Dr Li Kexin, Associate Dentist at NoFrills Dental

Dr Li Kexin graduated from King's College London with a Bachelor degree in Dental surgery. Always looking to expand her knowledge and expertise, she received a Postgraduate Certificate in Primary Dental Care from the University of Kent and continues to attend courses in order to enhance her skills and expertise.

One of her strengths and focuses in dentistry is working with anxious, elderly and high-needs patients. Her primary passions in the field are periodontics as well as preventive and aesthetic dentistry. She enjoys cooking and in her spare time, she likes to play the guitar.

Without further delay, we hope you enjoy our conversation with Dr Li.

Thank you for taking the time to talk with us. Could you briefly introduce yourself to our readers and tell us a little bit about your background?

Dr Li Kexin: I am Dr Li Kexin, an associate dentist at NoFrills Dental. I graduated from King's College London and worked for a year in the UK before returning to Singapore in 2019. I am a general dentist and performs regular procedures such as fillings, gum treatment and root canal therapy. I am also actively upgrading my skills and have been trained in aligner treatment such as Invisalign for more than a year now.

Do you remember when you decided that you want to specialize in dentistry and what motivated that decision?

Dr Li Kexin: I am not specialised and still trying to gain more experience to decide whether or not to specialise, and what to specialise in. I have interests in orthodontics and periodontics but they are very different fields hence I am taking courses (e.g. implant and aligners) to broaden my knowledge in these fields to aid my decision. Actually, nowadays even the general dentist can perform a wide variety of treatments thanks to new technology aiding us on our job, so one need not be a specialist to perform treatments such as implants, Invisalign and braces.

I remember my first visit to the dentist as a child. Suffice to say, there was a lot of crying involved! Do you recall your first experience with a dentist and how did it go?

Dr Li Kexin: As a child, I had a sweet tooth which inevitably led to a lot of cavities. I remember visiting the paedodontist (child specialist) to have fillings etc. done. The toothache experience was more traumatic than the dental visit itself, keeping me up the whole night and the pain was gone after I visited the dentist. Hence I was very obedient with my brushing and not eating sweets afterwards. I'm very thankful to the dentist who sorted out my toothache back then and has not had a cavity ever since.

In the past, there wasn't much emphasis on empathy and patient management so it widely depended on the personal character of the dentist. Has that changed, is it still depending on the person or is it in some way part of the education process?

Dr Li Kexin: Every dentist is unique and has their own patient management style. The dentists of the older generation that I have interacted with have all been quite empathetic. There is definitely a big focus on patient communication in dental education in the UK now as good patient management can not only build a good rapport between the patient but also prevent adverse situations from taking a turn for the worse. Many complaint cases lodged are not because of bad dentistry but inadequate patient management and these can definitely be avoided in certain cases. That said, it is important that patients find a dentist that they feel comfortable with as different styles would suit different people. For us as dentists, we also make sure to give our best for every patient that comes into our surgery.

You have a lot of experience with anxious patients, has that affected how you approach your patients in general?

Dr Li Kexin: Yes, because of the experience with anxious patients, I feel that I am more observant of the patient's overall response (including speech, body language) and this can help me identify how patients feel towards certain procedures. Some patients hate needles but are fine with fillings, while others may be alright with needles but fear the ultrasonic scaler used for cleaning. Being more perceptive also helps me communicate better with the patients.

I feel that for anxious patients the most important thing is to communicate with them to find out how we can make them feel more relaxed and have a smoother treatment process. With these, I would tailor my approach individually for each patient to make them feel more comfortable during the dental visit. For most anxious patients, once the trust has been built with the dentist, they tend to be much less nervous about dental visits and also turn out to be very compliant patients.

It's 2021 and things have changed so much. Are things still as scary as people think or are there little to no reason to be afraid of the dentist anymore?

Dr Li Kexin: Dentistry has always been a little misunderstood in my opinion, starting from a young age, if we misbehave our parents would say they would send us for extraction with the dentist. It is true that the mouth is a very private and confined area and some dental treatments can be slightly uncomfortable. But nowadays firstly there's better equipment and anaesthetic aids, usually, with anaesthesia, all dental procedures can be painless.

Secondly, the awareness for dental prevention has been much better as compared to the past, and if patients are attending check-up appointments every 6 months, issues get picked up early and are easily treated early, whereas previously patients might wait until problems (e.g. toothache) arises before attending the dentist, in which case the treatments needed would be more complex.

It is usually the non-regular attendees that would find dentistry scary since every time they attend for the pain they would be doing treatments such as root canal treatment, gum treatment or extractions. Regular attenders are also more accustomed to the dental setting and in case if the need for major treatments arises, they would be more relaxed as compared to non-regular attenders. Hence we are trying to promote regular check-ups and cleaning as much as possible.

What would you say to people who are adamant about even things like a simple dental checkup?

Dr Li Kexin: Usually people or patients who do not believe in regular dental checkups may lack the knowledge of the importance of dental checkups. As a dentist, I find that these patients need patience and time in changing their mindset, and I would explain to them the reasons why regular checkups are important, as well as rope in family members if possible to talk to them and let them understand the need for coming to the dentist regularly. In many cases, once they understand the reasons behind this, they would be happy to attend more frequently.

Preventive dentistry is one of your specialities. Other than regular checkups and brushing and flossing, what can we do to prevent problems? Is there something important that you'd wish more people knew and did when it comes to prevention?

Dr Li Kexin: When we talk about prevention, there are two major aspects that we are trying to prevent, gum disease and decay. For the prevention of gum disease, good brushing and flossing habits are essential. I remember in primary school they used to teach us how to brush but no one really taught us how to floss and this job is essentially left to the dentist. Many patients are still not flossing every day and it is our job to teach and advocate flossing to patients, as well as help them find the most suitable tools to aid them with the process.

For decay, the consumption of sugar also plays a major role and there are two issues that I'd like to highlight. The first is to be aware of hidden sugars in our diet. The higher the frequency of sugar consumption, the more likely to get decay, and even a teaspoon of sugar in our coffee, or a raisin snack during tea time counts towards that. Many foods nowadays have hidden sugars and it is good practice to switch to healthy snacks such as fresh fruits, cheese, or sugar-free biscuits between meals.

I also feel that the awareness for decay prevention in young children is slightly lacking. Many first time parents are not aware that they need to start brushing their child's teeth when the first baby teeth erupt, or that they can bring their baby in for dental checkups as early as 6 mths old. Baby food is also high in sugars hence they also have a higher chance of getting decay if habits such as leaving a bottle of milk with the baby overnight are not corrected in time. These are definitely information that I would be communicating to expecting mothers or parents of young children who attend dental checkups.

A lot of people believe that brushing your teeth harder removes more plaque. Is that true and what is the current consensus on how long we should brush, how often and how hard?

Dr Li Kexin: Plaque is the soft, white substance that accumulates on our teeth after a few hours. If you scrape your teeth with your nails tonight, you'll find that plaque is very soft and easily removed if brushing is targeted at the right area. Hence you don't need to brush hard in order to remove plaque. The yellow, hard substance that cannot be brushed off is calculus and would need to be removed by a dentist. In fact, brushing too hard can cause recession of gums and abrasion to the outer layer of the teeth which in turn will lead to sensitivity. Imagine you're brushing a ripe blueberry and cannot break its skin, that's roughly the amount of force needed for brushing your teeth as gums and teeth are delicate structures.

Brushing 2 times a day for 2 minutes each time, focusing on where the gums meet the teeth, and flossing at least once a day is the minimum requirement for maintaining cleanliness in the oral cavity. Always choose a soft brush and apply gentle pressure only.

Another focus of yours is minimally invasive dentistry. Can you explain what that entails? What kind of treatments and practices are considered to be less invasive?

Dr Li Kexin: Minimally invasive dentistry entails preventative dentistry and early detection of disease such that intervention can be cut to the minimum. If treatment has to be carried out, the least invasive option that preserves the most tooth structure is chosen. For example, when a cavity is detected, if it can be treated with a filling, we wouldn't be inclined to make a crown. And if there is a choice of filling materials, we would prefer to use composite (white filling material) as compared to amalgam (silver filling material) as amalgam requires us to cut a certain cavity shape to lock the filling in, which might cause a little removal of healthy tooth tissue.

Periodontal disease is a serious business. Do you often get patients who have waited long enough to develop it and how is it treated? Can you reverse the periodontal disease or only manage it?

Dr Li Kexin: Yes we do see patients with periodontal disease. Often they present as patients who have not attended a checkup for a prolonged period of time (e.g. more than 2 years). The most frequent complaint when they present might be bleeding or swollen gums, pain, or even shaky teeth, which shows that quite a lot of damage has already been done.

The danger of periodontal disease is that it is symptomless in the early stages. It initially develops as gingivitis which causes some inflammation in the gums, and maybe a little bleeding when brushing. At this stage, only gums are affected and the damage can be reversed by attending the dentist for a clean, as well as maintaining good oral hygiene habits at home. However, it is easily neglected as many patients are not even aware that they have gingivitis.

If gingivitis is left to propagate, the underlying bone gets damaged by the bacteria and the bone support of the tooth is weakened. The damage to the bone is irreversible and once this happens it is considered a periodontal disease. Once the bone is lost, it is impossible for the bone to regrow. In certain cases, the bone may be repaired by bone grafts with the periodontist (gum specialist), but in most cases, it would be a matter of maintenance and preventing the worsening of the situation. Again, this is done by regular attendance to the dentist for deep cleaning and good daily cleaning by the patient. A deep cleaning may sound painful, but you can request for the treatment to be done under local anaesthetic.

The key to the prevention and treatment of periodontal disease is a combined effort between the dentist and the patient. The dentist is responsible for early detection and education of the importance of good oral hygiene practices, whereas the patient needs to be responsible for their own daily cleaning and maintenance of their oral health.

Teeth whitening is a really popular treatment in Singapore and there are a few methods for getting whiter teeth. In your professional opinion, which whitening method is the best?

Dr Li Kexin: There are a few ways to get whiter teeth, depending on what is affecting the colour of the teeth. In smokers and people who drink a lot of coffee and tea, they may have extrinsic staining (staining on the surface), which can be easily cleaned off by the dentist during routine cleaning appointments. Whitening toothpaste would be able to help remove these stains but we do not recommend using whitening toothpastes for long term use due to their abrasive nature. If used for prolonged periods of time the outer layer of the teeth, the enamel, might be damaged.

If it is the inner colour of the tooth that needs to be improved, we would recommend consulting a dentist for professional dental whitening instead of using over the counter products or home remedies that are popular online. Professional teeth whitening uses a carbamide peroxide gel of varying concentrations depending on the delivery method, and the gel used by dentists are of much higher concentrations than over the counter products which contain the same ingredient. Hence you may find that using over the counter whitening products may not produce much effect. Home remedies are not recommended as they may not be safe. For example, an online remedy uses lemon juice and baking soda, both of which have erosive properties and would damage the enamel of the teeth, making the teeth look "whiter" temporarily, but in the long run, would have serious side effects like sensitivity.

Professional dental whitening prescribed by the dentist can be largely categorized into in-chair whitening and take-home whitening kits. In-chair whitening is done in a 2hr session, uses a stronger gel and blue light, and produces instant results, whereas take-home whitening involves making a customized tray for the patient, and giving the patient whitening gel to take home to use once a day over 7-14 days. Both systems produce good results and the dentist will recommend the system which is most suitable for the patient based on the patient's preferences. Usually, in-chair whitening is more suitable for those who want quick results, whereas take-home whitening would suit those who would like to take the treatment at their own pace and do it in the comfort of their own homes.

What is your opinion on teeth whitening kits for home use? Are there any risks with those?

Dr Li Kexin: Professional teeth whitening kits are easy to use and produce good whitening results. With all whitening, some sensitivity is to be expected during the treatment as a side effect, but it would settle once the treatment is stopped. Take-home kits generally have less sensitivity as compared to in-chair whitening systems. The dentist would give detailed instructions about how to use the take-home kits, but sometimes if too much gel is applied it can cause a mild chemical burn to the gums, again this is temporary and any discomfort caused would settle within 1-2 days.

And what about DIY methods like baking soda or hydrogen peroxide mixed with water?

Dr Li Kexin: DIY methods usually involve material that is not suitable for medical use, and "whitens" teeth by eroding away any surface stains of the teeth. The dangers of these methods are firstly erosion to the enamel, as the enamel becomes thinner there are higher likelihoods of sensitivity issues. Further weakening of the teeth can also make the teeth more prone to fractures. Furthermore, as enamel is translucent in colour, as it thins with erosion it shows the dentine layer underneath, which is yellower and goes against the initial goal of whitening.

Does whitening your teeth make them weaker in any way?

Dr Li Kexin: Professional dental whitening, done at controlled intervals, is completely safe. It would weaken teeth if done too frequently, hence consult your dentist for the most optimum frequency for whitening.

What can we do to maintain our teeth whiter without professional treatment? Any habits we should part ways with?

Dr Li Kexin: In order to reduce extrinsic staining, you can reduce your coffee/tea intake, or reduce smoking. It is difficult though, for most people to part ways with coffee and tea, hence a professional clean with the dentist every 6 months will help to get rid of extrinsic stains.

The internal colour of the teeth is decided by genetics, however, if you have done whitening treatments, you can try to avoid heavily staining food to preserve the results for a longer period of time. For example, curry and turmeric containing food, red wine, and dark sauces etc.

Do you have to do dental surgery often? What is the most common dental surgery you perform?

Dr Li Kexin: We are trained in surgery involving the teeth and the most frequent surgery that we do is wisdom tooth removal surgery. More complex surgeries such as gum surgery and implants can also be performed after we undergo further training.

We see many cases of impacted lower wisdom teeth growing sideways, which has a risk of causing decay to the tooth beside it. Because these teeth are at an awkward angle and are very far inside the mouth, a small surgery is required to break up the tooth to take it out.

What conditions require dental surgery treatment?

Dr Li Kexin: Removal of impacted wisdom teeth, or other impacted teeth (teeth growing at irregular angles or sites). Dental implants. Certain gum diseases etc.

What can you eat after dental implant surgery?

Dr Li Kexin: During the initial recovery period, there will be a bit of swelling and pain, hence soft food is advised for the first week after dental implant surgery. It is also advised to avoid shellfish for the healing of the implant site.

Sometimes there are only a couple of crooked teeth that need straightening or adjustment to fix a gap. Can brackets be put on just the affected teeth or do you still have to wear braces or aligners over all the teeth?

Dr Li Kexin: If the affected area is small and no adjustments need to be made on other teeth then yes, sectional braces, which consists of brackets only on a few teeth, can be put on the affected area. However, in most cases, teeth adjustment have to be done with the overall space requirement, occlusion, and aesthetics in mind. Moving one tooth might require space to be made by moving other teeth out of the way, and moving a few top teeth might affect the bite hence the bottom teeth have to be moved in relation to the top. Hence the majority of the time braces or aligners have to be worn over all the teeth.

Invisalign is a popular method for straightening teeth in large part due to them being transparent and removable. How do professionals like yourself decide whether braces or Invisalign are the most appropriate treatment method?

Dr Li Kexin: Braces and Invisalign are very different systems and each has its pros and cons. Braces are able to deal with all kinds of complexities whereas Invisalign now is able to deal with most complexities present. For most patients, they would have a choice between both systems. Braces may be indicated in very complex cases, or when certain teeth movements cannot be fully predictable with the Invisalign system. The dentist would assess the suitability according to the individual case of the patient

Do teeth straightening treatments provide permanent results? What happens after people stop wearing the aligners or braces?

Dr Li Kexin: No. In the first few years after teeth straightening treatments, the teeth have a tendency to move back to their original position. This is because the bone foundation under the tooth has not fully stabilized yet. Even after the stabilization period, our teeth position might still shift due to changes in bone structure with ageing, as well as habits and other interferences. Hence after teeth straightening treatments, retainers are recommended to keep the teeth in their final position. The use of retainers should be lifelong, or as long as the patient does not want the teeth to move.

There are many more questions to ask, but I don't want to take more of your valuable time for now. Thank you very much for doing this and providing us and our readers with very detailed answers!

Dr Li Kexin: My pleasure! And thank you for having me as well! Stay safe!

I hope you've found this interview as interesting as informative as I did. If you have more questions, or if you just want to find more information about Dr Li and the services provided by NoFrills Dental, don't hesitate to get in touch with them at:

Address: 3 Temasek Boulevard, North Wing, #03-317 Suntec City, Singapore 038983

Phone: +65 6337 7319