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A p u b l i c a t i o n o f M a l a y s i a n D e n t a l A s s o c i a t i o n

Dr Stephen Chen making a name in Australia

Oral Health Awareness Campaign 2019

28FDI World Dental Congress 2019, San Francisco

37The Use of Nitrous Oxide Sedation in Dental Practice

The International Training Workshop on Dental Technology for ASEAN Countries 2019

NURTURING FUTUREGENERATIONS OFDENTAL SURGEONS

July-Sept 2019

July-September 2019

Editor:Dr Mas Suryalis Ahmad

Contributing authors:Dr Leong Kei JoeDr Chong Zhen FengDr Sylvia Lim Sze WeiDr Ng Chun JieDr Jeannette WongDr Lim Yu XiangDr Chow Kai FooAssoc Prof Dr Mas Suryalis AhmadAssoc Prof Dr Firdaus Hariri

Ex-officioDr Chow Kai Foo

TreasurerDr Koh Mei Yen, Eileen

Advertisement LiaisonDr Wong Chin Mee, AngieDr Ng Su Chin, JanicePuan Razana Abdul Karim

MALAYSIAN DENTAL ASSOCIATIONMalaysian Dental AssociationD-5-1, Pusat Komersial Parklane,Jalan SS7/26, Kelana Jaya,47301 Petaling Jaya, Selangor.

Tel: 603-7887 6760 603-7887 6762Fax: 603-7887 6764E-mail: mdaassoca@mda.org.my mdentalassoc@gmail.comWebsite: www.mda.org.my

Conceptualised & Produced byPaul & Marigold (DeCalais Sdn Bhd)No. 23A-6 Strata Office,KL Eco City, Lot 215,Pantai Baru, Jalan Bangsar,59200 Kuala Lumpur

Tel: 603-2201 6499Email: arvind@paulandmarigold.comWebsite: www.paulandmarigold.com

Note:Views expressed are not necessarily those of The Malaysian Dental Association. The Malaysian Dental Association takes no responsibility for the consequences of any action taken based on any information published in MDA News and neither shall it be held liable for any product or service advertised in the same. No part of this publication may be reproduced without the permission of the publisher.

Messagefrom the Honorary Publication Secretary

Dear esteemed MDA members,

The recent MDA AGM held on the 16th of June 2019 has seen a new line up of MDA Council members, led by Dr Leong Kei Joe. While I carry on my position for another term, I hereby wish to congratulate the new Council members, and I hope we

would continue the legacy of the excellent leadership portrayed by our past MDA Office Bearers.

July-September 2019 has also been a memorable time for me. I have just received my Associate Professorship promotion and been appointed as the Deputy Dean (Student Affairs and Alumni) at the Faculty of Dentistry, Universiti Teknologi MARA. I must admit, that my service to MDA has played a huge role in contributing towards my career advancement. I have learnt so much about teamwork, respect, hardwork and professionalism, and I thank everyone for allowing me the opportunity to serve the Association.

Once again, congratulations to the new MDA 2019/2021 Council members, and all the best in carrying out your duties and responsibilities for the benefit of the profession and the public.

Regards, Assoc Professor Dr Mas Suryalis Ahmad, Honorary Publication Secretary 2019/2021, Malaysian Dental Association.

Activities

09 Malaysian Dental Association & Mercy Malaysia Sabah Outreach Clinic

10 Evening Lecture Series 07/19

11 Evening Lecture Series 08/19

12 Preparation Rules for CAD-CAM Restorations

13 Diastema Closure

14 Oral Health Awareness Campaign 2019

17 MDA Northern Zone Basic Implantology Training Programme

25 The International Training Workshop on Dental Technology for ASEAN Countries 2019

28 Report on the FDI World Dental Congress, San Francisco: 2nd-7th September 2019

Inside33 Nurturing Future

Generations of Dental Surgeons

37 The Use of Nitrous Oxide Sedation in Dental Practice

Features

July-September 2019

5Dear beloved members and colleagues,

Greetings from Malaysian Dental Association and Selamat Hari Kebangsaan Malaysia 2019. Since the association concluded the Annual General Meeting on the 16th June 2019, the council of MDA has been kept extremely busy

and has already attended a series of meetings arranged locally and also internationally. I am also pleased to inform you that the line-up of the council is now complete with the presence of Kol. Dr Hazudin Hj. Hassan, appointed council member representing the Dental Services Malaysian Armed Forces.

Indeed the significance of the association and the already paved collaboration made possible by the previous councils have indeed made MDA an important partner in various meetings / organisations. On this note, I also wish to inform all that MDA now has representation sitting in the Innovative Committee of Medical Device Authority with Dr Chow Kai Foo as the permanent committee member and Dr Siow Ang Yen as the alternate committee member. Dr Ng Woan Tyng is also appointed to sit in the National Antimicrobial Resistance Committee while Dr Leong Kei Joe is appointed as council member in the Malaysian Dental Council. Opinions and ideas presented by the association in these meetings are taken seriously for consideration no matter how small the participation may be. On this note, I must thank the council for their support in representing the association in some of these meetings. Apart from our 1st MDA council meeting that was held on the 28th July 2019, the list of official business meetings and functions attended by the council are as follow:

• National Oral Cancer Initiative meeting on the 2nd July 2019 (attended by Dr Leong Kei Joe). In this meeting initiatives and progress of the working committee were presented. It was decided that National Mouth Cancer Awareness Week would start on the 17th November 2019.

• Smile together with Polident (Polident Parents Day Launch by GSK) on the 3rd July 2019 (attended by Dr Leong Kei Joe). MDA also participated in the public forum on denture care.

• Sesi perbincangan mekanisma harga ubat bersama pengamal perubatan swasta on the 11th July 2019 (attended by Dr Leong Kei Joe)

• Committee meeting for Mouth Cancer Awareness Week 2019 on the 25th July 2019 (attended by Dr Mas Suryalis).

• Malaysian Dental Council Inquiry Meeting on the 1st August 2019 (attended by Dr Leong Kei Joe).

• Hong Kong International Dental Expo and Symposium (HKIDEAS) by Hong Kong Dental Association on 2nd till 3rd August 2019 (attended by Dr Leong Kei Joe). Other side meetings attended during this event (by Dr Leong Kei Joe and Dr Ng Woan Tyng):

• Meeting with Medical Protection Society Limited (MPS) on the 2nd August 2019. This meeting gave us the opportunity to voice our concerns on certain legal terms or governing laws that are not applicable to us in Malaysia. Our suggested edits have been taken positively and MDA looks forward to the signing of the contract.

Message from the MDA President

Dr Leong Kei JoePresident Malaysian Dental Association

MALAYSIAN DENTAL ASSOCIATION

MDA News

6• Meeting with Dr Cheol Soo KIM, President of Asia

Pacific Dental Federation (APDF) on the 2nd August 2019. This meeting was also jointly attended by Singapore Dental Association to discuss on the way forward for improving APDF and the status of Indian Dental Association’s representation in APDF.

• Persidangan Penyediaan Rancangan Malaysia ke12 (RMKe-12) untuk sektor kesihatan on 15th August 2019. Dr Mas Suryalis participated in Focus Group 10 (Clinical Research), Dr Ng Woan Tyng and Dr Chow Kai Foo participated in Focus Group 4 (Sustainable Healthcare Financing).

• Mesyuarat Jawatankuasa CPD on the 22nd August 2019 (attended by Dr Teh Yik Pin).

• SIRIM – Industry Dialogue on medical device sector on the 26th August 2019 (attended by Dr Leong Kei Joe). In this dialogue MDA shared its concern on the escalating cost of dental products due the cost of registration of these products with the Medical Device Authority and the possibility of unavailability of certain products if the suppliers deemed them non-profitable. MDA also urges SIRIM to continue to champion for research and innovative products for dental usage. SIRIM looked forward to introduce its products like synthetic bone to MDA.

• Malaysian Patient Safety Council meeting 1/2019 on the 26th August 2019 (attended by Dr Leong Kei Joe). MDA has been informed that Oral Health Program has already adopted the safety goals for dental usage and that data collection for this matter has already been started. The Malaysian Patient Safety Council hopes that in future safety goals specific to dental could be formulated and hope to see data collection to be performed by private dental clinics.

• Mesyuarat untuk megkaji semula kriteria pembangunan pendidikan secara berterusan bagi manual pelaksanaan program jaminan kualiti (QAP) dalam radiologi pergigian on the 29th August 2019 (attended by Dr Ng Woan Tyng and Dr Chow Kai Foo).

• National Antimicrobial Resistance Committee meeting on the 30th August 2019 (attended by Dr Ng Woan Tyng).

• 21st Annual Meeting of Chinese Stomatological Association (CSA) and 2019 China Dental Show at Shanghai on 28th – 29th August 2019 (attended by Dr Leong Kei Joe). Other side meetings attended during this event:

• The 3rd Belt and Road Joint Development Forum on Dentistry/Stomatology with the theme: Prevention of Children Oral Disease on the 28th August 2019. National Dental Associations (NDAs) from Bulgaria, Hong Kong, South Korea, Macau, Russia, Thailand, Singapore, Nepal, Sri Lanka, Myanmar, Cambodia and Indonesia shared their country’s experience on promotional efforts in overcoming early childhood caries.

• Closed door meeting between MDA – CSA (29th August 2019). CSA and MDA agreed to continue to maintain and strengthened the existing friendship. MDA urges CSA to continue support MDA SCATE and MIDEC through sharing of knowledge and technology in speaking at the scientific program and also participating in the trade exhibition. MDA will also support the upcoming FDI WDC 2020 at Shanghai, 1st till 4th September 2020, by sending a delegation from MDA council and promoting the event to our members. MDA also seeks the support from CSA (and also other NDAs during social events) to vote for Dr Chow Kai Foo who is running for the post of FDI Membership Liaison and Support Committee.

Amongst others the council has plans to follow up on the following matters:

• The lifting of moratorium of new dental schools and intake of dental schools

• The issue of fake dentist in the community

• Further discussion on regulations for the 2018 Dental Act and Private Healthcare and Facilities Services Act

• Issues related to the setting up of new private dental clinics

• The possible surge in dental practitioners entering the private sector

With so many matters that are directly affecting the dental profession, the MDA council humbly urges all members to stay united as a family through working together with all affiliates and stakeholders for the benefit of the profession and most of all for the Rakyat. Hence, we look forward for ideas and constructive criticism for this matter.

Yours, Dr Leong Kei Joe President Malaysian Dental Association

July-September 2019

7Dear esteemed MDA members,

It gives me a great pleasure to pen down my first message as the Honorary General Secretary of the Malaysian Dental Association. I would like to extend my sincere gratitude to all esteemed members for putting your faith in me and

electing me into the Council. I shall strive my best to serve the association whilst keeping the interests of the dental fraternity in mind.

The MDA membership is growing steadily and we now have a total of 7,451 members. As we are expecting more and more dental graduates to be registered with the MDC in few years down the road, it is important to encourage our new colleagues to join the MDA in order to stay relevant and updated in the latest advancement of the rapidly evolving dental industry.

Being an MDA member is not just about getting preferential member rates to attend the MDA Conventions, there are many other benefits as listed below:

• Opportunities to serve on various committees/sections in MDA to uphold the image of the profession,

• Assistance from MDA Public Complaint Bureau Committee when need arises,

• Preferential rates for Dental Indemnity,

• Complimentary classified ads on MDA Website, and

• Sponsorship by the Department of International Cooperation Ministry of Science and Technology China to participate the International Training Workshop on Dental Technology for ASEAN Countries

The MDA does not only cater for the professional needs of members, but we are also concerned about the lifestyles of our members. Thank you to the Honorary Financial Secretary Dr Angie Wong Chin Mee and her team, as we have managed to negotiate a few attractive deals for our members. They are as follows:

• Affinity Credit Card Programme with CIMB Bank,

• 7% Discount on Purchase of selected new BMW Fleets,

• Special corporate price of only RM988.00 to attend the BMW Driver Training Program,

Message from the Honorary General Secretary

Dr Chong Zhen FengHonorary General SecretaryMalaysian Dental Association

MALAYSIAN DENTAL ASSOCIATION

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MDA News

• 6% Discount on Purchase of selected new Mercedes-Benz Fleets, and

• Corporate Rebate on top of Monthly Retail Campaign for Purchase of selected new Proton models

If you have any contacts that you think would be helpful for us to get better deals for MDA members, do not hesitate to contact us at finance@mda.org.my.

I would also like to remind all members who have changed their contact details to provide us with an update with an email to mdaassoca@mda.org.my.

Lastly, I would like to wish all a prosperous and joyous Malaysia Day.

Dr Chong Zhen Feng Honorary General Secretary Malaysian Dental Association

The prime objective of the MDA:

To promote the art and science of dentistry for the benefit of the public.

July-September 2019

9Malaysian Dental Association & Mercy Malaysia Sabah Outreach Clinic

Reported by:Dr Sylvia Lim Sze WeiMDAEZ Committee Member

Activity: Medical and dental mission

Date : 26th -28th July 2019 (Friday –Sunday)

Venue: Kampung Suang Duyung, Pitas, Sabah.

Beneficiary: 61 patients

Doctors involved: Dr Mohd Firdaus, Dr Ng Jia Ying

MDAEZ sponsored dental disposables in collaboration with Mercy Malaysia Sabah Chapter to conduct an outreach dental programme in Kg Suang Duyung ,Pitas,Sabah.

MDA News

10Evening Lecture Series 07/19

Reported by:Dr Ng Chun JieMDASZ Committee Member

Date: 25th July 2019

Venue: a.b.c Dental Centre

Number of participants: 39

On 25th July 2019, the Malaysian Dental Association Southern Zone organised an Evening Lecture Series session with a primary focus on non-clinical related topics. We had the honor to have Joseph Yeoh, the marketing manager of Vatech

Malaysia, and Francies Tan, director of FVT Corporate Advisor Sdn Bhd. The event was organised at a.b.c Dental Centre, Johor Bahru, with 39 participants.

The event started with the lecture ‘ taxation,’ which gave an insight to the audience on the ways to maximise efficient tax management. During the talk, Francies also shared on the common issues and controversies related to taxation, particularly in the dental profession.

As patient communication and dental marketing are also imperative for our career success, yet less taught in the formal dental curriculum, Joseph Yeoh, delivered the lecture ‘Marketing That Walks In The Patients Shoes’. The talk gave a clear road map on the way to become a great communicator in the dental practice and excel in dental marketing.

It was a great evening which gave the dental colleagues many new inputs on dental practice management and patient communication.

July-September 2019

11Evening Lecture Series 08/19

Reported by:Dr Ng Chun JieMDASZ Committee Member

Date: 25th July 2019

Venue: a.b.c Dental Centre

Number of participants: 30

On 25th July 2019, we had an Evening Lecture Series covering both dental and non-dental topics, ‘Managing The Occlusion Of Anterior Aesthetic Restorations,’ delivered by Dr Simon Ng, and ‘Tips For Acquiring Loan,’ given by Danson Tan.

Dr Simon Ng, shared with the passionate audience many tips and tricks relevant to managing the dental occlusion. He generously shared on his cases that dealt with managing restorative procedures that involve occlusal rehabilitations and challenges that he usually faces in his practice to give the participants greater insight.

As getting a loan approved is very much relevant to the establishment of dental practices, Danson Tan talked about the topic extensively. He also covered the tips to have a clean credit profile for more effortless engagement with the financial institutions.

The session received highly positive feedback from the audience. And we are expecting more Evening Lecture Series sessions with a combination of dental and non-dental topics, to be conducted to come.

MDA News

12Preparation Rules for CAD-CAM Restorations

Reported by:Dr Ng Chun JieMDASZ Committee Member

Date: 19th August 2019

Venue: New World Hotel Petaling Jaya

Number of participants: 11

In this fast-evolving world, material science in dentistry has developed a lot of changes which significantly enhanced the clinical outcome of treatments. CAD/CAM, now being a significant technological advancement, has increased productivity and the chance to work with

new materials with a high level of accuracy. We were very honored to have Dr Eduarno Mahn, who is a certified Prosthodontist in Chile and Director of the Esthetic Dentistry Program at the Universidad de Los Andes, to discuss the new challenges of minimal invasive preparations in CAD-CAM technology.

On 19th August 2019, 11 participants joined Dr Eduarno Mahn for a full-day workshop in New World Hotel, Petaling Jaya. It was an intensive learning day filled with a comprehensive lecture and demonstration on step by step preparation of inlays, onlays, crowns, and endocrowns. In this workshop, participants learned about the advantages and disadvantages of the CAD-CAM technique, when cuspal coverage should be performed, and to make state of the art temporaries for the different indications.

Upon the request of the participants Dr Eduarno Mahn also selflessly shared and demonstrated his knowledge of a veneer preparation.

Heartfelt gratitude to Dr Eduarno Mahn for his dedication as well as Ndent and Ivoclar Vivadent for their sponsor and collaboration with Malaysia Dental Association Southern Zone( MDASZ). It was, indeed, a fruitful day. We were glad that everyone greatly benefitted from this full-day workshop.

July-September 2019

13Diastema Closure

Reported by:Dr Ng Chun JieMDASZ Committee Member

Date: 20th August 2019

Venue: New World Hotel Petaling Jaya

Number of participants: 12 participants

One of the most common aesthetic procedures encountered by general dentists today is diastema closure. On 20th August 2019, Dr Eduarno Mahn continued to teach us how to deal with diastemas in a simple, minimally invasive and predictable way.

During the course, Dr Eduarno Mahn explained about the techniques, and problems encountered when closing spaces and the emergence profile, followed by the demonstration of several methods for closing diastema. Lastly, the hands-on finished with the demonstration of finishing and polishing.

Throughout the workshop, Dr Eduarno Mahn interacted closely with everyone, be it during the course or break time. Participants were provided with extremely helpful, practical feedback.

A big thank you to Dr Eduarno Mahn and fellow participants for making this event a successful one. Not forgetting Ndent and Ivoclar Vivadent for their great support and collaboration with Malaysia Dental Association Southern Zone (MDASZ), and hence dentists in our region are able to continuously get benefit from courses to improve the future of oral health care.

MDA News

14Oral Health Awareness Campaign 2019

Reported by:Dr Jeannette WongMDANZ Secretary

The Oral Health Awareness Campaign (OHAC) is an annual campaign organised by AIMST Dental Students Association (ADSA). The aim of OHAC is to create awareness among the community regarding oral health and its importance as well as to

provide screening and early detection in order to prevent oral diseases.

With the theme of “Your Smile, Our Passion”, OHAC 2019 was divided into 2 phases, namely Dental Camp and Main Campaign.

The Dental Camp was held from 9th to 10th March 2019 at an orphanage called Pusat Jagaan Glory Children Care and Pusat Jagaan Harapan, an old folks and handicapped centre. The objective of the Dental Camp is to reach out to the underprivileged who are otherwise inaccessible during the main campaign at Central Square. With a dental team from the AIMST Dental Faculty, ADSA has successfully screened 40 underprivileged people including 10 orphans, 30 old folks and handicapped. Oral health education and interactive activities were carried out at the same time too.

This was followed by the Main Campaign from 15th to 17th March 2019 at Central Square, Sungai Petani, Kedah. Various activities were prepared for the community, including free dental screening, best smile competition, poster exhibitions, plaque disclosing demonstration, colouring/drawing competition, interactive activities and lucky draws.

July-September 2019

15

This campaign has successfully attracted more than 2000 visitors with 857 people having received free dental screening provided during the 3-day campaign, which was a record breaking feat. The positive feedback ADSA received from the public indicated that OHAC 2019 has

successfully played its part in imparting knowledge about oral health to the public through oral health counselling, oral health instructions, plaque disclosing and dental exhibitions.

MDA News

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As with the years before, MDA Northern Zone played its part in supporting a dental faculty in the northern region by sponsoring RM2,000.00 to ADSA towards the organising of OHAC. MDA Northern Zone would like to congratulate ADSA on their commendable efforts in providing oral health education to the public. Their enthusiasm and dedication towards making the campaign a success was impressive, and we wish them all the best for OHAC in the coming years.

July-September 2019

17MDA Northern Zone Basic Implantology Training Programme

Reported by:Dr Jeannette WongMDANZ Secretary

In partnership with Osstem, MDA Northern Zone’s Basic Implantology Training Programme targets dentists who are looking to explore the world of Implant Dentistry. This 2-module programme allows participants to understand the fundamentals of implant dentistry

from start to finish with a series of lectures and hands-on. A total of 29 participants attended this programme.

Module 1 was conducted at G Hotel Kelawai, Penang from 13th to 15th June 2019. This module started with a series of lectures presented by Oral and Maxillofacial Surgeon, Prof Dr David Ngeow. Among the topics covered over the 3 day period included diagnosis and treatment planning, radiological assessment and hands-on, bone biology and anatomy, soft tissue management, GBR and hard tissue management, understanding implant armamentarium, surgical stent and troubleshooting. Apart from lectures, participants were also given a hands-on on bone appreciation, surgical drilling and implant placement. Representatives from Osstem were present to provide models, instruments, equipments and guidance in order for participants to get to know and familiarise themselves with the Osstem implant system. Module 1 concluded with guest speaker Dr Tan Sock Hooi talking about dental implant treatment in private dental practice.

MDA News

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Module 2 was conducted from 27th to 29th July 2019 with Assoc. Prof Dr Chai Wen Lin presenting lectures that focused on the prosthetic component of implant dentistry, which covered the pink and white aesthetic, impression techniques, temporisation, occlusion and what to check during the issuing stage. A hands-on session on impression taking was also conducted at the end of Day 1. Day 2 saw Prof Dr David Ngeow continuing with lectures that covered prosthetic and surgical related complications and their management, an introduction to sinus augmentation, as well as maintenance and management of periimplantitis. On the last day of Module 2, participants relocated to Klinik Pergigian Mutiara, Bukit Mertajam for a day of live surgery. It was a fruitful learning experience as 6 implants were placed into 6 patients by the participants during the session. Meanwhile, a live video feed was also set up for those who were not able to get a good view during the live surgery.

July-September 2019

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MDA Northern Zone would like to extend our sincerest thanks to Osstem for a collaboration that has been very well received, as well as to the speakers for taking the time to impart with their knowledge and sharing their experiences with the participants.

MDA News

July-September 2019

MDA News

July-September 2019

25The International Training Workshop on Dental Technology for ASEAN Countries 2019

Reported by:Dr Lim Yu XiangMinistry of Health

The International Training Workshop On Dental Technology for Asean Countries, held from August 14th to August 28th 2019, was organised by Guangdong Provincial Stomatological Hospital and Stomatological Hospital of Southern Medical University,

Guangzhou. It was made possible by the kind sponsorship of the Department of International Cooperation Ministry of Science and Technology, China. Other participating countries included Indonesia, Philippines, Myanmar and Singapore.

Participation was open to all members of MDA and the programme was announced on the MDA website and through MDA E-mail. Due to a good relationship between MDA and the organiser, MDA nominated 6 members to participate in this program. The Malaysian delegation was led by Dr Lim Yu Xiang (Ministry of Health), and represented by Dr Ahmad Badruddin Ghazali (academician, IIUM), Dr Goh Jin Heng (private practitioner), Dr Lee Chia Hua (Ministry of Health), Dr Wong Ming Yin (Ministry of Health) and Dr Lim Shin Yi (Ministry of Health). The representatives from each country were also invited to give a speech during the opening and closing ceremony.

The programme included class meetings whereby all delegation leaders shared information regarding the practice of dentistry in their countries. Participants were given the opportunity to participate in the 12th Guangdong, Hong Kong, Macau and Taiwan Implant Forum 2019, where participants were exposed to implant knowledge and advance technology in implant field.

MDA News

26This programme continued with the daily workshop of Prosthodontics, Endodontics, Periodontics, Orthodontics and Implantology, including the hands-on of CAD-CAM, microscopic endodontics, etc. The participants also toured the Yue Cheng Dental laboratory, the hospital buildings and departments of Stomatological Hospital Southern Medical University. Participants were invited to visit 2 well-known manufacturing factories in Foshan town, which constructs dental instruments, dental chairs, light-curing units, etc. During the weekend, the delegates were treated to a sight-seeing tour of the city, including Guangzhou Museum, Huangpu Village, WanLing Mall, various historical places and Canton Tower.

The Malaysian delegation would like to thank the organiser and MDA for their continuous efforts to strengthen ties with regional and international dental associations to allow more golden opportunities such as this for MDA members.

July-September 2019

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MDA News

28Report on the FDI World Dental Congress, San Francisco: 2nd-7th September 2019

Dr Chow Kai FooFDI National Liaison Officer12/9/2019

With input from:Dr Leong Kei Joe Dr Lim Chiew Wooi Dr Chong Zhen Feng

The FDI World Dental Congress 2019 was attended by the MDA President Dr Leong Kei Joe, President-Elect Dr Lim Chiew Wooi, the Honorary General Secretary Dr Chong Zhen Feng and the MDA National Liaison Officer Dr Chow Kai Foo.

1. The Asia Pacific Dental Federation (APDF)/FDI Asia Pacific Regional Organisation (APRO) Meeting was much anticipated and the main issue of proper constitutional guidelines as to the status of a country within the APDF and that a candidate for any post must be supported by a written letter from the respective NDA (National Dental Association) was debated heatedly and passionately based on the Malaysian letter to the APDF Council. It culminated in an agreement passed and seconded for a review committee made up of 10 nations to study the matter and to come out with viable solutions on the matter. The nations and individuals in the constitutional review committee are Thailand, Malaysia, Singapore, Hong Kong, Sri Lanka, Pakistan, Philippines, Korea, current President Dr Kim and the Secretary General Dr Oliver Hennedige. The meeting also concurred that a proper registration of attending delegates be streamlined for future meetings.

2. Dr Chow ran for the FDI Membership Liaison and Support Committee in a field of 7. He was unsuccessful. The lessons learned are that in order to win in the FDI elections, a country will have to prepare to campaign diligently at the personal and public level and spend in terms of entertainment and preparation, backed by a team.

July-September 2019

293. The FDI President Elect was won by

Professor Ihsahne from Morocco. They brought a big team who campaigned very hard. They also hosted a lunch for the APDF and spent on other events and campaign materials.

4. We also attended the FDI open forum discussion on the policy statements. At the open forum, oral health policy statements were discussed and debated before being written into final drafts which were put into voting at the later session.

5. FDI policy statements can be read and downloaded online on the FDI website. These policy statements are important as a source of reference and in helping nations as they formulate rules and

MDA News

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regulations as they represent the consensus of the majority of member nations.

6. We attended the World Oral Health Forum where 9 panelists chaired by a WHO expert shared and discussed Universal Healthcare Coverage based on the theme, “The good, the bad and the necessary of Universal Healthcare Coverage (UHC). “Some of the take-home messages are:-

• UHC means that every person, everywhere has access to the health services they need without the risk of financial hardship when paying for them.

• Is it a human right? Perhaps it should be seen as a human responsibility for each other as members of one human family regardless of race or creed.

• Healthcare resources may be akin to food supply and distribution. There is more than enough food for everyone in the world. It is not a matter of supply but of distribution. Could it be the same in healthcare?

• There should be a consistent emphasis on prevention and not treatment. Treatment means we have failed to prevent. Prevention will result in less and less treatment. More and more treatment does not.

• There is a crying need not only for political will but also professional will and a continued determination to uphold the sacredness of human life regardless of race and creed.

• Though there was much sharing of very good points and useful information, I am a bit disappointed that the important focus of how UHC can be implemented effectively in a given country and remain non-profit and sustainable was not covered in depth.

7. Ideas learnt from FDI WDC Scientific Program and Trade Exhibition:

• Printing of delegates name tags on high – quality paper without need of plastic pouch.

• Trade talk / seminars within the exhibition venue using wireless headphones for each listener, eliminates the noises from crowds at the exhibition area. Furthermore, concurrent seminars / talks can be made possible even side – by – side, without any disturbance.

• Rotating hanging banner seems to be eye catching

• Membership corner for membership drive and networking area

• Scan – in is compulsory for entrance to all lecture halls

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San Francisco California is a really vibrant city. Cosmopolitan in nature with immigrants from all over the world including Asia showed us a friendly face despite numerous homeless people. Neighbouring attractions are Silicon Valley and the Yosemite National Park. The team had a great time building camaraderie and interacting famously with the locals. We walked the incredible Golden Gate Bridge and managed to squeeze in a visit to Yosemite where we were awestruck by the wondrous beauty of the mountains, valleys and majestic redwood trees.

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July-September 2019July-September 2019

Nurturing Future Generations of Dental Surgeons

Having completed his specialist training in periodontics in 1986 and PhD at the University of Melbourne in 2008, Dr Stephen Chen is now a clinical Associate Professor at the the Melbourne Dental School while running the ITI (International Team for Implantology), an international not-for-profit academic organisation.

Interviewee: Dr Stephen Chen

By: Khaw Chia Hui

MDA News

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How did you end up in Melbourne, Australia?I started my specialty training program in periodontics at the University of Melbourne in 1985. When I finished, I was offered a position at a specialist periodontal practice in Melbourne in 1987. My wife and I loved Melbourne so much we decided to stay.

Although I would like to return to Malaysia more often, most of the time I am back here for work related trips. (During our interview in September, Dr Chen was in Kuala Lumpur for the 13th Asian Pacific Society of Periodontology Meeting. He presented the third keynote address and it was on Implant Therapy in the Periodontal Patient: Risks and Management Strategies.)

Was dentistry your chosen field in university?If memory serves, I was the faculty’s fifth batch of students. While I spent five years in secondary school in Ipoh, I was a KL boy at heart, so the UM offer was a good one.

After graduation, I went into private practice where I mentored with Dr YS Tan and Dr Paul Lee. They were my early mentors and they really helped me develop my clinical skills and imparted their knowledge and industry know-how.

How about periodontics? How did you settle on this specialty?For me, a periodontist needs to be both a proceduralist and a physician. Proceduralists are focused on perfoming exacting and precise clinical and surgical procedures, whereas physicians diagnose and treat chronic diseases. Physicians also need to educate their patients, provide ongoing followup of their conditions and try to modify their behaviours in a positive way. Periodontics combines the attributes and skills of both the surgeon and the physician, as we deal with chronic diseases and perform surgical and reconstructive procedures. This makes it a very interesting discipline in dentistry.

You are also the president-elect of the ITI, an international not-for-profit academic organisation in the field of dental implantology. What role does ITI play?Implantology isn’t taught extensively to undergraduates in dental schools. Many dental surgeons gain their knowledge via short courses which might not be adequate.

Personally, my interest in implantology started in early 1991. In the early 2000s, ITI formalised an Australian chapter. With the ITI, the organisation is able to provide an extensive education programme for our fellows. and members and opportunities for mentorships.

ITI courses are divided into foundation, basic and advanced. Each category requires 60 to 80 hours so it is a real commitment.

ITI also has an online academy, scholarships, study clubs, research support and fellowship opportunities. Seeing we have more than 15,000 members. and over 45,000 affiliates worldwide in over 100 countries, it is a great organisation for those who are interested in implantology.

Seniors have a responsibility to impart good practice to the younger generation of dental surgeons.

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What is your advice to fresh dental surgeons?From my experience, getting a good mentor is key. I benefitted greatly from my mentors. A good mentor can help set you on a path towards a long-lasting career. They are also able to share their philosophies, ethics and experiences, things you won’t learn just from books. Seniors have a responsibility to impart good practice to the younger generation of dental surgeons.

Also try to cultivate a love of learning. This will also take you far. Hone your skills. Be inquisitive, don’t be close to new knowledge. However, be discerning as the explosion of information doesn’t necessarily translate into an increase in knowledge. Information and knowledge are not the same things. Knowledge is the synthesis of the relevant and meaningful information. Learn to filter the background noise.

I feel sometimes the over-emphasis on the business aspects of dentistry needs to be balanced with other factors that will make you a good dental surgeon. Patient-centric care should be your priority.

In your opinion, what is the role of private companies in the dental field?As I mentioned, there is an explosion of information out there. Information is being disseminated via traditional channels, social media, and private companies and so on.

There is no denying the vital role of private corporations in our field. Private companies provide resources, products, technology and support. For example, the 13th Asian Pacific Society of Periodontology Meeting that I’m attending now, involves partnerships with private companies.

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36But we need to recognize that commercial organizations naturally wish to show their products in a good light. Some of the promotional information may not be evidenced. Congresses and conferences should strive to provide evidence-based information and clinical techniques. Private companies can then provide their promotional information in the exhibition arena. To me, this is how it should be.

Since being in Australia, what are the challenges for dentistry there? I would say the biggest challenge is access to care for those who live in remote regions of the country, and those who are unable to afford private practice dentistry. Since dentistry is not covered by Medicare, patients have to self fund their treatment with the help of dental insurance. Those without the resources have to rely on a very overcrowded public health dental system.

You are quite active in professional associations such as the Australian and New Zealand Academy of Periodontists, Australasian Osseointegration Society, and Australian Society of Periodontology. How have these institutions helped you?Apart from meeting like-minded colleagues, you are given access to resources, courses, conferences and best practices. Information on the latest products, technology, legislation and industry developments are easily available via the professional associations.

Also a strong professional association acts as a voice to liaise with governments and other entities when it comes to advancing the field of dentistry.

I feel sometimes the over-emphasis on the business side of dentistry needs to be balanced with other factors that will make you a good dental surgeon.

July-September 2019

37The Use of Nitrous Oxide Sedation in Dental Practice

By:Assoc Prof Dr Mas Suryalis Ahmad Specialist in Special Care Dentistry, Deputy Dean (Student Affairs and Alumni), Faculty of Dentistry, Universiti Teknologi MARA.

Assoc Prof Dr Firdaus Hariri Consultant Oral and Maxillofacial Surgeon, Deputy Dean (Research and Development), Faculty of Dentistry, University of Malaya.

Nitrous oxide (N2O) inhalation sedation has been known to be an effective and safe method to reduce fear and anxiety while maintaining communication between the practitioner and patient (1). It is important for the dentist to consider the safety of the patient

and the dental team, as well as determining the indication and necessity for the use of this means of behavioural guidance modality before deciding to administer N2O sedation. The decision to use N2O should include these considerations (2):

• Other alternatives in behaviour management techniques.

• Patient’s dental needs.

• The effect on the quality of dental care.

• The effect on the patient’s quality of life in terms of emotional development.

• The patient’s physical considerations, including their medical health status.

Nitrous Oxide Inhalation Sedation is Indicated for (2, 3, 4): • Patients with fear and anxiety, whom basic behaviour guidance have not

been successful.

• Patients with gag reflex.

• Patients, whose cooperation is affected by lack of psychological/emotional maturity and/or physical/ mental disability- as assessed by the specialist anaesthetist with advice from the patient’s physician.

• Patients, whose developing psyche may be protected and/or medical risk, may be reduced with the use of sedation.

• A patient for whom profound local anaesthesia cannot be obtained.

Contraindications for N2O Include (2, 3, 4, 5): • Some patients with chronic obstructive pulmonary disease.

• Patients with upper respiratory tract infections.

• Patients with large tonsils or adenoids.

• Patients with phobia towards the use of mask.

• Patients with obstructed nasal flow such as those with nasal polyps, deviated nasal septum and sinusitis.

• Mouth breathers.

• Patients in the first trimester of pregnancy.

• Patients with moderate to severe intellectual disability.

• Certain patients with severe psychiatric and emotional disturbances or drug- related dependencies.

• May be contraindicated in patients with sickle cell disease.

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38• Patients treated with bleomycin sulphate.

• Some patients with behavioural issues.

• Patients who tend to develop cyanosis at rest.

• Patients who had an upper anterior apicectomy.

• Cooperative patients with minimal dental needs.

Advantages of N2O (2, 3, 4): • Help reduce fear and anxiety and minimise psychological

trauma while maintaining communication between practitioner and patient.

• Reduce patient’s untoward and aggressive movement or reaction towards dental treatment, thus guarding his/her safety and welfare and allowing procedure to be completed safely.

• Improve patient’s cooperation by raising patient’s pain threshold/ minimise physical discomfort and pain.

• Increase tolerance for longer appointments.

• Reduce gagging.

• Aid in the treatment of the psychologically/ physically/ medically compromised patient.

• Suitable for needle phobic patients.

• Level of sedation is easily titrated with rapid induction and fast recovery.

Disadvantages of N2O Sedation (2, 3, 4): • Administration requires good psychological support.

• Variable post- op amnesia.

• N2O pollution could happen if the patient is a mouth breather. However this could be prevented with good scavenging system.

The Use of N2O on Patients with Special Needs:Faulks (2007) reported that using N2O sedation for dental treatment has resulted in 91.4% success in improving compliance of patients with intellectual disability. No serious adverse effects occurred except for only minor adverse events (e.g. nausea) which occurred in 10.1% of sessions (6). However, Girdler (2009) suggested that N2O is contraindicated for individuals with severe intellectual disability (3).

The Use of N2O by Dental Practitioners in Malaysia (7):In Malaysia, recommendations on the use of sedation and analgesia by non-Anaesthesiologists has been developed by the Academy of Medicine, Malaysia (2012). It provides recommendations in preparation of facilities and equipment, as well as clinical management, which includes:

Nitrous oxide inhalation has

been known to be an effective and safe method to reduce fear and anxiety

while maintaining communication between

the practitioner and patient.

July-September 2019

39• General principles

• Pre-procedure preparation

• Administration of the sedation

• Patient support and monitoring

• Documentation

• Recovery

• Discharge

This document was developed and published to ensure patient safety, as well as to reduce mortality and morbidity associated with unsafe practice. It is highly advisable for dental practitioners to read through this document prior to conducting N2O sedation on patients. This document can be obtained via this link: https://www.google.com/url?sa=t&rct=j&q=&esrc=s& source=web&cd=1&cad=rja&uact=8&ved=2ahUKEwjS8Y C63anlAhVEjuYKHWOMDk4QFjAAegQIAxAB&url=http% 3A%2F%2Fwww.moh.gov.my%2Findex.php%2Ffile_ manager%2Fdl_item%2F554756755a584a69615852686 2693942626d567a6447567a61573973623264704947526 862694253595864686447467549464a6863476b76556d5 66a623231745a57356b595852706232357a58325a76636 c39545a57526864476c76626c3968626d5266515735686 247646c63326c684c6e426b5a673d3d&usg=AOvVaw0iX cGmSfdblw0mAV3wqjyf

In addition, continuous dental education among practitioners such as basic life support, management of common medical emergencies in dental settings and knowledge updates on common medical conditions should be emphasized to ensure patients’ safety and optimizing holistic dental healthcare.

Conclusion:In order to ensure patients’ safety during N2O sedation, it is recommended that a comprehensive investigation and assessment of the patient’s medical health should be conducted. For patients with medical conditions, suitability of patients to undergo sedation should be discussed with the medical counterparts to evaluate any risks and develop appropriate precautions. Consultation and consent-taking should include discussion of potential N2O side effects, intra- and post-operative risks of complications as well as the additional cost incurred.

References:1. Hennequin M, Collado V, Faulks D, Koscielny S,

Onody P, Nicolas E. A clinical trial of efficacy and safety of inhalation sedation with a 50% nitrous oxide/oxygen premix (Kalinox™) in general practice. Clinical Oral Investigations 2011:1-10.

2. American Academy of Pediatric Dentistry, Council on Clinical Affairs. Behaviour guidance for the pediatric dental patient. Clinical Guidelines Reference Manual 2015;40(6):254-67.

3. Girdler NM HC, Wilson KE,,. Clinical sedation in dentistry. West Sussex: Wiley-Blackwell; 2009.

4. Millet DWR. The uncooperative child. Clinical problem solving in Orthodontics and Paediatric Dentistry. Toronto: Churchill Livingstone; 2005.

5. Malamed S. Sedation- A guide to patient management. Missouri: Mosby Elsevier; 2010.

6. Faulks D, Hennequin M, Albecker-Grappe S, Maniere M-C, Tardieu C, Berthet A, et al. Sedation with 50% nitrous oxide/oxygen for outpatient dental treatment in individuals with intellectual disability. Developmental Medicine and Child Neurology 2007;49(8):621-5.

7. College of Anesthesiologists, Academy of Medicine Malaysia. Recommendations on the use of sedation and analgesia by non-Anaesthesiologists. Kuala Lumpur; 2012. Available from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1& cad=rja&uact=8&ved=2ahUKEwjS8YC63anlAhVEjuYK HWOMDk4QFjAAegQIAxAB&url=http%3A%2F%2F www.moh.gov.my%2Findex.php%2Ffile_manager%2 Fdl_item%2F554756755a584a696158526862693942 626d567a6447567a615739736232647049475268626 94253595864686447467549464a6863476b76556d56 6a623231745a57356b595852706232357a58325a766 36c39545a57526864476c76626c3968626d52665157 35686247646c63326c684c6e426b5a673d3d&usg= AOvVaw0iXcGmSfdblw0mAV3wqjyf

In order to ensure patients’ safety during N2O sedation, it is recommended that a comprehensive investigation and assessment of the patient’s medical health should be conducted.