Dental Tribune Pakistan

Toothpaste tubes are being portrayed as magic wands; Dr Ashar Nizamuddin Jamelle

By Dr Sonia Sameen
February 07, 2020

Dr Ashar Nizamuddin Jamelle graduated from Fatima Jinnah Dental College (FJDC), Karachi. Following his graduation, Dr Ashar joined Aga Khan University Hospital to complete his residency program in Operative Dentistry. Dr Ashar then went on to pursue Master's in Clinical Dentistry (MClinDent) Periodontolgy from Queen Mary University of London. He was also practicing, meanwhile, at The Royal London Hospital. After returning from the UK, Dr Ashar joined his alma mater, FJDC, as an Assistant Professor and Head of Department of Periodontology. Dr Ashar also runs his own private dental practice in DHA, Karachi. He actively participates in various curriculum activities in dental education sector to sustain his passion for dentistry. Recently he sat down with us to talk about his journey as a practitioner and discuss some pointers pertaining to Periodontology.

Dental Tribune Pakistan: How and when did you decide that you wanted to become a dentist?

DR ASHAR: Well, it was quite a journey. My parents are doctors, so I did have an idea about the direction in which I was to head. However, I noticed how hectic their schedules were. My mother is a gynecologist, and my father is an orthopedic surgeon, and they were away day and night. I initially thought dentistry would be a bit more relaxed in that capacity because there were no day-night shifts. However, as it turns out, that I had to work equally hard because same rules apply to dentistry more or less.

Dental Tribune Pakistan: Take us through your journey from dental school to your current position?

DR ASHAR: After graduating from the Fatima Jinnah Dental College, I realized that everything that I had envisioned was a fallacy. As a young graduate, you think that you have conquered everything after graduating, but in fact, you are met with new challenges every step along the way.

I was considering post-graduation at that time as well because it is very important. I was deciding on heading to the US, so I took my National Board Exams with the initial idea of wanting to settle there. However, I realized that if I pursued that path, I would have had to repeat two years of dental school.

I decided to head back home and sit for my FCPS-I exam, after which I joined the Aga Khan University for my residency, where I trained in Operative Dentistry for four years. That period was a very rich learning experience for me.

After completing my residency, I headed to the UK for two years. I was studying at Queen Mary University and working at the Royal London Hospital as well.

Following graduation, I moved back to Pakistan, where I have been working for the past five years as the Assistant Professor and the Head of Department of Periodontology at my alma mater, the Fatima Jinnah Dental College.

Dental Tribune Pakistan: Why Periodontology? And, was it a calculated decision?

DR ASHAR: When I was training at the AKU in Operative Dentistry, Periodontology was an area of study that always presented itself as an enigma to me. It was a mystery I wished to solve. Questions were being asked with no proper answers to them. Even during my undergraduate studies, I noticed that not much light was being shed on this area of study. I wanted to try and solve this puzzle. I was determined to even head to China to achieve my goal. Our religion also teaches us to go to any length to attain whatever knowledge you can. So, I decided to go on this path because it is very dear to me and so that I may understand it better and disseminate my knowledge further to others.

Dental Tribune Pakistan: What are the current trends in periodontal treatment techniques?

DR ASHAR: Dentistry is continually progressing. New techniques are being introduced day in and day out. A lot of the current trends now focus on using non-surgical methods such as lasers for gum regeneration and perio-endoscopes to visualize calculus and other lesions. Surgeries are also moving towards being as minimally invasive as possible, which allows reduced blood loss and present with a greater overall success rate.

Dental Tribune Pakistan: Between FCPS, MDS, and postgraduation from abroad, which option would you recommend to young dentists, and why?

DR ASHAR: Well, all of them have their own pros and cons. I have undergone the FCPS journey. It is a very structured and inclusive curriculum that incorporates everything from hands-on clinical work on patients to research work like dissertations. FCPS is a very strong learning curve, and as a practitioner, you go through a lot to understand everything step by step. It was, in fact, very similar to my experience in the UK. While I was pursuing my Masters in Periodontology, I was practicing as well on patients. Overall, it was an excellent learning experience.

MDS is a good option as well because it still has a way to go until it becomes a standard mode of study.

Dental Tribune Pakistan: Practicing abroad and now in Pakistan, what would you say are the key differences?

DR ASHAR: When I was practicing abroad in the UK, I learnt a new system that I had not experienced back home where they had referrals and more of a specialist clinical system prevailing. They send you patients specifically depending on your specialty. Over here, we do not have that system, and I think it is something we need to really work upon.

Despite such setbacks, clinics have progressed immensely and become very technologically sound. We have seen a lot of developments here in recent years. I encountered them back then abroad, but I am glad to see them making their way in our healthcare system as well. I believe it is a very positive progression in dentistry in Pakistan.

Dental Tribune Pakistan: What is the best advice that you can pass on to young dentists?

DR ASHAR: The most important thing I believe is to always work hard. You should always devote yourself to whatever you are doing. Whenever the opportunity presents itself, it is best to observe and learn because learning, in any shape or form, will benefit you. You never know when or where you might catch something new.

I would highly recommend considering post-graduation because it will really develop your skills and enhance your personality with time and experience. Never give up. It takes time, yes, but if you keep on working hard, you will get results. Keep at it and slowly, but surely, you will get there.

Dental Tribune Pakistan: Broadly, how do you think oral health relates to overall health?

DR ASHAR: The mouth is the gateway to our system. Whenever we examine the mouth, we always find something or the other that potentially relates to another internal condition. If there is a better system where people start visiting dentists regularly, we can screen a lot of things and work towards preventing it. It is all about prevention nowadays. Social media and television should be used to invoke this concept in the masses and bring the matter of regular dental visits forward.

Dental Tribune Pakistan: Discuss gum disease prevalence in Pakistan. How do these problems vary with the ascent of age?

DR ASHAR: Gum diseases are on the rise in Pakistan, and it is because of the causative factors that are highly prevalent in our society. Diabetes, especially if uncontrolled, can pose a significant threat to gum health. Patients should get their HbA1C levels checked regularly to assess their status better.

Another highly prevalent risk factor in our society is stress. We have a lot of people who smoke, which also contributes to gum disease. Genetics also play a role in causing gum diseases.

People generally tend to neglect tooth brushing, so poor oral hygiene is also a critical factor contributing to gum disease. We, as a society, do not stress the importance of hygiene. Islam states that cleanliness and hygiene are half of your faith. Therefore, we must take measures to bring such things to light and educate the masses.

We should have a specialist referral system so patients can come to us, and we can find the underlying diseases that might cause more serious problems in the future.

Dental Tribune Pakistan: How do gum problems in women vary from that in men? Discuss the effects of puberty (boys and girls), pregnancy, and menopause on an individual's oral health.

DR ASHAR: In women, there are surges of estrogen and progesterone during pregnancy. I have had patients come to me with enlarged and swollen gums. It can be quite a challenge to treat for the doctor and deal with for the patient. It is quite a prevalent occurrence. There are chances of bleeding and inflammation, as well. So, a pregnant patient should essentially go for her checkups more often so we can catch issues before they progress to an advanced stage.

If oral hygiene is maintained and regular checkups are scheduled, we will be better able to prevent such conditions.

Even during puberty, the body goes through a lot of hormonal changes that present themselves in the form of various lesions. So, if patients notice something out of the usual, they should consult their dentist at their earliest convenience.

Dental Tribune Pakistan: Discuss some of the early signs that point towards developing gum disease. What could be done about them?

DR ASHAR: Some of the early signs include wobbly teeth, which is something we find at a much later stage of the disease. Additionally, you can experience bad breath, bleeding gums, sensitivity, teeth drifting, and more. Sometimes, patients do not present with any symptoms. This is why checkups are essential because factors like genetics might come into play. So, essentially, you might be experiencing something in a very silent and seemingly harmless way, but you only realize the seriousness of the situation after it has gotten quite severe. It is good to have a biannual checkup so we can work towards prevention.

Dental Tribune Pakistan: What are the reasons behind the gum recession commonly encountered among our mature demographic? How can it be avoided?

DR ASHAR: Gum recession can happen if you have gum disease and periodontitis. Bone loss accompanies gum recession. The most common reason behind gum recession is overzealous tooth brushing. We tend to be very enthusiastic with tooth brushing, which tends to cause more harm than good.

Therefore, if you know someone who has a habit of brushing their teeth vigorously, as a dentist, you must counsel them and tell them what they are doing wrong. Teach them the right way to brush their teeth because if they continue to do so, it can result in recession. Recession further leads to aesthetic issues as well as sensitivity, which require surgeries to fix. Thus it is better to counsel them at the right time so things can work out in their favor better.

Dental Tribune Pakistan: Can toothpastes (advertised with tall claims) really CURE bleeding gums, tooth sensitivity, and toothache?

DR ASHAR: No, because I believe that toothpaste tubes are being portrayed as a magic wand that can fix anything, but the reality is that they cannot. If there is an underlying problem, it must be looked at and fixed by a dentist or a specialist. If the problem is not fixed, it will get worse, and things might progress into a very detrimental state, so again, instead of patients trying to diagnose their own symptoms, they should head straight to a professional.

Dental Tribune Pakistan: In your own way, bust the age-old myth: Scaling loosens the teeth!

DR ASHAR: Scaling does not loosen the teeth. This is a fallacy that needs to be busted. The reason why this issue comes up is because people come to get their scaling done at a very late stage. It is something they opt for only on special occasions like anniversaries, weddings, etc. If you are a regular patient, you will not experience any such thing because your problem will be fixed before it advances into a more damaging state. If people continue to neglect their oral hygiene and do not come to the dentist, then they are basically inviting problems over, so just be regular with your appointments.

Dental Tribune Pakistan: Are you engaged in any kind of volunteering activities? Tell us about them.

DR ASHAR: I have been doing a lot of workshops to engage young dentists into Periodontology so they can learn about it. I have a passion for promoting this because, again, Periodontology is a field very close to my heart. There are a lot of awareness campaigns that I frequently attend as well because I wish to push this idea as much as I can. Our masses lack awareness, so my goal is to do the most to support the cause and bring more and more dentists into Periodontology as specialists.

Dental Tribune Pakistan: Any special message for young dental graduates

DR ASHAR: I believe that we should enhance our knowledge as much as we can. Read, Go through articles. Learn about the techniques that you can use to help your patients, whether it is in diagnosis or treatment or anything in between. This will benefit everyone. That is how I reached where I am today.

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