Dr Victor Lee, dentist with a big heart and steady hands, has been practicing Dentistry for the last 30 years. He gives a good portion of his time to charity work providing dental care for the elderly, and is much-loved by his patients. He speaks with Aileene Thangaveloo, CMO at Caregiver Group, about dental health for the elderly, and how we all can do our part to fight the big bad enemies of decay, degeneration and aging!
Dr Lee began by giving us an idea of his background and how he came to start his career in Dentistry and progressed to his current role.
“As an 18 year old fresh out of Junior College, I didn’t have the slightest clue what I wanted to do!
So when I did reasonably well in my A levels, I did what most of my peers did, and applied to study Medicine in NUS, with Dentistry as second choice. Alas, during the interview they decided to put me in Dentistry instead of Medicine, so reluctantly I went into Dentistry. After 4 years in the Faculty, I grew to enjoy and eventually love it!
On hindsight, I can say that I would have made a very lousy medical doctor. I realise that I am more of a details rather than a big picture person, and I do not handle stress very well. I would be devastated if I had to deal with a life and death issue. In Dentistry the biggest tragedy is losing a tooth, which is rather less stressful than losing a life!
I became more passionate about Dentistry over the years. I enjoy meeting different patients every day and interacting with my colleagues. Each patient is unique and I learn something new every day. It is one of the few professions which allows you to be your own boss and enables you to be in control of the type and quality of work that you produce.
Dentistry is also a skill that is useful to society because everybody has teeth and needs them for normal functions - eating, speaking, smiling and singing. So it is especially rewarding when we use that skill to help the less fortunate, like the elderly, the disabled and the needy. Indeed I feel honoured to be able to do my part to help these people lead better and fuller lives."
Q. What’s a typical day in the life of Dr Victor Lee at Lee & Ong Dental?
A. Pretty hectic! But so exciting and fulfilling!
I typically see about 20 to 30 patients a day.
I’m a General Dentist so I do all sorts of work - this is what I love about being a generalist- our days are never the same. I could be doing a crown for one patient, then surgery for the next, and a root canal for another.
Once a week on my day off, I go to Ling Kwang Home for Senior Citizens to work on dentures for the elderly there. Our clinic has adopted this Home as our charity project and I’ve been going there for 30 years now. We provide dental treatment and dentures for free. We bring our materials and equipment over. We feel that this is a sustainable way to give back to society and are encouraging other clinics to do the same. If every private clinic adopts a welfare home nearby, we would be able to cover all the welfare homes in Singapore.
Q. In your experience and observation, how has dentistry changed over the past 20-30 years?
A. When I graduated in 1986, Dentistry was seen as a declining industry, what with tooth decay thought to be effectively reduced and controlled by Fluoride, and improved good oral hygiene and better dental care overall. Dental schools were closing all over the world as the prediction was they would need less dentists in the future.
Nobody however, expected the demand for other areas to increase dramatically. As the number of children decreased, every parent wanted the very best for their kids. So the demand for orthodontics and cosmetic work skyrocketed. Also, due to the greying world population, demand for dentures and bridges also increased. Later, Dental Implants came into the picture, which made Dentistry even more lucrative. And finally, the promise that Fluoride would reduce dental decay - just did not deliver. It was found that Fluoride merely delays the decay process. After water fluoridation, we saw less dental decay in children, but more in young and middle aged adults.
Dentistry has therefore changed a lot in the last 30 years. We have much better filling materials and techniques for restoring teeth. Our machines are improved and more efficient. We are moving on to digital dentistry where computers help us to diagnose and manage cases. They are developing 3-D printers which can carve a block of porcelain into a crown which can fit into your tooth. In orthodontics, wires now are designed to give just the right force to move teeth yet not cause any pain.
One thing however, does not change – in order to maintain a good set of teeth, you must have good home dental care and visit the dentist regularly.
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Q. Who are your typical patients, and which segment of the population do you feel, needs to focus more on their dental health?
A. As a general dentist, I see all sorts of patients. My special area of interest is Orthodontics, so I do see a lot of teenagers with crooked teeth. However I enjoy working on root canals and crowns as well as I find them particularly challenging.
The other area I am passionate about is the Elderly, especially those who are in Nursing Homes. This is the segment of the population that has been largely neglected. Our government’s priority has always been our young people, which is why we have so many dental buses and teams of dental nurses going to all our schools to provide dental care to every school-going child. But there is not even one bus for the elderly. This area is left in the care of volunteer dentists who would go there once or twice a month.
There are about 15 Nursing Homes with dental facilities in their premises and they are run entirely by volunteer Dentists and Hygienists. However there are many more Homes which do not have any dental care. In these Homes, the patients are brought to the nearest polyclinics on an ad-hoc basis. As we all know, polyclinics are often very busy and are not equipped to handle elderly patients from nursing homes. This is definitely an area that we need to focus on, especially in the light of our greying population.
Q. How do the elderly in Singapore approach care for their teeth as they age? A generation ago, our parents seemed to just wait for their teeth to be lost to decay or other dental issues, and towards their elder years, live with painful or ill-fitting dentures. Has that changed in recent times, and if so, how so?
A. The elderly is now a very heterogenous group. They range from the very healthy to the frail to the bedridden. So their dental conditions vary a lot, and how frail they are play a big part in their attitude toward dental health. As you would expect, healthy elderly are better able to brush their teeth and visit the dentist, so they tend to have a better set of teeth. However, in frail, bedridden elderly, maintaining good oral hygiene is a daunting task.
Certainly, compared to a generation ago, they are keeping more of their teeth even as they age. So we are seeing less and less fully edentulous cases. That presents us with another problem- as they age, they are more likely to get dementia, which makes them less able to take care of their natural teeth. This results in more dental infections in the elderly compared to before. However having natural teeth is still better than wearing full dentures as they allow you to have a better quality of life. As you mentioned, dentures tend to get painful and ill-fitting as their gums shrink due to ageing. Once that happens the patient will not be able to chew properly and that will affect their nutrition, which will in turn affect their overall health.
So our strategy is to enable our elderly to keep their teeth as long as possible by doing root canals, crowns and bridges. And if they really need to extract a tooth, we advise them to put in a dental implant to restore function. Hopefully, we can then delay the need for full dentures until they are past 90 years old.
Q. What are some tips for the elderly on how to take care of their teeth as they age? How can their family members help?
A. For the healthy elderly, dental care is the same as a normal adult, which is brush and floss their teeth daily. Use a mouthrinse daily if needed and visit a dentist twice a year.
The frail elderly may need help brushing their teeth. They may want to use an electric toothbrush if their manual dexterity is compromised. A small interdental brush may work better than dental floss for these frail elderly. And I would highly recommend using an antiseptic mouthrinse every night before bed. Needless to say, visiting the dentist regularly is most important.
The bedridden elderly and those suffering from dementia will present with the biggest challenge to good oral care. They have to depend on their caregivers to brush their teeth, so this is where the family members come in to provide assistance.
Q. Please tell us about the work you do with the Singapore Dental Health Foundation.
A. I have worked with the SDHF for nearly 30 years now. I was President from 2000 to 2010, exactly 10 years after which I felt I had to give way to younger blood.
We started the BDS (Bringing Dentistry to Singaporeans) project to reach out to the elderly and special needs group in welfare homes. The idea was to coordinate dental volunteer activity and to be a resource centre for dentists who want to volunteer their skills to the community. Now there are about 15 Homes which have a form of dental care for their residents. There are however, many more elderly homes which do not have any dental care. The problem is lack of manpower - we are not able to get enough dentists to volunteer. Many of these homes are willing to pay for a clinic in their premises, but the challenge is to get dentists to volunteer to work there on a regular basis.
We are now conducting a workshop on “Oral Care for the Elderly” specially designed for the caregivers. We realise that the oral health of the frail elderly depends entirely on their caregivers, whether at home or in a nursing home setting. And many of them tell us that they do not know how to care for their teeth. So we want to equip them with the know-how and, more importantly, convince them of the importance of having a good set of teeth so they will be motivated to brush their teeth on a daily basis.
Q. Are there other areas in dentistry you would like to share with our readers?
A. There is a new study that shows a link between Edentulism and Mortality. This means that the younger you lose all your teeth, the shorter your life will be.
There is another study that connects Edentulism with Dementia, which means the younger you lose all your teeth, the younger you will get dementia.
People must realise that losing all your teeth is a handicap, and must not be taken lightly. Sad to say, there are many people who are still having their teeth extracted because they think that they can be replaced by false teeth. We must make people aware that false teeth are like a false eye - they look good but you cannot have real function with them!
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