American Dental Association extends membership in US $12
American Dental Association's (ADA) offers Affiliate membership for dentists who practice outside of the United States. The ADA is interested in collaborating with dental professionals from around the world to network and in seeking ways to improve oral health throughout the world. For that, the Association welcomes dental professionals from around the globe to join as Affiliate members. There are several benefits of membership (including online access to JADA and the new Professional Product Review, and discounted registration to the ADA conference this year in San Francisco) and dentists in Pakistan only pay US$12 per year to join.

PDA awarded membership to all PMDC registered dentists
Landmark decisions taken in annual general body meeting

Pakistan Dental Association holds Annual General Body Meeting at Lahore on 18th November 2006. The meeting was advertised in main national and dental press. The AGM was attended by the 250 active PDA members. The Agenda of the meeting was as follows:

1. Review of the constitution
2. Membership drive
3. New wings for allied professionals
4. International conference 2007
5. Forthcoming PDA regional and central elections

Earlier to the AGM, PDA also conducted the special central council meeting which was also attended by all the zonal vice Presidents and representatives of the central council. After a long discussion, the central council presented the following resolution to the AGM which was overwhelmingly approved.

• All Dental surgeons with PMDC registration (valid and expired) are awarded the membership of   PDA without fee for five years effective 1st January 2007.

• PDA Elections will be held on 1st December after every three years. 

• Audit repot will be submitted to the election commissioner 30 days before the election.

• PDA Accounts must be closed 30 days before the election except election             expenditures and in case of failure to do this; election commission will have all the power to take necessary action against the council.
• Elections for PDA central council will be opened for all zones. All zonal vice presidents may use veto power for major decisions, which may deemed to have direct conflict with the interests of that particular zone.
  
  
• The mode of voting will only be through the postal ballot with necessary PMDC identification.
  
  
• Chief Election commissioner will be appointed 3 months before the election and must be the Ret. High court judge. The associate members of the commission will also not from the dental profession and will be the appointed by the chief election commissioner.
  
  
•   Problems of PDA plots will be resolved within 6 months.
  
  
• Continuing Dental Education programme will be run by the local branches through PDA central council.

•  It has been resolved unanimously by the Central Council that Audit reports of all the future national and international conferences must be submitted within 60 days after the conference. Failure to meet these requirements may cause suspension of the PDA membership of the related organizing committee. This decision prompts the organizers of the International conference, Islamabad and 28th APDC, Karachi to close the accounts with audit report.
  
• It has been unanimously resolved by the Central Council that Dr Nadeem Mughal on behalf of the council can collect the documents and authority letter of PDA central council plot in Karachi from Dr Kamran Vasfy and previous office bearers within a period of 30 days.

Various office bearers of PDA zonal and regional branches took oath at the AGM. The oath was taken by Dr. Shaheena Nusrat, Chief Dental Surgeon and Medical Superintendent, Punjab Dental Hospital, Lahore. Zonal Vice Presidents and representatives were instructed to share the resolution with regional associations and senior dentists and provide the feedback to the central council.

The oath was followed by dinner and musical concert.

PDA objects on the health hazard displays
Pakistan Dental Association has written letter to Pakistan Cricket Board requesting to ban the display of the eatables which contains proven health hazard ingredients. These eatables include beetle nuts and areca nuts. It was noticed that these eatables are sometimes advertised on the belongings of the cricket heroes which of course becomes very attractive to the public. It became more evident when such display was noted at the back of the bat of Mohammad Yousuf when he was waiving his bat towards the public during the high moments of breaking the international record of most centuries in a year.
Pakistan Dental Association requested Chairman PCB, Dr. Nasim Ashraf to ban these products same as the tobacco products. It was also resolved that if such practice is continued then Association will pursue the cause meeting the Chairman personally.

Advanced Detection Of Oral Cancer

Patients with early stage oral cancer may benefit from a more advanced screening process allowing for a more accurate diagnosis, according to a new study.

Lead author, Professor Epstein from the University of Illinois, Chicago, explained, ‘By combining conventional techniques with more modern techniques, we were able to better diagnose and determine the best options for patients with oral cancer.

‘This approach to diagnosing oral cancer may lead to easier identification of serious pathology, significantly lessening the need for unnecessary biopsies without additional risk of false negatives.’

Patients with early stage oral cancer are typically examined by their doctor for suspicious areas in the mouth and throat area. Doctors in this study wanted to test the value of two diagnostic aids in evaluating lesions in the oral cavity.

Chemiluminescent light, or brand name Vizilite and toluidine blue, a pharmaceutical grade dye, were used in addition to the conventional, visual and manual observations of the patient.

Patients were given routine visual examinations under incandescent light for suspicious lesions. The lesions that were deemed suspicious were then assessed with Vizilite, followed by the toluidine blue dye and then biopsied. Doctors then compared the findings from the conventional exam to the advanced, illumination and stain exam.

This study found that of the 84 patients studied, Vizilite improved either the brightness or sharpness of the identified lesions by 61 percent. Only biopsing lesions which retained the toluidine blue stain reduced the false positive rate by nearly 59 percent while maintaining zero false negatives.

de’Montmorency College of dentistry, Lahore becomes centre for MFGDP (U.K.) examinations
MFGDP study club established for preparation for Diploma of membership of the faculty of General ental Practice (UK)

For examinations it is exciting times at present for us, the FGDP(UK) and the Faculty of Dental Surgery (FDS), the two sister faculties at the Royal College of Surgeons of England. The Diploma of Membership of the Faculty of General Dental Practice (UK), MFGDP (UK)) is the first level diploma of the FGDP (UK) and the starting point for the career pathway.

Eligibility for the award of the Diploma
The Diploma of Membership of the Faculty of General Dental Practice (UK) of The Royal College of Surgeons of England may be granted to those who possess a dental qualification registrable in the UK with the General Dental Council, or with an equivalent body in their country of practice and are registered to practice dentistry.

The aims of the MFGDP (UK) are to:

• Improve the quality of patient care;
• Test the basic skills and understanding required for general dental care practice;
• Recognise the achievement of an appropriate standard of patient care;
• Recognise a commitment to lifelong professional development.

The MFGDP (UK) is open to dentists who are registered to practise dentistry and are at least six months post-qualified. Dentists also need to be working in a primary dental care setting to complete the qualification.

The Examination
The examination consists of three parts:

(i) Coursework Module consists of three components:
(a) A practice portfolio providing evidence of six key clinical skills (hereafter known as the key skills
      portfolio)
(b) An audit project;
(c) A clinical case.

(ii) Part 1 consists of three written papers:
(a) A multiple short answer (MSA) paper of twenty questions of two hours duration;
(b) A combined critical reading paper (CRP) and multiple choice question (MCQ) paper consisting of twenty questions of two hours duration.
Part 1 and the Coursework Module must be passed before the candidate applies for entry to Part 2.

(iii) Part 2
(a) Manual of Continuing Professional Development;
(b) Objective Structured Clinical Examination (OSCE) Assessment;
(c) A twenty minute final viva voce.
The examination centre is normally be The Royal College of Surgeons of England.

The Faculty has taken a decision that MFGDP examinations will be conducted outside the UK, so all the overseas centres will continue to offer MFGDP examinations perpetually and NOT the new MJDF which is exclusively for candidates in the UK. Passing this examination is the first step towards the Primary Care pathway in the UK which ends with a “Fellowship”.  It is also the entry examination to “specialisation”. So if the candidate who has done this exam needs to specialise by going for an M Clin Dent, MSc or FDS or other degrees they will get preference. Some examinations will use the “credits” in MFGDP and transfer to the new qualification. There is definitely an advantage. There is also advantage for eligibility for postgraduate examinations if you are in possession of MFGDP. 

However, it will not allow Pakistani qualified dentists to work in the UK on the strength of this examination. They will still have to do the IQE examinations. The GDC will however consider the MFGDP if the candidate goes through the “equivalence” route and the MFGDP will carry weight as the seven key skills will show the GDC that the candidate has gone through the Faculty Coursework Module.

The examination fees are usually dealt through with the British Council. The course work modules when they are finished will have to be posted to the UK and they will be marked here. For the Part 1 examinations in April 2008 there will be no need for examiners from the UK to come as local examiners can invigilate these examinations. The same paper will be sat by UK candidates at the same time. The marking of these papers can take place in the UK if the batches of answers are sent to the UK through the British Council.
Arrangements will be made by the Faculty for UK examiners to come to Lahore to conduct the Part 11 examinations in September 2008. The examination fees (£325 Part 1 fee plus British council charges) will need to be sent direct to FGDP (UK) by cheque or bankers draft that can be drawn on a UK bank. The papers will be couriered back to the UK by the British Council directly after the examination where they will be marked and result letters despatched as well as put on the website.

Part 11 examinations will also involve a surcharge to candidates to cover the costs of examiners travel and subsistence to overseas venues.  The amount can be calculated once the final numbers of those who are eligible and wish to sit in Part 11 will be determined.
 A minimum of 20 candidates would be required to make these examinations viable.  The examinations will need to take place at the same time as they are held in the UK therefore with the (+5hrs) time difference may need to start the examination at around 3pm.

Exemptions
(i) Candidates who have gained a pass in the MFDS Part A examination since October 1998 are exempt from sitting Part 1 of the MFGDP(UK). (ii) Candidates who have gained a pass in the MGDS Part I examination are exempt from sitting Part 1 of the MFGDP(UK).

MFGDP STUDY CLUB
de’Montmorency College of Dentistry, Lahore

Director
Prof. Dr. Nazia Yazdanie

Coordinators
Prof. Dr. Adnan Ali Shah
Prof. Dr. Sohail Abbass Khan
Prof. Dr. Waheed ul Hamid

Organising Committee
Dr. Asif Ali Shah
Dr. Wasif Ali Khan
Dr. Kamran Ali

Pathway Schedule 2007-2008

 April 2007

• Members Meeting of the Study Club
• Introductory Seminar by the U.K. Tutors
• Registration of the MFGDP Examination candidates

April 2007-December 2007

• Monthly study club meetings
• Candidates prepare Coursework module

October 2007-December 2007

• Invitation to the MFGDP Faculty
• Coursework module of the candidates assessment
• Recruitment of the local Examiners

 January 2008

• Recruited Examiners to attend two day residential examiner training course in U.K.

 April 2008

• Part I Examinations to be held at de’Montmorency College of Dentistry, Lahore

September 2008

• Part II Examinations to be held at de’Montmorency College of Dentistry, Lahore
  

Improving access to Oral health care in schoolchildren of rural Pakistan
Introduction

Poor oral health can have a detrimental effect on children’s performance in school and their success in later life. It has also been seen to effect the growth and development in children. Dental caries and periodontal disease effects majority of the Pakistani children, these diseases have been considered as compounding factors in children who fail to thrive. It is therefore obligatory to consider taking up the healthy school initiative in the country. Oral health could take a lead in this initiative since oral disease is prevalent at an epidemic level and since most of it is untreated the need for improved oral health remains high.
Utilization of dental services has been linked to positive health behaviours and receiving other preventive services. Even when essential health care services are available, they might not be accessible because oral health service utilization is dependent on many variables such as distance to be travelled to seek treatment; availability of appropriately trained personnel at the health facility; and the individual’s perceived need for care within the context of other predisposing and enabling variables. Perceptions and priorities influence such behaviour.

Access to care is considered to be fundamental societal right especially for children. Oral health care access is a key variable affecting health care-seeking behaviour and oral health status of individuals and societies.
In Pakistan oral health care is virtually non-existent in rural areas where more than 70 per cent of the population live. Although oral health facilities are supposedly available at 541 Rural Health Centres (1:200,000), the services are plagued with lack of trained manpower, non-availability of functional equipment, instruments and material. Moreover, oral health services are nationally provided as outpatient facilities meaning these services are not available after office / school hours (2 pm). Sporadic old-fashioned health education activities are conducted in schools, not considering that their effectiveness is nearly zero.
This project proposes to improve access to oral health care of schoolchildren in one pilot tehsil of the country. It proposes to improve perceptions and perceived need for care regarding oral health thereby improving the health care-seeking behaviour of these school children. It also plans to improve the oral health status of these individuals by providing in-house oral health services at school.

Method
School children will be given lessons on oral health and disease every morning in the school assembly; they will be encouraged to promote oral health in the school through peer-led activities. They will also be trained in basic oral examination with the help of wooden tongue depressor and tooth pick; and encouraged to examine, screen and refer each other for appropriate dental treatment. 
Two teams each comprising of a dental surgeon assisted by a trained dental chair assistant with fully functional portable dental unit, instruments and material will be stationed at each school for a period of two weeks every year to provide oral health education and dental treatment to the approximately 800 students in each school. There are 36 school weeks each year and each team will go through 18 schools in a year, thereby, covering 36 schools and approximately 28,800 school children.

Structure of a single intervention
Beneficiaries:                Approximately 800 children (1 school)
Duration:                        12 days
Human resources:         Two dentists, two dental chair assistants
Target:                            One class a day

Schedule of a single intervention:
Day 1:                          Teachers training workshop
Day 2-12:                     Daily Timetable
8 am:                            Oral Health Message in the School Assembly (Prevention)
8.15 am to 9.30 am      Oral Health Screening of one class
9.30 am to 1.30 pm:     Treatment for students of one class (extraction for pain relief and filling with ART technique for Caries Control)

Sustainability Assurance:
Pakistan is administratively divided into four provinces namely Punjab, North-West-Frontier Province (NWFP), Balochistan and Sind; and the Federally Administered Tribal Areas (FATA). Each province is sub-divided into administrative divisions, districts, and tehsils.  There are 24 Divisions, 89 Districts and 378 Tehsils in the country. District is the basic administrative unit and is headed be a District Nazim, who is the elected representative while the government is represented by the District Coordination Officer, the subdivision is population based and a district excluding the one with big cities, usually has a population range half a million to two million. Tehsil is the smallest administrative sub-unit having a population range of 140,000 to 300,000 and is headed by a Tehsil Nazim.

The Federal Ministry of Health is responsible for matters concerning national planning and coordination in the field of health, while the provincial Departments of Health implement these policies and provide health care services through government hospitals and other health outlets. However the actual health care delivery in the PHC context is the responsibility of the District Governments. Similarly education delivery is also a district subject.

For the Pilot project the District Nazim (Mayor) and the Tehsil Nazim of the pilot tehsil, District Coordination Officer, Executive District Officers of Health and Education of the pilot district and their subordinate staff at tehsil level will be involved in all the planning and implementation stages of the project.
The Federal Ministries of Health and Education; the Provincial Departments of Health and Education; and the Director Dental Services will be kept informed of the project.
A Consensus Building Workshop will be organized in collaboration with the Lever (Pakistan) and the project would be launched from that workshop.

(Two Million and four hundred and thirty three thousand two hundred Rupees – Approximately 30,500.00 Euros at exchange rate of one Euro for approximately eighty rupees)


Outcome Assessments
Objectives:
Improve access to oral health care of schoolchildren in one pilot tehsil of the country by:

1. Improving perceptions and perceived need for care regarding oral health.
2. Improving Oral health care-seeking behaviour of these school children.
3. Improving the oral health status of these individuals.
4. Providing in-house oral health services at pilot school.

Measures of Assessment:
One activity will comprise of:

1. Two weeks of Screening followed by treatment of children in one school by a team of one dental surgeon and one assistant.
2. Oral hygiene instructions given by the team to children collectively at school assemblies.
3. Information (oral/ leaflets) on effect of diet on teeth emphasizing on compromised esthetics and possible pain as consequences. Provide recommendations on frequency of sugary snacks in a day.

Assessment
a. Activity evaluation

1. log books for daily work performed by the team as;

• OHI (oral hygiene instruction)
• Fillings
• Extractions
• Scalings
• Root canal treatments

2. A file compiled and kept by class teacher that records treatment carried out on each child. 
3. After every activity (2 weeks) the log book entries will be compared with the record kept for each child for a random sample.
4. Pre and post activity assessment of knowledge of oral hygiene of a representative sample
5. Pre and post activity assessment of OHI practice i.e. brushing frequency, method, duration and time by means of demonstration.
1. time of brushing          e.g. before/ after meals
2. duration of brushing    by watch in seconds
3. frequency in a day       e.g. not at all once twice or more
4. method of OH              miswaak, brush and toothpaste or other
5. intake of sugary snacks    once twice or more
6. Pre and post activity assessment of children’s attitude towards dentist and dental treatment by questionnaire

b. annual evaluation

1. All activity assessment will be repeated in a random selection of schools
2. Change in care index pre and post one year of intervention in a random sample.
3. Evaluations repeated every six months in the same sample after the first year

• Sustainability Measurement:

• Six monthly project reports to concerned authorities.
• Project is recorded as an activity in the Annual Report by the concerned quarters.
• Similar project is proposed or launched in year 2 or 3 in the same or different district.