PUBLISHED IN PAKISTAN www.dental-tribune.com.pk JULY-AUGUST 2020 - Issue No. 04 Vol.7 PMDC annuls registrations of practitioners ... An exclusive interview with Dr Humayun Taimoor Antibody testing for SARS-CoV-2:We need to talk more ... NEWS Page 2 INTERVIEW Page 4 NEWS Page 9 COVID-19: Health ministry issues return to work guidelines for dental care services DT Pakistan Report K ARACHI - The Ministry of National Health Services and Regulations and Cooperation (NHSRC) recently released fresh guidelines for dentists who are resuming their practices again in COVID-19 pandemic. The detailed official document included recommendations that were in continuation of initial guidelines issued by the ministry earlier. According to the new guidelines, dental care settings invariably carry the risk of SARS-CoV-2 infection due to the specificity of its procedures, which involves face-to-face communication with patients, and frequent exposure to saliva, blood, and other body fluids, and the handling of sharp instruments. Hence, dental professionals should make sure to limit the contamination which can be done via the airborne spread, contact spread and contaminate spread. It also said, "The clinicians may choose to limit their procedures in early stages with a limited number of patients and can choose to add more with improving condition countrywide." Photo: DT Pakistan "All staff should be assessed for risk as an ongoing practice and anyone demonstrating symptoms or having symptomatic household contacts should not be allowed to work and should be instructed for self-isolation and staff with suspected COVID-19 should be arranged for testing as per government guidelines. After a period of 14 days, if they are Continued on Page 10 Pakistan Dental Association urges dentists to join hands in fight against COVID-19 DT Pakistan Report K ARACHI - COVID-19 s i t u a t i o n h a s b e e n c o m p l i c a t e d a n d disappointing, and the dental community was demoralized in such a scenario. Dentists have been worried since they were not earning much, along with the constant fear of the contracting virus. They have been fighting an invisible enemy; hence a very challenging time for dentists. Referring to the impact of a pandemic on the dental community, Dr Mahmood Shah, President Pakistan Dental Association (PDA), said that the COVID-19 had affected Photo: DT Pakistan every domain of life. The pandemic has inflicted the psyche, physical working, and financial aspects of dental practitioners in both public and private sectors and academic institutions. PDA tried its best to find remedies and steps that counter such setbacks and ways to cope with it. There is also a dire need to take action for the betterment of dental fraternity, and specific demands have to be made from the government to get support in this regard. He spoke at a live session organized on the topic, 'Current COVID-19 situation and its impact on dental professionals and dental practices.' Speakers who participated in the event were office bearers of PDA located in various provinces and cities of Pakistan. Dr Jawad A Kundi, President-Elect, PDA branch, Peshawar, Dr Mujeeb R Kalwar, President, PDA branch, Hyderabad, Dr Hasan Bashir, President, PDA branch, Gujranwala, Continued on Page 10
4 DENTAL TRIBUNE Pakistan Edition JULY-AUGUST 2020 INTERVIEW Recently Dental Tribune Pakistan sat down to talk about his journey as a forensic odontologist for our readers. Excerpts from his interview are as under: to all the aspirants prefer proper international accreditation, and the licence is issued by Pakistan Medical and Dental Council (PMDC) to practice this. Dental Tribune Pakistan: Kindly introduce yourself to our readers? Humayoun Temoor: My name is Dr Humayoun Temoor Beg, and I am a dental surgeon by profession. I am trained in forensic Odontology. I am residing in Pakistan for the last ten years. I initiated my services with Officer's Surgeon Medico-Legal as a professional forensic odontologist. About my background, I belong to a small town in Azad Kashmir, and most of my family members belong to the Military or Police department. In my career so far, various air crashes, including the Junaid Jamshed flight air crash incident and multiple bomb blast incidents. Allah has blessed me with respect, and I am always appreciated on many occasions. The focus on Forensic Odontology is the need DTP: Tell us about a few cases and your most memorable one? HT: See, I won't discuss cases of counter-terrorism cases, but all examples are challenging. I won't mention counter-terrorism cases because they are state property and identification cases. Every case is challenging. A detailed investigation has to be done. Yes, it has to be done in specific time- frame because some cases are solved quickly. Some claims take a lot of time. You have to prepare your pieces of evidence properly so that you can prove them in the court of law. As mentioned before, it's a general responsibility that whatever you say or whatever observation you give or any opinion that you forward can be proven in the court of law. of the hour: Dr Humayun Taimoor DTP: What made you chose this career option? HT: I always wanted to be different from the rest. I kept on practising after graduation; then my father told me to do specialization. At that time, there were not many options for specialization. Hence I went to England to complete my training in maxillofacial surgery. I soon realized that my thirst for knowledge didn't quench. I talked to my supervisor about it, and he introduced me to this course, and luckily Dr Katherine Adams accepted me into her class. Now she's an excellent friend of mine and mentor as well. Now, this course of Forensic Odontology is happening at the University of Dundee, and the course lead is my class fellow, Ms Sheela. Apart from me, last year two female dental surgeons have completed their Master courses from there, Dr Suman and Dr Falak and they are Karachi based from Dow University. I also want to thank Dr Shahjahan Katpar in this regard that he supported these girls and I also foresee that more people will join this field. I went to England to complete my training in maxillofacial surgery, but my thirst for knowledge didnt quench! DTP: In your experience, what would you say are the most common applications of Odontology within a forensic context? HT: Forensic Odontology has 7-8 sub-specialities like dental adjustments, Disaster Victim Identification (DVI), bite mark analysis, criminal liabilities, medical and dental neglect and disaster management planning. Facial reconstruction and facial mapping are one of the new things for the country, dental adjustments were happening before, but the process of this is detailed in Forensic Odontology. It can't be done through any other way. These techniques are further elaborated and are defined meticulously, and then there's training for that, without which it will be tough to perform forensic procedures. Some people might comment that the tasks can still be performed; it doesn't seem that difficult; maybe they are right. There is nothing in the world that is difficult, but, I give an example By Dr Muattar Hanif D r Humayoun Temoor is the first qualified and trained Forensic Odontologist in Pakistan. Graduated from Isra Univesity, Dr Humayoun Temoor completed his Master of Science (MSc.) in Forensic Odontology from the University of Glamorgan, Wales. He also completed his post-graduation in Oral Implantology from Goethe University Frankfurt, Germany. He is currently appointed as Senior Lecturer at University of Health Sciences, Lahore and continuing his services as Forensic Odontologist under Government of Punjab. 2020, Pakistan International Airlines (PIA) flight 8303, crashed on a second landing attempt short of the Jinnah International Airport, Karachi. Ninety- nine passengers, including eight crew members, lost their lives. Most of the deceased were left unidentifiable due to the fire that erupted because of the crash. National Disaster Management Authority (NDMA) and Pakistan International Airlines Emergency response unit assembled a forensics team for purposes of identification of the deceased. Dr Humayoun Taimoor was tasked as the Consultant Forensic Odontologist for the air crash victims' identification. He, along with his team, conducted numerous Dental Autopsies and identified the bodies. of this very incident. A dental surgeon, who is a friend of a family, came to meet us and said that he could identify the body quickly. The body was not in good shape, but somehow he recognized it. The body was then buried before I could even re-check it. Later through the dental data given by the family of the deceased, it was found that the body was not correctly identified, and the wrong body was buried instead. So it is a message to all those people who think that anybody can do this job. One cannot examine without training and certification. So it is my request DTP: Is it emotionally disturbing dealing with traumatic cases such as these? HT: I think it's a special blessing from Almighty Allah. I believe that there is no one but Allah, who can harm or benefit him. Yes, there are social pressures, work area pressures, professional demands are there. But this is for which we are trained. If we are prepared correctly, then we can overcome all these obstacles. Because without this we won't work as a team. It is a very responsible job because you are answerable to the state. Some people might comment that the tasks can still be performed; it doesnt seem that difficult; maybe they are right. There is nothing in the world that is difficult. DTP: Share your experience related to PIA flight crash incident? HT: I cannot say much about them because the investigations are still underway. When this incident happened, we were immediately called by my Vice-Chancellor, Prof Dr Javed Akram and ordered to get ready. Mr Javed Akram has a very charismatic personality and believes in quick response. I also had experienced working with him before when Havelian air-crash took place. He was Vice-chancellor back then too of Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad and he is a gem of a person. He gave me a team to take with me, and all the legal modalities were completed. NDMA Chief ordered my Vice-Chancellor and our team, one or two days before Eid reached Karachi in the evening. Here PIA, NDMA, PDMA (Provincial Disaster Management Authority), local Sindh council, took outstanding care of us, but for some reason, we couldn't initiate work. Still, when we commenced work, by the grace of Allah, we identified the body, on our very first day and I am very thankful to those families because we came just for them after leaving our homes and Eid celebrations. Our mission was to handover the Continued on Page 11
6 DENTAL TRIBUNE Pakistan Edition JULY-AUGUST 2020 NEWS President FDI stresses for unity among dental community towards a global vision DT Pakistan Report M ALAYSIA - Due to the coronavirus crisis, clinical practices all around the world are disturbed. It is essential to discuss the improvement in oral health and clinical practices to maintain the quality of prevention and care in global dentistry. Referring to the current situation of COVID-19, the International College of Dentists (ICD) Section XV hosted a live session on Zoom on the topic 'Steering oral health profession through COVID-19: How to maintain the course towards a global vision.' The moderator for the event was Dato'Dr How Kim Chuan, President ICD Section XV. The guest speaker for the event was Dr Gerhard Konard Seeberger. President FDI World Dental Federation, President of Academy of Dentistry International, Author, Co-author and peer reviewer in Italian and international journals, Past-speaker at FDI General Assembly, Committee member in Italian minister of Health. The panellists of the webinar included Prof. Dr Bedros Yavru Sakuk, New York University, College of Dentistry, Board Member of the European Regional Organization, and former Vice-Chairman of "Dental Practice Committee" in FDI, Dr Oliver Hennedige, Secretary-General of Asia Pacific Dental Federation (APDF) and APRO (Aerial Phenomena Research Organization), Executive Director of ICCDE (International College of Continuing Dental Education), Prof. Dr Mohamed Ibrahim Abu Hassan, Council Member of the Malaysian Dental Council, Chairman of Dental Deans Council of Malaysian Dental School and Prof Dr Arshad Mahmood Malik. Principal/ Dean HBS Dental College, Professor, Postgraduate Guide Supervisor, Examiner & Paper Setter. President Emeritus, Regent and Fellow Pakistan society of Oral Maxillofacial Surgery. Dr Seeberger covered various points in his presentation, including safe clinical practice for patients and the dental team. He highlighted the oral health improvement of people in times of the COVID- 19 pandemic. Dr Seeberger said that the maintenance of the quality of prevention and care in dentistry globally should be the utmost priority. He said that the economic changes in the post-COVID-19 would have its effect on dental practices and beyond. Dr Seeberger stated that "All over the world, we are reacting in the best manner to downsize the spread of the virus." Dr Seeberger mentioned, "We are still learning about this virus from different countries' experiences. And we shall not waste time waiting for the vaccine because we don't know how long it will take. We should stay calm, use common sense, and opt for personal and social hygiene." Dr Seeberger highlighted, "FDI has set up COVID- 19 library with all the factsheets in multiple languages." Moreover, he mentioned that dental professionals should seek guidance either from FDI, ECDC (European Centre for Disease Prevention and Control), WHO (World Health Organisation), or NDA (National Dental Association) regarding coronavirus. He discussed the use of different masks, including N95, surgical and facemask FFP3. "Dentists need to discuss and refer to experts in maintaining and re-establishing oral health and must emphasize their gatekeeping function in medicine to decrease the burden of non-communicable and communicable disease," Dr Seeberger said. Dr Seeberger suggested some guidelines for oral health experts regarding the triage on the phone before treatment, reception of patients in dental practice, and on-site and information on risks of COVID-19 and patient consensus. He also said that operator protection of the respiratory tract, eyes, body, hands, and treatment protocols must be followed. Endodontist highlights tactics to manage complex root canal anatomies DT Pakistan Report D UBAI - Root canal shaping and disinfection are the significant factors to impact access cavity designs. The skill to gain ideal cavity design depends on Dental Operating Microscope (DOM), Ultra Sonic (US), experience and operator skills. Referring to critical endodontic techniques, Dr Mostafa Anwar, BDS, DHHM, MDSc, PhD, Assistant Lecturer of Endodontics, The British University, expressed his views on "Predictable Tactics for Safe Management of Complex Root Canal Anatomies." He was speaking in a live zoom session broadcasted from Dubai, moderated by Moataz El-Sheikh. Continued on Page 10 Experts shed light on how to drive dental career further K ARACHI - Dental education experts got together for a seminar on Zoom recently to discuss the 'Higher Inter-Disciplinary Dental Education in London in a new era: Driving your career further.' from the perspective of senior dental academicians. The event was jointly organised by Barts and The London, School of Medicine and Dentistry and Fatima Jinnah Dental College (FJDC). "In this day and age, post-graduation has become very necessary. People are opting cities like London to seek knowledge," said Dr Asher Jamelle, Head of Department of Periodontology, FJDC, who was also moderating the discussion. The event focused on compiling and critically presenting the educational opportunities concerning the full-time specialty in Periodontology and Distance Learning masters in Oral and Maxillofacial Surgery courses available to enhance post- graduate experience and knowledge in taught training. The key-note speakers for the event, Prof Simon Holmes, Director of Distance Learning and Professor of Craniofacial t r a u m a a n d C o n s u l t a n t i n O r a l Maxillofacial Surgery, Royal London Hospital and Dr Domniki Chatzopoulou, Specialist Periodontist and Senior Clinical Lecturer shared valuable insight to increase chances to present successful application. The webinar session consisted of an interactive presentation discussing the predictable step by step clinical cases to aid optimum aesthetic outcomes. The demonstration of the importance of interdisciplinary training in soft and hard tissue regeneration was also done. The participants were thoroughly explained with the help of videos and digital material regarding the assessment and operative treatment. The speakers highlighted the importance of atraumatic experience and socket preservation through surgical techniques. Important critical factors in predicting the outcome in advance facial reconstruction were urged. Dr Asher concluded the event by thanking the participants and key-note speakers for taking time out in crucial times of COVID-19. -PR
8 DENTAL TRIBUNE Pakistan Edition JULY-AUGUST 2020 NEWS Baqai University initiates Health Professions Education course Photos: DT Pakistan K ARACHI - Baqai Medical University recently conducted the first 'Certificate of Health Professions Education 2020'. Renowned philanthropist and co-founder of Baqai Medical University, Prof Dr Zahida Baqai inaugurated the event along with medical educationists, Dr Ahsan Sethi, Dr Syeda Kauser Ali and Dr Syed Moyn Ali. The first contact session of the six-month course certification was launched under the guidance and supervision of the course director Prof Dr Shams Nadeem Alam and co-director Dr Ain Ul Haq. Despite the lockdown situation in the country, the course was carried out through online lecture sessions and discussions. The facilitators included Dr Ahsan Sethi, Dr Syeda Kauser Ali, Dr Syed Moyn Ali, Dr Sobia Ali and Dr Shahid Shamim. The course was designed as an essential part of the faculty development program. A total of 25 participants were selected, which included a mix of the Baqai faculty and external participants from different institutes across Pakistan. -PR Dr Ashar Afaq becomes the first dentist to be promoted to Registrar of DUHS K ARACHI - Dr A s h a r A f a q , A s s o c i a t e Professor and the former Vice Principal of the Dow International Dental College, DUHS, has been promoted as the Registrar of the Dow University of Health Sciences. Dr Ashar Afaq is the first dentist in Pakistan to have achieved the honor of being promoted to a senior administrative position at one of the country's most reputable universities. Dr Afaq graduated from the Hamdard University with a Bachelor's in Dental Surgery in 2004, after which he went on to pursue his postgraduate studies at the Queen Mary University of London. He has been associated with the Dow University of Health Sciences since 2011. -PR Baqai Medical University tops in Online-Classes Readiness across Pakistan K A R A C H I - T h e H i g h e r Education Commission (HEC) Islamabad in its "Ranking of Online-Classes Readiness of Pakistani Universities" has revealed that Baqai Photo: DT Pakistan Medical University, Karachi has been ranked at overall 38th position among all universities and 1st position in term of Exclusive Medical Universities in Pakistan. While talking to Dental News, Dr Ain, Head of Department of Medical Education informed that the Baqai Medical University acquired 93.75 percent cumulative score and also declared 21st among Private Universities in Pakistan. Baqai Medical University spokesperson has credited such triumph to the Pro-Vice Chancellors/Focal Persons, Deans, Registrar, Faculty, officers, employees, students and their parents upon this distinct success and achievement of the university. 100 Universities from all over Pakistan submitted their reports at HEC portal H E D R ( H i g h e r E d u c a t i o n D a t a Repository) and on the basis of the collected data, Online readiness was determined. -PR INFECTION PREVENTION AND CONTROL IN DENTISTRY YDCs Facebook live session with Dr Adil Bin Irfan K ARACHI - Young Dental Council (YDC) recently arranged a live session on their Facebook page. The keynote speaker for the event was Dr Adil Bin Irfan, Head of hospital safety and faculty at Altamash Institute of Dental Medicine. The session comprised of the latest cutting edge discussions to address current issues in dental management. i n c l u d e d presentations showcased on PowerPoint and Slide Share in order to give clear guidelines on infection control and prevention in dentistry. While referring to the topic, Dr Adil said, "The subject has been generally ignored by many dental practitioners, however my focus has always been on safety and prevention." T h e s e s s i o n Dr Adil shared his insight on the protection of patients, cross- infection and dental hygiene of the patient. He told, "The transfer of bacteria and disease to the patient is a top priority of professionals and every measure should be taken to prevent this." Through his session, Dr Adil covered all the aspects from the basics of infections and the importance of preventive measures essential to avoid these infections. He demonstrated modern methods to limit the spread of infections which surely helped the viewers. D r A d i l e m p h a s i s e d , "Medicating an oral problem is not the only responsibility of a dentist but to prevent the spread of disease carried by the patient, whether an oral or overall infection, is the main goal because many clinicians failed to realise that while treating one patient if you are afflicting 5 other individuals with the disease, you are actually failing as a dentist by putting others health in danger." The viewers appreciated the session and the ways involved to inculcate the engagement of the audience. YDC is a non-government and non-profit organisation run solely by the students of Karachi Medical and Dental Council. The council aims to unite dental students and professionals across Pakistan and to foster education, improve awareness about oral health and foster education, awareness about oral health between dental students and dentists. -PR
NEWS JULY-AUGUST 2020 Pakistan Edition DENTAL TRIBUNE 9 Antibody testing for SARS-CoV-2: We need to talk more about it By Jeremy Booth, DTI L ONDON, UK - Despite dental s e t t i n g s p r e s e n t i n g a significantly elevated risk of infection for those in and beside the chair, testing patients for the SARS- CoV-2 virus remains optional. Those advocating for testing say that it would help to keep dental practices safer, to reduce the amount of personal protective equipment (PPE) that clinics use, and to streamline appointment scheduling and treatment. A number of options are available, and one UK doctor is advocating for antibody tests for dental practices. Some dental practices are testing patients for the virus before they undergo an aerosol-producing procedure (AGP). Internationally, however, this remains optional. In the city of San Francisco in the US, for example, it is strongly recommended that dental patients undergoing any AGP be tested for SARS-CoV-2 via a reverse transcription-polymerase chain reaction (RT-PCR) test within seven days prior to the procedure. In the health directive from the city, which was updated on 15 June, it is stated that this "test should be performed as close to the day of the AGP as possible." And that, "this test is in addition to the screening requirements on the day of the scheduled procedure." Many readers will agree that this guidance raises as many questions as it answers: if a patient passes the screening requirements but could be asymptomatic, could they not have already had the virus weeks or months before without presenting symptoms? Will a rapid point-of-care test that detects viral activity-such as a PCR test-provide a dependable result? And is it practical to ask patients to self- isolate until the day of their appointment if the test is not conducted on-site? Dr Priya Suaris, medical director at UK company Salubritas, which is offering guidance on SARS-CoV-2 rapid testing and PPE to medical professionals, says that serological, or antibody, testing offers a dependable and convenient alternative to reverse transcription- polymerase chain reaction (RT-PCR) tests for dental clinics. An anaesthetist in private practice, Suaris spoke to Dental Tribune International (DTI) about the need for Serological tests detect antibodies in a blood sample. Fast and accurate, they could help dentists know if patients have had the virus and experienced no symptoms. (Image: Kateryna Kon/Shutterstock) testing in dental settings, and the rapid antibody testing kit that Salubritas is offering to dentists. "In dentistry, testing is very much voluntary at the moment, and we need to talk more about antibody testing," she began. "It seems daft not to be using some sort of testing in dentistry, because we do tests in all other areas of medicine and surgery, and so why are we not applying some of the technology that we have got to risk stratify our patients in some way?" [The] actual fact is that the antigen test, which is the swab test that we do in hospitals, is only 50-70% accurate Dr Priya Suaris, medical director, Salubritas She says that the UK government and media have given antibody testing a bad name. "They have made everybody really wary of it, but the actual fact is that the antigen test, which is the swab test that we do in hospitals, is only 50-70% accurate. And so if you have got a very mild form of COVID-19 and you have a swab test, it might not pick it up and may give you a negative result. This is currently the 'gold standard' in the UK, but it is not really a gold standard at all. The reality is that we actually have got really good testing if you can get the right test and work around its limitations. I think that these [antibody tests] are really easy to use point-of- care tests in the dental practice." While PCR tests provide a direct look at what is going on in the patient on the day of the test, antibody tests are a different way of looking at things: essentially, they offer a look into the past and can identify individuals who have had the virus, but have been asymptomatic. Suaris says that, ideally, dentists should be using both. "The problem with PCR tests is that they take a couple of days so, unless you are going to be really strict with your patients and say, 'Right, we are doing this test now, and you should self-isolate for The rapid antibody testing kit being distributed by Salubritas costs around £15 (16.75). (Image: Salubritas) two days until we get your test results back and you are back in our chair', it is going to be really difficult when people start getting back to work. You can't get dental patients to do that, no way." The testing kit on offer from Salubritas is a proven test that has been marketed internationally. It costs around £15 (16.75) and can easily I g M a n d be administered by dental teams. It works with whole blood, blood serum and blood plasma, has a detection time of 10 minutes and tests for the two a n t i b o d i e s I g G simultaneously. Crucially, it is reported to be more than 98% accurate. DTI asked Suaris about demand for the kits in the UK and the benefits of dental practices having a record of their patients' history of COVID-19. "What has happened is that dentists have had so much to contend with, and no one has actually talked about antibody testing, so it has not really crossed their minds. But what is happening now is that they are going back to work and are starting to see the benefits of testing their staff. Soon, I think, they are going to start seeing the benefits of testing patients." "We are charging our patient for the test, but we are also having to charge our patients for the PPE. But once they have had the test, if they are positive, then they may not need to have another one again-at least, not in this current phase of COVID-19. But if they test negative, then we would continue to test them at regular intervals just to see whether things have changed," she explained. The rapid antibody testing kit also communicates with a smartphone app, and users can opt to share selected information digitally with their healthcare providers. - Dental Tribune International
10 DENTAL TRIBUNE Pakistan Edition JULY-AUGUST 2020 COVID-19: Health ministry ... Continued from front page symptom-free they may return to work. Staff should be trained strictly to adhere to the guides of social distancing and hand hygiene issued by the government in light of COVID-19 and should be advised to avoid unnecessary contact with each other," an official release said. The guidelines stated that onlyemergency dental cases should be catered. "All patients who call the clinic for consultation must initially be scheduled for a remote dentistry consultation," NHSRC document said. The recommendations briefed that all patients are screened before entering and social distancing be maintained within the practice. Patients should continue to practice basic hygiene routines and should wear a mask when not receiving treatment. "For rationalization of clinic areas, zones may be marked on the floor using a material friendly with frequent disinfection which includes triaging zone, seating area, donning and doffing area," the release adds. NHSRC officials also recommended that best available quality of Personal Protective Equipment including gloves, a gown, eye protection (i.e., goggles or a disposable/reusable face shield that covers the front and sides of the face), and N95 or higher-level respirator should be available for all Dental Care Providers (DCP's), i.e. dentist and dental nurses. Sufficient stock of PPE for all clinic staff should be available in stock. According to stats reported on 17th July 2020, 255,716 cases of COVID-19 have been confirmed in Pakistan. Pakistan Dental Association urges ... Continued from front page Dr Noor ul Wahab, President, PDA branch, Karachi, Dr Umair F. Raja, President, PDA branch, Federal, Dr Jahangir Hammad, President, PDA branch, Quetta spoke on the occasion. PDA representatives expressed their views on various issues faced in their respective areas and what steps can be taken to improve them. The moderator for the event was Dr Muattar Hanif. Dr Mahmood said that though the current president of Pakistan was an ex-PDA president, the dental community's plight was still unheard. He said, "Dr Alvi knows the problems of the dental community, and I have tried to reach him many times. However, I didn't get any positive response from him. But still I will keep on trying to talk to him about the issues faced by the dentists so that the dental community can get the same attention that medical ones get." Dr Mahmood urged the PDA members to come on one forum to discuss the recommendations and jot down the demands that can be forwarded to the government as an official plea for help. "PDA can assemble some recommendations and forward to the government, which include practical aspects and can be sent to Dr Arif Alvi. He has always spoken about the unity of the dental community," Dr Mahmood said. Dr Shah highlighted that though private practitioners face tough times, it's the government practitioners facing the major setback. He said, "I feel that individual practitioners shouldn't ask for PPEs (Personal Protective Equipment) as they can compensate for their financial loss by increasing their fees. It's the government practitioners that need help, and PDA is more than happy to help them." While sharing the situation on Khyber Pakhtunkhwa, Dr Jawad A Kundi said that dentists are either accurately following dental recommendations or ignoring them altogether. "People who are showing casual attitude has to pay the price for that. Let us take care of all infection prevention protocols with extra precautions for COVID- 19. One should make sure that the place of treatment is well ventilated and a gap of 10 minutes should be given between each new procedure." Dr Mujeeb R Kalwar sharing the impact of COVID-19 in Sindh, said that dentistry was the most affected profession. However, despite the country's chaotic situation due to pandemic, many dental professionals were still not following SOPs (Standard Operating Procedures). He further added, "No matter how much SOPs are being forced to implement, we cannot escape from the contracting the virus. We have very close contact with the patients during procedures. Dentists are frontline soldiers in the fight against COVID-19 representing our dental family. We should not put the lives of our dentists and the government should provide full PPEs to all dental practitioners, and should declare them as front line soldiers." Dr Hasan Bashir shared the necessary steps taken by the PDA branch of Gujranwala. He said that they were currently working with local NGOs (Non-Government Organizations) and concluded that one should help themselves and others during such testing times. He said, "I don't see that dentistry is anywhere near in the agendas of the government. The reality is that we should be united and fight against the COVID-19 by ourselves instead of looking up to the government." Dr Hasan shared, "We requested our friends from China and other countries to import PPEs and other equipment for us. We also forwarded this equipment to our friends and fellow dentists all over Pakistan as a gift. We also distributed respirators among many others. For private practitioners, we allocated the staff of private practitioners to support them in such troubling times. We also trained practitioners in a series of lectures to guide people in terms of COVID-19. We should take a practical approach and think of utilising our resources under the guidance of PDA central council." Dr Noor ul Wahab stressed the need for awareness in the fight against COVID-19. He said, "We need to overcome the fear of COVID-19 through education and by following preventive measures. We have to arrange PPEs ourselves instead of looking up to the government. Consider every patient as a COVID carrier. We can only request higher authorities though the expectations are shallow. We can educate our dentists and guide people properly, because that's the only way out." Dr Umair F. Raja highlighted while sharing the situation in the Federal area, "We are living in extraordinary times and these are not typical situations. We have to learn and live with COVID-19. Dentists are obviously at higher risk of contracting the virus, because of the proximity with the patients and the type of procedures involved. Due to the fear of COVID-19, the patient's flow was reduced and affecting dentists profoundly. Though many attempts are being made, dentistry is still unable to restore at its full potential, regardless of all these guidelines. Dentistry has become more of a stigma that since dental treatments are usually expensive, hence dentists are also well off; thus, pandemic won't affect them much. We all need to sit down and formulate some demands to make things go forward for all dental fraternity." Dr Jahangir Hammad shared the setback faced in Balochistan and said, "When two of our dental surgeons got affected in the first week of lockdown, many of our dental practitioners quit their practices. The situation in our province is so unfortunate that we have to purchase PPEs through donations. We requested our government many times to facilitate us so that at least we can deal with patients in the Trauma centre." Dr Jahangir urged that the quackery has been a significant factor in creating havoc in times of pandemic. "Quacks are still performing all procedures without COVID-19 protocols. They are a significant threat in the spread of infection." In the end, Dr Mahmood said that the dental community should work on the same age to cater to the issues raised due to pandemic in the country. He said, "We should try our best to enforce dental practitioners to cover their nose and mouth adequately during procedures. I am hopeful that we will soon overcome this pandemic. We will try our best to comply with all the requests and suggestion on merits." Leading global trade fair ... Continued from page 4 SHOW SAFE, MEET SAFE, STAY SAFE and VISIT SAFE. These measures regulate safe interaction at the trade fair and ensure that exhibitors and visitors can once again meet in a relaxed manner. IDS therefore offers plenty of possibilities and room for spreading large numbers of participants out safely over the corresponding areas. Koelnmesse's digital signage system offers a further advantage. Planning the stands with larger floor areas will ensure that minimum distances can be maintained. As a result, the number of visitors at a stand will not be limited, provided that a minimum distance of 1.5 metres can be observed. At the same time, the distribution of trade fair participants and flow of visitors will be monitored and, if necessary, regulated with suitable technical devices. The safety concept for the upcoming IDS also includes restricting the ticketing system exclusively to online tickets and fully registering all participants to ensure traceability. Koelnmesse will review the security concept on a regular basis and adapt it to the latest conditions accordingly. IDS 2021 sees the crisis as an opportunity to rethink its trade fair philosophy and adapt to requirements that will certainly be different from those prior to the corona pandemic. However, face-to-face encounters will continue to be essential for maintaining existing contacts and developing new business opportunities. Only then can joint solutions for crisis management be developed, existing business relationships secured and new business contacts forged. IDS 2021 is therefore designed as an open forum in order to facilitate precisely this form of exchange across borders for the international dental industry. AUMA, the Association of the German Trade Fair Industry, also views trade fairs as an indispensable catalyst for economic development. In this regard, AUMA Chairman Philip Harting had this to say: "Trade fairs will once again provide impetus for purchasing and procurement in many industries through the presentation o f i n n o v a t i o n s a n d p e r s o n a l t r u s t - b u i l d i n g communication." IDS (International Dental Show) takes place in Cologne every two years and is organised by the GFDI Gesellschaft zur Förderung der Dental-Industrie mbH, the commercial enterprise of the Association of German Dental Manufacturers (VDDI) and is staged by Koelnmesse GmbH, Cologne. Endodontist highlights tactics ... Continued from page 6 He discussed that the primary endodontic treatments are performed to prevent or treat periodontitis. He said, "Before we start our primary endodontic treatment, we have to know how to predict the outcome. We have something that we called outcome predictors, which was introduced in the Toronto study, the famous Toronto study in 2006, whether there's pre-existing apical periodontitis, intraoperative complications, even if it's associated or not associated with apical periodontitis." While sharing many tips, Dr Mostafa highlighted that apical size preparation should be done within the recommended size. He said that "Excessive apical size preparation can never guarantee thorough cleanliness but will have a negative effect instead. Most of the cases it can decrease the fracture strength of the root." "Hence it is advised to remove tooth structure as little as practical," Dr Mostafa urged. Dr Anwar stressed that many dental professionals have their preference when they are choosing Master Apical File (MAF) size. It's an important step which is taken to the minor constriction (MC) of the apical foramen. Its diameter becomes the final prepared diameter of the canal at the MC. Dr Mostafa said, "In my experience, 26/04 as MAF is the perfect size in most of the canals; even severely curved ones. But the size of MAF can vary in large canals."
JULY-AUGUST 2020 Pakistan Edition DENTAL TRIBUNE 11 An exclusive interview with Dr Humayun Continued from page 4 deceased to their loved ones. Our goal is not to get fame. By the grace of Allah, I am an international consultant. I perform consultancy for two international organizations. It is very insignificant for me if someone demands fame all over the world. There are many organizations of forensic Odontology in America; there is an American Board of Forensic Odontology in Britain, there is the British Association for Forensic Odontology, also called BAFO. In the Royal College of London, Forensic Odontology has a separate chapter. Along with these, there is a division of ICRC (International Committee of the Red Cross) that look after forensic. I am their tutor for the past five years. I give lectures there. The science of forensic Odontology is given importance on a global level because it's a cost-effective science. After the training, a forensic odontologist can perform the same tasks that many machines cannot do and with very cheap tools like simple X-rays. I am mentioning here about identification processes. This is why dental identification is the quickest, affordable and reliable. In Interpol, there is a sub-committee on Disaster Victim Identification, and there is a chair available in forensic Odontology. I am a contact to that committee in Pakistan. By the grace of Allah, our standards are being monitored by all agencies. Since we are doctors, we are not technicians; we never felt the need to write 'scientist' before our name or get worried about writing 'Dr.' before our name. We are already blessed with respect by Almighty Allah. That's why those who need it, they talk about it. DTP: It is a general perspective that DNA testing is a better way forward than Dental Identification. Your views on this? HT: As I have mentioned before, as doctors, we have social acceptance. The DNA test is performed in the lab. You also know technicians do that lab testing. Technicians are called 'lab- tech' or 'DNA-tech'. These are very common terminologies. In America, just to elevate themselves, are referred to as 'Scientists'. You can look up the definition of a scientist. I won't talk much about it because I don't want to belittle anyone. My only purpose of coming here was to handover the deceased to their loved ones for which Allah has given me success for my efforts and those who have created obstacles in these tasks or they are questioning; I rest their case to Allah. As far as the authentication of Forensic Odontology is concerned, I request all of you to look up the website of DVI (Disaster Victim of Identification) of Interpol, DVI website which can be shared. It's written in English there are some steps mentioned in it. Kindly read them, and I request to go through it, 2-3 times. You will get an idea that DVI process, Disaster Victim Identification Process, the importance of dental identification. The Law of Universe is to use that science which is more cost-effective. If you try to shoot an ant with a cannon, then no one will call you smart even if you have a specialist for that in the country. The collection of dental data is no big deal. We initiated the dental data registry, last year, in 1st UHS Dental Conference. Our Vice-Chancellor in University of Health Sciences (UHS), D r J a v e d A k r a m , u n d e r h i s chairmanship. But since no response was given from the Government authorities, we were unable to work. Our mission was to compile the National Data Registry that can have verified data in case of such incidents through which we can identify people instantly, and not much funding has to be done for that. Not like billion of rupees because people here take billions of rupees just for their salary. We can work within the salary of a doctor or as a specialist. Then there is training for the people who are involved in it. We don't have to go anywhere else internationally. England, America, Australia etc. are provide training for this. I am also planning to initiate practice in Pakistan. The department is under in process, and we will start as soon as possible but to say that dental identification has no worth is not valid! DTP: What is the importance of identification? HT: Identity is essential. If we don't have a character, then nothing can work in society. Identity is a fundamental human right. United Nations and the Geneva Convention h a s m e n t i o n e d t h i s w i t h o u t identification; no human body can have a death certificate issued. Without the issuance of the death certificate, many issues can arise, like claims, re- marriage, distribution of properties. The death certificate cannot be released without identity. Look, as far as emotions are c o n c e r n e d , b e i n g a f o r e n s i c professional and a doctor, I have to focus on my work. I won't be able to perform if I involve emotions. Secondly, administrator issues are always there. But, I am thankful that I am provided with certain things like I was presented with the Mobile hospital from Sindh Government. At least, my team and I were given a clean space to work in, but since its placement was above ground level. We were facing trouble to shift bodies, up and down. Police gave us security and looked after us well. PIA, PDMA, N D M A , S i n d h G o v e r n m e n t ' s Rehabilitation Department, the people from these departments were also working with us. But it is such a tedious process. As I have said earlier, I will write a detailed report on the problems faced and their possible solutions. I believe that my Vice- Chancellor has already planned a lot of things within these couple of days. We soon, through the platform of the University of Health Sciences will give a piece of excellent news. DTP: What is the scope for Forensic Odontology for young dentists? HT: See, the profession of medicine is very noble, and in my personal opinion, only those should opt who from the very start doesn't have the desire to earn big financially. Dentistry, all over the world, its demand, its value, its scope is excellent. We also need to change our attitude somewhat. Attitude towards the profession needs to be replaced. Students usually ask me, 'what is the scope of Forensic Odontology in Pakistan?' To be honest, I disgust this word 'scope.' My response to them is that it's the very same scope that dentistry has. Ten years back, when I came back to Pakistan, I was also mocked. I was also called 'rich spoilt guy.' I, later on, got appointed in Government services. I kept on working in it. I never asked in the very same Government job. Allah put my services into many tasks. Hard work is under your control. The result of which is under Almighty Allah's command. This questioning of scope from others according to me, this very question is wrong. If you are not practising in dentistry, then you might do something else. If you are not doing clinical after graduating, you will opt for some other field. See, the thing is that I am not an 'Astrology Guru' that I can tell you about scope. Why don't we have trust in Allah's plans? Being a Muslim, why do we forget this that the things written in your fate, will ultimately come to you. The rizk written in your destiny cannot be given to someone else by Allah. My advice to all young dental students is to make your basics secure and then opt for specialization. New graduates should spend 2-3 years in Private or Government clinical practice so that they can get hands-on exposure with patients, and then move towards specialization and decide. The advantage of which will be your vision will be broadened, and your observational skills will develop. DTP: Do you think that Dental Identification is suffering due to lack of Administrative infrastructure? HT: Yes, very much. Unfortunately, people here have an identity crisis, and they get scared. I have my jurisdiction. I am not a DNA expert. Neither have I worked in DNA technology nor a technician. I am just a doctor. I don't go beyond my jurisdiction, and as a true professional, I don't call any science wrong, since I have my training. Now such people who have spent their lives in lab testings and have started their life as a technician because PhD programs are offered in lab technology etc. It doesn't make you a doctor. Yes a PhD doctor, for sure, but the status enjoyed by us can never be same for them. My suggestion to the concerned authority is that we should form the Disaster Victim Identification (DVI) unit in Pakistan at the earliest, in which people of various specialities will be included related to the identification. Such groups are all over the world, UK DVI, DVI Italia, Australian forensics, there are so many. Our neighbouring country, Malaysia, developed one after the Tsunami. We need Pakistan DVI unit and since I am trained and know how to manage that DVI unit, how to operative administratively, my master's program project was on DVI protocols and we can do this. We don't need massive funding. We don't need that much for this. We don't need crores! Equipment is required in this, but they are not much expensive. This system is somewhat already present but to bring them on one page and to form central command and control centre, that is very important. This is what the DVI unit does. It is inactive and then gets active, suddenly and streamline things, all by itself which can make things a lot easier. DTP: Your special message for our readers? HT: Disaster Victim Identification, Pakistan is the future. All the dental surgeons and citizens have to work collectively on this. We have to save our dental record, and I hope that we will get successful in forming National Dental Registry soon and we wouldn't have to opt for expensive techniques, by the will of Almighty Allah. We will quickly become capable of that. I request you all to pray. Thank you very much.