Somjot

I don`t dare to ask, what payment he wants for a castration.

I think it is you who is taking things the wrong way I recommended a clinic „employing not more than 5 or 8 dentists with two or three general practicians and the rest being specialists“, which implies that at least one of them is specialized on root canal treatment. And @Yellowtail recommended Bangkok hospital dental centre, which sounds like a big place, where you normally confined many dentists with different fields of expertise. You see, we perfectly understood, what you are looking for.

Exactly, dear @spock Or to use a phrase from the movie 300: “You Spartans Vulcans take pride in your logic. I suggest you imply it.” Sorry I'm a cineast. There are so many dental clinics in Bangkok; just Google them, find one of your taste and be done with it. Oops, again (GOT). In the medical field things work quite differently in Thailand. We westerners prefer to look for a good doctor or dentist and once we have found one, we stay with him or her “till death do us part”. In Thailand many doctors don't want to bother opening a clinic with all the risks and costs, so they work in hospitals, many times even in two or three different hospitals at the same time spending one or two days in one and then moving on to the next. That can be quite confusing for us as we want to see our doctor at any day of the week. I think that you might be more comfortable with a smaller clinic employing not more than 5 or 8 dentists with two or three general practicians and the rest being specialists.

Listen, I was not trying to advertise for them. I just knew, they had a microscope for root canal treatment, which is the proper equipment for a specialist. But of course, I have no idea about their staff. Generally spoken I would be careful with any place, which has 100% good reviews with maximum points (good reviews can be created or bought; bad reviews can be removed by a good lawyer), same as places, which have mostly bad reviews (speaks for itself). The reviews of those places are reliable, which are 95% good and the rest being bad. But this is just my personal experience. I have heard things similar to those, which you describe but you have to understand, I am the only foreign dentist in Thailand running his own clinic and I must be extremely careful, how I comment any other clinics, as I am - how do I express this? - permanently under a microscope myself, not a dental one as you can imagine. There are people just waiting for me to make a wrong move; I have no intention to grant them this favor.

Now that you're advertising your without any doubt very unusual method, I'd like to ask some questions: How did you get that grooves in the tooth so that your twine wouldn't slip off, especially without injuring neighboring soft tissue or teeth? How do you sterilize your twine and whatever instrument you use for creating those grooves. For a proper sterilization they must be exposed to heat for 20 minutes and a temperature of 121 °C with a pressure of 2 bar or for 5 minutes and 134 °C with 3 bar but you knew that already. What do you do in case of complications, just to name a few: 1. A wound infection, which can easily turn into a life-threatening osteomyelitis? 2. The twine I have seen on your picture will pull only on one side of the tooth comparable to the rope on the neck of a person sentenced to death, which in most cases will result in a broken neck. The effect on your tooth is that it is not only pulled but also tilted to one side at the same time which may result in a good part of the alveolar bone being ripped out too. 3. As the roots of the upper molars are very close to the sinuses, their extraction leads to a connection between mouth and maxillary sinus in many cases, which must be treated with a plastic maxillary sinus occlusion immediately. I have no doubt, you`ll concur that these complications must be attended to and cannot be ignored. How do you proceed in these cases?

Please keep in mind that you have been asking for an endodontist, aka root canal specialist. Now as I wrote, most root canal treatments can be successfully performed by experienced dentists but if there is a high chance for complications, the root canal specialist is the person you want to visit. In most cases they have a couple of months if not years of additional education and experience and the much better equipment than the normal dentist. For example they work with a dental microscope, a huge piece of equipment, normally fixed on the wall with prices starting 20,000,- € and more, not to mention the special motors for the treatment. As far as I know, the dental hospital has this equipment same as the Bangkok hospital Pattaya. However, generally I tried to avoid any kind of recommendations no matter if according to clinics, restaurants or hotels as one man's heaven is the next man's hell. And I would be a bit careful with those reviews. It is easy to ask friends and relatives for a good review without them ever having experienced your services but on the other hand side, some customers use this as a lever. Last year a guy came for a professional tooth cleaning, which was performed perfectly by my colleague within 50 minutes; after that he was handed a mirror to check the result. The guy was very happy, even complimented my doctor for his great and totally painless job, paid at the counter and left. Next morning, he called us by WhatsApp and complained, that after rechecking his teeth at home, he had noticed that 2 teeth are not completely clean. I apologised and offered him to come to my place immediately, so we can re-check and if necessary, re-treat. He said that he had lost his trust in us, was now traumatized and wants us to wire his money back. I asked: “We cleaned 26 teeth, which took us 50 minutes and because of 2 allegedly not perfectly cleaned teeth you want your complete money back?” “Smart guy.” He answered arrogantly and if I would refuse, he would write many horrible reviews about my clinic on Google Maps and many other social media, “so that you can close your dental <deleted>house within a month.”

This is correct.

Not only have I considered it, but I am also currently working in my own dental clinic in Pattaya. Why else would I go through that ordeal to get the Thai dental licence. Your implant looks great. The guy who did it, knew what he was doing. The distance to the neighboring teeth is perfect.

These days there seem to be so many specialists in dentistry. Any experienced, skilled dentist with good equipment can perform a root canal treatment. But if you have a history of failed root canal treatments or want to be 100% - there is no 100% in medicine - let's say, 98% sure that the treatment will be successful, then you have to go and see one of those endodontists. In Bangkok I would go to the dental hospital while in Pattaya I would recommend the Bangkok hospital Pattaya.

Looking at that executed … err … extracted tooth I can clearly see a lot of concrements in the subgingival area. This tooth must have been very loose and easily to extract, as those concrements always lead to gingiva and bone recession. But with a thorough subgingival curettage it might also tighten again and be in function by now. Next time you might want to try to keep the tooth first. And I doubt, that you could extract for example a hurting tooth with a deep caries but a healthy periodontal ligament, with your method.

§ 10 Para. 4 (Staatsangehörigkeitsgesetz) states: revoking your foreign citizenship is one of the requirements to get the German one § 12 quotes a few exceptions from § 10 para.4: Para. 2: the foreign country does not allow revoking the citizenship Para. 5: revoking the foreign citizenship would lead to significant disadvantages concerning the laws of assets / property or economical disadvantages for the foreigner. I think your friend will just have to ask. Sorry for my horrible translation; I am not familiar with "law language".

As I wrote, the whole thing happened 11 years ago and the laws have changed since then. My ex-wife showed me the announcement and she was worried for a while, as in the moment, when she would get the German citizenship the local City Hall would cancel the permanent residency for Germany in her Thai passport, as being a German citizen she wouldn't need a visa for Germany anymore. And we were worried, that when she would travel from Thailand to Germany, the officer would check her Thai passport (of course she wouldn't show her German one) and ask her, how she is going to enter Germany without a valid visa. We both made a bit of research. While she found out that many Hi So Thai nationals, the most famous at that time being Mr. Abhisit, had double citizenship, I got the information that the only “authority”, who would check her permission to enter Germany is actually the airline, as they are responsible for that. If they would allow any person on one of their planes who is not allowed to enter the country of destination, they are responsible for getting him back. The officer at the immigration desk does normally not check the visa. As far as I know she never had any issues with that.

As you may know Germany has the problem, that it is running out of Germans. So, they saw no other way out, than to select countries, where they would allow double citizenship. They knew for a long time, that renouncing the Thai citizenship to get the German one would be very hard for Thai nationals for example if they owned property back home. They just didn't care. As Thai citizens living in Germany are not known for causing a lot of trouble and if the worst they would do, is some fraud with Internet poker, in 2012 it was decided to grant them double citizenship. I know, because as soon as I got the information in that year, my now ex-wife applied for the German citizenship and got it one year later (we had been married for more than 10 years by then). And I also remember, that one day after the German government had announced that, there was an announcement on the website of every Thai embassy in Germany, that Thailand still does not accept double citizenship and that from now on immigration officers are ordered to control incoming Thai passengers from Germany and if they should catch one with double citizenship, there would be huge problems, although they never defined those problems. As far as I know foreigners for example from the Middle East are still not granted double citizenship and I can't say that I am disappointed about that. What I never forget, was the day, when my wife was invited to come and get her documents which proved that she is German from now on. The last thing she had to do was to read a list with hundreds of different terroristic organizations and confirm that she “does not cooperate or sympathize” with any of these organizations. I said “Wait a minute, this is our line of defense? This is how you separate the bad guys from the good guys? So I could sit here with an explosive belt making ticking noises and just sign, that I have nothing to do with any of these organizations and get my German citizenship?” The officer said “this is not funny.” And I answered “Absolutely not. I am confused and worried, as I don't see any kind of protection for our country from this list. There are rumors that some of those terrorists might also be liars.” She said “Sure, but if we find out later, that you have been lying about this, we can renounce the German citizenship at any time.” When leaving I said: “Yep! That would surely scare the <deleted> out of them.”

Honestly, since I passed the Thai dental board exam as the first and afaik until now only foreigner, I wasn't much interested in that matter. All I know, is that there used to be a few government universities, but later private universities opened, which caused huge problems, as the government universities said, they wouldn't accept the exam from the private ones. But all this has been resolved by now. The private universities are quite expensive and there have been rumors, that the government universities, which are much cheaper and officially only accept new students depending on their grades, were also quite expensive, the difference being the method of payment: on the table or under it. But of course those were only rumors.

The world`s leading company for dental whitening is Ultradent and the product`s name is Opalescence. We normally use the 20% concentration as I have seen many times that higher concentrations can cause extreme tooth sensibility with some patients, not all of them of course. I found a 35% concentration on Lazada but the whole thing is a bit funny. They also write “no brand” but what really worries me, is that they give you 2 trays for free. For home bleaching we take impressions of your upper and lower jaws and our technician casts models on which he manufactures individual trays which have a very tight contact to the gingiva but about 1 millimeter space to the teeth to protect all the surrounding tissues while the teeth are exposed to the bleaching material. If you use those trays you can see on the picture, the bleaching material will be just floating around in your mouth and lead to severe destruction.

Apologies if my writings were difficult to understand. I tried to use as many layman words as possible. Please understand, I am not a native speaker, so I have to translate the medical words into English first and then try to find the correct layman words. Takes some time to do it, but I am always happy to help.

I will ask my clinic manager tomorrow, which concentrations we have. If you could tell me the peroxide percentage of the bleach you would like to have, I can check for it.

Now you are getting more precise. You are clearly speaking about the upper molar area and yes, what often happens after tooth extraction, is that the sinuses move downwards so that in some cases the thickness of the bone on the alveolar ridge is only one millimetre. In that case an external sinus lift is required and quite some amount of bone granulate, I'd say the size of a walnut for each side. If there are maybe five to seven millimeters left an internal sinus lift might solve the problem. It would be easier if you would send me your panoramic X-ray.

What I wrote was, that bone actually DOES grow, but bone grafts are not necessary after every extraction. I never said they're useless - I even wrote, that I have made hundreds of them - but I always try to keep the surgery small. For example in many cases, if the bone is too thin, bone spreading might solve the problem and the bone graft can be avoided. But to go into all details would be too complicated.

Honestly, pulling your own teeth is not such a good idea. In case you have an advanced periodontal disease, as a result your teeth are only sticking in the gum and can easily be moved in any direction, then maybe self-extraction is possible. In any other case I would not do it. You could hurt yourself; the bleeding might not stop or some parts of the route might break off and stick in the bone without you noticing it, which can lead to severe infections later.

Phantastic thread by the way. I've been thinking about Thai citizenship for quite some time now. I have permanent residency since 2006, as it was mandatory to get a blue tabien baan, which again was one of many requirements to be allowed to certain exams. To pass them, which I finally managed 2010, would allow me to work in my profession in Thailand. I do see the advantages of Thai citizenship, but I am not much interested in buying land or a house as I live in a beautiful one already, perfectly located for my needs, with a 30-year lease. The residency is very comfortable and as all I must do, is getting my multiple re-entry permit, in case I want to travel abroad, which is not a big deal. The advantage is, that I am 100% legal. Thai citizenship requires to surrender the original one, mine being German, which I definitely don't want to. I have read in here, that it only requires “the intention to surrender the original citizenship”, but despite not having any experience with that, I doubt, the officials would accept any excuse like: “of course I intended to give back my citizenship but later I changed my intentions which is only human.” I'm pretty much sure the reason why they did not write “MUST give back the original citizenship” is, that many countries simply do not allow it and you just can`t give it back. But the German one can be given back, even worse, if you successfully apply for a new citizenship without asking for permission in advance, your German one is automatically revoked, once they find out. Any suggestions? And apologies, I did not read the entire thread, but I will do as soon as I have the time.

That is not entirely correct. Germany allows citizens of certain countries to keep their citizenship, while getting the German one. Thailand was added 2012.

Yep, that pretty much sums it up. ????

Thank you very much for your comment and luckily your assumption is wrong. Think about it, if bone could not regrow, how does a broken leg heal, how does an orthodontist move or turn teeth to the correct position? Same as muscle and skin bone is living tissue full of different cells, some of them called “Osteoblasts” which means nothing else than “bone builder”. The most important thing is a bone preserving extraction technique. The classic extraction technique says, extraction and after that compression. This means that after the tooth has been extracted the dentist would grab the extraction socket with his thumb and index finger and press it together forcefully, which leads to a smaller extraction wound, lesser bleeding and faster healing. The downside is that the depth of the bone will be reduced by half, so that in case, the patient would like to have an implant inserted in this area, his bone might have enough height and width but not enough depth. The bone preserving extraction technique does not include compression and tries to keep all the walls from the alveolar socket, especially the buccal ones, which are on the side of the cheeks and lips and very thin, which makes them fracture easily. This technique will lead to a preservation of the socket and almost no loss for the alveolar ridge so that there is no need for a bone graft in most cases. I don't know if you are familiar with bone grafts. They are harvested from the bone of different animals and can be equine (horse), bovine (cow), porcine (pork) or even from human bodies by eliminating the complete organic material from it. What is left is just minerals in a shape that reminds of bone. I never felt comfortable with any of them why I always used artificial bone made of Tricalcium Phosphate. The companies tell us, that once the bone graft is inside the extraction socket or the area, were you plan to insert an implant, the Osteoblasts and other cells will transform it into our own bone. I can confirm that this is not the truth. I have made hundreds if not thousands of bone graft surgeries in the last quarter century and every time I drilled into it to shape an implant site months later I could see rests of that bone graft in the drill cuttings. Don't get me wrong, bone grafts can be very helpful, for example when you do an external sinus lift, were you want to create an artificial space between the bony sinus floor and the so-called Schneider membrane and need a placeholder. But generally spoken my experience taught me, the smaller the wound, the lesser invasive the surgery, the fewer foreign material included, the higher the chance for success and of course the lesser the pain after the surgery. For example, the classical operation technique for an implant is a longitudinal incision on the alveolar Ridge followed by transverse relief incisions and then separation of the mucoperiosteal flaps from the bone with raspatories, which are repositioned and stitched together after the implant has been inserted. This facilitates the determination of the implant position but it's a huge trauma followed by severe pain. I don't do this anymore. I use a punch, a round knife, and cut out a circular piece of the gingiva, which is located exactly where I want to insert my implant and has the exact same diameter as my implant. As a result, at the end of the surgery there is no wound, no bleeding, no stitches and in most cases no pain but on the other hand a much faster healing and a higher success rate and not to forget – lesser costs for the patient. That is also a point, I have always on my mind: My patients trust me with their health. I could never take advantage of that trust by suggesting a bigger and more expensive surgery than needed and still be able to look at my face in the mirror. Since my first days as a doctor, I always and without exception advised and treated my patients as if I would sit in the dental chair myself. Feel free to ask any questions.

I have noticed that there seems to be confusion about dental treatment in Thailand or which kind of treatment is to be preferred, a root canal treatment or an implant. As I know a thing or two about these matters, I might be able to offer some clarity: the Tooth The visible part of our teeth is called crown; the rest of it, the root, is inside the jawbone, which again is covered by gum. The body of the tooth is made of Dentin. Is comparable to bone but much harder, 33% of it being organic and it is sensitive to temperature. In the crown area the dentin is completely covered by enamel. Enamel is 96% crystalline mineral, which makes it harder than steel but also susceptible to demineralization if exposed to acids. This might happen through ingestion of soft drinks and fruit juices or by bacteria, which digest the sugar in our food and produce lactic acid, which can lead to caries, aka as decay. As soon as the decay passes the enamel and reaches the dentin, the tooth starts reacting stronger to temperature, than the others. Up to this point it is possible to treat that tooth with a simple filling. If the decay reaches the pulp, that is where the fun begins. The pulp reacts to infections like any other part of the body: it starts swelling. We all know that no matter if you have an ingrown toenail or hurt your hand while fixing your car, it always starts swelling and as long as we do not touch the wound, it is not very painful. The problem with the pulp is its location in the pulp chamber, which is hard tissue. The pulp starts swelling, which causes pressure in the pulp chamber leading to more pain which again leads to more swelling and so on. So, if you have asked yourself, why toothache can be so severe. Now you know the answer. In such a case a root canal treatment might be a good choice. Root canal treatment Your dentist will use many different instruments, like Headstroem Files and Reamers to clean the pulp chamber and the root canals down to the little opening, the apex, where the small nerves and blood vessels leave the tooth. And he will repeatedly rinse the root canal to get all that infected material out, so that he can finally fill it. Now here is the catch: Nature does not always build straight things. Due to genetic reasons some people do not have root canals going straight down to the apex. Their root canals split (in most cases) in the last third into many accessory canals comparable to a river delta. There is no way to see those accessory canals on an X-ray let alone to correctly fill them. This can be quite frustrating, you just made a perfect root canal filling, the X-ray shows a beautifully shaped and perfectly filled root canal, but the patient keeps having symptoms. In that case there are two options: 1. you see a skilled maxillofacial surgeon, who will perform a so-called root resection, where he drills through the jaw bone and cuts off the bottom of the root, after which you have a 70 : 30 chance to keep that tooth for a while. 2. Extraction Generally spoken, if you have a history of failed root canal treatments or if the decay has reached areas beneath the bone already, extraction might be the right treatment. The question, which is the better treatment, a root canal treatment or an implant actually makes no sense. It is always better to keep your teeth, but only if this has a good prognosis. If not, an implant is a very good choice. Not only does it replace the tooth; it also preserves our ability in chewing, speaking and our aesthetics and it prevents atrophy, aka bone loss, which always occurs when a tooth is extracted. Implants The implant is basically just an artificial root in most cases made of titanium although there are also a few available made of zirconia. Some people prefer zirconia because of its white color assuming it is more natural and healthier. This is wrong as both are metals and have no natural occurrence in the human body. If the extracted tooth was infected, it is preferable to wait about three to six months before implantation, so that the cells in the bone can eliminate all remaining bacteria and regrow new bone into the extraction wound. After the insertion of the implant, the surrounding bone will need another two to three months to osseointegrate the implant, which means to grow on it giving it stability to withstand the chewing pressure. After that the dental technician will choose the right abutment, which connects the implant with the prosthetics and start with the production. His choice depends on the prosthetics planned for you, which could be a single crown, a bridge or some removable device. Now here's another catch: Worldwide there are more than 1000 implant manufacturers, many of them having different types of implants in their catalogues and all those implant systems are not compatible to each other, as they have different geometries and require a different set of tools. There is no EU DIN norm or US standard. The different implant types of one implant manufacturer (STRAUMANN) implants from different manufacturers It's the same with cars: you cannot put the generator of a BMW into an AUDI, although it is basically the same device. So if you don't know the manufacturer of your car, you don't know where to go, if anything has to be replaced. Luckily, when it comes to cars, name of the manufacturer is written somewhere on the car. Not so with implants. Interestingly most people with implants do not know their manufacturer. But one day you might lose a few more teeth and in order to connect the remaining teeth with the existing implant, for example to fix a bridge, all you need is a different abutment. Or let's say, that little screw which connects the abutment with the implant has loosened and just needs to be tightened a bit. If you don't know the manufacturer of your implant, you have a problem. different abutment types Even worse if your implant is from some no name cheap manufacturer, which has gone bankrupt and disappeared. Many cheap implants offered in Pattaya are from one of those many no name manufacturers so choose wisely. Apologies for my wrong spellings or grammar mistakes; I am not a native speaker. Feel free to ask me any question about dental treatment. Cheers Somjot