Appealing to all five senses can help patients forget they are at a dental clinic, says this periodontist, who has a range of methods to help her patients suffering from dental anxiety.
A periodontist with her own clinical practice, lecturer and trained yoga teacher, Dr. Marlene Teo from Singapore passionately believes that leading a holistic and healthy lifestyle helps boost immunity and combat periodontal disease.
What was your path to dentistry? Why did you decide to study this field?
I chose dentistry because I wanted to help people heal. The human body and how it works has always fascinated me. My dad is a gynaecologist and I always knew I was going to be a doctor. But he was always so busy; that’s why I wanted to work in an area that gave me more control over my time. Dentistry really provided that avenue for a work-life balance.
What were your first steps after your studies? Looking back to when you started, was there an important moment that had an impact on your career?
When I graduated, I wanted to be an orthodontist. I did all my exams and internships to be an orthodontist in Singapore, but Professor Ray Williams – a leading expert in the field of periodontology – influenced and changed my whole life. He came to Singapore to give a lecture on perio-systemic issues and I was fascinated. I happened to be sitting next to Professor Patrick Tseng and I mentioned, half-jokingly, that maybe I should be a periodontist instead.
It set off a whole chain of events, as the National University of Singapore was looking for periodontists. In 2002, there were only around 20 periodontists in Singapore and we did not know much about the perio-systemic link. I fell in love with periodontology. I feel like it’s a calling – to relate gum disease with inflammatory conditions in the body.
Unfortunately, Ray passed away on 28 October 2021 and I hope he knew how much he influenced my life. He took a chance on me back in 2003 and I have never looked back since. He will be sorely missed.
“To me, a holistic approach involves examining the patient as a person who presents with spiritual, emotional and health matters. We have to help the patient join the dots with their concerns.”
Now you are a periodontist and run your own clinic, An Dental. What is the most challenging part of your daily work? And what do you like most about your job?
The most challenging part is the administrative side of things. I love being a clinician, meeting patients and coming up with a comprehensive treatment plan for them. I get annoyed when I have to fill out forms or apply for grants, order materials, etc. However, I am very blessed to have a team that helps me with all the admin.
The best part of my job is the people – our team at An Dental and our patients. It feels like family when I go to work.
You are an advocate of the holistic approach. How do you implement this in your daily practice with your patients?
When a patient comes in, we listen carefully to their concerns and address what bothers them the most. The patient is not treated as just “teeth”. The teeth are part of the mouth, which is part of the face, and part of a person. To me, a holistic approach involves examining the patient as a person who presents with spiritual, emotional and health matters. We have to help the patient join the dots with their concerns.
You completed the foundation course of ACNEM (Australasian College of Nutritional and Environmental Medicine). Could you describe how you use this knowledge about nutritional and environmental medicine in your daily work?
I send the patients for blood tests and sometimes we do tests to determine vitamin and mineral deficiencies. A lack of critical nutrients may compromise the immune system and exacerbate gum disease. I also use probiotics in my treatment plans. These techniques were once considered “mythical”, but more research and data are coming out to support these adjunctive techniques to support good periodontal health and good general health.
“I send the patients for blood tests. Sometimes we do tests to determine vitamin and mineral deficiencies. A lack of critical nutrients may compromise the immune system and exacerbate the gum disease. I also use probiotics in my treatment plans.”
When we talk to dentists from various parts of the world, they usually mention that dentistry is separated from other medical fields. How is it in Singapore? Is collaboration between dental and other medical teams common practice?
In Singapore, it used to be really separate, but nowadays medical doctors are more open to working with us. Probably because of the large number of studies linking oral health and systemic health. For example, studies show there is an association with bruxism and obstructive sleep apnoea. So, I send some of my patients diagnosed with bruxism to the ENT specialist if the patient snores really loudly or has a very large soft palate. And the ENT specialist sends patients that need mandibular advancement devices to us.
As we move forward, I believe there will be a new paradigm where dental and medical teams are part of the whole system. Education of dentists and medical doctors will merge these two fraternities further.
What’s the level of oral health in Singapore? What are the issues that need major improvement?
There are two patient segments. One group is very conscious of their health with a good understanding of cavities, gum disease, implants, etc. I feel that it is because there is so much information on the internet and social media, so this literate and computer-savvy group has a very high dental IQ.
However, the second group is not so aware and believes it is normal for teeth to fall out, as their parents’ teeth fell out too. Many are less educated or have a language barrier to information that is on the internet. This leads to what I call a great divide, and we need to address these issues: to reach this group, to educate them and to change their mindset.
How do you motivate your patients to adopt prevention techniques? Do they follow your advice?
The patients that step into An Dental are very motivated and have come in almost as a “last resort” after visiting a few dentists. Very often, they had some form of gum treatment done, but the gum disease keeps coming back as there is an underlying systemic factor, or oral hygiene is not emphasised to the patient. So, when they come to An Dental, they are very keen to find out the root cause and fix the issue with a holistic plan. They are motivated to prevent the issue from coming back, and most are very compliant.
Of course, there are some who don’t follow the steps, drop out of the program and don’t come back. Clearly, we are not a good fit with them.
“As we move forward, I believe there will be a new paradigm where dental and medical teams are part of the whole system.”
You focus on soft tissue aesthetics in implant dentistry, multidisciplinary treatment planning, dental tissue regeneration… Do you have any communication tips on how to explain the more complicated and longer treatments to patients so that they are not scared, but are aware of everything – including the importance of their own home oral care routines?
I show patients before and after photos of the procedure, but don’t show them the actual surgery. Most patients are very squeamish about blood. I also give a customised treatment plan to the patient so they are aware of the steps involved. It’s like building a house. And of course, we always emphasise at-home oral care. We even have a dedicated oral hygiene room where our doctors and nurses show patients how to brush in the correct way.
Do you have any special training for dealing with patients who suffer from dental phobias? Could you explain how you work with these patients?
I don’t have any special training, but I am also a yoga teacher. When I give injections, I get the patients to slow down their breath and I cue their breathing. I get them to take “yoga breaths”. This slow diaphragmatic breathing activates the parasympathetic system and calms the nervous system.
“We have a dedicated oral hygiene room where our doctors and nurses show patients how to brush in the correct way.”
An Dental is also set up to engage all the five senses and calm our patients. For example, An Dental is designed like a zen spa with a living room, it doesn’t look like a clinic. Our dental chairs are white and look like reclining chairs. As for the sound, each room has its own music player and we play the patient’s favourite calming music.
We use aromatherapy and essential oils to distract the patients from the smell of disinfectant and we give our patients cushions to cuddle in the waiting area and stress balls to play with during dental treatment. And finally, they always arrive to a pot of tea in the waiting area. The key is to help these dental phobic patients feel welcome and safe.
What does being a lecturer mean to you? What’s your motivation to share your knowledge with other dental professionals?
As a lecturer, I get to share my thoughts and knowledge. As I prepare a lecture, or even as I answer these interview questions, I can crystallise my thought process. I do a lot of things based on gut feeling. Sometimes I get really interesting feedback from the audience and I use these ideas to add to my existing thoughts and knowledge. Being a lecturer is sort of bringing my creative ideas into form and sharing it with other people, and taking on others’ ideas – back into the creative cycle.
Welcome to the Billion Healthy Mouths Club
Proper routines in prevention are the future of dentistry – that’s why we at Curaden launched the Billion Healthy Mouths Club – a community of dental professionals committed to the idea of having proper routines in prevention and a holistic approach to dentistry. Periodontist Dr. Marlene Teo is one of those dental professionals who shares these values, and we proudly present his experience and thoughts with other like-minded people from the field. Keep reading our Gently magazine to discover more interviews with forward-thinking professionals from around the world.
You’ve also been active as the President of the Women’s Implantology Network, South East Asia. Could you tell us more about this organisation? What issues do you deal with?
Women’s Implantology Network, or WIN, is a global network of dental professionals committed to inspiring and engaging more women in implant dentistry. Traditionally, we have more male implantologists, surgeons, key opinion leaders and practice owners. When I went to implant conferences during my studies, the female bathrooms were largely empty during breaks and the male bathrooms had lines of men waiting to get in.
I remember a male dentist in Singapore once asked me, after I gave a lecture in 2006, “So, are you going to quit and become a housewife, or become a good periodontist? A woman can’t be both.”
What motivates us as WIN members is that we want to inspire and engage more women in implant dentistry, and to create a community where women feel safe to express their specific needs and feel heard.
We do get some men calling us feminists, but we don’t let it bother us. Unfortunately Covid has more or less thrown all our South East Asia plans away this past couple of years, as it is hard to get together. However, we did succeed in gathering some members for an online yoga class for charity, and it was amazing to flow together online.
It’s obvious that your attitude to oral health and your patients is really forward-looking in many aspects. What’s your wish for the future of dentistry?
I do wish for the mouth to be considered part of the whole body by the medical doctors, and for us all to work in an integrated way.
You mentioned that dentistry is the right profession for you because it enables you to keep a work-life balance. So what are your rituals that help you feel good in all spheres?
I make sure to schedule time with my family, like going to Pilates classes with my daughter, watching TV shows with my son and going on dates with my husband to try new coffee places. I also prioritise myself and make sure I get enough me-time. I do yoga every Sunday and meditate at least 10 minutes daily. I also make sure I have quiet time where I just space out and daydream or read a spiritual book. It has become a habit for me and really gets me in the flow of life. No need to cling too much to work or anything in life!
Dr. Marlene Teo is a periodontist currently practicing in Singapore. She graduated from the National University of Singapore, where she was also an Adjunct Lecturer from 2006 to 2018. Dr. Teo obtained her Masters in periodontology from the University of North Carolina, and is the current President of the Women’s Implantology Network, South East Asia. She lectures about her areas of interest – soft tissue aesthetics in implant dentistry, multidisciplinary treatment planning, dental tissue regeneration, and treating patients with dental phobias. She maintains a clinical practice focused on periodontics and dental implants, and is director of An Dental. To find out more about her, visit Marlene Teo’s website or follow her on Instagram.
