The absolute clinical picture of COVID-19 is still yet to be discovered; Dr Adil Bin Irfan

Dr Adil Bin Irfan graduated from the Fatima Jinnah Dental College in 2011. Following graduation, he worked as a Registrar and later appointed as Head of Hospital Safety at Altamash Institute of Dental Medicine.

After completing his post-graduation training of MCPS in Health Care Systems Management, Dr Adil focused more on healthcare quality management, patients’ and health personnel safety, infection prevention and control.

Dr Adil’s areas of interest include community-based awareness outreach programs, public health, hospital and healthcare management and research methodology.

Aside from involvement in academia, he is also a private practitioner. 

-by Dr Muattar Hanif

Dental News: Take us through your journey from dental school to your current position.

Dr Adil: I graduated from Fatima Jinnah Dental College in 2011 and did my house job from the parent institute in 2012. Just after getting done with house job, I got an opportunity to work as Registrar in the Department of Prosthodontics at Altamash Institute of Dental Medicine. Till date, I am working there as Registrar and OPD Incharge. In 2018, I did my post-graduation training in MCPS in Health Care Systems Management. Due to my special interest in Healthcare Quality Management, Patients’ and Health Personnel Safety, Infection Prevention and Control, I did several courses.

Life begins out of your comfort zone always have a passion for keeping growing and learning new skills

Notable ones are ‘One Year Diploma in Occupational Health and Safety Environment’ from Sindh Board of Technical Education, One Year Certificate Program in ‘Hospital Infection Prevention and Control’, IOSH Certification UK, a short course in ‘Epidemiology and Biostatistics’ from AKUH, training in Fire Safety and various certifications from Aga Khan University. Due to my intellectual post-grad qualifications, I have been appointed as Head of Hospital Safety at AIDM. Dr Adil is also an experienced Dental Surgeon and Specialist Trainer in Infection Prevention and Control in Karachi.

I conducted a first-ever specialized one-day hands-on workshop in Infection Prevention and Control in Dentistry with CODE-M in March 2020 and Facebook live session with YDC in June on the same topic. I am the first dentist in Sindh to earn this honour. I also run my practice with the name Dental Solutions Clifton where he is working as Managing Director and Consultant Dentist. During this pandemic, I started my Instagram page with the name of @dentistwithhumour, where I share hilarious and funny posts regarding dentistry to cheer up his fraternity during these tensed times.

DN: How are you looking at the current pandemic situation and its impact on the dental community?

ABI:  The absolute clinical picture of COVID-19 is still yet to be discovered, and we as a part of the dental industry are suffering from its devastating effects. Sadly, due to the irresponsible attitude and behaviour of our people, this pandemic’s effect is still on the rise in our country, and it is difficult to predict the extent and severity of its long-term impact on us and world over. There is a dubious future of dentists, especially the fresher graduates and the sustainability of dental practices is also a serious concern.

If I talk about private clinics, which are mostly run on a rental basis, including their staff’s salaries compounded by zero income, causes a huge socio-economic impact on our profession. Patients are also afraid of visiting dental clinics as dentists are declared as high-risk professionals due to proximity between doctors and patients which is one of the reasons.

DN: What are your recommendations for dental practices during COVID-19?

ABI: There is a need for a paradigm shift in our dental practices to keep everyone safe from this pandemic, including patients, their attendants, auxiliary staff, management team and of course, oneself being the dentist. Dental practice norms are transforming very differently within these few months since pandemic started to adapt to this changing situation. Before trying to adapt to that change completely, we should keep in mind that we belong to the category of a developing country, and this shift will demand a huge investment. We, as dental professionals, know all the guidelines provided by the CDC, ADA and NHS.

There is no comparison between virtual classes and hands-on experience

I will give recommendations according to the real picture of our field, but many of my colleagues might disagree with my recommendations. In my opinion, only a few well-settled dental practices can adapt that change completely the rest of them cannot. My recommendations are simple. There should be the use of proper personal protective equipment (PPE) by both dentists and assistants.

There’s no need of changing surgical gown or hazmat suit on every patient; they can be washed or sprayed by 5% hypochlorite solution until they are soiled or contaminated and same for the surgical mask. Use N95 respirator mask on top if possible. A combination of a surgical mask and a full-face shield can be used in situations when a respirator is not available. Use rubber dams where possible and high volume suction systems while using high-speed handpiece and ultrasonic scaling devices. Dental chairs and critical contaminated surfaces should be sprayed before and after treating every patient, wash your hands with normal soap before and after wearing gloves. Ensure proper ventilation and keep at least 20 to 30 minutes’ gap between appointments. Using barrier films on critical surfaces, but again it’s an expensive idea. Pre-procedural mouth rinse with 0.5–1% hydrogen peroxide for its nonspecific virucidal activity against viruses or with 0.2% povidone-iodine is recommended as it may reduce a load of coronavirus in saliva.

I will not apologize for being against teledentistry, as speaking to patients without clinical examination in person to me is unethical

For patients, asking travel history is a must. Limit appointments in a day, not more than 4 patients. Be mindful of aerosol generation in a day. No patients will be allowed without masks and hand sanitization is a must when patients walk into your practice. Coughing etiquettes, respiratory and hand hygiene and COVID-19 precautionary signs should also be posted on walls of your waiting area.

Lastly, I will not apologize for being against teledentistry, as speaking to patients without clinical examination in person to me is unethical. It’s like providing substandard diagnosis and care over the phone without proper investigation, and multiple instruments and aids are required like bite tests for fractured teeth, X Rays for bone integrity and hot and cold tests for pulp integrity.

As there is no hope of revival of this pandemic anytime soon and we have to work in this condition to prevent ourselves from further financial constraints and for the sustainability of our practices.

DN: What is your take on online classes and their continuity?

ABI:  In my opinion, it’s a necessity due to the current pandemic situation. As, you see due to COVID19 since march our government had ordered to close all schools, colleges and universities until we win the battle against this pandemic. So, due to this current situation, we are left with this as the means of teaching modality. It’s not just us who’s using this modality, almost every country in the world has now transformed to this. It may be new to most of us here in Pakistan, but if we talk about western countries, they have been conducting online courses/degree programs since long. To bring this innovation, it’s a privilege for me, my Department and Institute to introduce ‘Live Demonstration of Teeth Setup’ to the Undergraduate Students during this lockdown situation, by making the most of the Virtual Platform we have, and as per my knowledge, it was the first time in Pakistan that any of institute conducts the online undergraduate demonstration. The fate of the COVID-19 crisis is unclear shortly, so we have taken this step to keep our students updated to the clinical processes in Prosthodontics. It’s just the beginning; we will be conducting live demonstrations of all procedures on patients gradually, Insha Allah.

DN: Do you agree that virtual classes can be a suitable alternative for dental education, which specifically relies on hands-on experience?

ABI:  In my opinion, there is no comparison between virtual classes and hands-on experience. However, we can compare online classes with the traditional form of regular classes and demonstrations we usually do in labs and OPDs. As extraordinary times calls for extraordinary measures – it is the birth of an emerging trend of E-learning. The world has to take emergency measures and codes to replace traditional learning in the form of regular classrooms to E-learning in the face of this COVID -19 pandemic. But yes, we can say virtual classes are not the absolute replacement of traditional ones for dental education; they can be used as adjuvant until all these things get better.

DN: How much can dental workshops and symposiums play a role in the development of clinical skills?

ABI:  These workshops, symposiums and seminars provide learning opportunities for fresh graduates, especially. They get to meet new people, make collaborations, learn new skills and procedures which are usually not being taught at the undergraduate level. They also get a chance to learn different methodologies from international and national speakers. This broadens their mind with different aspects of problem-solving, and critical thinking skills, and ultimately it will help them to progress in a unique way. It also helps in polishing and sharpening their practical skills and be up to date on new and current advancement in different treatment modalities.

DN: Lastly, what is your message for young dentists?

ABI:  I will give two messages to my young/ fresh dental graduates. Firstly, follow your passion, dream and break the stereotype. This means if you are now a dentist, you don’t have to do dentistry and nothing else. Forget about what your family or society assumes. If you don’t have mental peace in doing dentistry, don’t do it, find alternate ways, everyone should always have a plan B or C in their mind. But once you leave dentistry stick to your plan B wholeheartedly because that profession is chosen by yourself. Secondly, if you have the passion and have the dream of being a dentist, do out of box things don’t just run after FCPS, MDS or MSc just in clinical subjects, there is an open field of Basic Dental Sciences, Public Health, Hospital and Healthcare Management in Pakistan explore it!

There is a need for a paradigm shift in our dental practices to keep everyone safe from this pandemic, including patients

Since our field has now become so saturated, it will be really hard to survive by doing dentistry alone. We have to do at least two things or invest in some business; otherwise, survival in these times is questionable.

Last but not least, make your hand clinically strong after all, you will have to earn your bread and butter from your clinical practice. Do attachments and internships at clinics or dental OPDs, until you find yourself confident enough to run your practice alone. Life begins out of your comfort zone always have a passion for keeping growing and learning new skills.

August 10, 2020

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