DT Pakistan No. 6, 2019

News / Interview with Dr Mahmood Shah

Open PDF View E-paper Edit Epaper Edit Epaper ads save

Table of contents

Open Link

) [13] => Array ( [image_url] => Array ( [2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/78925-5d13341f/2000/page-12.jpg [1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/78925-5d13341f/1000/page-12.jpg [200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/78925-5d13341f/200/page-12.jpg ) [key] => Array ( [2000] => 78925-5d13341f/2000/page-12.jpg [1000] => 78925-5d13341f/1000/page-12.jpg [200] => 78925-5d13341f/200/page-12.jpg ) [ads] => Array ( [0] => Array ( [post_data] => WP_Post Object ( [ID] => 78928 [post_author] => 0 [post_date] => 2024-10-23 22:12:26 [post_date_gmt] => 2024-10-23 22:12:26 [post_content] => [post_title] => epaper-78925-page-13-ad-78928 [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => epaper-78925-page-13-ad-78928 [to_ping] => [pinged] => [post_modified] => 2024-10-23 22:12:26 [post_modified_gmt] => 2024-10-23 22:12:26 [post_content_filtered] => [post_parent] => 0 [guid] => https://e.dental-tribune.com/ad/epaper-78925-page-13-ad/ [menu_order] => 0 [post_type] => ad [post_mime_type] => [comment_count] => 0 [filter] => raw ) [id] => 78928 [id_hash] => ad2ecd6b8108830c1b6d3741f8d0dd2842a324ce753aea6b634e588d9f9f5f98 [post_type] => ad [post_date] => 2024-10-23 22:12:26 [fields] => Array ( [url] => https://www.dtstudyclub.com/ [link] => URL ) [permalink] => https://e.dental-tribune.com/ad/epaper-78925-page-13-ad-78928/ [post_title] => epaper-78925-page-13-ad-78928 [post_status] => publish [position] => 42.857142857143,46.384039900249,51.87969924812,48.379052369077 [belongs_to_epaper] => 78925 [page] => 13 [cached] => false ) ) [html_content] =>

Open Link

PUBLISHED IN PAKISTAN

www.dental-tribune.com.pk
Oral biofilm: A
concern for all dental
professionals

An exclusive interview
with Dr Mahmmod
Shah

INTERVIEW

Page 8

NOVEMBER, 2019 - Issue No. 06 Vol.6

NEWS

Page 10

New world record:
German dentist
extracts worlds ...

New Medical and Dental Council
elects its President & Vice-President
DT Pakistan Report

K

ARACHI - The Medical
and Dental Council
constituted under the new
Pakistan Medical
Commission Ordinance 2019 held
its first meeting recently at a local
hotel in Islamabad. The meeting was
held is pursuant to section 4(2) of
the PMC, wherein the Ordinance was
formally presented followed by the
election of Medical and Dental
Council's (MDC) President and Vice
President; committees were formed
and duties were delegated.
The council members unanimously
elected Dr Arshad Taqi as President
and Mr Ali Raza as Vice President
of the Council unopposed. The
meeting was attended by members
of the newly formed MDC: Mr
Muhammad Ali Raza, Mr Tariq
Ahmad Khan, Dr Rumina Hasan, Dr
Asif Loya, Dr Arshad Taqi, Dr
Anees-ur-Rehman, Surgeon General
of Pakistan, Lt. General Dr Khawar
Rehman, and President CPSP
(College of Physicians and Surgeons
Pakistan), Prof. Dr Zafarullah
Chaudhry. Ms Roshaneh Zafar

attended the meeting via Skype.
After election, the President
Dr Arshad Taqi took over the chair
of the meeting. The trouble of the
medical and dental fraternity was

Ex-employees of grade
1-4 of PMDC applying
for positions will be
given priority.
As per the law, NLE was
to be conducted for the
first time in end of 2020
or start of 2021..
duly noted and in order to remove
hold from the processing of new
licences, renewals and other
certificates the meeting proceeded
to appoint temporary staff members.
The temporary members are to take
over during the transition period and
not stay in office for over 90 days.
Dr Nasser Mohiuddin, Director
General (Tech.), Ministry of National
Health Services Regulations and
Coordination (NHSR&C) was

Page 12

NEWS

appointed on temporary basis.
Temporary staff for the Medical
Authority was also appointed. It was
announced that remuneration of each
temporary member would be
determined by the Human Rights
(HR) Committee and approved by
the President.
Advertisement for appointment of
secretary to the Council and
members of the Medical Authority
on merit will be published at the
earliest and interviews and
assessments will be carried out as
per the system recommended by the
HR Committee. It was also clarified
that the 100 ex-employees of
Pakistan Medical and Dental
Council (PMDC) who fall in pay
grade 1-4 will be given first
preference and priority when
positions for similar nature are
advertised, as per the Section 49(3)
of the Ordinance.
The Council unanimously decided
that the Director Finance prepare
the necessary approvals for payment
of the 6 months basic pay and the
20 days salary for October 2019 of
all ex-employees of PMDC to ensure
Continued on Page 15

Digitalise verification
system for doctors: PMC
DT Pakistan Report

I

SLAMABAD - A press
conference was called by The
Pakistan Medical Commission
(PMC) recently. They announced
PMC's plan for digitalization of the
verification system of doctors and
medical students.
Dr Arshad Taqi,
PMC President
and Mohammad
Ali
Raza,
PMC's ViceP r e s i d e n t Image: DT Pakistan
presided the occasion.
While addressing a press conference,
Taqi said that following the formation
of PMC, they took several steps to
improve its working. The clearance
of pending cases of good standing
certificates and the verifications of
applications for doctors' were included
in the steps. The PMC clarified that
the Higher Education Commission
(HEC) would ensure that the PMC's
standards were implemented in
medical colleges as per the directives
of a new law.
"The HEC will conduct inspections
of medical and dental colleges whose
Continued on Page 15

Scientific Session on Advanced
Dental Sciences 2019
DT Pakistan Report

L

AHORE - The College of
Dentistry, Liaquat Medical &
Dental College (LMDC),
recently held a Scientific Session on
Advanced Clinical Sciences, in
collaboration with 1st UHS International Dental Conference. The
scientific meeting brought together
international and national speakers
from various reputed universities and
dental practices under one roof. The
theme of the event was "Together
towards Tomorrow."
The event was formally inaugurated
by the Patron-in-Chief, Prof Dr Aqib
Sohail, renowned Oral and

Maxillofacial Surgeon and Principal,
College of Dentistry, LMDC. He
conveyed gratitude to all the honorable
guests and speakers of the event.
Minister of Health Punjab, Prof Dr
Yasmin Rashid, was the Chief Guest
of the event.
In her address, Dr Rashid
appreciated the professional
commitment of the dental faculty and
congratulated the organizers of the
event for arranging such a beneficial
event. Vice-Chancellor, UHS, Prof Dr
Javed Akram, and Vice-Chancellor,
King Edward Medical University
(KEMU), Prof Dr Khalid Masood
Gondal, graced the event as the Guest
of Honor. Senior faculty members

Photo: DT Pakistan

from all specialties attended the event
including Prof Dr Nazia Yazdaine,
Prof Dr Abida Ijaz, Prof Abid Ashar,
Prof Dr Muhammad Qasim Saeed,
Prof Dr Abdul Moeed Zaigham, Prof
Dr Nasir Saleem, Prof Ayub Shah,
Prof Dr Hina Zafar Raja, and Dr
Saroosh Ehsan.

Eminent keynote international and
national speakers enlightened the
attendees with their knowledge and
spoke on various topics related
to the field of dentistry. Dr Ala
Ersheidat (Jordan), Dr Ansa Akram
(UK), Mr Mazahir Hussain (Spain),
Continued on Page 15

[2] => DTI Nov-Dec.FH10

NEWS

2 DENTAL TRIBUNE Pakistan Edition November 2019

4TH INTERNATIONAL CONFERENCE

I

Patient Safety Comes First- Experts
at Dentistry - Dental Symposium

SLAMABAD - Riphah
International University and
Riphah Institute of Health Care
Improvement and Safety organized
the 4th International Conference on
Patient Safety. A three-day extensive
program was designed including preconference workshops and lectures
from both national and international
speakers. The session was facilitated
by Prof. Dr. Yawar Hayat Khan,
Professor of Dental materials, Islamic
International Dental College (IIDC),
Director at CLIQ(Center of excellence
in Leadership, Innovation and Quality)
& ALSS(South Asia and UAL),
MSLDE( Master of Science in
Leadership and Dentistry) at
RACKODS (Ras Al Khaimah College
of Dental Sciences), UAE and
Co-facilitated by Prof. Dr. Ulfat
Bashir, Principal IIDC. Among the
esteemed panel of speakers included
Dr. Sabrin Azim, Assistant Professor
Oral & Maxillofacial surgery,
RACKODS, UAE, Professor Dr.
Azhar Sheikh, Dean Foundation
University Dental College, Prof. Dr.
Arshad Malik, Principal HBSDC
(Hazrat Bari Imam Sarkar Dental
College), Dr. Muhammad Humza Bin
Saeed, Associate Professor
Community Dentistry, IIDC . The
panel discussion was moderated by
Dr. Kanwal Zulfiqar, Assistant
Professor, Orthodontics, Head Quality
Assurance Team, IIDC. Deans of
various dental colleges were invited
in the conference.
The conference was focused on all
the aspects of healthcare with the
agenda to create awareness among
the health care practitioners and
contribute in their effective learning
by making the correct and verified
information and knowledge available.

Pakistan won big
at World Implant
Symposium

K

ARACHI - Dr Irfan
Qureshi stood third
in poster
competition at DWS
(Dentis
Wo r l d
Symposium) 2019,
Dentist & Gt-Medical,
Wo r l d I m p l a n t
Symposium held at
Madrid. He also won
grant of 500$ as a grand prize.
His poster was titled 'The
Vampire Sinus Lift- Digital
Restoration of One Q Implants
placed in Autologous Sinus
Augmentation'. -PR

Publisher/CEO
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

Photos: DT Pakistan

Haseeb Uddin
Designing & Layout
Sheikh M. Sadiq Ali

Patient safety in dentistry was one
of the primary focuses on the
Conference.
A Dental Symposium was organized
by the Faculty of IIDC. Informative
presentations regarding the patient
safety in dentistry and how it can be
improved and implemented were
engrossed.
Dr. Sabrin Azim presented the
clinical aspects of patient safety and
emphasized on building a culture in
all healthcare organizations and how
they are bringing exclusive changes
in their University RACKODS, UAE
in collaboration with Riphah
University.
Professor Dr. Azhar Sheikh talked
about the 'Patient Safety in dentistry
and Our responsibility'.
Prof. Dr. Yawar Hayat Khan,
explained the implementation of the
WISH (Waste Industry Safety and
Health) framework and the progress
that can be made within our facilities
with honest efforts.
Prof. Dr. Arshad Malik extensively
focused the adverse events resulting
from the negligence in clinical
procedures.

Dr. Muhammad Humza Bin Saeed
focused on the Importance of NonTe c h n i c a l s k i l l s a n d t h e i r
incorporation in the dental curriculum.
The presentation session was followed
by the panel discussion from the
eminent speakers.
The discussion included an
interactive Q&A session with the
audience. Panel discussed the various
aspects regarding the patient centered,
safe dental care. Role and
responsibility of an individual health
care worker was exclusively agreed
upon. Building of effective local Task
forces in collaboration with the local
communities was decided which
would monitor and work for
awareness and improvement of the
dental facilities within their area.
Development of patient safety
culture within the organizations and
eliminating the fear or punishment
factor in case of reporting any adverse
event or scenario was agreed. Building
a trust within the organization and
making sincere efforts towards a
defined goal of 'Quality Care for All'
was the concluding statement of the
Dental Symposium. -PR

DUHS participation in Oral Health
Promotional Activity at Health Asia

K

ARACHI - The Faculty of
Dentistry Dow University
of Health Sciences (Dow
International Dental College, Dow
D e n t a l
College and
Dr Ishrat-ulIbad Khan
Institute of
Oral Health
Sciences)
participated in the 17th Health Asia
International Exhibition and
Conference held at Expo Centre
Karachi from September 24th to
26th, 2019. The focus was to assess
oral health of traders, exhibitors and

visitors of the three-day exhibition.
The basic objective of this activity
was to provide free oral health
screening to the masses and deliver
h e a l t h
Photo: DT Pakistan promotional
activity to the
focused
population.
In
this
context
around 700 patients were observed
and screened for various oral health
diseases. The referrals were made
to dental hospitals of all dental
colleges of DUHS. The participants
Continued on Page 15

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
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.
International Office/Headquarters

Publisher and Chief Executive Officer
Torsten R. Oemus
Chief Content Officer
Claudia Duschek
Dental Tribune International GmbH
Holbeinstr. 29, 04229 Leipzig, Germany
Tel.: +49 341 48 474 302
Fax: +49 341 48 474 173
General requests:
info@dental-tribune.com
Sales requests:
mediasales@dental-tribune.com
www.dental-tribune.com
Material from Dental Tribune International
GmbH that has been reprinted or translated
and reprinted in this issue is copyrighted by
Dental Tribune International GmbH. Such
material must be published with the
permission of Dental Tribune International
GmbH. Dental Tribune is a trademark of
Dental Tribune International GmbH.
All rights reserved. © 2020 Dental Tribune
International GmbH. Reproduction in any
manner in any language, in whole or in part,
without the prior written permission of
Dental Tribune International GmbH is
expressly prohibited.
Dental Tribune International GmbH makes
every effort to report clinical information
and manufacturers' product news accurately
but cannot assume responsibility for the
validity of product claims or for
typographical errors. The publisher also
does not assume responsibility for product
names, claims or statements made by
advertisers. Opinions expressed by authors
are their own and may not reflect those of
Dental Tribune International GmbH.

[3] => DTI Nov-Dec.FH10

[4] => DTI Nov-Dec.FH10

NEWS
TMD and Splint Therapy workshop

4 DENTAL TRIBUNE Pakistan Edition November 2019

Hands-on workshop
held at IADSR

L

AHORE - Institute of Advanced Dental
Sciences and Research (IADSR) organized
a one-day workshop on 'Cross Infection
Control in a Private Setting'. It was held as a part of
the 9th Professional Diploma in Advanced General
dentistry (PDAGD). The workshop was facilitated
by Dr. Sameer Nasir BDS, MS (Restorative).
The workshop was initiated with an introduction
to cross-infection, the chain of infection, the pathway
of microorganisms and different modes of infection
transmission. Dr. Samir discussed the prevention of
infection transmission in-detail with SOPs which
must be practiced for infection control. He further
elaborated on different techniques for infection control
including sterilization, appropriate disposition of
contaminated waste material and wrapping to
participants. Further on, Dr. Samir taught management
of high-risk patients, general protocols for patient's
Photos: DT Pakistan

Photos: DT Pakistan

L

AHORE - Institute
of Advanced Dental
Sciences and Research
(IADSR) conducted a
two-day workshop on
'Temporomandibular Disorders
(TMD) and Splint Therapy'.
The workshop was organized
as a part of the IADSR 9th
Professional Diploma in
Advanced General dentistry
(PDAGD). It was facilitated by
Dr. Waleed Toosy BDS, FCPS
(Prosthodontics) and Asst.
Professor Avicenna Dental
College.
The first session comprised
of occlusion, its basic

introduction, and the centric
relationship between the
maxillary and mandibular teeth.
Next, occlusal adjustments
were taught by the facilitator
as it is one modality to
improve the overall pattern of
the tooth.
Participants were also taught
about canine guidance and how
things can go wrong if a
practitioner does not have
canine guidance. Anatomy of
the temporomandibular joint
(TMJ), the anatomy of articular
disc of the temporomandibular
joint, disorders of TMJ and
possible causes of disorders

were discussed in detail by the
facilitator. Participants were
further taught about the clinical
examination of the muscles and
clinical examination of the
disease. Splint fabrication was
demonstrated by Dr.Waleed
and was then performed by the
participants.
Problems raised during the
procedure were solved by
the facilitator, and the queries
raised by the participants
about the topic were also
solved by him. The two-day
workshop concluded by
achieving its desired learning
objectives. -PR

Hands-on workshop on Periodontology

L

AHORE - Institute of Advanced Dental
Sciences and Research (IADSR) held
a two-day workshop as a part of IADSR
9th Professional Diploma in Advanced General
dentistry (PDAGD) on 'Periodontology'. It was

The facilitator demonstrated the effective use
of probes to measure depth and to detect the
patient of perio disease. Next, furcation along
with its involvement and management, surgical
and non-surgical management of periodontal
Photos: DT Pakistan

examination, and cross infection control steps for
individual dental procedures. He emphasized
immensely on the immunization of practitioners
which is not practiced by many practitioners and
explained infection control in dental radiology and
computers as well.
The last session was hands-on, comprising an
identification of Instrument Processing area in private
practice, receiving instruments and washing,
autoclaving, instrumental drying and storage. The
dental unit for start, in between and end of the day
which also included preparation for fillings,
extractions, impressions, dental implants and aligners
were prepared by facilitators.
Participants performed the hands-on session
enthusiastically. -PR

facilitated by Dr. Muhammad Haseeb BDS,
MDS, MCPS (Perio), MFGDP and Asst.
Professor of HOD of Periodontic, University of
Lahore.
Dr. Haseeb elucidated participants how to
recognize the periodontal disease, its signs, and
symptoms and also emphasized on the probes
that are used. Types of periodontal surgeries,
indications for periodontal surgery and
differentiation between periodontitis and
gingivitis were comprehended to the participants.

disease, including regenerative therapy, guided
tissue regeneration, bone grafting procedures,
gingivectomy, periodontal restorative
interactions, ferrule effect, and periodontal flap
therapies were taught to the participants.
Dr. Haseeb also explained periodontal esthetics
including essentials of smile and causes of a
gummy smile.
The participants were assigned two case studies
to disseminate new knowledge and problems
Continued on Page 15

[5] => DTI Nov-Dec.FH10

[6] => DTI Nov-Dec.FH10

NEWS

6 DENTAL TRIBUNE Pakistan Edition November 2019

Dr Faizan awarded coveted
Diplomate status of ICOI

K

Pakistani authors
cited in JDRs
centennial series
DT Staffer

K

ARACHI - The Journal on Dental
Research completed its 100 years
in 2019. Complementing JDR's
Centennial Celebration an article was
recently published in the journal by the
title: Periodontal Medicine: 100 Years of
Progress. The researchers and authors for
the paper, including J.D. Beck, P.N.
Papapanou, K.H. Philips, and S.
Offenbacher, selected 29 total studies that
were the "first" of their kind to discuss, in
depth, periodontal medicine research done
over the past 100 years, with particular
focus on the effects of periodontal disease
on 3 pathological conditions: cardiovascular
disease, diabetes mellitus, and adverse
pregnancy outcomes.
The researchers belonging to University
of North Carolina School of Dentistry and
Columbia University College of Dental
Medicine, USA, organized the selected 29
studies in an overview timeline and broken
down into timelines by topic: cardiovascular
disease (n = 10), diabetes (n = 12), and
adverse pregnancy outcomes (n = 7).
Among the researches, selected to study
the relation between periodontics and
cardiovascular diseases, was one by
Pakistani authors, titled: Non?surgical
periodontal therapy reduces coronary heart
disease risk markers: a randomized
controlled trial. The authors Syed A. H.
Bokhari, Ayyaz A. Khan, Arshad K. Butt,
Mohammad Azhar, Mohammad Hanif,
Mateen Izhar, Dimitris N. Tatakis.
It is a matter of pride for the dental
research sector of the country that our
researchers are gaining not only visibility
but also acknowledgement and appreciation
on a global level.

Photo: DT Pakistan

ARACHI - Dr Syed
Muhammad Faizan,
a renowned name in
the field of Oral
Implantology in Pakistan,
was awarded the Diplomate
status of the world's largest
implant organization, the
International Congress of
Oral Implantologists (ICOI), in Franfurt, Germany.
The ICOI, founded in 1972, is not only the world's largest dental
implant organization, but also the largest provider of continuing dental
implant education. The Diplomate Status is the highest honor that the
professional society ICOI can bestow on a dental professional involved
in Oral Implantology. Dr Faizan achieved it through efforts in advanced
education, research, and actual clinical experience.
Dr Faizan completed his Masters in Oral Implantology from the
prestigious Goethe University of Frankfurt, Germany, and is a Fellow
of ICOI as well. He has been working as the Founder and Director of
Vanguard institute of Oral Implantology in Karachi. -PR

Dr Zahid appointed as president,
PARD 2020 Cabinet

K

ARACHI - Dr Zahid Iqbal
has been appointed as the
president of Pakistan
Association of Restorative Dentistry
(PARD). As per the new cabinet

on board as advisors.
Dr Zahid recently presented at two
esteemed international caliber
conferences- 7th Pakistan
International Orthodontic Conference

Photo: DT Pakistan

(2020), Dr Robia Ghafoor assumed
the office of Vice President; Dr
Farhana Raza Khan, General
Secretary; Dr Haroon Ashraf, Finance
Secretary; Dr Javeria, Dr Dil Rasheed,
Dr Abrar Ali, and Dr Amin were taken

and 6th Annual IADR. His
presentation was on the topic: Local
Research on effect of different
irrigants and intracanal medicaments
on endodontic microbes: From
laboratory to clinical. -PR

Oral health promotion program by Dow Dental College

K

ARACHI - The
Department
of
Community and
Preventive Dentistry and the
Department of Oral Biology of
the Dow Dental College recently
conducted a combined oral health
promotion program in
collaboration with the Colgate
Palmolive Company at Hoor Bai
Hajiani Girl High School located
at Ghazdarabad, Garden East. The
trip was planned under the
supervision of Dr Adnan
Sukkurwala, Dr Muhammad Taqi,
and Dr Syed Jaffar Abbas Zaidi.
They were accompanied by
students of third and first-year
BDS, and trained lecturers,
including Dr Babar Zia, Dr Amber
Saeed, Sanam Faheem, and
Rimsha Qasim.
The purpose of this visit was to
promote oral health awareness
among school children while
bringing early clinical exposure
to first-year dental students. The
intraoral examination was
performed by third-year dental
students on 200-250
students while being
assisted by first-year
dental students. The
data was recorded on
WHO dental forms.
The BDS students
imparted information
regarding brushing
techniques using
models and charts,
instructing the children
to maintain their basic
oral hygiene.
At the end of the
session, kits, including

Photo: DT Pakistan

toothpaste, toothbrushes, and
brushing charts, by Colgate were
distributed among children to
encourage them to improve their
oral health. The administration of
the schools appreciated the efforts
of the dental team and ensured
their full cooperation in continuing
the program with the Dow Dental
College in the future.
Early clinical exposure of the
first-year dental students with

peer-assisted learning and
mentoring from third-year students
is in line with PMDC's latest
standard of curriculum aimed at
bringing social accountability to
dental colleges along with
increased student motivation and
confidence. The Dow Dental
College has taken this
unprecedented initiative in
bringing dental curricular reforms
to address societal needs. -PR

Photo: DT Pakistan

[7] => DTI Nov-Dec.FH10

[8] => DTI Nov-Dec.FH10

8 DENTAL TRIBUNE Pakistan Edition November 2019

INTERVIEW

The long-overdue shift in
the paradigm of Pakistani
dentistry is essential;

Dr Mahmood Shah
By Dr Hira M. Khan

r Syed Mahmood Shah became
president of the Pakistan Dental
Association in 2017 but has been
working with the association for over a decade.
Dental Tribune International spoke to him
about his contribution to the dental profession
and community, in Pakistan, from his position
of power.
Dr Mahmood Shah was also elected as
Chairman of Oral Diseases Commission, Asia
Pacific Dental Federation (APDF) at APDF
Elections held during 40th APDC. He told
Dental Tribune International about his efforts
toward positive representation of Pakistan on
global dental platforms.
After completing BDS and residency at
Liaquat National Hospital, President Pakistan
Dental Association Dr Syed Mahmood Shah
moved to Ireland for his Diploma in Dental
Health from Trinity College, University of
Dublin. On returning, he joined Sindh
Government Service. Later, he got admission
in University of California, Los Angeles, in
an Orthodontics program. On completion of
his foreign degree, he resigned from
government service and devoted himself to
fulltime practice. For over 20 years, Dr Shah
practiced at private dental hospitals before
he finally established his own dental clinic.
The excerpts of the interview are as under:Dental Tribune Pakistan: Please tell us about
yourself, why you chose to become a dentist and
an orthodontist?
Dr Syed Mahmood Shah: Dentistry was not my
first choice. After I did my intermediate in premedical from St. Patrick's College, I went on to
pursue admission in MBBS program at Dow
Medical College. I could not get in at that time
and decided to opt for dentistry. Back in the days,
Liaquat Medical College was the only institute
offering dental program in Karachi. To date, I am
unable to fully express enough gratitude for this
turn of event. Dentistry has given me the status
and prominence that could not have been possible
in the medical field.
About how I stepped into the Orthondontic
specialty: I spent many years in government service
after graduation; during that time the practice was
mainly about minor oral surgery. Most of the cases
were of RTA or extractions, which led to the
exhaustion of my interest in oral surgery. I applied
for admission in endodontics and orthodontics
programs in a foreign university and got accepted
for both. However, I had begun finding

Orthodontics as a very exciting field, and I still
think it is an extremely interesting specialty. I feel
that maxillofacial surgery and orthodontics are the
only two main specialties in dentistry, because
other procedures, including RCT, restorations etc.,
are very commonly performed by general dentists
as well. But orthodontics is a specialist's field and,
therefore, I chose it.
DTP: Introduce PDA, its vision, its objectives,
and the role played by its office bearers?
MS: Pakistan Dental Association (PDA) was
formed in 1960 and has been representing the
entire Pakistani dental community ever since. We
have a Central Office, which represents the entire
country; I am currently the President of that. Then
we have 5 further divisions, each for the 4 provinces
and the federal capital. These are called zones.
These zones are further subdivided into branches
established in all major cities.
The PDA network functions to safeguard the
interest of the dentist, to promote oral and dental
health, and to advise the relevant bodies on what
should be the policy institutions and policy matter
as PDA sees it. PDA's major role is also to represent
Pakistan in the global dental community. I am
proud to state that Pakistan is a very active member
of the World Dental Federation (FDI), which has
representation from around 200 countries

Over the years, PMDC has derailed from
its regulatory responsibilities and has
turned into Private Medical and Dental
Colleges Recognition Council.
worldwide. The FDI President on a couple of
occasions has asked for an invitation to Pakistan.
They want to visit our country. Similarly, we have
represented Pakistan well at the Asia Pacific Dental
Federation. I am currently the Chairman Oral
Disease Commission of APDF.
DTP: What achievements do you count as PDA's
greatest? Please specify the achievements under
your specific tenures.
MS: Unfortunately, I cannot name an achievement
of PDA that brought a significant paradigm shift
in dentistry in Pakistan, and there are reasons for
that. But to highlight a few achievements let's start
with the Asia Pacific Dental Conference, which
was held in Karachi in 2006. 28 countries took
part in the conference, for which I was the patron.
In 2012 and 2015, again, international conferences
were organized in Pakistan. I was the patron of
these as well.
During my current tenure as the President PDA
(Center), my most notable achievement is the
revival of the branches. Despite challenges, I
managed this uphill task, by conducting elections
in 19 cities of the country where PDA branches

were either inactive or absent. I am of the
viewpoint, the task of organizing conferences and
symposiums should now be handled by these
branches, now that we have activated them. The
Central Council of PDA mainly participates in
presenting policy matters.
DTP: In your view, what are the main problems
that agitate the dental profession?
MS: The problems are varied because the field of
dentistry itself is. We have academicians, private
practitioners, and young dentists. Then there is
another category of postgraduate students and
another of undergraduate students. All these groups
are facing different problems. What I see as the
leading problem in dental field is the
overproduction of dentists in Pakistan, especially
in the urban areas, which is giving rise to
unemployment; whereas, the rural areas are not
producing enough dentists. This mismatch will
amount to a significantly problematic situation if
government does not intervene with effective
policies.
DTP: Your contribution to dentistry in Pakistan
as chairman of oral disease commission APDF
and other similar positions held in the past?
MS: Yes, I have held a similar position in the past
as well; I was the Vice-President of APDF. The
protocols and responsibilities change with ranks.
As APDF officers, we have to carry out tasks
aligned with the targets assigned to us by APDF.

Unfortunately, I cannot name an
achievement of PDA that brought
a significant paradigm shift in dentistry
in Pakistan.
For example, we are currently working on a report
on the prevalence of dental caries in the Asia
Pacific region, which will also include data from
Pakistan. The report will have recommendations
on how to fight and limit the prevalence and
incidence of dental caries in this region.
APDF is not like FDI where you are given grants,
but you might be allotted conferences via which
revenue is generated, especially by the hosting
country. Pakistan last hosted APDC in 2006. We
have made all possible efforts to bring the
Conference back, but remain unable due to the
order situation in the country.
But now, APDF has tentatively allotted Pakistan
the APDC in 2022, which will be an immense
achievement if we can execute it.
DTP: Why is it that female dentists are hardly
represented in PDA, while they outnumber male
dentists?
MS: About females in Dentistry, I am of the
opinion that the reason that dentistry is still thriving

[9] => DTI Nov-Dec.FH10

INTERVIEW
in Pakistan is because of the female dentists. It is
kind of a paradox. Let me explain: 80% of the
admitted candidates in dental colleges are females,
out of which 80% of the graduating females never
practice, or leave practice after spending a year
or two in it. (This is a guesstimate.) The practicing
dentists left behind are few and mainly male.
Despite that the unemployment rate for dentists

Dental colleges no longer involve
PDA in conferences.
is high. Imagine if 100% of the graduating lot was
to enter the workforce, we would have a crisis.
Due to lesser working women in the field we
see lesser female representation in associations
like ours.
DTP: What are your comments on PMDC, its
role, and the new ongoing changes?
MS: Aha! PMDC is my favourite subject to speak
on. Over the years, PMDC has derailed from its
regulatory responsibilities and has turned into
"Private Medical and Dental Colleges Recognition
Council". And so instead of promoting general
and oral health, PMDC has become more interested
in raiding colleges. PMDC used to be an effective
body when its roles were well-defined. It would
take notice of significant matters like quackery

According to PDA's current stance, all
dentists, new and senior, are
considered part of the Association.

November 2019 Pakistan Edition DENTAL TRIBUNE 9
50 dental colleges in the country, yet the dental
council is attached to the PMDC like an appendix.
The need for separation is based on the fact that
the woes and challenges, and, therefore, the
solutions, of dentistry in Pakistan, are different.
Secondly, I want to request the President of
Pakistan to form a steering committee with MNAs
from PTI, PML-N, PPPP, and representation from
PMA, PDA, and PAMI. These are the 6 major
stakeholders of the future of medicine and dentistry
in Pakistan. A PMDC draft that is unanimously
agreed upon by this committee should be passed
in the National Assembly. This should be a smooth
process considering all parties were involved in
the decision-making. If need be an expert health
planner should be involved since PMDC should
be a healthcare-specific council. I believe that the
subsequent bill will win without opposition. Shortcut ordinances that are reinvented and introduced
after every few months carry no promise but the
promise to relapse.
Secondly, there also needs to be a Dental Act,
which will specify standards for dental practice.
Mandatory specifications of dental units, radiology

Dentistry is Pakistan is thriving
because of female dentists. It is a
paradox! Let me explain
units, etc.; creating a system for an organized
dental structure and addressing tier-based problems,
all come under Dental Act.
PDA has been striving for the introduction of,
both, Dental Council and Dental Act and will
continue to do so.

differences between a member and nonmember.
Ideally, a PDA member should receive benefits
like discounted fee structure for PDA conferences
and CDE programs in return for an annual
membership fee.
PDA is planning a membership drive, especially
for young dentists, with the assistance of our
longtime media partner- Dental Tribune
International. For this drive, we are designing a

APDF has tentatively allotted Pakistan
the APDC in 2022.
package of incentives for the members.
However, our registered core members do receive
relief. The 13% tax on dentists imposed by Sindh
Revenue Board was waived due to the struggle of
my predecessor, former-PDA President Dr Saqib
Rashid. This relief is only for dentists registered
with PDA.
DTP: Do you think that PDA is engaging enough
with young dentists?
MS: PDA was very active in dental schools when
there were lesser of them. For example, Karachi
started off with just one dental college and now
there are several, which in my opinion sets a
counter-productive narrative for PDA. Now, these
colleges organize their conferences and
symposiums without needing PDA's involvement.
The better byproduct of this, however, is the
formation of specialty associations like those for
maxillofacial surgery, orthodontics, operative
dentistry, etc. These associations have more to do
with academics; they have PG students as
members, either by choice or compulsion. So, they
are far more visible and active.
PDA mainly works for the general dentist for
now, and unfortunately has lesser penetration in
dental schools. This will change with the
introduction of more CDE programs in the future.

a n d d i ff e r e n t e p i d e m i c s . D u e t o t h e
underperformance of PMDC, Pakistan has become
one of the unfortunate countries where we do not DTP: According to the updated PDA constitution,
have proper data on disease prevalence; we are the new president will assume office on January
clueless in terms of numbers about our dental 1st, 2020. Is that right? What are your comments?
caries prevalence, periodontal index, and oral MS: When constitutions are formed, tentative
cancer spread. We do not even have a plan to limit
these conditions. When you do not have
DTP: Please comment on the smartphone
DTP: There are several issues of
the diagnosis, how will you draft
Authentik's its anti-quackery. Do you think in this digital age it is
youth as well as some seniors
a treatment plan? This is one
the right step forward in the fight against the menace of bogus healthcare
in dentistry that PDA has
of my main questions for
services?
failed to take up; the
PMDC.
MS: Oh yes, absolutely! The App fulfils the patient's right to complete transparency. An individual
unconstitutional
Currently, PMDC
must be aware of the genuineness of their healthcare provider's qualification, and Authentik allows
stipend situation
is running on Ad
that. With this App, you can know within seconds whether your dentist, gynaecologist or general
being one example.
hoc- and individualphysician is registered or not. On feeding the name of the doctor, the Authentik App will produce all
How would you
based policies. A new
their degrees registered with the PMDC. And so, a quack's name will not appear on the application,
respond to this?
candidate would come
hence saving you from their trap of malpractice. Additionally, you will also save yourself from
MS: I am not going to say
into power and, instead
contagious diseases, which are commonly acquired from quack's clinics, since they rarely
that these issues are not our
of working on inherent
practice proper sterilization. So I would say that Authentik is providing an effectual
responsibilities, but you have
issues, would start doing things
strategy in safeguarding the wellbeing of the general public.
to understand that we do not
their way. There are no concrete, longhave the
authority to act; our
term policies, which leads to the Council's faltering
limited to highlighting
time and again, whereas the real healthcare issues dates are added. January 1st is mentioned as the responsibility is
dental community, and
remain unresolved and are left to multiply. Despite first calendar year, but the current PDA office did the issues of the
Continued on Page 14
having around 50 dental colleges in the country, not assume charge on that date. Our elections were suggesting solutions
the trend of oral diseases in still on the rise, which held in August, so you can well imagine that if
does not make sense. Something somewhere is the tenure did not start on January 1st, it will not
end on it. There are other dates mentioned for
very wrong.
After discussion with my council I drafted a letter important events as well, but they are tentative
and shared it with President Dr Arif Alvi. In the and are not always met. PDA is at liberty to make
letter I pointed out the flaws in PMDC; the Council alterations in dates if the need arises and the change
runs on revenue collected from doctors and dentists, is not in violation of the constitution.
Having said that let me assure you that the next
yet the new ordinance promoted a selected council
instead of one produced after fair elections between elections for PDA center will be held in 2020. And
it will be a year of change in PDA.
representatives of the same field.
The solution is simple; there is no need to
reinvent the wheel. The PDA has suggested it and DTP: Do you suggest that fresh dental graduates
would consider it their most impactful delivery to should seek PDA's membership, and why?
the dental field if a separate Pakistan dental council MS: As the president, I would say yes, every
was made. There are separate councils for Nurses, dentist should be a member of the PDA. However,
Homeopaths as well as Tib, then the forced according to the current stance of PDA, all dentists,
unification of medical and dental council makes new and senior, are considered part of the
no sense. There are over 30,000 dentists and around Association. Reason for which is the lack of defined

[10] => DTI Nov-Dec.FH10

NEWS

10 DENTAL TRIBUNE Pakistan Edition November 2019

Oral biofilm: A concern for all dental professionals

he oral microbiome is an
incredibly complex bacterial
community. In total, it harbours
over 700 bacterial taxa. The oral
microbiome with its various
microorganisms exists in the form of
a biofilm, that is, microbial structures
readily forming on all hard- and nonshedding surfaces in a fluid system.
For this reason, the oral cavity with its
many surfaces, including the hard tissue
of teeth, hard substance of implants
and crowns, and soft tissue of the oral
mucosa and the tongue, represents the
ideal ground for microbes to colonise
and biofilm to develop.
This development is mediated
through the formation of a salivary
pellicle, followed by subsequent
colonisation of single bacteria, which
proliferate, agglutinate and form
complexes in which an intense
exchange of molecules occurs. In a
state of equilibrium, oral biofilm plays
a crucial role in maintaining oral
homeostasis and preventing disease
development. However, with time,
biofilm provides its own metabolic
products to attract secondary plaque
bacteria with high pathogenic potential
that can ultimately lead to certain
imbalances. Once the complex biofilm,
the maturation of which may take
weeks or even months, fully exercises
its pathogenic potential, the oral
microbiome can be disrupted, which
in turn leads to dysbiosis and causes
disease in the mouth and elsewhere in
the body.
Role of oral biofilm in the aetiology
of disease
Oral biofilm is medically important
because it has broad implications for
maintaining not only oral health but
also systemic health. It is estimated
that biofilms account for over 80% of
microbial infections in the body.
Research has undoubtedly shown that
biofilm-dependent infections, including
oral diseases such as caries, and
periodontal and endodontic disease,
thus pose major public health and cost
concerns globally.
Periodontal disease, in particular, is
considered one of the most prevalent
diseases worldwide, affecting up to
50% of the worlds adult population,
according to FDI World Dental
Federation. Previous research has
established connections between
periodontal disease and preterm births,
low birthweight, diabetes, and risk
factors associated with cardiovascular
disease and stroke. Globally,
periodontitis is responsible for an
estimated US$54 billion per year in
lost productivity and a major portion
of the US$442 billion spent annually
on oral disease, according to the
European Federation of
Periodontology.
Despite the success in prevention of
oral disease over the past decades, the

Prof. Thomas Beikler is an expert in the field of preventive dentistry with a special interest in microbiology and
immunology of oral diseases. In an interview with Dental Tribune International, he shared his view on the current
state of oral biofilm management. (Images: SDA; EMS)
prevalence of periodontal disease
remains high. In an interview with
Dental Tribune International, Prof.
Thomas Beikler, Director of the
Department of Periodontics, Preventive
and Restorative Dentistry at the
University Medical Center HamburgEppendorf in Germany, said: The
enormous efforts in the past to promote
oral hygiene around the globe have
fortunately resulted in a drastic
reduction of caries prevalence;
however, periodontal disease seems
not to have been affected to the same
extent. Therefore, theres only one way
to address this problem: research,
research and research.
Control of oral biofilm
Owing to the vast implications of
oral biofilm for dental and general
health, its effective control represents
a major challenge. There is no question
that the formation and maturation of
oral biofilm need to be tackled by
dental professionals across all
specialties in all countries worldwide.
The backbone of any therapeutic
and preventive approach is the
disruption of the intra-oral biofilm. An
example of technologies that have been
successfully demonstrated to aid supraand subgingival instrumentation are
air polishing devices with low-abrasive
powders that can disrupt the biofilm
on all intra-oral surfaces, including
mucous membranes and difficult-toreach subgingival areas, without
harming the hard tissue and the even
more vulnerable soft tissue, Beikler
explained. Their effects can be
augmented by antimicrobial and
immune- and microbiome-modulating
strategies. Regarding the latter,
probiotics offer an interesting and
promising alternative to the use of
unspecific antimicrobial agents like
chlorhexidine or phenolic compounds.
However, additional research, that is,

appropriately designed and wellstructured multicentre clinical trials,
is critically needed to fully appraise
their therapeutic effects, he continued.
Another major challenge that needs
to be taken into consideration in this
respect is that trying to eliminate a
specific pathogen using antimicrobial
agents may disturb the sensitive
microbial ecology and eventually
induce microbial dysbiosis of the oral
cavity.
At this point in time, no specific
therapy is known to reverse an intraoral dysbiosis and to successfully reestablish a eubiotic oral microbiota.
Although many hypotheses exist, we
still dont know the exact mechanisms
that cause an intra-oral dysbiosis and,
as a consequence, unfortunately dont
have a specific strategy to reverse it.
However, there is no doubt that home
and professional biofilm management,
that is, the regular quantitative
suppression of biofilm formation, are
beneficial to the patient and a hallmark
of preventive dentistry, said Beikler.
Education on oral biofilm
Until the early 1990s, dentists
confined their treatment for combating
oral plaque to removing calculus twice
a year because there was only limited
understanding of biofilm. Over the
past decades, research on and improved
knowledge about the parameters that
determine the development of oral
disease have spurred the development
of new preventive strategies. For
instance, piezoceramic instruments and
low-abrasion powders have made
professional biofilm management safer,
minimally invasive and more
comfortable for both the patient and
the dental practitioner. Moreover, the
launch and further development of
AIRFLOW devices by EMS
fundamentally changed biofilm
management and eventually resulted

in the development of Guided Biofilm
Therapy, an innovative concept for
contemporary prophylaxis.
As research and development of new
technologies and therapies continues
to progress, so too does knowledge in
the dental professional community
need to advance for effective
integration of these developments into
everyday practice for the well-being
of the patient.
As biofilms can be found on all oral
surfaces, it is clear that all dental
disciplines, ranging from dental
hygienists to orthodontists, are highly
affected by oral biofilm and its
sequelae, highlighted Beikler.
Unfortunately, prevention is
sometimes still considered to be
toothbrushing augmented by some kind
of professional tooth cleaning.
However, the whole oral cavity should
be the therapeutic focus of a systematic
preventive approach.
In order to educate dental
professionals worldwide, the Swiss
Dental Academy will broadcast the
first 24-hour webinar in dentistry
shortly. Starting on 23 November at 1
p.m. CET, over 30 expert speakers will
be lecturing online about the latest in
preventive dentistry for one whole day.
Under the title Modulation of intraoral biofilm, Beikler will be giving a
presentation on 23 November at 5 p.m.
CET. This lecture aims to enhance
awareness of the fact that the
quantitative reduction of biofilm
around teeth by toothbrushes and some
sort of professional tooth cleaning is
definitely not sufficient and that
systematic approaches are needed to
reduce the prevalence of oral disease.
Moreover, I will be giving a short
overview of strategies that have the
potential to modulate the oral
microbiome. - Dental Tribune
International

[11] => DTI Nov-Dec.FH10

NEWS

November 2019 Pakistan Edition DENTAL TRIBUNE 11

Researchers link increased use of
Study finds chewing
gum could help
antibiotics to Parkinsons disease

ELSINKI, FINLAND - Antibiotic
overprescribing continues to be a
major concern in dentistry. In most
cases, readily prescribing antibiotics to patients
before a dental treatment does not ensure
effective and appropriate dental care
intervention. Additionally, it accelerates
antibiotic resistance. A recent study has found
that higher exposure to commonly used oral
antibiotics, especially broad-spectrum
antibiotics and those that act against anaerobic
bacteria and fungi, may also increase the risk
A recent study has linked high exposure to commonly
of developing Parkinson's disease.
used oral antibiotics to an increased risk of
In a case-control study, the researchers extracted Parkinson's disease. (Image: fizkes/Shutterstock)
data from national registries and compared
antibiotic exposure between 1998 and 2014 in some commonly used antibiotics, which are known
13,976 Parkinson's disease patients with 40,697 to strongly influence the gut microbiota, could be
non-affected persons matched for age, sex and a predisposing factor."
place of residence. Antibiotic exposure was
In the gut, pathological changes typical of
examined over three different periods: one to five Parkinson's disease have been observed up to 20
years, five to ten years and ten to 15 years before years before diagnosis. The researchers have also
the index date, based on oral antibiotic purchase associated symptoms such as constipation, irritable
data.
bowel syndrome and inflammatory bowel disease
Owing to the disruptive effects of antibiotics on with a higher risk of developing the disease.
the gut microbial ecosystem, the findings suggested Exposure to antibiotics has been shown to cause
that excessive use of certain antibiotics can changes in the gut microbiome and their use was
predispose patients to Parkinson's disease, with a associated with an increased risk of several
delay of up to ten to 15 years.
diseases, such as psychiatric disorders, Crohn's
"The link between antibiotic exposure and disease and Parkinson's.
Parkinson's disease fits the current view that in a
"The discovery may also have implications for
significant proportion of patients the pathology antibiotic prescribing practices in the future. In
of Parkinson's may originate in the gut, possibly addition to the problem of antibiotic resistance,
related to microbial changes, years before the antimicrobial prescribing should also take into
onset of typical Parkinson motor symptoms such account their potentially long-lasting effects on
as slowness, muscle stiffness and shaking of the the gut microbiome and the development of certain
extremities," said lead author Dr Filip Scheperjans, diseases," Scheperjans concluded.
a neurologist from Helsinki University Hospital
The study, titled "Antibiotic exposure and risk
based at the Neurocenter at Meilahti Hospitals in of Parkinson's disease in Finland: A nationwide
Helsinki.
case-control study", was published online on 18
"It was known that the bacterial composition of November 2019 in Movement Disorders, ahead
the intestine in Parkinson's patients is abnormal, of inclusion in an issue. - Dental Tribune
but the cause is unclear. Our results suggest that International

fight dental caries

ONDON, UK - Though the relative
benefits of chewing gum are often
subject to debate, a number of studies
have shown that the sugar-free varieties can
promote oral health. On this topic, a recent
review has found some evidence that chewing

A systematic review has found that
chewing sugar-free gum reduces the incidence
of dental caries by 28%.
(Image: Lizardfilms/Shutterstock)

sugar-free gum could help to reduce the further
development of dental caries in both adults
and children.
The systematic review was conducted by
researchers from King's College London. They
identified and subsequently analysed 12 studies
published over the last 50 years that explored
the impact on oral health and the intervention
outcomes of chewing sugar-free gum.
The research team found that chewing sugarfree gum reduces the incidence of dental caries
by 28% and that it could be used as a possible
preventive agent in combination with oral
health education and supervised toothbrushing
initiatives. However, the researchers were quick
to clarify that their findings were far from
definitive for a number of reasons.
Continued on page 15

Research to illuminate resistance
of oral flora to antiseptics

REIBURG/REGENSBURG,
GERMANY - Over the last
two decades, antibiotic
resistance has been investigated many
times and has been the subject of
public debate. However, resistance to
antiseptics, locally acting disinfectants,
has received less attention. Now,
researchers from the Medical CenterUniversity of Freiburg and the
University Hospital Regensburg are
investigating how such resistance
develops for the caries pathogen
Streptococcus mutans and how this
might also lead to antibiotic resistance.
For the next three years, the
researchers will receive joint funding
of 664,000 from the Deutsche
Forschungsgemeinschaft (DFG,
German Research Foundation). Using
selected bacterial species and patient
samples, the researchers will
investigate how microorganisms of

the oral flora change when treated
with chlorhexidine.
"Our goal is to understand the
development of resistance of oral
bacteria to chlorhexidine, both on the
genome level as well as with regard
to changes in the bacteria
metabolism," said Prof. Ali al-Ahmad,
head of the research group at the
Department of Operative Dentistry
and Periodontology at the Medical How oral flora develops resistance against oral disinfectants will be the main
focus of a research project funded by the DFG, German Research Foundation.
Center-University of Freiburg. He will
(Image: Loucha Reengchay/Shutterstock)
lead the project in collaboration with
Dr Fabian Cieplik, senior physician is associated with resistance to the shotgun metagenomic analysis,
at the Department of Operative antibiotics-a cross-resistance-will be will be used. With this method, it will
Dentistry and Periodontology at the investigated by both research groups be examined whether the composition
University Hospital Regensburg. "One with the help of different methods. of the entire bacterial oral flora of
of the project's questions is whether "In the future, we might be able to p a t i e n t s , w h o h a v e t o u s e
freely available chlorhexidine-based specifically decide when a broad- chlorhexidine over a longer period of
mouthwashes can also contribute to spectrum antiseptic should be used time owing to an oral surgical
the development of resistances," said and when alternative drugs are procedure, will change under the
Cieplik.
sufficient," explained al-Ahmad. influence of the antiseptic. - Dental
Whether resistance to chlorhexidine
In addition, a special genetic test, Tribune International

[12] => DTI Nov-Dec.FH10

NEWS

12 DENTAL TRIBUNE Pakistan Edition November 2019

New world record: German
dentist extracts worlds longest
human tooth

FFENBACH,
GERMANY T o o t h
extraction is part of the
day-to-day business in
a dental practice.
However, last year, Dr
Max Lukas was fairly
stunned when he
pulled out a tooth that
turned out to be above
average in length.
Now, the dentist, who A German dentist extracted the 37 mm long tooth and received
runs a dental office in an entry in Guinness World Records. (Image: Max Lukas/dpa)
Offenbach, has received
his official Guinness World Records certificate.
The tooth was extracted in September 2018 because it had caused inflammation in
the patient's upper jaw. "Owing to the length of the tooth the swelling reached his right
eye and caused the patient great pain," explained Lukas to DTI. "Preoperatively, I could
already see that the tooth was extraordinary long in the panoramic X-ray," he added.
For the extracted canine tooth, which measured 37 mm, Lukas was given an entry in
Guinness World Records at the end of October. He spent about a year submitting the
necessary paperwork and having the tooth checked before it could be listed. "The entry
in the Guinness World Records was very difficult and included quite a few obstacles,"
said Lukas. - Dental Tribune International

New glue could be
dentistry game changer

ICTORIA, BRITISH COLUMBIA, CANADA - In
a recent development that might change the adhesive
market within dentistry and other industries,
researchers from the Department of Chemistry at the
University of Victoria (UVic) have developed a new "hyperglue". Researchers hope to make everything from medical
implants to protective clothing more corrosion resistant, and
have plans for the product to be on the market as soon as
possible.
In the study, the team of chemists and composite materials
researchers discovered a broadly applicable method of
bonding plastics and synthetic fibers at the molecular level
in a procedure called cross-linking.
Speaking to Dental Tribune International about the impact
the glue might have on the dental industry, lead researcher
Prof. Jeremy E. Wulff said, "In principle, the cross-linker

Researchers from the University of Victoria have developed
a new glue that may revolutionize the dental industry.
(Image: Kristina Kokhanova/Shutterstock)

could be used to promote adhesion between enamel or other
parts of the tooth and a wide variety of synthetic polymers.
This could enable the use of more inert polymers in tooth
repair and reconstruction than are currently employed.
Alternatively, the cross-linker could be used as a strengthening
agent for enamel, in much the same way that we currently
use it to strengthen polymer fabrics like woven ultra-high
molecular weight polyethylene."
Explaining that traditional adhesives work either by surfaceenergy effects or by reaction with polar groups on the surface
of polymers, Wulff noted: "This is fine for things that have
a high surface energy and lots of functional groups. However,
many things we'd like to be able to glue like polyethylene
and polypropylene don't have these features and as a result
traditional adhesive tend to fail for these materials."
Although there is a wide range of glues on the market, Wulff
said that what sets this new product apart from others is that
it reacts by insertion into carbon-hydrogen, oxygen-hydrogen
or nitrogen-hydrogen bonds. "Since virtually every polymer
(except for Teflon) contains C-H bonds, the cross-linker
works to provide good adhesion for pretty much everything.
In fact, it works best for things like high-density polyethylene
that are extra-troublesome for traditional adhesives," he
explained.
According to Wulff, the product is already playing an
important role in the Comfort-Optimized Materials for
Operational Resilience, Thermal-transport and Survivability
network. Additionally, a team of researchers from the
University of British Columbia, UVic and the University of
Alberta are collaborating to create high-performance body
armor. Epic Ventures, the company that sponsored the research
is currently launching a spinoff company called XlynX
Materials to commercialize the cross-linker; however, Wulff
was not able to comment on when the glue will reach the
consumer market.
The study, titled "A broadly applicable cross-linker for
aliphatic polymers containing C-H bonds", was published
on Nov. 15, 2019, in Science. - Dental Tribune International

[13] => DTI Nov-Dec.FH10

NEWS

November 2019 Pakistan Edition DENTAL TRIBUNE 13

Dental school establishes
novel opioid-free pain
management guidelines

P

ITTSBURGH, U.S. Doctors continue to
routinely prescribe
opioid pain relievers for dental
procedures. However, current
evidence suggests that
alternative, nonopioid
medications typically work as
well or even better for
managing pain after dental
treatment and do not cause
side effects such as nausea,
vomiting and constipation or
have the potential for misuse.
To help fight the opioid
epidemic, the University of
Pittsburgh School of Dental
Medicine (Pitt Dental
Medicine) has become the
first dental school in the
nation to put in place opioidfree pain management
guidelines for a wide range
of procedures performed in
its clinics.
"It's not a cookbook
approach to how to take care

of patients," said Prof.
Bernard J. Costello, dean of
the school. "This allows
clinicians to make good
choices based on what they
know of the biology of the
patient and the patient's
concerns."
The new guidelines
advocate that clinicians should
avoid prescribing opioid pain
medication. If a patient cannot
tolerate opioid alternatives or
requires additional pain relief,
clinicians should only
offer opioids with the lowest
potency possible and instruct
the patient to take the
medication no more than three
times a day. Moreover,
clinicians should check the
patient's details on the
Pennsylvania Prescription
Drug Monitoring Program
database. Additionally, if a
patient is already taking
opioids for chronic pain

Enamel hypoplasia used
to indicate gender equality

T

ÜBINGEN, Germany: Scandinavia is regarded as a
role model with regard to gender equality. Now,
historians at the University of Tübingen have
investigated whether there is a historical reason for this. In
a recent study, they traced the roots of gender quality in the

A recent study used enamel hypoplasia-evidence of
malnutrition and poor health during childhood-as an
indicator of gender equality. (Image: Brian Spatola/Otis
Historical Archives, National Museum of Health and Medicine

Scandinavian periphery over the last two millennia by using
the enamel hypoplasia values of tooth fossils as an indicator.
Based on this data, they found that, in these remote outlying
areas of Scandinavia, gender equality had a higher value
than in other European regions.
The researchers compared the health of men and women
from the past 1,000 years, using data gathered from ancient
teeth and skeletons. The study was based on European data
from the Global History of Health Project. It incorporates
data from studies on human skeletons from more than 100
European sites from the past 2,000 years.
The researchers examined especially closely the information
provided by teeth: "We looked at teeth in particular, because
they can reveal more information than other human remains.
Continued on page 15

The University of Pittsburgh School of Dental Medicine has developed a set of
updated pain management guidelines to help fight opioid addiction in the U.S.
(Image: StanislauV/Shutterstock)

management or for a
substance use disorder, an
alternative plan should be
considered in consultation
with a pain management
clinician before additional
opioids are prescribed.
According to the school,
opioid mortality rates are
increasingly high in the
Appalachian corridor, which
includes
We s t e r n
Pennsylvania. Opioid misuse

and addiction may also
present a great economic
burden, as treatment costs
approach $90,000 (81,000)
per hospitalization. However,
in the Appalachian region,
there are now deliberate
strategies in place focusing
on minimizing dental pain
after treatment and
eliminating the need for
opioid pain relievers.
"Pitt Dental Medicine is

leading the way with the
adoption of this new protocol
by teaching our students and
residents the best way to
manage pain effectively
without the unnecessary risk
of opioid dependence,"
Costello stated. "When these
trainees move on to other
practices, they'll take these
opioid-free guidelines with
them". - Dental Tribune
International

[14] => DTI Nov-Dec.FH10

14 DENTAL TRIBUNE Pakistan Edition November 2019
An exclusive interview with

Dr Mahmood Shah ...
Continued from page 9

and pushing for them.
We cannot pass legislations making amends
overnight; we can recommend and then it is up to
the government to implement those plans. Note
that the hitches in house job programs, stipends,
and college fees are not limited to the dental sector,
but the medical field is also dealing with them
despite the enormity of influence of the Pakistan
Medical Association. Like PDA, PMA has also
been struggling to get the needed and recommended
changes implemented, but has remained
unsuccessful.
The initial proposition for the annual fee structure
of dental colleges was suggested to be around
600,000PKR; after protests claiming that this was
excessive, the amount still stretched to 900,000PKR.
But now if you research you will find out that the
fee has gone up to 1,200,000, which is ridiculously
exorbitant. PDA has recommended a forensic audit
of this tragedy; an official documented
recommendation letter has been forwarded to

Nowadays colleges organize their own
conferences and symposiums, without
needing PDA's involvement.
President Alvi. Now, it is up to the government to
act on it. I believe that the earnings of our medical
and dental colleges are unjustifiably high.
Unfortunately, education has become one of the
best businesses in Pakistan.
Coming to the issue of underpayment of stipend,
it is condemnable that neither house officers nor
PG students are paid their rightful stipends. But
again, the implementation of a corrected system is
a federal responsibility. PDA has raised these issues
time and again. Similarly, on the matter of the
failing of PMDC, PDA has raised its voice several
times. The state of the Council is regrettable; there
is no concrete policy, and the council and regulations
change every other month. I wrote a 6-page letter
to Dr Alvi in this regard but has yet not received
a response. The reason that we are compelled to
lean on to Dr Alvi is that he has been the president
of PDA in the past and knows all of its ins and outs
and various concerns. Now, that he is in a position
of power, he is capable of addressing all those
problems.
Talking about solutions, I have resorted to trackII diplomacy; I have been in contact with a few
dentists that are personally close to the president.
I have many times requested for a meeting between
President Alvi and a PDA delegation. The response
that I received was that the president wishes all
stakeholders to first unite on a platform and then
approach him. To that I say that it was even
impossible for the holy prophets to convince
everyone, so why is it expected from PDA. The
president must meet with all parties individually
and then make an ultimate, informed decision. I
have worked with him several times and have found
him as an intelligent man. He needs to realize and
resolve the issues of the dental community on an
urgent basis. As a watchdog of the dental
community, if summoned, PDA is ready to meet
with the higher authorities to present the prevalent
concerns and their respective solutions.
DTP: Do you think that dental colleges are
incapable of paying the rightful stipend to their
house officers and postgraduate students?
MS: As far as private colleges are concerned, they

can pay 100% of the rightful stipend to their
students, but unfortunately, they do not. Private
colleges may get offended by my stance, but I
believe they do have the funds to pay their students
and they should. When my daughter was studying
at a dental college, even she was not being paid
fully. I suggested that the entire batch should

My most notable achievement is the
revival of PDA branches.
collectively write a letter bringing light to this
injustice. But the issue is that since the students
are naïve and easily intimidated, they refrain from
stepping forward like this. They fear that their
degree might be held back or their house job might
get terminated.
In the case of government colleges, their lopsided
policies are to be blamed. On one side, they are
paying salaries of 8 to 12 lacs to their government
doctors, but are depriving the poor kids of their
stipends. If this problem is not addressed, our dental
community will progressively wither away instead
of flourishing.
DTP: Has the issue of stipend been brought up
to PMDC by PDA?
MS: Yes, I did approach PMDC on behalf of PDA,
Shabbir Lehri was the president of the former at
that time. I presented our concerns regarding the
underpayment of stipends and excessive annual
fees of medical/dental colleges. I would share facts
and recommendations with him regularly, which
he did address. During his tenure, he organized
surprise visits to colleges where the administration
was asked to produce their financial statements.
Due to legal lacunae, the college admin would
refuse to produce the documents labelling them as
confidential. And so, PMDC had to step down. But
then this cannot be accepted as an excuse, a strategy
should be worked around it, but unfortunately, no
further action was taken.
DTP: Are you satisfied with the current dental
curriculum being taught in the country? Can our
graduates compete on global platforms?
MS: Firstly, we need to understand that syllabus
and curriculum are two different things; we wrongly
use the two terms interchangeably. Syllabus is what
is taught in class, whereas, curriculum encompasses
admissions, syllabus, examination pattern, and
future prospects of the students. I believe we do
not have a defined curriculum. Syllabus cannot be
called curriculum.
Coming to the second part of your question,
please understand that we need to produce dentists

The leading problem is the
overproduction of dentists in Pakistan
for our country and not for them to later pursue
practice in the Middle East or West. And for that,
our 4-year program is sufficient. If a 5-year program
is implemented, wherein the subjects are further
split into parts one and two, all you are doing is
adding the burden of an additional yearly fee on
the students' parents. There would not be any
qualitative addition, nor is it needed. To increase
the program duration from 4 years to 5 years will
merely be a cosmetic change. What could be done
is that the one year of house job can be made part
of the BDS program, so the degree is allotted after
completing the entire 5 years. Other than that there
is no needed to make any significant change; our

dental graduates are competent enough and are
doing well. For decades, our graduates have been
going abroad for postgraduation and have been
doing well at it.
The real issue is with our postgraduation programs
that are beginning to get rejected in various
countries. Starting from two years, on to three
years, and now our PG programs stretch over four
years. Yet, we could not get at par with foreign
degrees, which proves that the duration of a program
has no link with its quality. Another issue to discuss
here is how PMDC is now gradually limiting options
for the graduates to go abroad and has been trying
to encourage students to do postgraduation from
Pakistan only. On one hand, it is good, but higher
education from abroad should also be encouraged
to an extent. It costs millions to study from abroad,
especially from the West, and once you come back
with the degree, there is a chance that PMDC will
not recognize it. And so, lesser people are taking
the risk. Countries like Turkey and others in the
Far East provide high-quality education, which is
much more affordable, but again, PMDC refuses
to recognize their degrees.
DTP: So what do you suggest in regards to
curriculum development for dental education?
MS: Curriculum planning is a specialized subject.
If a surgeon is given sole responsibility for it, he
will plan a surgery-based curriculum, similarly, a
physician will create a medicine-based system.
Curriculum planners are specialized professionals
that create an organized and systematic curriculum
that is in alignment with the needs of the country
and the relevant sector. Our inefficient planning is

Maxillofacial surgery and orthodontics
are the two main specialties
in dentistry.
the reason we are unable to get on par with the rest
of the world. It is regrettable. Countries like
Bangladesh, Nepal, and Burma are producing
efficient dentists through a structured curriculum;
their methodologies are modern and at par with the
world. And these dentists are serving their nation.
In Pakistan, we relate modern dentistry to digital
x-rays and rotary endodontics, which is ridiculous.
So much more is required! To get there, the longoverdue shift in the paradigm of Pakistani dentistry
is essential.
DTP: Lastly, your message for young dentists?
MS: I would like to assure them that the field they
have chosen is a very good one; it is a tough field,
however. You have to pour your heart and soul into
it, and you have to be very competent to gain a
place in the community. Especially now. Earlier,
the procedures were simpler and were being
performed by every general dentist. Now, Dentistry
has become more refined and specialty-based. I
have been around the globe and witnessed the dental
profession in many countries firsthand. I am proud
to say that the standard of practical dentistry in
Pakistan is one of the best, but we do need to sustain
it. The young dentists need to focus on polishing
and upgrading their clinical skills, for which there
is a wide array of short and long courses.
Specialization is becoming increasingly important
with passing day. For a general practitioner with
only a BDS degree, there is still scope, but only if
you have the utmost competency in clinical skills.
If you are going to work with a casual approach,
to succeed in this field will not at all be possible,
especially in this age of cutthroat competition.

[15] => DTI Nov-Dec.FH10

November 2019 Pakistan Edition DENTAL TRIBUNE 15

New Medical and ...
Continued from front page

that these payments are made as soon
as possible.
As per the law the National Licencing
Exam (NLE) was to be conducted for
the first time in end of 2020 or start of
2021 after the graduation of MBBS
(Bachelor of Medicine, Bachelor of
Surgery) and BDS (Bachelor of Dental
Surgery) in 2020. However, the council
recorded the concern that given the
required preparation and infrastructure
required it may difficult to implement.
The Academic Board was entrusted with
the role of setting its standards and
structure so the council could evaluate
the time required to implement NLE
based on the methodology adopted by
the Board.
Special Assistant to Prime Minister
on NHSR&C, Dr Zafar Mirza, along
with Secretary Dr Allah Baksh Malik,
Deputy General (Tech.), Nasser
Mohuddin, Mr Saeed Khan Nazi,
Director Regulation, Dr Sabeen Afzal,
and Deputy Director PMDC, Dr Farah
Mazhar attended the meeting on special
invitation.

Digitalise verification ...
Continued from front page

education standards will be set by
theeducation standards will be set by
the commission," said PMC President.
He said that the PMC had taken many
steps to improve its system as per
international standards. The registration
for students who wanted to sit for the
National Examination Board (NEB)
Step-1 exam on December 1 had been
processed and their admit cards had
been prepared as well.
Taqi further added that the new
website of the commission had also been
made functional on an urgent basis.
Additionally, the commission hired the
services of eight managers and 22
supporting staff members to run dayto-day affairs. The staff had been hired
for 90 days till permanent employees
are appointed, he noted.
He informed that an email id info@pmc.pakistan.gov.pk - had been
made functional as well, and all students
and doctors were requested to send their
queries and applications to the provided
address. He assured that their concerns
would be responded to on an immediate
basis.
A 24-hour helpline and customer
service facility has been set up and will
be made operational shortly to provide
all students and doctors with a toll-free
number to have their queries answered
at any given time, including status
updates concerning their pending
applications, if any, Taqi added.
Dr Taqi said that the IT networking
system had also been enabled at the
PMC to provide internet and
connectivity while arrangements for the
digitalisation of the PMC were currently
being processed.
He said that the process for new
student registrations and the issuance
of provisional licenses to students had
been overhauled and simplified. New
forms for the registration of fresh

students and the granting of provisional
licenses were being sent to colleges and
universities shortly and provided to
students online as well, he added.
Students could submit the fee online
at any NBP branch across the country
rather than having to undertake the
cumbersome process of preparing bank
drafts, etc. An online verification service
from NADRA had been arranged to
enable the immediate verification of
credentials by the commission to ease
the burden on students and doctors who
had to obtain verifications themselves
in the past, he noted.
This would enable the institutions to
be affiliated with HEC-recognized
University. It would also assist in
registration with the PMC for recording
and tracking medical and dental students.
Thus, ensuring that the PMC could
efficiently issue licenses when these
students graduate.
Vice-President, PMC said that the fee
for MBBS and BDS programs, for which
admissions were underway, remained
at a maximum of Rs950,000. He
clarified that hostel charges were
separate from the fee. The PMC will
not allow anyone to charge more fees
than the stated amount.
Meanwhile, former employees of the
defunct Pakistan Medical and Dental
Council (PMDC) staged a protest against
the dissolution of the council and
establishment of the PMC. The protest
was arranged on the call of the PMDC
Employees' Movement. It was a sit-in
in front of the council's headquarters to
raise the voice against the dissolution
of the commission.
During the press conference, the
participants raised slogans outside the
building. When asked about the protest,
the PMC President said that he and his
team were working on the task given
by the government to improve the
commission. They had no time to pay
attention to such protests.
During the press conference, the
participants raised slogans outside the
building. When asked about the protest,
the PMC President said that he and his
team were working on the task given
by the government to improve the
commission. They had no time to
pay attention to such protests.

Scientific Session on ...
Continued from front page

Prof Dr Abid Ashar, Prof Dr Nauman
Rauf, Dr Aqif Anwar Chaudhry, Dr
Gulraiz Zulfiqar, Dr Muhammad
Mozzam, Dr Hamza Hassun, and Dr
Faiza Sharif presented the latest
information, best practices, and
advanced techniques being used in
dentistry.
Two pre-conference workshops were
also organized at the Lahore Medical
and Dental College. Dr Ala Ersheidat
conducted a hands-on workshop on "Soft
Tissue Grafts," and Dr Ansa Akram
conducted an interactive workshop on
"M. Orth Examination preparation."
The session concluded with an
outstanding participation of about 300
dental specialists, general dental
practitioners, postgraduate residents,

house officers, and students. A vote of
thanks was issued by Prof Dr Saima
Razaq Khan, Chairperson of the
Organizing Committee. She appreciated
the chairpersons of various committees
and their members, respected sponsors,
the LMDC administration. She
expressed her gratitude to Prof Dr Javed
Asghar, CEO, Prof Dr Shaheena Asif,
COO, Prof Dr Majeed Chaudhry,
Principal, LMDC, and Mr Asad,
Director Finance, for their efforts to
make this event a success.

DUHS participation in ...
Continued from page 2

socioeconomic backgrounds and
different nationalities, including
Pakistani, Chinese, Turkish and Iranians.
Dean faculty of Dentistry Prof. Dr
Shahjahan Katpar, Vice-Principal DIDC
Dr Ashar Afaq, Associate Professor
Department of Community Dentistry
Dr Qaiser Ali Baig, along with Lecturers
Dr Wajiha Anzar, Dr Eisha Abrar, Dr
Marium Panwar, Dr Hina Rasheed, Dr
Yumna Shaheen Ali, Dr Amber Saeed,
Dr Umar Bin Irfan, and Dr Rimsha, and
staff from Dow University organized
and managed the event.
Principals from all 3 dental colleges
including Prof. Dr Amynah Tariq
(DIDC), Prof. Dr Arshad Hassan (DDC)
and Prof. Dr Anwar Ali (DIIKIOHS)
visited the event and appreciated the
entire team of focal persons for
conducting such activity. The activity
was lauded for its great success in terms
of students learning objective and patient
oral health awareness platform. -PR

Hands-on workshop on ...
Continued from page 4

which are identified during clinical
practice. The hands-on session consisted
of surgical perio procedures and crown
lengthening which was performed by
the participants on typodonts. The
problems faced by participants during
procedures were solved by the facilitator,
and their concerns about the topic were
cleared by him as well. The session was
concluded by achieving its desired
learning objectives. -PR

Study finds chewing gum ...
Continued from page 11

"There is a considerable degree of
variability in the effect from the
published data and the trials included
were generally of moderate quality,"
explained lead author Dr Avijit
Banerjee, Professor of Cariology and
Operative Dentistry at King's College
London.
"However, we felt there was a definite
need to update and refresh existing
knowledge about sugar-free gum and
its effect on dental caries and oral health.
We are planning further research to
determine the acceptability and
feasibility of using this method in public
health," Banerjee continued.
Previous studies have shown that
chewing gum can increase the level of
certain vitamins in blood plasma, as
reported last year by Dental Tribune
International. The specific relationship
between the development of dental

caries and chewing sugar-free gum had
not previously been explored, according
to Banerjee.
The study, titled "A systematic review
and meta-analysis of the role of sugarfree chewing gum in dental caries", was
published online on 19 November 2019
in the Journal of Dental Research:
Clinical and Translational Research,
ahead of inclusion in an issue. - Dental
Tribune International

Enamel hypoplasia used ...
Continued from page 13

The nutrition experience of males and
females during childhood can be read
from the hypoplasia phenomenon. These
are horizontal lines on the teeth which
appear if the female or the male child
suffered from severe malnutrition and
poor health during childhood,"
explained Dr Jörg Baten, Professor of
Economic History at the university.
"We hypothesised that if girls and
women received less food and care than
the male members of society, they would
have more such damage," said Dr Laura
Maravall, postdoctoral researcher at the
university. "The extent to which values
differ between men and women is
therefore also a measure of equality
within the population," she added. The
close connection between the relative
frequency of enamel damage and the
general state of health was demonstrated
by measurement of the corresponding
thigh bones. The length of the femur
provides information about height,
which is relatively greater in individuals
with good health and a good diet.
The study found that Scandinavian
women in the remote rural areas already
had relatively good health and
nutritional values during the Viking erain the late eighth to eleventh centuriesand the medieval period thereafter. The
corresponding value is 0.8 equality
advantage for Scandinavian women,
whereas in the rest of Europe most
values fall in a band around 1.2 ratio
units. This suggests that the currently
high gender equality had a precedence
during the Middle Ages. According to
the researchers, this greater gender
equality appears to have led to a longterm positive development for the
overall society.
"We focused on this topic of research,
because we want to understand the longrun trends of gender equality and what
it means for economic growth. There
is a big debate in economics about
whether gender equality causes
economic growth or whether gender
equality is only by-product of economic
growth. Looking at poor regions during
early times-like Scandinavia-we can
contribute an important case study
which supports the previous view,
namely that gender equality really
causes economic growth," concluded
Baten.
The study, titled "Valkyries: Was gender
equality high in the Scandinavian
periphery since Viking times? Evidence
from enamel hypoplasia and height
ratios", was published in the August
2019 issue of Economics and Human
Biology. - Dental Tribune International

[16] => DTI Nov-Dec.FH10

) [page_count] => 16 [pdf_ping_data] => Array ( [page_count] => 16 [format] => PDF [width] => 694 [height] => 1049 [colorspace] => COLORSPACE_UNDEFINED ) [linked_companies] => Array ( [ids] => Array ( ) ) [cover_url] => [cover_three] =>

[cover] => DT Pakistan No. 6, 2019

[toc] => Array ( [0] => Array ( [title] => News [page] => 01 ) [1] => Array ( [title] => Interview with Dr Mahmood Shah [page] => 08 ) ) [toc_html] =>

Table of contents

[toc_titles] =>

News / Interview with Dr Mahmood Shah

[cached] => true )