DT India & South Asia No. 8, 2021

Indian dentists: Did vaccination reduce positivity rate during second wave? / World Health Assembly‘s resolution on reducing oral disease burden / Human genome editing for public health – WHO recommendations / The ever increasing cost of oral cancer treatment in India / Correlating rotated mandibles with back and knee pain / Prevention of periodontal disease could save billions

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DENTALTRIBUNE
The World’s Dental Newspaper · South Asia Edition

Published in India

www.dental-tribune.com

WHA‘s resolution

Genome editing

World Health
Assembly
resolution on
reducing oral
disease burden

Human genome
editing for public
health – WHO
recommendations

08/21

Oral cancer

Save billions

The ever increasing
cost of oral cancer
treatment in India

Prevention of
periodontal disease
could save billions

” Page 04

” Page 03

” Page 05

” Page 07

Indian dentists: Did vaccination reduce
positivity rate during second wave?

Vaccination against SARS-CoV-2 has a definitive role to play in reducing the positivity rate amongst
dentists during the second wave across all age groups. (Image: Canva).

By Dr. Divyesh Mundra
India’s first study to assess
the effectiveness of COVID-19
vaccines
in
preventing
infection
among
dental
practitioners during the second
wave of the pandemic in India
was published by four senior
academics three senior specialist
dentists (oral and maxillofacial
surgeon, oral pathologist, public
health dentist) and community
medicine specialist from ESIC
Dental College, New Delhi and
SGT University, Gurugram,
Haryana respectively.
Study objectives:
Primary: To assess whether
COVID-19
vaccination
has
helped to reduce the positivity
rate amongst dentists during the
second wave.
Secondary: To assess whether
1. Vaccination protects against
COVID-19 across all age groups.
2. Vaccination leads to less
severe symptoms in vaccinated
persons.
3. Two dose of vaccine leads to
less severe symptoms compared
to one dose.
4. Single dose of vaccine
is as effective as the two dose
regime in preventing COVID-19
infection.
5. The vaccine is effective in
preventing COVID-19 in persons
with comorbidities.

6. COVISHIELD is more
effective than COVAXIN in
preventing infection or vice
versa.
Methodology:
Sample Size (N): 4,493 dentists
from 26 states and seven Union
Territories (UTs) across India
Study
Design:
Crosssectional questionnaire
State and UT-wise distribution of respondents
Region-wise

Total:
4,493

1

West

1,953
(43.5%)

2

South

1,255
(28%)

3

North

611
(13.6%)

4

East + Centre

288
(6.4%)

UT

268
(6%)

North East

118
(2.6%)

No.

5
6
No.

West

Total:
1,953

1

Maharashtra

1,495

2

Gujarat

367

3

Rajasthan

82

4

Goa

9

No.

South

Total:
1,255

5

Lakshadweep

2

6

Andaman
& Nicobar
Islands

1

7

Dadra and
Nagar Haveli

1

No.

North East
(NE)

Total:
118

1

Tripura

89

2

Sikkim

14

3

Assam

8

4

Meghalaya

4

5

Arunachal
Pradesh

2

6

Mizoram

1

Age-wise distribution
74% of dentists were below 45
years

1

Karnataka

587

2

Andhra
Pradesh (AP)

265

Age

Total: 4,493

3

Telangana

215

25-35 years

1,719 (38%)

4

Tamil Nadu
(TN)

95

35-45 years

1,625 (36%)

45-55 years

888 (20%)

5

Kerala

93

55-65 years

192 (4.3%)

65-75 years

64 (1.4%)

75-85 years

5 (0.3%)

No.

North

Total:
611

1

Uttar Pradesh
(UP)

322

2

Punjab

135

3

Haryana

97

4

Bihar

22

5

Himachal
Pradesh (HP)

19

6

Uttarakhand

16

No.

East + Centre

Total:
288

1

West Bengal
(WB)

149

2

Madhya
Pradesh (MP)

49

3

Jharkhand

47

4

Chhattisgarh

33

5

Odisha

10

No.

Union Territory (UT)

Total:
268

1

New Delhi

200

2

Chandigarh

41

3

Jammu &
Kashmir (J&K)

13

4

Puducherry

10

No.

Union Territory (UT)

Total:
268

Age-wise
distribution
of
Comorbidities
• 81% of dentists had no
comorbidities
• No comorbidities: 80% were
below 45 years

Age

Comorbidities

No comorbidities

Below
45
years

425

2919

Above
45
years

425

Total
4,493

850
(19%)

• 96% (N=1,100) dentists above
the age of 45 years were vaccinated

Age

Vaccinated

Not vaccinated

Below
45
years

2,862

482

Above
45
years

1,100

49

Total
4,493

3,962
(88%)

531
(12%)

2. COVID-19 vaccination and
positivity rate
• 9% of dentists became
COVID-19 positive in spite of
taking vaccination
• 15% of dentists became
COVID-19 positive in the unvaccinated group

All
ages

COVID-19
+ve

COVID-19
-ve

Vaccinated

364

3,598

Unvaccinated

78

453

Total
4,493

442
(10%)

4,051
(90%)

3. Effectivity of COVISHIELD
vs COVAXIN in preventing
COVID-19 infection
• 5% took Serum Institute’s
COVISHIELD, of which 9.5%
contracted COVID-19
• 5% took Bharat Biotech’s
COVAXIN,
of
which
8.4%
contracted COVID-19

724

Type
of Vaccine

COVID-19
+ve

COVID-19
-ve

3643
(81%)

Covishield

339

3324

Covaxin

25

274

Total
3,962

364
(20%)

3,598
(80%)

Results:
1. Whether a vaccine protects
against COVID-19 across all age
groups
• Total 88% of dentists were
vaccinated with at least one dose
of either COVISHIELD/COVAXIN
• 86% (N=2,862) of dentists
below the age of 45 years were
vaccinated

4. Whether one dose of vaccine
is as effective as two doses in
preventing COVID-19 infection
• One dose : 8.2% turned
COVID-19 positive

[2] =>

2

News

• Two dose :
COVID-19 positive

08/21

10%

turned

All
ages

COVID-19
+ve

COVID-19
-ve

Dose 1

128

1,431

Dose 2

236

2,151

Total
3,962

364
(20%)

3,582
(80%)

5. Effect
of
vaccine
in
preventing COVID-19 in persons
with comorbidities
• Without comorbidities: 10%
became COVID-19 positive
• With
comorbidities:
8%
became COVID-19 positive

All
ages

COVID-19
+VE

COVID-19
-VE

Without
comorbidities

370

3,273

With
comorbidities

72

778

Total
4,493

442
(10%)

4,051
(90%)

6. Whether vaccination leads
to less severe symptoms in
vaccinated persons
• In vaccinated group: 82%
mild and 16% moderate
• In non-vaccinated group :
79% mild and 21% moderate

All
ages

Mild
symptoms

Moderate/Severe

Vaccinated
+ve

286

62

Unvaccinated
+ve

56

15

Total
419

342
(82%)

77
(18%)

3. Vaccines seem to be equally
effective against infection in
dentists with comorbidities as in
healthy dentists.
4. There is no relation between
the type of vaccine administered
and the positivity rate among
vaccinated dentists.

7.
Whether two doses of
vaccine leads to less severe
symptoms compared to one dose
• Mild symptoms: 84% who
received two doses of vaccine and
80% who received one dose of
vaccine

All
ages

Mild
symptoms

Moderate/Severe

Dose 1

102

26

Dose 2

184

36

Total
348

286
(82%)

62
(18%)

Reference:
Sanjeev Kumar, Susmita Saxena,
Mansi Atri, Sunil Kumar Chamola;
Effectiveness of the Covid-19
vaccines in preventing infection
in dental practitioners – results of
a cross-sectional ‘questionnairebased
survey.
medRxiv,
3 June 2021. doi: https://doi.
org/10.1101/2021.05.28.21257967

Dr. Divyesh Mundra (BDS)
completed his Masters in Public
Health (MPH) Administration
from the School of Health Systems
Studies (SHSS), Tata Institute of
Social Sciences (TISS), Mumbai.
He is a healthcare management
professional having five years
of diverse experience across
hospital administration, patient
advocacy, public health policy, and
implementation of public health
programs. Divyesh actively tweets
on challenges confronting the
Indian healthcare system including
medical and dental education.

Author:

Primary Objective:
To assess whether vaccines
could reduce the COVID-19
positivity rate among dentists
during the second wave.

Conclusion:

1. Vaccination
against
SARS-CoV-2 has a definitive role
to play in reducing the positivity
rate amongst dentists during
the second wave across all age
groups.
2. A single dose of vaccine
seems to be as effective as two
doses of vaccine in preventing
infection with SARS-CoV-2.

This is India‘s first study
to assess the effectiveness
of COVID-19 vaccines in
preventing infection among
dental practitioners during the
second wave of the pandemic.

Results:
88% of dentists were
vaccinated with at least one dose,
breakthrough infections were
seen in only 9% of the dentists,
only 8% of dentists with comorbidities had breakthrough

Dr. Divyesh Mundra

infections, amongst all the
breakthrough infection cases
82% of the dentists had only
mild symptoms and 16% had
moderate symptoms.
Conclusion:
This study found that
COVID-19 vaccines reduced the
positivity rate among dentists
during the second wave. Both
COVISHIELD and COVAXIN
were effective in preventing
severe infections irrespective
of age, number of vaccine doses
administered or the presence of
co-morbidities and no relation
was found between the types
of
vaccines
administered
or their efficacy. Very few
breakthrough infections were
seen and majority of the cases
were mild.
Results of this study
strongly
suggest
that
vaccinating majority of the
population with at least one
dose of vaccine prior to the
occurrence of any new wave
of infection shall be very
advantageous.

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08/21

World Health Assembly‘s resolution
on reducing oral disease burden
By Amisha Parekh,
Dental Tribune South Asia
The increasing burden of
untreated dental conditions and
lack of oral health initiatives
in global health agendas has
been a cause of concern for
ages, recently brought to the
limelight in the past few years.
The World Health Assembly
(WHA) passed a historic
resolution on oral health in
May 2021, initiating efforts
in alleviating this burden.
This article summarizes the
resolution passed by WHA.
Global burden of oral
conditions [1,2]: The Lancet oral
health series in 2019 reflected
how oral health had been
isolated from traditional health
care and health policies. It has
been estimated that oral diseases
affect nearly 3.5 billion people.
The Global Burden of Disease
(GBD) study found that untreated
dental conditions are a significant
global health challenge with
significant economic impacts
and must be included in the
global health agenda.
Challenges faced: A global
health network for oral health
must understand the challenges
faced, influence global health
policies, and drive health system
reforms. Such global health
networks face four strategic
challenges:
•
Defining the problem
and ways to address it - The
ever-widening gap between
high and low/ middle-income
countries in terms of provision
of dental services; dental services
primarily
being
delivered
privately leading to a businessoriented mindset and disjoint
in terms of solutions such as
upstream
actions
(taxation
and fiscal policies) versus
downstream actions (focused
on dental health education
and
complex
biomedical
interventions) for addressing the
oral health inequalities are some
of the common challenges faced
today.
•
Portray dental issues
in ways that inspire external
audiences to act. Traditional
population dental metrics such
as DMFT may have certain
limitations. It may also fail to
compare the burden of dental
diseases against all maternal
conditions
combined
like
hypertensive heart disease,
anxiety disorders, schizophrenia,

World Health Assembly passed a major resolution on oral health initiating efforts in alleviating this burden. (Photo: Paul Kagame/ Flickr)

cardiovascular and cerebral
diseases, etc. There is a need to
encourage the use of comparable
metrics systems such as those
used in the GDB study to address
oral health problems in ways that
resonate with external players
whose resources are required.
•
Forge alliances with
external
actors
(coalition
building) - Dental organizations
such as the International
Association for Dental Research,
World Dental Federation, and
World Health Organization
(WHO) global oral health unit
that operate in isolation need to
instead work towards coalitionbuilding with especially those
outside the healthcare sector
and work on ways to inculcate
oral health into the Political
Declarations of the high-level
Meetings on the prevention and
control of non-communicable
diseases and universal health
coverage (UHC; i.e., access to
essential quality health services
without financial hardship).
•
Establish institutions
to facilitate collective action
(governance). A global network
consisting of dental and nondental members representing all
parts of society, including those
influencing health priorities and
resource allocation, is needed
to get oral health recognized
as a population health priority
worldwide.
Fundamental gaps challenging the development of a global health network for oral health. The research priorities

needed in order to overcome
the three fundamental gaps in
knowledge are as follows:
•
Global
oral
epidemiology
and
health
information systems – For a
global health network to function
efficiently, there is a need to
improve certain aspects like
community oral health surveys
and surveillance, reporting of
data and develop a database
repository, develop an analytic
framework that leverages the
interconnectedness
of
oral
conditions, degree to which
incomplete data can generate
actionable
estimates of oral
health
burden
worldwide,
following a systematic and
comprehensive approach to data
management and developing
an appropriate global health
information system to serve
evidence-based planning and
monitoring.
•
Collection, harmonization, and rigorous assessment of evidence for equity in
prevention and treatment There is a need to evaluate the
relative importance of environmental, socioeconomic, commercial, and behavioral risk factors
on the burden of oral conditions,
identify health policies and interventions that can reduce inequalities in health and oral health simultaneously and evaluate the
impact of existing (or about to be
implemented) health policies on
oral health by using quasi-experimental designs.
•
Strategies to deliver
essential quality oral health

care without financial hardship:
Research
priorities
include
revisiting dental curricula and
educational methods, building
inter-professional and intersectoral teams to develop
competency frameworks that
help
policymakers
tackle
the social and commercial
determinants of health at all
levels, identifying strategies to
incorporate social policies into
health systems, and evaluating
the impacts of these changes on
population oral health.
World Health Assembly‘s
resolution [3]: The World Health
Assembly (WHA) is the forum
through which the World Health
Organization (WHO) is governed
by its 194 member states. WHA
in May 2021 approved a historic
resolution on oral health that
indicates to inculcate oral health
within the non-communicable
disease agenda and that oral
healthcare interventions should
be included in universal health
coverage programs. It urges the
member states to address the
key risk factors (high intake
of free sugars, tobacco use,
and harmful use of alcohol)
shared between oral diseases
and other non-communicable
diseases and enhance oral health
professionals‘ capacities. It also
recommends shifting from the
traditional curative approach
towards a preventive approach
that helps promote oral health.

Conclusion:
If our objective is to reduce the
global burden of untreated oral
conditions, dental care needs to
be integrated into primary health
care focusing on prevention and
interception of the disease at an
early stage. Also, global health
networks for oral health need
to be established for achieving
this goal. Dental professionals
can play a significant role by
addressing the high prevalence of
untreated dental conditions, the
challenges faced in distribution
and access to dental care, and
preparing for the future threats
that align with the goals of global
health. Lastly, the inclusion of
dental treatment in universal
health coverage packages shall
play a significant role in making
oral health affordable to all.
References:
1.
The Lancet oral health
series. https://www.thelancet.
com/series/oral-health
2.
Hugo FN, Kassebaum
NJ, Marcenes W, Bernabé E.
Role of Dentistry in Global
Health:
Challenges
and
Research Priorities. J Dent
Res.
2021;100(7):681-685.
doi:10.1177/0022034521992011
3.
World Health Assembly
Resolution paves the way for
better oral health care. https://
www.who.int/news/item/2705-2021-world-health-assemblyresolution-paves-the-way-forbetter-oral-health-care

[4] =>

News

08/21

Human genome editing for public
health – WHO recommendations
By Amisha Parekh,
Dental Tribune South Asia
The World Health Organization (WHO) has released two
new reports that provide the first
global recommendations for establishing human genome editing as a tool for public health,
with an emphasis on safety, effectiveness, and ethics. This article summarizes what human
genome editing does and WHO’s
new recommendations for its application worldwide.
Human genome editing [1]:
Genome editing constitutes a
group of technologies that have
the ability to change an organism‘s
DNA allowing genetic material
to be added, removed, or altered
at particular locations in the
genome. A popular example of one
such genome editing approach is
CRISPR-Cas9 (clustered regularly
interspaced short palindromic
repeats and CRISPR-associated
protein 9) which can be used to
add or delete pieces of genetic
material, or even make changes to
the DNA by replacing an existing
segment with a customized DNA
sequence.
The
CRISPR-Cas9
genome editing system is faster,
cheaper, more accurate, and
more efficient than other existing
methods. Genome editing could
play a crucial role in the prevention
and treatment of human diseases
in the future, however, its safety
and efficacy for use in people
are still undergoing research.
Currently, it is being explored in
a wide variety of diseases such
as cystic fibrosis, hemophilia,
and sickle cell disease, cancer,
heart disease, mental illness, and
human immunodeficiency virus
(HIV) infection.
Global registry on human
genome editing [2,3]: Most genome
editing is limited to somatic cells,
which unlike the egg and sperm
cells (germline cells) affect only
certain tissues and are not passed
from one generation to the next.
However, changes made to genes
in germline cells could be passed
to future generations posing a
number of ethical challenges
highlighting the need for robust
oversight in this area.
In
December
2018,
WHO established a global,
multidisciplinary expert advisory
committee (the Expert Advisory
Committee on Developing Global
Standards for Governance and
Oversight of Human Genome

WHO‘s reports focus on systems-level improvements that are required to build capacity in all countries to ensure that human genome editing is
used safely, effectively, and ethically. (Photo: Canva)

Editing, hereafter called the
Committee) to examine the
scientific, ethical, social, and
legal challenges associated with
human genome editing (somatic,
germline, and heritable).
Further, in 2019, the WHO
approved the first phase of a new
global registry to track research
on human genome editing
allowing all relevant research and
development initiatives to register
their trials.
WHO’s latest recommendations on human genome editing
[4-8]
: The WHO advisory committee’s first report focused on issues
of governance breaking down genome editing into five different
areas (changing somatic cells after
birth; changing somatic cells inutero; changing germline cells;
changing how DNA is expressed
rather than the DNA code itself,
and making changes to enhance
a person’s genetic lot rather than
treating the disease). The committee outlined hypothetical scenarios within each area and discussed the potential oversight mechanisms that might work for them
taking into account the values,
ethical dilemmas, and financial
realities of various societies.
The second report focused
on a list of suggestions to be
taken up by the WHO, including
facilitating meetings to explore
the use of patent pools and other
ethical licensing mechanisms,
establishing
a
system
for
researchers to report unsafe or

unethical gene-editing research,
and putting out a policy statement
restricting
human
genome
editing research and commercial
enterprises to operate only in
countries where the technology is
regulated.
Overall, these two reports
focus
on
system-level
improvements that are required
to build capacity in all countries
to ensure that human genome
editing is used safely, effectively,
and ethically at the same time
highlighting how governments
might establish this technology as
a tool for improving public health
for the less controversial forms of
gene editing.
The nine discrete areas
covered in the recommendations:
1. Leadership by the WHO and
its Director-General.
2. International collaboration
for effective governance and
oversight.
3. Human genome editing
registries.
4. International research and
medical travel.
5.
Illegal,
unregistered,
unethical, or unsafe research and
other activities.
6. Intellectual property.
7. Education, engagement, and
empowerment.
8. Ethical values and principles
for use by WHO.
9. Review of the recommendations.
Lastly,
WHO
shall
be
implementing
some
new

immediate efforts such as
establishing a small expert
committee to determine the
next steps for the registry and
better monitoring of the clinical
trials using human genome
editing technologies of concern.
Similarly, it shall convene a group
of multisector stakeholders to
develop an accessible mechanism
for
confidential
reporting
of
concerns
about
illegal,
unregistered, unethical, and
unsafe human genome editing
research. The committee also
advised that within the next three
years the WHO’s science division
shall begin reviewing how well the
public health authority is following
through on its recommendations.
References:
1. What are genome editing
and CRISPR-Cas9?
https://medlineplus.gov/gen e t ic s/u nde r s t a nd i n g/g e n o micresearch/genomeediting/
2. WHO launches global
registry on human genome
editing.
https://www.who.int/
n e w s/it e m/2 9 - 0 8 -2 0 19 -wh o l au n c he s -g lob a l-r eg i st r y- onhuman-genome-editing
3. Human Genome Editing
(HGE) Registry. https://www.
who.int/groups/expert-advisorycommittee-on-developing-glob a l- st a nd a rd s -for-gove r n a n ce-and-oversight-of-human-genome-editing/registry
4.
WHO
issues
new
recommendations on human
genome
editing
for
the

advancement of public health.
ht t p s://w w w.wh o.i nt/n e ws/
it e m/12- 07-2021-wh o -i s s ue s newrecommendations-onhuman-genome-editing-for-theadvancement-of-public-health
5. World Health Organization
advisers urge global effort to
regulate genome editing. https://
www.statnews.com/2021/07/12/
genome-editing-world-healthorganization/
6. Human genome editing:
r e c o m m e n d a t i o n s . h t t p s ://
w w w.who.i nt/publicat ions/i/
item/9789240030381
7. Human genome editing:
a framework for governance.
https://www.who.int/publications/i/item/9789240030060
8. Human genome editing: position paper. https://
w w w.who.i nt/publicat ions/i/
item/9789240030404
1)
WHO‘s
latest
recommendations on human
genome editing consist of
two reports that will help
establish this technology
as a tool for public health
with an emphasis on safety,
effectiveness and ethics.
2) The first report focuses
on issues of governance
breaking
down
genome
editing into five different
areas.
3) The second report
focuses on a list of suggestions
to be taken up by WHO that
will help regularize the use of
this technology.

[5] =>

News

08/21

The ever increasing cost of
oral cancer treatment in India
Author:

IMPRINT
PUBLISHER & CHIEF EXECUTIVE
OFFICER
Torsten R. OEMUS
CHIEF CONTENT OFFICER
Claudia DUSCHEK
DENTAL TRIBUNE SOUTH ASIA
EDITION
PUBLISHER
Ruumi J. DARUWALLA
CHIEF EDITOR
Dr. Meera VERMA
CLINICAL EDITOR
Dr. Dilip DESHPANDE
RESEARCH EDITOR
Dr. Shobha DESHPANDE
ASSOCIATE EDITOR
Dr. GN ANANDAKRISHNA
EXECUTIVE EDITOR
Dr. Rajeev CHITGUPPI

Dr. Divyesh Mundra

Early detection and prevention of oral cancer will be critical in reducing the economic burden of the
disease. (Image: Canva).

By Dr. Divyesh Mundra
India spent approximately
INR 2,386 crore on oral cancer
treatment in 2020, which will
increase to more than INR 23,000
crore in the next ten years.
These numbers have been
revealed in a study conducted
by a team of senior oncologists
from the Tata Memorial Centre
(TMC) in collaboration with
Guy‘s Hospital, London, UK. „A
prospective study to determine
the cost of illness for oral cancer
in India“ - is the first-ever study
in India on costs of treating oral
cancer in India, published in the
journal ecancer.
India accounts for almost
a third of oral cancer‘s global
incidence and the rate has
increased by 68% in the past
two decades, making it the most

common cancer among Indian
males. For this reason, the current
study holds great significance.
Researchers
conducted
the study from a healthcare
provider’s perspective using a
validated bottom-up method.
Treatment costs and service
utilization were obtained using
probabilistic sensitivity analyses.
Findings of the study:
1.
Total INR 16 million
(USD 214,237) was the direct
healthcare cost to treat 100
patients with oral cancer.
o
Of this, the salaries of
healthcare personnel contributed
the highest (56.9%) to the total
costs. Next were the variable
(24.2%) and capital (18.9%) costs.
o
The personnel costs
for OT (27.1%) were the highest
followed by the IPD (24%).

o
Medical
equipment,
with MRI imaging being the
highest, accounted for 97.8% of
capital costs.
2.
The unit cost of treating
early-stage disease was INR
1 million that jumped to INR
2 million for advanced-stage
disease. Also, compared to the
early stage, the variable costs for
oral cancer surgery in advanced
stages were 1.4 times higher.
3.
The average cost of
oral cancer treatment increased
by 44.6% with adjuvant therapy
compared to surgery alone.
Early
detection
and
prevention are critical. They can
help with a 20% reduction in
advanced-stage disease, which
could save India Rs 223 crores
annually.

Dr. Divyesh Mundra (BDS)
completed his Masters in Public
Health (MPH) Administration
from the School of Health Systems
Studies (SHSS), Tata Institute of
Social Sciences (TISS), Mumbai.
He is a healthcare management
professional having five years
of diverse experience across
hospital administration, patient
advocacy, public health policy,
and implementation of public
health
programs.
Divyesh
actively tweets on challenges
confronting the Indian healthcare
system including medical and
dental education.

ASSISTANT EXECUTIVE EDITOR
Dr. Amisha PAREKH
DESGINER
Anil LAHANE
PRINTER
Mehernosh & Burzin MISTRY
Ampersand, Mumbai, India
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[6] =>

News

08/21

Correlating rotated mandibles with back
and knee pain
By Dr. Ajay Kakar

A study was carried out
to evaluate the correlation
between mandibular rotations
in patients with a history of mid
back pain, lower back pain, and
knee pain.
The human body is a complex
interconnected network that can
be observed and understood as
an interactive interplay of various
components, each playing its
unique role in maintaining the
functionality of the human
body. Human observations have
classified these components
into various systems with their
individual roles to play. A
couple of key systems are the
musculoskeletal system and the
nervous system.
The musculoskeletal system
has been very aptly described in
the Smylist® concept as a spiders
web running from the top of the
head to the tip of the toes. Working
in harmony with signals received
from the nervous system, the
muscles function by contracting
and elongating at the required

The study demonstrated correlation between mandibular rotation
and foot position discrepancy which leads to posture compensations
of various forms leading to mid-back, low back, and knee pain.
(Image: Canva).

times to provide locomotion, the
ability to eat, speak so on, and so
forth.
Mandibular rotation is a condition that has been defined in the
Smylist® concept as a mandible
that is shifted from its ideal position due to an uneven rotation
of the condyles in a horizontal,
saggital, and vertical plane. This

rotation may be in any one plane
or in more than one plane. The
Smylist® concept is a creation of
Dr. Maria Csillag which addresses dento-facial aesthetics as well
as dental function in a very new
and unique fashion. The concept
also explains how the origin of a
variety of systemic situations is
due to a “rotated mandible”. This

study was done to find the prevalence of such conditions concerning mid and lower back pain
and kneed pain.
The study obtained data
from 48 subjects in the form of
face photographs, photographs
of the position of the feet after
the Smylist® three jump test,
and a detailed Smylist® history
form. The face photographs were
evaluated and the mandibular
rotations were determined and
the diagnosis was carried out
based on the Smylist® concept.
This was then cross-checked with
the foot position photographs
and the mandibular rotations
confirmed. The foot positions
were documented only after the
three-jump test, which brings the
feet into their natural position.
This
study
confirms
that the representative foot
positions discrepancy is seen
in all mandibular rotation
cases as postulated by the
Smylist® concept. All 48 cases
demonstrated the mandibular
rotation of varying severities
and all of them reported varying

degrees of one or more of the
three categories of pain. The
study definitely demonstrates
the
correlation
between
mandibular rotation and foot
position discrepancy which
leads to posture compensations
of various forms leading to midback, low back, and knee pain.

Authors:

Jay
Patel1,
Aishwarya
Mahajan2, Ajay Kakar3* and
Maria Csillag4
1
Principal Investigator,
Nashik, India
2
Investigator,
Nashik
India
3
Guide, Mumbai, India
4
Guide and Creator of
the Smylist® Concept, Aesthetic
Dentist, Budapest, Hungary
*Corresponding Author: Ajay
Kakar, Guide, Periodontology,
Mumbai, India.

Dental procedures present low risk of
aerosol transmission of SARS-CoV-2

The researchers behind a University of Bristol-led study say that
certain dental procedures, such as ultrasonic scaling, do not appear
to generate additional aerosol. (Image: DC Studio/Shutterstock)
By Jeremy Booth,
Dental Tribune International
BRISTOL, UK: The largest
study
to
date
specifically
measuring aerosol generation in
dental settings found that many
common procedures produced
negligible volumes of aerosol.
The study is yet to be peerreviewed; however, according to
the authors, the findings support
current guidance that deems
many dental procedures as
posing a low risk of SARS-CoV-2
transmission and suggests that
the level of risk associated with
the use of ultrasonic instruments
could be downgraded.
Led by researchers at the
University of Bristol, the study

pointed out that the existing
classification of dental procedures
as posing a high or low risk of
aerosol transmission was based on
the limited evidence that had been
available in the early months of the
pandemic.
“One challenge in aerosol
research is separating this salivarycontaminated aerosol from the nonsalivary contaminated instrument
source,” the authors wrote. They
explained that there are three
possible sources of aerosol during
dental procedures and that not all
of them are considered to pose a
risk of SARS-CoV-2 transmission.
Aerosol generated by the patient—
during speech or coughing, for
example—may
be
infectious,

aerosol generated by dental
instruments is not considered
to be infectious, and salivacontaminated aerosol generated
by the use of an instrument in the
mouth of an infected patient may
be infectious.
The study aimed to quantify
the aerosol concentration produced
during a range of dental procedures
and, where it was detected, to
separate
saliva-contaminated
aerosol from that originating from
an instrument not contaminated
with saliva.
A total of 41 patients
underwent
15
different
periodontal, oral surgical, and
orthodontic
procedures,
and
these were captured using timestamped protocols. No aerosol
was detected in nine of the
41 procedures, and only six
procedures generated a volume of
aerosol that was detectable above
background levels. “Examination
with dental probe, hand scaling,
local anesthetic delivery, routine
extraction (with forceps and/
or elevator), raising a soft-tissue
flap, orthodontic bracket removal,
alginate impression taking, threein-one water only, and suturing did
not generate detectable aerosol and
do not appear to pose an aerosol
transmission risk,” the study read.

It continued: “For the other
six procedures where aerosol was
detected, the percentage of total
procedure time that aerosol was
observed was 12.7% for ultrasonic
scaling, 19.9% for three-in-one
air only, 42.9% for three-in-one
air + water, 28.6% for high-speed
drilling, 32.9% for slow speed
drilling and 35.8% for surgical
drilling.”
“[Other] procedures, such as
ultrasonic scaling, do not appear to
generate additional aerosol above
that of the instrument itself and do
not increase the risk to dentists” –
Dr. Mark Gormley, University of
Bristol
A
University
of
Bristol
press release explained that the
authors found that an ultrasonic
instrument produced significantly
lower aerosol volume than a
high-speed dental drill, despite
the two instruments currently
requiring the same precautions.
“Also, aerosol produced during the
ultrasonic scaling procedure was
consistent with the clean aerosol
produced from the instrument
itself and did not show additional
aerosol is produced that could
potentially spread COVID-19.”
Dr. Tom Dudding, joint first
author of the study and restorative
dentistry specialty trainee in
the Bristol Dental School at the

University of Bristol, said in the
press release: “Our study confirms
much of the guidance around
dental procedures deemed as
low risk of spreading COVID-19
is correct, but suggests that the
ultrasonic instrument could be
seen as lower risk than it currently
is.”
Dudding added that the
findings of the study could advocate
for a reduction in the precautionary
measures that have been put in
place during the pandemic and,
thereby, allow for the expansion of
dental therapy. Dudding singled
out these precautionary measures
as including fallow times and
additional personal protective
equipment.
Dr. Mark Gormley, senior
author of the study and consultant
senior lecturer at the Bristol Dental
School, said: “[Other] procedures,
such as ultrasonic scaling, do not
appear to generate additional
aerosol above that of the instrument
itself and do not increase the risk to
dentists, relative to the risk of being
near the patient.”
The study, titled “A clinical
observational analysis of aerosol
emissions from dental procedures”,
was published online on 12 June
2021 on medRxiv.org.

[7] =>

7

News

08/21

Prevention of periodontal disease
could save billions
By EFP
BRUSSELS, Belgium: The European Federation of Periodontology (EFP) recently commissioned
the Economist Intelligence Unit
(EIU), a provider of forecasting
and advisory services, to perform
an analysis on the financial and
human cost of periodontal disease
in six western European countries.
Overall, the results show that preventing new cases of periodontitis
by eliminating gingivitis would
save up to €101 billion over a tenyear period.
Periodontitis
is
largely
preventable with good oral hygiene
and regular dental check-ups, yet
in western Europe, developments
in the prevention and management
of the disease appear to have
stagnated, according to the report.
The prevalence of periodontitis has

remained largely unchanged over
the last ten years and awareness
of the disease among the general
public and non-oral healthcare
professionals is poor.
Few studies have modeled the
economic burden of periodontitis
and return on investment (ROI)
of treatment, particularly across
different countries. The EIU analysts
developed a model to examine the
ROI of prevention and management
of periodontitis. Separate modeling
was performed for France,
Germany, Italy, the Netherlands,
Spain, and the UK. The following
overview summarises the projected
economic outcomes per country for
the scenario in which gingivitis is
eliminated over a ten-year period.

This analysis on the financial and human cost of periodontal disease in six western European countries is
one of the most comprehensive of its kind, according to the European Federation of Periodontology. (Image:
hanohiki/Shutterstock)

France:
•
Projected savings over a
ten-year period: €10.34 billion

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Germany:
•
Projected savings over a
ten-year period: €10.04 billion
•
ROI of every euro invested
in eliminating gingivitis: €57.50
•
Cost per healthy life year
after ten years: €19.00 (compared
with €35.00 with the current
strategy, visiting the dentist only
when a problem emerges).

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Your distributor:

•
ROI of every euro invested
in eliminating gingivitis: €40.40
•
Cost per healthy life year
after ten years: €18.00 (compared
with €39.00 with the current
strategy, visiting the dentist only
when a problem emerges).

LifeCare Devices Private Limited
New Jubilee Building, Office no. 1, Laxmiben Chheda Road, Nalasopara West, Palghar 401 203.
Mumbai Metropolitan Region, Maharashtra, INDIA. | E: info@lifecare.in | Customer Service : +91 99304 50170
| Customer Service WhatsApp : +91 99304 50169 | Management WhatsApp : +91 99304 50163/+91 99997 86275

Italy:
•
Projected savings over a
ten-year period: €35.83 billion
•
ROI of every euro invested
in eliminating gingivitis: €15.20
•
Cost per healthy life year
after ten years: €114.00 (compared
with €183.00 with the current
strategy, visiting the dentist only
when a problem emerges).
The Netherlands:
•
Projected savings over a
ten-year period: €7.76 billion
•
ROI of every euro invested
in eliminating gingivitis: €18.70
•
Cost per healthy life year
after ten years: €82.00 (compared
with €142.00 with the current
strategy, visiting the dentist only
when a problem emerges).
Spain:
•
Projected savings over a
ten-year period: €12.70 billion
•
ROI of every euro invested
in eliminating gingivitis: €19.80
•
Cost per healthy life year
after ten years: €36.00 (compared

with €72.00 with the current
strategy, visiting the dentist only
when a problem emerges).
The UK (out of pocket):
•
Projected savings over
a ten-year period: €24.68 billion
(£21.16 billion)
•
ROI of every euro invested
in eliminating gingivitis: €23.92
(£20.50)
•
Cost per healthy life
year after ten years: €50.00 (£42.87;
compared with €91.00 [£78.00]
with the current strategy, visiting
the dentist only when a problem
emerges).
The authors noted that
both eliminating gingivitis and
increasing the rate of diagnosing
and treating periodontitis to 90% in
the modeling had a positive ROI for
all countries and gains in healthy
life years compared with business
as usual. Neglecting management
of gingivitis had the opposite
effects. The authors highlighted
the importance of greater emphasis
on self-care and prevention at
the individual and societal level,
including nursery-based dental
care and toothbrushing workshops
in schools.
“Dental tariffs and the costs
of accessing a dentist is a barrier
to early treatment for the general
public,” states the paper. The
authors concluded that the costeffectiveness of managing gingivitis
and periodontitis shown in this
analysis demonstrates that dental
costs deserve a review by European
policymakers and commissioners.

[8] =>

7 News

7/19

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[cover] => DT India & South Asia No. 8, 2021

[toc] => Array ( [0] => Array ( [title] => Indian dentists: Did vaccination reduce positivity rate during second wave? [page] => 1 ) [1] => Array ( [title] => World Health Assembly‘s resolution on reducing oral disease burden [page] => 3 ) [2] => Array ( [title] => Human genome editing for public health – WHO recommendations [page] => 4 ) [3] => Array ( [title] => The ever increasing cost of oral cancer treatment in India [page] => 5 ) [4] => Array ( [title] => Correlating rotated mandibles with back and knee pain [page] => 6 ) [5] => Array ( [title] => Prevention of periodontal disease could save billions [page] => 7 ) ) [toc_html] =>

Table of contents

[toc_titles] =>

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