DENTAL TRIBUNE The World’s Dental Newspaper · South Asia Edition Published in India www.dental-tribune.in 07/20 Post-Covid world For the young dentist: 5 steps to stand out in the post-Covid world through strong online branding Dental aerosols Clinical use of Chlorine dioxide in the prevention of coronavirus spread through dental aerosols. ” Page 03 A pioneer Dr Hirji Adenwalla – a pioneer in cleft surgeries in India, a great humanitarian and visionary SARS-CoV-2 Safer dental clinics are just a swab away: Testing patients for SARS-CoV-2 ” Page 04 ” Page 06 ” Page 07 Oral health matters! The Lancet first ever commission on Oral Health across the world have been appointed as Commissioners on the first-ever LCOH. LCOH will be co-chaired by Colombian public health dentist Dr Carol Guarnizo- Herreno and UK’s Prof. of public health dentistry Dr Richard Watt, who also is the Director of WHO’s Collaborating Centre on Oral Health Inequalities. Key Priorities of Lancet’s Commission on Oral Health: and minimising environmental impact. 4. Commercial Determinants Highlight and expose the influence of industry and profit motives on all aspects of oral health including education, research, service delivery and policy and develop appropriate means of minimising this influence and improving the transparency of industry relationships with oral health stakeholders. 1. Governance and Advocacy Background of Lancet Oral for Global Oral Health Health Series: Explore best practices to raise the political and policy profile of oral health and integrate oral health within the wider health policy and development frameworks. 2. Equity, Social Justice and Lancet’s series published on 18th July 2019 on Oral health argued that it has been isolated from traditional healthcare and health policy for too long. It called for greater prominence of oral health on the global health agenda campaigning for Non- Communicable diseases (NCD’s) and Universal Health Coverage (UHC). Key Messages: 1. Despite being largely preventable, oral diseases are a major global public health problem. Most prevalent oral diseases globally are untreated dental caries in deciduous as well as permanent teeth, severe periodontal disease, complete tooth loss and cancers of the lip and oral cavity. 2. Most prevalent Oral Diseases worldwide (2010) Dr Robert Weyant DMD, DrPH Pittsburgh Univ. School of Dental Med Oral Health Canada Dr Paul Allison OMFS, DrPH, PhD Canadian Academy of Health Sciences Canada Dr Mary McCallum DMD Private Dental Practice UK UK UK Brazil Brazil Brazil Dr Blanaid Daly MSc DPH, PhD Dublin Dental University, Ireland Dr LD Macpherson Dentist + MPH+ PhD University of Glasgow, UK Katie Dain MA (SOAS), London CEO, NCD Alliance, London Dr Roger Celeste PhD (Epidemiology) UFRGS Dr Marco Peres PhD (Epidemiology) Griffith Univ., Queensland, Australia Dr Aluisio J Barros MD, PhD University Federal de Pelotas (UFPel) South Africa Dr Lekan Ayo Yusuf PhD (Health Educn) Deputy VC, SM Health Science Uni South Africa Dr Usuf Chikte Msc DPH + PhD Stellenbosch University, South Africa France Dr Benoit Varenne PhD (Epidemiology) NCD Department, WHO Netherlands Dentist Stephan Listl PhD (Economics) Radboud University, Netherlands Hong Kong Dr Judith Mackay Medical Dr. Hong Kong University (HKU) Kenya Dr MW Muriithi BDS +MPH Ministry of Health, Kenya Australia Dr Sharon Friel MSc, PhD Australian National University (ANU) Japan Fiji Dr Manabu Sumi Medical + PhD Ministry of Foreign Affairs, Japan Dr Leenu M MDS (Orthodontics) Private Group Dental Practice Colombia Dr Gina Watson MBBS + MPH Country rep of WHO/PAHO in Ecuador Develop improved evidence- based monitoring systems to assess oral health equity, review evidence of the effectiveness of interventions to reduce oral health inequalities and inform policy development to promote oral health equity. 3. Health System Reform, Governance and Transformation Provide evidence to support policymakers to develop robust and resilient oral healthcare systems across the globe including resources, human payment integrated delivery systems, models, relevant technology The Lancet in early 2020 established a Commission on Oral Health. A Lancet Commission is a scientific review, inquiry and response to an urgent and often neglected or understudied health predicament. Importance of the Lancet aim to achieve transformational change with a particular focus on policy or political action. Composition Lancet Commission on Oral Health (LCOH): of Commission Lancet Commissions are international, science-led, multi- disciplinary collaborations that 27 experts across clinical dentistry, research, policymaking, health and human rights advocacy from 16 countries academic SN. Nationality Name Education Current Organisation India India Dr Manu Mathur PhD (Epidemiology) Public Health Foundation of India (PHFI) Mirai Chatterjee MPH (John Hopkins) SEWA RURAL, Gujarat Thailand Dr Supreda A DDS Thai Promotion Health Foundation Thailand Dr Viroj T MD, PhD Ministry of Public Health Dr Habib Benzian DDS, MScDPH, PhD New York University Dr Cristin Kearns DDS, MBA Univ. of California, San Francisco (UCSF) USA USA USA by Dr Divyesh Mundra Last year, The Lancet Series aimed to get global oral health on global health agendas. On 25 June 2020, The Lancet announced that 27 experts across research, policy, advocacy & clinical dentistry from 16 countries will continue this work via a Lancet Commission on Oral Health. Dr Divyesh Mundra gives more details on the Lancet Health Commission and its plans. In July 2019, The Lancet published a path-breaking two- part Oral Health Series that highlighted the global public health burden of oral diseases affecting 34% of the population across the globe and the need for a radical reform of dental care systems, whose treat-over- prevent model has to combat the global challenge of combating oral diseases. failed In recognition of the global public health importance, woeful neglect of oral diseases and commitment to include global oral health within medicine and global health agenda, The Lancet in early 2020 established a Commission on Oral Health. What is the Lancet Commission? 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
2 News 07/20 caries a. Untreated in permanent teeth: Ranks 1st, affecting 35% OR 2.4 billion people b. Severe Periodontitis: 6th, affecting 10.8% OR 743 million people c. in deciduous teeth: 10th, affecting 9% of the global child population loss affects 2.3% OR 158 million people Lip and oral cavity cancers: Top 15 most common cancers in 2018 (IARC) d. Complete Untreated caries tooth e. 3. Oral diseases impose a economic burden families and individuals, substantial on societies. In 2015, oral diseases the US $ 357 accounted for billion in direct costs (treatment the US $ expenditures) and indirect costs 188 billion (productivity to absence from work and school) losses due in diseases 4. Personal consequences of chronic untreated oral diseases are severe and include unremitting pain, sepsis, reduced quality of life, lost school days, disruption to family life and decreased work productivity 5. Oral share common risk factors with other NCD’s which include tobacco use, harmful alcohol consumption and free sugar consumption. Of particular concern is the effect of free sugar consumption on the prevalence of caries, obesity and diabetes. Integrated public health policies needed to tackle shared common risks 6. high-tech 21st-century dentistry continues to adopt a treatment dominated, interventionist, increasingly and specialised approach to dental care. Such an approach has failed to tackle the global burden of oral diseases. Radical reform of dental care systems urgently needed 7. A preventive approach focusing on population-wide impact needed as the current individualistic clinical paradigm has failed to achieve sustained improvements in population oral healthy. 8. Provider payment systems should put more emphasis on incentivising prevention instead of rewarding restorative and interventionist dental care 9. A range of highly developed corporate marketing strategies is used by the global sugar industry to increase their sales and profits. For e.g. By 2020, Coca- Cola set aside the US $ 12 billion on marketing across Africa PepsiCo set aside the US $ 12 billion for marketing its products in India WHO’s total budget of 2017 was the US $ 4.4 billion Tighter legislation required regulation by and governments Dr Divyesh B Mundra is an analytical healthcare management professional. 10. Pressing need to develop a clear and transparent conflict of interest policies and procedures to limit the influence of the sugar industry on dental research and oral health policy. Author: Dr Divyesh B Mundra in Masters Health Administration (MHA) from the most reputed Tata Institute of Social Sciences (TISS), Mumbai. Since then, he is working for one of India‘s most innovative healthcare organisations (private hospital chain) based out of Bangalore, Karnataka. He is an avid reader and tweets daily on the Indian healthcare system. In 2015, oral diseases accounted for the US $ 357 billion in direct costs (treatment expenditures) and the US $ 188 billion in indirect costs (productivity to absence from work and school) losses due Researchers develop saliva-based SARS-CoV-2 test and examine COVID-19 prevalence among dentists by Dental Tribune International federal Saskatchewan S A S K A T O O N , Saskatchewan, Canada: Researchers from the University of (USask) in Saskatoon are currently working on two large projects that have recently received substantial funding. The first project is aimed at developing a novel saliva-based test for SARS-CoV-2 detection, whereas the second one aims to examine COVID-19 incidence rates among Canadian dentists. led by the University of Regina (U of R) in Saskatchewan and McGill University in Montreal, respectively, have secured $1.2 million (€1.1 million) in funding from the Canadian Institutes of Health Research. Approximately half of funding, over $550,000 (€445,000), will go to the researchers at the USask College of Dentistry and the USask Vaccine and Infectious Disease Orga n izat ion—Inter nat ional Vaccine Centre. The two projects, the The first part of the project will be led by Dr. Walter Siqueira, an associate dean at the USask College of Dentistry, in collaboration with Prof. Jun Yang of Western University in London, Ontario, and will focus on developing a new diagnostic test for the detection of SARS- CoV-2 peptides in saliva. “We expect that the accuracy of this test will be high because the peptide/proteins we are using is a marker for a specific SARS-CoV-2 antibody, whereas other tests often aren’t that specific” According to the researchers, the test has clear advantages over similar SARS-CoV-2 detection methods currently being used in research. For example, it is less invasive and more sensitive and yields results in less than 5 minutes. Additionally, the test will come at an affordable price and can conveniently be taken at home or in places that do not have health care facilities. to The prototype testing device will be similar in size to a cellphone and will include features similar those of pregnancy tests. Once the virus biomarkers combine with SARS- CoV-2 antibodies, an indicator will turn a certain color, thus indicating the presence of the virus in the saliva. “We expect that the accuracy of this test will be high because the peptide/proteins we are tests often aren’t using is a marker for a specific SARS-CoV-2 antibody, whereas other that specific,” Siqueira noted in a press release. “As well, other saliva-based tests are based on ribonucleic acid (RNA) which synthesizes proteins, but this test is based on proteins themselves, and since proteins last longer in the saliva than RNA, the virus is more detectable,” he added. Siqueira hopes that the test will also prove useful in detecting mild or asymptomatic COVID- 19 cases, since most of the tests currently in use are not able to do so. The saliva samples will be acquired from the Saskatchewan Health Authority and the Royal University Hospital, and the test should become available to the public by March 2021. A different part of the study is being led by a researcher from U of R, Dr. Mohan Babu, who is responsible for developing antiviral peptides that will block SARS-CoV-2 from entering or replicating human cells. Examining COVID-19 incidence rates among Canadian dentists In the second project, the researchers will collect saliva samples from dentists in Canada to determine the incidence rate of Dr. Walter Siqueira from the University of Saskatchewan College of Dentistry is the lead researcher in a study aimed at developing a test that identifies SARS-CoV-2 peptides in saliva. (Image: University of Saskatchewan) COVID-19 among dentists upon their return to the workplace. protect both the patients and the dentists.” “The close contact between dentists and patients, along with the use of aerosol-generating procedures, makes dental offices a potentially high-risk environment for the COVID- 19 transmission,” said Siqueira. “Now that dental offices are beginning they are infection control, treatment protocols and other procedures, but there is minimal scientific evidence to these measures. More information is needed to ensure we have evidence-based infection control guidelines that implementing support reopen, to that four weeks The researchers will collect saliva samples from 220 dentists every for one year. They will also distribute questionnaires contain COVID-19-related questions. The data will enable the team to accurately assess the potential risk of infection in dental offices, to determine the correct personal protective equipment that should be used in dental settings, and to identify appropriate infection control measures in order to ensure the safety of patients and staff.
3 News 07/20 For the young dentist: 5 steps to stand out in the post-Covid world through strong online branding by Rajeev Chitguppi, Dental Tribune South Asia Dr Kumar Anshul (BDS, MBA), who has leveraged social media & personal branding to his advantage at multiple times during his professional journey, gives tips for the young dentists on how they should establish their brand using some of the best tools available online. “The world accommodates you for fitting in, but only rewards you for standing out.”― Matshona Dhliwayo As we slowly come out of lockdown, we can’t help but wonder how exactly a post- coronavirus world will look like and how will it impact the day-to- day clinical practice of a Dentist. Though not all dental procedures are ‘elective’ over an extended period of time (which means, sooner or later, an ailing patient has to knock the doors of a dental practice), an average middle- class citizen will think twice before shelling out cash for treatment, thanks to the knee-deep recession perpetuated by mass-layoffs, job losses and reduced levels of production- all brought up by the pandemic. tax-paying This article discusses a few steps you should take, a few changes you should make in your lifestyle and a few skills that you should master to continuously pursue differentiation, make your online branding game strong, thereby standing out amongst the crowd. your dental groups Improving online presence is not limited to joining multiple on Facebook and discussing your cases there. Having a strong digital identity should be aimed at improving your brand equity and let the people in your vicinity know that you exist (and exist for good). Here are some handy tips. 1. Start collecting & documenting reviews/testimonials from patients You ensure should that is happy every patient who with the treatment leaves with a documented review/testimonial. These testimonials can be a gold mine later for your blog, website, promotional material & social media handles. There are multiple ways a testimonial depending upon the record/document to thought leader in Dentistry, you need to create a dedicated group of friends (i.e. fellow Dentists) and followers (i.e. prospective patients) over a period of time, who will vouch for your opinion and will spread the word about you. Thought leadership takes time (sometimes years); knowledge and expertise in the stream; a high level of punctuality & commitment (in creating & disseminating content). All your efforts in personal online branding should aim at making you emerge as a Thought Leader in Dentistry. Author: Dr Kumar Anshul Dr Kumar Anshul has ‘The Marketing Guy’ worn in different capabilities- hat as a freelancer during his undergraduate days in the dental school, as an entrepreneur, as a Marketing Manager for a bootstrapped startup, as a Marketing & Communication Manager for a leading Dental Equipment firm and finally as a Marketing Strategy & Communication Manager for one of the world’s largest Medical Device firms. He has social media & personal branding to his advantage at multiple times during his professional journey and lately has started one-to- one coaching to young Dentists on career development, personal branding & digital marketing through his Instagram channel:- https://www.instagram.com/ ansh_isb/ leveraged is BDS Dr Anshul from Manipal University and an MBA from Indian School Of Business, Hyderabad. In his free time, he likes to blog on www. kumaranshul.com and dabble in foreign language learning. For the Young Dentist: 5 steps to stand out in the post-Covid world through strong online branding: Dr Kumar Anshul feasibility & willingness of the patient concerned: - a. Video: A clear 30-60 seconds video shot on your smartphone will do the needful. You might want to do a few trial- runs before shooting the final version. b. Google Reviews: If your clinic is listed o Google, you should request the patient to write an online review on Google as well (in addition to the video testimonial) c. Post-It: Facebook Reviews: If your Facebook page is up & running (explained later), you can give the link of the review section (every Facebook page has a review section, the link of which can be shared to the patient) to the patient and request him/her to write a review d. of geriatric or paediatric patients, where it is difficult to get an online review, you can request them to write it on a simple Post-it. You can use the images of these Post-it reviews later in your online promotional material. Avoid using Visitor’s Book to get the review written as they can’t be used later for promotion on digital platforms. case In 2. Start building a mailing list Even before you start content creation and dissemination, you must start building a mailing list. As a rule, you should include the e-mail ids of your patients. Next would be to collect business cards from people around your vicinity (who can be your prospective patients) and get someone to manually add all the emails in your mailing list. Email Ids collected from these two sources can be used to build your initial mailing list which you can keep building in the future with the help of your website/blog & social media campaigns. You can use Mailchimp (Free for 500 emails) or Mailerlite to drive your Email Marketing. 3. Personal Blog Regardless of the fact that you have your own dental practice or you work with an institution/ organization, a personal blog will not only help you to put your thoughts in words, but will also put you ‘out there’. You can write about your experiences in Dental School, oral hygiene awareness, new advancements in Dentistry etc. Try to write on topics which targets the two most important segment- Prospective patients & fellow dentists. You can easily start a blog on Wordpress. For a more sophisticated design (without the knowledge of any programming language), you can use Wix or Weebly. Once your blog is up & running, you should move to the next step- registering your presence on major social media platforms. 4. Learn the basics of Social Media:- The three most viable social media channel on which a Dentist should be present are Facebook, Instagram and Linkedin a. Apart from your personal profile on Facebook, it is advisable to have a Facebook Page. The page should be named on your own name (for ex. Dr XYZ) if you want to share non-dental content on the page or your dental clinic’s name attached to your own name (for ex Smile Dental Clinic by Dr XYZ) in case you want to keep it exclusively for dental content. In case you are a consultant and don’t have your own practice yet, you can use a Generic name such as “Dentistry by Dr XYZ”. What is important is to include your own name & profile picture to push your own brand identity. b. Instagram and hence is more the visual-based best platform to share your clinical cases and pictures of your community participation, workshops, courses etc. Ensure you link your Instagram page to the Facebook Page so that you don’t need to post twice. Also, use proper hashtags to attract the audience towards your page. c. LinkedIn, by far, is the most professional social media platform. The best advantage of LinkedIn is that you can maintain your full professional identity & achievements at one place in your Linkedin Profile, which you can share it among your target segment. You can mention your education, description of your professional experience, certifications, patents, media releases etc. The new feature on LinkedIn also allows you content creation in the form of blog posts & videos. 5. Be a thought leader through strategic & continuous content creation Regardless of the platform, you use to create content, the trick is to have a well thought of strategy and timeline for creating content (blog posts, videos, social media posts etc) and following it rigorously. Hubspot has a free online course on Inbound Marketing which is strongly recommended to help you devise your content strategy. A thought leader is someone who is well-informed, opinionated and a trusted resource for his/her area of expertise. To become a
4 News 07/20 Clinical use of Chlorine dioxide in the prevention of coronavirus spread through dental aerosols. the prevention of transmission of disease? Coronavirus is known to be mostly present in the mouth and respiratory tract. Dentists can minimise the risk of viral load considerably by rinsing every patient’s mouth before they walk into the clinic and during their procedure. Chlorine dioxide can be used for the same. The EPA has set maximum concentration as 0.8mg/l for chlorine dioxide and 1.0 mg/l for chlorite ion.  researches have demonstrated that gargling with drinking water the incidence of upper respiratory tract infection. This very much coincided with the presence of 0.5 mg /l of chlorine which had been used to disinfect water. Japanese reduced The following study shows the use of chlorine dioxide in reducing virus load in aerosols. A cohort of 120 patients with chronic periodontitis was pooled in for a single centre; double-blind; three group parallel designed the study. The study aimed at studying the efficacy of commercially available pre-procedural mouthwash; chlorine dioxide mouthwash, water and 0.2% CHX Gluconate. The aerosol produced by the ultrasonic unit was collected from 5 locations in the mouth. The same was then smeared on blood agar plates and incubated at 37°C for48 hours to study the growth of CFUs. The result showed the number of CFUS to be drastically lower in patients that underwent mouth rinse with chlorine dioxide & 0.2% CHX Gluconate as compared to the water mouth rinse candidates. Also, CFUs drastically reduced in the plates with samples from the chlorine dioxide. However, their mean post-procedural CFUs were not very different. note Please Conclusion: Chlorine dioxide mouth rinse is found to reduce virus load significantly. in certain places chlorine dioxide is used for disinfection. Ogata found that the antimicrobial nature of chlorine dioxide is derived from its property of denaturing proteins present on virus cells. This involves the oxidation of certain amino residues majorly tryptophan and tyrosine present in the proteins.  further confirmed this theory by studying chlorine dioxide’s antimicrobial 2012, Ogata denaturation In Use of Chlorine dioxide in the prevention of coronavirus spread through dental aerosols. by Rajeev Chitguppi, Dental Tribune South Asia This article by Dr Anuj Gandhi and Malvika Gandhi reviews the literature available on the use of Chlorine Dioxide in dental clinics and makes a hypothesis as to why ClO2 is safe even in higher concentrations when added to the dental unit waterlines in order to minimize the virus transmission through dental aerosols. What is the current pandemic all about? Coronavirus disease/ COVID- 19/ SARS-COV2 is an infectious disease caused by a coronavirus. Infected patients show symptoms like temperature, cough, loss of smell, respiratory illness. They may do away mild symptoms without any special treatment. Patients of low immunity, aged or having a history of COPD, cardiovascular disease, diabetes cancer, are very susceptible and need immediate attention. Coronavirus spreads through infected patient’s saliva droplets and nose discharges. . What is chlorine dioxide (ClO2)? reddish-yellow Chlorine dioxide is a yellow artificially to manufactured gas. Chlorine dioxide is added to water for surface treatment and to make water fit for human consumption. When chlorine dioxide is added to water it forms chlorite ion which is also used to decontaminate water.  Chlorine dioxide is used in the pre-oxidation stage, wherein the ClO2 oxidizes the floating matter, bringing coagulation, prevents the growth of algae and bacteria (biofilm). Chlorine dioxide is active as a biocide for 48 hours in the water. about and Coronavirus dental threat Coronaviruses practice is present in saliva in par with levels found in nasopharyngeal samples. One patient’s saliva also showed virus till 11th day after being hospitalized. Thus, salivary gland cells are being studied in the role of virus entry, and progress of is highly available in the epithelial lining of oral mucosa making COVID 19 infections highest in the oral mucosa. infection. ACE2 Covid-19 spreads from one person to another. When an infected person sneezes, coughs or speaks the saliva droplets or nasal discharges get released in the air. These discharges are heavy and thus don’t travel far and settle down quickly on the ground or tables doorknobs clothes etc.  If a healthy individual comes across these droplets or breathe the air where the infected has sneezed or spoken, there are chances of COVID-19 to be passed on to the other. In a patient setting if a dental practitioner comes across a Covid-19 infected patient there are 100% chances of the dentist getting infected. In such a situation Dental practitioners are at great risk. How deadly is SARS COV2 Virus? The COVID-19 virus enters the human cells by binding to the host cell via their spike protein to angiotensin-converting enzyme 2 receptor (ACE2). Infected patients with SARS COV2 spread more viruses in their asymptomatic stage, and those in the later stages of disease shed it at a faster rate. The virus is studied to be more efficient in travelling more distance and becoming aerosolized . Higher viral loads have been detected in nasal passages and the upper respiratory tract of infected people, thus when such patients talk, open their mouth, sneeze or they emit out loads of virus. Similarly, regular dental procedures like ultrasonic scaling, airotor based procedures various infected aerosols. This increases the chance of infecting the doctor and their fellow practitioners. Also since the virus may settle on the chair the instruments the dental tray etc. the chances of disease transmission increase to other patients as well. produce A respiratory infection can be transmitted via various particles/ molecules: 1. Droplet nuclei: less than 5 mm(diameter)  2. Droplet: more than 5-10mm (diameter) 3. Aerosols: 50mm(diameter) less than 4. Splatter: more than 50 mm  microns enter the respiratory tract and particle below 0.1 microns like the coronavirus enter the bloodstream and start targeting organs of the body. When a virus gets into the air as aerosols during sneeze cough or dental treatments they can travel a long-distance and propagate secondary infection in the environment. These aerosols remain in the air and pose a threat to healthcare workers and contaminate surfaces. Viruses are contained in the following places for the specified duration. • Up to 72 hours on plastic and stainless steel surfaces. • Up to 24 hours on cardboard surfaces. • Up to nine hours on copper surfaces. • Up to three hours in suspended aerosols. One study showed that ultrasonic sterilization transmits 100,000 microbes per cubic foot with 6 feet of aerosolization and that microbes can last between 35 minutes-17 hours.  Covering these dangers to dentists/ healthcare professionals /patients; OSHA (OCCUPATIONAL SAFETY AND HEALTH ACT) released “Guidance Preparing Workplaces for COVID-19. on This document categorizes aerosol occupations production as very high risk, occupation.  with Nose filters out particles above 10 microns, particles below 10 So how can dentists minimise the virus load in their set up for
6 News 07/20 Dr Hirji Adenwalla – a pioneer in cleft surgeries in India, a great humanitarian and visionary treating a huge number of poor patients from all over India and surrounding countries. He went on to operate around 500 to 600c left cases per year for nearly 2 to 3 decades up to the age of around 90 yrs. He cared for the poor to an extent that he had a charitable account of his own. If ever he came across any poor patient he would give them the money to pay the hospital bills and operated on the patients free of cost. He was the one who got the Smile Train project to India and helped thousands of poor people benefit from cleft surgeries free of cost. After working for over 40 years and treating children with cleft problems, a new partnership was formed in 2001, when Jubilee Mission Hospital and Dr Adenwalla became Smile Train’s first Indian partners. Over the next 19 years, Smile Train helped the Charles Pinto Centre transform into a modern, multi- disciplinary hub of cleft care and training with Dr Adenwalla at its core. Under Dr Adenwalla’s guidance, the centre went on to cleft become one of India’s leading comprehensive training centres, which has been guiding young medical students coming there from all over India. An excellent teacher, highly principled professional, who never compromised on ethics at any point in time. Dr Adenwalla fought cancer in his seventies bravely and overcame it. Dr Adenwalla continued to perform at least four cleft surgeries per week till the day he passed away in that same small house on the Jubilee hospital grounds, which he and his wife had first moved into more than 60 years ago. Credits: 1. Dr Sachin Majati - Oral Maxillofacial Surgeon who worked under Dr Adenwalla‘s mentorship. Dr Adenwalla was the one who got the Smile Train project to India and helped thousands of poor people benefit from cleft surgeries free of cost. Ad Dr Adenwalla, the Smile Maker, put smiles on the face of more than 15,000 children by doing cleft surgeries, a lot of them free of cost. (Photo: smiletrain.org) by Rajeev Chitguppi, Dental Tribune South Asia Dental Tribune South Asia pays tribute to Dr Hirji Adenwalla - an eminent cleft lip and palate surgeon who passed away on 27th May 2020. The man, who was fondly called as the Smile Maker, put smiles on the face of more than 15,000 children by doing cleft surgeries, a lot of them free of cost. A highly inspiring story in times ofDr Hirji Adenwalla completed his medical education and specialization in surgery at Jerbai Wadia Hospital in Bombay and moved to Kerala, where he founded the Charles Pinto Centre for Cleft Lip and Palate at the Jubilee Mission Hospital, Thrissur in 1959. The centre was named in honour of his former boss. Although he excelled as a surgeon and gained massive respect from all around, he kept on thinking about serving the poor people in the area. In the late nineties, he shifted his focus exclusively into cleft lip and palate, in which he gained immense experience and started 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: email@example.com www.lifecare.in
7 News 07/20 Safer dental clinics are just a swab away: Testing patients for SARS- CoV-2 by Jeremy Booth, Dental Tribune International LANSING, Mich., U.S.: Allowing dental professionals to test their patients for SARS- CoV-2 would decrease the high risk of transmission of the virus in dental clinics. Furthermore, dentists in some jurisdictions are now being prevented from performing elective treatment if their patients have not tested negative for the virus. Dental Tribune (DTI) spoke with a Michigan State University researcher who has developed a point-of- care testing kit that would be suited to dental settings. International (MSU) Dentists in Japan now have authorization to take nose and throat swabs so that patients can be tested for SARS-CoV-2, and U.S. dental organizations have issued an urgent call to get testing kits into clinics throughout the country. As this story went to press, a mandate to restart elective medical care in Alaska effectively ruled out the broad recommencing of elective dental care because it stated that patients must return a negative test result for SARS-CoV-2 within 48 hours prior to a procedure that generates aerosols. The Alaska Board of Dental Examiners asked state regulators for dentists to rely instead on strict patient screening protocols, but this was rebuffed by the state’s chief medical officer, Dr. Anne Zink. “It’s increasingly challenging to identify COVID patients,” she told local radio broadcaster KTOO. “This is an incredibly sneaky disease that appears to be most contagious in or early symptomatic people with symptoms that can look almost like anything else.” pre-symptomatic the Alaska is one of the first U.S. states to reopen nonemergency health services, but may not be the last jurisdiction to place its dentists in a paradoxical situation where they are unable to treat patients without proof of a negative test result, yet are not in a position to administer the tests themselves. SARS-CoV-2 testing kits for the dental team The urgent need for such testing kits has led to a flurry of activity by test developers, such typically the spikes on the surface— from samples that are collected in the nasal cavity. The scalability of antigen testing, relative to RT- PCR or isothermal amplification methods, has resulted in this method being touted as a solution for the mass testing that countries may require before they can reopen their economies and education systems completely. These tests may however be less effective in testing asymptomatic individuals. American Dental Association Executive Director Kathy O’Loughlin has said that “all dentists need a fast point-of-care test A SARS-CoV-2 point-of-care that accurately predicts the presence or absence of COVID-19 virus in real time.” (Image: Photoroyalty/Shutterstock) serological test being is also as Dr. Brett Etchebarne, who runs the Etchebarne laboratory at MSU College of Osteopathic Medicine, where he assistant professor of emergency medicine. Etchebarne has developed an in vitro diagnostic test, one variation of which has been developed to suit smaller health practices such as dental clinics and could easily be administered by dental teams. the possibility exists for the dental practitioner and his or her staff to take a sample from a patient while in the waiting area getting ready for treatment” – Dr. Brett Etchebarne, assistant professor of emergency medicine, MSU “I do believe that “Dentists have the necessary protective equipment to begin with, and they are working in the oral care area already, and so everything fits together quite easily,” Etchebarne explained. “Dentists already have autoclaves and already do limited kinds of analytics. I do believe that the rapid process in which my test is able to be completed allows for a solo practitioner, or a technician, to easily take the swab and easily lyse the sample so that it is no longer an infectious, dangerous pathogen. That sample can then be analyzed using a molecular technique that can be run on a digital drive app or hot plate, which you could easily work into a dental clinic or office. So, I do believe that the possibility exists for the dental practitioner and his or her staff to take a sample from a patient while in the waiting area getting ready for treatment.” The reverse transcription polymerase chain reaction test is administered using a swab, and the results can be ready within 15 to 20 minutes, allowing patients to proceed with their appointment, Etchebarne said. tests supply, additional ideally would With masks and other items the ability short in in dental to administer require clinics personal minimal protective equipment. Etchebarne commented that samples are deactivated in the medium that is used for analysis, meaning that samples could be safely handled using protective equipment. “Dentists are already covered pretty well here, so we are not looking to add too much to the equation. All of the equipment used for the tests would be consumable and disposable, so that the risk of further transmission of infection is really obviated.” standard Etchebarne and his team have developed variations of the test that use nasopharyngeal or oropharyngeal swabs, and they are working on a saliva sampling method that would remove the need for a swab altogether. When DTI spoke to Etchebarne on April 28, he said that he was currently awaiting emergency authorization from the U.S. Food and Drug Administration (FDA) for the test. “I am hoping that we will have all loose ends tied up in the next few weeks, and that a whole new platform will be available to people, which I think is going to be quite exciting, based on our analysis and all that we are hearing from the various collaborators and helpers that we have had in order to make this product available,” he said. administered in Peru. (Image: Luis Enrique Saldana/CC BY 2.0 creativecommons.org) What testing methods are available? The U.S. Centres for Disease Control’s SARS-CoV-2 RT-PCR diagnostic panel. (Image: U.S. Centres for Disease Control) Currently, there are four main approaches for testing for SARS- CoV-2. Reverse transcription polymerase chain reaction (RT- PCR) tests rely on respiratory samples that are obtained through methods such as nasopharyngeal swab taking. If the virus has progressed from the throat to the lungs, sputum samples are recommended. This method is being widely used in affected countries, and the time required for laboratories to return results from RT-PCR varies from a few hours to two days. in At found least one isothermal test has been amplification the FDA, and approved by South Korea researchers isothermal have amplification may deliver faster results owing to the ability to run the tests in decentralized facilities. Antigen tests detect proteins from the surface of the virus— that tests Serological detect antibodies in a blood sample that the body produces in order to fight the virus. This testing method could be useful in measuring the percentage of a population that has contracted and may therefore be immune to the virus. for Demand SARS-CoV-2 testing kits has led to the sudden emergence of a commercial market for testing kits that American Dental Association Executive Director Dr. Kathy O’Loughlin dubbed the Wild West. In mid- April, O’Loughlin commented that “all dentists need a fast point-of-care test that accurately predicts the presence or absence of COVID-19 virus in real time. Unfortunately, very few tests have met a high standard for specificity and sensitivity, which means a potential for high rates of false negatives and false positives,” she warned. All dentists need a fast point-of-care test that accurately predicts the presence or absence of COVID-19 virus in real time. relative isothermal The scalability of antigen to RTPCR testing, or amplification methods, has resulted in this method being touted as a solution for the mass testing that countries may require before they can reopen their economies and education systems completely.
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