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Divisions in Dentistry – types of dentists in Selangor, Malaysia

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the various dental specialist at your service in Malaysia
the various dental specialist at your service in Malaysia

Divisions in Dentistry – types of dentists in Selangor, Malaysia

Types of Dentists in Selangor, Malaysia

Many Malaysians believe that all dentists perform every aspect of dentistry.

Although some general dentists provide most categories of oral services, most dentists refer patients to specialised dentists for specific treatment that they do not perform themselves. In this article you will learn about the various types of dentists and the services they provide. You will be able to identify the areas of dentistry that have specialists with extra education, and those that do not have specialists. Also, your vocabulary will increase, allowing you to better understand the subsequent chapters in this book.

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GENERAL DENTISTRY in Selangor, Malaysia

All dentists are general dentists when they graduate from dental school, but some complete general-practice residencies of 1 year or more to enhance their skills. Types of therapy offered by general dentists differ significantly based on their personal interest and abilities, but most or perhaps all typical oral needs can be well satisfied by a general dentist. These persons can usually be identified by one or more of the following degrees: D.D.S. and B.D.S (equal degrees) in Malaysia. Dental practice is called practice because that is actually what happens. As general dentists accumulate years of “practice” experiences, they become more competent in the areas in which they are most involved. Many dentists specialise in areas described in this article.

The various subcategories within dentistry have the same names as the dental specialties. These subcategories will be described as specialties to allow you to identify the name of the dental division in which your area of need is treated, and to prepare you to use dental terminology with your practitioner. Please remember that general dentists also practice most of the areas included in the following specialties. Currently there are seven recognised clinical specialties and two nonclinical specialties.

SPECIALTIES

1. Endodontics in Selangor, Malaysia

An endodontist (Root canal Specialist) completes at least 2 years of postdoctoral education specialising in endodontics. This area of dentistry includes treatment of teeth with diseased pulp tissue (FIG. 2.1). The inside of a tooth, called the dental pulp, is often referred to as the nerve. The pulp includes nerve tissue, blood vessels, connective tissue, and tooth regenerative cells.

FIG. 2.1 The two upper front teeth were injured in an accident. Their pulps (nerves) have died, and thus, require root canal therapy. Usually, such teeth are discoloured and require crowns (caps) later.
FIG. 2.1 The two upper front teeth were injured in an accident. Their pulps (nerves) have died, and thus, require root canal therapy. Usually, such teeth are discoloured and require crowns (caps) later.

Tooth pulp can be injured in numerous ways, such as a blow to the tooth, trauma of any type, an incorrect occlusion (bite), deep dental decay (caries), and inadvertent abusive dentistry. When a dental pulp is injured, it usually responds in only one way: pain. The toothache that occurs when a dental pulp is injured causes extreme pain that demands therapy to allow the patient to return to normal activity.

Pain relief is provided by having the general dentist or endodontist perform root canal therapy. Teeth usually contain one to four (and occasionally more) root canals (FIG. 2.2). A small hole is made through the top of the tooth or crown (cap) into the dental pulp, and the diseased pulp is removed. A piece of rubberlike material called gutta-percha is inserted in place of the pulp. It is cemented into the tooth with a sealant to medicate the tissue at the deepest end of the dental pulp, where it exits from the tooth into the jawbone. Other types of materials may be used to fill root canals, including various pastes and metallic or plastic reinforcements.

FIG. 2.2 The grey internal chambers in each tooth are root canals that house the dental pulp.
FIG. 2.2 The grey internal chambers in each tooth are root canals that house the dental pulp.

After the dental pulp has been removed and the remaining root canal filled, a metallic, ceramic, carbon, or fibre post (FIG. 2.3) may be cemented into the tooth to connect the weakened top portion (crown) of the tooth with the now hollow root.

FIG. 2.3 Often, posts of various types are placed into root canal-treated teeth. These connect the weakened top part of the tooth to the root.
FIG. 2.3 Often, posts of various types are placed into root canal-treated teeth. These connect the weakened top part of the tooth to the root.

Root canal therapy is successful in more than 95% of cases but occasionally,

root canal-treated teeth are still painful. Occasionally the tooth root end, deep in the bone, becomes infected in a root canal-treated tooth and requires further therapy, called an apicoectomy. In this situation a small incision is made in the gum over the root end of the tooth. 

Any diseased tissue is removed, and a filling is placed in the root end. The site is sutured for proper healing. In addition to a post, a root canal-treated tooth may require a crown (cap) for adequate strength (FIG. 2.4).

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FIG. 2.4 A and B, Three of these upper front teeth required root canals, posts, and ceramic crowns (dental caps) after root canal therapy.
FIG. 2.4 A and B, Three of these upper front teeth required root canals, posts, and ceramic crowns (dental caps) after root canal therapy.

2. Oral and Maxillofacial Surgery in Selangor, Malaysia

A person specialising in this area is an oral surgeon or oral and maxillofacial surgeon. These practitioners are dentists, or dentists with both D.D.S and M.B.B.S degrees, who have completed postdoctoral education in oral and maxillofacial surgery. Most of the simple oral surgical procedures (FIG. 2.5), including routine extraction of teeth (exodontia), are accomplished by general dentists. More complex surgery or treatment of oral-facial trauma is usually accomplished by oral surgeons. Oral and maxillofacial surgeons accomplish routine extraction of teeth; complicated extraction of teeth, including impacted (nonerupted) teeth; removal of oral tumours (growths); surgical movement of jaws to compensate for malformations, poor bite, or inadequate facial aesthetics; and other complex oral surgery and facial plastic surgery. These specialists also treat seriously ill patients with oral surgical needs.

FIG. 2.5 A to C, Minor oral surgery such as this is accomplished by most general dentists.
FIG. 2.5 A to C, Minor oral surgery such as this is accomplished by most general dentists.

This field of expertise commonly overlaps with that of ear, nose, and throat (ENT) specialists and some plastic surgeons. When considering complex surgery around the face or jaws, it is advisable to consult with practitioners in all the overlapping specialty areas.

3. Oral and Maxillofacial Radiology (X-Ray) in Selangor, Malaysia

All dentists and dental hygienists, as well as most dental assistants, have sufficient background to accomplish typical dental radiography. However, sophisticated radiographs require special expertise, such as those that show various characteristics of the skull, the temporomandibular joint (TMJ), all of the teeth in one view, and many others. A few dentists limit themselves to this specialty, which requires 2 years of postdoctoral education. Numerous radiographic laboratories are staffed with well-educated technicians and/or dentists. Almost without exception these laboratories provide high-quality dental radiographic services.

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4. Oral Pathology in Selangor, Malaysia

Oral pathologists are dentists who are involved with microscopic identification of the condition of oral tissue that has been removed surgically. These dentists, who have 2 or more years of postdoctoral education, are usually found in dental schools and hospitals. If you were to consult your dentist or dental specialist with a suspicious-looking area in your mouth, your dentist would take a biopsy (removal of a small piece of tissue) of that area and send it to an oral pathologist for microscopic identification.

A very simple diagnostic tool is also available for superficial oral lesions. A stiff brush is rubbed over the lesion, taking some of the cells with it. This material can be observed microscopically to provide a tentative diagnosis of the suspicious lesion.

5. Orthodontics (Braces) in Selangor, Malaysia

Many general dentists and Pediatrics dentists (children’s dentists) perform tooth- movement procedures, but those specialising in orthodontics have completed at least 2 postdoctoral years of education in orthodontics. These practitioners are involved with prevention and treatment of malocclusion (poor bite or inadequate tooth alignment, FIG. 2.6). Most patients seeking orthodontic therapy are motivated by poor facial and tooth appearance and not by inadequate function. However, when poor tooth appearance is corrected, inadequate function is usually corrected also. Most major orthodontic cases are usually treated by orthodontists, but some general dentists or Pediatrics dentists with a special interest in orthodontics and some postdoctoral education also practice orthodontics (braces).

Regardless of the orthodontist or general dentist providing the treatment, when complex, expensive orthodontic procedures are being considered, obtaining a second opinion is suggested.

FIG. 2.6 A and B, These children have dentitions that are developing in mal-alignment and will need the services of an orthodontist.
FIG. 2.6 A and B, These children have dentitions that are developing in mal-alignment and will need the services of an orthodontist.

Orthodontic (Braces) procedures in Malaysia usually require many months for completion, with multiple visits to the demtist. Thus, you should consider the location of the practitioner relative to your home. Although many patients consider orthodontic therapy to be primarily for adolescents, many practitioners now perform adult orthodontics. Although orthodontic therapy for adults requires more time than the same treatment in the immature bone structure of adolescents, adult braces is certainly possible if the patient is interested and does not mind the appearance of bands and wires for a time while the tooth movement is taking place (FIG. 2.7). A new type of orthodontic therapy not requiring display of metal is now available (Clear Aligners) for some patients.

FIG. 2.7 A to H, A 27-year-old female patient is shown before and after orthodontic therapy. Adults can have orthodontics.
FIG. 2.7 A to H, A 27-year-old female patient is shown before and after orthodontic therapy. Adults can have orthodontics.

6. Pediatric Dentistry in Selangor, Malaysia

Most general dentists treat children. However, a paediatric dentist, or pedodontist, prevents or treats the special dental problems of children (FIG. 2.8) and has completed at least 2 years of postdoctoral education in Pediatrics dentistry. Although most general dentists treat routine dental problems of children, many dental conditions in children may require a specialist. An example is an infant with extreme dental caries (decay). Additionally, some children have psychological problems with dentistry. These psychological problems make routine dental treatment in a typical general dental clinic impossible.

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FIG. 2.8 A relatively infrequent malformation, amelogenesis imperfecta.
FIG. 2.8 A relatively infrequent malformation, amelogenesis imperfecta.

When necessary, most Pediatrics dentists use sedation to calm children in their Clinic. When treating children who need general anaesthetic for special physical or behavioural challenges, most Pediatrics dentists provide routine dental services under general anaesthetic in a hospital or surgical center.

7. Periodontics in Selangor, Malaysia

Some general dentists treat gum and oral bone diseases, but a practitioner who

specialises in this treatment is a periodontist-a dentist with 2 to 3 years of postdoctoral education in periodontics. These dentists treat the supporting structures of teeth (bone and soft tissue) and prevent the development of gum and bone diseases (gingivitis, periodontitis, and others). Periodontal diseases are common in adults over 30 years of age, and because pain is not a regular symptom, patients often neglect the problem far too long. Periodontal diseases are responsible for the majority of tooth loss of adults (FIG. 2.9).

FIG. 2.9 Periodontal disease claims more adult teeth than dental caries (decay) and should be prevented.
FIG. 2.9 Periodontal disease claims more adult teeth than dental caries (decay) and should be prevented.

Periodontal diseases begin without the classic signs and symptoms of most diseases. Tartar (hard accretions) and dental plaque (a soft, whitish, creamlike substance) accumulate on tooth surfaces (FIG. 2.10). As this occurs, irritation of the gums is obvious because of redness and bleeding. Removal of the tartar at this time, and continued improvement of oral hygiene (plaque removal), usually causes reduced gum bleeding and redness, and a return to healthy pink, firm gums. However, continued poor oral hygiene without professional tartar removal stimulates further gum irritation, subsequent bone loss, and eventual loss of teeth. Most periodontal diseases are preventable.

FIG. 2.10 Gross deposits, tartar, and plaque contribute to periodontal disease.
FIG. 2.10 Gross deposits, tartar, and plaque contribute to periodontal disease.

8. Prosthodontics in Selangor, Malaysia

Prosthodontics is the replacement of missing parts of teeth, bone, gums, or facial structures. Most general dentists perform some prosthodontic procedures, but a

prosthodontist specialises in prosthodontics, having completed 3 or more years of postdoctoral education in one or more phases of this specialty. There are three phases of prosthodontics: 

(1) fixed prosthodontics (crowns and bridges) cemented onto teeth or implants in the mouth (FIG. 2.11), 

(2) removable prosthodontics (complete or partial dentures that are removable from the mouth by the patient, FIG. 2.12), and 

(3) maxillofacial prosthetics (a less-known part of dentistry in which noses, eyes, other parts of the face, and other body parts are replaced with  prostheses [artificial parts] FIG. 2.13). General dentists accomplish prosthodontic procedures, except for maxillofacial prosthetics. However, prosthodontists usually perform the more complex types of prosthodontic therapy.

FIG. 2.11 A and B, Replacement of missing teeth with fixed prostheses (dental bridges).
FIG. 2.11 A and B, Replacement of missing teeth with fixed prostheses (dental bridges).
FIG. 2.12 A to C, Crowns were placed on the upper front teeth, and a removable  partial denture replaces the remainder of the upper teeth.
FIG. 2.12 A to C, Crowns were placed on the upper front teeth, and a removable  partial denture replaces the remainder of the upper teeth.
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FIG. 2.13 A to D, Replacement of nose for an accident victim. Artificial ear will be held in place by metallic implants and/or glue.
FIG. 2.13 A to D, Replacement of nose for an accident victim. Artificial ear will be held in place by metallic implants and/or glue.

Complex prosthodontic procedures are often necessitated by significant loss of teeth, bone, and soft tissues. Treatment plans vary widely. Also, perceived need for prosthodontic therapy varies significantly, as does expertise of dentists, prosthodontists, and laboratories that support these practitioners. It is suggested that multiple professional opinions be obtained before extensive prosthodontic therapy is begun.

Prosthodontic therapy usually has a predictable expected longevity directly related to quality and type of prostheses, complexity of patient need, and subsequent oral hygiene. The expected longevity should be discussed with the dentist to determine the potential cost-effectiveness of the proposed therapy.

9. Public Health Dentistry in Selangor, Malaysia

Your geographic area has a dentist whose main goal is the most adequate prevention and treatment of dental disease for an entire geographic population. These dentists, who also have 2 or more years of postdoctoral education, usually do not practice clinical dentistry but are employed by government; they are an excellent resource for your community.

10. Non-specialty Areas in Dentistry in Selangor, Malaysia

The areas described above are specialties in that they have been defined as requiring additional education by various national or international organisations, such as the Malaysian Dental Association. Qualified practitioners in these areas may legally call themselves specialists, but status and education vary significantly from country to country. The specialties previously described in this article are

currently accepted in Malaysia *** (not verified). Check with your local dental society for differences in other countries. Other clinical areas in dentistry are identified easily, and some practitioners limit their activities to these areas. However, these subjects do not have specialty status and may not have specialty educational programs.

When you visit practitioners who indicate that their dental clinic emphasis is limited to one of the areas described below, you must judge each situation individually based on other referring practitioners’ opinions and your confidence in the person involved. 

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A. Aesthetic or Cosmetic Dentistry in Selangor, Malaysia

Over the past 25 years many dentists have become highly interested in making their patients look as beautiful and acceptable as possible. Clinical procedures include all areas of dentistry and related health sciences, but they are usually associated with the restorative and prosthodontic areas of dentistry: bleaching teeth, bonding porcelain or resin (plastic) veneers (FIGS. 2.14 and 2.15), tooth-coloured restorations (fillings) for posterior (back) teeth, crowns (caps), recontouring teeth, and other restorative procedures.

FIG. 2.14 A to C, Cosmetic upgrading of upper front teeth requires a special curing light for the plastic placed on the teeth.
FIG. 2.14 A to C, Cosmetic upgrading of upper front teeth requires a special curing light for the plastic placed on the teeth.
FIG. 2.15 A and B, Smiles can be greatly improved with simple, inexpensive bonding procedures.
FIG. 2.15 A and B, Smiles can be greatly improved with simple, inexpensive bonding procedures.

Various professional organisations emphasising this part of dentistry are active internationally, and it is quite possible, but not assured, that a practitioner emphasising aesthetic or cosmetic dentistry by announcement will be more knowledgeable and/or more highly skilled than a typical general dentist in this area of dentistry.

B. Family Practice in Selangor, Malaysia

This phrase is neither accepted nor denied by any organization; the designation of family practice usually infers that the general dentist is interested in serving entire families for typical routine dental needs.

C. Implantology in Selangor, Malaysia

Over the past 35 years, the use of dental implants (objects placed in the bone to replace teeth has grown enormously (FIG. 2.16). Many global professional organisations exist, signifying interest and/or activity of practitioners in dental implants. Announcement by a dentist of emphasis in this area may or may not indicate special expertise in implants. There is general knowledge among dentists in any geographic area concerning fellow practitioners who have acceptable ability with implants. Implants may be used to replace one tooth, several teeth, many teeth, or all teeth. Prostheses (artificial dentures) may be (1) fixed, (2) fixed for the patient and detachable for the dentist (fixed detachable), or (3) removable.

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FIG. 2.16 A dental implant becomes integrated with the jawbone and can be used to support many dental reconstructive methods. In this model, the clean area around the dental implant shows how it fits into the bone.
FIG. 2.16 A dental implant becomes integrated with the jawbone and can be used to support many dental reconstructive methods. In this model, the clean area around the dental implant shows how it fits into the bone.

Various national and international groups have approved dental implant use, and this area of dentistry is growing rapidly. If any new specialties are to be recognised officially, implantology is one of the most likely candidates.

At this time, special expertise in implants is shared by the following types of dentists 

(1) surgical placement of implant: periodontists, oral surgeons, prosthodontists, and general dentists; 

(2) prosthodontic placement of prosthesis or tooth replacement over implant: prosthodontists and general dentists. Many highly experienced general dentists or specialists accomplish both the surgical and prosthodontic aspects of dental implantology.

D. Occlusion (Dental Bite), TMD (Temporomandibular Dysfunction), and TMJ (Temporomandibular Joint) 

This area of emphasis is highly important for patients who have a problem with their occlusion (bite) or temporomandibular joints (the joint between the lower jaw and the remainder of the head). However, it is one of the most confused and confounded areas in dentistry. Numerous national and international organisations emphasise this subject, and members of one of those organisations will have more knowledge and expertise in this area than a typical general dentist.

A second opinion is always advisable in this area before therapy begins, since significant differences in professional opinion exist on almost any area of treatment. Specialists most active in occlusion are oral surgeons, prosthodontists, and some orthodontists and periodontists.

E. Restorative Dentistry or Operative Dentistry in Selangor, Malaysia

Restorative or operative dentistry refers to the procedures that most patients consider the most common task of dentists restoring teeth. Why should this be an area of emphasis when every dentist learns significant depth in the subject in dental school? There are different levels of treatment in restorative or operative dentistry, and many levels of quality are observable. For example, a tooth may be restored with a typical silver filling, with an average longevity expectation of 14 years, or a well-done cast gold restoration for a lifetime (FIG. 2.17). Nearly every dentist can place a silver restoration, but only a small percentage of general dentists oriented toward operative dentistry have refined their skill to a level at which they are able to place a lifetime cast gold restoration.

FIG. 2.17 A and B, Cast gold restorations may last for a lifetime, and they need not be unsightly when smiling.

Postdoctoral programs of 2 or more years are available in operative dentistry, and most dentists who complete these programs become dental educators. There is not a nationally recognised specialty for this area, although dentists practicing in this area are asking that their organisations be recognised as such. 

F. Oral Medicine and Oral Diagnosis in Selangor, Malaysia

You may know someone who has had a strange oral disease that escaped diagnosis and proper treatment by any health practitioner. Some of these conditions are part of a systemic disease, and some are limited to the oral cavity. A few dentists limit their activity to this area; most of them are located in dental schools or hospitals. Educational programs of 2 or more years are available in oral medicine and oral diagnosis. Most dentists who complete the programs are dental educators. Although this area is not a recognised specialty, some dentists feel that it should be, and they are lobbying for such status.

G. Preventive Dentistry in Selangor, Malaysia

Many dentists list preventive dentistry on their designations in some way. Many dental diseases, including the three major ones- dental caries (decay), periodontal disease (gum and bone disease), and malocclusion (bad bite or poor tooth aesthetics) can be prevented to some degree. Although preventive dentistry is not a specialty area, it is likely that dentists designating themselves as preventive in emphasis will provide you with more information and stimulation in that area than a Malaysian general dentist will.

H. Holistic Dentistry in Selangor, Malaysia

All of medicine, including dentistry, has attempted to return to a consideration of the whole person instead of one organ, anatomical part, or disease. There has been too much emphasis on diseased parts and not on the whole person, including preventive, psychological, nutritional, and intellectual factors.

Persons calling themselves holistic practitioners are usually more interested in the whole person and will provide information and/or therapy beyond the level of your initial interest. Many are very prevention oriented. However, some dentists have been criticised for being too involved with the fringe, less-accepted, nontraditional alternative preventions and treatments. Such judgment will be up to you, with the help of the opinions of others.

SUMMARY

Most dental patients in Malaysia want to find a good general dentist who has adequate knowledge about all the areas described in this chapter to be able to practice most of them and to refer you to someone else if necessary. In addition to general dentistry, you now know the names of nine recognised dental specialties

(endodontics, oral and maxillofacial radiology, oral and maxillofacial surgery, orthodontics, pediatric dentistry, periodontics, prosthodontics, oral pathology, and public health dentistry)**** (NOT VERIFIED by the MDC) and eight other identifiable areas within dentistry.

This vocabulary will help you discuss dental therapy with dental professionals in Malaysia. It will also help you understand the many implications involved as we discuss alternatives for dental care.

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