an interdisciplinary approach apr-jun 2… · apriljune 201 dear esteemed mda members, 5 a s the...
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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
11
30MDA Toastmasters Club 2018
37The Use of General Anaesthesia in Dentistry
Prof Dato’ Dr Zainal AriffAbdul Rahmanropes in medical professionalsin critical cases
9th Borneo Dental Congress & Trade Exhibition Cum 10th Malaysian Dental Association Eastern Zone (MDAEZ) Annual General Meeting
ANINTERDISCIPLINARYAPPROACH
NE
WS
Apr-Jun 2019
April-June 2019
Editor:Dr Mas Suryalis Ahmad
Contributing authors:Dr Ng Woan TyngDr Siow Ang YenDr Har Wai YanDr Ng Chun JieDr Tham Ken WahDr 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: [email protected] [email protected]: www.mda.org.my
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Tel: 603-2201 6499Email: [email protected]: 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/ MDA News Editor-In-Chief
Dear esteemed MDA members,
The MDA Annual General Meeting, scheduled on 16 June 2019, has seen a new line up of MDA Council members being elected for the 2019/2021 session. I would like to wish all the best to the new MDA Council members. May MDA continue to
flourish under the leadership of the new President, Dr Leong Kei Joe.
It seems that I will continue to serve in the Council for the next term. Thank you to MDA for allowing me this opportunity to continue serving the Association. I welcome any suggestion to ensure the sustenance of MDA in serving the profession and the public.
Till we meet again in the next issue,
Dr Mas Suryalis Ahmad Honorary Publication Secretary, Malaysian Dental Association 2017/2019.
Inside
Activities
11 9th Borneo Dental Congress & Trade Exhibition Cum 10th Malaysian Dental Association Eastern Zone (MDAEZ) Annual General Meeting
14 Rubberdamology Master Class by Dr Ashwin
15 The Vertipreps
16 Ipoh CPD Programme 2019
30 Malaysian Dental Association (MDA) Toastmasters Club 2018
33 An Interdisciplinary Approach
37 The Use of General Anaesthesia in Dentistry
Features
April-June 2019
5Dear esteemed MDA members,
As the second quarter of FY 2019 draws to a close, my presidency also expires. On behalf of the outgoing MDA Council and all subcommittee, I express our sincere gratitude for the opportunity to complete and serve our
two-year term. It has been a great honor while rewarding, and personally enriching experience to represent the dental fraternity in this fast-changing and evolving dental landscape. I take this golden opportunity to express once again our utmost gratitude to the general membership for the continued support to the Council, and above all, our beloved Association.
I also take this opportunity to express once again, my sincere appreciation to all MDA stakeholders for their support and the close collaboration with the MDA. They are our comrades in the oral health playground, namely the Oral Health Program, Ministry of Health, the Dental Deans’ Council, the Dental Division of Malaysian Armed Forces, the affiliate associations and the dental trade partners.
As we look back on an extraordinary year, I would like to acknowledge the ongoing commitment and dedication of the MDA council members, standing committees and subcommittees, not forgetting the MDA Secretariat staff. They certainly deserve all the compliments for the evident paced growth and stability of the Association detailed in this year’s annual report. While the person at the top should get the blame when things go wrong, the praise for the good should belong to all of them.
Message from the MDA President
MALAYSIAN DENTAL ASSOCIATION
Dr Ng Woan TyngPresident Malaysian Dental Association
MDA News
6I truly understand that members of the Council, the committee and the Association have been through a lot of sweat and tears in order to secure our benefits and interests. I must admit that all of them have demonstrated great loyalty and diligence towards your respective obligations. Truly, MDA is proud to have such proactive members who have never failed to serve the Association with admirable endurance while exhibiting the spirit of teamwork. And thus, I would like to take this opportunity to say that I appreciate each and every single effort and sacrifice from the bottom of my heart. I feel so proud and honored to have been able to lead this excellent team.
April-June 2019
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MDA News
8Ladies and gentlemen,Again another remarkable year 2018 lies behind us. The 16 June 2019 marks the date set for the 76th MDA Annual General Meeting ( AGM). The Notice of AGM and Agenda, appended with the Annual Report 2018/2019 had been duly sent to you via email.
It has always been a pleasure to be able to present such accomplishments in our beloved association. While truthfully providing a real portrait of the Association, the Annual Report also showcases many notable achievements. It reflects not only the strong performances and growth in 2018 but also above all, the direction of the MDA leadership and opportunities of the future.
I take pride to report that the management by the finance committee has been successful in positive financial perspective. Kudos to the finance committee of MDA, comprising members from Headquarters and Zones !! Congratulations on another great year so well documented in the financial report.
On this note, dear esteemed members, please be assured the MDA council always seeks to strive for the best in the journey we aspire to make our beloved Association sustainable for the benefit of all members at large, and the profession in particular.
As I respectfully hand over to Dr Leong Kei Joe and his esteemed Council, it is my fervent hope that we will continue to forge stronger bonds of rapport and radiate our spirit of cohesiveness on all MDA events. I sincerely hope that in the future there will be greater leaders who would make a bold move to step up and take over the new leadership. Rome was not built in a day. In order to raise the MDA to greater heights, we need new ideas and fresh blood to run and improvise the Association.
Best regards Dr Ng Woan Tyng President Malaysian Dental Association
April-June 2019
9Dear esteemed MDA members,
Greetings from the MDA. The MDA AGM will be convened tomorrow 11am at the MDA Headquarters at Kelana Jaya. Hence, this would be my last message to you as your
Secretary in MDA. I am truly grateful to the trust and support that you have given me for the past 2 years. There were many important policy changes happening which will affect all of us. I am writing to you to give the final update on the advocacy of dental practice which we went through in our council term.
The Dental Act 2018 was passed in the Parliament before GE14 and gazetted by the current Health Minister. However, it is still yet to come into force as the Dental Regulation has yet to be approved. There are still many issues that the MDA is advocating to change and I trust our incoming President Dr Leong & his team will continue on the work and ensure that this would be a fair Act for the Dental Fraternity and the General Public.
There will be a new CPD requirement for all X-Ray operators whereby one needs to attend 5 hours of CPD in 3 years time to renew their X-Ray licence. The Bahagian Kawalselia Radiasi Perubatan (BKRP), MOH is developing a Quality Assurance Programme (QAP) for Dental Radiology which will eventually be made compulsory for all Dental X-Ray operators. The MDA was invited to participate in the drafting of the QAP. One of the major concerns that we raised in the QAP was the compulsory CPD hours that an X-Ray Operator needs to undergo in order to renew the X-Ray licence. The MDA is in the opinion that most dental CPD talks and lectures include the element of Dental X-Ray and we had advocated the committee that to accept that such CPD talks would be counting towards the 5 hours of the CPD requirement. The committee has accepted our proposal and hence the 5 hours CPD would be easier to attain for all of us. Meanwhile, please be prepared as the enforcement would be announced anytime soon.
Message from the Honorary General Secretary
Dr Siow Ang YenHonorary General SecretaryMalaysian Dental Association
MALAYSIAN DENTAL ASSOCIATION
10
The prime objective of the MDA:
To promote the art and science of dentistry for the benefit of the public.
We received feedback from our members that there is a long lead time for X-Ray machine licensing for a new dental clinic. The MDA had requested the BKRP to issue the purchasing & installation of X-Ray machine during the renovation of a new Dental Clinic to reduce lead time to provide X-Ray services to patients of a new dental clinic. I had a chance to speak to En Bazli, the director of BKRP and discussed the possible way forward on our request. En Bazli promised that he shall be meeting the Cawangan Kawalan Amalan Perubatan Swasta (CKAPS) to discuss on a viable way to facilitate this request. Hopefully, our request could have acceded and our members no longer need to wait for months to get X-Ray Licensing in order to provide X-Ray facility to their patients of a new dental clinic.
The Policy and International Relations Division of MOH invited the MDA for a discussion on foreign equity participation in private healthcare facilities in Malaysia. Currently, MOH allows a foreigner to set up a private dental specialist clinic with full (100%) ownership and not allow a foreigner to own any shares (0% ownership) in a private dental GP clinic. However, upon enquiry with them, I was told that currently there are no private dental specialist clinics owned by foreigners, even though ownership has been allowed since 2015. I represented MDA to the discussion and conveyed the position of MDA that we are not in favour of allowing a foreigner to own any private dental practices for both specialist and GP clinics. We requested the MOH to amend the policy to not allow a foreigner to own any private dental practices.
Serving together with you, Dr Siow Ang Yen Honorary General Secretary Malaysian Dental Association
MDA News
April-June 2019
119th Borneo Dental Congress & Trade Exhibition Cum 10th Malaysian Dental Association Eastern Zone (MDAEZ) Annual General Meeting
Reported by:Dr Har Wai YanSecretary 9th BDC
The 9th Borneo Dental Congress (9th BDC) and Trade Exhibition cum 10th Malaysian Dental Association Eastern Zone (MDA EZ) Annual General Meeting was held at Shangri-La’s Tanjung Aru, Kota Kinabalu from 22 – 24 March 2019. The theme “Unleash the Picasso in You”
aptly reflects the role of dental practitioners in delivering their work as an art. Hence, the importance of honing one’s skills and knowledge is emphasised to create beautiful and valuable artwork just like the masterpieces created by Pablo Picasso himself.
The 9th BDC offered a launchpad for knowledge-sharing and networking for a total number of 374 participants, including 9 VIPs, 178 dental practitioners, 119 dental auxiliaries, and 68 traders. This was truly an international congress as the participants came from different parts of the world such as Korea, Indonesia, Brunei, India and Malaysia. This congress was proudly officiated by The Right Honourable YB Datuk Stephan Wong Tien Fatt, Minister of Health and People’s well-being of Sabah.
The lectures and workshops of the 9th BDC extended its registration to both dental practitioners and dental auxiliaries. There were 11 lectures for the Scientific Programme and 5 lectures for the Dental Auxiliary Programme. A total of 8 and 4 workshops were offered to dental practitioners and dental auxiliaries respectively. Speakers from Singapore, Indonesia and Malaysia gathered their best to bring us new dental technologies, new restorative techniques and improved treatment protocols to the dentistry in Borneo. This year, the committee members had aspired to incorporate a poster competition session into the 9th BDC by inviting two specialists as judges. Delegates from overseas had also shown their interest in participating in this competition. This three-day congress has laid the foundation for thought-leaders, academicians and researchers to share their ideas and views on modern dentistry.
MDA News
12The trade exhibition was launched with a ribbon cutting ceremony by our Guest of Honour. This trade fair provided an expanded showcase of the latest dental equipment from around the globe. A number of 68 traders with 34 booths presented exhibits ranging from laboratory equipment to instruments for various treatment modalities. Keeping up with the advancement of dentistry, traders have also introduced more up-to-date dental equipment and technologies to the delegates in order to move up to par with the fast growing dental field.
Apart from the scientific programmes and exhibition, the 9th BDC also brought delegates an exciting social event
- a Beachside Party. This was a first of any Borneo Dental Congress to organize an outdoor informal dinner featuring one of the best sunsets in the world combined with soft-felt sand. The colourful lanterns hung above, coupled with laughter from the guests, definitely added points for the ambience. In attendance at the dinner was the Principle Director of the Oral Health Programme, Dr Norlina, and Sabah State Director of Health, Datuk Dr Christina Rundi, President of Malaysian Dental Association, Dr Ng Woan Tyng, speakers, the MDA council members, EXCOs, and delegates from all over the world.
April-June 2019
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Participants of the Poster Presentation Competition
Group photo during the opening ceremony of the 9th BDC
The MDAEZ AGM was held on 24 March 2019 and the newly-elected office bearers elected are as follows:
Chairman: Dr Sim Wen Sann
Secretary: Dr Cindy Chong Ei Yen
Treasurer: Dr Chen Yu Nieng
Exco members: Dr Alex Lo Shen En Dr Sylvia Lim Sze Wei Dr Jonathan Lin Chee Hang Dr Lynn Ko Wei Linn Dr Ignatius Niap Tat Yuen
Internal Auditor: Dr Chu Kok Weng
Like how Pablo Picasso revolutionized the era of modern abstract art and created Cubism, the 9th BDC had indeed unleashed the Picasso in all the delegates to explore the beauty of Modern Dentistry. Delegates have learnt to embrace the flow of change, from practicing conventional dentistry to more comprehensive treatment planning. The experience gained from this event, for both delegates and exhibitors, and even for the organizing committee is one to be treasured. With it comes inspiration to strive harder in the pursuit of knowledge and skill in order to provide quality service and treatment to our patients.
MDA News
14Rubber damology Master Class by Dr Ashwin
Reported by:Dr Ng Chun JieMDASZ Committee Member
Starting the daily use of the rubber dam is the beginning of wisdom. When the rubber dam comes through the door, slipshod methods go out of the window. It marks the beginning of better dentistry. “ J.M. Prime (1937).
Rubber dam isolation of the operating field is imperative for restorative dental procedures, it gives dental practitioners a stress free condition, clean working field, and highly predictable clinical outcome.
On 12 April 2019, the MDA Southern Zone was most delighted to have Dr Ashwin Kumar, an endodontist who is also a prominent speaker on the topic of Rubberdamology, in Johor Bahru to conduct the Rubberdamology Master Class. The workshop was held at a.b.c Dental Centre, conducted in a small group of 12 participants to maximize learning benefits and efficacy of the participants.
Lectures on basic & advanced dental isolation techniques, and soft & dental hard tissues management (e.g. DMA, DME, Injection Molding Technique, PTFE application) related to rubber dam isolation were given in a comprehensive way to the enthusiastic audiences, followed by 8 rubber dam isolation exercises.
Participants were given hands-on exercises with both Nictone and Sanctuary rubber dam of various consistencies. Heartfelt gratitude to the Sanctuary Dental’s team for your presence with us and your tremendous support.
We received highly positive feedback from the participants and we thank all the parties for your participation.
May we work together to perfect the art of dentistry in our region!
April-June 2019
15The Vertipreps
Reported by:Dr Ng Chun JieMDASZ Committee Member
As the shoulderless approach of crown preparation technique becomes increasingly popular the Malaysian Dental Association Southern Zone invited Dr Ashwin Kumar and Certified Dental Technician Trish Sewpersad to conduct a 2-day course on the
crown preparation techniques. The course was held at the Vertipreps, on 13 & 14 April 2019, at a.b.c Dental Centre.
The course was participated by 9 enthusiastic dentists from different parts of Malaysia and comprehensively covered both the clinical as well as laboratory part of the crown preparation and fabrication techniques. Dr Ashwin and CDT Trish delivered the course contents in a fun and easy way. The course itself was highly interactive between speakers and participants.
We have received exceptional reviews from the participants that encourage us to conduct more dental courses in the near future.
MDA News
16Ipoh CPD Programme 2019
Reported by:Dr Tham Ken WahMDANZ Secretary
On 26 May 2019, Malaysian Dental Association Northern Zone held the Ipoh CPD Programme 2019 at Weil Hotel, Ipoh. The one-day event was aimed to contribute in the continuous professional development of members. A total of 65 delegates
had registered for the event.
This year we had interesting lectures touching on topics relevant to daily dental practice by 3 local speakers. They are Dr Jeyavel Rajan, Associate Professor Dr Siti Mariam AB Ghani and Micko Ng.
Dr Jeyavel Rajan shared his expertise by giving lectures: “Bioceramics – A Game Changer in Endodontics Part I & Part II”. The presentations focused on bioceramics and the wide areas of use of bioceramics in endodontics. Dr Jeyavel shared the step by step approach to achieve successful regenerative outcomes where the teeth were restored to a healthy state that permits the continuation of root development. He also shared tips in managing endodontics mishaps with Mineral Trioxide Aggregate (MTA).
The CPD programme continued with a lecture by Associate Professor Dr Siti Mariam AB Ghani, with the topic “Replacing Missing Tooth with Adhesive Bridges: It Is As Simple As It Is? ”. The lecture covered the design and techniques implemented in adhesive bridges cases as a minimally invasive treatment options for a maximum preservation of healthy tooth structure. Associate Professor Dr Siti Mariam also shared tips on case selection through detailed examination of the occlusion and history taking to ensure the success of the prostheses.
April-June 2019
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The last lecture was given by Micko Ng, sales manager from 3M company, with the topic: “Dental Sterilization Best Practice: Innovative Solutions Improving Patients’ Live”. The 1 hour lecture covered various aspect in dental sterilization.
Following the success of this event, MDA NZ will continue to organize more of such constructive events, for the benefits of all dental profession in the region.
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30Malaysian Dental Association (MDA) Toastmasters Club 2018
Reported by:Dr Foo You HanPresident Malaysian Dental Association Toastmasters Club
The Malaysian Dental Association Toastmasters Club (MDA TMC) has been charted in April 2017 after two Toastmasters Demonstration Meeting on 8/10/2016 and 25/2/2017. The club meeting has been conducted in monthly basis, on Saturday evening. To date 19
meetings have been conducted from April 2017 to October 2018. There are currently 10 club members.
MDA TMC enjoyed a successful year in 2017/2018 under leadership of Club President, Dr Neoh Leong Seng, assisted by his Executive Committee Members. The current Club President, Dr Foo You Han has been leading the club from April 2018 to date. It serves as a good platform for MDA members to develop leadership skills, communication skills and public speaking skills. By mastering these skills, members are able to communicate better in daily clinical practices with colleagues and patients besides being more confident in sharing knowledge in front of the public. It also allows them to further enhance and expand on their friendships and network.
The meeting begins with “Table topics”. A two-minutes impromptu speech delivered by four to six speakers, selected randomly about members and guests. Next, “prepared speech” (4-7 minutes) will be delivered by three members. All the speaking session will be evaluated by the evaluators. Ah-Counter, timer and Grammarian, which plays an important role in the meeting. The best speakers for “Table Topics” and “Prepared Speech” and Evaluators will be selected by voting system. Awards ceremony will be conducted by the Toastmasters of the evening and presented by the President. A dental related presentation by the member or invited guest is the highlight of the meeting at the end of each session.
Club’s online presence has been focused through its social media accounts (Facebook), as a means of both promoting activities, informing the community of the Club’s achievements and goings on, as well as serving as a means to attract new members.
April’s Meeting
April-June 2019
31ActivitiesOn 8/9/2018, MDA Toastmasters Club had our first joint meeting with the MIEA Toastmasters Club, coordinated with the help of our club advisor, Joanne, the President MIEA TMC and Srim Ram. Our EXCO members, Lo Sue Ann, Chong Bo Dhi, Allen The and Ong Kah Shin, went for Club officer trainings on 21 August and 30 August 2018, to better understand their roles to improve the club’s performance.
Our Past Club Meetings
MDA News
32MDA Toastmasters Club Exco Member (2017/2018)President: Foo You Han
Immediate Past President: Neoh Leong Seng
Vice President Education: Lo Sue Ann
Vice President Membership: Lim Ee Lian
Vice President Public Relations: Sonia Lee Vern Chien
Honorary Secretary: Allent Teh Bang Cheng
Honorary Treasurer: Chong Bo Dhi
Sergeant at Arms: Ong Kah Shin
MDA TMC Meeting I. 28 April 2018
a. Theme: Color Your Lifeb. Lecture: Dental Entrepenuership,
Dr Bala Saravananc. Guests: 25 pax
II. 26 May 2018
a. Theme: The Balancing Actb. Lecture: To do or Not to do,
Dr Neoh Leong Sengc. Guest: 4 pax
III. 30 June 2018
a. Theme: Open Mindedb. Lecture: Surgical Removal of Impacted Lower
Wisdom Tooth, Dr Ha Kien Oonc. Guest: 15 pax
IV. 14 July 2018
a. Theme: Progressb. Lecture: Dental Photography, Dr Sonia Lee/
Dr Syedc. July: 8 pax
V. 11 August 2018:
a. Theme: Independence Dayb. Lecture: Orofacial Pain, Dr Chan Siew Wuic. Guest: 3 pax
VI. 8 September 2018
a. Theme: Unity is Prosperityb. Lecture: Regenerative Endodontics, Dr Jeyeval c. Guest: 19 pax
VII. 13 October 2018
a. Theme: Transformationb. Lecture: Chemical Warfare in Endodontics,
Dr Neoh Ein Yauc. Guest: 10 pax
VIII. 24 November 2018
a. Theme: Just Do Itb. Lecture: Posterior Composite by Dr Foo You
Han, Anterior Composite by Dr Chong Bo Dhic. Guest: 2 pax
IX. 15 December 2018
a. Theme: Sophistication is Simplicityb. Lecture: Retrieving Broken File By Dr Rusmanc. Guest: 9 pax
Upcoming EventWe’re fortunate to be having these 3 very experienced speakers and excellent clinicians share with us their knowledge on fundamental but really important things for daily dental practices. Dr Wong Keng Mun, Dr Dominic Leong and Dr Jeffrey Seow. Core 3D will be helping us by sponsoring the food for the participants.
The Dates is on the 17 of November 2018 and the Venue is at MDA Secretariat. People interested can register with the link below:
https://goo.gl/forms/aBZ2WS01aJp2FzUY2
Early Bird: RM 100 (Before 31/10/18)
Normal Fee: RM 150 (From 1/11/18)
We’re also working on the first Malaysian Dental Intervasity Debate Competition for the upcoming SCATE 2019. We’ll be working alongside people from Toastmasters Club and MDSA to make this event a success. We’ll be having a debate training session on the 1st of December 2018, Preliminary Competition on 15 December 2018 and the Finals at SCATE 2019. Invitation letters has already been sent to the respective deans of each dental school in Malaysia. The rules and regulations and the poster will be attached on the email sent.
Poster for the Lion’s meeting
April-June 2019
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April-June 2019
An Interdisciplinary Approach
Prof Dato’ Dr Zainal Ariff Abdul Rahman has dedicated his life to the field of dentistry, in academia as well as being hands-on in drawing up and implementing life-saving procedures in the public health system.
Interviewee: Prof’ Dato’ Dr Zainal Ariff Bin Abdul Rahman
By: Khaw Chia Hui
MDA News
34From growing up in Kelantan’s Kuala Nal to having spent five years in Dhaka, Bangladesh to pursue your dentistry degree, it must have been an eye-opening experience. How were those early days for you?I was born in 1960 in Kuala Nal, an idyllic village in Kelantan. I ‘balik kampung’ often and I’m happy to say nothing much has changed. But prior to me leaving the country for my studies, I haven’t even left the state.
I was first in Rajasthan, India for about two years. I got to see for myself the levels of severe poverty. It was truly an eye-opener. It also taught me that there was something to be done for other people. In a way, I felt blessed that I was given more in life.
After Rajasthan, I was in Dhaka for five years in the 1980s where I obtained a degree in Bachelor of Dental Surgery in 1987 from University of Dhaka.
There was a big difference of culture and I had some language barrier, especially with my patients. I later did pick up a bit of the local language that made it easier to communicate with them.
In those days, we had to pay patients to get treatment, not the other way around. We have to at least match their wages as they could not afford to sit at the clinic to wait. If they stopped working to seek treatment, it would have severely impacted their earnings.
Even then, there wasn’t much in terms of advance oral care. We were mostly treating for caries and periodontal disease. Loss of teeth was common.
It was an experience that I valued in the face of the harsh life the people faced in those times.
How did you come to a decision to join academia?After graduation, I had worked at a few private clinics in Melaka and Johor. I was offered a dental officer post in Sabah and at the same time by Universiti Malaya in January 1989. I decided to join UM. I have always been inclined to join the university. There was also a shortage of staff at the dentistry faculty.
We were encouraged to pursue postgraduate degrees, in order to boost the university’s teaching staff. That was what I did. I had applied for a postgraduate programme in the UK, and receiving a Master of Science in Oral Surgery at London University in 1993.
Although I spent four years in the UK, I hardly had time to take in the sights. My course was demanding as I had my masters and fellowship programmes at the same time. I was among the first batch to do that. I also did my training in two teaching hospitals in London and one in Ireland.
I became a fellow at the Royal College of Surgeons in Ireland in 1995 and the Royal College of Surgeons of England in 1999.
How did you apply your knowledge when you returned to Universiti Malaya?At the time, UM did not have the full scope of surgical services in deformation, fractures and oral cancers. One of my primary focus was to prepare a strong platform for postgraduate training programme by widening the surgical scope. Later, I started to get involved with cleft lip and palate surgery.
This area of surgery used to be dominated by the plastic surgeons. My team and I suggested we started a multidisciplinary clinic that addressed the issue in a holistic way.
My colleagues in the orthodontics, prosthodontics, paedodontic, psychology, otolaryngologist, special needs and linguistics were part of the team. Apart from surgery, we wanted to provide patients with an improved or optimised quality of life.
We felt that the patients needed that type of support. I’m happy with the success of the clinic as Malaysia is recognised for advancing the care for cleft lip and palate.
In 1998, we started our postgraduate training in oral and maxillofacial surgery.
My colleagues in the medicine, psychology, special needs and linguistics were part of the team. Apart from surgery, we wanted to provide patients with an improved or optimised quality of life. We felt that the patients needed that type of support. I’m happy with the success of the clinic as Malaysia is recognised for advancing the care for cleft lip and palate.
April-June 2019
35Aside from cleft lip and palate, another area that you have advanced is craniofacial surgery, particularly for children. Can you share some of your work in that area?In 2004, we combined our knowledge and expertise with neurosurgery to venture into surgical management of craniofacial syndromes an area that was still considered as frontier science. We saw the need for an interdisciplinary approach. Craniofacial surgery is a major one, especially when it is done on children.
To prepare, we would have countless meeting with paediatric specialists in neuro, anaesthesia, ENT, clinical geneticist, and more. After all, the surgery process takes three to six months.
After years of our efforts, we have become a referral centre for this specialty, comparable to other renowned centres in the world. I’m proud to note that in 2012, our team recorded the largest forward movement of facial bones at 27mm on a three-year-old child. This was an achievement for a team that was formed in less than 10 years.
When you were appointed dean of UM’s dentistry faculty, how did you manage your responsibilities at UMMC?While being a dean comes with a lot of administrative responsibilities, I would still consider myself a full-time surgeon.
My schedule has allowed for me to be on-call at the hospital one in seven weeks.
I keep updated with day-to-day issues and emergency surgeries as well. My appointment as dean will end on July 31, and I admit to looking forward to my retirement.
What is your take on the current dental undergraduates at UM?I think many of them go through a tough adjustment period as much of our early education in Malaysia is exam-based.
MDA News
36We have made changes to the courses where the students have to grasp knowledge of basic medical sciences and applied them throughout their clinical years.
We also ensure the students receive clinical exposure earlier in the programme compared to before.
We really get the best of the best because the entry requirements are so tough. Every year we have more than 700 applicants when the university can only take about 50.
Over the course of your career, you are a member of several professional associations. Why is it important for you to do so?Associations are a good platform to advance your specialty and knowledge. In general, experts in each specialty are close knit, internationally.
I find my peers are immensely helpful in sharing knowledge and best practices. That is my experience at the Malaysian Association of Oral and Maxillofacial Surgeons and the International Association of Oral and Maxillofacial Surgeons.
There are plenty of opportunities to learn from one another, especially peers from developed countries are highly inspired to advance oral and maxillofacial specialty services in developing or underdeveloped countries.
Malaysia has also contributed towards establishing oral and maxillofacial surgery services in Cambodia.
Over the years MDA has been moving the dental fraternity forward in Malaysia by international networking for sharing of knowledge and expertise as well as looking out for the welfare of dental professionals.
You are a lifetime member of Eastman Academy International Chapter and a founding member of the Malaysian chapter. Can you share why you started a Malaysian chapter?You’d be surprised to find that many senior dental professionals are graduates of the Eastman Dental Institute at the University College London. So, setting up of a Malaysian chapter is a way of keeping the alumni together.
In your opinion, how has dental care in Malaysia improved over the years?We still see variation in terms of care in different states, especially in the remote areas. However, it has improved with the numerous outreach programmes conducted every year.
In certain parts of the country, we also have satellite clinics for dental specialists. While the ratio of specialists to patients have improved, we have yet to achieve the ratio we see in the developed countries.
Recent findings on the implication of dental diseases on patient general health especially in non-communicable diseases may demand changes in the landscape of health delivery in Malaysia.
Malaysia has also contributed towards establishing oral and maxillofacial surgery services in Cambodia.
April-June 2019
37G
eneral anaesthesia (GA) is “a controlled state of unconsciousness accompanied by a loss of protective reflexes, including the ability to maintain airway independently and respond purposefully to physical stimulation or verbal command”1.
General Anaesthesia is Indicated for1: • Patients who cannot cooperate due to a lack of psychological or
emotional maturity and/or mental, physical, or medical disability.
• Patients who may experience ineffective local anaesthesia due to acute infection, anatomic variation or allergy.
• Patients who are extremely uncooperative and phobia towards dental treatment.
• Patients who require complex surgical procedures and/or immediate comprehensive dental care.
• Patients whose developing psyche may be protected by, and/or medical risk may be reduced with, the use of general anaesthesia.
• Patients requiring immediate, comprehensive oral/dental care.
General Anaesthesia is Contraindicated for1: • A patient with minimal dental needs, who is healthy and cooperative.
• A patient who has predisposing medical conditions that may put him/herself at risk if general anaesthesia were to be performed on him/her. Such evaluation is usually performed by the specialist anaesthetist and physician.
• A very young patient with minimal dental needs, which can be addressed by the used of therapeutic measures and/or deferral of treatment.
• The convenience of patient or practitioner.
Advantages of General Anaesthesia2: 1. Patient’s cooperation is not absolutely essential.
2. The patient is unconscious during dental treatment. Therefore, the dentist is able to perform the procedure without behavioural interference from the patient.
3. Patient is unable to recall his experience due to amnesic effect of GA.
4. GA usually has a rapid onset of action, with a desired anaesthetic effect possibly achieved via titration of drugs.
The Use of General Anaesthesia in Dentistry
By: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 Oral and Maxillofacial Surgeon, Deputy Dean (Research and Development), Faculty of Dentistry, University of Malaya.
MDA News
38Disadvantages of General Anaesthesia2: 1. Management of patients under GA requires a team
of professionals with an advanced training, which includes the specialist anaesthetist, dentist and supporting healthcare staff.
2. The procedure requires special anaesthesia equipment.
3. The procedure involves depression of patient’s protective reflexes and vital signs, which may be potentially life-threatening.
4. A well-equipped facility, with recovery area for postoperative monitoring is required to conduct GA.
6. Intraoperative and postoperative complications are more common in GA compared to sedative procedures.
7. Patients receiving GA require extensive preoperative evaluation and assessment as well as fasting.
8. Patients who have received GA require post-operative supervision by a responsible adult, including the need to adhere to dietary advice.
GA Considerations in Patients with Special Health Care Needs8:1. Geriatric anaesthetic considerations:
Dodds (1999) 3 explained that as the patient gets older, there is less physiological and functional capacities to help a patient tolerate any acute adverse effects under general anaesthesia.
Moller (1998) et al 4 reported that as the patient gets older, the risk of postoperative cognitive dysfunction increases. Presence of underlying advanced systemic disease may further complicate the situation.
2. Anaesthetic considerations in individuals with intellectual disability:
Cavaliere (1999) 5 found that plasma levels of cortisol and prolactin is significantly higher in patients with profound intellectual disability compared to the mild to moderate intellectual disability during venepuncture and extubation. This correlates with an increase in heart rate and blood pressure.
Patients with certain syndromes may present with various abnormalities that can increase their risk of morbidity and/or mortality while being treated under GA. For example, performing GA in a Down syndrome patient requires careful assessment and
General Anaesthesia (GA)
is “a controlled state of unconsciousness
accompanied by a loss of protective reflexes, including the ability to maintain airway independently and
respond purposefully to physical stimulation or verbal command.”
April-June 2019
39administration by a specialist anaesthetist in view of other management difficulties such as cardiac defects, respiratory disease, difficulty in intubation, bleeding disorder, skeletal limitation (atlantoaxial subluxation) and presence of infectious disease 6.
It was found that the use of GA in patients with intellectual disability increases with the severity of intellectual impairment especially in the management of acute and painful conditions 7.
3. Anaesthetic considerations in people with disabilities8:
The extent of physical disability may affect the level of risk associated with GA. For example:
• Patient with severe scoliosis and vertebral abnormalities: GA may affect their functional residual capacity of the lungs and respiratory function.
• Patients with cerebral palsy: there is a risk of recurrent lung infection in patients with a history of chronic aspiration.
• Quadriplegic patients: there is a higher risk of arrhythmias with succinylcholine due to nerve demyelination and a raised level of serum potassium.
• Morbid obesity: there is an increased risk for morbidity and mortality under GA. The risks include reduced functional residual capacity of the lungs, respiratory pulmonary disease, aspiration, drug overdose and prolonged anaesthetic effects.
4. Complications associated with medically compromised patients:
Messieha (2009)8 concluded that there is an increased risk for GA for patients with ASA > 2. The ASA (American Society of Anaesthesiologists) physical status is a widely used classification system to assess the risk of anaesthesia for patients. It includes the following risk categories:
ASA 1: a normal healthy patient.
ASA 2: a patient with mild systemic disease.
ASA 3: a patient with severe systemic disease.
ASA 4: a patient with severe systemic disease that is a constant threat to life.
ASA 5: a moribound patient who is not expected to survive without the operation.
ASA 6: a declared brain-dead patient who organs are being removed for donor purposes.
Suitability of patients to undergo GA is assessed by a specialist anaesthetist, after careful and thorough investigation and assessment of the patient’s medical health. The patient and/or family need to be informed, during consultation and consent-taking prior to GA procedure, about the potential side effects, intra- and post-operative risks of complications as well as the additional cost incurred. Extensive evaluation of risk versus benefit will need to be conducted in coordination with the managing physician/clinician, specialist anaesthetist and patient and/or family/carer.
References:1. 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.
2. Dougherty N. The dental patient with special needs: a review of indications for treatment under general anesthesia. Special Care in Dentistry 2009;29(1): 17-20.
3. Dodds C. General anesthesia: practical recommendations and recent advances. Drugs 1999;58(3):453-67.
4. Moller J, Cluitman P, Rasmussen L, Houx P, Rasmussen H, Canet J, et al. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. Lancet 1998;351(9106):857-61.
5. Cavaliere P, Cormaci M, Proto A, Alberti A, Colabucci F. Clinical and hormonal response to general anesthesia in patients affected by different degrees of mental retardation. Minerva Anestesiologica 1999;65(7-8):499-505.
6. Scully C. Medical Problems in Dentistry. 6th ed. Toronto: Curchill Livingstone; 2010.
7. Petrovic B, Markovic D, Peric T. Evaluating the population with intellectual disability unable to comply with routine dental treatment using the International Classification of Functioning, Disability and Health. Disability and Rehabilitation 2011; 33(19-20):1746-54.
8. Messieha Z. Risks of general anesthesia for the special needs dental patient. Special Care in Dentistry 2009;29(1):21-5
