Research is unlike poetry, does not improve with repetition: Dr Ayyaz Ali Khan

In conversation with: Dr Ayyaz Ali Khan

The Health Talk Powered by Dental News recently interviewed the Founding President of International Association of Dental Sciences & Research (IADSR) and Editor in Chief of Journal of Pakistan Dental Association, Dr Ayyaz Ali Khan, to talk about his professional journey in dental research and to shed some light on the scope dental research in Pakistan. 

What is the training required to write a clinical research article? 

You need to be trained for anything, if you go for driving, you need to have training in driving. Therefore, clinical research requires a fair amount of training. There are opportunities available. In Pakistan, there are at least four to five institutions that are offering diplomas in clinical research. Or one can do what I did, hit and trial. Get embarrassed, and learn along the way.

Do you believe there is a scope for research in dentistry?

Oh yes. Dentistry and medicine thrive on research. But the issue I believe is that whenever I have interacted with individuals wanting to build a career in research, they always tend to do what they want to do, and that is not how research works. In research, you need to see what the need of the time is. For example, we started doing research in oral systemic conditions, and we had initiated this research when countries in the west had also just started their research on this topic.

We did it for ten long years, and we did fairly well because there was a lot of interest in that and people were able to get research grants on it.

Research is unlike poetry, it does not improve with repetition. So what we tend to do is, we come across research and think ‘God, this is good. Let me do this at my hospital’. How would it be different? This is not clinical research. Clinical research is trying out new things and trying out things that are viable in your surroundings.

But why look at global trends? Why not research domestically, on a topic that has not been done before?

Brilliant. See, oral health, and the oral structures are the same everywhere. I’ll give you an example. When we started our work we researched to find a correlation between cardiovascular diseases and periodontal disease. So what we did was, the tried to establish a link in that, and we got a PhD out of it.

But the prime thing we did was, 2 years ago, Dental Research, the prime research journal in dentistry published an article called “Evolution of Periodontal Medicine” and it referred to 12 articles, and Alhumdullilah, ours was one of them.

Our study was carried out by doing simple scaling and we found out that based on inflammatory markers, we could reduce the risk of a cardiac episode by 18% just by doing simple scaling.

Now, this was huge, and it was not done before. This was because the last study done on this subject included 67 participants. Since Pakistan has a lot of patients, out of a total of 5000 patients, we had finalised around 272 at the Punjab Institute of Cardiology. This, by default, was the largest randomized control trial done, in the world.

 

Are there any submission guidelines for a prepared clinical manuscript?

Every journal has its own, and they’re right there in black and white when you visit the website.

What are the challenges you face as editor-in-chief of JPDA?

Multiple. First of all, the financial problems, we are trying to keep the journal alive. Most of our reviewers work voluntarily for us.

Several of the submissions do not follow the guidelines, and other studies would not be up to the mark.

And then, in all honesty, for some manuscripts, if the content is strong and enough material is present, sometimes, we have to re-write the manuscript ourselves.

Therefore, there are multiple times, when a manuscript goes back and forth. So we cannot be very strict

At the same time, to keep the journal going, we need those articles as well.

So there’s a dearth of standardized manuscripts, reviewers, a major dearth in article writing skills.

What was the motive behind starting IADSR, for which you are the Founding President?

The reason for starting IADSR was that we noticed that there are certain skills taught to us in dental school, and then there are certain skills expected of us, when we start up our own clinic.

So there’s a gap there.

One major reason was to have a practice-ready dentist and to eliminate those gaps.

Secondly, when we graduate, we feel that we know it all. But the concept of continuing professional development is to fill gaps in 3 sectors: Education, Research, and Healthcare.

The reason is that in my time, you didn’t have to be good, you just needed to be willing to put in the work but in your time, the competition is tough, you need to excel to be in this field.

 

What dental advice would you like to give nursing mothers and pregnant women?

Multiple suggestions. Firstly, if you have a dental problem, get it sorted out ASAP, and if you go to the dentist, please tell them that you are pregnant so that they may handle the situation accordingly.

We had even won a project of 30,000 Euros on this subject, and the logo was “Brush day and night for a healthy mother and child” and we did this project in Karachi, Lahore and Islamabad in 2011 or 2012.

Through this project we found out that pregnant mothers are actually very perceptive to changes at the time of their pregnancy and when they’re bringing their child up. So, it’s important to encash upon that.

We saw women brushing, who have never done it before, who started brushing everyday, twice a day and when monitored they continued to that…… till the time they were pregnant.

The bacterial load in the pregnant mother or a nursing mother, increases the bacterial load in the bloodstream. This in turn is transferred to the child.

We are currently working on the correlation between periodontal disease, and gestational diabetes, therefore we have PhD coming up, on the subject.

So we are looking into that, there have been studies, but they’re not comprehensive enough, on this subject.

What dental advice would you like to give cardiac patients?

We did a study, it has been published. This research says that if your are a high-risk cardiac patient, and one does a simple scaling, brush day and night, your chances of becoming a medium-risk patient are at 22%.

If one is a medium risk, and you do the same, your risk is 22%. So 1/5th of the risk is reduced by just improving oral hygiene.

We have done research on this already, and it is globally acclaimed.

So while referencing our own research I believe that this information is out there for cardiac patients to make use of in order to reduce the risk of a cardiac incident.

 

How often would you suggest patients get their scaling done?

That’s controversial. There are studies that claim that plaque will reappear within 5 to 7 days if not taken care of properly.

There are also schools of thought that say that if you polish the existing calculus enough, the gap between the teeth would reduce, the patients will be able to maintain their oral hygiene more easily.

So it’s very controversial how frequently one should get scaling done. However, some experts do say, that if you brush your teeth well, even once a day, its enough.

What message do you have for those who want to enter the field of research?

Look its D to D. That’s what my grandfather would always say. It means ‘Deserve to Desire’.

Clinical research is not something that you can walk into. Clinical research requires a lot of hard work and requires a lot of regulations.

For example, we lost a research contract of 100,00 euros just because we could not get an insurance on ground for our subjects.

Because there was no insurance company that was willing to do it for us.

So clinical research has a very strict set of rules. And you need to know what you’re doing. Because I would recommend not to do a clinical research if it is not registered by the Register of Clinical Research (USA). Its online, and its free of cost. But you have to register every clinical research there.

Because then that clinical research is authenticated by the methodology, once submitted.

You can start by doing simple studies, but please don’t tell me that there is a DMFT score of this much. You need to give me something more than that.

Correlate it with carbonated drinks, correlate it with the consumption of confectionary, or do something different.

As I said, repetition does not make research better. Do 1 or 2 systemic reviews, if you do a systemic review you would know what to look for in a randomised control trial because that is the end result of a clinical trial.

If you are doing a clinical trial you are doing a randomised control trial, and that is the crown.