PUBLISHED IN PAKISTAN www.dental-tribune.com.pk MARCH, 2020 - Issue No. 02 Vol.7 An exclusive interview with Dr Ambrina Qureshi Dentine hypersensitivity experience using ... Coronavirus guidelines for dental practitioners ... INTERVIEW Page 4 CLINICAL PRACTICE Page 6 NEWS Page 10 COVID-19: Pakistans dental fraternity and industry face unprecedented challenges By H. Hasan T he recent escalation of the COVID-19 situation has definitely affected every domain of human life. The sudden surge has raised fears that the outbreak could pose a major challenge to an already strained n a t i o n a l h e a l t h c a r e s y s t e m . According to recent statistics reported by the New York Times, dentists are at the greatest risk, as they can encounter diseases and infections daily and typically work in close proximity to one another and their patients. In a matter of days, Pakistan's own COVID-19 tally has soared past 1 , 2 0 0 c a s e s , m i r r o r i n g t h e exponential growth in new infections seen in Italy. The worsening situation has prompted all four of the country's provinces as well as Azad Jammu & Kashmir and Gilgit-Baltistan to impose considerably strict lockdown measures. While some in the country, p a r t i c u l a r l y i n t h e f e d e r a l government, have criticised the provinces' preventive steps as premature and overkill, official data on healthcare and quarantine facilities and conversations with members of the medical fraternity reveal why Pakistan can ill afford to repeat Italy's mistakes. With such situation in backdrop, the question arises whether the dental community is ready to face this pandemic. Many dentists have proactively limited their practice to emergency procedures only. Though this step was taken purely on voluntary basis, but no proper guidelines have been circulated by Pakistan's Dental Authorities. According to the Centers for Disease Control and Prevention, it Photo: DT Pakistan is advised to limit patient inflow and take proper measures. The patient's history should be taken thoroughly, including travel history. Make sure that the patient is not accompanied with attendants, if possible. After every procedure hand-piece should be replaced, the chair, trays and area in 1-feet radius should be disinfected. A gap of at least an hour between each procedure. "We are potentially looking at a total disaster if we fail to take precautions now," warned Dr Tahir Shamsi, who heads the National Institute of Blood Diseases. "Our healthcare system is already in shambles, struggling to handle routine workload much less COVID-19 patients." The dental practice may change altogether once this virus is gone "If we don't take steps to contain it now, we may end up seeing patients lying in our corridors, streets and footpaths," he said. "More than 170 COVID-19 patients fighting for each intensive care unit bed. Not to mention those suffering from other diseases will be deprived too," Dr Shamsi added. With 132,227 beds and 7,697 health facilities across Pakistan the challenges are huge. Sindh has the highest number of health facilities with 3,525 HCEs and many field hospitals are underway to fight the menace. Experts recommend to make sure that only non-invasive procedures are carried out. Emergency and pain relief to be the only focus. Use of hand-pieces be discontinued for the time being. The waiting area should be ventilated properly and encourage time difference between appointments so that there are least number of patients waiting. It is advised that dental community take proper measures to keep themselves safe by wearing masks, gloves and clean clothes. Those having industrial set-up, should put workers on rotational basis and educate them on social distancing. Non-essential staff should be allowed to work from home. [ ] it is time that dental industry prepares itself for the unprecedented challenges once this is over Liaqat Humayun, President of the Dental Trade and Manufacturers Association Due to certain external factors, the prices of protective face masks have been escalated. The stakeholders should ensure the provision of these protective gears to their staff. Pakistan's renowned dentist Prof. Ayyaz Ali Khan says that it is time to only do the emergency procedures while Prof Mahmood Haider recommends consultation and pain Continued on Page 11 PDA: PMDC should work independetly DT Pakistan Report K ARACHI - The Pakistan D e n t a l A s s o c i a t i o n ( P D A ) t h e h a i l e d restoration of t h e P a k i s t a n M e d i c a l a n d Dental Council (PMDC) and its employees on the orders of the Islamabad High Court (IHC). T h i s w a s s t a t e d b y Dr Mahmood Shah, President of the PDA. "It is heartening to note that the Pakistan Medical and Dental Council has been restored by the IHC," noted the PDA. The PDA and its office bearers demanded that the PMDC be made fully functional so that it can carry out its duties and obligations to medical and dental professionals. Owing to the dissolution of the PMDC, doctors, and dentists faced tremendous problems in regards to their pending work and day-to-day requirements. This action of the government had put Pakistani doctors working overseas in a lot of trouble as the PMDC is the only recognized body, and nobody recognized the PMC. Doctors looking for good standing certificates had to run from pillar to post, but their work could not be done. Those awaiting registration were also made to wait indefinitely. It is high time that the government lets the PMDC work independently and bring an end to the sufferings of healthcare professionals. The PMDC should also start planning transparent elections once this COVID-19 pandemic is over. Wi t h t h e i n v o l v e m e n t o f representative bodies like the PMA and the PDA for the PMDC elections of doctors and dentists.
4 DENTAL TRIBUNE Pakistan Edition March 2020 INTERVIEW The culture of critical thinking is lacking in our country; Dr Ambrina Qureshi By Dr Muattar Hanif Dental Tribune Pakistan: Tell us a little about your background, especially what made you chose dentistry as your profession? Ambrina Qureshi: I did not choose dentistry initially. My passion was always towards philosophy and arts and subjects like that. But it's a familial trend where our ladies in the family are doctors and the gentlemen are the lawyers. So initially I opted Arts. I was already doing my Bachelors in Arts at St. Joseph College and I [already] had chosen subjects like Philosophy, European History and English literature. It took one year for my mother to really convince me and bring [me] back to the track where the family was going on so. And that is how I came into the dentistry. We should start spreading awareness to the rural populations through tele-dentistry DTP: How do you think the raging oral cancer problem can be addressed? AQ: I always say that all these things like awareness, prevention, promotion and education these all should be integrated in your [dental] curriculum. And it is our undergraduate students who during their training period can actually take care of such things and can spread the awareness. They can help us address these issues by finding out the updated statistics and finding out the ways how to promote prevention of such debilitating conditions. DTP: How can we increase awareness regarding gutka or other tobacco-related products? AQ: My answer is same. The awareness or the address of the issues these all should be made integral part of the undergraduate curriculum. The undergraduate students during their training, should learn how to identify the oral conditions, even the general conditions, which are linked to the oral or poor conditions and they should address it. They should be finding out ways how to prevent it. They should be finding out ways how to educate the masses about the poor effects of the risk factors which are associated with these conditions. New generation of the females should learn how to negotiate with the things DTP: What steps can be taken to address the issues of people in rural areas? AQ: You see, technology is growing fast. And I think we should understand that the use of technology has entered even in the rural areas, like every person has a mobile phone these days. So why not start introducing tele- dentistry. You know, start spreading awareness to the rural populations through teledentistry or even like integrating this teledentistry into your curriculum. Again, I think these are the things which are the need of the hour and this is how we can address these issues and this is how we can solve these issues, to some extent. DTP: How can we motivate dental professionals to give back to their community? AQ: I think it's very difficult to motivate dental professionals, especially the new graduates. Everyone has spent money on their education and they would not like to go to the rural areas. This is a very frank answer that I am giving! The only solution which I can think of, at this point is again, integration. Get your students to identify these problems during their training period. They can help us identify these problems and spread awareness. You cannot ask or you cannot motivate the new graduates to go back to the rural communities or in their own communities because everyone wants to go up. If a person has started from Karachi, maybe, they would like to go to U.S. or UK rather than going back to Karachi or even if the person is coming from a rural area, he would not like to go [back] there. Because he has, again spent money on his or her education. So let these things, which we know that are the current problems, into your curriculum. Get your curriculums be reformed. So that while we are educating our dentists, they are also supposed to solve the problems of our community. This should go side by side. Awareness, prevention, promotion and education- these all should be integrated in dental curriculum DTP: How can public sectors help in oral health issues? AQ: See, public health issues today are not the [first] priority, to be very sorry. The kind of standards or the regulations we have, whether it's the Public Sector College or a Private Sector Institute All of them just want to follow those 'particular' regulatory standards. When all are just going to focus on meeting those standards, which have been imposed on them, then why would someone care about the public? [Who will care] regarding, what is happening in the public or like what the public is suffering from? I think the Public Sector would have played a very important role in prevention, in public health promotion, in awareness, in education in such basic things. But somehow the Public Sector has also started competing with those standards. Now people are more focused on, you know, forensic odontology and implantology, such big difficult words are these! and you know on specialty based dentistry. We all have forgotten Continued on Page 11 D r Ambrina is the Chairperson of Community & Preventive Dentistry at Dow University of Health Sciences (DUHS). She is also the member of the Syndicate of DUHS. Prof. Dr. Ambrina Qureshi graduated from Fatima Jinnah Dental College (FJDC), Karachi. Following her graduation, she joined Liaquat University of Medical & Health Sciences as a Lecturer in Community Dentistry. Dr Ambrina then went on to pursue Master's in Philosophy (MPhil) Community Dentistry from Shaikh Zayed Federal Postgraduate Medical Institute, Lahore. To update her thirst for knowledge, Dr Ambrina is currently pursuing PhD (Doctor of Philosophy) Community Dentistry. Currently she is working on a research project which is a three arm diabetes-periodontitis trial funded by the National Research Programs for University (NRPU) Higher Education Commission. Recently she sat down with Dental Tribune Pakistan to talk about her journey. RAPID FIRE . Does the duration of brushing really make difference to your teeth? AQ: I think twice. . Which technique can make brushing really effective? AQ: Yes, it's the sweep method that is more important. Sweep the brush through like [the bristles are] between your teeth. Let the bristles slowly swipe away the plaque and everything. That is the best method. . How to counter bad breathe? AQ: You need to look into the underlying cause. Most of the time it's the underlying systemic disease that is usually the cause of the bad breathe. You need to look into that. . Babies do not need brushing, is it true? AQ: No it's not true. Absolutely not. Babies do need to brush their teeth and it's the responsibility of their parents to do that. . Brushing should be done only after taking a meal, true? AQ: Ideally it's good. But even if you skip brushing at least cleanse your mouth. . White teeth are healthy teeth, really? AQ: White teeth are healthy teeth if they are naturally white. Not if you've colored it white [artificially]!
6 DENTAL TRIBUNE Pakistan Edition March 2020 CLINICAL PRACTICE Dentine hypersensitivity experience using toothpaste with added bioglass: A clinical trial By Drs Stefano Daniele&Andrea Alessandri, Italy I n our clinical practices, dentine hypersensitivity (DH) has always been a challenge. Our best approach was to suggest at-home solutions such as sensitivity toothpaste or mouthrinse, but often there was no significant relief experienced by our patients. Last year, we met Richard Whatley, CEO of BioMin Technologies, who gave us some samples of BioMin F toothpaste for provision of relief from DH, and he explained the technology behind the effectiveness of this novel bioactive glass-based toothpaste. The bioglass particles contained in BioMin F toothpaste adhere to dental hard tissue and then slowly dissolve in saliva to release calcium, phosphate and fluoride ions, which precipitate on nucleation sites as fluorapatite crystals to occlude open dentinal tubules. A c c o r d i n g t o B r ä n n s t r ö m s h y d r o d y n a m i c t h e o r y, f l u i d movement inside the dentinal tubules in response to evocative stimuli such as coldfirst of allbut also hot and sweet food and beverages, stimulating the odontoblast fibres and nerve endings and thereby creating a brief and acute pain, like an electric shock. This is what patients refer to as pain from DH. A special polymer in BioMin F toothpaste is able to chemically bond the calcium from the bioglass to the hydroxyapatite of enamel. This adhesion is similar to that of glass ionomer cement to tooth surfaces. Saliva slowly dissolves these bioglass particles. This enables the release of ions from bioglass particles over 812 hours after brushing to create new crystals of fluorapatite, which form on nucleation sites like peritubular dentine and the internal surfaces of dentinal tubules. The formation and development of these fluorapatite crystals closes exposed dentinal tubules and provides relief from the pain of DH. It is important to note that the fluoride concentration in BioMin F toothpaste is much lower than that of other DH or caries prevention toothpastes, which often utilise several thousand parts per million of fluoride (from 1,000 to almost 5,000 ppm in some countries). BioMin F has a fluoride concentration of only 530 ppm, and this concentration is sufficient to promote the formation of fluorapatite crystals on the tooth surfaces. Soluble-fluoride toothpastes Fig. 1: Small areas of cervical loss of enamel, resulting in exposure of dentine to evocative stimuli, in particular cold and air, and thus Fig. 2: Large areas of cervical loss of enamel due to powerful phenomena of abrasion and erosion of enamel and high dentine dentine hypersensitivity pain. hypersensitivity pain. Fig. 3: Percentage of patients included in the clinical trial who reported dentine hypersensitivity pain to the dentist on consuming hot, cold or acidic foodstuffs or brushing their teeth. Fig. 4: Of the patients in the trial, 48.27% reported prior use of sensitivity toothpaste. Fig. 5: Of the patients treated with BioMin F, 27.58% had no further dentine hypersensitivity pain and 52.72% reported a reduction. Fig. 6: Of the patients in the trial, 73.07% reported that BioMin F toothpaste is more effective than other sensitivity toothpastes in reducing dentine hypersensitivity pain. Fig. 7: Patients evaluation questionnaire in which she reported vomiting bouts during BioMin F treatment, but a complete absence of dentine hypersensitivity (score of 9) despite this severe acidic challenge. (typically including sodium fluoride or sodium monofluorophosphate) require a high concentration of fluoride because most of the available fluoride is washed away by the salivary flow, but at such high concentrations, it forms amorphous crystalline calcium fluorite on dental hard tissue and not fluorapatite mineral. It is very important to start remineralisation on initial carious lesions such Codes 1 and 2 on the International Caries Detection and Assessment System. A scientific paper on caries research published in 2013 by Hill et al. shows that only a fluoride concentration of below 45 ppm is effective in promoting remineralisation when combined with calcium and phosphate to form fluorapatite crystals. It is in its crystalline phase that it is able to exchange ions in the oral environment ( e q u i l i b r i u m b e t w e e n r e m i n e r a l i s a t i o n a n d demineralisation). The crystalline phase of fluorapatite developed by bioglass has enhanced acid-resistant features too. Most concentrated-fluoride dental products, such as toothpaste and varnishes, might be able to form an amorphous crystalline phase on enamel, but that is not remineralisation, as mentioned, but calcium fluorite. Calcium fluorite is not acid-resistant like fluorapatite crystals, but resistance to acid is a v e r y i m p o r t a n t f e a t u r e f o r overcoming the DH challenge. In fact, an amorphous and not acid- resistant layer is prone to dissolving in contact with erosive beverages or foodstuffs, thereby restarting DH pain owing to the re-exposure of dentinal tubules. Clinical trial with BioMin F for dentine hypersensitivity We started the trial in November 2018 and included only patients with pronounced DH of a grade of moderate to severe. In July 2019, we collected the last recall from this trial. For the trial, every participant was given a sample of BioMin F and instructed to use the toothpaste twice a day for two weeks before recall. At recall, the evaluation sheet given to the participants contained some general questions, covering their experience of the flavour of the toothpaste, its texture and its foaming capabilities, for example, as well as some specific questions, such as concerning their prior use of other toothpastes for DH. In particular, the questionnaire asked the patients to grade the scale of relief from DH using BioMin F on a scale of 0 to 10. We considered that an average score Continued on Page 10
8 DENTAL TRIBUNE Pakistan Edition March 2020 NEWS Endodontics workshop focuses on usage of dental operating microscope R AWALPINDI - A workshop on dental operating microscope (DOM) and its use in root canal treatment was recently conducted by the Department of Operative Dentistry, Margalla Institute of Health Sciences (MIHS). The event was chaired by Dr Amjad Mahmood Principal MIHS. Renowned endodontist Dr. Taemoor Iqbal was invited as keynote speaker of the event. The aim of the workshop was to highlight the concepts of use of magnification in endodontics. Photos: DT Pakistan The session was facilitated by Dr. Ayesha Naveed, Head of Medical Education Department, MIHS and Dr. Lubna Pasha, Head of Department of Operative Dentistry MIHS. The session was attended by faculty, house surgeons and students from different college. Dr. Taemoor emphasized on importance of magnification and use of DOM in endodontics. He told that the enhanced vision with magnification and illumination from a microscope could enable endodontists to explore new endodontic horizons. The lecture was followed by a live demonstration on patient by the speaker, introducing the participants on the use of DOM. Later on participants were given a chance to work under the microscope. The participants actively participated throughout the whole session and explored a new domain of endodontic dentistry. Later Dr.Amjad Mehmood and Dr.Taemoor Iqbal distributed the certificates to the participants and the organizers. Efforts of organizers were appreciated for their hard work and more such events were promised in the future. -PR Dr Jamal headlines infection prevention and control in dentistry K ARACHI - A one-day interactive session and hands on workshop on 'Infection Prevention and Control in Dentistry' was recently conducted as part of first specialized course. The session was headed by Dr Jamal Syed, Director, Center of Dental Education Photo: DT Pakistan and Medical (CODE-M). The workshop was conducted by Dr Adil Bin Irfan, Faculty and Head of Safety, Altamash Institute of Dental Medicine. The workshop demonstrated all aspects of the Infection Prevention and Control in Dentistry protocols for dental auxiliaries and dentists. The course also gave knowledge on different levels of precautionary measures based on the risk levels a patient brings to any establishments. It also highlighted ways to act efficiently and economically according to the various types of patients that dental health care professionals can encounter. The burning issue of the coronavirus was also one of the topics Continued on Page 11 Dental experts deliver lectures on maxillofacial trauma cases J AMSHORO - A one-day maxillofacial trauma seminar was held recently held at Liaquat University of Medical & Health Sciences (LUMHS), Jamshoro. The seminar was organized by Department of Oral and Maxillofacial Surgery LUMHS with the collaboration of Pakistan Association of Oral Haider, Prof Noor Ul Wahab, Prof Adnan Aslam, Prof Muhammad Waseem Ibrahim, Prof Zahid Ali, Dr. Muhammad Shahzad, Dr. Suneel Kumar, Dr. Kashif Ali Channar, Dr Shaheen Ahmed and Dr Salman Shafique. Prof Amir El Barbari from Egypt and Dr. Manuel Blanco-Guzman from United Kingdom shared their and symphysis fractures, surgical approaches for mandibular fracture, load bearing and load shearing osteo-synthesis, frontal sinus injuries and its current management, orbital trauma and its management, challenges o f p a n - f a c i a l t r a u m a , management of tele-canthus, pediatric fractures and open Photos: DT Pakistan & Maxillofacial Surgeons and Ziauddin College of Dentistry. The chief guest for the occasion was the Honorable Vice Chancellor of Liaquat University of Medical and Health science Prof. Dr. Bikha Ram Devrajani. The objectives of the seminar were to throw l i g h t o n n u m e r o u s maxillofacial trauma cases and explicate its various treatment m o d a l i t i e s . T h e s e m i n a r included different lectures on facial trauma and its treatment. The panel of speakers and experts consisted of 9 national and 2 international speakers. These included Prof.Morveyn Hossein, Prof Syed Mehmood expertise through video link. The event was moderated by Prof. Dr. Syed Ghazanfar Hassan, Chairman Oral & M a x i l l o f a c i a l s u r g e r y Department LUMHS. The speakers enlightened post-graduate students from their knowledge and shared their expertise on facial trauma a n d t h e i r m a n a g e m e n t , including soft tissue trauma of the skin and trauma of the facial bones. The lecturers put s p o t l i g h t o n s u r g i c a l approaches for maxillary fractures, zygomatic bone fractures, their fixation, optimal management of mandibular angle, body, para-symphysis treatment of mandibular condylar fractures. The session concluded by an open question/answer session and case base panel discussion which further enlighten and updated the post-graduate students on the management of maxillofacial trauma fractures. The chief guest appreciated the entire team of focal persons for conducting such activity and awarded shields to speakers who participated in t h e s e m i n a r. T h e Vi c e Chancellor eulogized the seminar for its great success in terms of learning objectives and maxillofacial trauma awareness. -PR FDC organises 3rd session orthodontics workshop Photo: DT Pakistan L AHORE - Faryal Dental College (FDC) recently held 3rd session of orthodontics workshop. The session was organized under supervision of Prof Dr Farhat Amin, Head of Department, Orthodontics. The session included detailed lectures by Dr Mariam Masood, Assistant Professor, Orthodontics and Dr Adeel Iftikhar, Senior Registrar, Orthodontics. The workshop included lectures on anterior-posterior and vertical discrepancies in dentofacial region. A detailed demonstration was given on Phantom heads and orthopedic appliances usage were discusses. The lecturers highlighted the management of Class II, Class III, open-bite and Continued on Page 11
NEWS March 2020 Pakistan Edition DENTAL TRIBUNE 9 Local students smile wide, thanks to free dental checkups by BUMDC K ARACHI - The dental team of Bahria University Medical and Dental College (BUMDC) recently conducted a free dental checkup and awareness session. The camps were setup in schools located in the vicinities of Baba and Bhitt Islands. The dental team was divided into 2 units with the first unit sent to a government school at Baba Island and the second unit to a school at Bhitt Island. The dental team performed the duties of full-mouth examination and checking of dental status of each student of the school. Oral hygiene Photos: DT Pakistan The dental team comprised of 45 dentists chaired by Dr. Kulsoom Fatima Rizvi, Vice Principal, BUMDC and Head of Community Support Program (CSP) and Preventive and Community Dentistry department, Dr. Shama Asghar, Head of Operative Dentistry department, Dr. Beenish Fatima, Head of Oral Biology Department and Senior Lecturers Dr Muhammad Mohsin Haider, Dr. Raima Bashir, Dr. Arqam Najmi and Dr. Umiama Khan along with 35 House Officers. The team were escorted by Pakistan Navy (PN) personnel to the respective islands. instructions were also provided to each student. Children were especially instructed about proper brushing techniques on dental models. Reminders for tooth brushing and healthy vs poor diet were also distributed. The students actively participated in the dental activity. Director Administration, Cdr M.Faisal Sadiq PN met the dental team and appreciated their efforts. He was pleased at the execution of a successful dental hygiene awareness session and encouraged the team to make it a regular feature to visit the under privileged population. -PR SIOHS screens 1,200 childern for oral disease K ARACHI - The Department of Community & Preventive Dentistry, Sindh Institute of Oral Health Sciences (SIOHS), Jinnah Sindh Medical University (JSMU) recently screened nearly 1,200 children Photo: DT Pakistan for oral diseases and provided guidance and awareness to them. The event was held to commemorate National Oral Health month. Head of Community Dentistry department, Dr Marium Azfar and the out - reach Coordinator, Dr. Imran Khan supervised the team of faculty and students. The screening program was held at The Citizen's Foundation's Sindh Police School campus in Qayyumabad. Dr Marium Azfar told that the screening event was part of JSMU's outreach programme in collaboration with Colgate-Palmolive. Dean of SIOHS, Prof. S.M.Kefi Iqbal inaugurated the event and presented certificates and shields to the participants. The Vice Chancellor, Professor S.M.Tariq Rafi stressed that JSMU should regularly hold outreach programmes according to its vision of building healthy communities in its area of operation. -PR Free dental camp setup by BUMDC K ARACHI - A free dental c a m p w a s r e c e n t l y o rg a n i z e d b y S h i f a Welfare Association near Kaybees Restaurant, Munawar Chowrangi, Karachi. Five dental House Officers from Bahria University Medical and Dental College (BUMDC) voluntarily participated in the activity. The dental team conducted the session under the supervision of Dr Kulsoom Fatima Rizvi, Vice Principal, Dental Section. The patients were evaluated, diagnosed and referred to BUMDC. They were also provided with free medication for temporary relief. -PR Photos: DT Pakistan Dentists need to take more action to combat the opioid epidemic, says expert P ITTSBURGH, U.S. - In a recent study on opioids reported by Dental Tribune International (DTI), researchers found that the overprescribing by dentists in the U.S. was common, particularly for patients at high risk of substance abuse. In the study, the team used Truven Health MarketScan Research Databases to assess close to 550,000 dental visits by adult patients between 2011 and 2015. From that, they were able to attain their results. In an in-depth discussion with the study's lead author, Prof. Katie J. Suda from the Division of General Internal Medicine at the University of Pittsburgh School of Medicine, Suda gave more insight into her work and described some possible measures to combat the issue. Speaking to DTI about the confronting statistics and what could be done to curb the trend of overprescription, Suda said that there was a lack of resources and tools to help dentists in the area of pain mitigation. She added that, if there were better tools in place, dentists could be influential in being part of the solution to the opioid epidemic. She said, "Similarly to medical providers, dentists need to have resources to aid them in their prescribing decisions for pain medications. These should include clinical guidelines specific to oral health and education on how to talk to their patients about treating their oral pain." The establishment of guidelines is one of the significant issues around opioid prescription across the medical and dental fields, and surgeons at Baylor Scott & White Health hospitals, a large health care system in Texas, recently implemented a pain management program that reduced longer-term opioid prescriptions by two-thirds. That kind of initiative is something Suda believes dentists also need to adopt. "In the interim, individual dentists can implement their own practice-specific guidelines. For example, all In a recent discussion Dental Tribune International had with an expert on the opioid epidemic, the role dentists play in combating the problem was front and center. (Image: Antonio Guillem/Shutterstock) patients without a contraindication could receive ibuprofen and acetaminophen post-extraction. Only low-potency opioids could be prescribed, for example acetaminophen with codeine instead of oxycodone." How the problem has reached these proportions is unclear, but Suda was quick to note that, although dentists are involved in the opioid epidemic, the epidemic is not their fault. "There are many causes of the opioid epidemic and dentists are only one prescriber group," she said. However, Suda pointed out that there has been no lack of information to help dentists understand the epidemic better. Public health and professional organizations have disseminated information widely, and the American Dental Association has provided educational programming and literature summaries relevant to oral pain on group email lists as well as implemented a policy to combat the issue. In conclusion, Suda said: "Dentists should also check their local prescription drug monitoring program before they write a prescription for any opioid." - Dental Tribune International
10 DENTAL TRIBUNE Pakistan Edition March 2020 NEWS Coronavirus guidelines for dental practitioners and students W .. Schools should encourage students to engage in self-learning, to make full use of online resources and to learn about the latest academic developments. .. During this period, it is easy for students to be affected by disease-associated fear and pressure; dental schools should be prepared to provide psychological services to those who need them. "For dental practices and hospitals in countries/regions that are (potentially) affected with COVID-19, strict and effective infection control protocols are urgently needed," said corresponding author Prof. Zhuan Bian in a press statement. "Dentists should take strict personal protection measures and avoid or minimise operations that can produce droplets or aerosols. Four-handed technique is beneficial for controlling infection. The use of saliva ejectors with low volume or high volume can reduce the production of droplets and aerosols." The authors called for further discussion and research on how to improve current infection control strategies and how to respond to similar contagious diseases in the future. According to the World Health Organization by 19 March 2020, COVID-19 had been diagnosed in 166 countries, totalling 207,855 laboratory-confirmed cases and 8,648 deaths. The study, titled "Coronavirus disease 2019 (COVID-19): Emerging and future challenges for dental and oral medicine", was published online on 12 March 2020 in the Journal of Dental Research, ahead of inclusion in an issue. - Dental Tribune International UHAN, CHINA - The COVID-19 pandemic, which originated in Wuhan, has become a serious public health challenge of international concern. Researchers from Wuhan University School and Hospital of Stomatology have now released a paper which includes a number of recommendations for dental practitioners and dental students on how to deal with the virus SARS-CoV-2 that poses emerging and future challenges for dentistry. Infection control measures are necessary to prevent the virus from spreading further and to help control the pandemic. Owing to the characteristics of dental settings, the risk of cross infection can be high between patients and dental practitioners. For dental practices and hospitals in areas that are (potentially) affected by COVID- 19, strict and effective infection control protocols are urgently needed. This article, based on experience and relevant guidelines and research, introduces essential knowledge about COVID-19 and nosocomial infection in dental settings and provides recommended management protocols for dental practitioners and students in (potentially) affected areas. Recommendations for clinical practice include the following: .. During the outbreak of COVID-19, dental clinics are recommended to establish pre-check triages to measure and record the temperature of every staff member and patient as a routine procedure. .. Preoperative antimicrobial mouth rinsing could reduce the number of microbes in the oral cavity. .. Dental emergencies can occur and exacerbate Researchers recommend that dentists and patients alike wear protective masks and goggles at all times while they are at the dental office. (Image: MODANO/Shutterstock) in a short period and, therefore, need immediate treatment. Dental dams and high-volume saliva ejectors can help minimise aerosol or spatter in dental procedures. The treatment planning of tooth fracture, luxation or avulsion is dependent on the age of the patient, the traumatic severity of dental tissue, the development of the apex and the duration of tooth avulsion. .. In the regions that are heavily affected by COVID-19, patients waiting in dental clinics should also be provided with medical masks. If aerosol-producing procedures are unavoidable, dental practitioners need to wear gowns and facial shields or goggles. The paper also listed recommendations for dental education: .. During the outbreak period, online lectures, case studies and problem-based learning tutorials should be adopted to avoid unnecessary aggregation of people and the associated risk of infection. Dentine hypersensitivity ... Continued from page 6 of 9 or 10 meant that the DH has been completely resolved using BioMin F toothpaste for only two weeks. The clinical photographs in Figures 1 and 2 are of patients who reported diffused DH in the cervical areas of the teeth and this was treated with BioMin F for two weeks. This approach substantially reduced or eliminated their pain from DH. Figure 3 shows the percentage of patients included in the clinical study who reported pain after consuming cold, hot or acidic food and after brushing their teeth with cold water. Most patients included in the trial had diffuse (58.62%) or occasional (37.93%) DH, and only 3.44% did not report any DH. Of the 29 patients included in the clinical trial, the majority (48.27%) reported that they were already using a toothpaste to specifically address DH (Fig. 4). It is interesting to note, as shown in Figure 5, how many patients using BioMin toothpaste twice a day for two weeks experienced a reduction in DH pain. Most of the patients found it relieved their pain from DH. In particular, 27.58% of patients treated with BioMin F for two weeks reported an elimination of hypersensitivity, Fig. 8: Open tubules on the dentine surface (research at Queen Mary University of London). Fig. 9: Tubules occluded after brushing with BioMin F (research at Queen Mary Fig. 10: Tubules remained occluded after acid challenge (research at Queen Mary University of London). University of London). while in 52.72%, the pain had been significantly reduced. Just 20.68% reported no obvious change after using BioMin F for two weeks. Importantly, no patients reported an increase in DH pain. One of the last questions asked of patients was whether they felt that there was a greater benefit to using BioMin F, rather than their previous toothpaste, to tackle DH, and a large number (73.07%) reported a positive response as shown in Figure 6. We would now like to describe in detail one particular clinical case from the trial which demonstrates the acid- resistant features of fluorapatite crystals produced by the bioglass in BioMin F. The 44-year-old female patient with high DH started the BioMin F trial according to our instructions (twice a day), and after just a few days, she reported greater relief from DH and she was very satisfied. In the following days, the patient had repetitive bouts of vomiting with gastric acid reflux with a very low pH (a pH of around 1) capable of removing any mineral pellicle or aggregate covering tubule orifices and which would likely cause DH pain to reoccur. Naturally, the patient feared that this would happen. At the conclusion of these episodes, she checked her hypersensitivity pain by rinsing her teeth with cold water after brushing in the cold air of winter, and she told us that the benefit of using BioMin F remained unchanged (Fig. 7). This suggests, as evident in microscopy studies undertaken at Queen Mary University of London, that the bioglass contained in the toothpaste does not produce an amorphous mineral layer on the tubule orifices, but produces a true mineralisation process through which fluorapatite crystals form that appear to be acid-resistant. This is shown in Figures 810. Editorial note: A list of references is available from the publisher. This article was published in prevention- international magazine of oral health, Vol. 4, issue 1/2020.
COVID-19: Pakistans ... Continued from front page management only. Dr Awab Alvi said that the fight against the coronavirus can only be succeeded if everyone in dental practice, maintain good protection protocol. Especially in regard to the protective equipment, dental fraternity needs to assist each other and consider the financial constraint imposed with it. The dental practice may change altogether once this virus is gone. Dentists may have to adopt stricter measures like face visors and better protective gears, commented Dr Awab. Dr Mahmood Shah, the President of Pakistan Dental Association termed the current scenario as the biggest challenge the community has ever encountered. Talking to the president of the Dental Trade and Manufacturers Association, Liaqat Humayun, he termed the situation as a complete economic meltdown. "The impact we are seeing is huge. With institutions closed and the prices of consumables soaring it is time that dental industry prepares itself for the unprecedented challenges once this is over," he said. "The prices of masks alone have gone up by 400 times and same is the case for surgical gloves. Import has come to a standstill, staff has been relieved in some cases and the business carried out is based on stock available," he concluded. The industry stalwarts like Idrees Qadri and Ashraf Ghauri also said that the dental industry stands to suffer the most in the healthcare sector and must brace itself for challenges in the post COVID-19 era. The industry faces acute cash-flow shortage with no payments coming and the whole business cycle is halted with clinics going for emergency/consultation only and in many cases closed. Even in such dark times, there is a light of hope. A student based initiative called 'Agahi For Corona' has been started to help the community. The campaign, headed by Dr Talha M.Siddiqui, Vice Principal, Baqai Dental College, Baqai Medical University and Dr M.Ainul Haq, Assistant Director and Head Department of Medical Education, Baqai Dental College, Baqai Medical University, includes students, House Officers, doctors, dentists, pharmacists, physiotherapists and paramedics The only redeeming feature at this point in time is that the whole world is adversely affected. It is true that the dental industry is badly hit with the catastrophe, but the collective efforts can resuscitate the community back. An exclusive interview with Dr Ambrina Qureshi Continued from page 4 what actual basic need of our country was. The basic need of our country was prevention. And it still is. We should all try to focus on prevention rather 2020 Pakistan Edition DENTAL TRIBUNE 11 March than you know We should give it time to an extent where it can be addressed. I think it's time that we all should understand what our community needs rather than what are our standards demands. entrance there are many females and hardly any males. This could be because of the prevailing educational movement. But unfortunately, if we look into the other side of the picture, we will find out that only 15 percent of these women DTP: PMDC (Pakistan Medical and Dental Council) dissolution has caused a stir among dental community. Your comments on that? AQ: I don't see a major stir among dental community, to be very honest. I think the stir was mostly around the people who were direct sufferers of this dissolution [which were] the employees of the PMDC. What actually Dental Community really wanted? They were m o r e c o n c e r n e d a b o u t t h e i r registrations. They were more concerned about their faculty registrations, their experience certificates and so on. So I think if it is still in continuity then the dental community is not much worried. The most worriers are the people who were actually working for the PMDC. DTP: Students have to appear in NLE (National License Exam) to become eligible in house job. Your take on that? AQ: First of all NLE has not started as yet. I suppose this will be implemented in coming year, somewhere. Let's just wait for it to come. I think if the We should start spreading awareness to the rural populations through tele-dentistry government has decided such a thing [that is because] all other countries are also doing it. So I don't think there is any harm in it. But let the time come and then maybe we are able to see if it [turns out to be] good or bad. DTP: Why is Pakistan's post- graduation degree lagging behind on global level? AQ: I think the culture of thinking and [especially] the culture of critical thinking, to be more precise and the culture of questioning, is lacking in our country. Our postgraduate or be it be our undergraduate students, I think they all are lagging behind because they are not given chances. They themselves are not in a habit of questioning. They are rather overburdened by a spate of assignments, quizzes and presentations and you know things like that. So all the time they are more focused on to meet their concerned targets And this is with both the undergraduates as well as Post-Graduates. I think this culture needs to be instilled in our society .The culture of questioning and critical thinking is important, you know. DTP: In clinical practice we have a higher male to female ratio as dental professionals in Pakistan, why do you think this trend is prevailing? AQ: There are many females in this profession, when the [admission in dental colleges] takes place. At the Reading systematic reviews are important rather than reading some simple articles who have done their graduation, would continue their Post-Graduation or even you know pursue in their clinical fields. They are hardly given an opportunity to become head of the departments or institute, or like becoming Dean or Principal. There are very few women who get this chance. I think that is basically because of the gender inequity rather than inequality, I must say. DTP: As a woman, how do you think female dental professionals can work along with all the burdens they carry, some tips for them? AQ: To be very frank, this burden is not what they have put on their on their shoulders. Most of the burden is given to them by their male counterparts because probably they are not able to handle it (laughs). I think women are more powerful to carry that burden and they are very happy in carrying that burden. But there is a little suggestion for them from my side. They need to be negotiators. They need to learn how to negotiate things which, unfortunately, we were not taught while we were developing. So I think for the new generation of the females, it's my advice that they should learn how to negotiate with the things, how to negotiate with the burden which had been given to them. [They should learn] how to lessen it down and how to put it back on male counterpart. This is my answer. DTP: What are the hot topics for dental researches these days? AQ: It's the way how you present it. It's the way how you write it. Even if it is a very, you know, not a hot topic. If you write it in a way and you know sell it in a way that is impressive. I think it can become hot. DTP: Do you think research at under grad level really have any worth? AQ: As I mentioned earlier, Students need to develop those skills of critical thinking and questioning. And all this comes through working on research. So I think it's very important for an undergraduate to start learning about research, yes. DTP Any suggestions you want to give for dental students who are thinking to do research in future? AQ: Why in future why not in present? In fact they should start doing research now! And my sincere suggestion would be, if they really want to do research. There is this prevailing stereotypical comment that read more and you'll understand more about research. What you [actually] need to read, that is important. Reading systematic reviews are important rather than reading some simple articles. Read systematic reviews! That is how you would come to know what is happening all over world. Systematic reviews would give you conclusive ideas where the gap is and how you can fill those gaps. So get into a habit of reading systematic reviews of all the topics that are of your interest. DTP: Researches done in Pakistan are still struggling to level with the ones done on international level, how do you think this difference can be eradicated? AQ: How this difference can be eradicated? Maybe its answer would come later. Why this is happening is more important. This is happening because, again I think our undergrads even our post grads, and they are not given the proper guidance of how to do research. As I already mentioned, they should develop a habit of reading systematic reviews. Reading systematic reviews with meta-analysis would give them an idea where the gap is [by comparing it with] the international level and where those gaps need not to be and how those gaps need to be filled. So once they do that, there is nothing that can stop them from publishing into good international journals or from doing international level trials and researches. What currently they are doing is they are copying researchers which are already being done. So copying is not research. Doing it again and in their own good methodological, you know, that is the need of the day. DTP: Any message for new dentists? AQ: They should understand what our public needs are, what they really want. And you should help them understand their needs as well. So awareness is important. Spread awareness for the sake of this public. Dr Jamal headlines ... Continued from page 8 discussed in the workshop. The tutorial on World Health Organization-WHO based guidelines to hand hygiene was the highlight of the course. Participants included students from multiple institutions and few belonged to interior Sindh. The interactive session, video demonstrations and IPACD awareness was appreciated by the audience. Dr Adil also revealed about his upcoming advance course in IPACD with the specialist speakers from Australia in next few months at CODE- M. -PR FDC organises 3rd sessions ... Continued from page 8 deep bite malocclusions. Later, Dr Afifa Ahsan, Associate professor, Oral Biology gave a detailed lecture on the importance of maxillary first molar in development of occlusion and malocclusion. The college administration supported and appreciated the efforts of orthodontics department in organizing the session. -PR