DT Pakistan No. 2, 2020

News / Interview with Dr Ambrina Qureshi: "The culture of critical thinking is lacking in our country" / Clinical Practice / News

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PUBLISHED IN PAKISTAN

www.dental-tribune.com.pk
Dentine
hypersensitivity
experience using ...

An exclusive interview
with Dr Ambrina
Qureshi

INTERVIEW

Page 4

MARCH, 2020 - Issue No. 02 Vol.7

CLINICAL PRACTICE

Page 6

Coronavirus
guidelines for dental
practitioners ...

NEWS

Page 10

PMDC should
COVID-19: Pakistans dental PDA:
work independetly
fraternity and industry face
unprecedented challenges K
DT Pakistan Report

T

By H. Hasan

he recent escalation of the
COVID-19 situation has
definitely affected every
domain of human life. The sudden
surge has raised fears that the
outbreak could pose a major
challenge to an already strained
national healthcare system.
According to recent statistics reported
by the New York Times, dentists are
at the greatest risk, as they can
encounter diseases and infections
daily and typically work in close
proximity to one another and their
patients.
In a matter of days, Pakistan's own
COVID-19 tally has soared past
1,200 cases, mirroring the
exponential growth in new infections
seen in Italy. The worsening situation
has prompted all four of the country's
provinces as well as Azad Jammu &
Kashmir and Gilgit-Baltistan to
impose considerably strict lockdown
measures.
While some in the country,
particularly in the federal
government, have criticised the
provinces' preventive steps as
premature and overkill, official data
on healthcare and quarantine facilities
and conversations with members of
the medical fraternity reveal why
Pakistan can ill afford to repeat Italy's
mistakes.
With such situation in backdrop,
the question arises whether the dental
community is ready to face this
pandemic.
Many dentists have proactively
limited their practice to emergency
procedures only. Though this step
was taken purely on voluntary basis,
but no proper guidelines have been
circulated by Pakistan's Dental
Authorities.
According to the Centers for
Disease Control and Prevention, it

Photo:
DT Pakistan

is advised to limit patient inflow and
take proper measures. The patient's
history should be taken thoroughly,
including travel history. Make sure
that the patient is not accompanied
with attendants, if possible. After
every procedure hand-piece should
be replaced, the chair, trays and area
in 1-feet radius should be disinfected.
A gap of at least an hour between
each procedure.
"We are potentially looking at a
total disaster if we fail to take
precautions now," warned Dr Tahir
Shamsi, who heads the National
Institute of Blood Diseases. "Our
healthcare system is already
in shambles, struggling to handle
routine workload much less
COVID-19 patients."

The dental practice may
change altogether once
this virus is gone
"If we don't take steps to contain
it now, we may end up seeing patients
lying in our corridors, streets and
footpaths," he said. "More than 170
COVID-19 patients fighting for each
intensive care unit bed. Not to
mention those suffering from other
diseases will be deprived too," Dr
Shamsi added.

With 132,227 beds and 7,697
health facilities across Pakistan the
challenges are huge. Sindh has the
highest number of health facilities
with 3,525 HCEs and many field
hospitals are underway to fight the
menace.
Experts recommend to make sure
that only non-invasive procedures
are carried out. Emergency and pain
relief to be the only focus. Use of
hand-pieces be discontinued for
the time being. The waiting area
should be ventilated properly and
encourage time difference between
appointments so that there are least
number of patients waiting.
It is advised that dental community
take proper measures to keep
themselves safe by wearing masks,
gloves and clean clothes. Those
having industrial set-up, should put
workers on rotational basis and
educate them on social distancing.
Non-essential staff should be allowed
to work from home.

 [ ] it is time that dental
industry prepares itself
for the unprecedented
challenges once this
is over  Liaqat
Humayun, President
of the Dental Trade
and Manufacturers
Association
Due to certain external factors, the
prices of protective face masks have
been escalated. The stakeholders
should ensure the provision of these
protective gears to their staff.
Pakistan's renowned dentist Prof.
Ayyaz Ali Khan says that it is time
to only do the emergency procedures
while Prof Mahmood Haider
recommends consultation and pain
Continued on Page 11

ARACHI - The Pakistan
Dental Association
(PDA)
hailed the
restoration of
the Pakistan
Medical and
Dental Council
(PMDC) and its
employees on
the orders of the
Islamabad High
Court (IHC).
This was stated by
Dr Mahmood Shah, President of
the PDA.
"It is heartening to note that the
Pakistan Medical and Dental
Council has been restored by the
IHC," noted the PDA.
The PDA and its office bearers
demanded that the PMDC be made
fully functional so that it can carry
out its duties and obligations to
medical and dental professionals.
Owing to the dissolution of the
PMDC, doctors, and dentists faced
tremendous problems in regards
to their pending work and
day-to-day requirements. This
action of the government had put
Pakistani doctors working
overseas in a lot of trouble as the
PMDC is the only recognized
body, and nobody recognized the
PMC.
Doctors looking for good
standing certificates had to run
from pillar to post, but their work
could not be done. Those awaiting
registration were also made to wait
indefinitely.
It is high time that the
government lets the PMDC work
independently and bring an end to
the sufferings of healthcare
professionals.
The PMDC should also start
planning transparent elections once
this COVID-19 pandemic is over.
Wi t h t h e i n v o l v e m e n t o f
representative bodies like the PMA
and the PDA for the PMDC
elections of doctors and dentists.

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NEWS

2 DENTAL TRIBUNE Pakistan Edition March 2020

THE 8TH INTERNATIONAL STUDENTS DENTAL CONFERENCE

Dental students made Pakistan
proud at the global event

UBAI - Under the patronage
of H. H. Sheikh Dr. Sultan
Bin Mohammed Al Qasimi,
Member of the Supreme Council of
the UAE, Ruler of Sharjah and
President of the University of Sharjah,
the University of Sharjah's Dental
Student Association, the 8th
International Students' Dental
Conference was recently held.
The ISDC (International Students'
Dental Conference) is the biggest
2020 event for dental students and 1st
and 2nd year dental graduates. It
involved over 700 participants from
all over the world coming together to
share knowledge, as well as build
friendly and professional bonds
among each other. Students delegation
from Pakistan also actively
participated in the global event.
The two-day conference consisted
of symposiums conducted by
internationally recognized speakers
who contributed enormously to the
dental field and its advancement along
with presentations delivered by dental
students, as well as participants
presenting their posters in the
conference hall.
The conference also included two
interactive debates regarding dental
controversies, as well as clinical
competitions and workshops.
Five students from Sardar Begum
Dental College, Gandhara University
participated in the conference. Dr.
Yasir Israr presented his original

Syed Hashim A. Hasan
hashim@dental-tribune.com.pk
Editor Clinical Research
Dr. Inayatullah Padhiar
Editors Research & Public Health
Prof. Dr. Ayyaz Ali Khan
Editor - Online
Haseeb Uddin
Designing & Layout
Sheikh M. Sadiq Ali
Dental Tribune Pakistan
3rd floor, Mahmood Centre, BC-11,
Block-9, Clifton, Karachi, Pakistan.
Tel.: +92 21 35378440-2
Fax: +92 21 35836940
www.dental-tribune.com.pk
info@dental-tribune.com.pk

Photos:
DT Pakistan

Dental Tribune Pakistan cannot assume
responsibility for the validity of product
claims or for typographical errors. The
publisher also does not assume
responsibility for product names or
statements made by advertisers. Opinions
expressed by authors are their own and may
not reflect of Dental Tribune Pakistan.

research paper titled "Awareness of
dentist regarding antibiotic resistance
in teaching dental hospital of
Peshawar." Dr. Zahid Hussain
presented his original research titled
"Fake news, myths and remedies
regarding oral health in patients
coming to teaching dental hospital of
Peshawar." Dr. Wajeeha Aftab
presented her poster presentation titled
"Stress, depression and anxiety in
TMO's of teaching dental hospital of

Peshawar." Dr. Haisam also presented
his poster presentation tilted
"Knowledge regarding cross
infections in dental assistants of
teaching dental hospital of Peshawar".
All these research projects were
completed under the guidance of Dr.
Syed Imran Ali Shah Gilani.
The students also participated in
Dental Olympics and Dr. Zainab
stood first position in Quiz
Competition. -PR

Intl speaker offers insight on
enamelsaliva relationship

A H O R E Research and
Ethical Review
Committee of College of
Dentistry, Lahore Medical
and Dental College
(LMDC) recently organized
a seminar entitled,
enamelsaliva
continuum. Dr Paul
Anderson, a Professor
of Oral Biology and the
Chair of Dental
post-graduate
committee, Queen
Mary University of
London (QMUL), was
invited to speak on the
topic. The seminar was
formally officiated by the
Chairperson, Research and
Ethical Review Committee,
Prof. Dr. Nazli Shujaat and

Publisher and CEO

was attended by faculty
members, House Officers
and post-graduate residents.
Prof. Anderson gave a
very insightful and
forthcoming talk which was
thoroughly appreciated by

the audiences. He talked
about enamelsaliva
relationship and how this
"peptide" skin of teeth
serves to protect enamel
surfaces from acidic attack
by influencing the surface

chemistry of calcium
hydroxyapatite, the mineral
component of enamel
and how novel X-ray
microscopic methods have
assisted in the studies of
enamel-saliva continuum.

LMDC, Prof. Dr. Aqib
Sohail gave a vote of
thanks to Prof. Anderson
and the organizing
committee
for
arranging a successful
seminar.
He
emphasized on
the
importance of acquiring
post-graudate degree
Photos:
and encouraged the
DT Pakistan
House Officers and
Prof. Anderson ended his post-graduate residents to
l e c t u r e w i t h a v e r y actively pursue postcomprehensive overview graduate residents courses
of dental post-graduate offered at QMUL. He
courses offered at QMUL. concluded by presenting
To w a r d s t h e e n d , the plaque of appreciation
Principal Dental College to the guest speaker. -PR

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[3] => DTI Mar-Apr.FH10

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INTERVIEW

4 DENTAL TRIBUNE Pakistan Edition March 2020

The culture of critical
thinking is lacking
in our country;

Dr Ambrina Qureshi
By Dr Muattar Hanif

D

r Ambrina is the Chairperson of
Community & Preventive Dentistry at
Dow University of Health Sciences
(DUHS). She is also the member of the
Syndicate of DUHS.
Prof. Dr. Ambrina Qureshi graduated from
Fatima Jinnah Dental College (FJDC),
Karachi. Following her graduation, she joined
Liaquat University of Medical & Health
Sciences as a Lecturer in Community Dentistry.
Dr Ambrina then went on to pursue Master's
in Philosophy (MPhil) Community Dentistry
from Shaikh Zayed Federal Postgraduate
Medical Institute, Lahore. To update her thirst
for knowledge, Dr Ambrina is currently
pursuing PhD (Doctor of Philosophy)
Community Dentistry. Currently she is working
on a research project which is a three arm
diabetes-periodontitis trial funded by the
National Research Programs for University
(NRPU) Higher Education Commission.
Recently she sat down with Dental Tribune
Pakistan to talk about her journey.

RAPID FIRE
. Does the duration of brushing really make
difference to your teeth?
AQ: I think twice.
. Which technique can make brushing really
effective?
AQ: Yes, it's the sweep method that is more
important. Sweep the brush through like [the
bristles are] between your teeth. Let the bristles
slowly swipe away the plaque and everything.
That is the best method.
. How to counter bad breathe?
AQ: You need to look into the underlying
cause. Most of the time it's the underlying
systemic disease that is usually the cause of
the bad breathe. You need to look into that.
. Babies do not need brushing, is it true?
AQ: No it's not true. Absolutely not. Babies
do need to brush their teeth and it's the
responsibility of their parents to do that.
. Brushing should be done only after taking
a meal, true?
AQ: Ideally it's good. But even if you skip
brushing at least cleanse your mouth.
. White teeth are healthy teeth, really?
AQ: White teeth are healthy teeth if they are
naturally white. Not if you've colored it white
[artificially]!

Dental Tribune Pakistan: Tell us a little about
your background, especially what made you chose
dentistry as your profession?
Ambrina Qureshi: I did not choose dentistry
initially. My passion was always towards philosophy
and arts and subjects like that. But it's a familial
trend where our ladies in the family are doctors and
the gentlemen are the lawyers. So initially I opted
Arts. I was already doing my Bachelors in Arts at
St. Joseph College and I [already] had chosen
subjects like Philosophy, European History and
English literature. It took one year for my mother
to really convince me and bring [me] back to the
track where the family was going on so. And that
is how I came into the dentistry.

We should start spreading
awareness to the rural populations
through tele-dentistry
DTP: How do you think the raging oral cancer
problem can be addressed?
AQ: I always say that all these things like awareness,
prevention, promotion and education these all
should be integrated in your [dental] curriculum.
And it is our undergraduate students who during
their training period can actually take care of such
things and can spread the awareness. They can help
us address these issues by finding out the updated
statistics and finding out the ways how to promote
prevention of such debilitating conditions.
DTP: How can we increase awareness regarding
gutka or other tobacco-related products?
AQ: My answer is same. The awareness or the
address of the issues these all should be made
integral part of the undergraduate curriculum. The
undergraduate students during their training, should
learn how to identify the oral conditions, even the
general conditions, which are linked to the oral or
poor conditions and they should address it. They
should be finding out ways how to prevent it. They
should be finding out ways how to educate the
masses about the poor effects of the risk factors
which are associated with these conditions.

New generation of the females
should learn how to negotiate
with the things
DTP: What steps can be taken to address the issues
of people in rural areas?
AQ: You see, technology is growing fast. And I
think we should understand that the use of
technology has entered even in the rural areas, like
every person has a mobile phone these days. So
why not start introducing tele- dentistry. You know,
start spreading awareness to the rural populations

through teledentistry or even like integrating this
teledentistry into your curriculum. Again, I think
these are the things which are the need of the hour
and this is how we can address these issues and this
is how we can solve these issues, to some extent.
DTP: How can we motivate dental professionals
to give back to their community?
AQ: I think it's very difficult to motivate dental
professionals, especially the new graduates.
Everyone has spent money on their education and
they would not like to go to the rural areas. This is
a very frank answer that I am giving! The only
solution which I can think of, at this point is again,
integration. Get your students to identify these
problems during their training period. They can
help us identify these problems and spread
awareness. You cannot ask or you cannot motivate
the new graduates to go back to the rural
communities or in their own communities because
everyone wants to go up. If a person has started
from Karachi, maybe, they would like to go to U.S.
or UK rather than going back to Karachi or even if
the person is coming from a rural area, he would
not like to go [back] there. Because he has, again
spent money on his or her education. So let these
things, which we know that are the current problems,
into your curriculum. Get your curriculums be
reformed. So that while we are educating our
dentists, they are also supposed to solve the problems
of our community. This should go side by side.

Awareness, prevention,
promotion and education- these
all should be integrated in
dental curriculum
DTP: How can public sectors help in oral health
issues?
AQ: See, public health issues today are not the
[first] priority, to be very sorry. The kind of standards
or the regulations we have, whether it's the Public
Sector College or a Private Sector Institute All of
them just want to follow those 'particular' regulatory
standards. When all are just going to focus on
meeting those standards, which have been imposed
on them, then why would someone care about the
public? [Who will care] regarding, what is happening
in the public or like what the public is suffering
from? I think the Public Sector would have played
a very important role in prevention, in public health
promotion, in awareness, in education in such
basic things. But somehow the Public Sector has
also started competing with those standards. Now
people are more focused on, you know, forensic
odontology and implantology, such big difficult
words are these! and you know on specialty based
dentistry. We all have forgotten
Continued on Page 11

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6 DENTAL TRIBUNE Pakistan Edition March 2020

CLINICAL PRACTICE

Dentine hypersensitivity experience using
toothpaste with added bioglass: A clinical trial
By Drs Stefano Daniele&Andrea
Alessandri, Italy

I

n our clinical practices, dentine
hypersensitivity (DH) has
always been a challenge. Our
best approach was to suggest at-home
solutions such as sensitivity
toothpaste or mouthrinse, but often
there was no significant relief
experienced by
our patients. Last year, we met
Richard Whatley, CEO of BioMin
Technologies, who gave us some
samples of BioMin F toothpaste for
provision of relief from DH, and he
explained the technology behind the
effectiveness of this novel bioactive
glass-based toothpaste. The bioglass
particles contained in BioMin F
toothpaste adhere to dental hard tissue
and then slowly dissolve in saliva to
release calcium, phosphate and
fluoride ions, which precipitate on
nucleation sites as fluorapatite
crystals to occlude open dentinal
tubules.
According to Brännströms
h y d r o d y n a m i c t h e o r y, f l u i d
movement inside the dentinal tubules
in response to evocative stimuli such
as coldfirst of allbut also hot and
sweet food and beverages, stimulating
the odontoblast fibres and nerve
endings and thereby creating a brief
and acute pain, like an electric shock.
This is what patients refer to as pain
from DH.
A special polymer in BioMin F
toothpaste is able to chemically bond
the calcium from the bioglass to the
hydroxyapatite of enamel. This
adhesion is similar to that of glass
ionomer cement to tooth surfaces.
Saliva slowly dissolves these bioglass
particles. This enables the release of
ions from bioglass particles over 812
hours after brushing to create new
crystals of fluorapatite, which form
on nucleation sites like peritubular
dentine and the internal surfaces of
dentinal tubules. The formation and
development of these fluorapatite
crystals closes exposed dentinal
tubules and provides relief from the
pain of DH.
It is important to note that the
fluoride concentration in BioMin F
toothpaste is much lower than that of
other DH or caries prevention
toothpastes, which often utilise
several thousand parts per million of
fluoride (from 1,000 to almost 5,000
ppm in some countries). BioMin F
has a fluoride concentration of only
530 ppm, and this concentration is
sufficient to promote the formation
of fluorapatite crystals on the tooth
surfaces.
Soluble-fluoride toothpastes

Fig. 1: Small areas of cervical loss of enamel,
resulting in exposure of dentine to evocative
stimuli, in particular cold and air, and thus
dentine hypersensitivity pain.

Fig. 2: Large areas of cervical loss of enamel
due to powerful phenomena of abrasion and
erosion of enamel and high dentine
hypersensitivity pain.

Fig. 3: Percentage of patients included in the
clinical trial who reported dentine
hypersensitivity pain to the dentist on
consuming hot, cold or acidic foodstuffs or
brushing their teeth.

Fig. 4: Of the patients in the trial, 48.27%
reported prior use of sensitivity toothpaste.

Fig. 5: Of the patients treated with BioMin F,
27.58% had no further dentine hypersensitivity
pain and 52.72% reported a reduction.

Fig. 6: Of the patients in the trial, 73.07%
reported that BioMin F toothpaste is more
effective than other sensitivity toothpastes in
reducing dentine hypersensitivity pain.

Fig. 7: Patients evaluation questionnaire in which she reported vomiting bouts during
BioMin F treatment, but a complete absence of dentine hypersensitivity (score of 9)
despite this severe acidic challenge.

(typically including sodium fluoride
or sodium monofluorophosphate)
require a high concentration of
fluoride because most of the available
fluoride is washed away by the
salivary flow, but at such high
concentrations, it forms amorphous
crystalline calcium fluorite on dental
hard tissue and not fluorapatite
mineral. It is very important to start
remineralisation on initial carious
lesions such Codes 1 and 2 on the
International Caries Detection and
Assessment System. A scientific
paper on caries research published in
2013 by Hill et al. shows that only a
fluoride concentration of below 45
ppm is effective in promoting
remineralisation when combined with
calcium and phosphate to form
fluorapatite crystals. It is in its
crystalline phase that it is able to
exchange ions in the oral environment
(equilibrium
between
remineralisation
and
demineralisation).
The crystalline phase of fluorapatite
developed by bioglass has enhanced
acid-resistant features too. Most
concentrated-fluoride dental products,
such as toothpaste and varnishes,
might be able to form an amorphous
crystalline phase on enamel, but that
is not remineralisation, as mentioned,
but calcium fluorite. Calcium fluorite
is not acid-resistant like fluorapatite
crystals, but resistance to acid is a
very important feature for
overcoming the DH challenge. In
fact, an amorphous and not acidresistant layer is prone to dissolving
in contact with erosive beverages or
foodstuffs, thereby restarting DH pain
owing to the re-exposure of dentinal
tubules.
Clinical trial with BioMin F for
dentine hypersensitivity
We started the trial in November
2018 and included only patients with
pronounced DH of a grade of
moderate to severe. In July 2019, we
collected the last recall from this trial.
For the trial, every participant was
given a sample of BioMin F and
instructed to use the toothpaste twice
a day for two weeks before recall.
At recall, the evaluation sheet given
to the participants contained some
general questions, covering their
experience of the flavour of the
toothpaste, its texture and its foaming
capabilities, for example, as well as
some specific questions, such as
concerning their prior use of other
toothpastes for DH. In particular, the
questionnaire asked the patients to
grade the scale of relief from DH
using BioMin F on a scale of 0 to 10.
We considered that an average score
Continued on Page 10

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NEWS

8 DENTAL TRIBUNE Pakistan Edition March 2020

Endodontics workshop
focuses on usage of dental
operating microscope

AWALPINDI - A workshop on dental
operating microscope (DOM) and its use
in root canal treatment was recently
conducted by the Department of Operative Dentistry,
Margalla Institute of Health Sciences (MIHS). The
event was chaired by Dr Amjad Mahmood Principal
MIHS. Renowned endodontist Dr. Taemoor Iqbal
was invited as keynote speaker of the event. The aim
of the workshop was to highlight the concepts of use
of magnification in endodontics.

Dental experts deliver lectures
on maxillofacial trauma cases

AMSHORO - A one-day
maxillofacial trauma
seminar was held recently
held at Liaquat University of
Medical & Health Sciences
(LUMHS), Jamshoro. The
seminar was organized by
Department of Oral and
Maxillofacial Surgery LUMHS
with the collaboration of
Pakistan Association of Oral

Haider, Prof Noor Ul Wahab,
Prof Adnan Aslam, Prof
Muhammad Waseem Ibrahim,
Prof Zahid Ali, Dr. Muhammad
Shahzad, Dr. Suneel Kumar,
Dr. Kashif Ali Channar, Dr
Shaheen Ahmed and Dr
Salman Shafique. Prof Amir El
Barbari from Egypt and Dr.
Manuel Blanco-Guzman from
United Kingdom shared their

and symphysis fractures,
surgical approaches for
mandibular fracture, load
bearing and load shearing
osteo-synthesis, frontal sinus
injuries and its current
management, orbital trauma
and its management, challenges
of pan-facial trauma,
management of tele-canthus,
pediatric fractures and open
Photos: DT Pakistan

Photos:
DT Pakistan

The session was facilitated by Dr. Ayesha Naveed,
Head of Medical Education Department, MIHS and
Dr. Lubna Pasha, Head of Department of Operative
Dentistry MIHS. The session was attended by faculty,
house surgeons and students from different college.
Dr. Taemoor emphasized on importance of
magnification and use of DOM in endodontics. He
told that the enhanced vision with magnification and
illumination from a microscope could enable
endodontists to explore new endodontic horizons.
The lecture was followed by a live demonstration
on patient by the speaker, introducing the participants
on the use of DOM. Later on participants were given
a chance to work under the microscope.
The participants actively participated throughout
the whole session and explored a new domain of
endodontic dentistry. Later Dr.Amjad Mehmood and
Dr.Taemoor Iqbal distributed the certificates to the
participants and the organizers. Efforts of organizers
were appreciated for their hard work and more such
events were promised in the future. -PR

Dr Jamal headlines infection
prevention and control in dentistry

ARACHI - A one-day interactive session
and hands on workshop on 'Infection
Prevention and Control in Dentistry' was
recently conducted as part of first
specialized course. The session was headed by Dr
Jamal Syed, Director, Center of Dental Education

& Maxillofacial Surgeons and
Ziauddin College of Dentistry.
The chief guest for the
occasion was the Honorable
Vice Chancellor of Liaquat
University of Medical and
Health science Prof. Dr. Bikha
Ram Devrajani. The objectives
of the seminar were to throw
light on numerous
maxillofacial trauma cases and
explicate its various treatment
modalities.The seminar
included different lectures on
facial trauma and its treatment.
The panel of speakers and
experts consisted of 9 national
and 2 international speakers.
These included Prof.Morveyn
Hossein, Prof Syed Mehmood

expertise through video link.
The event was moderated by
Prof. Dr. Syed Ghazanfar
Hassan, Chairman Oral &
Maxillofacial surgery
Department LUMHS.
The speakers enlightened
post-graduate students from
their knowledge and shared
their expertise on facial trauma
and their management,
including soft tissue trauma of
the skin and trauma of the facial
bones. The lecturers put
spotlight on surgical
approaches for maxillary
fractures, zygomatic bone
fractures, their fixation, optimal
management of mandibular
angle, body, para-symphysis

treatment of mandibular
condylar fractures.
The session concluded by an
open question/answer session
and case base panel discussion
which further enlighten and
updated the post-graduate
students on the management of
maxillofacial trauma fractures.
The chief guest appreciated
the entire team of focal persons
for conducting such activity
and awarded shields to
speakers who participated in
t h e s e m i n a r. T h e Vi c e
Chancellor eulogized the
seminar for its great success in
terms of learning objectives
and maxillofacial trauma
awareness. -PR

FDC organises 3rd session orthodontics workshop

Photo: DT Pakistan

and Medical (CODE-M). The workshop was
conducted by Dr Adil Bin Irfan, Faculty and Head
of Safety, Altamash Institute of Dental Medicine.
The workshop demonstrated all aspects of the
Infection Prevention and Control in Dentistry
protocols for dental auxiliaries and dentists. The
course also gave knowledge on different levels of
precautionary measures based on the risk levels a
patient brings to any establishments. It also
highlighted ways to act efficiently and economically
according to the various types of patients that dental
health care professionals can encounter. The burning
issue of the coronavirus was also one of the topics
Continued on Page 11

AHORE - Faryal Dental
Photo: DT Pakistan
College (FDC) recently
held 3rd session of
orthodontics workshop. The
session was organized under
supervision of Prof Dr Farhat
Amin, Head of Department,
Orthodontics. The session
included detailed lectures by
Dr Mariam Masood, Assistant
Professor, Orthodontics and
Dr Adeel Iftikhar, Senior Registrar, Orthodontics.
The workshop included lectures on anterior-posterior and vertical discrepancies in dentofacial
region. A detailed demonstration was given on Phantom heads and orthopedic appliances usage
were discusses. The lecturers highlighted the management of Class II, Class III, open-bite and
Continued on Page 11

[9] => DTI Mar-Apr.FH10

NEWS

March 2020 Pakistan Edition DENTAL TRIBUNE 9

Local students smile wide, thanks to
free dental checkups by BUMDC

K

ARACHI - The dental team of
Bahria University Medical and
Dental College (BUMDC) recently
conducted a free dental checkup and
awareness session. The camps were setup in
schools located in the vicinities of Baba and
Bhitt Islands.

The dental team was divided into 2 units
with the first unit sent to a government
school at Baba Island and the second unit
to a school at Bhitt Island. The dental team
performed the duties of full-mouth
examination and checking of dental status
of each student of the school. Oral hygiene

SIOHS screens 1,200
childern for oral disease

K

ARACHI - The Department of Community &
Preventive Dentistry, Sindh Institute of Oral Health
Sciences (SIOHS), Jinnah Sindh Medical
University (JSMU) recently screened nearly 1,200 children

Photos: DT Pakistan

Photo:
DT Pakistan

The dental team comprised of 45 dentists
chaired by Dr. Kulsoom Fatima Rizvi, Vice
Principal, BUMDC and Head of Community
Support Program (CSP) and Preventive and
Community Dentistry department, Dr.
Shama Asghar, Head of Operative Dentistry
department, Dr. Beenish Fatima, Head of
Oral Biology Department and Senior
Lecturers Dr Muhammad Mohsin Haider,
Dr. Raima Bashir, Dr. Arqam Najmi and
Dr. Umiama Khan along with 35 House
Officers.
The team were escorted by Pakistan Navy
(PN) personnel to the respective islands.

Free dental camp setup
by BUMDC

K

ARACHI - A free dental
camp was recently
o rg a n i z e d b y S h i f a
Welfare Association near Kaybees
Restaurant, Munawar Chowrangi,
Karachi. Five dental House Officers
from Bahria University Medical
and Dental College (BUMDC)
voluntarily participated in the
activity. The dental team conducted
the session under the supervision
of Dr Kulsoom Fatima Rizvi,
Vice Principal, Dental Section.
The patients were evaluated,
diagnosed and referred to BUMDC.
They were also provided with
free medication for temporary
relief. -PR

Photos:
DT Pakistan

instructions were also provided to each
student. Children were especially instructed
about proper brushing techniques on dental
models. Reminders for tooth brushing and
healthy vs poor diet were also distributed.
The students actively participated in the
dental activity. Director Administration,
Cdr M.Faisal Sadiq PN met the dental
team and appreciated their efforts. He was
pleased at the execution of a successful
dental hygiene awareness session and
encouraged the team to make it a regular
feature to visit the under privileged
population. -PR

for oral diseases and provided guidance and awareness to
them. The event was held to commemorate National Oral
Health month.
Head of Community Dentistry department, Dr Marium
Azfar and the out - reach Coordinator, Dr. Imran Khan
supervised the team of faculty and students. The screening
program was held at The Citizen's Foundation's Sindh
Police School campus in Qayyumabad.
Dr Marium Azfar told that the screening event was part
of JSMU's outreach programme in collaboration with
Colgate-Palmolive. Dean of SIOHS, Prof. S.M.Kefi Iqbal
inaugurated the event and presented certificates and shields
to the participants. The Vice Chancellor, Professor S.M.Tariq
Rafi stressed that JSMU should regularly hold outreach
programmes according to its vision of building healthy
communities in its area of operation. -PR

Dentists need to take more action to
combat the opioid epidemic, says expert

P

ITTSBURGH, U.S. - In a recent study on opioids
reported by Dental Tribune International (DTI),
researchers found that the overprescribing by
dentists in the U.S. was common, particularly for patients
at high risk of substance abuse. In the study, the team
used Truven Health MarketScan Research Databases to
assess close to 550,000 dental visits by adult patients
between 2011 and 2015. From that, they were able to
attain their results.
In an in-depth discussion with the study's lead author,
Prof. Katie J. Suda from the Division of General Internal
Medicine at the University of Pittsburgh School of
Medicine, Suda gave more insight into her work and
described some possible measures to combat the issue.
Speaking to DTI about the confronting statistics and
what could be done to curb the trend of overprescription,
Suda said that there was a lack of resources and tools to
help dentists in the area of pain mitigation. She added
that, if there were better tools in place, dentists could be
influential in being part of the solution to the opioid
epidemic. She said, "Similarly to medical providers,
dentists need to have resources to aid them in their
prescribing decisions for pain medications. These should
include clinical guidelines specific to oral health and
education on how to talk to their patients about treating
their oral pain."
The establishment of guidelines is one of the significant
issues around opioid prescription across the medical and
dental fields, and surgeons at Baylor Scott & White Health
hospitals, a large health care system in Texas, recently
implemented a pain management program that reduced
longer-term opioid prescriptions by two-thirds. That kind
of initiative is something Suda believes dentists also need
to adopt. "In the interim, individual dentists can implement
their own practice-specific guidelines. For example, all

In a recent discussion Dental Tribune International
had with an expert on the opioid epidemic, the role
dentists play in combating the problem was front and
center. (Image: Antonio Guillem/Shutterstock)

patients without a contraindication could receive ibuprofen
and acetaminophen post-extraction. Only low-potency
opioids could be prescribed, for example acetaminophen
with codeine instead of oxycodone."
How the problem has reached these proportions is
unclear, but Suda was quick to note that, although dentists
are involved in the opioid epidemic, the epidemic is not
their fault. "There are many causes of the opioid epidemic
and dentists are only one prescriber group," she said.
However, Suda pointed out that there has been no lack
of information to help dentists understand the epidemic
better. Public health and professional organizations have
disseminated information widely, and the American Dental
Association has provided educational programming and
literature summaries relevant to oral pain on group email
lists as well as implemented a policy to combat the issue.
In conclusion, Suda said: "Dentists should also
check their local prescription drug monitoring
program before they write a prescription for any opioid."
- Dental Tribune International

[10] => DTI Mar-Apr.FH10

NEWS

10 DENTAL TRIBUNE Pakistan Edition March 2020

Coronavirus guidelines for dental practitioners and students

UHAN, CHINA - The COVID-19
pandemic, which originated in Wuhan,
has become a serious public health
challenge of international concern. Researchers
from Wuhan University School and Hospital of
Stomatology have now released a paper which
includes a number of recommendations for dental
practitioners and dental students on how to deal
with the virus SARS-CoV-2 that poses emerging
and future challenges for dentistry.
Researchers recommend that dentists and patients
Infection control measures are necessary to
alike wear protective masks and goggles at all
prevent the virus from spreading further and to
times while they are at the dental office.
help control the pandemic. Owing to the
(Image: MODANO/Shutterstock)
characteristics of dental settings, the risk of cross
infection can be high between patients and dental in a short period and, therefore, need immediate
practitioners. For dental practices and hospitals treatment. Dental dams and high-volume saliva
in areas that are (potentially) affected by COVID- ejectors can help minimise aerosol or spatter in
19, strict and effective infection control protocols dental procedures. The treatment planning of tooth
are urgently needed. This article, based on fracture, luxation or avulsion is dependent on the
experience and relevant guidelines and research, age of the patient, the traumatic severity of dental
introduces essential knowledge about COVID-19 tissue, the development of the apex and the
and nosocomial infection in dental settings and duration of tooth avulsion.
provides recommended management protocols . In the regions that are heavily affected by
for dental practitioners and students in (potentially) COVID-19, patients waiting in dental clinics
should also be provided with medical masks. If
affected areas.
Recommendations for clinical practice include aerosol-producing procedures are unavoidable,
dental practitioners need to wear gowns and facial
the following:
. During the outbreak of COVID-19, dental clinics shields or goggles.
are recommended to establish pre-check triages
The paper also listed recommendations for dental
to measure and record the temperature of every education:
staff member and patient as a routine procedure. . During the outbreak period, online lectures, case
. Preoperative antimicrobial mouth rinsing could studies and problem-based learning tutorials should
reduce the number of microbes in the oral cavity. be adopted to avoid unnecessary aggregation of
. Dental emergencies can occur and exacerbate people and the associated risk of infection.

. Schools should encourage students to engage
in self-learning, to make full use of online resources
and to learn about the latest academic
developments.
. During this period, it is easy for students to be
affected by disease-associated fear and pressure;
dental schools should be prepared to provide
psychological services to those who need them.
"For dental practices and hospitals in
countries/regions that are (potentially) affected
with COVID-19, strict and effective infection
control protocols are urgently needed," said
corresponding author Prof. Zhuan Bian in a press
statement. "Dentists should take strict personal
protection measures and avoid or minimise
operations that can produce droplets or aerosols.
Four-handed technique is beneficial for controlling
infection. The use of saliva ejectors with low
volume or high volume can reduce the production
of droplets and aerosols."
The authors called for further discussion and
research on how to improve current infection
control strategies and how to respond to similar
contagious diseases in the future. According to
the World Health Organization by 19 March 2020,
COVID-19 had been diagnosed in 166 countries,
totalling 207,855 laboratory-confirmed cases and
8,648 deaths.
The study, titled "Coronavirus disease
2019 (COVID-19): Emerging and future
challenges for dental and oral medicine", was
published online on 12 March 2020 in the
Journal of Dental Research, ahead of inclusion
in an issue. - Dental Tribune International

Dentine hypersensitivity ...
Continued from page 6

of 9 or 10 meant that the DH has been
completely resolved using BioMin F
toothpaste for only two weeks.
The clinical photographs in Figures
1 and 2 are of patients who reported
diffused DH in the cervical areas of
the teeth and this was treated with
BioMin F for two weeks. This
approach substantially reduced or
eliminated their pain from DH.
Figure 3 shows the percentage of
patients included in the clinical study
who reported pain after consuming
cold, hot or acidic food and after
brushing their teeth with cold water.
Most patients included in the trial had
diffuse (58.62%) or occasional
(37.93%) DH, and only 3.44% did
not report any DH.
Of the 29 patients included in the
clinical trial, the majority (48.27%)
reported that they were already using
a toothpaste to specifically address
DH (Fig. 4).
It is interesting to note, as shown
in Figure 5, how many patients using
BioMin toothpaste twice a day for
two weeks experienced a reduction
in DH pain. Most of the patients found
it relieved their pain from DH. In
particular, 27.58% of patients treated
with BioMin F for two weeks reported
an elimination of hypersensitivity,

Fig. 8: Open tubules on the dentine surface
(research at Queen Mary University of
London).

Fig. 9: Tubules occluded after brushing
with BioMin F (research at Queen Mary
University of London).

while in 52.72%, the pain had been
significantly reduced. Just 20.68%
reported no obvious change after
using BioMin F for two weeks.
Importantly, no patients reported an
increase in DH pain.
One of the last questions asked of
patients was whether they felt that
there was a greater benefit to using
BioMin F, rather than their previous
toothpaste, to tackle DH, and a large
number (73.07%) reported a positive
response as shown in Figure 6.
We would now like to describe in
detail one particular clinical case from
the trial which demonstrates the acidresistant features of fluorapatite
crystals produced by the bioglass in
BioMin F. The 44-year-old female

patient with high DH started the
BioMin F trial according to our
instructions (twice a day), and after
just a few days, she reported greater
relief from DH and she was very
satisfied.
In the following days, the patient
had repetitive bouts of vomiting with
gastric acid reflux with a very low
pH (a pH of around 1) capable of
removing any mineral pellicle or
aggregate covering tubule orifices
and which would likely cause DH
pain to reoccur. Naturally, the patient
feared that this would happen. At the
conclusion of these episodes, she
checked her hypersensitivity pain by
rinsing her teeth with cold water after
brushing in the cold air of winter, and

Fig. 10: Tubules remained occluded after
acid challenge (research at Queen Mary
University of London).

she told us that the benefit of using
BioMin F remained unchanged
(Fig. 7).
This suggests, as evident in
microscopy studies undertaken at
Queen Mary University of London,
that the bioglass contained in the
toothpaste does not produce an
amorphous mineral layer on the tubule
orifices, but produces a true
mineralisation process through which
fluorapatite crystals form that appear
to be acid-resistant. This is shown in
Figures 810.
Editorial note: A list of references
is available from the publisher. This
article was published in preventioninternational magazine of oral health,
Vol. 4, issue 1/2020.

[11] => DTI Mar-Apr.FH10

March 2020 Pakistan Edition DENTAL TRIBUNE 11

COVID-19: Pakistans ...
Continued from front page

management only. Dr Awab Alvi said
that the fight against the coronavirus
can only be succeeded if everyone in
dental practice, maintain good
protection protocol. Especially in regard
to the protective equipment, dental
fraternity needs to assist each other and
consider the financial constraint
imposed with it.
The dental practice may change
altogether once this virus is gone.
Dentists may have to adopt stricter
measures like face visors and better
protective gears, commented Dr Awab.
Dr Mahmood Shah, the President of
Pakistan Dental Association termed the
current scenario as the biggest challenge
the community has ever encountered.
Talking to the president of the Dental
Trade and Manufacturers Association,
Liaqat Humayun, he termed the
situation as a complete economic
meltdown. "The impact we are seeing
is huge. With institutions closed and
the prices of consumables soaring it is
time that dental industry prepares itself
for the unprecedented challenges once
this is over," he said.
"The prices of masks alone have gone
up by 400 times and same is the case
for surgical gloves. Import has come to
a standstill, staff has been relieved in
some cases and the business carried out
is based on stock available," he
concluded.
The industry stalwarts like Idrees
Qadri and Ashraf Ghauri also said that
the dental industry stands to suffer the
most in the healthcare sector and must
brace itself for challenges in the post
COVID-19 era.
The industry faces acute cash-flow
shortage with no payments coming
and the whole business cycle is
halted with clinics going for
emergency/consultation only and in
many cases closed.
Even in such dark times, there is a
light of hope. A student based initiative
called 'Agahi For Corona' has been
started to help the community. The
campaign, headed by Dr Talha
M.Siddiqui, Vice Principal, Baqai
Dental College, Baqai Medical
University and Dr M.Ainul Haq,
Assistant Director and Head Department
of Medical Education, Baqai Dental
College, Baqai Medical University,
includes students, House Officers,
doctors, dentists, pharmacists,
physiotherapists and paramedics
The only redeeming feature at this
point in time is that the whole world is
adversely affected.
It is true that the dental industry is
badly hit with the catastrophe, but the
collective efforts can resuscitate the
community back.

An exclusive interview with

Dr Ambrina Qureshi
Continued from page 4

what actual basic need of our country
was.
The basic need of our country was
prevention. And it still is. We should
all try to focus on prevention rather

than you know We should give it
time to an extent where it can be
addressed. I think it's time that we all
should understand what our community
needs rather than what are our standards
demands.

entrance there are many females and
hardly any males. This could be because
of the prevailing educational movement.
But unfortunately, if we look into the
other side of the picture, we will find
out that only 15 percent of these women

DTP: PMDC (Pakistan Medical and
Dental Council) dissolution has caused
a stir among dental community. Your
comments on that?
AQ: I don't see a major stir among
dental community, to be very honest. I
think the stir was mostly around the
people who were direct sufferers of this
dissolution [which were] the employees
of the PMDC. What actually Dental
Community really wanted? They were
more concerned about their
registrations. They were more
concerned about their faculty
registrations, their experience
certificates and so on. So I think if it is
still in continuity then the dental
community is not much worried. The
most worriers are the people who were
actually working for the PMDC.

Reading systematic
reviews are important
rather than reading some
simple articles

DTP: Students have to appear in NLE
(National License Exam) to become
eligible in house job. Your take on
that?
AQ: First of all NLE has not started as
yet. I suppose this will be implemented
in coming year, somewhere. Let's just
wait for it to come. I think if the

We should start
spreading awareness to
the rural populations
through tele-dentistry
government has decided such a thing
[that is because] all other countries are
also doing it. So I don't think there is
any harm in it. But let the time come
and then maybe we are able to see if it
[turns out to be] good or bad.
DTP: Why is Pakistan's postgraduation degree lagging behind on
global level?
AQ: I think the culture of thinking and
[especially] the culture of critical
thinking, to be more precise and the
culture of questioning, is lacking in our
country. Our postgraduate or be it be
our undergraduate students, I think they
all are lagging behind because they are
not given chances. They themselves are
not in a habit of questioning. They are
rather overburdened by a spate of
assignments, quizzes and presentations
and you know things like that. So all
the time they are more focused on to
meet their concerned targets And this
is with both the undergraduates as well
as Post-Graduates. I think this culture
needs to be instilled in our society .The
culture of questioning and critical
thinking is important, you know.
DTP: In clinical practice we have a
higher male to female ratio as dental
professionals in Pakistan, why do you
think this trend is prevailing?
AQ: There are many females in this
profession, when the [admission in
dental colleges] takes place. At the

who have done their graduation, would
continue their Post-Graduation or even
you know pursue in their clinical fields.
They are hardly given an opportunity
to become head of the departments or
institute, or like becoming Dean or
Principal. There are very few women
who get this chance. I think that is
basically because of the gender inequity
rather than inequality, I must say.
DTP: As a woman, how do you think
female dental professionals can work
along with all the burdens they carry,
some tips for them?
AQ: To be very frank, this burden is
not what they have put on their on their
shoulders. Most of the burden is given
to them by their male counterparts
because probably they are not able to
handle it (laughs). I think women are
more powerful to carry that burden and
they are very happy in carrying that
burden.
But there is a little suggestion for them
from my side. They need to be
negotiators. They need to learn how to
negotiate things which, unfortunately,
we were not taught while we were
developing. So I think for the new
generation of the females, it's my advice
that they should learn how to negotiate
with the things, how to negotiate with
the burden which had been given to
them. [They should learn] how to lessen
it down and how to put it back on male
counterpart. This is my answer.
DTP: What are the hot topics for dental
researches these days?
AQ: It's the way how you present it. It's
the way how you write it. Even if it is a
very, you know, not a hot topic. If you
write it in a way and you know sell it in
a way that is impressive. I think it can
become hot.
DTP: Do you think research at under
grad level really have any worth?
AQ: As I mentioned earlier, Students
need to develop those skills of critical
thinking and questioning. And all this
comes through working on research. So
I think it's very important for an
undergraduate to start learning about
research, yes.
DTP Any suggestions you want to give
for dental students who are thinking to
do research in future?
AQ: Why in future why not in present?
In fact they should start doing research
now! And my sincere suggestion would
be, if they really want to do research.
There is this prevailing stereotypical
comment that read more and you'll
understand more about research. What

you [actually] need to read, that is
important. Reading systematic reviews
are important rather than reading some
simple articles. Read systematic reviews!
That is how you would come to know
what is happening all over world.
Systematic reviews would give you
conclusive ideas where the gap is and
how you can fill those gaps. So get into
a habit of reading systematic reviews of
all the topics that are of your interest.
DTP: Researches done in Pakistan are
still struggling to level with the ones
done on international level, how do you
think this difference can be eradicated?
AQ: How this difference can be
eradicated? Maybe its answer would
come later. Why this is happening is
more important. This is happening
because, again I think our undergrads
even our post grads, and they are not
given the proper guidance of how to do
research. As I already mentioned, they
should develop a habit of reading
systematic reviews. Reading systematic
reviews with meta-analysis would give
them an idea where the gap is [by
comparing it with] the international level
and where those gaps need not to be and
how those gaps need to be filled. So
once they do that, there is nothing that
can stop them from publishing into good
international journals or from doing
international level trials and researches.
What currently they are doing is they
are copying researchers which are
already being done. So copying is not
research. Doing it again and in their own
good methodological, you know, that is
the need of the day.
DTP: Any message for new dentists?
AQ: They should understand what our
public needs are, what they really want.
And you should help them understand
their needs as well. So awareness is
important. Spread awareness for the sake
of this public.

Dr Jamal headlines ...
Continued from page 8

discussed in the workshop. The tutorial
on World Health Organization-WHO
based guidelines to hand hygiene was
the highlight of the course.
Participants included students from
multiple institutions and few belonged
to interior Sindh. The interactive session,
video demonstrations and IPACD
awareness was appreciated by the
audience. Dr Adil also revealed about
his upcoming advance course in IPACD
with the specialist speakers from
Australia in next few months at CODEM. -PR

FDC organises 3rd sessions ...
Continued from page 8

deep bite malocclusions.
Later, Dr Afifa Ahsan, Associate
professor, Oral Biology gave a detailed
lecture on the importance of maxillary
first molar in development of occlusion
and malocclusion.
The college administration supported
and appreciated the efforts of
orthodontics department in organizing
the session. -PR

[12] => DTI Mar-Apr.FH10

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[cover] => DT Pakistan No. 2, 2020

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