[Drsumitra]

Dubai School of Dental Medicine (DSDM), a new specialist dental school at Dubai Healthcare City, accredited by the Ministry of Higher Education and Scientific Research, today signed an agreement with The Royal College of Surgeons of Edinburgh (RCSEd), a UK organization dedicated to the pursuit of excellence in dental practice.
Dubai School of Dental Medicine offers postgraduate programmes in a range of dental specialties. As part of its efforts to provide top-quality dental specialists for the region through world class academic programmes, DSDM will conjoint its Master of Science diploma in partnership with the specialist dental membership examinations offered by The Royal College of Surgeons of Edinburgh.
Marwan Abedin, CEO of Dubai Healthcare City, said: “The agreement with The Royal College of Surgeons of Edinburgh comes in line with our objective of serving as a medical education hub in the region. The collaboration paves the way for dentists in the UAE and the region to pursue specialization courses with the backing of acclaimed institutions such as The Royal College of Surgeons of Edinburgh. We look forward to building synergies with other global medical institutes.”
“Today, DHCC has emerged as a medical hub that offers high quality treatment in line with international standards. However, the Middle East lacks home-grown professionals, although the region holds significant talent that can be groomed into a top-notch healthcare workforce. Towards this end, DHCC is seeking to provide the latest training programmes in healthcare specialization.”
“The inception of Dubai School of Dental Medicine has taken DHCC a step closer to developing into a strategic medical education center for the Middle East.”
Professor Richard Ibbetson, Dean of the Faculty of Dentistry, RCSEd said: “The Royal College of Surgeons of Edinburgh is pleased to endorse the programme curricula in Dubai School of Dental Medicine and will conjoint with the institution’s exams. We are also delighted that DHCC has agreed to act as an examination hub in the Middle East providing the college with an opportunity to extend its influence as a global benchmark of standards in dental specializations. We are keen to support DHCC’s aim to build a specialized medical talent pool in the region, which is in line with our vision.”
Professor David Wray, Dean of DSDM, said: “Dubai School of Dental Medicine has been instituted to graduate talented dental specialists who will offer high quality dental treatment in the region. We additionally aim to provide dental graduates with academic and clinical training, which will groom them to become independent specialist practitioners. We are delighted that The Royal College of Surgeons of Edinburgh has partnered with us, which will allow us to extend comprehensive post-graduation programmes to achieve our vision. We look forward to our inaugural academic year and have recently enrolled the first batch of students for 2013.”
Driven by its interest to offer education, training and examination opportunities to enhance the competence of healthcare professionals, The Royal College of Surgeons of Edinburgh liaises with external medical bodies and organizations representing the global surgical workforce. One of the most sought after medical training centers among doctors across the world, a global benchmark for higher specialist training, the medical college enjoys an international network with some 20,000 fellows and members based in almost 100 countries worldwide.
Dubai School of Dental Medicine will graduate up to 35 dental specialists every year. The school will offer accredited programmes in dental specialties such as endodontics, oral surgery, orthodontics and paediatric dentistry and intends to extend its programmes to include prosthodontics and periodontics in September 2013.
The internationally-acclaimed faculty at DSMD comprises senior academic staff and specialists from the US and the UK with extensive experience in postgraduate education and research. Students will pursue their academic curriculum at the Mohammed Bin Rashid Al Maktoum Academic Medical Center, which hosts the DSDM academic offices

 

        

[Drsumitra]

The Tamil Nadu Chief Minister, Jayalalithaa, today strongly opposed the introduction of a National Eligibility Entrance Test for admission to under-graduate and PG courses in dental colleges. She said such a move would hamper the smooth implementation of the reservation policy.

In a letter to Prime Minister, Manmohan Singh, she said she came to know that the Dental Council of India has issued a gazette notification to this effect and recalled her Government’s objection to such entrance tests for under-graduate and post-graduate medical courses.

Jayalalithaa said entrance exam for professional courses has been abolished in the State since 2007 after an Expert Panel found such exams put students from rural and lower socio-economic backgrounds at a disadvantage, due to the lack of geographical and financial access to training centres.

Such entrance examinations result in the growth of expensive coaching centres, she said.

Noting that the State has been following 69 per cent reservation for Backward and Most Backward Communities and SCs and STs in professional courses, she said the introduction of a National Eligibility Entrance Test would “create confusion and litigation in the smooth implementation of this reservation policy both in under-graduate and post-graduate admissions.”

Strongly protesting the move by the DCI, Jayalalithaa urged that the State may be exempted from the test and allowed to continue with its existing system for admission to under-graduate and post-graduate dental seats.

 

        

[Drsumitra]

 The Hindu reported The parents of Sirish had marked February 9 on the calendar as he was going to perform a dance for his annual day at his Montessori school. Instead, what they got to see was the post-mortem report which stated that their three-year-old had died of anaesthesia overdose leading to lung failure.

The dejected couple told The Hindu that their life had been turned upside down after their son passed away on February 6 after they took him to a private clinic in HSR Layout for a toothache.

The family also cancelled the 80th birthday celebrations of Sirish’s grandfather, which was to take place on February 7.

Sirish’s father, K.S. Lokesh, who is getting ready for a legal battle, said: “A minor cleaning of his teeth turned fatal. The doctor didn’t even seek permission to anaesthetise him.”

Assistant Commissioner of Police (Madiwala subdivision) H. Subbanna said the police were waiting for the Forensic Science Lab report to take action.

Sirish, who was taken to Annayamma Dental and Eye Care Clinic in HSR Layout, died after the dentist, Raviraj, allegedly administered the fatal overdose of anaesthesia.

        

[Drsumitra]

The Madras high court has granted conditional anticipatory bail to five people who apprehended arrest in connection with the case of bribing Dental Council of India members for approval of postgraduate courses in a private dental college.

Justice R Subbiah, granting conditional anticipatory bail to Dr S Murukesan, K Ramabhadran, R Karunanidhi, T Palani and Dr Gunaselan, said they should appear before the CBI authorities daily at 10:30am and directed them to surrender their passports and also execute a personal bond for 1 lakh.

 

        

[Drsumitra]

Dentistry at a Crossroads: The big issues
By William T. Brown, DDS
What are the Big Issues? In dentistry, they involve decision-making. Making a decision implies that there has been careful and thorough deliberation and research of the dental practice. However, in my experience, many dentists tend to skip the stop-and-think step.

So in this first Dentistry at a Crossroads column, I am going to outline a system for astute decision-making that dentists can use when tackling the Big Issues.

The importance of a dentist’s self-insight or self-understanding cannot be underestimated as the basis for decision-making. What we want to do is link the dentist’s self-study with his or her self-understanding. One detail of this process that is often overlooked is developing the ability to accept feedback from auxiliaries and patients.

After graduation, most dentists feel competent performing basic dental procedures. The problems in practice arise from poor organizational ability and basic knowledge of good human relations. In my case, the first few years of practice could best be described as "doctor-centered" because I was blind to the real needs of my patients and staff. In essence, I followed the random path of successful peers, and I devoted energy trying to change who I was as a person instead of channeling my activity into gaining satisfaction more suited to my talents, abilities, and desires. I realized that I must step back and understand my limitations, skills, aspirations, goals, and myself.

Many dentists express feelings of frustration that their practices and life don’t match their expectations. That is, interoffice conflicts, not enough "good" patients, income barely meeting expenses, nothing left over for retirement savings, external forces dictating professional decision-making, continual staff turnover, frustration that clients won’t accept your level technical abilities, and a permanent government connection from student loans.

How do you deal effectively with these discordant stresses?

Most dentists spend more time planning a vacation than planning their practice

At the outset of any serious thought about your vocation, you need to understand your practice. To have more than a superficial sense of the workings of a complex entity requires an in-depth appraisal completed in-house as a team or staff endeavor.

In my experience, the best intentions of outside consultants cannot equal the effectiveness of a team effort. I consider this to be valid because of the unique and intimate knowledge the staff has of the genuine workings of the organization and the patients. A consultant looking at the practice from the outside is unable to discern the subtleties of the inner workings of a complicated arrangement. In addition, each staff member has "skin in the game." Even though consultants are well-meaning, they’re not truly accountable for results.

On the other hand, the aftereffect of an internal practice appraisal commits each member responsible for the results of their individual and collective efforts every day of the week and every month of the year. That is a major difference.

Where do you start?

At the beginning, ask yourself these questions:

What are my goals today, this year, and in the next five years?
Who am I?
Does my self-understanding tie in with my goals?
It is also critical to ask "What is my practice?" Because the record of your practice is the best evidence as to what has happened.

To help in this process, I recommend a questionnaire developed by Dr. Nathan Kohn Jr. as a dental practice self-appraisal. I used this approach in my office.

The primary purpose of such a questionnaire is to help dentists think through their situation. It should not be viewed as a panacea. It is a guideline to growth, development, and progress toward goals you have in mind — not yet on paper and not yet programmed into action. It may be used as a basis for decision-making.

Having your auxiliaries assist you and participate in the assessment is important. Even though the questionnaire is long, it is not truly comprehensive, and the objective is to include other problems that concern or interest you.

It is good training to assign some of the more detailed tasks to auxiliaries to study what is happening in the practice. This activity will increase their ability to understand their position and yours. The more time and effort put forth in attempting to answer the questions as carefully as possible, the more help you will be able to get in the construction of an operations manual. Your staff can fill out some parts of the questionnaire with the dentist checking and thinking with them in terms of their answers. However, on balance, the activity is a group effort.

Increased empathy and acceptance

One of the most profound results from our in-house appraisal was increased levels of empathy and acceptance of roles played by each team member. The staff gained a respect and appreciation for some of the problems confronting the dentist that they would never have realized without the process of analysis.

The scrutiny of the inner workings of our organization resulted in personal growth for everyone on the team. The connection achieved in our undertaking resulted in considerable improvement in our ability to communicate with each other and our patients.

We repeated the practice analysis several times, and each time it became less demanding. The workshop resulted in every staff member developing a sense of community and ownership in the practice. For example, by cultivating an environment that encouraged candid observations without fear of retribution, the practice benefited. The forthright comments from teammates provided breakthroughs in our most important procedures (such as our codiscovery examination) and increased effectiveness in our mission of patient education. Many of our advances would never have been realized without the genuine team perceptions.

Dealing with Big Issues in your office signifies decision-making, which should be based on knowledge grounded in careful inspection of your practice. Working as a team will result in realizing your expectations.

 

        

[Drsumitra]

GSKCH rolls out global niche toothpaste brand Parodontax
Consumer and healthcare firm GlaxoSmithKline on Friday announced the national roll out of its second global oral care brand Parodontax – a toothpaste that helps in reducing bleeding in gums. The firm already sells Sensodyne toothpaste for sensitive teeth, launched two years back.

The average incidence of bleeding gums globally is 33% and in India too, there’s untapped opportunity for specialised oral care products, Jayant Singh, executive VP, marketing, GSKCH said.

 

        

[Drsumitra]

A dental jewellery festival was organised at Thind Dental Clinic, Jamalpur, on Friday. The festival recorded a huge response from young men and women alike.

Namrata Sinmar, who studies art at Khalsa College, was very happy to get dental jewellery for her tooth. "I saw the photograph of dental jewellery in a film magazine, and was after my mother that I wanted it. My mother agreed, and she insisted that I must get the dental jewel fixed from a dentist only."

Sukhwinder Kaur, an NRI, came all the way from Moga to get the dental jewel fixed on her tooth.

Sandeep Singh, an engineer who works in the private sector, came to the festival with a friend, and got a shining jewel on his tooth.

In addition to the young men and women, Dr Thind had a surprise guest: a 58-year-old businessman. Madan Gaba, a resident of Tajpur Road who owns a mobile store, came with his wife Harinder Gaba. "Her husband got the dental jewel fixed, and our entire team was delighted to see both of them so happy," said Dr Thind.

Madan Gaba said he was inspired by a family friend who had dental jewellery on her tooth. "There is a popular song of Gurdas Mann that says dil hona chahida jawan te umran ch ki rakheya. That is what drives me too," he said with a smile.

Dental jewellery refers to tiny pieces of jewellery designed to be bonded to the teeth. These can be made of gold, white gold set with diamonds, precious stones or crystals. Dental jewellery is bonded to the tooth with medically approved dental glue or dental composites. These are shiny and beautiful, and are worn to enhance the beauty of a person’s smile without risk of any damage or allergies.In Ludhiana too, the style statement of tiny crystals, glittering gold or white gold is catching on this season. According to Dr Thind, tiny glittering stars, flowers or crystals are the more favoured designs in dental jewellery. "The price ranges from Rs 1,000 to Rs 5,000. Dental jewellery is a global trend, and Ludhianvis are liking it too. It is specially favoured by girls and young women. Recently, some of my clients bought dental jewellery for themselves. Some young men bought it to gift it to their loved one on Valentine’s Day, and got it gift-wrapped too," he added.

Dr Thind pointed out that while buying dental jewellery, many of his young clients were full of questions. "They ask me if the trinket will damage the tooth in any way. Getting dental jewellery fixed is a matter of personal choice, and it does not damage the tooth in any way. It is simply glued on the tooth and stays on till it is removed by the dentist," he said.

 

        

[Drsumitra]

Global Information Inc. would like to present a new market research report, "Dental Implants Market to 2018 – Technical Advancements and Procedure Efficiency are Resulting in the Increased Preference for Dental Implants over Traditional Dental Devices" by GBI Research.

The global dental implants market is expected to grow at a Compound Annual Growth Rate (CAGR) of 10% from $3.4 billion in 2011 to $6.6 billion in 2018. The major factors driving the market are the increasing preference for dental implants as a treatment option for tooth replacement over traditional solutions, and the availability of advanced solutions for dental implants based on digital dentistry, thereby increasing procedure efficiency. In an effort to increase physician adoption, a number of manufacturers are focusing on training and education programs, which are expected to drive the adoption of dental implants in a big way. Emerging countries such as India and China show potential for market growth due to increasing awareness and large patient populations, although price and surgeon efficiency could restrain the market.

Emerging countries such as China, India and Brazil are expected to be the fastest growing markets globally due to factors such as favorable demographics, increasing urbanization and better patient awareness. This is reinforced by the fact that China, India and Brazil accounted for 16% of the market in 2011, expected to increase to nearly 24% in 2018.

The dental implants markets in China and India are expected to grow at very high rates of 19% and 24% respectively during the forecast period. These countries account for a huge patient population due large populations and correspondingly large aging populations.

According to Nobel Biocare, there are nearly 70 million edentulous people in India alone (Nobel Biocare, 2009). As a result there is a huge demand for dental implants as a treatment option for tooth replacement. An increased life expectancy in these countries is also seeing more people opting for tooth replacement treatments.

Major manufacturers are focusing on establishing market presence in these geographies through wholly owned subsidiaries in China and India. Straumanns recent acquisition of a 49% share in Neodent has given it enhanced access to the Brazilian market. Smaller local manufacturers are also capitalizing on the growing demand for dental implants in countries such as China.

The presence of local players and chains of private dental laboratories in countries such as China and India is expected to drive the adoption of dental implants.

The dental implants market accounts for 78% of global market revenue, followed by dental biomaterials with 12% and crowns and bridges with 10%.

There is an increasing preference for dental implants as a treatment option over conventional devices such as the crowns, bridges or dentures. Nearly 50 million patients in Japan, North America, and European regions have false teeth or bridges, but only 2% of the total patient population has dental implants. However, with 500,000 dental implant procedures annually in the US alone, a rapid uptake of dental implant procedures is to be expected in the future (AAID, 2011),

Conventional fixed bridges require neighboring teeth to be ground down, leaving them susceptible to tooth decay, gum disease and eventual loosening of the teeth. Dentures are also associated with certain limitations, especially removable dentures which can slip while eating or speaking, causing discomfort.

Dental implants are, on the other hand, effective long-term solutions for the treatment of tooth loss, and will eventually fuse with the underlying bone through osseointegration. Implants are similar to the natural tooth and can be placed within the bone, making it resemble and perform the functions of the natural tooth.

The potential clinical and economic benefits are therefore making dental implants a viable treatment option over conventional treatments for tooth loss.

 

        

[Drsumitra]

While 5.3 million children will gain dental coverage in 2014 thanks to the Patient Protection and Affordable Care Act (ACA), up to 11 million adults could drop their own dental coverage when their children are covered separately, according to the National Association of Dental Plans. And parents who switch to dental coverage under their medical insurance may have to change dentists.

Currently, adult and children’s dental plans are mostly sold as group plans offered by employers. These dental plans are separate from medical plans. As one of the 10 essential health benefits under the ACA, pediatric dental benefits will be part of medical plans sold outside of the insurance exchanges. Pediatric dental plans also will be sold in insurance exchanges, both packaged with medical plans and as standalone dental plans.

While large companies (more than 50 employees — in 2016 this will increase to 100) won’t be affected by the upcoming changes in 2014, employees in small groups will have to decide this year how to get the dental benefits mandated for their children.

“We’re looking at 1 or 2 million additional children who will get new private dental coverage through small employer groups or exchanges.”
— Evelyn Ireland, National Association
of Dental Plans
What that means is the dental coverage that nearly 23 million children now have as part of their parent’s policy in the small group market will be duplicated by their medical coverage beginning in 2014, according to Evelyn Ireland, the executive director of the National Association of Dental Plans. About 5.3 million children are expected to gain dental coverage next year, mostly through public programs such as Medicaid or the Children’s Health Insurance Program (CHIP).

To avoid duplication, parents have to decide by the end of this year whether to take their children off their separate dental coverage. If they do, they may have to change dentists for the children, depending on which dentists are in the medical carrier’s network.

"I don’t think there’s any question that children’s coverage will be expanded, whether it’s through Medicaid, CHIP, or private programs," Ireland told DrBicuspid.com. "Even though there are a lot of complexities and moving parts, by the time enrollment starts in the fourth quarter, we’re certainly going to increase the number of kids covered. We’re looking at 1 or 2 million additional children who will get new private dental coverage through small employer groups or exchanges."

But while millions more children will gain access to dental care, many of their parents will probably drop their own dental coverage, she added.

"Our studies show that when children’s coverage is separated from their parents in the small group market, as many as half of the parents that are currently insured may drop their dental coverage for economic reasons," Ireland noted. "We’re looking at potentially 10 to 12 million adults who may drop coverage because they can get their children covered separately. So they may decide to get their kids’ teeth fixed instead. And studies show if adults don’t have coverage, they don’t go to the dentist as often."

What about insurance carriers?

From a dental insurer’s perspective, the changes will probably move some of their customers from group plans to individual plans, according to Joanne Fontana, an actuary who tracks health insurance for the actuarial and consulting firm Milliman. This marks the first time there will be a need for pediatric-only plans, she pointed out.

"Some dental insurers aren’t too anxious to jump into the individual marketplace," Fontana told DrBicuspid.com. "With the exchanges, you have an individual marketplace where people will be purchasing pediatric oral care, so insurers will be making sure they position themselves and their product so they can attract business. It’s also important to understand that people on the exchanges may look a little different than the group of people that have historically been covered under employer-sponsored plans."

The kind of coverage employers will offer once the exchanges are in place remains to be seen, she added.

"I think dental is still viewed by employers as a value-added benefit, and you want to offer good benefit packages to your employees," Fontana said. "The broader issue is, are employers going to keep offering any kind of coverage, or are they going to say, ‘Nope, go buy medical and dental coverage wherever you want.’"

The ACA provides subsidies for those with lower incomes (under 400% of poverty level) who opt for coverage in the exchanges, but only if an employer doesn’t provide adequate coverage, Ireland pointed out.

"The exchanges are not a way for individual consumers to dump coverage provided through their employer and go on exchanges," she said.

Separate consumer cost-sharing limits for medical and dental plans will be applied to coverage purchased through the exchanges. Starting this year, annual out-of-pocket expenses for medical will be capped at $12,500 for a family of four and $6,250 for individuals, either for medical expenses only or when medical with dental coverage are included together in a policy. When dental is purchased separately, a "reasonable out-of-pocket limit" (OOP) is required under the proposed rules. The NADP has suggested $1,000 as a standard OOP limit, Ireland noted.

The rules set strong incentives for consumers to use dentists and medical providers who are in-network because OOP costs for out-of-network providers are not counted toward the consumer’s OOP limits, she said.

Also, changes in orthodontic coverage provided through small employers will require a demonstration of medical necessity. Milliman estimated that only about 30% of orthodontic claims now meet that standard, Ireland said.

Notably, there will be no annual limits on children’s dental coverage purchased through exchanges or small employers. But annual limits will remain in place for children’s dental coverage purchased through large employer groups.

Consumers will more often take their children to a network dentist — especially for orthodontia — so that their out-of-pocket costs will count toward annual caps, Ireland said.

"We’re certainly going to increase the number of children covered and that’s the goal," Ireland noted. "The problem is that separating children from their parent’s coverage could result in a shift in their choice of providers, and that could result in a net loss of adult coverage, so we could end up with a net loss of people covered for dental benefits — which could translate into less dental demand."

 

        

[Drsumitra]

Oral health has become an important component of a University of Colorado (CU) physician assistant program, reflecting a growing trend toward interdisciplinary collaboration among health professionals.

Physician assistants (PAs) are particularly useful for doing oral exams in children, especially for underserved populations and in rural areas, according to Mark Deutchman, MD, a professor in both the medical and dental schools at CU.

Dr. Mark Deutchman introduced an oral health curriculum in the University of Colorado School of Medicine and teaches medical topics to dental students.
The university began incorporating dental education into its physician assistant curriculum in 2009, largely through the efforts of Dr. Deutchman. The concept "has grown like wildfire" in the last few years, he told DrBicuspid.com.

He introduced an oral health curriculum in the medical school, teaches medical topics to dental students and developed the school’s Smiles for Life curriculum, which has been endorsed by the ADA. Dr. Deutchman also serves in the Delta Dental Frontier Center Project, which provides collaborative education, combining oral health and preventive practices in primary care.

The CU program includes comprehensive oral health courses that incorporate aspects of the Smiles for Life program, which teaches core areas of oral health relevant to medical clinicians.

"We’re training people to recognize that oral health is a component of your overall health," he said. "Number one, it’s a knowledge of the importance of oral health. Oral disease has an exacerbating impact on other diseases and vice versa."

Consider the oral impact of various medicines, Dr. Deutchman added. "If you put somebody on medications that dries up their saliva, you’re going to increase their risk of getting root caries," he said.

The physician assistant curriculum now includes classes on the oral-systemic connection and hands-on workshops for doing oral exams and oral cancer screening. Students are also taught how to check children’s teeth and apply fluoride varnish.

Emphasis on prevention

Oral health is a great match for physician assistants because they have always been involved in preventive care, according to Anita Glicken, former director of CU’s physician assistant program who now heads the National Commission on Certification of Physician Assistants Health Foundation.

She also helped start the National Interprofessional Initiative on Oral Health (NIIOH), a consortium of dentists, physicians, nurse practitioners, and physician assistants working to improve oral health that was funded by the DentaQuest Foundation, the Washington Dental Service Foundation and the Connecticut Health Foundation.

“We’re training people to recognize that oral health is a component of your overall health.”
— Mark Deutchman, MD, University of
Colorado
"PAs are at the front and back end of the disease process and are often the first point of contact for patients, so it really makes sense to intervene at that level," she told DrBicuspid.com.

Also, they have traditionally worked with colleagues from other health professions, Glicken said. But the real impact of physician assistants the last couple of years has been identifying oral cancers, she noted. They are also particularly useful for screening early childhood caries.

"A large percentage of PAs work with underserved populations, especially in rural areas at federally qualified health centers and community health centers," Glicken noted. "PAs are providing care to patients that otherwise wouldn’t have access to that kind of trained intervention."

Some 46 of Colorado’s 64 counties are rural or frontier areas.

Since few pediatric dentists are located outside urban areas, one of the challenges is getting general dentists to work with young children, because they are unaccustomed to dealing with such patients, according to Dr. Deutchman. "You have to not be afraid the kid is going to holler because when he hollers it’s bad for the other patients. But when he hollers, guess what? His mouth is open," he laughingly noted.

Physician assistants and nurse practitioners do a lot of health maintenance and routine exams, Dr. Deutchman pointed out, so they are key to helping identify oral problems.

Referring patients to dentists and physicians is a core PA function, Glicken added, noting that the hardest part is often finding dentists to provide follow-up care.

"This is really an active partnership of building interprofessional competencies in oral health," she said.

 

        

[Drsumitra]

Joint Statment of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry Ad Hoc Work Group on Child Abuse and Neglect
JOINT STATEMENT OF THE AMERICAN ACADEMY OF PEDIATRICS AND THE AMERICAN ACADEMY OF PEDIATRIC DENTISTRY

ABSTRACT

In all states, physicians and dentists recognize their responsibility to report suspected cases of abuse and neglect. The purpose of this statement is to review the oral and dental aspects of physical and sexual abuse and dental neglect and the role of physicians and dentists in evaluating such conditions. This statement also addresses the oral manifestations of sexually transmitted diseases and bite marks, including the collection of evidence and laboratory documentation of these injuries.

In all 50 states, physicians and dentists are required to report suspected cases of child abuse and neglect to social service or law enforcement agencies.1–4 Physicians receive minimal training in oral health and dental injury and disease and thus may not detect dental aspects of abuse or neglect as readily as they do child abuse and neglect involving other areas of the body. Therefore, physicians and dentists should collaborate to increase the prevention, detection, and treatment of these conditions.

PHYSICAL ABUSE

Craniofacial, head, face, and neck injuries occur in more than half of the cases of child abuse.5–14 Careful intraoral and perioral examination is necessary in all cases of suspected abuse. Some authorities believe that the oral cavity may be a central focus for physical abuse because of its significance in communication and nutrition.15 The injuries most commonly are inflicted with blunt trauma with an instrument, eating utensils, hands, or fingers or by scalding liquids or caustic substances. The abuse may result in contusions; lacerations of the tongue, buccal mucosa, palate (soft and hard), gingiva alveolar mucosa or frenum; fractured, displaced, or avulsed teeth; facial bone and jaw fractures; burns; or other injuries. These injuries, including a lacerated frenum, also can result from unintentional trauma. Discolored teeth, indicating pulpal necrosis, may result from previous trauma.16,,17 Gags applied to the mouth may leave bruises, lichenification, or scarring at the corners of the mouth.18 Multiple injuries, injuries in different stages of healing, injuries inappropriate for the child’s stage of development, or a discrepant history should arouse suspicion of abuse. Age-appropriate nonabusive injuries to the mouth are common and must be distinguished from abuse based on history, the circumstances of the injury and pattern of trauma, and the behavior of the child, caregiver, or both. Consultation with or referral to a pediatric dentist is appropriate.

SEXUAL ABUSE

The oral cavity is a frequent site of sexual abuse in children.19 The presence of oral and perioral gonorrhea or syphilis in prepubertal children is pathognomonic of sexual abuse.20 When gonorrhea or syphilis is diagnosed in a child, the case must be reported to public health authorities for investigation of the source and other contacts. A multidisciplinary child abuse evaluation for the child and family should be initiated.21 Pharyngeal gonorrhea is frequently asymptomatic. Therefore, when a diagnosis of gonorrhea is suspected, lesions should be sought in the oral cavity, and appropriate cultures should be obtained even if no lesions are detected.22–26

When obtaining oral or pharyngeal cultures for Neisseria gonorrhoeae, the physician must specifically ask for culture media that will grow and differentiate this organism from Neisseria meningitidis, which normally inhabits the mouth and throat. Gonococci will not grow in routine throat cultures.27 Even when selective media is used, nonpathogenic Neisseriaspecies can be confused with N gonorrhoeae. Laboratory confirmation using two different types of tests is needed to properly identify N gonorrhoeae. Detection of semen in the oral cavity is possible for several days after exposure. Therefore, during examination of a child who is suspected of experiencing forced oral sex, cotton swabs should be used to swab the buccal mucosa and tongue, with the swabs preserved appropriately for laboratory analysis of the presence of semen.

Unexplained erythema or petechiae of the palate, particularly at the junction of the hard and soft palate, may be evidence of forced oral sex.28,,29 Although cases of syphilis are rare in the sexually abused child, oral lesions also should be sought and dark-field examinations performed. Oral or perioral condylomata acuminata, although probably most frequently caused by sexual contact, may be the result of contact with verruca vulgaris or self-inoculation.30

BITE MARKS

Bite marks are lesions that may indicate abuse. Dentists trained as forensic odontologists may be of special help to physicians for the detection and evaluation of bite marks related to physical and sexual abuse.31 Bite marks should be suspected when ecchymoses, abrasions, or lacerations are found in an elliptical or ovoid pattern. Bite marks may have a central area of ecchymoses (contusion) caused by two possible phenomena: 1) positive pressure from the closing of the teeth with disruption of small vessels or 2) negative pressure caused by suction and tongue thrusting. The normal distance between the maxillary canine teeth in adult humans is 2.5 to 4.0 cm, and the canine marks in a bite will be the most prominent or deep parts of the bite. Bites produced by dogs and other carnivorous animals tend to tear flesh, whereas human bites compress flesh and can cause abrasions, contusions, and lacerations but rarely avulsions of tissue. If the intercanine distance is <2.5 cm, the bite may have been caused by a child. If the intercanine distance is 2.5 to 3.0 cm, the bite was probably produced by a child or a small adult; if the distance is >3.0 cm, the bite was probably by an adult. The pattern, size, contour, and color(s) of the bite mark should be evaluated by a forensic odontologist or a forensic pathologist if an odontologist is not available. If neither specialist is available, a pediatrician or pediatric dentist experienced in the patterns of child abuse injuries should observe and document the bite mark characteristics photographically with an identification tag and scale marker in the photograph. The photograph should be taken at a right angle (perpendicular) to the bite. A special photographic scale was developed by the American Board of Forensic Odontology (ABFO) for this purpose, as well as for documenting other patterned injuries and should be obtained in advance from the vendor (ABFO No. 2 reference scale. Available from Lightening Powder Co, Inc, 1230 Hoyt St SE, Salem, OR 97302-2121). Names and contact information for the ABFO certified odontologists may be obtained from their Web site (www.abfo.org). Written observations and photographs should be repeated daily for at least 3 days to document the evolution and age of the bite. Because each person has a characteristic bite pattern, a forensic odontologist may be able to match dental models (casts) of a suspected abuser’s teeth with impressions or photographs of the bite.

Blood group substances can be secreted in saliva. DNA is present in epithelial cells from the mouth and may be deposited in bites. Even if saliva and cells have dried, they should be collected on a sterile cotton swab moistened with distilled water, dried, and placed in a cardboard specimen tube or envelope. A control sample should be obtained from an uninvolved area of the child’s skin. All samples should be sent to a certified forensic laboratory for prompt analysis.32 The chain of custody must be maintained on all samples submitted for forensic analysis. Questions of evidentiary procedure should be directed to a law enforcement agency.

DENTAL NEGLECT

Dental neglect, as defined by the American Academy of Pediatric Dentistry,33 is “the willful failure of parent or guardian to seek and follow through with treatment necessary to ensure a level of oral health essential for adequate function and freedom from pain and infection.” Dental caries, periodontal diseases, and other oral conditions, if left untreated, can lead to pain, infection, and loss of function. These undesirable outcomes can adversely affect learning, communication, nutrition, and other activities necessary for normal growth and development.33

Failure to seek or obtain proper dental care may result from factors such as family isolation, lack of finances, parental ignorance, or lack of perceived value of oral health.34 The point at which to consider a parent negligent and to begin intervention occurs after the parent has been properly alerted by a health care professional about the nature and extent of the child’s condition, the specific treatment needed, and the mechanism of accessing that treatment.35

The physician or dentist should be certain that the caregivers understand the explanation of the disease and its implications and, when barriers to the needed care exist, attempt to assist the families in finding financial aid, transportation, or public facilities for needed services. Parents should be reassured that appropriate analgesic and anesthetic procedures will be used to assure the child’s comfort during dental procedures. If, despite these efforts the parents fail to obtain therapy, the case should be reported to appropriate child protective services.33,,35

CONCLUSION

When a child has oral injuries or dental neglect is suspected, the child will benefit from the physician’s consultation with a pediatric dentist or a dentist with formal training in forensic odontology.

Pediatric dentists and oral and maxillofacial surgeons, whose advanced education programs include a mandated child abuse curriculum, can provide valuable information and assistance to physicians about oral and dental aspects of child abuse and neglect. The Prevent Abuse and Neglect Through Dental Awareness (also known as PANDA) coalitions that have trained thousands of dentists and dental auxiliaries is another resource for physicians seeking information on this issue (telephone: 573/751-6247; e-mail: moudeL@mail.health.state.mo.us).

Physician members of multidisciplinary child abuse and neglect teams should identify such dentists in their communities to serve as consultants for these teams. In addition, physicians with experience or expertise in child abuse and neglect should make themselves available to dentists and to dental organizations as consultants and educators. Such efforts will strengthen our ability to prevent and detect child abuse and neglect and enhance our ability to care for and protect children.

 

        

[Drsumitra]

In a fresh twist to the Dental Council scam, letters written by the members of Dental Council of India (DCI), accessed exclusively by CNN-IBN, have raised serious questions against the present Chairman of the Council, Dr Dibyendu Majumdar. In one of the letters, written by a member of the DCI Dr Joseph Issac to the Union Health Ministry, questions the manner in which the Council is being managed to suit private colleges.
Meanwhile, a petition has also been filed in the Kerala High Court against the DCI chairman Dr Majumdar and others for alleged acts of corruption and impropriety. "They bargain the management. They blackmail the management and if they don’t come to terms, they don’t clear the files," Dr Issac alleged.
An email, written by another DCI member Dr Jayaraj creates more embarrassment for the dental body as it questions the manner in which an entire general body meeting of the DCI was manipulated to give clearance to some new courses, all for some considerations.

"I will step down if any corruption case can be proven against me," Majumdar, who denied the allegations of bribery against him, said. He, however, added, "Cannot act against erring members unless their nominating states act against them."
On January 18, the President of the DCI of Tamil Nadu, Dr Gunaseelan, was arrested by the Central Bureau of Investigation for his alleged involvement in a multi crore scam in private dental colleges across the country.
Dr Gunaseelan’s aide, Dr Murugesan was caught red handed by the CBI with a bribe Rs 25 lakh in cash, taken from a private dental college, in lieu of permissions being granted for starting a post-graduate course. The arrest was made after the investigating body conducted raids across several places in Tamil Nadu, Kerala and Andhra Pradesh.
This is not the first time that the DCI is at the centre of a storm. Allegations of similar nature have been made against some members of the Council in the past.
The allegations have always been related to either increasing seats in colleges or showing enough faculty members, even if it is just on paper. CNN-IBN has been reporting on flaws within the Dental Council for almost three years now.
When a specific complaint was made before the Health Minister Ghulam Nabi Azad in May 2012, he had promised that the matter will be looked into and some action will be taken. However, nothing has been done till now. There is a list of measures suggested by the Dental Council to improve its own credibility, but the measures would not have any impact unless the constitution of the Council is relooked.

 

        

[Drsumitra]

 Its a very nice way to plan out our lives and clinics and be able to manage everything……we all should make resolutions and stick by them

        

[Drsumitra]

The Central Bureau of Investigation’s (CBI) recent raids and arrests of the Dental Council of India (DCI) members are just the tip of the iceberg, going by what people in the know say and what certain documents reveal.

Pursuing the matter, Deccan Herald managed to access several documents that show the DCI in poor light and people fighting the cause allege that it is a hub of corruption.

One of the main allegations is that the DCI, the statutory body governing dental colleges in the country, has granted unwarranted permission for new colleges and courses while a major problem of unregulated faculty appointment and ghost faculty is rendering courses ineffective, with students barely seeing their teachers. Some of the teachers work part-time, which is illegal.

A few years ago, some members of the fraternity managed to convince the council to instal biometric systems to check the attendance of the faculty and keep a tab on ghost faculty drawing salaries from colleges they never visited.

Going by the documents, the council, however, “has failed to implement ‘its’ policy decision of monitoring faculty attendance through a system of biometric system, thus rendering unfruitful the expenditure incurred on the procurement of biometric machines for this purpose at a cost of Rs 1.32-crore.”

In addition, the council has approved 1,187 new postgraduate seats for 2012–13 even as it knew that there are no full-time faculty or infrastructure to support it.

In a writ petition filed by Dr Shaji K Joseph before the Kerala High Court, it is submitted that Dibyendu Mazumder, president, DCI, Mahesh Verma, vice-president, DCI, executive committee (EC) members Satheesh Kumar Reddy, Y Bharath Shetty, S M Jayakar and Riyaz Farooq and DCI member Pradeep Chandra Shetty have committed criminal misconduct.

“The criminal misconduct committed by respondents 4 to 10 (the aforementioned) in accepting gratification from private dental institutions in India for recommending 1,187 new postgraduate seats (Master of Dental Surgery) for 2012 – 2013 sans full-time faculty and infrastructural facilities.” The said members have been alleged as having amassed more than Rs 50 crore as gratification in granting permission for the same.

The petitioner has argued that they did this by abusing office and flouting Sections 9(1) and 10A (7) of the Dentists Act, 1948 and misguiding the Centre for getting its approval.

The Kerala High Court has alreay issued notices to the persons concerned.
Usha Mohan Das, vice-chairperson of the women’s dental council of the Indian Dental Council (IDA) said: “I know tens of people whose postal address (both residential and clinics) do not match with the cities/towns the colleges they are faculty members at operate from. I have submitted certain evidence to the CBI.

“…There are many in Bangalore alone, who visit the respective colleges only during inspections, about which, sadly, the colleges are tipped off in advance,” she added.

She said that she had lodged a complaint with the CBI as the DCI’s executive committee members were hand in glove with touts and college managements. Out of the eight EC members, two—S M Jaykar and Bharath Shetty, whose places were also raided–—are from Karnataka, while Sateesh Kumar Reddy is from Andhra Pradesh. With a majority of all the dental colleges in India located in Karnataka and Andhra Pradesh, these EC members have a lot of conflicts,” she said.

 

        

[Drsumitra]

Central Bureau of Invest­igation (CBI) sleuths on Monday arrested and interrogated S. Srilekha, the MD of the Adhiparaksakthi Dental College & Hospital in Melmaruvathur in connection with the Dental Council of India bribery scam.

“She (Srilekha ) is expected to appear before us again on Tuesday,” said a CBI official.

Based on a court order, Srilekha, the daughter of a retired inspector general of police and the daughter-in-law of godman Bengaru Adigal of Melmaruvathur on Monday reached the CBI office in Haddows Road.

There she was arrested and interrogated by the anti-corruption branch of the CBI in the city at 10 am. The college official had been absconding for more than 15 days and the sleuths had even conducted searches in her house in Adyar last week.

The CBI had earlier arrested as many as five persons, including two doctors, who were members of DCI in connection with the `25 lakh bribe that was allegedly given by the management of the Adhipara­ksakthi Dental College to receive permission to start a PG dental course.

The sleuths had arrested DCI member Dr S. Murukesan on January 8, when the representatives of the Adhiparaksakthi Dental College allegedly handed over the first installment of `25 lakh (of the `1 crore bribe) to him at his clinic in Royapettah.

Apart from the Adhipa­raksakthi Dental College, the CBI investigators had also conducted nationwide raids at four other dental colleges, as well as the residences of three executive council members of the dental council in Mang­alore, Benga­lu­ru and Hyderabad

 

        

[Author]

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