Dental Tribune Pakistan Edition No.1, 2016

Editor - Online Haseeb Uddin 14 DENTAL TRIBUNE Pakistan Edition January 2016 Raheel Sharif awarded honorary fellowship of CPSP Continued from front page in the country, his remarkable achievements against terrorism and for modernizing the health care system in Pakistan Army. AEEDC Dubai - A Global platform for the Dental World Continued from front page Four/Six Handed Dentistry, Hypnodontics, Infection Control, Laser Dentistry, Microscopic Dentistry, Oral and Maxillofacial Surgery, Oral Implantology, Oral/Medical Photography, Oral Pathology, Oral Medicine, Orthodontics, Pediatric D e n t i s t r y, P e r i o d o n t o l o g y, Prosthodontics, Restorative Dentistry and Robotic in Dentistry. AEEDC Dubai 2016 exhibition is the gateway to the emerging and far-reaching dental market in the MENASA region and all the movers and shakers of the region will be there. Coronary heart disease patients with no teeth.... Continued from page 12 continued Vedin. “Around 16 percent of patients had no teeth and roughly 40 percent were missing half of their teeth.” During the study period, 746 patients had a myocardial infarction. There was a numerically increased risk of myocardial infarction for every increase in tooth loss, but this was not significant after adjustment for risk factors and socioeconomic status. Vedin said, “We found no association between number of teeth and risk of myocardial infarction. This was puzzling (because) we had robust associations with other cardiovascular outcomes, including stroke.” Tooth loss could identify patients who need more prevention efforts Gum disease is one of the most common causes of tooth loss. The inflammation from gum disease is thought to trigger the atherosclerotic process and may explain the associations observed in the study. Poor dental hygiene is one of the strongest risk factors for gum disease. “This was an observational study so we cannot conclude that gum disease directly causes adverse events in heart patients,” Vedin said. “But tooth loss could be an easy and inexpensive way to identify patients at higher risk who need more intense prevention efforts. While we can’t yet advise patients to look after their teeth to lower their cardiovascular risk, the positive effects of brushing and flossing are well established. The potential for additional positive effects on cardiovascular health would be a bonus.” Reassessing risk factors for periodontal disease Continued from page 12 to suffer amputation or death due to peripheral vascular disease. Clearly, not only will control of diabetes facilitate management of periodontitis, but also, probably more importantly, effective management of periodontitis is likely to have major beneficial effects on the serious sequelae of diabetes. Unfortunately, the medical profession is largely ignorant of the potential benefits of establishing and maintaining periodontal health. The publication Type 1 Diabetes in Adults: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care (updated in July 2014) was compiled by a consensus reference group made up of 30 members.[4] These included physicians, endocrinologists, nurses, ophthalmologists, dieticians, podiatrists and lay people, but no dentists. Its 153 pages make no mention of dentistry or periodontal disease. The National Institute for Health and Care Excellence document on Type 2 diabetes, also updated in 2014, too fails to mention dentistry or periodontal disease. Smoking We have known for over 20 years that smoking increases the risk of periodontal breakdown. Odds ratios for developing periodontal disease as a result of smoking constitute a range: 2.5,[5] 3.97 for current smokers and 1.68 for former smokers,[6] and 3.25 for light smokers to 7.28 for heavy smokers.[7] A smoker with 20 pack years (20 cigarettes per day for 20 years) is up to 600% more likely to lose teeth owing to periodontal disease, whereas a patient with poor plaque control has around a 15% risk of progressing to destructive periodontitis. Why then do we refer to hygiene phase therapy when smoking is a much greater risk factor than poor oral hygiene? How many dentists spend as much time on smoking cessation counselling as on oral hygiene instruction? Sugar Traditionally, teaching on caries prevention has focused on the number of sugar exposures per day, especially between meals. Academic paedodontists suggest that provided there are two daily exposures to fluoride in toothpaste, a maximum of six sugar exposures a day is unlikely to lead to significant enamel decalcification in children. However, a large study conducted in 2015 by Bernabé et al. evaluated 1,702 adults over 11 years and concluded that “the amount of, but not the frequency of, sugars intake was significantly associated with DMFT [decayed, missing and filled teeth] throughout the follow-up period”.[8] It thus appears that, at least in adults, “how much” is more important than “how often” with regard to sugar consumption. This is all the more significant since DMFT measures real outcomes over significant time spans, while many studies on both caries and gingivitis are very short term and use surrogate outcomes, such as decalcification on an enamel sample, or plaque and gingivitis indices as the basis of their conclusions. Patients are only really interested in real outcomes. Obesity The third National Health and Nutrition Examination Survey showed that body mass index was significantly associated with periodontal disease. Other studies have indicated a less strong association, and with the compounding variable of blood sugar levels in prediabetics, it is presently unclear whether obesity is in fact an independent risk factor or is associated with the established role of diabetes. Regardless, obesity is a known risk factor for Type 2 diabetes and cardiovascular problems, and it is part of the dental professional’s role to inform patients of these interrelationships. Recent research in England has suggested that 1.4 million obese patients would benefit from gastric band or bypass (bariatric) surgery. Currently, around 8,000 people a year receive the treatment on the National Health Service (NHS). If all 1.4 million were offered surgery, the researchers estimate it would avert nearly 5,000 heart attacks and 40,000 cases of Type 2 diabetes over four years. They do not, however, discuss potential costs of this surgery, which can vary from £3,000 to £11,505, according to NHS England. Assuming £5,000 per procedure, this would total around an additional £7 billion in health costs. Nor is there much discussion on death rates (0.5–1% with the present skill level of surgeons). Even if surgical skills do not diminish, we should anticipate between 7,000 and 14,000 additional deaths. It is likely that comprehensive periodontal treatment of all obese/prediabetic patients would be significantly less costly and, hopefully, result in few if any fatalities. Conclusion It is clear that the simple story of plaque control preventing progression of common dental diseases is largely fiction rather than evidence-based fact. While effective oral hygiene will always be a significant part of the management of dental diseases, the modern dental professional must be equally aware of the other common risk factors outlined in this article. Dr Irfan appointed Examiner by RCS Edinburgh ARACHI- Dr Irfan Qureshi, one of the most renowned Implantologsists of the country was recently appointed examiner for Implant Dentistry by the Royal College of Surgeons, Edinburgh for a period of 5 years. Implantology is a rapidly growing field and is one of the most popular and cutting edge treatment option for tooth replacement. There are other examiners from Pakistan appointed by Royal College of Surgeons in the past but Dr Qureshi`s achievement is unique because he is the first and the only examiner appointed for Implant Dentistry by the Royal College of Surgeons, Diploma Implant Dentistry and a prized exam and the most expensive dental exam conducted by the college. In 2013 Dr Irfan Qureshi became the first and so far the only Pakistan based dentist to earn the Diploma Implant Dentistry from Royal College of Surgeons Edinburgh. He recently completed the necessary paperwork and underwent examiners training at The Royal College of Surgeons Edinburgh. The college is known as one of the best in the world for examination and assessment. Dr Irfan continues to strive hard in his efforts to excel. K International Symposium at Seoul, South Korea ARACHI- Dr. Abubakar Sheikh associate professor and Head of Department of endodontic at Fatima Jinnah Dental College recently attended the world Neobiotech International symposium at Seoul, South Korea from Pakistan to present at the Core members meeting of the Global Academy of Osseointegration. Dr. Abubakar Sheikh a fellow of the College of Physcians and Surgeons of Pakistan is a practicing implantologist both at the institute and his private practice for a number of years. His presentation and cases were highly appreciated by all the participants and as a result he was also inducted as a member of the GAO core group which will enable him to work and share knowledge and skills with the experts in implantology from all over the world and to present internationally in future also. K

Dental Tribune Pakistan Edition No.1, 2016

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