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Dr Sam Zhi Heng

Consultant Paediatrician
MBBS (UM), M.Paeds (UM), A M (Malaysia)

Dr Sam Zhi Heng obtained his medical degree (MBBS) from University of Malaya in 2009 and subsequently completed his Master of Paediatrics in University of Malaya in 2017. He obtained National Specialist Register in general paediatrics. He is a life member of College of Paediatrics, Academy of Medicine Malaysia. He had been trained and practised in different major hospitals in the country in paediatric specialty such as Hospital Tuanku Ja’afar Seremban, University of Malaya Medical Centre, Hospital Selayang, Hospital Sibu Sarawak and the latest in Hospital Port Dickson before he joined Columbia Asia Hospital Petaling Jaya as a resident paediatrician. He was adjunct lecturer in paediatrics in SEGi University and honorary lecturer in paediatrics in International Medical University (IMU) previously. He is a certified Neonatal Resuscitation Program (NRP) provider and also obtained Advanced Paediatrics Life Support (APLS) certificate. He had published an article on Respiratory Syncytial Virus (RSV) infection in children in an international journal. Dr Sam has special interest in neonatal and infancy care and early childhood nutrition in which he has presented in a few national conferences. He also been awarded Best Oral Neonatology Presentation Award in the Regional Congress of the Perinatal Society of Malaysia in 2018 on a study regarding term small for gestational age (SGA) babies. Dr Sam regularly shares his thoughts on his Facebook link (DrSamColumbiaAsiaPJ).

Dr Nicholas Lim

Consultant Obstetrician & Gynaecologist
MD (UNIMAS), MRCOG (UK)

Dr Nicholas Lim graduated from University Malaysia Sarawak in 2002 and obtained his Specialist Membership Degree (MRCOG) from Royal College of Obstetricians & Gynaecologists (RCOG) in the UK in 2010. He has since worked at Penang Hospital, Royal Gloucestershire Hospital, St. Michael’s Hospital in Bristol as well as Pantai Ampang Hospital. Having been in private practice in the Klang Valley since 2012, his current place of practice is Columbia Asia Hospital Petaling Jaya. Dr Lim’s special interests are in maternity care and childbirth as well as gentle birthing and general gynecology care. He also runs online antenatal workshops and shares his thoughts on current topics pertaining to pregnancy and childbirth regularly on his Facebook link (Nicholas Lim OBGYN).

Dr Loo Ping Ling

DDS. FICD. FADI. FICCDE. COMS. INT.CERTIFICANT ABDSM

Dr Loo Ping Ling is a Dental Sleep Medicine and Oral Myology Specialist. She graduated from Malaysia National University and attained her additional postgraduate qualifications from both Graduate School University (US) and Tufts University Boston (US). She is currently an active member of International Association of Oral Myology (IAOM) and an International Certificant of American Board of Dental Sleep Medicine.

Dr Loo founded Little GiGi Dental Group in 2013, a dental group that is known for its myofunctional treatment and children dentistry. Dr Loo has been working closely with specialists from Australia, United State, China, Finland, and Taiwan. With her tremendous clinical experience, Little GiGi is awarded the first and only LM (Finland) Certified Children Orofacial Development Management Center in Southeast Asia. Besides, Little GiGi is also holding the title of the first Myobrace (Australia) Certified Provider in Southeast Asia.

A mother of three, Dr Loo herself faced a lot of difficulties in providing dental care for her kids so she fully understands the dilemma faced by parents in this regard. The assumption of an unpleasant experience for their children at the dentist can alter the thinking and behaviour of parents in their approach to children dental care. The inspiration to make visiting the dentist an absolute treat and an overall joyful experience for both children and parents is what spurred Dr Loo to establish Little GiGi.

Dr Loo believes that at the end of the day, it is crucial to ensure a child’s dental journey begins in the right place and the right surroundings. Every child should get excited about seeing a dentist. Beyond just ensuring a healthy set of teeth, it’s just as important for them to gain happiness and knowledge about the importance of dental health which will stay with them for the rest of their lives.

    Ask A Doctor

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    Questions for the Doctor

    Please refer to your physician if you have immediate concerns that need prompt attention. Questions submitted before the 15th of each month will be answered by the 1st of the following month. All other queries received after the 15th of each month will only be answered on the 1st of the subsequent month after the most recent to come. We reserve the right to only respond to questions deemed appropriate and will respond to the 10 most relevant at any one time.

    Question : Toothache?

    Toothaches occur when erosion or decay penetrates the tooth’s pulp chamber, which contains nerves and minuscule blood vessels that are extremely sensitive. One of the most common reasons for toothache is diet-related, such as drinking too much soda or eating foods that possess high sugar content, such as candy.

    If you notice that your child is being stubborn when it comes to brushing their teeth, this may indicate that they are experiencing a toothache. When your child is suffering from a toothache, it is essential that you are as gentle and nurturing as possible.

    If your child is suffering from a toothache, plain warm water (never hot or cold) with a teaspoon of table salt can help relieve the tenderness. They should rinse their mouth out with salty water whenever they feel pain. A cold pack against the cheek may also reduce painful twinges. However, if over-the-counter pain relievers are ineffective and the ache fails to subside within 24-36 hours, you should bring your child to see a dentist.

    Unfortunately, temporary remedies will only provide a stop-gap solution for the pain, and a trip to the dentist will be necessary. If your child has a cracked or chipped tooth, a cap or filling may be necessary, especially if it’s a permanent tooth. A children’s dentist will be able to do this for you. If an emerging tooth is found to be pushing against an existing tooth, some may have to be removed.

    Depending on how excruciating the pain is, a toothache may be a symptom of any of the following dental problems:

    • Emerging teeth
    • Chipped teeth/cracked enamel
    • Loose and/or missing fillings
    • Tooth erosion and/or decay
    • Food inadvertently stuck between the teeth can gradually become more painful. The wedging force that pushes teeth away from one another irritates the roots as well as the gumline
    Question : Are there changes I should make to my diet?

    There is no need to increase caloric intake until the final trimester. Pregnant women are recommended to take around 2000 calories daily and increase to around 2200 calories in the third trimester. So it’s untrue about the myth that pregnant moms must eat for two!

    There are certain food or beverages that should be avoided during pregnancy. Raw or uncooked meat, poultry and fishes are big no-no’s. Unpasteurized milk and cheeses made of such milk should be avoided too. As ginsengs cause thinning of blood if taken in large amount for prolonged period of time, expectant mothers are advised to stay away from ginsengs during pregnancy. As we all know too, alcohol is to be avoided and caffeine intake (ie. tea or coffee) should also be kept to the minimum.

    Question : How much weight should I expect to gain during my pregnancy?

    Overall, an average pregnant mother is expected to gain on average about 12.5kg throughout the pregnancy.

    In view of morning sickness and food aversions during the first trimester, most expectant mothers may lose or just gain minimal weights during this period.

    As for the second and third trimester, mothers with normal BMI [18.5 – 24.9] are expected to gain around 0.5kg per week. Therefore, I usually expect mothers to gain around 2-3kg during our monthly visits in the second trimester and around 1-1.5kg during our fortnightly antenatal visits in the final trimester.

    Question : Do you recommend any prenatal classes?

    Yes I strongly recommend expectant couples (especially the first timers) to sign up to Prenatal

    Classes. Most classes are conducted online nowadays during this pandemic.

    Prenatal classes cover mainly the pregnancy and labour processes, early neonatal care and breastfeeding educations. Some classes may add in sessions on prenatal exercises and postnatal care educations.

    I personally conduct Prenatal Classes from time to time. Do subscribe to my Facebook page

    http://www.facebook.com/nicholaslimobgyn for the latest classes & info pertaining to pregnancy & delivery.

    Question : Baby Bottle Tooth Decay

    Baby bottle tooth decay, also called early childhood caries (ECC), is the deterioration of a young child’s tooth enamel due to prolonged or excessive exposure to sugar or sweetened liquids.These liquids can include milk, formula, juice, sodas, or any other sweetened liquid. The sugars in these drinks will pool around the teeth and gums, feeding the bacteria that causes dental plaque. Bacteria naturally present in the mouth break down these sugars, producing acid which attacks the teeth. Over time, the enamel becomes damaged and the teeth become decayed.

    Question : Preventing Baby Bottle Tooth Decay

    The most important thing to remember is to never allow your baby or child to fall asleep with a bottle that contains a sugary liquid (that includes milk!) You should also be cleaning the gums or teeth twice a day to prevent plaque from building up throughout the day.

    You can begin cleaning your child’s mouth before teeth even begin to emerge by rubbing a clean cloth against the gums. This will keep the gums clean, and will also help ease the pain in a teething baby. When brushing a child’s teeth, use a soft bristled toothbrush. Lastly, make sure to bring your child into Discovery Kids Pediatric Dentistry for a dental cleaning and exam at least every 6 months, beginning before your child’s first birthday.

    If you believe your baby is at risk for baby bottle tooth decay, please don’t hesitate to contact our pediatric dental office! Find a pediatric dentist near me. We can make sure your child’s teeth are healthy and address any potential issues.

    Question : Pacifier Use Thumb Sucking

    Infants are born with a natural sucking reflex. This reflex soothes, comforts and relaxes them. While pacifier use and thumb sucking habits can be adorable at an early age, and can even help make your child happy and calm, they can cause dental issues if the habits last past the eruption of the permanent teeth.

    Question : What Problems Can Thumb Sucking And Pacifiers Cause?

    Thumb sucking and pacifier use can cause numerous problems, both the aesthetics of your child’s smile and its ability to function normally. Below are a few of the problems caused by thumb sucking and pacifier use:

    An open bite – An open bite will prevent your child’s teeth from coming together when they close their mouth. This will cause problems biting, chewing, and speaking.

    A narrowed palate – The palate is the roof of the mouth. Because a child’s mouth is so pliable, their palate may conform to the shape of the thumb or the pacifier, causing the arch of the mouth to be too high and narrow. You may even see a crossbite.

    Misalignment of the jaw – If the thumb sucking is forceful enough, the jaws may shift out of alignment.

    Question : How To Help Your Child Kick The Habit

    Many children will ditch the pacifier or stop sucking their thumb on their own before they begin school. However, if the habits persist, you may need to intervene. Learn more about ways you can do to help your child kick the habit of Pacifier Use and Thumb Sucking.

    Question : I am in my second trimester. Is it normal to pee when I sneeze or laugh?

    On the contrary, urinary incontinence in pregnancy is more common in the first and third trimester as compared to the second trimester. This is because during the first trimester, the enlarging womb is located right next to the urinary bladder, thus compressing and exerting pressure on it.

    As for the late third trimester, urinary incontinence can occur after the engagement of the baby’s head (baby’s head dropping) into the pelvic cavity. This is due to the fact that the baby’s head is again compressing against the urinary bladder in the pelvic cavity. All these are more common whenever the mother exerts pressure or strains whenever she sneezes or laughs.

    Urinary incontinence can also occur when there is urinary tract infection (UTI). So it is common for the doctor to examine her urine for infection whenever a mother presents with urinary incontinence during pregnancy.

    Weakening of the pelvic floor muscles due to pelvic floor muscle damage from traumatic childbirths or prolonged squatting will also lead to urinary incontinence.

    Question : When do I need to stop using birth control if I’m trying to get pregnant?

    With the exception of the injectable contraception (birth control), most women regain

    their fertility in seven days after the discontinuation of their birth controls such as the oral contraceptive pills, skin patches, intrauterine contraceptive device (IUCD) or implants.

    Women on the injectable birth control may have their fertility delayed up to 3 to 6 months after their last injections. With prolonged use, some women may take up to 8 to 10 months to get pregnant. Therefore, women needing birth control for a short period of time are not recommended to use the injectable birth control.

    Birth control methods like condoms, diaphragms, cervical caps, pull-out (withdrawal) and natural rhythm methods does not affect a women’s fertility.

    Question : Why is children dental health important?

    Baby teeth helps children chew, speak and smile. They also play an important role in holding space in the jaw for proper emergence of adult teeth. If milk teeth are shed too early, there adult ones are likely to drift, causing crooked teeth. There are vital statistics to prove that children suffering from tooth decay are three times more likely to miss school.

    As it’s regarded as one of the most chronic illness in children, tooth decay can seriously affect a child’s eating habits, speaking and learning abilities. This subsequently leads to poor nutrition, poor academic performance, loss of confidence and poor social development. The effects of this can extend well beyond their childhood.

    It’s critical to get it right when a child begins his / her dental care journey. Be careful not to induce elements of fear. This is crucial to enable parents to cultivate their children’s voluntary dental health habits which leads to a healthy and happy journey to adulthood. The importance of good dentition for children should never be underestimated.

    It helps improve a child’s speech ability which positively impacts their academic performances. A smile filled with a healthy set of teeth is equally important for a child’s self-esteem, especially in school and public places. As such, beyond just dental care, it’s critical to build confidence in kids and refine their personalities.

    Question : When is the right age for children to visit a dentist?

    It is an incorrect idea that the baby teeth should be allowed to decay and drop off to make way for the growth of adult teeth. Every child has to be checked by a dentist by the time the first baby tooth is up, followed by a visit once every six months.

    Question : What causes crooked teeth?

    Majority of children now have crooked teeth, which is evident from five years of age. Hereditary factors or big teeth in small jaws are not responsible for crowded teeth or incorrect jaw development. The real culprits are mouth breathing, tongue thrusting, reverse swallowing and thumb sucking, which are known as incorrect myofunctional habits.

    Allergies, asthma and open mouth posture compound the issue and most children have at least one of these myofunctional problems contributing to incorrect dental and facial development.

    If the tongue and lips are not functioning correctly, crowded teeth and underdeveloped jaws are the result. These are called incorrect myofunctional habits. If function and jaw shape are correct, there is plenty of room for the teeth.

    As a child’s face grows forward and downwards, the jaws are influenced and reshaped by facial muscles.

    If these muscles are functioning correctly, the tongue is in the proper position and the mouth is predominantly closed, a child has the ability to reach their full genetic potential with enough room for the front and back teeth to fit into their correct position.

    Video illustration: https://youtu.be/xRIq6VwbSI4

    Question : Is Crooked Teeth Preventable?

    YES, by addressing the incorrect myofunctional habits via MYOFUNCTIONAL THERAPY.

    Myofunctional Therapy involves using a series of removable pre-orthodontic appliances that are worn for 1-2 hours each day plus overnight while sleeping. It focuses on correcting the underlying causes of crooked teeth, often without the need for braces or extraction of teeth, unlocking natural growth and development. Treatment is best suited to children aged 3 to 15.

     

    Myofunctional therapy evidence based treatment video

    https://www.youtube.com/watch?v=dWveo-p0cOM

     

    myofunctional therapy promotional video

    https://www.youtube.com/watch?v=k0FMxRx4Tls

    Question : I know that COVID-19 infection is dangerous but how dangerous is it to a pregnant woman?

    The immunity status of pregnant women is compromised and their lung functions are reduced, especially in the 3rd trimester. The current practice is for pregnant mothers with COVID-19 infection be admitted to a medical facility for closer monitoring as the risks for ICU admission, mechanical ventilation and death is higher for pregnant women. The infection also increases the risk of blood clot formation in pregnant women. COVID-19 infection also increases the risk of premature delivery and the current recommended mode of delivery for women with COVID-19 infection is via Caesarea section.

    Question : I’m currently pregnant and in my second trimester. I’ve been hearing the Ministry of Health advocating double-masking to the public. How is it done and would it affect my baby?

    Double-masking has been practiced for a while now and recent study by CDC in the US have shown that it reduces the risks of transmission of the COVID-19 infection. The studies showed that a cloth mask blocks off about 51.4% of the wearer’s exposure to COVID-19 whereas a surgical mask has a reduction rate of 56.1%. With double-masking (surgical mask inside and cloth mask outside), it blocks off about 85.4% of exposure. Be mindful that the surgical mask is meant as a single-use entity and should not be recycled. The cloth mask should be changed and washed on a daily basis.

    Question : I’ve just found out that I’m pregnant and I’ve heard that COVID-19 infection is extremely dangerous to pregnant mothers. Can I get myself vaccinated as soon as possible?

    Getting yourself vaccinated and protected against COVID-19 infection is extremely pertinent at this stage. Pregnant mothers can be vaccinated between 14 weeks to 33 weeks + 6 days of pregnancy. Since 25th June 2021, the JKJAV & MOH have approved the safe usage of all three available vaccines in Malaysia (Pfizer-BioNTech, AstraZeneca & Sinovac) in pregnant & breastfeeding mothers. The first Covid-19 vaccine was administered to a pregnant mother on 26th June 2021. Ever since then, thousands of expectant mothers in Malaysia had received their vaccines with no severe adverse effects reported.

    Question : Should we use minyak angin or balms on children?

    Parents from different races had the tendency to use balms, ‘minyak angin’ or ‘风油’ routinely on their new born babies, be it either Malay, Chinese or Iban. Indian parents who use ‘minyak angin’ are relatively less. As we are of Asian background, this is not surprising and this is a very common practice amongst parents. Parents thought this can reduced the ‘gas’, ‘wind’ or ‘angin’ in the tummy which can make the baby more comfortable, tummy less bloated, less cry, less pain, breath better etc. In fact, this is a common belief among the community. The oil will be applied on the baby’s tummy, chest, feet, hands, scalp or even nose. Balms or ‘minyak angin’ is also being used when a child is bitten by insects especially mosquitoes. The content of the oil consists of camphor and menthol. Camphor is extracted from the wood of the camphor tree. It has a strong odour and taste which can be easily recognised, and will create heat and subsequently cooling sensation. Hence, this will create a mild pain-killing effect at the nerve endings of the skin.

    Minyak angin’ should not be used in babies less than 2 years old, unless proven safety otherwise.

    • Because most of the product contains camphor, in Malay ‘kapur barus’ and menthol.
    • It is easily absorbed through the skin and into blood circulation easily.
    • It can cause haemolysis or breakage of red blood cells in a new born baby especially G6PD deficient baby, and baby will get jaundice (yellowish discolouration) and pale.
    • It can cause seizures, severe nausea and vomiting if overdose and is toxic to the neurological system.
    • Camphor also potentially can cause liver damage or injury.
    • Risk of allergic reaction and skin irritation caused by ‘minyak angin’ to the fragile skin of the baby either due to camphor and menthol had been well documented.
    • Risk of accidental ingestion of the oil by baby which happened on and off and babies were admitted to hospital for observation of side effects of the ‘minyak angin’.
    • A study on the effect on the camphor and menthol on animal suggested that these contents may induce secretion in the airway which may lead to blockage or airway