The expert’s guide to good teeth

While poor oral hygiene does affect the teeth, the gums and also other parts of the oral cavity, it has been linked to cardiovascular diseases as well. Infection of the gums — or periodontitis in other words — is quite troublesome and can damage the teeth, soft tissue and the bone. It can potentially be a portal for entry of other infections into the body.

What are the best whitening techniques? Will brushing your teeth twice a day actually make your teeth whiter and shinier?

In-office tooth whitening procedures involve bleaching agents. It is about an hour-long process, involving four steps, with bleaching gel being changed every 15 minutes. The results depend on the expertise of the dentist and the quality of the materials used. However, if the highly caustic bleaching gel is leaked onto the gums it can cause severe harm.

Commercially available tooth pastes cannot lead to the same results, since the bleaching agents need to remain in contact with the teeth for a prolonged period of time. Furthermore, the same strength of bleaching agents is not found in tooth paste preparations available to the public, for a very good reason. Bleaching agents can burn the gums even in small concentrations.

Does eating excessive sweets actually lead to tooth decay?

No. If the snacking is limited to certain times of the day and the teeth are duly brushed, then tooth decay does not necessarily ensue. Though this is not documented, but if a child is nibbling candy at intervals throughout the day or consumed it as the last meal of the evening, then there is a greater chance of dental caries.

How often should people with no apparent dental complaints get checkups?

We advise a dental visit every six months, and people who are more conscientious about their dental health do comply with this advice. This helps to catch disease processes at an early stage when changes are still reversible.

How far do traditional cleaning techniques like miswak and manjan help? Can they substitute for regular toothpaste and toothbrush?

The research on this subject is still ongoing. While, they do have a scrubbing or cleaning effect on the teeth and they are better than not cleaning the teeth at all, I don’t think they can substitute for the toothpaste and brush. The tooth brush can reach the inaccessible crevices in and around the teeth, which might be missed otherwise.

How adversely do tobacco products affect oral health?


The teeth of many smokers do not just get discoloured, but are also adversely affected by gum disease, which in advanced cases can cause them to lose their teeth. Even if the teeth are replaced by implants, poor oral health due to continued smoking is going to affect them as well.

Other tobacco containing products such as gutka and paan can lead to precancerous changes in the mouth. People from disadvantaged socioeconomic backgrounds often seek medical attention when their situation has deteriorated significantly. At times, they are even unable to open their mouth, which signifies the onset of oral cancer.

What options do people with missing teeth have?

Implants are basically artificial teeth made out of titanium metal which is biocompatible. When it is placed into the bone, the latter integrates it and they can last 20 years. This procedure is contraindicated in smokers because the tissue in which the implant is embedded undergoes deterioration. Just as in the case of natural teeth, the load of the implants is transferred to the bone. Implants are better than dentures, since they save a lot of wear and tear of the soft tissue and save time otherwise spent removing and cleaning dentures or false teeth. Of course, if someone is not in the habit of taking care of the natural teeth, then the life of the implants will also be reduced. The quality of life in people with implant is better than that of those who use dentures, but implants are more expensive and people skilled in the implant procedures are also fewer.

Small dental clinics have mushroomed in urban centers. Do people seeking dental services at these facilities run any risks?

It is very important to seek the assistance of qualified dental professionals. Relatively less known places may suffer from limited expertise and some even may be operating without an autoclave – which is necessary for purposes of sterilization.

Braces are getting big in Pakistan, what advice do you have for parents who think their children need them?

These patients are easier to treat the earlier they seek help — roughly between the ages of 8 to 13 years for girls and less than 16 years for boys. Techniques other than braces — such as dental appliances — can be employed to change the shape of the jaw. Interventions required will be simpler, faster and hence relatively cheaper. At an older age, bones are harder to manipulate and surgical correction might be deemed necessary.

Dental health is often not easy on the pocket. Treatment in many cases is for cosmetic reasons. How can dental work be made more accessible for the poor?

The earlier the patient presents the problem, the less extensive and less expansive the treatment options are. For example, in dental caries if the patient comes early, a filling is done, which is both curative and preventive against further tooth decay. At a later point in time the patient may need to go through a long root canal treatment to save the tooth, and then need a crown for the tooth appearance and preservation. A visit in six months therefore, might be more economical, less cumbersome, and more successful. Also, if the patient goes to the outpatient department of dental schools, that might cut costs for them as well.

What is the latest technology in dentistry? Has it made its way to Pakistan?

The implants are a huge milestone in dentistry. Previously, we tried to preserve the natural teeth as much as possible, even if they had deteriorated. However, now implants can almost function as well as a new set of teeth.

The aesthetics aspect is progressing as well. Other than tooth whitening, there are dental veneers, which are basically a manicure for the teeth. Thin tooth colured materials can be bonded to the front of the teeth to change their colur, cover the gaps, or change the shape of crooked teeth. This has still not gained popularity in Pakistan and is offered in limited places.

Dr Mohammad Altamash has been working in the field of dentistry for 40 years. He graduated from Khyber Medical University in 1970 and later pursued his post doctorate from the University of Munich, Germany. He has been running a successful clinic in Karachi for the last 22 years and founded the Altamash Institute of Dental Medicine recognized by the Pakistan Medical and Dental Council and affiliated with Karachi University and Karolinska Institute in Sweden. Dr Altamash is also a fellow of the American College of Dentists.

Published in The Express Tribune, March 21^st, 2012.