DENTAL TRIBUNE The World’s Dental Newspaper · South Asia Edition Published in India www.dental-tribune.in 08/20 Dental tourism Patients pack bags as dental tourism resumes A tribute A tribute to Dr B S Bagi: A pioneer in forensic odontology & medicolegal research in India ” Page 02 Why Nano−Dexa Editorial on Dexamethasone: Why Nano−Dexa formulations are the need of the hour in Covid times ” Page 03 Consensus guidelines EFP publishes first international consensus guidelines for periodontitis treatment ” Page 05 ” Page 06 An Epidemiological Perspective of COVID-19 in India – Dr. Riddhi Babel (PhDc, MPH, BDS) a high vulnerability in mega- urban slums, and the major socio- economic divide which pushes up the community transmission rates. Simultaneously, the low death rate could be misrepresentative of the ground reality. The present- day case fatality rate (CFR) of India stands at 3% and this measure conveys the burden or the severity of the disease . However, it does not assign the true risk of mortality since there might be individuals with mild symptoms, along with asymptotic cases as well as cases that have been misdiagnosed. All these factors pose a major challenge to an accurate estimation of CFR. At present, the testing curve of India is flattening with the number of the average daily tests corresponding to 1 per 100K people . Additionally, the country lacks considerably when it comes to having a centralized death registration system. Besides, the test required to confirm death due to COVID-19 is not easily accessible for everyone. Testing data helps us with the proper interpretation of confirmed cases and deaths. The positivity rate, the number of confirmed cases are the key metrics that would give us an improved understanding of COVID-19 in the country as testing competencies increases. India rate of testing enough At this point in time, the is positivity 8.73% which is another way of determining if the government is individuals . The positivity rate is a ratio of all positive test to the total tests conducted and is one of the indicators of testing capacities of territory. Currently, Maharashtra, Delhi and Tamil Nadu have one of the highest positivity rates of roughly about 20% to 25% respectively leading to a fear of a higher number of any There is an urgent need to ramp up the testing. According to WHO guidelines, before easing social distancing measures, a positivity rate of less than 5% should be observed for a minimum period of 14 days. (Photo: Daniel Twal from Pixabay) by Dental Tribune South Asia It is essential to observe a downward trajectory of cases along with low positivity rate for the successful reopening of the different parts of the country. Investment in the public health system by the government and trust in public health experts is fundamental in India’s fight against this virus, writes Dr Riddhi A. Babel (PhDc, MPH, BDS), PhD candidate at Rutgers School of Public Health Epidemiology Coronavirus disease (COVID- 19) is an ongoing global pandemic that originated in Wuhan, China in, December 2019. As of June 29, 2020, more, then 10 million individuals have been infected with severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) and approximately 500,000 deaths have been reported worldwide . Currently, India is the fourth worst-hit country in the world after the United States, Brazil, and Russia with almost 500,000 cases, confirmed number of thereby disproportionately burdened by roughly two-thirds of the load of the South-East Asia region’s cases. A country with a population of 1.3 billion, India had instituted one of the harshest lockdowns by ramping up efforts early on to control the spread of the disease. The primary reason for this lockdown was to delay the onset of the peak of the disease thus enabling the healthcare facilities to better prepare for the situation in light of the global shortage of essential commodities. However, the alarming spike in the recent number of cases across different regions specifically Mumbai, Delhi, and Gujarat, has been disturbing. One of the several explanations could be the migrant worker crisis where workers returned to their hometowns on foot or crowded buses and trains which could have been mitigated had the country undergone a planned lockdown. India is particularly vulnerable due to its high population density, cases going undetected. Mumbai is considered the epicentre of this epidemic in India. A high rate indicates that the test coverage is narrow since they are being conducted only among individuals who are seeking medical attention and thus there is an inherent bias. Thus, there is an urgent need to ramp up the testing. According to WHO guidelines, before easing social distancing measures, a positivity rate of less than 5% should be observed for a minimum period of 14 days. It is essential to observe a downward trajectory of cases along with low positivity rate for the successful reopening of the different parts of the country. Therefore, there is a necessity for more robust testing and these tests should be scaled to the size of the outbreak in order to effectively identify new cases and respond to the pandemic through contact tracing, isolation of new cases, and treatment. of the The primary mode of transmission SARS- CoV-2 that causes COVID-19 is through respiratory droplets between people who are in close contact with each other. Thus, in the absence of any potential treatment, this infectious disease has changed the future course of dentistry due to the specificity of its procedures with dentists facing unique challenges and outlook during this crisis. Dental practices should find a balance between urgent and non-emergent services to patients. The practice of dentistry involves the use of handpieces, ultrasonic scalers, and rotary there instruments. Currently, are no research studies that have been able to assess the risk transmission during of virus dental practice, however, the virus has been shown to persist in the aerosol for hours . This delivering definitely demands additional precautionary measures to be implemented in dental settings. checks, isolation, mouth According to the Centers for Disease Control and Prevention (CDC), dental offices should ensure proper ventilation to promote air circulation along with usage of portable HEPA air filters, prescreening of patients, temperature rubber dam rinse before dental procedures, use of anti-retraction handpiece and protective gears. In addition, should mandatorily dentists employ four-handed dentistry when using ultrasonic devices, and two-before-and-three-after hand hygiene during this period. At this time, there have been no known COVID-19 clusters attributed settings anywhere in the country. The current need of the hour is the promotion of teledentistry and integration of oral dental records with medical health records as a public healthcare initiative for a sustained coordinated effort to control the virus transmission. simultaneous to dental in Due to the unprecedented nature of COVID-19, to restrain the continued spread of the India, preventing disease the spread of misinformation and educating individuals with awareness programs about the calamity of this disease is critical in the absence of any evidence- based intervention. Area-specific closures and patchwork lockdown in conjunction with periodic risk assessments of the rolled- back public health measures, scaled-up testing programs, and identification of hotspots must be undertaken. It is also imperative to make the data easily findable, available along with its detailed descriptions for easy comparison
2 News with different countries and on a regular basis. In conclusion, investment in the public health system by the government and trust in public health experts is fundamental in India’s fight against this deadly virus. References: 1. WHO. 20200629-COVID-19- sitrep-161. 2020. 2. Johns Hopkins University & Medicine. Mortality Analyses - Johns Hopkins Coronavirus Resource Center. 2020. 08/20 Author: 3. Johns Hopkins Universit & Medicine. How Does Testing in the U.S. Compare to Other Countries? Johns Hopkins Coronavirus Resource Center. pdf. 2020. - 4. Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci. 2020;12(1):9 Dr Riddhi A. Babel candidate Dr Riddhi A. Babel, PhDc, MPH, BDS is an Epidemiology PhD at Rutgers School of Public Health. She currently interns at New Jersey Department of Health (NJDOH) as a Health Data Specialist tasked with the development of an HIV epidemiological profile for two counties specifically, in NJ. Besides this, she is also a course instructor over the summer session at Rutgers SPH. She graduated with an MPH from the prestigious Johns Hopkins Bloomberg School of Public Health. Right after, she did an internship with World Health Organization (WHO) in Health Emergency Information and Risk Assessment (HIM) department at the Regional Office for Africa, where she was responsible for media monitoring and analysis, production of risk assessments outputs. Her primary research interest is focused on assessing the regional differences of HIV infection among MSM experiencing and discrimination and to understand the intersectionality of different public health frameworks of multiple social categories. stigma Patients pack bags as dental tourism resumes by Jeremy Booth, Dental Tribune International LEIPZIG, Germany: No international tourism means no dental tourism, but what does that mean for the patients and dentist who rely on it? When borders began to close around the world in March owing to the SARS-CoV-2 pandemic, tens of thousands of dental patients had treatment abroad either cancelled or postponed. As borders begin to reopen, those travelling for medical treatments are being welcomed with open arms. their travel Dental tourism is a major contributor to medical tourism, and both are big business. In the US alone, around 1.4 million residents annually to countries such as Mexico, Costa Rica, Israel and Thailand to receive medical treatment, and dental treatments are estimated to account for around 70% of these trips. Speaking to Newsweek in April, Josef Woodman, CEO of medical tourism operator Patients Beyond Borders, said: “It’s safe to say that at least 100,000 patients cancelled their medical or dental trips in March, with some 500,000 cancellations on the horizon through [to the end of September] 2020.” in Dentists Hungary welcome tourists from across Europe In Europe, where travel restrictions between countries have eased, dental tourism to popular destinations such as Hungary and Croatia is starting to resume. Firstmed Services is a dental tourism operator that has offered treatment in Hungary to visitors from Austria, Germany, Some dental tourism destination countries are reopening their borders and patients are eager to resume or end their dental treatment as soon as possible. (Image: Maridav/Shutterstock) Italy and Switzerland and for over 20 years. The company’s founder and CEO, Eszter Jopp, According to Eszter Jopp, CEO of Firstmed, the patient experience for dental tourists to Hungary remains largely the same. (Image: FirstMed Services) confirmed to Dental Tribune International that treatments in Hungary had resumed. “Dental treatments have been taking place at our partners’ offices in Hungary since the opening of the border on 7 June,” she said. “Dental patients from Germany can travel to Hungary for dental treatment again. Swiss patients have been allowed to enter Hungary without any restrictions since 19 June. All our patients now want to continue or end their dental treatment as soon as possible,” she added. Jopp said that she had been in constant dialogue with the company’s patients and partner dentists since the start of the health crisis and that patients were able to begin their treatment when necessary at partner clinics in Germany. She said that the company’s partner dental clinics in Hungary have strict guidelines in place: “We have published extensive COVID-19 service information on our websites for our patients from the beginning of the pandemic. This way, our patients always knew what the current status was, and when their dental treatment could take place.” considerable “We were also in regular contact with our partner clinics in Hungary. Of course they had financial losses, but at least they were able to treat their Hungarian patients,” Jopp continued. She explained that one of Firstmed’s partner clinics—Cosmodent in Budapest—made use of the closure period to relocate to larger offices so that it could increase capacity and more easily comply with physical distancing measures. Another—HD-Dental in Mosonmagyaróvár—used the time to make its clinic safer by air-sanitising equipment. installing According to Jopp, the patient experience for dental tourists to Hungary remains largely the same. “Until this point, there has not been much of a difference for patients travelling to Hungary for treatment compared with the time before COVID-19. The interest is as great as before. Patients want to travel to Hungary for cheap dental treatment to save money. Only the journey is currently more arduous—there are currently fewer flights and hotels open.” Thai regulations may be future of dental tourism and tourists Medical seeking plastic and cosmetic surgery procedures fertility treatment will be some of the first tourists to be allowed to visit Thailand when it reopens its borders to tourists on 1 August. These patients must arrive by air and will be required to show proof of a SARS-CoV-2-negative result of a test taken within 72 hours of arriving in the kingdom. They will also be tested for the virus during and after the course of their treatment and will be required to make their own arrangements for a 14-day quarantine period. Around 30,000 travellers have requested entry into Thailand for the purposes of medical tourism. those Dental tourists were not included on the list of first entrants, but coming from countries which have been successful in handling the pandemic are expected to be allowed to visit the kingdom as general tourism resumes. Tourists from Japan, China and South Korea could be among the first groups that will be able to visit Thailand for tourism purposes, according the Bangkok Post. to
3 News 08/20 A tribute to Dr B S Bagi: A pioneer in forensic odontology & medicolegal research in India by Dental Tribune South Asia ii) Medicolegal jurisprudence & Dr Baburao S Bagi (B.D.S, L.L.M) - a pioneer in Forensic Odontology and Medicolegal Research in India, left for his heavenly abode last week. Here is a heartfelt tribute to Dr Bagi from Dr Sameer Patil, Principal, Sinhgad Dental College and Hospital, Pune who had, in the early years of his career, had a close association with Dr Bagi. Dr Baburao S Bagi (B.D.S, L.L.M) served as an honorary teacher to the Forensic Department, KLE Society‘s Jawaharlal Nehru Medical College & Hospital, Belagavi (1972-1985). He was also an honorary teacher in the Dept of Oral Pathology at the KLE ‚S Institute of Dental Sciences, Belgavi (1986 - 1997) Forensic Odontology Dr Bagi was one of the pioneers in and Medicolegal Research in India, well known for his phenomenal work several national & international scientific publications for over 4 decades. He was also Orofaical Medicolegal Expert & Advocate judiciary Compensation for for Orofacial Assessment in Road Traffic Accidents. Dr Bagi has authored & published two books i) Scientific Basis of Human Dental forensic Odontology. Dr B S Bagi - A Profoundly Different Personality... Zara Hatke types! It is with a sense of grief I am writing this about a person who was so passionate in everything he did. I remember him as an honorary teacher who taught us Dental Anatomy as well as Medico-legal issues, Ethics in Dental practice and Jurisprudence and Forensic Odontology. How relevant are these fields today! It only goes to remind us how ahead of times was he to have the expertise to teach these 30 years ago. I really am not sure whether or not he received any remuneration for the classes he conducted for us as he did for our senior batches as well as many junior batches after us at the then KLES‘ Dental College, Belgaum. This was in the late ‚80s and early ‚90s of the previous millennium. God! I‘m feeling old now. „Bagi Sir“ as we addressed him, was a towering personality, a tall and solidly built individual with an equally strong booming voice...definitely none would miss this personality even in a crowded place. Add to this was an interesting sense of dressing, so typically his hallmark that you just cannot forget such personalities. I still remember that day when I had just finished my MDS in Orthodontics at KLES‘ Dental College, Belgaum, he had sent a message asking me to meet him at his clinic. I was quite pleasantly surprised when he asked me if I would be interested to start consulting in his clinic for Orthodontic cases. It was my first offer for Consulting and I had gladly accepted it. And it was during these few years of my interaction, I confronted a person so very different from all the notions and perceptions we carried about him as a person. It was definitely a revelation to me then to note how humble he was! A quality individual, a concerned dentist, an empathetic doctor and more importantly a great human being. Apart from his bachelor‘s degree in dentistry, he had a qualification in law and had undergone speciality training in Forensic Odontology. It was at his persistence, I became the Founder Life Member of Indian Association of Forensic Odontology. He was also a very active member of Indian Dental Association of Belgaum Branch and served in varying capacities including as a President. He was active the Karnataka State Chapter of IDA as well and was a the in A tribute from Dr Sameer Patil (Principal, Professor and Head of Orthodontics and Dentofacial Orthopaedics, Sinhgad Dental College and Hospital, Pune) very good organizer of conferences and Scientific meets. A very versatile individual... indeed he was! He had a typical practice, with mostly patients from nearby villages thronged his clinic. And they used to carry their produce from the farms to supplement any shortage of money they had towards treatment, which Dr Bagi whole-heartedly accepted knowing their inability to pay. Overall, human being that he was...he has raised great a a wonderful Son, Dr Manish, another wonderful, down-to-earth, extremely polite and well-behaved followed his kid who father‘s footsteps to become a Dentist himself. All these memories are flashing by and I can see him gleaming and flashing a beaming smile as usual. Heaven can be the only place for such souls. Words are failing me now as I say „Om Sadgati Bagi Sir“ Dr Sameer Patil (MDS) Ad Relax your patients and make them feel more comfortable during dental procedures Matrx Nitrous Oxide and Oxygen Conscious Sedation Systems There are many good reasons to use nitrous oxide sedation in your dental practice: • Safe - N2O/O2 has been used globally for over 100 years • Relieves patient anxiety and discomfort • Patients remain awake, yet more relaxed, making it an excellent patient management tool • Improves patient experience, resulting in return visits Matrx is made in the USA 210 Udyog Mandir 1 7-C Bhagoji Keer Road Mahim West, Mumbai 400016 India Phone: +91 22 61 46 47 48 Email: firstname.lastname@example.org www.lifecare.in
4 News 08/20 US dentistry teeters toward recovery by Jeremy Booth, DTI the steadily continued NEW YORK, U.S.: Dentists in the U.S. are seeing more patients despite and alarming spread of SARS-CoV-2 within the country. In the same week that the daily number of new confirmed cases of COVID- 19 40,000, analysts at Baird Equity Research found that patient volumes had increased by an encouraging rate. The analysts said that this suggested that the rising number of infections in the U.S. was not currently impacting the recovery of its dental market.. topped Baird has been surveying U.S. dentists on a weekly basis since the SARS-CoV-2 pandemic began to affect dental care in the country in mid-March. In its 16th survey, conducted on June 25, analysts found that countrywide patient volumes had improved to -28% of what they were in the same week last year. This represented an increase of 6.2 percentage points on the prior week, and an increase of 50.0 percentage points compared with the results of the weekly survey that Baird conducted on May 7, which found that patient volumes across the country were 78% lower than they had been a year earlier. The lowest patient volumes recorded by Baird so far were in its April 9 survey, which found that dentists across the U.S. had seen a staggering patient decline of 80.5%. to -33% from In the June 25 survey, the increase in patient volumes was driven by dental practices in the New England and Middle Atlantic regions, where patient volumes increased -54% in the prior week. In the South Atlantic region, patient volumes increased to -17% from -26% in the same period. “We consider these improvements encouraging as they not only reestablish momentum for the broader domestic demand recovery, but also seem to suggest rising COVID case counts in some states aren’t yet impacting dental’s domestic recovery,” the analysts wrote. But more U.S. dental practices may be closing their doors to elective procedures as a result of the resurgent infection rates. The June 25 survey found that 8% of dental offices across the country Against a backdrop of resurgent SARS-CoV-2 infection rates, more U.S. dental clinics appear to be closing their doors but patient volumes are increasing. (Image: G.Tbov/Shutterstock) that were closed for general dental care, up from 4% on June 18. The analysts emphasized this increase was within the survey’s approximate ten point margin of error, but commented that “we are tempted to believe this jump from 4% to 8% of all domestic offices in our survey being closed this week might reflect the rising COVID case counts.” The 4% closure figure from the June 18 survey had been a significant improvement on the 12% of dental offices that were closed in the prior week. One month before that, the figure was 55%. Physical distancing in dental clinics cuts patient numbers The 28% drop in patient volume currently being seen in U.S. dental clinics may partly be a result of the physical distancing measures that dentists are taking to protect themselves and their patients. The extra time needed between patients means that clinics are making fewer appointment slots available, and not all of these slots are being booked. An average of 13.1 appointment slots were being offered per day per dentist, Baird found, which constituted around 60% of a normal, pre-pandemic daily appointment schedule for U.S. dentists. The latest survey showed that 70.5% of these available appointment slots were being booked by patients, up from 65.9% the week before. “We believe this, along with a few of the other data points highlighted earlier […], suggests rising COVID case counts across the U.S. aren’t yet having a noticeable impact on patient visits,” the analysts hypothesized. dentists participated in the latest survey, and 93% of them were general remaining dentists 7% were specialists. Of the respondents, 54% worked in a single-doctor practice and 46% in a multidoctor practice. Ninety-one and the Ad PRINT EVENTS EDUCATION DIGITAL SERVICES Dental Tribune International The World's Dental Marketplace www.dental-tribune.com
6 News 08/20 EFP publishes first international consensus guidelines for periodontitis treatment by Dental Tribune International BRUSSELS, Belgium: In 2018, the European Federation of Periodontology (EFP) released a new global classification system for periodontal health, diseases and conditions—the outcome of a joint workshop held by the EFP and the American Academy of Periodontology the previous year. Following up on this, the EFP has now released an evidence-based treatment guide for periodontitis, with the aim of improving periodontal treatment throughout Europe and beyond. has the most inflammatory common As chronic non- communicable disease across the worldwide population, periodontitis been associated with a range of systemic conditions, including cardiovascular disease, diabetes and certain types of cancer. According to the EFP’s new treatment guidelines, it is also estimated that, annually, patients Profs. Mariano Sanz (left) and Iain Chapple, two of the co-authors of the European Federation of Periondontology’s new treatment guide for periodontitis. (Images: EFP) spend approximately US$54 billion across the globe on direct treatment of periodontitis. The EFP’s new guidelines provide a step-by-step approach to the treatment of periodontitis ranging in severity from Stage I to Stage III. According to the organisation, a separate guideline covering the treatment of Stage IV periodontitis will be published at a later date. in To formulate these guidelines, a panel that included dental professionals representing each of the 36 national periodontal societies the EFP was established. Other stakeholders from Europe-based scientific societies supported the panel throughout the process, along with relevant experts from the US. Ad they “Successful of other inflammatory conditions including diabetes,” said Prof. Mariano Sanz, a co-author of the guidelines, in a press release from the EFP. “These guidelines outline how to manage this disease, since in the early stages its treatment is straightforward, and the consequences are minor.” [periodontal] treatment transforms people’s lives: become more confident, smile, and go out more,” added fellow co-author Prof. “After successful treatment, patients who take control of their oral health and lifestyle can halt periodontitis in its tracks and keep their teeth for life,” he said. The paper, titled “Treatment of Stage I–III periodontitis—the EFP S3 level clinical practice guideline”, was published online on 27 July 2020 in the Journal of Clinical Periodontology. Iain Chapple. In the guidelines, four sequential steps for periodontal therapy are proposed: 1. guiding behavioural change in the patient to reduce periodontal inflammation, along with professional removal of supragingival biofilm and calculus; 2. professional cleaning of subgingival biofilm and calculus, with additional if needed; therapies 3. more complex treatments, such as repeated subgingival instrumentation and potential surgery; and 4. long-term supportive periodontal care, supplemented by regular check-ups and good oral hygiene. “Periodontitis is a devastating condition which leads not only to pain and soreness in the gums, but also to chewing problems, unpleasant changes tooth length and position, poor self- esteem, withdrawal from social activities, and an increased risk to Ad NOW OFFERING SPECIAL 20% DISCOUNT Belmont leads the way with totally new generation of dental treatment centre. (*Exclusive of Taxes. Terms and Conditions apply.) Exclusive Distributor in India: LifeCare Devices Private Limited T: (022) 6146 4725, 6146 4727. E: email@example.com l Mumbai l Delhi l Bangalore l Kolkatta l Chennai l Pune l Ahmedabad l Madurai l Hyderabad l Chandigarh l Lucknow l Jaipur l Vijayawada
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