Interview: Explanation given to patient after procedure, is an excuse!

Recently he sat down with Dental Tribune Pakistan to talk about his journey as a practitioner and discuss some pointers pertaining to Periodontology.

Dental Tribune Pakistan: What made you choose periodontology?

Dr Ahmad: During my graduation, all the specialities were very well established in Pakistan, except for Periodontology, in which we didn't have a single fellowship program in Pakistan. Though we have already learned almost all dentistry facets, I knew it was the periodontology that touched my heart the most during my undergraduate studies. It all happened during my final year; I was genuinely intrigued by the field. My mentor, Dr Khurram, was the very reason who influenced me to pursue periodontology more. He is one of the pioneers who brought periodontology to Pakistan. He has always been a role model for me. The rest of the dental specialities in Pakistan are indeed top-notch, but it needs more focus and attention when it comes to periodontology. And that's how my interest was developed.

DTP: What are the biggest challenges that the field of Periodontology is facing in Pakistan?

DA: The first thing I feel is that the domain of periodontology requires time and attention. The actual spotlight was shone on periodontology back in 2016. Though baby steps are taken, I can assure you that the speciality of periodontology is on the right track. Secondly, in my experience, I felt that supervisors and mentors play a pivotal role in developing interest in any field. They are more like role models for the young aspiring dentists. We need such instructors who develop interests in the young inquisitive minds of undergraduate students. But it's just a matter of time, I believe, that the field will get the due recognition that it deserves.

"I highly recommend students do their bit of research, even in free time. Be informed well, especially about what you are aiming for"

 

DTP: Are there opportunities available for fresh graduates abroad in the domain of Periodontology?

DA: We all are grown up in a country where opportunities are limited, and candidates are many. So, thinking out of the box and being pushed to strive for greatness is the only way to counter such heavy competition. In my second year, I developed this hobby, where I used to search for dental colleges and programs offered abroad. I highly recommend students prepare, even in their free time, and do their bit of research. Be informed well, especially about what you are aiming for.

If I speak about Canada, I can tell that it's a land of opportunity. The scope of periodontology here is immense. But just like any other domain, the competition here is insane. Not just for periodontology, but any field. Yes, the population here is less than Pakistan, but then these people who have migrated here possess great expertise and mind-set skills. Thus further raising the bar.

"If a general dentist is experienced enough and critically analyses himself, I am sure their clinical practice would be far better than specialists"

DTP: Do you think there's a lack of a multidisciplinary approach in Pakistan?

DA: Everything has its own set of pros and cons. In Pakistan, private practice works in a limited financial circumference. Dentists have to pay bills, rent, and provide a salary to staff. They have to manage things within earning. No matter how much we like or not, a multidisciplinary approach is not a choice. It is what they have to do. Hence, when a patient comes and wants a root canal treatment, one cannot let that patient go. They have to cater to that patient, despite being an expert in that domain or not. These patients are the source of income for private dentists.

In Canada, a specialist cannot practice general dentistry. The system followed here in Canada is referral based. If specialists start doing general practice, then instead of referring patients to specialists, these general dental practitioners will turn into competitors.

If a general dentist is experienced enough and critically analyses himself, I am sure their clinical practice would be far better than specialists. One needs to work continuously on excelling their skills, which even general dentists can.

"Dentists usually create high expectations for the patient, which will never work. Explain before procedure rather than post-procedure because then that’s not an explanation, it’s an excuse!"

DTP: Implant topic is not much included in the curriculum at the undergrad level, your comment.

DA: During my time under graduation, the implant was not much included in the curriculum. I remember that the prosthetic side of the side was not taught in detail. So I do understand that lacking. But when it comes to the clinical side of the things, the reality is that undergrad students don't do implants, that's why general dentists prefer to take courses or workshops to excel in the implantology. It's the clinical skill in other fields such as periodontology that I feel need more focus.

DTP: Who is an ideal candidate for implant placement surgery?

DA: I don't categorize myself as an expert. Each day I am coming across something new to learn. So as per my limited knowledge, many things need to be thoroughly considered before placement of the implant. Before anything else, ensure that the patient has periodontal stability, and there are no deep pockets because that deep pockets can alleviate the chances of periodontitis and implant failure. Implant placement requires many minute details to consider, like bone, soft tissues, probing, and lack of periodontal disease, smoking status, and overall oral hygiene habits. If these things are not planned, then there are high chances of implant failure. In my experience, patients are willing to pay extra cash to get an implant. But, I politely refuse them, due to their history. Every dentist should understand that if the foundation is not sound, then the implant can't be stable. Treatment planning is essential. It's better to have plans A, B, and C and discuss the reality of things with the patient. Dentists usually create high expectations for the patient, which will never work. Explain before procedure rather than post-procedure because then that's not an explanation, it’s an excuse.

DTP: What are the recent advancements in periodontology and implantology?

DA: I believe that periodontology has started to get more limelight in recent times. Firstly, most researches, even the one directed to oral maxillofacial surgery, are done in periodontology. The studies done on periodontology touches the domain of basic sciences and others. Also, another reason that I feel is the marketing aspect. Every manufacture companies try their best to create a possibility where they can make something and sell it. Hence such companies try their best to promote it as well. Periodontology enables these companies to open the doors for innovation. I am aware that the trends and advancements in periodontology are rapidly progressing. Each day, new things are offered. But then again, one needs to have a solid base as a dental practitioner.

We have guided surgeries for quite some time. Then there is a 'nav-system' where we are looking at the screen and navigating the CBCT implant placement as per the live instructions displayed on the screen. New developments are similarly made in graftings, such as bone grafts and soft tissue grafting. But then again, you cannot blindly trust technology as these devices have their own set of limitations. It would be best if you had your fundamentals strong to pick when the technology is going off the radar.

"Supervisors and mentors play a pivotal role in developing interest in any field. They are more like role models for the young aspiring dentists"

DTP: Any last messages for young dental students?

DA: I request every young dental practitioner that no matter how many cases you did daily. Do give yourself a favour and reflect on those cases thoroughly. As a student of science, there has always been an opportunity to learn more. Try to look at all the options that could have been done and could be done in future cases. I understand that it's a competitive world we are in, so try to study and work on shortcomings even in your spare time. If there are dental programs or training that can offer you more insight, then go for it. Make the most of your time as a dental student and learn as much as you can.