unsure about the health of your teeth and gums please feel free to let us know your concerns. We usually recommend whitening your teeth after braces, rather than before. This is because some patients notice uneven tooth colour when their braces are removed. The lighter colour is a result of the brackets protecting the enamel from exposure to all of the food and drink you have consumed during the course of your treatment. Is it okay to whiten your teeth before getting braces? Aftercare Once your braces are fitted, you’ll need to make small changes to your day-to-day behaviour. Here are some of the habits you can start the day after your appointment. Keep pain relief handy. You may experience some discomfort for up to a week as you adjust to your new braces. If necessary, take some over-the-counter pain relief like Paracetamol (e.g. Panadol/Tylenol) or Ibuprofen (e.g. Nurofen/Advil). Eat soft foods. You will most likely prefer to eat soft foods during the weeklong adjustment period. Bananas, soups, rice and pastas are all great options. Brush your teeth after eating. Keeping food out of your braces can be tricky, but try to start brushing your teeth after every meal. Get a soft travel toothbrush and pop it in your bag so you’ll always have it on you. Clean between your teeth with floss, inter-dental brushes or waterpik’s Yes you still need to floss with braces! Use either superfloss to thread the stiff end under the wire and floss as normal. This can be cumbersome and time consuming but is the most effective. Platypus floss picks are handy for patients who struggle to use super floss. However, they are one-time-use and use the same piece of floss every time. A waterpik is the most convenient option. This uses high-powered water jet to dislodge the food and plaque between the teeth. However this requires additional cost and can get quite messy. An inter-dental (Tepe) brush is needed for cleaning between the braces. Make sure you press the brush against each side of the braces. We suggest you use the inter-dental brush right after brushing your teeth with toothpaste still in the mouth. Please note, the inter-dental brush is for cleaning in-between your braces and not a replacement for flossing in most cases. When do you start seeing changes with braces? You may notice a difference in your smile after four weeks, but generally, it takes two to three months for braces to begin noticeably straightening your teeth. As with all orthodontic treatment, every person’s bite and circumstances are different – meaning the time it takes for braces to start visibly aligning your teeth will differ as well. People with slightly crooked teeth or had tooth extractions will probably notice a difference sooner than those with severe malocclusion. What is Invisalign? They are clear, thin and removable aligners that worn over the teeth and changed by the patient every week. Each aligner is programmed to move the teeth as programmed by your doctor and you will see your teeth gradually straighten giving you a beautiful smile. The aligners are worn 20-22 hours per day except when eating, drinking and when you need to brush and floss. The advantages include: Comfort Invisibility Removable Ease of brushing and flossing Highly accurate Simulation of final results No metal brackets and wires Used in children and adults How do I get started? Please feel free to book a dental check up with our dentists or a consultation with our specialists. Our staff will take 3D digital impressions (scan) of your teeth - this replaces the traditional putty moulds that are messy and can trigger a gag reflex in patients. This is a highly accurate scan that pieces images of your teeth together and gets sent to Invisalign where your teeth are modelled and your doctor works on your individualised treatment plan based on your goals and main concerns. X-rays will be prescribed if needed. How do I clean my aligners? We recommend brushing them twice a day with a soft bristled toothbrush, separate from the one you brush with. You can use the following solutions to soak them in, please rinse thoroughly afterwards: Mouthwash Lukewarm water Lemon water Diluted liquid soap and water Denture tablets (once a week for 20-30 minutes) Use an ultrasonic bath to wash it Please note you will be switching them every 7 days so they may not have the time to discolour before moving into a new tray. Can I see my final result? One benefit of digital treatment plans is that we can project the final result based on the treatment goals. This simulation can be shared and discussed with you at any time in the office or remotely. What are chewies? Invisalign chewies are a soft chewing device the size of a cotton roll that can be re-used by patients treated with Invisalign. It is a small cylinder made of a soft spongy plastic that are used to help eliminate spaces between the aligner and the tooth to improve the overall fit. They can be used after every time you place you aligners in or approximately for a total of 5-10 minutes / day. Position the chewie between your teeth (either ‘longways’ or ‘shortways’ and bite down. Move it from one end of your mouth to the other continuing to bite up and down until you have bitten on it with all of your teeth. How to use chewies? What are attachments? Attachments are tooth-coloured structures that are placed on your teeth to help Invisalign move your teeth in the desired position. They are temporary and is based on a composite resin material - the same material used for dental fillings. They help the Invisalign grip the shape of your teeth for more effective and predictable movements. We generally avoid placing attachments on any implants or crowns patients may have. Attachments are usually placed two weeks after the start of your treatment and is a painless process. What is IPR (Interproximal reduction)? When there is crowding and we need more space to align the teeth, we will discuss something called IPR as a possible alternative to extracting teeth. Interproximal reduction (IPR) involves a metal strip that goes in between the teeth to slenderise the shape of teeth. It is a very common procedure done simply in the clinic and only takes 5 minutes. You will feel like it is a metal piece of floss pulling the teeth. This involves removing minimal amount of enamel to create space and does not cause sensitivity to the teeth. Prior to interproximal reduction, teeth slightly overlap. After wires are removed, the orthodontist gains some space by gently contouring the sides of the overlapping teeth. Following interproximal reduction, teeth have sufficient room to align, the patient has a more aesthetically-pleasing smile and an improved bite. Photo courtesy of American Association of Orthodontists. When can I expect my aligners to be ready? Aligners take approximately three to four weeks to be fabricated and shipped to Hong Kong from the United States. Overall, patients will find clear aligners more comfortable over metal braces as there are no wires and brackets rubbing against the cheeks and lips. The movement in aligners is programmed to be gradual and targeted but are much more effective if worn 20-22 hours/day. However, clear aligners require commitment and can be quite troublesome to some. Is there less pain if I wear clear aligners over traditional braces? Can I wear elastics with aligners? Yes - aligners can have pre-cut hooks where you can attach rubber bands to. Additionally, we will place a metal hook on your tooth where the elastic band stretches to for ease of placement rather than the plastic being distorted. What happens if my aligner breaks before I’ve worn it for 7 days or I’ve lost a set? Please jump to the next aligner and wear it for a few more days. Feel free to Whatsapp us a photo of your teeth with and without aligners on if you have concerns regarding the aligner fit. Frequent breakage or loss of aligners will lead to "off tracking" and will require ordering new sets, which will slow treatment down and may incur additional costs. I see a large gap (>3mm) between my tooth and aligner? Is that normal? When you first fit your aligners at your initial appointment, the aligners should fit as snug as possible meaning they wrap around your entire tooth. Over the course of treatment, because of either the aligner has not been worn enough or not properly put on - the aligner can start to “lose track” of certain teeth meaning it is no longer wrapped around the tooth and cannot move the tooth as effectively. At the initial stages this can be corrected by use of chewies in the particular area and staying in your last most fitted aligner for a few more days before switching into the next aligner to give the aligner time to get that tooth “back on track”. Additionally sometimes it is simply a difficult movement for the aligner along with the shape of the tooth being hard to grip, you may find the gap frequently in the same spot. If you are unsure, we welcome you to send us a picture of you wearing the aligners as the first point of contact so that we can instruct you on what to do. If necessary, we may schedule an appointment to come into the clinic for a new scan. Your Invisalign treatment may span over the period of months to years. The total number of aligners in your initial set is not necessarily directly related to your treatment time. We often describe it as “tailoring a dress”. We do it in stages, and may scan your teeth when we feel it is necessary or when you have finished wearing all your aligners in the batch. When we perform a refinement scan, this just means we want to update Invisalign and tell them specifically what areas to focus on to provide you with more effective treatment. The refinement scan is then sent to Invisalign and there is a 4 week processing time required until the new batch of aligners come back. In the mean time, we will ask patients to continue with their aligners but switch to 14 days per aligner or wear the last one they have nightly until the new ones arrive then go back to a 7 day cycle. What is a refinement scan? Why do I notice more visible staining on the attachments while I’m wearing my Invisalign? The attachments are made of composite resin and is stable and does not discolour easily. However there are a lot of reasons that can cause staining: It is an irregular surface on the tooth and can accumulate more plaque and stain easily Frequent acidic beverages such as soda, coffee, wine, black tea stain them over time (we recommend use of a straw) Intake of citrus fruits frequently with the Invisalign Use of tobacco Intake of turmeric, curry Inadequate cleaning of aligners after eating Poor oral hygiene Bonding agent used in the dental procedure Dental care professionals can clean the accumulated debris around the attachment in case of surface staining. They may also remove and polish these attachments if required. However, we avoid extensive polishing attachments as doing the same can result in slight changes (alteration) in their shape, making them useless to work with existing aligners. Can I whiten my teeth during my Invisalign treatment? We generally advise patients to hold off on whitening their teeth during orthodontic treatment as the whitening gel cannot reach the tooth surface below the attachments. Patients may end up with spots on parts of teeth below these attachments when removed.

Teeth Shifting: Signs, Causes, Prevention and Treatment Teeth shifting isn’t usually something you notice overnight – it can take months or years to recognise a change in your smile. It is normal for your teeth to shift over time. Your teeth will continue to move ever so slightly over the course of your life toward the front and centre of your mouth – a process known as mesial drift. But this shift is incremental, so you won’t be able to see it happening day-by-day. However, several factors – including periodontal (gum) conditions and other health issues – may exacerbate the degree of movement your teeth undergo. This can lead to complications including crooked teeth and a misaligned jaw. If you’re concerned about your teeth shifting and want to minimise their movement, it’s best to see us for a professional assessment to either start monitoring the movement of correcting it early before it worsens. What causes teeth to shift in adults? We often see patients who have seen changes in the position of their upper and particularly their lower front teeth as late teens or as young adults. Some of these patients had very well aligned teeth before. It is easy to blame the wisdom teeth for these changes, as this is the time that they tend to erupt, but there are actually many other possible factors which can affect teeth positions. Your teeth are housed in remodelling bone, rather than set in “concrete”. Therefore, teeth positions can be affected by any or a combination of the following factors. Late lower jaw growth which can lead to inward tipping of the lower front teeth Changes in the elasticity of the cheeks and lips and/or pressure from the tongue Loss of gum tissue or bony support for the teeth through gum disease Loss of teeth or changes to the bite Do teeth shift back after braces? Yes – without the correct use of your retainer. Braces exert a subtle yet steady pressure on your teeth, slowly shifting them into alignment. Once your braces are removed, your teeth will always have some potential to move out of position, however, the amount is unpredictable and can differ greatly between individuals. This is where your retainer comes in. A retainer is an orthodontic device designed to hold your beautifully aligned teeth in position. It’s incredibly important that you wear your retainer every night for the long-term. If you have fixed retainer, ensure you have it checked with us or your dentist regularly every 6-12 months. If you’re athletic, we also recommend that you wear a sporting mouthguard to safeguard your newly straightened teeth during contact sports. How do you know if your teeth are shifting? Signs of teeth shifting include: An uncomfortable or ill-fitting retainer. Your retainer is custom made to fit your well-aligned teeth. So if your retainer no longer fits, this is a sure sign your teeth have shifted. Unfortunately, this is usually due to incorrect wear of your retainer. Mid-line shift of teeth. With correct tooth alignment, your two upper and lower front teeth should fall in the center of your nose and eyebrows. An increase in asymmetry in one or both dental arches – known as midline drift – is a common sign of shifting teeth. Gum bleeding. May be a sign of periodontal (gum) problems, which may increase the likelihood of teeth shifting. Gaps in your teeth. This is a common and easy-to-spot sign that your teeth are shifting. Gaps may also be a sign of developing periodontal (gum) problems. Tooth pain or sensitivity. If your teeth are more tender or more sensitive than usual, this could indicate shifting teeth. The best way to ensure stability of your treatment result is to see us for retainer reviews every 6-12 months. We will take a digital scan for your teeth and superimpose it with the original scan taken when the braces came off to check very accurately if your teeth are shifting. The good news is, if they have shifted, often making a new retainer based on the first scan will shift them back to their original positions. Teeth shifting is an incremental and gradual process, so it generally does not cause pain. How to prevent your teeth from shifting Close monitoring using digital iTero scans at your regular dentist/hygiene or retainer review appointments to accurately assess potential changes to teeth position, wear and gum recession. Correct use of your retainer. Regular dental check-ups. Your general dentist will assess the health of your teeth and gums to help prevent teeth shifting due to gum disease. Good dental hygiene. Brushing and flossing regularly will prevent food and bacteria from building up, preventing issues such as gum disease that can cause teeth shifting. Fabricating a night guard with the general dentist if there is a grinding or clenching habit. Naturally, the body inevitably changes as we age. Tooth movement, like wrinkles, occurs with time as a part of the normal ageing process. Thankfully we can hold off unwanted teeth changes, through maintaining good oral health and the simple wearing of retainers.