Dentistry in the past was a skill to be passed on from generation to generation. Dentistry at present bears a huge difference that now dentist are qualified and highly skilled with latest research and techniques. Amongst the various afflictions that dentistry in Pakistan is affected by, one is the lack of Periodontists, leading to less than desirable teaching standard of the subject and an absolute lack of postgraduate training in the speciality, and with the largest burden of oral diseases being caries and periodontal disease, this is not a problem to be overlooked any longer. However, the dental sector does anticipate fresh zephyrs coming its way, arising hopes of a better future, and Dr Nadia Sultan is one of them. Dr. Nadya Sultan Ali a graduate of Baqai Medical University did her MCPS two year residency training programme from Baqai in 2000 and passed the exam in 2001. She is currently at Dr. Ishrat-ul-Ebad Institute of Oral Health Sciences where she heads the Associate Professor and Head of Perio department. She started her teaching career with Baqai and later joined LCMD before joing Dow in 2008.She has many research publications to her name and has played a lead role in many educational workshops, attended numerous conferences, symposiums, seminars and arranged activities for the community being part of Aga Khan Social Welfare Board as well as a member of local health board. She was recently interviewed by Dental News for its dental dialogue and the excerpts of the interview are as under Q. Your views on postgraduate training in Pakistan? Ans. History of Dentistry in Pakistan starts even before the country’s birth. Postgraduate training in Pakistan afford trainees the opportunity to learn from the attending dentists who serve a supervisory role, something generally unavailable in private practice. These postgraduate programs are so constricted that trainees may see anywhere from 8-15 patients a day, or even more.These programmes provide a dentist with a wide range of experiences including oral surgery, oral pathology, oral medicine, and treating medically compromised patients. These programs will often emphasize the importance of managing comprehensive dental treatment plans and adjusting them based on the patient’s medical condition. During training, resident maybe faced with the task of managing patients that require dentistry in a hospital setting due to a compromised medical condition. Medical management of dental patients maybe emphasized in weekly grand rounds and rotations. These rotations not only increase the trainee’s knowledge and experience but also allows physicians, resident or attending to see how dentistry and medicine are related allowing for a better referral relationship in future practice. Postgraduate dental training is essential for the production and provision of specialist care in the health care system. There are many postgraduate dental centres in Pakistan that are providing excellent training programmes, better than some training hospitals in developed countries. As we all know that current situation in UK and USA is not conducive for Pakistani dentist due to tight emigration rules and expenditure and ever changing training policies, so as I said that in Pakistan we are providing excellent training programmes and at DIKIOHS we are planning to start some new and more postgraduate programmes InshAllah which will meet the international standard. Q. What have you learnt as an academician in the past few years? Ans. Over the past few years, I realized that most of the preparation for academic leadership is focused on how to effect institutional changes and make a positive difference. These certainly are the “big ticket” items, enjoy your colleagues, you will get used to the no-win feeling in leadership. Academic quality is like a statue of the human form, people are like snowflakes; no two are alike, when condition are right they stick together, and they make a mess when they melt. Over the years, performance assessment has been widely employed in dental education, objective structured clinical examination (OSCE) being an excellent example. Students come to the classroom where preconceptions about how the world works. Prevail if there initial understanding is not engaged, they may fail to grasp new concepts and information that are taught or they may learn them for purposes of a test but served to their preconceptions outside the classroom. Students must have a deep foundation of factual, understand facts and ideas in the context of a conceptual work frame, and organize knowledge in ways that facilitate retrieval and application. Students need to monitor their learning and actively evaluate their strategies and their current levels of understanding. Q. Who is at risk for getting gum disease? Are there some common causes? Ans. The main cause of periodontal gum disease is plaque. Anyone who doesn’t brush or floss teeth regularly or well enough to remove plaque, is at risk of getting gum disease. A part from poor oral hygiene, other major risks factors include age. smoking cigarettes or use of spit tobacco, stress, genetic susceptability, systemic diseases that interfere with the body’s inflammatory system e.g; cardiovascular disease , diabetes and rheumatoid arthritis , underlying immuno deficiencies such as Aids, poorly contoured restorations , taking medications that cause dry mouth , females hormonal changes such as with pregnancy or the use of oral contraceptives . Tobacco use is believed to be one of the biggest risks for gum disease. Q. What are gingivitis and periodontitis and how are they related? Ans. Gingivitis is the mildest form of periodontal disease. It causes the gums to become red, swollen and bleed easily. There is usually little or no discomfort at this stage . Gingivitis is often caused by inadequate oral hygiene, and is reversible with professional treatment and good oral home care. Untreated gingivitis can advance into periodontitis with time; plaque can spread and grow below the gum line. Toxins produce lay bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turn on itself, and the tissues and bone that supports the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and the gums) that become infected. As the disease progresses, the pockets deepen and more gum tissuses and bone are destroyed often. This destructive process shows very mild symtoms, eventually teeth can become loose and may have to be removed or when gingivitis is not treated , it can advance periodontitis “(which means inflammation around the tooth)”. In periodontitis, gums pull away from the teeth and spaces are formed “(called pockets)’ that become infected. The body’s immune system fights the bacteria, as the plaque spreads and grow below the gum line , bacterial toxins and body’s natural response to infection start to break down the bone and the connective tissues that holds the teeth in place. If not treated, the bones, gums and tissues that support the teeth get destroyed. the teeth may eventually become loose and have to be removed. Q. What are some signs and symtoms that someone has gum disease ? Ans. Gum diseases often silent, show on symtoms until at an advanced stage of the disease, however warning signs of gum disease include: red swollen gums or tender gums or pain in mouth. Bleeding while brushing, flossing, or eating hard food. gums that are receding or pulling away from the teeth, making the teeth look longer than before. loose or separating teeth, pus between gums and teeth, sores in mouth, persistent bad breath. Q. How is the gum disease treated ? Ans. The main goal of treatment is to control the infection, the number and the types of treatment will vary, depending on the extent of the gum disease. The best way to treat all gum disease is to practice good oral hygiene which includes brushing teeth twice a day,flossing teeth regularly (preferably daily), no smoking and regularly visiting your dentist (at least once every 1-2 years but more frequently if necessary) Treatments range from non-surgical therapeutic control of bacterial growth to surgery in order to restore supportive tissues. Non surgical treatments for gum disease includes : scaling and root planning , gingival curettage where as surgrical treatment for gum disease includes flap surgery / pocket reduction surgery, bone graft , soft tissue grafts, guided tissues regeneration, bone surgery. In some patients the non surgical procedure of scaling and root planning is all that is needed to treat gum diseases. Surgeries are needed when the tissue around the teeth is unhealthy and cannot be repaired with non surgical options . Q. Can the symptoms of gum disease be reversed ? Or will the disease usually progress ? Ans. Gingivitis (Inflammation of Gums) is reversible with good oral hygiene practice, but periodontitis (inflammation of the supporting structures) , if left untreated, can lead to tooth loss. Q. How to prevent periodontal infections affected during pregnancy? Ans. First , to prevent periodontal disease during pregnancy it is especially important to develop and practice good oral hygienic habits which include brushing at least twice a day, flossing once a day, and using an antimicrobial mouth rinse. If a professional cleansing is due, it should not be skipped simply because of pregnancy. Q. What would you like to say about Pakistan Dental Associations role for dental community? Ans. The Pakistan Dental Association is an organization of dentists which has as its aim, the encouragement of the oral health of the public and promotion of the art and science of dentistry. PDA is playing a vital and active role especially to maintain the honour, interests, dignity, and unity of the dental profession and to educate the public in dentistry,oral health and prevention of dental problem. PDA as also guiding and helping it members especially the fresh graduates in the establishment of their career. Q. Uncontrolled diabetic may create higher risk of developing bacterial infections of the mouth. What is your experience about diabetic patients? Ans. Diabetes is a disease that can affect the whole body, including our mouth. Since periodontal disease is a bacterial infection, a diabetic with uncontrolled disease may experience more frequent and more severe gum disease. My experience tells that dental care is particularly important for people with uncontrolled diabetes because they face a higher than normal risk of oral health problems due to blood sugars. Poorly controlled the less the blood sugar, controlled the more likely are oral health problems will arise. Q. Any message? Ans. Do whatever you want, to whatever you do should be related to what you have done. We should not forget our commitment to our profession, keeping a humble attitude we should accept and allow changes and impart knowledge to others. Be honest in identifying your skills. Dentistry is very close to my heart and I do want some new improvements in the field of periodontology because the field over the time has improved remarkably and has become an integral part of our everyday dentistry. At the moment we have a lot to do in order to make a mark on the international dental community. We do impart knowledge to our postgrads and undergrads but we ourselves don’t add our own research-based knowledge. I believe that we are lacking in research, so we are deficient in advanced technology. Q. Do you have any specific plans for DIKIOHS? Ans. I have a big responsibility on my shoulder being the head of Periodontology department and working in DIKIOHS. Yes, we plan to bring our Perio at department of DIKIOHS to a level of excellence and want to introduce latest technologies and treatment options not only to the students but for the patients coming to our OPD. We are planning to invite speakers from other national and international reputable universities, to enlighten us with developed and advanced aspect of dentistry. I have tried my utmost to deliver the best at my command to the dental community. I, to my credit, have many publications which include research, clinical articles and case reports and still me and my departmental team and I are working on different projects for the benefits of the institute . I am very lucky that I have all the co-operation and guidance from my honorable Vice chancellor Prof. Masood Hameed Khan and from the pro vice Chancellor and principal Prof, Dr Umar Farooq.
