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Preventive Dentistry

1.            Dentistry a discipline of Prevention.

2.            HIV Infection and role of oral Health Physician.

3.            Postgraduate institute of public health.

4.            Community dentistry needs gearing up for prevention of dental diseases in Pakistan.

5.            Dental hygienist – qualification and job description.

6.            Dental public health dental anatomy, histology and Physiology.

7.            Promotive and preventive side of rural health, present and future.

8.            Dental public health in Pakistan and suggestion for integration.

9.            Activity report concerning WHO

10.         Workshop on oral health care, Lahore 4-8 June, 1990.

11.         Recommendations of national workshop of oral health.

12.         Recommendations on prevention of dental diseases.

13.         Periodontal disease in children in Pakistan.

14.         Steps for preventive dentistry.

15.         Public Health problems in rural areas.

16.         Promotion of Dentistry.

17.         How to have healthy teeth and better health.

18.         Common dental diseases, prevalence and their causes and dental need for rural community of Pakistan.

19.         Tooth paste and its use.

20.         Primary dental health care at basic health units.

21.         Future of postgraduate dental education.

22.         Improvement in the science of dentistry.

23.         Reconstruction of Institute of Public Health 6-bnirdwood road, Lahore.

 
 


 
 
Dentistry a discipline of Prevention
 

Dentistry today is a influential discipline with important ties nearly every branch of medicine. Dentists are now “physicians of mouth” diagnosing and treating a wide range of disorders with oral manifestations. Dentistry is one of the few health professions poised to become largely a discipline of prevention.

 

This turning point came about thirty years ago when dental researchers proved that two most prevalent oral problems – tooth decay and periodontal disease – that are infectious disorders. These findings propelled dental science into main stream of bio medical research. They also revolutionized dentistry. Tooth loss is now no longer considered an inevitable consequence of aging, but rather the result of disease that could be diagnosed treated and ultimately prevented.

 
Oral Health Science:
 

Today, oral health science is not only part of main stream biomedical research, it has moved to the fast track. Dental scientist have been quick to adopt the new techniques of cell and molecular biology, particularly recombinant DNA and monoclonal antibody methods. With these new tools, dentists are advancing knowledge of fundamental mechanism underlying the health and the disease the molecularization of dental research is also accelerating the transfer of laboratory findings into clinical application.

 
Aids and other health problems:
 

From an initial focus on caries and the periodontal diseases, research has grown to encompass the full spectrum of oral health concerns. Now dental scientists are discovering mechanisms of self functions common to many issues. The work is contributing to understanding of cancer, arthritis, diabetes, heart disease, musculoskeletal disorders, congenital defects, acquired immune deficiency syndrome (AIDS) and other health problems.             

 
Dental Caries:
 

Tooth decay is the old companion of man since before the time of recorded history. Until the beginning of the century, however, did the truth begin to emerge that decay results from acids in the mouth. Now experiments prove that caries is an infectious disease, caused by acid producing bacteria.

 
Immune Cell Defects:
 

Periodontal disease research is benefiting from a concentrated study of relatively rare diseases that affect young people: Juvenile periodontitis and pre-pubertal periodontitist. Both diseases appear to involve specific inherited defects in a critical host defence cell, the polymorphonuclear while blood cells. These findings have given rise to a five site collaborative clinical study to shed lights on the familial nature of periodontal disorders and aid in identifying individuals at risk.

 

The discovery of abnormalities in the neutrophil body’s major line of defense against bacteria may explain the susceptibility of some persons to swear periodontal infections. Studies are continuing in an effort to identify key factors involved in both normal and defective neutrophil movements to the infection site, and to design treatments to correct this impair cell function. 

 
Diabetes & Periodontal Disease:
 

Periodontal disease is a frequent complications of diabetes mellitus. To help unravel the complex interactions of these two disease processes, a study in collaboration with diabetes experts and biological scientists in dentistry is carried out and the research team found that gum disorders are associated with bacteria of various types strongly causing periodontal disease and the one third of the diabetics have lost all their teeth most likely due to this form of periodontal disease. This will lead to a better approaches to treatment and the ultimate prevention of this serious complications.

 
Smokeless Tobacco:
 

The research has explored the links between tobacco use and soft tissue malignancies. The use of smokeless tobacco in our country in the form of snuff increases the risk of oral cancer. There are other problems associated with smokeless tobacco include localized gum recession and leukoplakia (a pre-cancerous conditions) where snuff is usually placed. Moreover, these products release nicotine, into the blood stream and produces blood level of nicotine comparable to those produced by cigarette smoking and thus regular and long term use of nicotine is associated with health risks, including possible cardiovascular risks due to elevation of blood pressures heart rate and certain blood lipids and hormones.

 

(Reference: National Institute of Dental Research (NNIDR Bathesda, Maryland, USA)


 

HIV INFECTION AND ROLE OF ORAL HEALTH PHYSICIAN

INTRODUCTION

                HIV infection has become a global problem, perhaps three quarters of the world’s countries are becoming victims of HIV and AIDS. Increasing number of countries have reported this matter to the WHO and thus there is increased awareness of the HIV infection as a global problem. The WHO has activated its activities “GLOBAL PROGRAMME ON ACQUIRED IMMUNODEFICIENCY SYNDROME AND ORAL HEALTH PROGRAMME” in order to provide consultation and ot promote the information exchange concerning the infections diseases in the delivery of oral health care in Sept., 1987. Nearly 57000 cases of AIDS have been reported uptil the end of August 1987 and the number is on the increase. The disease is more in the Caribbean, South America, Africa, Europe and North America. However, the virus is found all over the world.

                The United States in 1989 was concerned about the worldwide epidemic of Acquired Immune Deficiency Syndrome.   The Surgeon General reported that 90% of those infected by this virus 5 years ago are now dead, and the disease/virus has been labeled as “one of the most lethal of mankind’s infections”. And thus the USA Government has committed to spend more than two billion dollars to the fight against AIDS including 600 million dollars for research.

Role of Oral Health Personnel in Prevention of HIV

·                     Oral Health personnel have a vital role in prevention of transmission of human immunodeficiency virus infection. Because due to their position they can provide guidelines to industries for designing safer oral health facilities and equipment.

·                     They can disseminate knowledge and can educate patients, health workers and colleagues about the disease.

·                     They can prevent the transmission by oral care instruments by proper sterilization and instruction.

·                     They can provide care to patients infected with the virus responsible for AIDS.

·                     They can advise regarding vaccination (Hepatitis-B) immunization.

 

The education efforts concerning the HIV infection by oral health physician is becoming a mechanism for community message for AIDS to the public and therefore education of oral health physician must be conducted rapidly and in coordination with other health care disciplines. Because they are to diagnose, refer and provide cure services in conjunction with other health disciplines in any center, clinic or hospital. 

                Besides the educational therapy the hospital staff who are exposed to such patients should be vaccinated by a vaccine (B-Hepatitis). A course of this vaccine provides perhaps 100% protection against the infection. 

Mode of Infection

                There are three main routes of transmission. 

1.                   Penetrative: Sexual intercourse (Homosexual) or Heterosexual).

2.                   Blood and blood contact (including transmission and blood products).

3.                   Perinatally: from infected mother to child.

 
Blood Donors

                In developing world especially in our country there are professional blood donors waiting at the various blood banks, mostly they are addicts or homosexual. They are not screened for HIV. Similarly skin-piercing instruments, needles and scalpels are not sterilized and they can contribute to HIV transmission. 

                The counseling of oral health physician, his knowledge, his personality and his sense of prevention can ultimately become successful in control of this disease.

 

                Such patients can be counseled to reduce the risk of acquiring infectious diseases and oral health physician, through his experience and skill can recognize oral signs and symptoms of infectious diseases and can refer to proper quarters for diagnostic evaluation appropriate treatment and prevention of spread to non-infected persons. 

                It is must for the oral health physician to have current knowledge of epidemioloogy and modes of transmission of infectious disease because: -

1.                   He is to be confronted with these issues in his practice.

2.                   Through the recommended strategy for infection control by the WHO: he can prevent cross infection among the patients of hepatitis, herpes, and HIV.

3.                   He is to prepare the public for reducing risk behaviour for accurate information and for motivational behaviour.

 
Recognition of Infectious Agents

1.                   The scientifically documented risks for transmission of infectious agents in oral-care settings should be identified and distinguished from perceived risks.

2.                   Risk of infectious disease transmission from oral health physician to patients is very low.

3.                   Risk of disease transmission to oral health physician is notably grater.

4.                   Hepatitis-B virus (HIV) represents a “worst case scenario” relative to transmission of infectious diseases.

5.                   HIV can be transmitted by small amounts of contaminated blood or other body fluids in the daily environment.

6.                   Study documents are available showing the increased risk of oral health physician to hepatitis-B virus compared to the general population because 1ml of infected blood of a hepatitis-B carrier can have upto 10 billion infective viral particles. It is estimated that every year about 50, 000,000 new cases are being reported. And more than 2 billion die as a result of hepatitis-B. 1 in 5 carriers may die prematurely as a result of liver cirrhosis. 1 in 20 carriers will die prematurely from liver cancer. Because of the nature of work of health worker his risk of catching infection becomes 10 times higher than the normal population. 

The Risk of Transmission to Health Personnel

 

                If there is parenteral or mucous membrance exposure to blood or body fluids of patients infected with HIV i.e. by injury from contaminated instruments, onset of disease is rapid.

 

Therefore there is a need:

 

a.                   To develop oral care strategies for HIV infected patients.

b.                  Disseminate information on early detection & oral manifestations of HIV to oral health physician and :

c.                   Extend the Global oral data bank to include oral manifestation of HIV infections.

d.                  Develop information, training packages and curricula for oral health physician.

 
Infection Control
 

                Our equipment is of two types:

 

a.                   Critical.

b.                  Non-critical.

 
Critical
 

                Needles, Burs, Suction tips, hanpieces, and impression trays. They can penetrate in the tissues and in close intact.

Non-Critical
 

                Items that come in contact with intact skin and clothes like, chair, unit, lamps etc. The critical items are to be sterilized or disinfected thoroughly to reduce the transmission of infectious agents between patients and oral health personnel. And thus there is need for proper sterilization to destroy the pathogenic organisms, such as HVI & HIV.

               

Sterilization through steam autoclave at 121 C for 20 minutes or dry heat at 170 to 180 C for 2 hours are usually employed. Other choices like boiling for 20 minutes or chemicals disinfectants like sodium hypochlorite 0.1 to 0.5%. Hydrogen peroxide 6% may be used after cleaning /rinising the instruments in cold water. For non-critical items disinfection by whipping with chemicals is acceptable e.g. by sodium hypochlorite. It can decrease the risk of spread of infections. 

 

Prevention of Transmission of Hepatitis-B & Herpes in Dentistry

 

                At the primary oral health care level it includes:

 

a.                   Oral examination of the patient.

b.                  Health education to the family, and to the community workers. 

c.                   Referral to the health authorities.

d.                  Emergency care.

e.                  Surface care.

 

In such primary settings a pressure cooker may be used to replace steam autoclaves. Special care may be taken not to be pricked with needle during extraction of the teeth. Similarly in oral epidemiological survey and emergency care the instruments should be steam autoclaved or boiled, or chemical disinfectants may be used:

 

-                      Double ended instruments may be avoided because they are more dangerous.

-                      Needles and syringes should be disposable and should be placed carefully, not to be pricked.

-                      Instruments like knifes and ultrasonic blades may be kept away after use, and similarly method of disposal of such needles and other sharp instruments should be done by a safer way.

 
Conclusion
 

                Risk of transmission of infectious diseases can be managed with information; technology and routine implementation of asepsis provided the oral health personnel have got commitment to the cause of humanity. The HIV positive individual can be treated preferably in the oral medicine department of the hospitals. There is human as well as professional obligation to treat and care for the HIV infected persons.

 
 
REFERENCES:
 

1.                   Surgeon Generals Report (1989). “AIDS a Battle the World Must Wing” Voice of America. Vol. No. 32.

2.                   Hilleman MR (1985), Journal of Infect Diseases, 151, 407, 419.

3.                   Polakoff S (1986) Br. Med. J., 293, 37-8.

4.                   Proceedings of an International Symposium Prospects for the Control of hepatitis-B, Berlin 26-27, Sept. 1986. Postgraduate Med. J (1987) 63, Suppl. 2)

5.                   Immunisation against Hepatitis-B, report of the Board of Science & Education. British Medical Association, March, 1987.

6.                   WHO/ORH/INFECT. CTR/87 (1987) Infection Control & Hygiene in Oral Care Settings, Geneva, 2-3 Sept. 1987.

7.                   Voice October (1987), Editorial, Russ Woodgates by Stephen Sinclair. 

 
 


POSTGRADUATE INSTITUTE OF PUBLIC HEALTH

 

The PMDC in his report dated 29-30th December 2001 has granted recognition for only one year to MPH programme with the understanding that DPH and DMCH are to be discontinued over the next year as the staff is not sufficient at present. The PMDC further advised that only 30 students be allowed for admission in MPH programme. Institute shall be re-inspected after one year for checking the rectification for the deficiencies pointed out. This is indeed a sad situation because keeping in view the necessity of the importance of preventive and social sciences. There was necessity for the preventive and social medicine in the country thus there was need for administrator in this field. Keeping the objective of the Government of the Punjab has priority for preventive for social medicine, with the active support of Govt of Pakistan and WHO and Institute was established at
6-Birdword Road, in 1949. The Institute was developed there was almost 14 full-fledged departments in 1985. There was a special facility for the refresher courses and para medical courses. Near about 1960 full time departments were established, department of medical Entomology and parasitology, maternal and Child health, Bacteriology, Occupational Health, Environmental Health, Nutrition and Dietetics, Epidemiology, Infectious Diseases, Public Health Practice and Administration, Biostatists, Medical social science, Health Education , Para medical sciences. 

 

With this popularity the name of Institute is Hygiene and Preventive medicine was changed perhaps in 1979 to College of Community Medicine and head of the Department was named as Principal instead of Dean. Due to the widening activities of the college the department of Dental Public Health was created to impart comprehensive training to postgraduate, undergraduate and to dental hygienists under the provision of Dr. M. A. Soofi, 1975. Post of Professor was created in 1985. This institute is the only institute of Public Health of the country and have been preparing experts in public health and maternal and child health. It is got huge area, calm and quite locality. It has trained fellows in community medicine and many doctors has qualified MCPS through college of physician and Surgeon Pakistan. It has been funded by many international agencies and it has created a name in the pages of WHO. The teaching staff was of high standard and almost all the head were Dean/Principal but unfortunately substitutes were not created with the results after the retirement of the learned professor the chairs of the professors could not be fulfilled by those who could share and admire the academic qualification.   At present there are two professor and posts of 6 professors are vacant. This institution is very useful and it got history of half century. It has given value and direction of research to many bright students of the medicine. The closure of the DPH and DMCH is not a good news because instead of expansion PhD we are closing down historical courses. On these courses many men and women worked very hard. I therefore, urge upon the government and the authorities that DPH course may not be closed rather it should equated at par with MPH and those who have qualified DPH examination with dissertation to the Punjab University have attended full time course of various department mentioned. Moreover MPH should the acquitted with DPH because both the course are one academic year. This is being done that the history shall continue. I shall further advise teachers may be invited from abroad through WHO to conduct postgraduate courses like M Phil PhD and short courses should be conducted.  

 

The Government of Punjab already expend huge money on construction of new block, Dept. of Virology and hostel and if the PGMI shifted to services hospital premises then the whole area given. The public health is the pivot science deal with the growth and development of the child, mother, population and thus the institute of public health should embark upon creating better institution with better dimension so that who could produce the brains in public health for the future generation. 

 

If we set the example today which the tree of community medicine was plant which was planted in 1949 growth up now, and if we think for the preventive dentistry and modern technology , then we shall have different view in Pakistan.


 
 
Community Dentistry –

Needs Gearing up for Prevention of Dental Diseases in Pakistan

 

Prof. Dr. M. A. Soofi

 

The inclusion of community dentistry in Pakistan Journal of Orthodontics and Pediatric Community Dentistry under the Chief Editorship of Dr. Khalid Almas an Internationally known scholar and Dr. Akhtar Bukhari a popular worker of community dentistry is perhaps beginning of new era in the history of dentistry in Pakistan. So far, there is no such department of community dentistry or public health dentistry in any teaching institution of dentistry, both in public sector and private sector in Pakistan except Public Health Dentistry. Four and half crore population of the country is unaware about the principle of preventive dentistry. It is lucky that some of the retired and existing professor have done the postgraduation in public health dentistry but instead adopting this profession they have widened their brilliancy in other field except that the author adopted the profession after doing the postgraduate higher diploma (DPD) in 1970 U. K. The topic of my dissertation was “ Periodontal disease in children in Pakistan”. 

 

It took me many years to install the project of dental public health in a medical institution of post graduate level. Starting in 1978 and it went up steadily to the post of professor. To start the post-graduate courses for MDS in public dentistry two years dental hygienist course, the recommendations were prepared for Institute of Public Health Dentistry at Pakistan level. It was the initiative that we wanted to act according to the needs of the people :

 

a.                       To reform the current oral health syllabus for graduates and postgraduates which should be supplemented with public health subjects.

b.                       We wanted to create the dental hygienist school so that the trained workers should be available in community service at basic health centre, rural health centre and tehsil centre. 

c.                       We developed the seminars on the prevention for safe water and other factors to control the dental disease in Pakistan.

d.                      We argued College of Physician Surgeon Pakistan for starting of postgraduation examination in community dentistry and later on attitude was develop for FCPS fellowship. I remained coordinator for MCPS Community Dentistry. Through this interest we have developed the progressive science for the approach to go further in this field.  

 

Pakistan is facing periodontal disease in all sector of the society high or low, it needs management, prevention and surgical module of the treatment. Similar situation in dental caries and the orthodontics problems. Oral cancer and other dental ailment which can be prevented by screening and public health awareness. What is needed now? That curriculum may be added with the community dentistry including public health epidemiology statistics so that the management process should be initiated the students should be exposed to the community for diagnosing the cases. We have carried out the survey in Baluchistan and Punjab while the previous survey prior to Pakistan were carried out by Day and Shourie (1947). Therefore, the public health dentistry should be united in the curriculum because all the branches of science needs integration for prevention. This shall create a close link between the oral health and public health services provided by an institution. It shall give the chance to the students for carrying out responsibilities for administering the health services like formation of the plans, priorities and area of the city in which the public health project is to be evolved. The community dentistry is effective service, easier and better for the human beings as prevention is better than care.   

References: :

1.                  Day, C.D. Marshall and Shourie, K. L. (1947). Hypertrophic gingivitis in Indian children and adolescents. Ind. Med. Res. 35: 261.


 
DENTAL HYGIENIST – QUALIFICATION AND JOB DESCRIPTION
 
ADMISSION QUALIFICATION:
 

Basic qualification for admission to the course of Dental Hygienist is matriculation. However, F.Sc (Pre-Medical) are preferred.

COURSE DURATION:

Duration of the course is two years which involves basic subjects i.e. Anatomy, Physiology, Pharmacology, Pathology and Bio-Chemistry in general. Particular stress is given to the Oral Cavity. The clinical subjects are taught Operative Dentistry, Public Health Dentistry, Oral Surgery, Oral Anaesthesia and Radiology for practical training.   The students have to attend the some quota of the patients of various specialisties for practical.

JOB DESCRIPTION:

a.                  To assist Dental Surgeon and to work under his supervision and guidance.

b.                  To do the scaling and polishing of the teeth.

c.                   To extract shaky and ilk teeth under the local infiltration anaesthesia.

d.                  To do the filling of the children and simple cavities with silver amalgam.

e.                  To give health education and demonstration to the mothers and children and to emphasis on the need of balance food and type of the food to prevent the dental diseases.

f.                    To apply topically fluoride to the teeth.

g.                  To assist in the research and epidemiological survey under the advice of Dentists.

h.                  To reduce the work load of the Dental Surgeon, who can do operative work in efficient way and can save the time of the Dental Surgeon. 

RECOMMENDATION:

NPS-12 is recommended on basis of training and experience.

DENTAL PUBLIC HEALTH
DENTAL ANATOMY, HISTOLOGY AND PHYSIOLOGY
 

Anatomy of teeth, Jaw and associated parts. Muscles of mastication – ligaments, Saliva – Salivary glands and its importance to dental health. Enamel – Dentine – Cementum, pulp, periodontal membrane and gums Development of teeth, tissue and jaw eruption and absorption of teeth. Different type of teeth.

DENTAL PATHOLOGY

Disease of mouth, muscles, face tumours – congenital, deformities like cleft palate, changes in teeth caused by general diseases.   Inflammatory conditions – gingivitis, pericoronitis, periodontitis dental alveolar abscess.   Dental caries – Pulp involvement – Granuloma – and apical involvement.

ORAL MEDICINE

Oral sepsis and general health, blood dyscrasias and oral tissues nutritional deficiencies and oral disease.   Skin disorders and oral health. Psychological manifestations and dental tissues. Allergic manifestation in teeth. Alcholism and addiction and oral health. Hormonal disturbances and oral tissues. Mental intoxication and occupational disorders of teeth.   Virology in oral diseases. Fusiformus baccilli infection and bleeding gums. Stomatitis – various forms: Gingivitis, periodontitis. 

BACTERIOLOGY

Role of bacteria in dental disease, laboratory technique to get a sample for tests growth of bacteria and sensitivity testing against antibiotics qualitative and quantitative method (MIC). 

PHARMACOLOGY

Role of broad spectrum antibiotics, antiseptics – lotions, gargles – tooth paste and common drugs used in dentistry. Anaesthetics, analgesic antipyretic – anticonvulsant drugs and their manifestation in oral tissues. Astringents and anodynes. Tranquilizer and their necessity in dentistry.   Vitamins and iron in teeth & staining of teeth drugs not to be used in pregnancy. Drugs used in root canal therapy –apisectomy – periodontal surgery.

PREVENTIVE DENTISTRY

Epidemiology of periodontal diseases – dental decay, fluorides and malocclusion. Aetiology of periodontal diseases:

a.                   Acute disease

b.                  Chronic disease

c.                   Stomatitis

d.                  Fungus

 

Fusospirocheatal. Infection and bleeding gums.

Prevention of dental disease, diet and dental disease, fluoridation of water supply and other uses of fluoride in dentistry. Genetics and tooth.

PUBLIC HEALTH DENTISTRY

Role of public health services. The public health aspect of dentistry. School Dental Health service. Maternity child health and its management – coordination of dental health services – dental health services in other courses. Dental health Education – Dental health planning.

PREVENTIVE ORTHODONTICS

Normal occlusion and its variation – occlusion in various nations. Incident of malocclusion and problems associated – provision of orthodontic treatment.   Public health centres. Diagnosis and Preventive Orthodontics.

PREVENTIVE JURISPRUDENCE

Law and ethics applied to public health dentistry. Ethics of epidemiological studies and research projects. Out-line of forensic odontology, dental investigation like mass disasters – Recognition of bodies – general law of negligence law relating to consent. National health services – in Pakistan and medical and Medical and Medical Dental Council Regulations.

 
 

DIPLOMA – MATERNAL AND CHILD HEALTH (DMCH)

Genetics and teeth – Racial characteristics of teeth. Early development of teeth, jaw, line of exposition of mail teeth, permanent teeth, born defects in teeth, effects of drugs during pregnancy and teeth – nutrition during pregnancy, general consideration – neonatal teeth.

Nutrition during childhood, first feeding and malocclusion drugs during childhood. Dental care during pregnancy of mother, dental sepsis and general health of mother, treatment during pregnancy -–need of extraction of tooth during pregnancy, dental disorders of mother and their prevention.

 REPORT ON THE INTERNATIONAL “NO TOBACCO DAY”

ORGANIZED BY THE PUBLIC HEALTH ASSOCIATION OF PAKISTAN

CHIEF ORGANIZER:          Prof. Dr. M. A. Soofi

CO-ORDINATOR:                Miss Sanila Taj, Executive Director, PHAP.

Prof. Dr. M. A. Soofi, Former Principal College of Community Medicine, Assistant Treasurer PHAP proposed on the PHAP Executive Committee meeting held on 24th May, 1992 that the PHAP should organize a symposium and a walk on 31st May 92 the day designated by WHO to be the International No Tobacco Day.

The Committee agreed to the proposal and decided to sanction Rs. 5000/- from the PHAP accounts for the purpose. In addition, Dr. Akram Sheikh, MS Sir Ganga Ram Hospital, Member PHAP Executive Committee, kindly offered to arrange a donation of about
Rs. 5000/- for the same cause.

PRESS CONFERENCE

27th May 1992 at 11.30 AM at Flaties Hotel, Lahore.

A press conference was held in connection with the International “No Tobacco Day” on 27th May at Flaties Hotel, Lahore.

Lt Gen (Retd) Fahim Ahmed Khan (President PHAP), Prof. Dr. M. A. Soofi (Chief Organizer No Tobacco Day), Dr. Akram Sheikh addressed the Press Media, apprising the significance of the Day.

WALK

29th May, 1992 at 6.00 AM from Aitchison College Lahore to Faisal Chowk the Mall Lahore.

A Walk against the use of Tobacco was arranged on Friday the 29th May 1992, Malik Saleem Iqbal, Minister for Information and Broad Casting, Govt of the Punjab was the Chief Guest on the occasion. The number of participants was about one hundred.

The Walk was given coverage by all the National Dailies. Besides, Lahore TV gave it a very good coverage in the Urdu and Punjabi News.

200 soft drinks bottles were obtained for the walkers from the Pepsi bottlers free of any cost. No member of thePHAP Executive Committee except Dr. Akram Sheikh and Dr. Shaheena Manzoor could participate in the Walk.

NAWA I WAQT DAILY –FORUM held on 30th May 92 at 11. 00 AM

A Forum was held on the subject at Aiwan e Iqbal, Nawa i Waqt Daily, Prof. Dr. M. A. Soofi, Dr. Mrs. M. A. Soofi, Dr. Akram Sheikh, Dr. M. Aslam Khan, and Miss Sanila Taj participated. The Forum Report was published in the Nawai Waqt Daily of Friday 5th June, 1992 because the Friday Paper is published and distributed at national level.

FREE DINNERS AT AVARI HOTEL

A draw was held and four lucky winners were given coupons to take free lunch in Avari Hotel.

SYMPOSIUM

31st May, 1992 at 5.00 PM, Pakistan National Centre Alfalah Building Lahore. A Symposium was held on the occasion of the International No—Tobacco Day, at Pakistan National Centre, Lahore. Ch. Muhammad Iqbal, Minister for Agriculture, Government of the Punjab, was the Chief Guest on the occasion. Prof. Dr. M. A. Soofi, Dr. Shaheena Manzoor, and Dr. M. Aslam Khan spoke on the occasion. Llahore TV andPress media covered the occasion well. No member of the PHAP Executive Committee could attend the Symposium.

T. V. PROGRAMME

On 27th May, 1992 a 30 minutes talk was delivered on PTV in Punjab, by Dr. Shehryar Sheikh, Director Institute of Cardiology and Prof. Dr. M. A. Soofi, former Principal College of Community Medicine, on the subject of “Smoking and Heart Problems”. The talk was telecasts at national level. Objectives, activities and achievements as well as the future plans of the Public Health Association of Pakistan were brought to light by the speakers in the programme.

VIDEO FILM

A video film has been made to record all the celebrations of the Day. A questionnaire was prepared to collect data pertinent to the smoking habits and awareness of its hazards among people. Besides a good coverage by the National Press, certain magazines and journals also published research papers written by Prof. Dr. M. A. Soofi: It includes Herald, Punjab Medical Tribune (PMA) and Medical Tribune Karachi, Islamabad.

I highly appreciate the assistance and cooperation extended by Miss Sanila Taj, Executive Director (PHAP) and the PHAP Office staff in making the celebrations of the day a great success.

 


 

PROMOTIVE AND PREVENTIVE SIDE OF RURAL HEALTH,

PRESENT AND FUTURE

 
 

Before we discuss the promotive and preventive side of the Rural Health it is essential that we should have the knowledge regarding the Province of Punjab in respect of statistical data. Total population of Province of Punjab is 5,44,87,000 (Five Crore Forty Four lac Eighty Seven Thousand) whereas the Urban Population is 15031000 (One Crore Fifty Lac Thirty One Thousand) comprising of 8002000 (Eighty Lac Two Thousand) male and 7029,000 (Seventy Lac Twenty Nine Thousand) female.   Similarly the Rural population is 39456000 (three crore ninty four lac and fifty six thousand) comprising of 20607000 (two crore six lac and seven thousand) male and 1,88,49,000 (one crore eighty eight lac forty nine thousand) that of female. The area of Punjab is 2,05,346 ( 2 lac 5 thousand 346 k.m) Sq. K.M. and its population density 265 person per Sq. Kilometer.

 

Punjab is divided into 8 civil division, having 29 districts, 86 tehsils.   The total number of the villages are 25094 and number of the union council are 2367 and there are 290 rural development marakiz. There are 18 cannts, 63 Municipal Committees, 132 Town Committees and 7 Corporations. It is estimated that the infant mortality rate is 115-120 per 1000 live births, and as maternal mortality rate is 7 per 1000 live births. Morbidity rate is 31% and death rate is 14.6% population.   The annual growth rate is 2.95% against annual growth rate of Pakistan which is 3.1%.

 

The health delivery system in Punjab at present is in the form of Hospitals, Dispensaries, Rural Health Centres, Sub Health Centres, T. B. Clinics, MCH Centres, and Basic Health Units. There are 3941 centres in both Rural and Urban areas. There are 28 Hospitals, 853 Dispensaries, 144 Rural Health Centre, 547 sub health centres, 101 MCH Centres, 1395 Basic Health Units in the Rural Areas.

 

There are 2947 sanctioned posts of medical officers, 503 Women Medical Officers, and 109 Dental Surgeons among these 489 Medical Officers, 233 Women Medical Officers and 22 Dental Surgeons Jobs are lying vacant.

 

The Government of the Punjab has granted the budget grant of Rs.82,05,86,86,550 (Rupees 82 crore, 5 lac, 86 thousand 5 hundred and 50 only) for the year 1986-87.   The budget is to be spent by the institutions run under the control of Director, Health Services of Punjab, whereas there is another grant of Rs. 681660350 (68 crore 16 lac 60 thousand 3 hundred and 50 only)   for special institution for expenditure of professional technical and general hospitals and clinics Rs. 1013100 (10 lac 13 thousand and 1 hundred) is to be spent for administration. Therefore, total budget for health under grant number 16 Non-Development for 1986-87 is Rs. 1,50,32,60,000 ( 1 Arab 50 crore, 32 lac 60 thousand).

 

The Government of Pakistan has got the intention to increase the Rural Health Centres and Basic Health Units and the number of Doctors, which is evident from the data, that in 1951 we had 2, 621 doctors and in 1984, we had 38,322 doctors. Similarly the number of dental surgeons increased from 377 to 1,303 in 1984. The Health Centres have increased to 319 in 1984, which has started with 217 in 1980. The Government is keen to have 9,939 Rural Health Centres in 1988, population per facility of 73,800. Similarly basic Health Units, Dispensaries, MCH, etc. to 9, 154 in 1988 population per facility 9,750.     Similarly the number of the will increase in Pakistan to 36,000 for population per facility to 2, 940 and Dentists would be 1700 for 62350 population per facility.

 
TARGETS
 

1.                  Conversion of 2,620 existing of facilities into BHUs with residences.

2.                  Construction of 2,665 new BHUs with attached residences for doctors and staff.

3.                  Construction of 625 new Rural Health Centres.

4.                  Construction of 1,715 doctors residences at the existing BHUs.

5.                  Provision of 4000 teaching beds in existing medical Colleges and another 4000 in District and Tehsil Hospitals and 1220 beds in Tehsil Hospitals for referral care.

6.                  Hostel accommodation for House Surgeons, Physicians & Trainee Registrars.

 

TARGETS IN HUMAN TERMS

 

1.                  Protection of 24 million children against six major killers of children.

2.                  Protection of 8 million children against complications and mortality of diarrhoeal disease through oral rehyderation salts.

3.                  Protection of 1.25 million children suffering from third degree malnutrition.

4.                  Providing help during pregnancy and childbirth from the present 24 percent to 100 percent of mothers through 45,000 trained birth attendants, backed by Lady Health Visitors and Female Doctors.

5.                  Rehabilitation of 1 million disabled and prevention of occurrences of disabilities.

6.                  Availability of Primary Health Care to all and referral where needed.

 

The 6th and 7th Plan will shift from the objectives to practical side for providing a systematic link between the village community and supper structure of the modern health system, depending upon the density and scatter of the population, basic health unit will be provided to serve about 5000 to 10000 population.   This will include among other things midwifery, child care, immunization, diarrheal disease, malaria control, child spacing, mental health and school health services within its area. Out of such research services will be provided for maternity and child health care through trained birth attendants: -

 
POLICY SHIFTS OF THE SIXTH PLAN
 

1.                  Emphasis on preventive care by protecting all children by poly immunization against the six preventable diseases of children diarrhoeal diseases control and improved maternal care.

2.                  Consolidation of existing facilities in contrast to expansion and development of Rural Health Infrastructure. Expansion is only envisaged in unserved areas.

3.                  Each rural health facility to be manned by one qualified doctor and by substitute.

4.                  Double shifts in the out patient department of all teaching Hospital and District, Tehsil Taluka Headquarter Hospitals.

5.                  Freezing of seats in medical colleges and stress on quality rather than quantity.

6.                  Rehabilitation of disabled and prevention of disabilities.

7.                  Government patronage to traditional medicine.

8.                  Involvement of the Community (local bodies) in Primary Health Care.

9.                  Proper management training to health functionaries.

10.              Introduction of users charges to reduce subsidy.

11.              Rapid expansion of Private Sector.

 

Under the 5 points programmes, Socio-Economic Development of Prime Minister of Pakistan 1.41 Billion rupees have been financially allocated for Rural Health similarly 1.25 billion has been allocated for rural water supply and sanitation, and 1.98 billion has been allocated for rural roads and 5.27 billion has been allocated for electrification. Total amount stands 23.19 billion for Socio-economic uplift of the rural and Katchi Abadies.

 

Under the Health Section of the 5 points programmes, basic health units is to be set up in each of the Union Council. In addition of Rural Health Centre would be set up in a group of 4 to 5 union council during 1986-87, 343 new basic health units and Health Centres are to be set up in the country.   These units beside providing normal health care, takes steps for prevention of disease. 

 

These Health Units would be provided adequate number of doctors and paramedics and modern hospital equipments. Each basic Health unit would be provided with the Laboratory facility for maternity and child health care.   Each rural health centre would have doctors including lady doctors with necessary complementary staff, operation theatre, Laboratory and Ambulance in addition to facility for the prevention of the disease. In this way we shall be able to overcome the health problems of the rural population in Punjab and elsewhere.

 

There is a need that the medical professionals should identify the critical problems being faced by the country. One of the major problems is increase of birth rate.   The birth rate all over the globe is becoming very high.   It is estimated that by year 2000 the population of the world will be 6 Arab, 20 crore, which in 1960 was 3 Arab and in 1980 4 Arab 80 crore.   It is said that half of the population of the world is located in China, Bahart, Russia and America. Russia has reached the population of 28 crores. 

 

The population rate of Pakistan is 3.1 % annually whereas unemployment rate is 4% which has reached to 20,40,000. If the population is unchecked it shall create more health problem, un-employment housing and education etc.   We should also control the communicable disease.

 

Over the last few years, a deadly and mysterious disease has erupted and begun to spread around the world. It a global pandemic with its victims doomed to certain death.   The disease is called AIDS, the initials of its full name, acquired immune deficiency syndrome. Medical researchers are still puzzled about the origin of AIDS.   Today, AIDS appears to be most prevalent in central Africa, the United States, Haiti, and Europe.   The World Health Organization is preparing a worldwide campaign to combat AIDS.

 

Our own well being is dependent on the well being of the others. We as a Pakistani have to learn that we have to live as a Muslim and better citizen as members of human community.   It is true that to change our system we have to adopt the comfort of our religion and its tradition to struggle against such problems, faced by our society.    Islam has defined the concept of human community and after adopting its principal much of the preventive work is being carried out for the well being of our nation.   Let us enrich the Islamic education to our population and work for Health and Peace of the Country.

 
SOURCE OF INFORMATION:
 

1.                  Pakistan Health and Social Welfare (1982), Ministry of Information and Broadcasting, Director of Films and Publications, Government of Pakistan, Islamabad.

2.                  Basic Facts of Pakistan (1984-85), Government of Pakistan Ministry of Finance, Islamabad.

3.                  Socio-economic Development under 5-Points Programme, by Abdul Majid Khan, Pakistan Times 23 March 1987.

4.                  Statistical and Budget Section, Director of Health Services, Punjab.

 
 
 


 

DENTAL PUBLIC HEALTH IN PAKISTAN AND

SUGGESTIONS FOR INTEGRATION

 

By Prof. Dr. M. A. Soofi

 

Dental Public Health, is a branch of community medicine based upon collective efforts, to check the disease from the community and to adopt measures for prevention, treatment and education including the research activities, because the preventive measures have been assessed for their efficacy and simplicity in their implementation both by the individual and community as a whole.

 
DEVELOPMENT OF DENTAL PUBLIC HEALTH
 

The development of dental public health in Pakistan has linked with the local indigenous treatment and serbvices established long ago pre partition. In undivided India, de’Montmorency College of Dentistry,Lahore was established in 1934. This Institution, since then holds premier position in providing the undergraduate dental education and treatment in its attached hospital to the public. Dental schools were available in Calcutta, Bombay and Delhi for producing the licentiate dentists for the treatment – Mardar-e-Millat Mohtarma Miss Fatima Jinnah was also the recipient of the license in dentistry from Calcutta Dental School prior to partition. In 1947 Marshal Day, the then Principal of the Dentistry College, Lahore gave attention to the school children for purposes of healthy dentition and thus he made a survey of Diyal Singh High School and Queen Merry School. In this way concern over the ill-dental health of the school children was emerged and concept of dental health education started. 

 

After the partition of sub-continent and establishment of independent state for Muslims of sub-continent by Quaid-e-Azam Mohammad Ali Jinnah, creator of Pakistan, dental education increased to the size of four existing institutions for undergraduate dental education in Pakistan (1) Liaquat Medical College, Jamshoro Hyderabad (2) Nishtar Medical College, Multan and (3) Khyber Medical College, Peshawar.

 

The education increased for curriculum but the preventive concepts and goals remain to be adopted. The Health Department at Central and Provincial Governments level created curative clinics of dentistry in almost all district headquarters of Pakistan and bigger Tehsils have also been provided with dental clinics with more facilities of treatment and less of the community work. The dental care for the children and mass prevention, education and administration in community dentistry are still to be developed.

 
PROBLEMS OF DENTISTRY IN PAKISTAN
 

The dentistry in Pakistan is getting popularity among the masses and changes are expected by them. But the labouring potentials of dentists in Pakistan are being derived by (1) many less job vacancies (2) high cost of instrument for private practice and (3) less prosperity in private practice in prevailing growing economic stress because the unqualified practice is extended to each corner of the country.

 

The gloomy picture of this profession is also due to lack of future provision of dental education and research and it is neglected relatively by the medical administration. There is no reciprocal relationships between the teaching of undergraduate and postgraduate research. The dentists having qualified many years back are starving for higher education. There is no chance for the dental graduates to increase their knowledge and status and thus many of them migrate to the different countries of the world and are obliged to settle down abroad for their prosperity and enterprise of their magnitude of research for proper promotion and object of their project, settle down in practice and there they are properly encouraged by the host governments. 

 

It is interesting to note that on one side dentists are serving the medical science Anesthesia and are considred as a complete component of the medical team, but for their promotion in status and knowledge they cannot wear the garments of postgraduate study diploma in Anesthesia (DA) because basically they are dental graduate and not medical graduate. What a tragedy? According   to the local proverb “Small crew is justified but the big crow is unjustified to be slaughtered for eating”.   Dentist is accepted as Anesthesiast but not accepted as post graduate anesthesiast student. Similarly, an unfortunate dentist, who by his virtue of hardwork, labour, interest, devotion in the field of medical pathology obtained research degree of Master of Philosophy in Pathology (M.Phil), perhaps in 1968. Since then the step-son of the medicine having the postgraduate research degree has not been given the right to apply as Assistant Professor in Pathology because basically he is a dental graduate and not a medical graduate. On other side of Dentistry his postgraduate degree is not being considered as postgraduate work is not in Dentistry and he (M. Phil) is constantly acting as Demonstrator in Nishtar Medical College, Multan. So the dentistry in Pakistan is a profession of gloom and concern. I, therefore urge that this discrimination and step motherly treatment may be stopped with for inducing better environment of the professional knowledge and economic growth in the country. The dentists should be provided with chance of enterprising if he is capable, why he should not be given the administration of whole medical system. We have seen in the past the chair of enterprise of Secretary Health was captured by Gynecologist, Blood Specialist, Physician and General Surgeon and why it should be captured not by a dentists. If he is creative, and possesses the sense of commitment and responsibility. Most of the dentists are dynamics and they are sensitive about the institution and they also possess the idea of their career and if they are considered as specialists, their chances of promotion may be fixed at par with the medical graduates.

 
Suggestion for Integration
 

Why dentists are not considered at par with the other medical graduates, some say the course of dental graduates is of years and that of medical graduate is of five years, though both the graduates appear at the University for 4 professional examinations, both graduates are given admission in their respective institutions after F. Sc. Per medical. The distance of one year is actual point of conflict. Let this education be integrated in the following form:  

 

a.                   Curriculum of Dentistry may be increased to five years in addition to one year basic subjects of Anatomy and Physiology may be added in addition to Community Dentistry. In this way the dental graduate shall have the equal basic knowledge about the basic subject and this shall decrease his problem, hardships and obstacles to achieve his rights and he shall be better educated than. It shall decrease the heart-burning to their counterpart and in this way he shall be able to achieve easily degree of
B. Sc. After the first professional examination like medical graduate.

b.                  All graduatges candidates willing for adopting the career as a dentist should be admitted in the medical colleges in the same way and after fourth year specialized training of dentistry may be added an exxxtra one year after medical graduation may be kept for their specialization as a periodontist, public health dentist, conservationist, orthodontist, oral physician and oral surgeon etc. This pattern of education already carried out in many of the countries of the world like Scandinnevia, USSR, Itlay, Spain and Pertugal, the separate dental education is adopted in U. K. And USA but the education is integrated and is being given by the medical schools in hospitals.   If this is adopted then (a) each medical college established in Pakistan should have a chair of specialist of dentistry/public dentistry of the medicine and dentistry, and (b) Medical graduates should be selected for higher training abroad for specializing in the field of Facio-Maxillary and other oral Plastry. So this way the medical schools should be part of medicine and dentistry and the chair of dentistry may be labeled as Dean or Head etc. This is the way how the continuing education in dentistry shall be achieved. 

 

Recommendations and Suggestions for the Development and Improvement of Dentistry

 

a.                   There is need of promulgation of Legislation and Dental Act to save the population from the crude and unscientific treatment; to safeguard interest of the qualified dentists for their jobs and for their private practice investment. In this way we shall set up an example of development in dentistry according to the tradition of the WHO elsewhere, and the Government should ban the unqualified practice at par with other countries of the world.

b.                  For continuing postgraduate dental education and professional standing and adopting specialization in this branch of medicine and in order to preserve and to improve the standard of practice and education, there must be provision of regular and frequent opportunities to the dentists throughout his working life because to maintain the knowledge and skills and new advances, there is need of suitable supervisors who possess the suitable values and are in a possession of opportunities to be provided to the trainee students. The teachers must have their contribution in profession in the recognized journals and his accumulative knowledge he has got the flexibility to part with the consequences of such talents shall bring bright future for the nation and the dentistry.

c.                   Dental surgeons should be given equal opportunities and facilities which shall be provided to the Medical officers in the forthcoming Health Policy.

d.                  Dental Surgeons should be treated at par with the Medical Officers while considering career structure, pay scales, promotion, etc.

e.                   The Dental faculty should be created at the Central and Provincial level and senior dental surgeons should be appointed for the administration of the dental services of dental surgeons in the Provinces and Centre.

f.                   Dental Health Education and School Health Services may be included in that list and the post of the Dental Hygienists (candidates from College of Community Medicine) should be created at each dental clinic to help the patients.

g.                  In order to fill up the dearth of the teachers in dentistry, the Associate Professors having diploma from the foreign universities in thier specific subject should be upgraded by giving relaxation at par with themedical diplomats who have been promoted to help the profession. I may add here that the Community Medicine has been given relaxation for upgrading the post of professors, which is also component of Public Health Dentistry.


Activity Report Concerning WHO

Prof. Dr. M. A. Soofi, Former Principal, CCM, Lahore &

WHO Oral Health Project Coordinator in Pakistan

 

Since taking over as National Coordination of WHO Oral Health Project in Pakistan, Prof. Dr. M. A. Soofi took up the assignment and chalked out a long term plan to utilize the available resources. To achieve the national oral health goals in Pakistan. Some Workshops, Seminars, Celebrations and other programmes were organized. A little are summarized below:

 
WHO Workshop (June 4-8, 1990)
 

A five day national workshop from 4th of 8th June, 1990 was organized. The main objective was to infuse concept of preventive dentistry and develop national thinking among the dental surgeons/ graduates of Pakistan through such efforts on scientific lines. The workshop proved to be a part of campaign which resulted in improving public health movement based on solid and well structured organizational net work.   Dental Surgeons/Graduates all over the country were invited to participate with the action plan to be adopted to achieve the ultimate goals. The main objectives of the WHO Project of Oral Health in Pakistan were highlighted in detail. 

 
WHO Health Day
 

It was observed on April 7, 1991 at College of Community Medicine, Lahore by Prof. Dr. M. A. Soofi. Provincial Health Minister was the Chief Guest. Emphasis were laid to achieve the goals of WHO under the theme: Complete Preparedness if Disaster strikes:

Prof. Dr. M. A. Soofi, Principal, College of Community Medicine, Lahore highlighted the precautionary and preventive measures with regard to WHO day theme. 

 
Family Health Workshop
 

With the collaboration of World Bank and Asian Development Bank, a one day workshop was organized under the Chairmanship of Professor Dr. M. A. Soofi, Principal, College of Community Medicine, Lahore on May 17, 1991.

 

WHO Workshop on Sanitation (July 27, 1991)

 

Preventive measures, promoting of the provision of safe water for drinking was stressed. The Workshop was organized by Prof. Dr. M. A. Soofi, Principal, College of Community Medicine, Lahore sponsored by WHO. It was attended by 40 delegates comprising of Sanitary Engineers and Medical Officers from all over the country of Pakistan. 

 
WHO Day (October 1, 1991)
 

On the occasion of “elderly people day” designated by WHO. In the symposium organized at Pakistan National Centre by Prof. Dr. M. A. Soofi welfare system for “Old Age Peoples” was planned. It was presided over by the Health Minister, Government of the Punjab.

 
7th April, 1991 -- WHO Day
 

WHO designated 7th April as ‘Environmental Pollution Day’. It was celebrated at Conference Hall of College of Community Medicine. The symposium was presided over by Prof. Dr. M. A. Soofi. Prof. Dr. M. A. Soofi presented a detailed study report reflecting causes of pollution and diseases spreading due to Environmental Pollution all over the world as well as in Pakistan.

 
No Tobacco Day – WHO Day
 

Keeping in view the WHO commitment to improve health services in the world ‘No Tobacco Day’ was observed on 31st May, 1992, by Prof. Dr. M. A. Soofi at Pakistan National Centre, Lahore. It was prresided over by Ch. Iqbal Ahmed, Minister for Agriculture, Government of Punjab. Preventive measures and steps to be taken was discussed in detail. 

 
Press Conference
 

With the collaboration of Public Health Association of Pakistan Prof. Dr. M. A. Soofi organized a press conference. In his press conference he stressed that smoking creates a large number of diseases. Therefore it must be discouraged at public places and urged upon the government that regulation should be passed in this connection. 

 
Walk against Tobacco (May 29, 1992)
 

To highlight the dangers of smoking ‘walk against tobacco’ was demonstrated which was headed by Punjab Health Minister, Prof. Dr. M. A. Soofi, Principal (Retd) College of Community Medicine, and others. The participants showed unity to discourage smoking and stressed upon the community to quit this uneconomical and dangerous habit.

 
 

 

WORKSHOP ON ORAL HEALTH CARE, LAHORE 4TH – 8TH JUNE, 1990

 
INTRODUCTION
 

A national workshop on strengthening concept of public health dentistry/communications at a professional level was held at Department of Dental Public Health, College of Community Medicine, Lahore (Pakistan) from 4th- 8th June, 1990. Workshop was sponsored by WHO with the cooperation of Federal Government of Pakistan and the Government of Punjab.   This was the first workshop on the subject sponsored by the WHO. Follow up according to protocol and action plan is expected at country level.

 

The workshop brought together 23 participants from the provinces, 12 from Punjab, 3 from Sind 2 from Baluchistan, 3 from Azad Kashmir and 2 from Social Security. One of the participant was from the Directorate of Health Services, Punjab, Lahore.   From WHO, Prof. M. A. Soofi acted as a temporary Advisor whereas Prof. Asad Ullah Lone, acted as a Facilitator. The Department of Dental Public Health, College of Community Medicine, Lahore was the main department involved in this workshop and took active part in the activities of the workshop.

 

In addition to Prof. M. A. Soofi, ten senior teachers of various specialities cooperated in extending their knowledge to the participants.   Senior teachers of the faculty of College of Community Medicine, Lahore acted as Coordinators in the plenary session groups.

 

Theopening ceremony at the campus of CCM, was conducted on 4th June, 1990. Senior Prof. and Paediatric Specialist Prof. S.M.K. Wasti was the Chief Guyest, and Prof. A. U. Lone inaugurated the ceremony.   Speeches were made by Prof. S.M.K. Wasti, Prof. A. U. Lone, Prof. M. A. Soofi and President of Pakistan Dental Association. Messages from Chief Ministers of Punjab and Baluchistan and Governor of Punjab were read by Dr. Shahid Anwar. Speakers appreciated the WHO for sponsoring such workshops and credit of organization was mentioned for the coordinator. (The participants were sent a questionnaire for bringing in data to the coordinator regarding vital statistics & incidence of dental problems in their areas).

 
OBJECTIVES OF THE WORKSHOP
 

The objectives of the workshop were according to the action plan prepared before, however:

a.                   Principal Objectives:

To improve training of dental health personnel in preventive dentistry in order to enable them to effectively assume the task of oral health physicians in their areas of duties and in context of primary health care.

 

b.                  Specific Objectives:

1.                  To identify areas of interest in training dental health personnel in preventive dentistry and mass education for dental health in the context of primary health care.

2.                  To strengthen the concept of utility of dental auxiliaries in the health program and to provide such facilities in the teaching centres.

3.                  To create the sense of integrated dental health care with medical care in MCH centres, educational institutions.

4.                  To examine the existing school health services and adding dental care in school health program.

5.                  To examine the existing health system and organization in the context of developing a suitable dental health administrative setup or modification and adoption in present system according to present needs.

 
WORKSHOP ACTIVITIES
 

A 5 days program with 9 workshop modules was planned to achieve the above objectives, each module and specific teaching were followed by exercises and group discussions under supervision of learned teachers.   Plenary sessions were used to make the presentation to introduce the module theme as well as to the discussion on reports. Each group leader, different in each session presented the module as part of exercise in front of other participants, for approval of recommendations.   The group composition remained same but the facilitator/teachers were rotated for effective teaching. National representation and experience consideration guided the formulation of groups, and groups were designated A, B, C, & D and each module was further divided into sub-topics.

 

Module-1, was concerned with dental health challenges and goals of WHO, the introduction was given by Prof. Dr. M. A. Soofi, who devoted much of time in explaining the need for training teachers and etiology and risk factors regarding the dental diseases. Later on plenary groups were assigned to discuss this matter in sub-topics.

Mudule-2, was titled Dental Health Care for mother and child. Prof. M. A. Soofi emphasised on the need for dental clinics in MCH centres to fulfil the needs for participation and dental health care of very important part of society.   And through this goals of WHO can be achieved through such integrated system. Associate Prof. Shamim Manzoor also discussed in length the need for dental clinics in MCH centres as there are lot of problems. She mentioned in her speech the dental Act, 1918 of England in which dental examination of pregnant mother was made essential. This will be better for understanding the social and cultural habits and will prove more effective approach in achievement of WHO goals.

 

Module-3, was concept of development of auxiliary worker, and community participation for motivation of the public and working for minor ailments and treatments.   The dental hygienist who are trained at College of Community Medicine, Prof. Soofi emphasised the appointment of trained dental hygienist at rural health centre for Basic Health Unit, for school health programme and each existing dental clinic at Tehsil & District Headquarter Hospitals. Discussions included the fact that in the absence of dental act large proportions of qualified dental hygienist/ professionalists who have received their training from the Department of Dental Public Health find difficulties in getting the jobs according to their training and they practice dentistry privately which shall damage the private practice of qualified practitioners. Prof. Soofi demanded that training of such type of health workers is to only provide dental health information to the community and emphasis is made that they had to work under direct supervision and physical presence of a dental surgeon and mentally they are tammed that their role is assistance of the dental surgeon who is the planner and policy maker in diagnosing a case and he writes instruction to the hygienists for performance of his/her jobs.

 

Module-4, ‘Health System in Pakistan’ was introduced and discussed by Prof. M. A. Soofi and Dr. Saeeda Rashid, Head of the Department of Public Health Practice.   The group discussions finalised that present health systems talks the provisions of management of dental services by dental surgeon. It was formulated that dental surgeon may be included in the health system to provide supervision for harmony and better achievement of the dental clinics by the dental surgeons. Since the dental surgeon does not hold any post in the present health system the proper motivation and emphasis on the oral health care not be passed onto the public with the presence concept of the integrated approach does not prove bright.

 

Module-5,  ‘Epidemiology & Biostatists’ was introduced by Prof. M. A. Soofi and Dr. Khalid Almas, Dr. Ayyaz Ali Khan, Sheikh Zaid Hospital talked about the need of epidemiological studies in dentistry.   This session was spent on explaining how to fill the simplified WHO chart of CPTIN introduced by FDI and WHO. Keeping in view the importance of this subject discussion with all participants tok place. The participants were taken to the clinic for practical training in use of WHO probes and filling out simplified CPTIN charts. They were also introduced to the teaching models available in the Department of Dental Public Health, like empty teeth periodontal problems, caries, canceral tooth, morphology etc. 

 

Module-6,  ‘Dental Health Planning’ was introduced by Prof. Soofi. Dates and slides shown and main dental prblems and their solution according to the need and demand of community trained dental physician, he emphasized training of dental surgeon in public health dentistry at under and postgraduate level. Because the dental disease can only be controlled by trained manpower who have a proper service structure in the ministry of health. Prof. Soofi also said that there is a considerable shortage of trained instructors in this field in undergraduate institutions. There is a need that this training will gear up the promotion of this science and this shall solve the primary health problems. He also said that there is a lack of knowledge in the public and in present dental graduates thus there is a need to enhance their understanding with suitable teaching materials and techniques to approach the public. He felt that such training will improve the performance of dental health worker in controlling the diseases. Number of areas were identified where dental surgeons are not involved in management. Therefore, much os the dental manpower is without proper job.

 

Module-7, ‘Dental Health Education’. Prof. M. A. Soofi highlighted the importance of dental health education and communication based upon social and cultural values, he said the dental surgeons should enhance their commitments through dental health education by involving the religiously effective persons, by training the school teachers and effective personalities like councellors MPAS and MNAs.   He emphasized that for mass communication a plan may be formulated for public relationing with mass media, administration for better results, he further said that there is a need to train all categories of health workers by the dental surgeons to provide them dental health education.  


 
 

Percentage Tabulation of the Results obtained from the Evaluations forms filled by the Participants during the WHO Workshop on Oral Health from 4th – 8th June, 1990.

 
 
                                    QUESTIONS                                                 ANSWERS

                                                                                                            50%     75%     100%

1

Are you satisfied with oral health workshop?

10.52
36.08
52.63
2

Have you learnt during this workshop?

21.00

36.08
42.00
3

How much your mind is motivated towards Public Health Dentistry?

21.00
26.32
47.37
4

How much have you learnt from lectures?

31.06
42.00
21.00
5

How much have your learnt from group discussions?

26.32
42.00
31.06
6

How much have you learnt from practical training?

31.06
36.08
21.00
7

How much have you learnt about addressing a gathering as leader?

21.00
36.08
42.00
8

How far group discussion have been beneficial to you?

5.26
32.06
58.00
9

Do you think the programme was heavy?

26.32
 
 
10

Are you satisfied with the participation allowance paid by WHO?

79.00
 
26.32
11

Do you recommend that coordinator should have arranged for participants accommodations?

79.00
 
26.32
12

Are you satisfied with the duration of the workshop?

47.37
 
47.37
13

Do you think such workshops should be conducted often?

100.00
 
 
14

Do you recommend younger persons or senior persons for such workshops?

100.00
 
68.40
15

Do you agreed to the recommendations chalked out by plenary groups?

100.00
 
 
16

What step you shall take to motivate the community?

A
100.00
B
52.63
C
52.63
 


RECOMMENDATIONS OF NATIONAL WORKSHOP ON ORAL HEALTH AS W. H. O. ORAL HEALTH PROGRAMME IN PAKISTAN

 
 

1.                  Dental Surgeons should give utmost attention to encouraging and promoting preventive measures in their areas.

2.                  Dental Surgeons should incorporate teachers, religious scholars and local leaders into preventive health education activities at all levels.

3.                  Dental Association and Medical Association and other such organizations should recommend through Seminars and discussions the practice of breast feeding and comfortable environment of diet etc. to pregnant and lactating mothers as tooth Bud is on formation, a good food to a mother is a better source of reservation to future teeth. Similarly breast feeding helps the child for proper development of oral soft tissues, dental tissues and dental arches for proper occlusion. Moreover, mother’s milk is protected from germs and no risk of diseases occurs and there is production of antibodies – means better dental health as healthy child possess non-susceptible tooth. 

 

In order to implement goals of Workshop six (6) specific areas needed to be developed.

 

I.                   CONSCIOUSNESS, RAISING DENTAL HEALTH MOTIVATION

Increase Awareness and appreciation for values of Quran and Hadis, on Oral Hygiene among the masses in order to prevent dental diseases from Community.

Targets:            The community at large – school teachers, leaders, health workers, mothers, children’s Association or such other Associations be considered for teaching of dental hygiene.

 
Strategies

a.                   Need for multi-sectorial approach, need for influencing decision makers Administrations, Schools Health Executives and Politicians.

b.                  Need for optimum use of relatively culturally accepted mass media, posters, leaflets, booklets, sermons in mosque etc. etc.

 

II.        DENTAL HEALTH EDUCATION & NUTRITION

 

            Promotion of dental health through nutrition, all type of food, raw vegetables, breast feeding and fluoridation of water.

 
Targets.
 

            The community at large including all health workers, children sports, and nurses, midwives, hospital administration, nutritionist, private practitioners and others may be guided for this topic.

Strategies.
 

            This must be consistent, health education and nutrition must be explained – practical instructions given if possible.

 

PROJECT FORMULATION

 

            Strengthening and implementing curriculum of B.D.S. with up-to-date knowledge of preventive dentistry.

 

ADMINISTRATION & LEGISLATION

 

Objective.

            Implementation for suggestion for dental health Administration set-up, like Doctor Medical Health Services Cadre, Service Structure and Seniority, promotion and dental Act. Ban on quackery, facilities to dental graduates at par with Medical Graduates.

 
Targets

            Smooth service structure and post-graduate training and education, through Institute of Public Health Dentistry.

 
Strategies
           

            To obtain influence of pressure groups. To move bill in the National Assembly for Medical and Dental Act.

 
Incentive
 

            Project formulation and activities through Pakistan Dental Association.

 
IV.      HEALTH SERVICES & DENTAL CARE
 
Objective

            To improve dental health services throughout Pakistan.

Targets

            All health personnel be involved and trained and educated about the importance of dental care and hence to obtain better budget.

 
Strategies
 

            To involve men of importance and executives.

 
Incentives
 

            To modify the present administration set-up with dental surgeons.

 
V.        COMMERCIAL FIRMS OF TOOTH PASTE
 
Objective
 

            Control advertisement without any authority in PTV or News Paper Advertisement of tooth paste powder may be approved by the Government and Pakistan Dental Association. Sensitize health administration to subtle profession by commercial firms and to educate them to monitor the activities of these firms.

 

            Monitoring of advertisements in Medical and Dental Journals for formulas which are processed for preparation of materials.

 

Targets

 

            Tooth-paste industry- health workers and consumers to be involved.

Strategies

            Formulation of code of esthics for toothpaste/tooth brush industry.

 

VI.       PERFECT FORMULATION & ACTIVITIES

            Increasing by trade and commercial boards. Mass media – Dental Health Education.

 

Objective.

            Maximum use of dental health education – message must be simple with concent of Pakistan Dental Association.

 

Target

            General public and Health Workers.
 

Strategies

            Association effective as possible.
 

Project Formulation

            Through all relevant areas – Dental Surgeons Dental Hygienist religious leaders lectures.

 


 

RECOMMENDATIONS ON PREVENTION OF DENTAL DISEASES:

 

1.             Dental Health Education should be delivered to the people through mass media T.V, Newspapers, Radio, Periodicals, Films etc.

2.             Advocate use of simple and low cost accessible oral hygiene methods like miswak etc.

3.             Stress on our own cultural values for diet, hygiene, and particularly breast feeding.

4.             Introduce school dental health service, with particular consideration of regular check up of children’s teeth and local fluoridation in the form of mouth rinses and topical fluorides.

5.             The dental clinics in the THQ & DHQ hospitals should be well equipped and staffed for trating dental caries and introduction of chapter in dental hygiene in primary school curriculum and sensitizing the primary school teachers about dental health.

6.             Regular workshops for oral health workers to sensitize them for preventive measures.

7.             Community based dental health training at under and postgraduate levels.

8.             Early diagnosis of the problem should be emphasized through regular checkup.

9.             Community Workers should also be sensitized for dental health education.

10.         Coordination between medical 7 dental personnels.

11.         Dental Act should be implemented.

12.         Safety measures to protect orodental structures should be observed in factories and traffic.

13.         Correction of any excess or deficiency of fluoride in community water supply.

14.         Sticky foods and snakes, containing high fermentable Carbohydrates should be discouraged.

 


 

PERIODONTAL DISEASE IN CHILDREN IN PAKISTAN

National Conference on Health Care & The Child at Jinnah Hall, Lahore on 5th Feb. 1981.

 
Summary
 

Children of Pakistan, according to various studies are suffering from Periodontal Disease and that needs prevention, through Public Health Practice, an introduction of Postgraduate Diploma Courses in Preventive Dentistry and Dental Hygienist are key to built Dental Public Health team for combating the Dental Disease from our Community. Periodontal Disease is an inflammatory condition of Periodontal apparatus.

 
ANATOMICAL REVIEW
 

The periodental apparatus is as follows: -

1.         Gingivae.

            Gingivae a part of oral mucosa membrance that covers the alveolar process of in jaws and surrounds the neck of teeth. It is pink in colour, it is divided as :

 

a.                   Marginal or unattached gingivae. This is a free margin of gingivae that surrounds the teeth, in a collar like fashion.

b.                  Attached gingivae. It extends from marginal gingivae to the alveolar mucosa.

c.                   Inter-Dental Papilla. It extends inter proximally. 

 

2.         Periodontal Membrance

 

            It is component of periodontal apparatus. It is made of connective tissue-which surrounds the root of tooth and connects it with the bone. It continue with connective tissue of gingivae and communicates with narrow spaces through the vessal channel with the bone.

 
Normal Structural Characteristics
 

That periodontal membrance includes bundles of connective tissue fibers, connective tissue cells, strands of epithetiun blood vessels lymphatics and nerves. Principal fibres or collagenous fibres are most important element, for a part of it inserted into cementum. The principal fibres are arranged in groups some may ramify the gingivae and few extend between the approximatic teeth.

 

A.                Transeplat Fibres

Extend introproximally over the alveolar crest and are emted in the cementum of adjacent teeth.

B.        Alveolar Fibres.

           

            Extend obliquely from cementum to alveolar crest, just beneath the epithelial attachment. It counter balances the coronal thrust of more apical fibres and helps the teeth to be in socket.

 

            Horizontal Group

 

            It extends at right angles to the long of the tooth from cementum to the alveolar bone. 

3.         Oblique Group

 

            Extends from the cementum in a eoronal direction obliquely to the bone. This is largest group of fibres and bears the vertical stresses transforming them into tension on the alveolar bone.

4.         Apical Group

            Radiates from the cementum of the tooth at the fundus of the socket to the bone.

C.           Cementum  
 

Cementum is classified mesenchmal tissue which form the outer covering of anatomical root.

 
D.          The Alveolar Bone
 

The portion of jaws which forms socket of the teeth is called alveolar process. It is made of osteceytes embedded in a calcified intra cellular matrix.

 

TYPES OF PERIODONTAL DISEASE AVAILABLE AMONG THE CHILDREN

 

Gingivitis – Inflamation of Gingivae as : -

a.                   Acute necrotizing gingivitis

b.                  Chronic desquamatic gingivitis

c.                   Puberty gingivitis

d.                  Perieoronitis- crupting gingivitis.

 

In all such conditions inflamation is common feature. Bacterial plaque is known source of aetiology. Materia alba, calculus are additional source of irritation and casaction.

 

Disease is distributed to single tooth or group teeth or may be generalized throughout the mouth. On the basis of location the disease is termed as : -

 

a.                   Marginai

b.                  Rapillary

c.                   Attached

 

So reviewing the anatomical explanation we now discuss the distribution and epidemiological study of the periodontal disease carried out here and elsewhere.

 
The Epidemiology of Periodotal Disease
 

Epidemiological investigations have been carried out in many parts of the world, starting from 1912 till today; still the epidemiology of periodontal disease is one of the important challenges before the dental profession in general and to preventive dentistry in particular at the moment.   There are, of course, retarding factors, e. g. Degree of accurate diagnosis, system of examination, expense and physical difficulty of X-Rays and absence of uniform method of assessment with the result that comparison has become difficult. Before the advent of indices, various subjective studies show vast variation even when carried out in the same place. King (1940) observed 90% result where campbell and Cook (1942) noticed 22% gingivitis in Dundee (U.K) McCall (1926) observed 98% gingivitis in USA and Brucker (1943) noticed 8.3% in the same country.

 

There is a need of standardized study in order to compare the results of one place with another.   The quantitative indices do exist and are of recent origin. Still the task of comparison is to be considered with some problems of invariability of examiners, etc. etc.

 

Similarly, factors of age, sex, intraoral distribution, local agents and other environment need to be considered for evaluating the periodontal disease in a community.

 

Prevalence and Severity of Periodontal Disease in Pakistan Early Study

 

There have been few epidemiological studies of periodontal disease in Pakistan. This is surprising in view of the widespread belief that there is a particularly high prevalence of certain types of periodontal disease in Pakistan an India. The earliest study was by Day & Shourie (1947) who studied children and adolescents of Lahore from Islamia High School and Queen Mary College, Lahore. Age range was 6 to 20 years. There were 1054 boys from a middle class School from 9-17 years and from Queen Mary College there were two groups-girls & boys of lower age.   Total subjects were 1377 a typical cross section of Lahore population. The criteria for assessment of gingival disease was followed according to King (1945).

Hypertrophic types of the gingival disease were observed and gingival disease was found highest so far reported elsewhere. Among 1054 subjects from Islamia High School, only six were free of gingival disease. Four age groups showed the disease about 100% and at all the age groups it was over 99% and average incidence was 99.43%. 73.62% showed either severe or very severe, whereas 25.8% slight to moderate gum disease.

 

In the case of girls the incidence is significantly less, % age of incidence of disease was 73.74% for 176 girls in comparison with boys 99.43 % of the same age group. This group comes from higher socio-economic division. A small group of boys 62 from 5-11 years attending the Queen Mary College was examined.

 

On comparing 58 boys to 106 girls of the same age group it was found that incidence of disease is more with boys than with girls.

 

It was found subjects with calculus had severity of disease and it was more common with school boys than girls. No relations could be made of ascorbic acide and gingival disease except vitamin –a deficiency might be the cause for hypertrophic exagition Gums.

 

Day and Tandan (1940) studied 756 children of School at Lahore and found 68% had gingivitis. Deposition of calculus and poor oral hygiene was observed. This study was carried out for incidence of dental caries and gingivitis was also included. Marshall Day was a Dean at de’Montomorency College of Dentistry, Lahore, emphasised the need of dental health education. 

 


 
STEPS FOR PREVENTIVE DENTISTRY
 

1.                  The Pakistan Dental Association Lahore Branch has arranged dinner meeting at Hotel Salateen, Lahore on June 28, 1974.   Dr. W. M. Barsum, Professor and Head of the Department of Prosthetics, University of Cairo delivered lecture on Maintenance and Service of Complete Denture to senior member of Association. Dr. Soofi presided over and Stage Secretary was Dr. Shuja ud Din Qureshi.

2.                  The Pakistan Dental Association Lahore Branch and International College of Dentists jointly held meeting at Inter-Continental Hotel, Lahore. Brig. Sahib Dan Khan, Minister for Agriculture was Chief Guest. The meeting was also attended by Dr. W. M. Barsum and Dr. Soofi spoke on Preventive Dentistry in Pakistan. It was attended by Dr. Sadiq Malhi, Minister for Communication. This function was also attended by medical men, dental surgeon, PMA and medical member including Dr. B. A. Yazdani, Capt. Aslam Khan, Dr. Randhawa and Dr. Bukhari.

3.                  The Pakistan Dental Association held a seminar about Care of Teeth on 7th Sept. 1975 at local hotel, presided over by Governor Punjab Muhammad Abbas Abbasi. Governor Punjab appreciated the services of Dr. M. A. Soofi, President Pakistan Dental Association who have been working for people through this preventive programme. Dr. Soofi suggested that all the Rural Health and Basic Health Centres should have dental clinic and dental hygienists should be trained and posted at such places.

4.                  The Pakistan Dental Association held Social Get Together meeting on 9th Jan. 1974 in which Rana Shaukat Mehmood, Minister for Health, Government of Punjab was the Chief Guest. Dr. M. A. Soofi invited attention of Minister for Health about Prevention of Dental Diseases in Community.  

5.                  Dental Care for Mother and Child in Pakistan. Dental Care Seminar on Mother and Child in Pakistan was inaugurated by Governor Punjab Muhammad Abbas Abbasi. Speakers were Dr. Abdul Khaliq and Dr. Mrs. A. K. Awan. It was very impressive and successful function which was highlighted the problem of dentistry in Pakistan and given weightage to dental profession because Dental science is at par with medical science. 

6.                  On 1 Jan. 1984, Lt Gen W. A. Barki Former Minister for Health and President of College of Physicians & Surgeons Pakistan emphasis that creation of College of Physicians & Surgeons Pakistan has given new look to the Medical Profession. He said previously for higher studies peoples were traveled abroad, now after establishment of College of Physicians & Surgeons Pakistan, students are availing the opportunity of doing postgraduation and fellowship in dentistry. He said dental speciality will be included in College examination. He appreciated the idea of Dr. Soofi, President Pakistan Dental Association that he has addressed college for creating dental science fellowship in the college. General Barki promised to help the demand of dental surgeons that examination of dentistry should be conducted in the college. 

7.                  Pakistan Dental Association held seminar on Allama Iqbal in 1975 at Gymkhana Club, Governor Punjab Justice Aslam Riaz was the Guest of Honour. Dr. Soofi attributed this phenomenon to the change in habit of eating the type of diet and formation of bacterial plaque and changes in environmental patterns. He, however, hoped that with modification of habits compatible with an enjoyable oral health and modern living, will help reduce the incidence of dental disease and control the greatest epidemic of all times. He said in many countries of developed world, a considerable decline in dental diseases has been recorded.   Enumerating causes of dental diseases, he said the dietary pattern of a society, negligence towards preventive inclinations, susceptibility of dental decay, dental tissue resistance’s due to malnutrition and inherited diseases tendency, are responsible factors for dental diseases.   Inadequate health education is another major factor for spread of dental diseases particularly among children.   The intellectuals failure and faults in educational curriculum of dental graduates towards dental public health measure, lack of organizing seminar on dental health education and dental weeks to guide people for the importance of dental health are yet another factors for the spread of this disease, he added.   He suggested that dental health planning and organization for solving problem of the community and the dental diseases and dental experts, introduction of postgraduate diploma in dental health in medical colleges, hard work, research and devotion is essential.

 


 
PUBLIC HEALTH PROBLEMS IN RURAL AREAS
 

Rural areas of East Pakistan are faced with innumerable public health problems. These problems result in the poor health of our villagers, which in turn results in the loss of vitality and energy to work. In a country like ours with agricultural economy most of the population living in the rural areas earn their livelihood by agriculture. Lack of energy and vitality leads to less production and the famous adage “Health is Wealth” comes to light. To ensure more agricultural output these stupendous public health problems need to be effaced. All the assertions that I have made in this respect is gathered from my experiences on personal contact with more than five lac people after living seven tenable years here and visiting more than 4000 villages in about 370 Thanas of total 411 in East Pakistan.   These are only a few salient sublime problems and there are many more which will meet the revealing eyes of each and every individual in every village of East Pakistan.   A very common sight in our rural areas is row of children with not bellies; fissures in lips and watering eyes in uncountable numbers.   What leads to this state of affairs? Pot bellies happen due to enlarged spleen, intestinal worms, rickets and malnutrition. Deficiency of vitamin B complex causes fissures. Watering eyes and varuious skin diseases are due to infections.   Our orthodox villages are completely ignorant of the basic hygienic principles. Only a few common rural health problems are being discussed hereunder.  

 
OLD DISEASE
 

Smallpox is a disease of great antiquity in our rural areas. This extraneous disease is outmoded in this modern age and can easily be prevented if proper law is enforced and action taken.   Each person should be instructed to take vaccination and those who refuse to take it should be punished. Persons responsible for vaccination and other duties sometimes submit fabricated reports of having vaccinated so many persons although the number of persons shown as vaccinated sometimes exceeds the actual population.   This is beyond the hallucination of the big bosses staying in the urban areas who take the report to be true and never bother to question its genuineness. In some cases the potency of vaccine due to long storage has also been questioned.   Some persons should have sufficient powers to deal with such situations ruthlessly whenever it arises without loss of time to bear fruitful results. Malaria is another disease of our rural areas. Although emaciated pot bellied, stunted growth figures are not much in evidence now a days but still malaria poses some problems in the foot hills of the Garo ranges and South East portions of East Pakistan including Cox’s Bazar and Chittagong Hill Tracts. In the rest of the province eradication of malaria is so far progressing very satisfactorily, as a result, everywhere in the province especially in Dinajpur one can find happy, smiling active individuals the same persons who a few years back used to have a gloomy emaciated dozy appearance?

 

Tuberculosis a disease almost unheard of in the villages is becoming common now a days.   Due to rapid urbanization. Famine and natural calamities, villagers come in streams and flock to the cities in the hope of better jobs with good wages. But to their utter disappointment they fail to get respectable jobs with sufficient money, enough to provide a square meal a day. Thus they are confined to live in the slum areas of the cities. These are the most crowded areas where Hygiene is one word totally unheard of. As a result these ill fated people fall an easy victim to T. B. When these diseased people go to the villages they carry the germ and succeed in spreading it among the innocent village folk. 

 

Gastro-intestinal disease, dysentery, diarrhea, intestinal worms and cholera are other infectious and contagious diseases from epidemic. These diseases too help in lowering the resistance power of our village; folk, Contaminated water and foodstuff are the main cause for this magnitude of disease in our rural areas. In some villages tube wells are scanty, their existence is much below the number needed. Even these few tube wells are not in places of convenience.   In most cases these are situated in such places that the rural population cannot conveniently use them.   Besides some of these are always out of order.   Even if they are in order the people lack the knowledge of taking advantage of it.   Therefore, they use well, ditch, pond and river water. Our orthodox people being unaware of the hygienic and health rules drink, bathe and wash clothes along with the animals in the same source of water. Even a person infected with a disease does the same.   In this way the disease spreads from one person to another until the whole population is brought within its reach. To exaggerate this colossal problem and to eschew from it, is to place tube wells in place of convenience for the villagers in central places and within easy reach of everybody. When these are out of order they should be immediately repaired without loss of time; there should be some person responsible for this job. Proper health education should be given to illiterate innocent villagers. 

 
TACKLING THE SITUATION
 

Improper disposal of night soil is another cause of the problem. Latrines are almost non existent in the rural areas resulting in various worm infections especially hook worm which causes anaemia among the village population. Works programmes which are doing good jobs can easily tackle this problem. They can easily make few separate latrines for men and women in central places of the village; to retrieve from these diseases. This does not require much money and help from the technicians. Finally people should be made to use these to acquire good health.   The dirty incorrigible sedate habits of the people need to be changed. 

 

Too many children in a family not only causes shortage of food and other facilities among the family members but also lowers the vitality of mothers and cause poor health of the off springs. Although the Family Planning Department is striving hard in this respect vet the message of it is yet to reach the remotest areas of the province where communication is bad. This problem can only be solved through personal approach and it will provide a joyous cordial atmosphere among the villagers.

 

Malnutrition is another serious cause for the poor health of our village folk. Mostly our village population lives on rice and common salt. Few of them can afford to get proteins, vitamins, minerals and salts needed for the maintenance of proper health, vitality and sustenance of an individual. The presumption is that in the bygone good old days people used to consume whatever they produced. But now due to good communication between the rural and urban areas people bring all their products to the markets for selling to earn cash money at the cost of their health. Kitchen garden in each and every house can help a lot in this respect, as the villagers will be able to consume the products of their own garden. 

 

Proper medical aid is yet to reach the remotest areas of our province. Few charitable dispensaries that used to provide medical care to the rural population are no longer in existence today.   Government dispensaries are without proper medicine and doctors. Though rural health centers are coming up yet they are not properly staffed. This cardinal state of affairs can easily be changed by raising the status of the octors and their wages.   Young medical graduates should be attracted to serve in these health centers and dispensaries by providing them with some incentive as is done in many other countries in the form of double pay and generous non practicing allowances in case of non practicing assignments. Those who work for two years at the rural health centres and dispensaries should only be sent abroad for higher studies and not the others.    These will help a lot to solve this problem.   

 
MEDICAL CONTROL
 

For proper functioning of the preventive side of medicine proper maneuvering is needed. All preventive health services should be brought under one control preferably under an autonomous body. The reason for this is that now the local bodies and Government both have dual control over basic health workers which results in no proper control at all. As a result the field staff do not bother to work properly because they know that it is almost impossible to be punished in due course for neglecting one’s work.   In health matters even a day’s delay in prevention may lead to loss of thousands of lives.   The sooner we face these problems in true spirits and try to solve tem in a practical way wholeheartedly and not in a patchy way, the better it is for our country. We are lucky as our village population is ready to receive welcome and cooperate with anything which is good for them provided they can be made to understand. My experience shows that individual house to house repeated contact is bound to produce good results and solve many problems. 


 
 
Promotion of Dentistry
 

The Executive Committee of Pakistan Dental Association (PDA) under the chairmanship of Dr. M. A. Soofi has decided to hold an International Dental Conference of the Muslim World in Pakistan and Armed Forces Institute of Dentistry Rawalpindi (1983) was selected the venue of the Conference.   All the preparation were made, and Chairman of the said Conference was proposed Brig. Atta ur Rehman, the then Dean Dental Faculty and Commandant Armed Forces Institute of Dentistry. The background of this decision was the result of personal meeting of
Dr. M. A. Soofi with President Islamic Republic of Pakistan General Muhammad Zia ul Haq in 1980 at Lahore when he was Chief Guest in annual function of King Edward Medical College and Prof. Dr. M. A. Soofi proposed the President of Pakistan to hold international Dental Conference of “Umat e Musalima”. The President appreciated this idea and promised to preside the Conference and the President advised the Minister for Health Dr. Basharat Jazbi and Director General Health Services Lt. General Iqbal Khan to extend all possible help to make this Umat-e-Musalima Conference success and this matter was put up before the Executive Committee of Pakistan Dental Association, Lahore Branch and Fellows of International College of Dentists, Section 24, USA. 

 

As usual the conspiracy emerged against this idea by the senior dental surgeons in Armed Forces Institute of Dentistry that Brig. Atta Ur Rehman should hold International Dental Surgeons Conference himself and should be organized by the Armed Forces Institute of Dentistry independently instead of Pakistan Dental Association and Dr. M. A. Soofi.   Since Brig. Atta ur Rehamn has been choosen as Chairman by PDA for International Islamic Dental Conference, he drifted and started working for holding conference of Dental Surgeons instead of PDA from 22-26 March, 1983. He was wise enough to keep my services involved a Member Organizing Committee, and Secretary Coordination and Publicity of the Conference and he write a letter as follows: -

 
 
My dear Dr .Soofi

              “Thank you very much for your letter of 6 March 1982. As you have know Lt. General Fahim, Surgeon General Armed Forces that President of Pakistan General Muhammad Zia ul Haq have been kind enough to give his approval of holding of an International Conference of Dental Surgeons in Rawalpindi/Islamabad on 22nd to 26th March, 1983 and we are making preparation.

 

              As you are very experiences member of the Dental Profession and have been involved in organising such conference, without your help and cooperation such a large undertaking cannot be efficiently organised.   Positive of your cooperation and help, inclusion of your name in the list of organising committee have been suggested without your permission.

              In view of this forthcoming conference I think we should not have separate Muslim World Dental Conference, it should naturally become part of an International Conference.

 

              Our total energies should be directed towards preparation of this conference to make it a big success.   I will send you a copy of the proposal as soon as it is issued by the Government. I am very grateful of the fact that you considered me suitable and has offered me the chairmanship of the organizing committee. I am thankful for the feelings expressed by you for my humble contribution in the field of dentistry”. 

 
Dear Brig. Atta ur Rehman
 

Keeping in view of my dedication to the profession, I accepted the offer and will join hand with you alongwith my team of workers. Thus I wrote a letter dated 10 March 1983 to Brig. Atta ur Rehman accepting my joining for successful conference. This conference was inaugurated by General Zia ul Haq, President, Islamic Republic of Pakistan, which was attended by large number of Generals, doctors and dental surgeons etc. etc. It was very successful conference and I read my paper on Fasigyn and presided over one of paper session.

 


Prior to this conference I had written letter to leaders of dental profession of various provinces and suggesting creation of Pakistan Dental Association Centre, as there only two active branches one at Karachi and other at Lahore. The gist of the letter was that we are gathering here at Rawalpindi. Let us consider to form a Central Body by election. I will not be a candidate as I had enjoyed office of Secretary General and President of Pakistan Dental Association United Pakistan. 

 

I was all the time very keen to expand the dental profession and was very keen to promote the medical profession, because without medical profession, dentistry cannot flourish and I do consider dentistry is part and parcel of medical field. I used to very active as a student and was in forefront of all the activities of the college and in medical colleges as well.   During my student life in Dental College (1952-56) I was elected as General Secretary (1954-55) and President (1955-56) of de’ Montmorency Dental Students Union. We used to hold our Union function and annual sports day together with KEMC Union thus I presented welcome address and poem to Mohtarma Fatima Jinnah she was Chief Guest in annual sports day on 22 Dec. 1952 and participated in drama “Khala” in 1952 at King Edward Medical College because we were given medical education by KEMC teaching staff basic subjects and clinical subjects for 3 years. We have learnt a lot from the gracious personalities of medical profession and coordination with other staff. It was a great honour and excellent learning through wisdom and intellect of the medical men.   The Medical Teachers of KEMC, were always very kind, nice and cooperative. There was a positive students relationship and teachers used to encourage the talents inside of a boy or girl. We had lot of respect for such teachers. 

 

When I came to know that Madri-e-Millat Mohtarma Fatima Jinnah is come to KEMC as Chief Guest, I went to the office of Col. Illahi Bux to get permission to recite my poem as welcome in annual sports day.   I was first year student. He saw my poem and I read before him. He smiled and allowed me to read and I read it after getting printed at my own. Due to encouragement of Medical Teachers I got this position. Poem is as under : -

 
 
 
 

I joined as pioneer dental surgeon of Baluchistan on 23.11.1956 at Sandeman (Civil) Hospital Quetta as incharge of dental surgery affairs through West Pakistan Health Services. I used to hold clinical meetings of the medical men as a Secretary. I used to read my papers and used to listen presentation by the learned Medical teachers, physicians and experts of medicine at Aminuddin Medical School, Quetta.    Prof. Dr. M. Hayat Zafar now the President Pakistan Medical and Dental Council was posted as a physician at Quetta, after his MRCP return from London. He and other physician appreciated my academic activities and we had a very good time of learning and exchange of views and in good friendly atmosphere in the ward and outdoor. Due to my academic and clinical activities, Dental Department was well built and equipment were purchased and treatment started.   

 

When I transferred to Lahore in Aug 1961 from Quetta (Baluchistan) to Mayo Hospital Lahore, I had good relation with Medical Superintendent Prof. Dr. Raiz Qadeer, at the campus of outdoor and indoor, we had good relations with all medical men. With nice understanding I could create dental surgery dept. in an area and place of visiting surgeon Dr. Riaz Qadeer, Professor of surgery KEMC.   The Dental Clinic was started as honorary by Dr. M. Z. K. Niazi in 1958 on his return from USA in a very small room nearly Dispensary. So I arranged to shift and installed Dental Unit.   (News cutting of Pakistan Times for installation of equipment). I remained in Mayo Hospital 1961-64 and 1966 to 1968. I had treated Mr. Manzoor Qadir the then Federal Law Minister, Khan Abdul Qayyum Khan, Abdul Sammad Achakzai, Justice S. A. Nazir, S. A. Mahmood, Minister and senior professors of Medical Colleges. 

 

When I was taken as a elected member of PMDC from two provinces I played my role very efficiently and my potentials were appreciated by almost all members of the council and president of the council Prof. Dr. A. J. Khan, he appreciated a lot of my services rendered for promotion of medical profession.   I shared all the discussion and participated in the medical seminars, read my paper concerning medical field for example; Redness of Eyes, Hyperplasia of Gums.  

 

I was much involved for the promotion of dentistry alongwith the promotion of medical profession and once I move motion against the name of PMDC (Pakistan Medical & Dental Council), as it should be Medical Council, with name PMDC means Medical is separate and Dental is separate, which is not, because Dentistry is a part of human body, my plea was there should be only one council, under this umbrella, all the sub-specialities, like dentistry, ENT, Orthopedic & Eyes, medicine etc. are included because there is one body and teeth and jaws are parts of the body why to label medical and dental separate. I was always pleaded that the dentistry as part of medicine. Once I was refused to cast vote in PMA General Election though I was a Life Member of Pakistan Medical Association, Lahore and Finance Secretary, PMA, I put an application before the Civil Judge, Lahore, that my refusal to cast a vote is illegal. I pleaded the case, that PMA leadership should prove that Maxilla & Mandible are not part of the body and our teaching is a separate. We were taught allopathic system of medicines at KEMC. So the Judge after hearing said “Medical profession should prove that Maxilla and Mandible are not part of the body.    They are separate, their treatment is separate? The Judge after hearing my arguments, and being a healer of the part of body, Dr. Soofi not be excluded from the election. The Judge after hearing both the parties concluded that “petitioner Dr. M. A. Soofi can cost vote and can contest the election in PMA” because he is the healer of the part of the body of the same system”.   On my return from U. K. after doing DPD from Dundee University 1979 I was posted at Civil Hospital Mardan. I organized PMA and was elected Finance Secretary, MPA Mardan and remained very active. At DHQ Hospital Mardan 1970-73 I had treated Abdul Ghafoor Khan Hoti, Mohammad Ali Khan Hoti and their families and conducted clinical meeting and enjoyed reputation.  

 

I joined Institute of Hygiene and Preventive Medicine, Nov. 1973 as a Demonstrator. I started working for creation of Dental Public Health Department and I was selected as Assistant Professor in 1975 and became Associate Professor in 1977. When I met the General Muhammad Zia ul Haq, President, Islamic Republic of Pakistan and General Sawar Khan, Governor Punjab in 1980. I had exchanged views as representative of medical association so I talked to the Governor, General Sawar Khan and I read letter.   The dental college is not getting successful because lacks teachers. I also suggested this college should became a part of the King Edward Medical College, like Lady Willington which is independent but it is part of KEMC I have also written to next Governor Lt. General Jillani. Letter written to General Zia ul Haq, President Islamic Republic of Pakistan is as under: -

 
 

            “ Kindly refer to my personal suggestion given to your honour at the International Alumni, King Edward Medical College, Lahore, on 29th March, 1980, that we would like to hold a Congress of Public Health Dentistry of the Muslim World. Your honour warmly appreciated this suggestion and assured all possible assistance in this regard. I am grateful both personally and on behalf of the Pakistan Dental Association for appreciation and assurance to hold such an International Congress, which shall be first of its kind under your patronship. 

 

On the same evening, I had the opportunity to meet Lt. General Muhammad Iqbal Chaudhary, Director General Health, Government of Pakistan, at the banquet dinner of Alumni of KEMC and he too expressed happiness. Lt. General Muhammad Iqbal was present when your kind honour assured me for holding such a Congress at Lahore. Hakim Muhammad Saeed Dehlvi, your adviser on “TIB” too assured his full cooperation and assistance in this regard, when I disclosed him this idea. He too appreciated this idea. 

 
            Benefits of the Congress:

§     It shall take stock of the prevailing conditions of the Dental Health in the Muslim World. 

§     It shall formulate and chalk out strategy to combat the problems confronting the Muslim World.

§     Its deliberations shall not only benefit the Muslim World but it shall also assist the Worlth Health Organization and Unicef. 

§     It shall provide to the Vetran Specialists in Dental Public Health for having an opportunity to exchange views and benefit each other from their experience. It shall benefit to all Muslim World individually and collectively.

§     The Congress shall provide an opportunity to launch a collective and massive programme to educate the people in their countries’ languages.

§     It shall also provide the forum to chalk out preventive measures for the Muslim World and there shall be more chances for future research.

§     There shall be more information about the mal nutrition or infection in oral cavity. The type of the diseases in the various countries according to their environments. 

§     It shall highlight the Muslims’ contributions in the scientific field during the course of discussion.

§     There shall be a special session to discuss the “Holy Quran” and “ Hadis” and the contributions of the Holy Prophet (Peace be upon Him) for the dental health.

§     It shall also establish liaison with Pakistani Doctors working abroad or elsewhere.

§     Last but not the least, it shall provide opportunity to lead the Muslim World, under your guidance, in Dentistry. 

 
Programme – duration and inauguration.
 

            The Congress shall remain in session for 3 days at Lahore. It will be inaugurated by your honour in the end of September or beginning of October 1980, subject to your convenience.

 

            Kindly provide me an opportunity to meet your honour for further detailed programme and your kind advice. Kindly also accept chief patronship of this Congress.

 

                                                                                                Sd/-

(Dr. M. A. Soofi)

Copy to: -

            Lt. General K. M. Arif,

            COS to the President,

            CMLA’s Secretariat,

            Rawalpindi
 

            Lt. General C. K. Hassan,

            Secretary

            Ministry of Health

            Govt. of Pakistan
                Islamabad.


 
HOW TO HAVE HEALTHY TEETH AND BETTER HEALTH
 

By Prof. Dr. M. A. Soofi

 

Healthy teeth and general health are closely related to each other. Teeth also provide assistance to eat, speak and smile.   The condition of the mouth should be free of the bacteria or infection i.e. the teeth will be free of dental caries. The gums should be free of microbes and calculus and other oral structures, lips, cheeks and tongue should be free of abrasion or ulcers. The dentition should be regular and it should not disturb the aesthetics.

 

Oral cancer is a very common manifestation of the oral cavity, it often causes by rough-edged tooth, rough filling, more smoking (Huqah, use of snuf and betal chewing) in addition to genetic engineering. HIV and AIDS can be exhibited in the oral cavity and almost all other systemic diseases can be detected.  

 

Pre-cancerous lesions, leucoplakia, submucous fibrosis, fungating and burrowing cancer can be detected.   Therefore, to prevent the pathological lesion-dental caries and periodontal problems and alignment of the teeth we want to launch 7 points programme to prevent the dental diseases.

 
Pre-birth Care
 

That the pregnant mother may be provided well balanced food comprising of optimal calories 3300 during pregnancy, vital nutrients and minerals may be given also. The mother should be kept free from any infection, fever or pregnancy –vomiting. She too also be provided comfort, better psychological environment. She should be free of psychological tension of “Nand” and “mother-in-law” because teeth start forming after three months of gestation period. And the child is born with 20 milk teeth and 20 buds of permanent teeth (are present) in the child mouth. Therefore for better development of deciduous (milk teeth) and permanent teeth balanced food is essential.

 
After Birth
 

The Child should be breast fed. Because it contains better nutrients of mother’s milk and creates better defence mechanism of body and that of teeth. Because the teeth are being developed by the general blood supply of the mother.   Then the child should be kept away from (i) bottle feeding. Due to bottle feeding and nipple sucking the upper teeth are pushed forward while the lower are displaced towards tongue.   Moreover upper lips become short and maxillary arch becomes “V” shaped instead of “U” shaped. (ii) Child should be kept away from “thumb” sucking, mouth breathing, lip biting, tongue biting and keeping the other postures of body in order. 

 
Foods
 

Eat foods that have vitamins and minerals-protein and chorbohyderates and fats. A well balanced diet containing all the components mentioned above is key to oral health and for the body too. If the nutritious diet rich in vitamin and mineral is taken the body becomes full of the defence against the bacterial agents. The nutrients are available in fruits, vegetable, breads, cereals milk and milk products, meat of all kinds and fish.

 
Teeth Harms of Sticky Foods
 

Don’t eat sweet of sticky foods between the meals. To decrease your chances of cavities and plaque formation, do not eat the sticky food in between your meal or after the meal. The food carrying high sugar or starch like breads, cakes and cookies is harmful for teeth if not cleaned. 

 

Beware of the foods sticky in nature and do not keep such sticky foods in your mouth because they give the plaque more time to produce acids to attack the tooth enamel. Try to avoid foods that stick to your teeth like to those of Tofees which contain honey molasses. If you eat such foods high in sugar then try to clean after your meals and rub your tongue. 

 
 
 
Brushing of Teeth
 

§ Brush your lower teeth from gums upwards.

§ Brush upper teeth from downwards.

§ Brush back and front of teeth and chewing surfaces.

§ Move and press bristles against food particles.

§ Choose the right tooth brush.

§ Daily flossing removes the plaque and food particles.

 
Use of Trusted Dental Aids
 

Regular tooth brushing with dental cream having fluoride protects tooth from decaying because the fluorides help strengthen tooth enamels and strong enamel helps to fight against cavity.

 
Regular Check up
 

Visit to Dentist regularly. Regular dental check up and cleaning are important and necessary even when there are no specific problems visible.

 

The directives of Islam pertain to a clean style of life because a Muslim has got a distinction to build up an healthy society. The basic values of Islam are piety, cleanliness, care in addition to honesty, hard work and education to the human beings. The Holy Prophet Muhammad (SAW) was the first health educator in the world and He (SAW) particularly stress upon the dental health. As such it has been proved by many evidences that the wooden stick miswak is beneficial and better than the mechanical methods and powders for maintenance of oral health. A muslim has to perform ablution especially before saying his prayer; five time a day which can reduce the dental plaque and becomes a source of reduction in the dental diseases because cleanliness by miswak-five time a day, is enough to keep the mouth and oral cavity clean and it automatically takes away the oral disease.

 

As per our survey more than 95 population of Pakistan is suffering from periodontal diseases; 60% are of dental caries 40% children have got irregular teeth, oral carcinoma is also a big challenge.

 

Talking about the causation about the disease, Prof. Dr. M. A. Soofi said that sweets and chocolates are major causative agent of dental decay in the children in addition to bottle feeding and imbalanced diet. Snuf and betal and smoking in any form, is harmful for the teeth, gums and all oral diseases as he said most of the oral cancer are being caused by such materials. Beri and Cigar and Huqah all can cause oral cancer in the mouth.

 

For the educational purposes of the community a colourful souvenir carrying research of intellectuals in this field and Two Decades of PDA Lahore, a quiet movement for reforming and building up the profession will be published. Press media is also requested to extend every help for the promotion and achieving the goals of this National Symposium by publicizing the lectures and other materials helpful in this drive.

 


 

COMMON DENTAL DISEASES, PREVALENCE AND THEIR CAUSES AND DENTAL NEED FOR RURAL COMMUNITY OF PAKISTAN

 
 
Two common Dental Diseases are : -
 

1.         PERIODONTAL DISEASE

 

Periodontal disease is a commonest dental ailment inflicting the younger population in Pakistan and if uncontrolled, it involves the older people. Various research studies of W.H.O. and the study of the author show that most of the population from 12 to 17 years is suffering from different grade of periodontal disease. Hardly there is a person who is free from this ailment.

 
Prevalence of the Dental Disease

Day and Tandan (1940), Day ad Shourie (1947) carried out studies at Lahore and found high incidence of periodontal disease among the younger age group. Similar studies of Metha et al. (1953), (1955) carried out in India reveal the high incidence of this disease. Ramfjord (1961) investigated the rural and urban population of Bombay (India) and found 100% prevalence of the periodontal disease. Soofi (1962) studied school children at Quetta and found 85% of the population having periodontal disease. Likewise studies of the McCell (1953) who observed 90% of disease in USA. Westin et al (1937) found 86.5% of gingivitis in Swedish school children. Saunders and Taylor (1930) noted 94% of gingivitis with Maori children in New Zealand. In the United Kingdom the incidence of the disease is likewise high, King (1940), (1945), Parfitt (1957), McHugh et al (1964), Sutcliffe (1968) and Sheiham (1960).

 

This has proved that the country is facing problem of periodontal diseases, especially in younger group which is evident from the epidemiological studies mentioned above. There is likelihood of increase of periodontal disease, if proper programme is not chalked out, to check the disease either by preventive methods or by curative means.

 

Periodontal disease involves the gingiva and other periodontal apparatus. The disease starts as an inflammation of the gingiva i.e. gingivitis, which leads to periodontal disease and that leads to early tooth loss, alongwith various ailments of general body and loss of taste of food.

 

Glickman (1967) explained that tooth loss due to periodontal disease become significant problem at the age of 35 years, but however, he mentioned that disease starts inearly days; by 15 years of age, 4 out of 5 persons have gingivitis and 4% periodontal disease is already present. In a population of 111 millions (in USA) at least 20 millions have lost all natural teeth and periodontal disease was present in 75% of the remainder. Glickman who is an authority on periodontal disease in the world, has mentioned that periodontal disease can be controlled by a local factor which are accessible, correctable and preventable. In most cases the gingivitis, the periodontal disease is preceded by inflammation, and he has mentioned that sole pathological process and local irritant combined with micro-organism are preferable cause for this disease. 

 

The major causative factor for this disease is unhygienic condition in the oral cavity where bacterial plaque is formed Declan (1968) while finding cluturable micro-organism he has taken a small plaque from periodontal pocket and found that: -

 

a.                   Strept – Mitis 29.4% of the total pocket flora.

b.                  Bacteriodes melanimogenicus 9.1 % of the pocket flora.

c.                   Vibryo – fusiformus – spirochete and actinomyces.

 

were available. The secretions, out of this bacterial plaque, attacks the gingiva and the periodontal disease takes its start. The disease (gingivitis) takes its formation and if it is unchecked it goes depend and after gingivitis, it involves the periodontal apparatus. Other studies also show that gingivitis is caused by local factor as compared to avitaminosis, blood dyscrasias or any other factors. The commonest sign and symptoms are redress of gingiva, bleeding from the gums, some times pain; in later stages pus oozes out of the crevix of gums and teeth become shaky due to loss of alveolar bone, with the result: -

 

a.                   Patient suffers from gums-ache

b.                  Patient cannot eat food of his taste for fear of pain which leads to law resistance of body.

 

Relation of systemic, illness and chronic periodontal disease

 

The relation of systemic illness and chronic periodontal disease as focal of infection has long been demonstrated and referred to repeatedly in literature and numerous miscellaneous disturbances in the body, have been considered due to presence of this disease. (Richards 1932) Roud et al. (1936) Fish (1937) Winslow (1938) Murray (1941) Elliot (1939) Robinson (1950) Carrod et al (1960). If proper steps are not taken in planning Health Services for further checking of the dental ailment, the general health of the Pakistanis shall be affected as referred to above, the work of the various workers. Several authors have made relation between the bad gums and the general health (which should be discussed in separate article).

 
Prevention

a.                       Cleanliness of the mouth after each meal is an important factor and use of tooth brush of the medium size is advised with any tooth paste.   This shall: -

(1)                retard the onset of the gingivitis and shall reduce the incidence of the gingival disease.

(2)                It shall improve the gingival health and produce stippling in the gingiva

(3)                It shall reduce the plaque and accumulate debris

(4)                It shall reduce the calculus formation

(5)                It shall keep the patient away from visiting the dentist and last but the least it shall reduce the discomfort and improve the economy of the family, and

(6)                It shall keep the general health in proper condition.

 

b.                       It is preferable that meals should be ended with fruit or piece of vegetable contrary to sweet dish. Regular visit to gum specialist after six months.

 
Treatment
 

Periodontal disease can be treated by advance method of science of periodontology and tooth loss can be prevented by personal care and by proper care of a dentist. 

 

2.         DENTAL CARIES

 

This is a second major dental disease.   According to WHO (1962) dental caries is defined aslocalized posteruptive, biological process of external origin involving softening of the hard tooth tissue and proceeding to forming a cavity in a tooth. Whereas other people have defined it, dental caries is a disease of calcified tissues of the tooth caused by acids resulting by the action of micro-organism on carbo-hydrates; characterised by de-calcification of inorganic portion and accompanied by destruction of organic portion. Lesion is in outest portion of the teeth.

a.                   Forms of the Acids

Acids are derived from carbo-hydrates after they have been acted by the enzymes of microbial flora.

 

            b.         Micro-Organism

                       

                        The common bacterias – Lacto : Strepto Dipth Yeats, Staph. Etc.   These bacterias are aggravated in a plaque which is formed by accumulation of the food debris and mucoid of the saliva and the carbo-hydrates in the diet.

 

c.                   De-calcification         

 

De-calcification depends upon the degree of acid and the duration of contact with the teeth. Acid is potential to decalcify the teeth at 5 pH. Normally PH of mouth is 7.2 decalcification takes place after critical PH 5.2.

            d.         Substrate and Enzymal System
 

                        A suitable substrate enzymal system is essential for production of acids, mostly on monosaccharide and disaccharides. Since the commonest carbohydrates in the diet are starch and sucrose, with smaller amount of glucose and fructose. Thus quantitatively the important substrates which penetrate the plaque are sucrose and maltose. Disaccharide are splitted into monosaccharides before they are converted to the acids.

                        Sucrose            invertase          Glucose           +          fructose
                        Maltose           Maltase            Glucose           +          Glucose
                       

Some times enzymes like invertase and maltase are available with any micro-organism. Thus plaque is confronted with the task of metabelizing mixture of sugar prominently glucose.

The glucose is broken down by some micro-organism in the presence of oxygen, glucose is metabolized to carbondioxide and water, if the oxygen is removed, lactic and other acids may accumulate. Staphy-lococci and yeasts are responsible for breaking down the glucose to acid, just like in the muscle. The other organisms, like streptococci and lactobaccilli play an important role in the production of acid to disintegrate the surface of the tooth or forming a cavity. The bacterial plaque is major factor which influence the disintegration of the teeth.

 
Retention of the Acids
 

The effect of caries process, on the tooth is by the circumstances in which the tooth retains environmental factors: -

a.                   Dental Plaque

An organic nitrogenous mass containing multitude of organism adhering to surface of the teeth.

           

b.                  An anatamic Character

All teeth differ in their shape and form, some provide more chance for retention of acids in their fissures. Some time the position of the tooth is such that acids get more chance to disintegrate its outer surface for further destructing the organic material.

 

            c.         Position or Arrangement of Teeth in Dental Arch

 

                        In certain cases the teeth are irregular and this mostly happens by wrong habits – hereditary and retaining of milk teeth in the mouth. When the teeth are irregular the acids get more chance for retention and the result is destruction of the teeth.

 
            d.         Presence of Dental Appliances 
                       

                        Some time the dental appliances give a change to acids for retention purpose. If they are ill-devised in wrong filling – dentures – orthodontic appliances – fixed crown and bridges, it also provide chance for retention of the acids and the caries could happen.

 

e.       Attitude of individual towards the cleanliness

         

          Each individual has got different attitude towards cleanliness of the oral cavity; some people are prompt and some don’t clean their teeth with the result retention of the acids takes place and destruction of the teeth happens.

 
INHIBITORY FACTORS
 

There are natural factors in mouth which contribute to dissipation of acid formation on the teeth e.g. an amount of saliva, composition i.e. organic or inorganic, PH, vicosity, antibacterial factors and buffering capacity. So all the factors correlates to caused dental decay i.e.

            TOOTH

                        Its :-
                                    Composition
                                    Morphology

                                    Position of the tooth

            SALIVA AND DIET

                                    Physical factor, quantity of diet etc.

                                    Local Factor:

                                                Carbohydrate content

                                                Vitamin Content

                                                  Fluorine intake and neglect of the individual help to cause the dental decay

 

However, systemic condition don’t very much effect the dental decay. It has been observed that diabetes, endocrine glands production, infectious disease and constitution and hereditary factor are not directly connected with the causation of the dental decay. However, they do influence otherwise.

 

            THEORY OF THE CARIES

 
                        Acidic
                        Proteolysis
                        Chelation
 

            ACIDIC THEORY

 

            This is the oldest theory of dental caries which is still very much positive. According to this theory the cariogenic diet, provides adequate substrate for enzymic degradation.

 

            ORAL MICRO-ORGANISM

 

            In dental plaque micro-organism convert the substrate into acids in such quantity and concentration to demineralise the enamel surface of the tooth.

 

            SUSCEPTIBILITY OF THE TOOTH SURFACE

 

            Stephan (1944) made observation which is positively convincing for rapid formation of the acids by the dental plaque.  He found, there was a drop of pH in the dental plaque at 4.5 within 5 minutes after ingestion of glucose solution. The pH returns to neutrality after 30 minutes. The production of acids contribute to caried process.

 

            PROTEOLYSIS CONCEPT

 

            Some workers suggested that the dental caries start with destruction of the enamel organic matrix and its process disintegrate the enamel like bricks wall collapse after removal of mortar. Frishic & Nuckolls (1947) believed that initial change was the proteolysis of the surface membrane and interprismatic protein of the enamel. Gollieb (1947) suggested that enamel lamellae were the site of caries initiation. However, hypothesis of caries of this nature is failed to demonstrate this process practically.

 

            CHELATION THEORY

 

            The proponder of this theory pleads that initial demineralization of the enamel surface does not happen due to production of the acids by the substrate, acted upon micro-organism but doe to chelation process. Schalz & Martin (1962) who are originator of this theory but could prove it otherwise. They could prove it theoretically and this concept failed to convince other workers.

 
PREVENTION OF DENTAL CARIES
 
            By patient
By Dentist
By the State; and
By Social Organizations 
 
By Patient
 

The patient can prevent the occurrence of dental decay and other ailments by self care, following the proper methods of tooth brush i.e.: -

a.                   before going to bed and after breakfast

b.                  he avoids sticky food before retirement; and

c.                   visits his Dentist by every 6 months for regular check up.

 

Patient’s care and aptitude helps a lot in preventive programme.

           

            Muller (1956) states that German dislike the idea of teeth extraction. Similarly in Switzerland parents are much more concerned with the children teeth and school dental service. There are special health education programmes. In Holland the people are also keen to prevent the loss of teeth due to dental decay. Newzealand’s people are regular at use of tooth brush and preventive measures individually and collectively.

 
BY DENTIST
 

            A dentist can prevent the occurrence of dental decay by: -

 

a.                   the process of filling the cavity after application of his knowledge and skill by the use of instruments;

b.                  when a patient regularly visits him he just inform the patient about the pit or spot to be filled in time.

c.                   Persuade his patient to be more careful and cooperative in preventing the dental disease as a part of dental health education.

d.                  the dentist should get out of his clinic and motivate the public or school children by demonstrating the means of prevention, causes of the dental decay and inform the patient about the coming pain or extraction in case the treatment is not carried out.

BY THE STATE
           

            The state and local authorities can pay an important role in preventing the disease by an introduction of dental public health measures in the country, school dental service in the educational institutions and regular check up as a part of medical fitness.

 

            The State should encourage the public means of communications i.e. T.V., Radio and News Papers for preventive work. Most of te country of the world, even Iran has got the preventive organization in the country for preventive work. State can control the disease by proper water analysis and in case the Fluoride salt is lacking in drinking water i.e. less than one part in one Million parts of water the fluoridation is introduced.

 
PRIVATE AGENCIES
 

            In case the Government’s resources are limited for introducing dental public health, Private Agencies like Red cross, Maternal and Child welfare Association, Family Planning, Pakistan Medical Association, Pakistan Public Health Association, APWA Organization can help in controlling and prevention of the dental decay by at least health education programme and setting of dental clinic at their own organization.

 

DENTAL AID FOR RURAL COMMUNITY OF PAKISTAN

 

            The majority of population of Pakistan comes from rural areas and so far, no attention is being paid for dental care of this population either in any rural clinic or planning health centre or any employee dispensary by the previous Government, with the result that: -

a.                   there is complete absence of dental public health aid in the rural areas

b.                  rural population is entirely ignorant about the dental health and its utility and importance; and

c.                   lack of guidance, remains an immediate feature to the rural population

 

The dental clinics have been designed by the Government mostly in District headquarter’s hospitals.   The population of all districts of Pakistan is so high that single dental surgeon cannot look after the public health, the health education or care of the school’s children or any step for the rural community except he is busy in extraction of the teeth at district headquarter’s hospital.

 
DENTISTRY
 

            Dentistry is an over growing profession expanding in knowledge and technique as a branch of general medicine.   There are special branches but early need is that of dental public health or public dentistry. If it is introduced this shall benefit: -

 

a.                   to a dentist which shall encourage him for a postgraduate training in public health;

b.                  it shall benefit the population of the country;

c.                   it shall help the designers for its expansion;

d.                  it shall provide the involved modes and methods of research; and

e.                   it shall provide a chance to collect and determine: -

(1)               Prevalence

(2)               Type

(3)               Extent

(4)               Severity of the diseases in the community

f.                   it shall also help us in making service to collect and provide information on dental condition of the community and

g.                  last but the least it shall provide us the data for our study in comparison to the data of the other countries of the world.

 
NEED OF THE COMMUNITY
 

The major needs of the rural community are : -

a.                   immediate availability of the dental aid;

b.                  relief of dental pain; and

c.                   proper guidance and assurance for dental problems

 

However, the community does not need luxurious, costly and modern equipments with modern uniform of the dentist or Assistant. The community does not need English speaking persons with rude behaviour, with un-sympathetic attitude with non-affectionate feelings. But community needs, sympathetic attitude, affectionate feelings and man of motto of service to the human community to render service in an ordinary manner, in a ordinary room with ordinary field dental chair and ordinary room with small amount of medicines.

 

KNOWLEDGE ABOUT THE POPULATION IN PAKISTAN

 

According to census of 1961 of Pakistan 86.9% of the population lives in villages, whereas 13.1% dewels in urban areas. There are 35,412 villages in West Pakistan. 74.3% of the population is dependent on agricultural or pasture land.

 

Literacy rate is 15.9 % for the whole country, 23.4 % males and 7.6 % females are literate. The majority of the literate people live in cities and majority of the rural population are illiterate. There are 9, 123,004 children between the ages of 5 to 14 years.

 

There are four provinces in Pakistan, 51 districts, 193 tehsils, 37067 villages, 3302 union councils and 23 cantonment boards whereas the Province of Punjab has got 19 districts, 72 tehsils, 103 towns, 42 health centres and 9 cantonment boards.

 

HOW TO GET?

 

a.                   Our country is facing financial difficulties

b.                  This is a developing country

c.                   There is a dearth of qualified and experienced dentists.

d.                  The State cannot spend much of the budget on the foreign modern equipments which cost about 50,000 to 60,000/- rupees for a clinic and last but the least our country is not rich to afford for luxurious equipments.

 
SOLUTION:
 

a.                   At present there are about 120 unemployed dentists and the dental clinics so far are only attached to the district headquarter’s hospital of Pakistan except at a few Tehsil Headquarter’s hospital.

Government may start dental clinics at existing 72 tehsils of Punjab immediately. This shall help: -

(1)               Tehsil population

(2)               Unemployed qualified dentists will be absorbed; and

(3)               It shall be a complete medical aid – and barrier of dentistry and medicine shall break.

b.                  Dental Public Health School: -

Dental Public Health School may be established first at Lahore, then at other places like Hyderabad, Peshawar and Quetta to produce Dental Health Visitors or Dental Hygienists or Male Dental Health Workers. The course of curriculum should be of two years at par with Lady Health Visitors Course. The facilities and the curriculum of instructions of public health dentistry can be utilized in collaboration with the Institute of Preventive Medicine. The course will be conducted under Public Health Department of the Province. This shall produce para-dental staff which shall be spread over in rural centres, in sub centres and in the primary and middle schools. These persons shall educate the people, guide them properly and shall do the minor and immediate treatment under the supervision of Tehsil Dental Officers which shall eradicate the dearth of Dental Man power. 

 

c.                   Cheaper Dental Clinics

 

A field dental chair with cheaper equipments costing about 2000 to 3000 rupees can be installed in rural centres for rural population to solve their immediate problems.

 

EPIDEMIOLOGICAL STUDIES

 

When the programme will be introduced the epidemiological study of the rural population shall be must which shall guide us for future planning of the dental aid.

 

DENTAL ACT

 

Government of Pakistan should enforce an Act that art and science for practice of dentistry should be in hands of qualified personnel. No person should be allowed to use the word doctor unless he is a graduate from any University of the country. Similarly, the Dental Hygienist should not allowed to use the word doctor. They shall only work under the direct supervision of Dental Officer.  It is further suggested that the present un-qualified person should be registered separately as unqualified practitioner dentist after constituting a committee of the experts to judge their ability for registration in that register.

 
Summary:
 

a.                   Rural population needs immediate dental relief centre.

b.                  Cheeper dental clinics are the proper answer under the present financial position of the country.

c.                   Para-dental schools should be started to produce the dental man power.

d.                  Preventive dentistry is a final answer. 

 


 
TOOTH-PASTE AND ITS USE
 

Tooth paste is very commonly used by the citizens daily for prevention and protection from the dental diseases. Many companies introduce their Toothpaste claiming the prevention of dental caries, periodontal diseases and plaque control. Companies plead that these toothpaste reduce the plaque and relieves the complaint of gums etc.    

 

No Toothpaste can treat any disease because the gingival, periodontal disease are the bacterial and absorption of the Boone and periodontist can only be treated by proper diagnosis which is to be determined by clinical examination and laboratory test and temperament, attitude and life style of the patients. Toothpaste are only means to clean the teeth. Plaque can be reduced further by the rubbing teeth with finger.   Toothpaste hardly play any such role and they cannot prevent diseases or treat diseases. We examined all the tooth paste, almost all the toothpaste have following ingredients :

                       

(1) Antiseptic material   (2) Soapy matters (3) Abrasive ingredients 

(4) Sophisticated Colour and taste
 

Rest of the things are added by the Companies to attract the people. Major job of tooth paste is to facilitate the movement of tooth brush actively.   If people clean their teeth after each meal with any thing and continue this practice they can secure themselves against diseases. If it has become gingivitis, swelling of gums then the gum papilla or margin become rounded in contrast to normal tissue how toothpaste can be help it and in case a person becomes most irregular, then severe inflammation with swelling, redness situation are seen. All these conditions cannot however be controlled by any toothpaste or mouth wash, we have to treat properly with care of diagnosis perhaps in some cases surgical intervention. 

 

The poor oral hygiene is a result of negligence of the individual not to know the importance of cleanliness after each meal. Medium of cleanliness, time and place of keeping of tooth brush, alongwith    and two brush are to be used.   To treat any disease of the body, healer is to be diagnose properly, he is to get information clinically, and few laboratory tests are carried out then the decision is to be made to treat the patient. All these charmed things are not truth, therefore, tooth paste plays a role of cleanliness with nice taste, flavour.  

 


 
PRIMARY DENTAL HEALTH CARE AT BASIC HEALTH UNITS —
DENTAL PUBLIC HEALTH PROGRAMME
 
 

A system of primary health care is one of the element of the health system. It is the basic element upon which all the other elements are built. Primary Health Care is not an important aim in itself; it is the means to achieve better health, a step i the development and in the hierarchy of the health services. This outline is based upon 8 basic components of Primary Health Care i. e :

a.                   Health Education

b.                  Promotion of food supplies and proper nutrition

c.                   Adequate supply of safe water and basic sanitation

d.                  Maternal and child care, including family planning, and oral health care

e.                   Immunization

f.                   Prevention and control of locally endemic diseases

g.                  Appropriate treatment of common diseases and injuries (including dental)

h.                  Provision of essential drugs

 

Obviously all areas do not enjoy the level of the development or healthcare system, because in our society a limited number of privileged people and population mainly in Urban areas, are benefited from most of the available health care facilities, sophisticated and expensive equipment and treatment, involving most of the health resources of the country. With this system of primary health care which is to be provided in families of farmers or workers or general public with net work of facilities in health and Dental Health field, at the secondary and tertiary centre, this means an improvement. And credit goes to philosophy of the primary health care system, and the administrators who prepare guide lines for improvement of the situation. This is the real effort which is made to rationalized health expenses and activities to make dental health care available for entire population. The health worker / dental team needs certain training to fulfil obligation of Public Health.

 

OBJECTIVES OF THE TRAINING

 

a.                   Principal objective

To improve the public health concept of the health personnel in communication of Dental Health Education, in order to enable him to be effective for assuming the task of communication and health education and dental treatment of individual, families and communities in the context of basic health unit care and dissemination of knowledge about modern preventive practices and surgical techniques.

 

b.                  Specific Objective

 

(1)               To identify the areas of needs of health personnels in communication for Dental Health Care in context of basic Health Unit Care System/Public Health Care.

(2)               To examine the existing level of ideas of dental health understanding and aptitude of oral health treatment or any person or institution already doing so and to determine their adequacy to the needs of the population identified.

(3)               To strengthen the teaching of communication/Dental Care Education in health personnels training at this training center in the above context by developing suitable teaching learning modules which can be adopted to the local needs.

(4)               To develop the close collaboration within the health sector by the dental manpower to become responsible through training for management of dental public health.

(5)               Through such areas of training, the concept of primary health care, community organization understanding cultural values and their effect on dental health.

(6)               The education of the families in the villages in practice of oral health discipline towards healthy living. For prevention of dental disease, ill health and mal-nutrition, in relation to Maternal and Child Health. 

 

Such factors Fibrous food and uncivilized diet are important to develop the jaw in proper order “U” shaped and good teeth in order to enable food to be well chewed and prepared for digestion and absorption, because when teeth are missing or diseased, it is impossible to chew the food properly and proper development of the jaw is delayed because good sound teeth and well developed jaws are important for health, appearance and speech.

 

The WHO accepted goal of health for all in 2000 it concerned the oral health as well. World wise experience has shown that there are many good preventive and curative methods in Dentistry and provided their use, a significant decrease in oral disease occurs.

 
PROBLEM IDENTIFICATION IN ORAL HEALTH
 

 To aid the BHU/ PHC it is the most important task, that a criteria needs to be established for selection of the problems, as mentioned above according to the local situations, in relation to cultural patterns, economic status and family set up. The oral health problems are of emergency nature, and there is a need of target for prevention among the children, young and the aged. The families and all types of workers need attention.

 

In all the types of services i.e. preventive, curative, educative, referal, there is comprehensive need to have other kind of knowledge of socio-economic problems confronted to population. Because the prevention of disease depends upon understanding of the etiology and natural history of the disease without knowledge on scientific basis, it is not unreasonable to suggest anything for prevention of dental caries or periodontal disease or oral cancer to the population.

 

The dental and periodontal tissues are part of living body and necessity of the knowledge is valuable in subjects of Anatomy, Physiology, Pathology, Bacteriology, Medicine, Surgery and dental surgery, therefore the treating & prevailing of the dental diseases there is need of elaborate curriculum for educational values to the dental surgeon.

 

DENTISTRY IS A BIOLOGICAL SCIENCE

  

Dentistry is also a biological science, when the healer is introduced to the patient, through learning the art of diagnosis or technical procedure, there are certain common conditions and uncommon conditions, which can guide for research reforms of science, so in such circumstances, where complete dental treatment is not provided but many advanced nature diseases are present. The doctor can go for making some studies and this shall increase his status and research. The dental graduate is fully aware of: -

 

a.                   Knowledge of dental diseases

b.                  Skill to handle the dental problems

c.                   The attitude of Dental Hygienist for research and community social service

 

For each programme effectiveness depends upon the team of the workers, their knowledge, attitude and social behaviour. For making a programme more successful and achieving objectives mentioned above and strategy.

 

A community dental health worker (Dental Hygienist) is to be included in these schemes for interrelation or oral health with general health policies. This personnel under the supervision of dental officer will carry out the preventive work and curative therapy of minor nature. For me a doctor is a leader of a team to execute the policies of the Government, and checking the responsibilities of each component of health scheme.

 

The doctor should identify certain diseases for overall health policies formulation and solving of the major proportions through conciling the meaningful decisions, but rest of the school groups, mothers, teacher or religions leaders or local workers and discussion for preventive education through the use of dental auxiliaries.

 
TRAINING PROGRAMME OF DENTAL DOCTORS
 

At present in 29 districts and 89 tehsils dental officers are providing the dental health services, according to present planned system as an integral part of health system for a community.   The Rural Health Centres (RMC) so far are expected to be provided with a oral health care programme in future. After this provision at RHC the services to the communities for dental health care shall became of great value, with easier approach, both of the area, community and by the BHU as a referral cases. Since presently we had to provide preventive care and emergency care to the population at the BHU. Therefore training to the dental officer as leader of the team. For example, accidental trauma to an infant or young child is very common in the rural population, and to handle such accidental situation, relating to the oral cavity in knowing the extent of the dental injury, evaluation for the treatment of immediate nature or for referral purposes, is essential.

 

Pain is a common feature and removal of pain is only possible effectively, by knowing the cause, and to know a cause, there is a need of better study, in a move scientific way syllabus. 

1.                  Reviewing of dental anatomy, Physiology, Pathology and Bacteriology.

2.                  Etiology of dental caries and its prevention and identification & measures for relief of pain associated with caries.

3.                  Etiology of periodontal diseases, prevention, classification, relief of pain & bleeding associated with it. 

4.                  Dentofacial Articulation, pain T.M.J, old cases of dentofacial trauma and injuries to the Jaws and their management.

5.                  Oral lesions etiology, identification, prevention social aspect of these.

6.                  Overall preventive measures, (Miswak technique, brushing and modern therapies, Fluoridation, school health services and religious gathering).

 

Practical training, knowledge regarding instruments and handling the same for identification of oral health problems for process of relieving of pain and other immediate problems of: -

 

a.                   Managing oral health problem in a separate office.

b.                  Keeping record of such problems for collection of data.

c.                   Use of various medicaments and prescriptions.

 
 

The ability of the dental health care physician is to cope with the patients for the immediate problems in Oral Health, he will confirm to the expectations of the programme. Because there is no real substitute to patients by better understanding and proper handling by the doctors. The doctors level of intelligence, personality to a problem, in solving the situation will be an achievement. Because in the bignning, patients will not be motivated, his first suggestions and approach might not architect the confidence of the people because of the customs and prevailing system in society. It will depend on the doctors, in solving the health problems, which will bring a special significance in achieving the target of minimizing the disease because all such efforts of the doctor, Government financing agency, health team, and the public will contribute to consolidation of the initial interest of the patients, and the family which has brought them to the office or surgery or basic health unit, even for simple pain relief.

 

ORAL HEALTH MEASURE

 

Many rural children, according to many studies have poor and reduced ability to concentrate, for a few moments on the Dental Health Care. The results of these habits and customs, the oral Hygiene of the rural population stands poor, with heavy accumulation of plaque and calculus. Many among them, might not be able to manage tooth brush once in life or they could restrict to rinse their mouth and use the fingers. Few people do use the stick/ Miswak/bark of the tree. But most of them are free of this habit of cleaning the teeth.

 

Old Dietary habits are particular importance as the rural population has developed, the taste for modern sweets and drinks and other forms of the modern foods which are causing gingival and caries to the development and other oral disease. So far, oral hygiene practice as simple as possible is their need.   The oral cleaning after each food is reasonably effective, if being carried out at least once a day or twice a day and thus there is a need to arrange for oral health measures designed for specific degrees of the rural population by dentist. 

 

So, Dental Public Health is a broad spectrum to minimize the disease. It creates awareness among the people.   On it gives exact pictures to explain the situation to the gums and helps in research and precaution for future.

 
Role of Dental Officer in a Community
 

The behavioural management of the dental officer is also of the major significance, clearly a sympathetically concerned dental officer for the welfare of the child or that of the family will have a considerable advances of opportunity of reliance and confidence of the population.

 


 
 
FUTURE OF POSTGRADUATE DENTAL EDUCATION
 

By Prof. Dr. M. A. Soofi

 

The dental education has been ignored in the past and no reforms executed to give it a proper shape to produce teachers in the field of both clinical and basic dental sciences.   Advent of College of Physician and Surgeons Pakistan and the efforts of the University of Punjab for producing postgraduates in various branches of dentistry could not fulfill the need for future of dentistry in various fields. Thus the dental profession lacks teachers both in basic sciences and in clinical sciences and as such even College of Physicians and Surgeons Pakistan could not produce teachers in community dentistry, periodontology, paedontics etc., with the result that most of the dental institutions lack these specialities because there is no professor in the teaching cadre, having advance training or degree from abroad. There are a few DPD who have retired though they had not practiced public dentistry or taught except there was one professor of community dentistry
(M. A. Soofi ) who had practiced and created & developed a dept of dental public health at Preventive Institute and retired as a Dean Institute of Public Health. In basic sciences, there is no guide available in the subject having FCPS or equivalent degree to guide in research and teaching of these subjects. 

 

Similar situation is in the basic dental subjects like dental material, oral anatomy & physiology and oral pathology, there is even no FCPS in this subject.   Thus these subjects could not enhance the graduate and even the postgraduate education. The profession could not get the brilliancy of MDS from the University of Punjab in these basic subjects and in the clinical subject mentioned above.   If we could trace the resources of teachers in oral pathology, we have got two persons in oral pathology, one in the Army and one at Nishtar Medical College, Multan. If we could trace teacher in periodontology, there was one, who is retired.    He was the one, who got postgraduate training of one year at London (1965-66). Since he could not be accommodated in Dental Institution. He got attachment with medical institution (M.A. Soofi). 

 

This is good luck that we have got two persons who are Ph.D by London University recognized by PMDC one at Lahore (Prof. Nazia Yazdanie) and other at Peshawar. According to the rules and regulation of PMDC the teacher can guide only two trainee scholar in a year. There are certain clinical subjects like operative dentistry, oral surgery and orthodontics, at present we have got one or two guides in these subjects located at Lahore. But there are about 50 FCPS students candidates waiting for attachment with the institutions for Part-II training. These scholars have passed P-I of FCPS but training slots with institutions are not available.   Most of the institutions are not fully equipped with modern operatory, research facilities and lack in supervision / guides. Similarly there are many MDS students and Ph.D scholar students but we lack guides / superior.

 

There are two undergraduates/ postgraduates training institutions (1) de’Montmorency College of Dentistry, Lahore is a premier institution and (2) Dental Section at Nishtar Medical College, Multan, perhaps both institutions have one professor each, it means both institutions have got two regular professor and third professor is attached to Jinnah Hospital Lahore who is going to retire. So there is urgent need for induction of postgraduate scholars and there is need to plan or to make arrangements to provide teachers to colleges for bright future. If the retired teachers can be attached in the capacity of professor emeritus, it will help the institutions or government should make arrangements to invite Pakistani scholars sitting outside like Dr. Khalid Almas a graduate of de’Montmorency College of Dentistry, Lahore has done master degrees and fellowships from abroad and was attached with King Saud University, Saudi Arabia for the last 8 years and now he has been offered Associate Professorship in Periodontology, at Dental College, New York University, USA. He has published about 100 articles and he was external examiner for students of M.Sc and Ph.D at Sudan.   If the Pakistani scholars are not available then Universities, College of Physicians & Surgeons Pakistan and Government should make concerted efforts to bring some foreign scholars for a period of two years in almost all the fields who should train our younger scholars so as to be with the International level. 

 

Dentistry is an entirely changed world with new dimensions of the profession, more complicated and more research oriented. There is need to improve the quality of both clinical and basic dental sciences. We have the potential and manpower to come in line the world, for this clinical competency is required. Certain competent professionals who have passed their master degree from Punjab University having no scope of service structure however, they can become good guides and they can teach the curriculum designed by the University.   There is need to provide research facilities to the students specially in periodontology, in community dentistry.   We need teachers, let this part be played by University of Health Sciences to invite teachers & skilled scientists from abroad. 

 

According to Economic Survey of Pakistan 2002-2003, there is one dental surgeon for 29,405 people and one doctor for 1,466 people. The registered dentist in the country are 5,068 and similarly we lack other health workers for our population. 

 

Pakistan lacks dental postgraduate institutions and postgraduation in various subjects, for example, we have got only one examination Master of Dental Surgery MDS through Punjab University, whereas there are many institutions in the world which provide master degrees and diplomas in various field of dentistry like; MCCD (Diploma of Membership in Clinical Community Dentistry, Royal College of Surgeons of England, Royal College of Physicians and Surgeons, Glasgow, MCDH (Master of Community Dental Health, DCDH (Diploma in Child Dental Health, Queen’s University, Belfast, DDH (Dipolma in Dental Health, University of Birmingham, DDO (Diploma in Dental Orthopaedics, Royal Faculty of Physicians and Surgeons, Glasgow, DDR (Diploma in Dental Radiology, Royal College of Radiologists, DDS (Doctor of Dental Surgery, Universities of Birmingham, Manchester, Edinburgh, Glasgow, DDSc (Doctor of Dental Science, Universities of Leeds, Durham, Newcastle upon Tyne, Dundee, DMD (Doctor of Dental Medicine, DPD (Diploma in Public Dentistry, University of Dunee and St Andrew’s, DPDS (Diploma in Postgraduate Dental Studies, University of Bristol and DRD (Diploma in Restorative Dentistry Royal College of Surgeons of Edinburgh. We have no person as a teacher who is highly qualified in above said specialities. We also lack dental institutions, India has got about 42 dental colleges in various parts of country providing postgraduate and undergraduate education, in Pakistan we have got de’Montmorency College of Dentistry, Lahore, Dental Section, Nishtar Medical College, Multan, Dental Section Bolan Medical College, Quetta, Khyber College of Dentistry, Peshawar, Dental Section Ayub Medical College, Abbotabad, Dental Section Liaquat Medical University, Jamshoroo. There are now mushroom growth of dental and medical colleges in the private sector creating a controversy whether to recognize them or not.   So there is need to create good infrastructure for more dental institution to provide better dental health care to the population.

 

Now life style is different, road traffic accidents, burns, shooting and other such emergencies are increasing day by day.   There is need to develop maxillo-facial trauma emergency centres.   Over and above infectious diseases, pollution is increasing day by day.   Severe Acute Respiratory Syndrome (SARS) is a new challenge and Hepatitis needs prevention through trained physicians, para-medical manpower and dental surgeons who are equally trained and experienced. 

 

Dentistry is a medical science and dental surgeon is in similar position as of a medical doctor because he too has to manage medical emergency in his clinic.    This is reason that a dental graduates has to be trained in basic medical subjects and clinical medical subjects of medicine and surgery in a attached medical college.   Dental surgeons also has to look after the cardiac patients, diabetics and seizure patients and so he need to be well equipped with the latest knowledge and latest challenges of the world of today including Hepatitis, laser application, diagnosis and research work. Therefore, there is a need that government should chalk out programme for dental teachers seriously so as to equip the dental profession in order to produce good teachers. At present dental institutions both in the public sector and private sector lack qualified teachers, therefore, the standard of education instead of improving is getting degraded. We have to increase budget for Health Sector. At present, both private and public sector, expenditure on health is very low e.g. total expenditure in this context is estimated Rs. 28.814 billion (Rs. 6.609 billion on development and Rs. 22.205 billion) on treatments and non-development side, which is equivalent to 7% of the GDP. There is need for community trained health workers, though we had started dental hygienist courses to deliver lectures in dental health education, nutrition and dental health and do remedies for small problem.  

 

At present there are about 5 Ph.D candidates pursuing Ph.D programme in clinical subjects. How they shall be guided when only one teacher / Ph.D professor is at de’ Montmorency College of Dentistry, Lahore. For Ph.D or M.D.S. studies we need top class guides in various subjects.   Similar position is of M.D. S. (35) students and FCPS II (25) students.  


 
IMPROVEMENT IN THE SCIENCE OF DENTISTRY—PUNJAB
 

By Prof. Dr. M. A. Soofi

 

The Province of Punjab is lucky to have two leading institutions one at Lahore de’Montmorency College of Dentistry and the other at Nishtar Medical College, Multan. de’Montmorency College of Dentistry is situated on Fort Road Lahore and is a pioneer institution of the sub-continent. It was founded the then Governor of Punjab Sir Geoggery Fritz Harvey. de’Montmorency Punjab Dental Hospital starting function in 1930. In 1934 the College was established initially for medical graduates for two years condense course. Later in 1936 four year course of BDS was started and the College was affiliated with University of Punjab. It is a parent and premier institute, it has produced many dental graduates who are working in Pakistan and abroad in very high ranking position of profession. The college is also associated with KEMC and Mayo Hospital for basic and clinical medical subjects. The admission is about 78 students per year in the first year. 

 

Dental Section Nishtar Medical College Multan was established in 1974 and it carries the admission 54 students each year. 

 

There are four professional examinations, in the first year the students have to taught Human Anatomy, Histology and Embryology, Physiology and Biochemistry, Science of Dental Materials, Pakistan Studies and Islamiyat, Dental Material and procedures. Some of the basic science subjects Anatomy, Physiology are taught in KEMC and N.M.C. respectively. The rest of the subjects are taught in the Dental College/Dental Section. Similarly in the 2nd year General and Dental Anatomy, Pharmacology, General Pathology, Oral Physiology, Histology and pre clinical techniques in the Operative and Prosthetic departments and in the 3rd year the subjects are general medicine, general surgery, oral pathology, oral microbiology, oral medicine, and periodontology, dental radiology, partial denture prosthetics. In the 4th year the subjects are operative dentistry- including endodontics, crown and bridge, paedodontics, public health dentistry, Oral & Maxillofacial surgery, including forensic dentistry and toxicology, dental practice management, dental jurisprudence, prosthodontics pre-clinical and orthodontics including children Dentistry Radiology.

 

Both the institutions on dental side lack Professors , Associate professors and Assistant Professors i.e. the staff position is not in accordance with PMDC status. At Lahore we have one professor, Prof. of prosthetic (Principal), and Prof. of Oral Surgery recently has been transferred to Multan. Rest of the two major departments are without the appointment of the professors. 

 

Operative dentistry, is very important branch of dentistry, at present, it is being run only by Assistant Prof., therefore the department at present need, Prof. Associate Professor and one more Assistant Prof. Similarly Oral and Maxillofacial   Lacks one Prof., one Associate Prof. and one Assistant Prof. and there is need for another Assistant Prof. because one Assistant Professor in on long leave. The Dept. of Orthodontics is being run alone by Assistant Prof. it needs Prof., Associate Prof. and one more Assistant Prof. to give proper teaching, demonstration and clinical guidance and to supervise postgraduate scholars, who doing MDS, Ph.D, or FCPC. It may be added that the de’Montmorency College has been placed as postgraduate institution.

 

In addition to the BDS admissions clinical services classes, lectures, there are about 45 postgraduate MDS, FCPS students who are being guided by Assist. Prof .So the situation is of very low standard and not in according to the rules of PMDC. To guide someone there is need for rich experience of teacher, who had research record in one speciality for not less than 20 years then only he can produce research. 

 

At Nishtar College Multan the situation is more weaker there is one Assistant Prof. heading the department and it needs also to develop the department. Resultantly Prof. of Oral Surgery of de’Montmorency College of Dentistry has been posted at Multan. There was lot of unrest at Multan.   What is solution and answer?

 

1.       Urge to develop i.e. creation of the posts, advertisement for the posts, selection of the candidates. There are several scholar present in Lahore who have done MDS and FCPS they are competent to be taken as Assist. Prof. and person Assist. or Associate are competent to be promoted to the higher grade.

 

2.       There are many Pakistani abroad they should be called for and they should be given incentive and attraction to come back and serve both the institutions.

 

3.       Will to remove the threat of dissatisfaction. There is much dissatisfaction among the postgraduates institution that they are not provided the opportunity to apply and serve the profession and under graduates are facing unrest for lack of teachers. It is fact that the advancement is oriented among the students by the delivery of the knowledge of experienced teachers, who can translate the concept and philosophy of dentistry for helping the ailing population. If there is no teacher, there is a loss to the patient not only but loss to the reputation of the institution.

 

Staff Position:

The premier institution de’Montmorency College of Dentistry, Lahore has got one professor, heading department of Prosthetic and he too is dean of Dental Faculties of Punjab University and Principal but he is going to retire after 7 months. Who shall take over the institution after his superannuation. As second professor of oral surgery has been transferred to Dental Section, Nishtar Medical College, Multan recently. So at present both the institutions are run by one professor. 2nd to professor of prosthetic at de’montmorency college of Dentistry, Lahore, there is Associate Professor who is Ph.D. Are there preparation to raise / promote Associate Professor to the vacant post of Professor- who shall head the institution?

 

The profession has got another two senior oral surgeons at Lahore, both are near to retirement, one is attached with Jinnah Hospital and drawing his pay from post of Dental Public Health-Institute of Public Health and other is Medical Superintendent of Punjab Dental Hospital, and recently have been given contract of Project Director- Institute of Dental Science for two years.  

So we lack teachers in teaching institution. If sincere and meaningful attention is not given it shall be difficult for junior to control the situation.

 

Our objective is to develop the institutions and makes them ideal centres for learning Dentistry. Learning is of three types:

Undergraduate                                 BDS training for 4 years

Postgraduate                                     MDS training in various sub-specialities

                                                                FCPS training     -do-

                                                                MSC training    -do-
 

How, new energetic graduate can explore or carry out research without experienced teacher or specialist. The students cannot find out new dimension in thinking and developing new site without guidance. Let me declare that with existing conditions and circumstance, it is difficult to carryout research in various dimension, in thinking, in academic, expression of dentistry and to face future challenges.

 
Suggestion:
 

1.                   System of promotion of existing staff be stimulated without any delay, vacancies of Prof., Associate Prof. and Assistant Prof. may be created for those post, which are essential.

2.                   Qualified scholars, MDS, FCPS be invited to apply for the post of Associate Prof. and immediately interviewed carried out for selection.

 

There are 19 Dental Colleges both at public and private sector in Pakistan, but all are lacking teachers in the same way, as mentioned above:

 

Professor available—in service :

               

1.                   Prof. Tariq Zaman, Principal, de’Montmorency College of dentistry, Lahore

2.                   Prof. Yaqoob Beg Mirza, Ex Principal, de’Montmorency College of dentistry, Lahore

3.                   Prof. Muhammad Saeed (Transferred to Multan)

 

Retired Professor available but all are above age of 70 years:

 

1.                   Prof. M. Saleem Cheema

2.                   Prof. B. A. Yazdani

3.                   Prof. M. A. Soofi

4.                   Prof. Mazhar Qureshi 

5.                   Prof. Waheed Sheikh

 

I as the former principal and prof. of dental public health and a teacher many time had offered my services honorarily in the field of public health and periodontology but I was given the task of Pakistan studies and Islamic Studies for three years after my retirement I had taught these subjects. I still offer my services in advisory capacity for demonstration of my skill of periodontology to the students and teachers as Professor Emeritus.

 

My humble request to the Health Minister and Governor Punjab is for special attention to save these two important institutions. These institutions should be stabilized with proper teachers and facilities.   

 
 


 
 

RECONSTRUCTION OF INSTITUTE OF PUBLIC HEALTH

6-BIRDWOOD ROAD, LAHORE

 

By Prof. Dr. M. A. Soofi

Background

Institute of Public Health is a solid symbol of preventive medicine that has been standing since 1948.  Its creation was inspired by a dedicated man and a reknowned teacher of preventive medicine, Prof. Samad Shah. His aim was to promote preventive medicine so that common diseases in the country could be controlled, thus the foundations of Institute of Public Health were laid by Dr. Samad and a group of like-minded people. WHO and UNISEF also contributed to the institution. This institute has produced thousands of postgraduate DPH, DMCH who have been serving efficiently in Health Departments of all provinces of Pakistan as DHO, Director Health Services and are a source of strength for the Health Ministry. Therefore this speciality is a choice of medical professionals who want to control disease. The DMCH diploma is for improving maternal and child health and due to this knowledge reduction in child mortality rates was achieved. Other similar postgraduate diploma holders in Public Health were responsible for holding and ensuring environmental sustainability. This is an institute responsible for promoting health and devising ways to combat HIV/AIDs, malaria and other epidemic and endemic diseases. It is a very important institute to wipe out disease from Pakistan. It was thought that “Prevention is better than cure” as Pakistan has always suffered from a dearth of doctors.  

In 1980 the institute was renamed as College of Community Medicine and thereafter about 11 departments of different specialities have been working here. It runs the courses of DPH, DMCH, DHA and Para medical courses. The College was affiliated with University of Punjab for awarding Diploma Courses in Health Education and Hospital Administration has been started since 1988. The college is affiliated with College of Physicians and Surgeons Pakistan, Karachi for purpose of training in FCPS (Community Medicine).

Para-medical / Courses for Sanitary Inspector, Dental Hygienist, Lab. Technician, Dietetion are carried out, their examining body is Punjab Medical Faculty. The college has conducted several seminars and postgraduate Refresher Courses, workshops and research. The College used to celebrate 7th April as World Health Day each year. 

List of Departments Working.

1.    Department of Public Health Practice.

2.    Department of Dental Public Health.

3.    Department of Medical Entomology and Parasitology

4.    Department of Infectious Diseases.

5.    Department of Bio-Statistics.

6.    Department of Epidemiology.

7.    Department of Occupational Health.

8.    Department of Bacteriology.

9.    Department of Nutrition and Dietetics.

10.Department of Maternal and Child Health.

11.Department of Hospital Administration.

12.Department of Environmental Health.

 
LIST OF REFORMERS - DEANS

1.    Prof. Dr. K. Samad Shah.                                 010.9.1949                24.06.1956

2.    Prof. Dr. Niaz ud Din                                         25.06.1956                13.01.1964

3.    Prof. Nazir Ahmed                                             14.01.1964                11.08.1967

4.    Prof. Dr. Attique Ur Rehman Ansari               11.08.1967                14.10.1971

5.    Prof. Dr. Akhtar Hussain Awan                       14.10.1971                18.07.1979

6.    Prof. Dr. Nazir Alam Naru.                                18.07.1979                19.02.1980    

PAST HEADS / PRINCIPAL

1.    Prof. Dr. Nazir Alan Naru                                 19.02.1980                05.12.1986

2.    Prof. Dr. Shamim Raza Bokhari                      06.12.1986                07.12.1990

3.    Prof. Dr. A. U. Lone.                                          07.02.1990                14.06.1990

4.    Prof. M. Nazir Akhtar                                         14.06.1990                22.12.1990

5.    Prof. S. A. R. Gardezi                                        22.12.1990                30.01.1991

6.    Prof. M. Nazir Akhtar                                         30.01.1991                27.03.1991   

7.    Prof. Dr. M. A. Soofi                                           27.03.1991                27.07.1991

 
INTERNATIONAL STATUS

The College has enjoyed international reputation as public health institute in the past. It has served the country in many public health matter. Prevention still is better than cure, WHO always stresses upon progress in health system. It means “effective health promotion and discussion of prevention services” in order to give people of Pakistan a chance to lead a long and healthy life. The WHO also focused on the reduction of risks to health which should be primary responsibility of the Government. So far this part is lacking in the Health Department Government of Pakistan and Punjab, of course have not recognized the importance of this issue of prevention. We lack health professionals. We lack public health experts, therefore Government has not involved itself in reducing the risk factors for diseases or dengue. Policy makers, elected representatives did not play their role in the process of disease prevention. We only take action, when a crisis occurs, like attack of dengue, polio etc.

 
 
 

PREVENTION IS POTENTIAL TOOL FOR ALL DISEASES.

Actually preventive medicine and public health medicine have little weight with our administration. Over and above, the political will seems to be lacking and policy makers are silent on the subject. For them, U.K, USA is the choice of check up and treatment. In the villages, there is no safe water programme for people to drill water from wells, no sanitation. Even in towns and cities, Sewerage System is choked, there is no proper drainage. Food adulteration, smoke in the environment, unhealthy atmosphere, all these factors are responsible for diseases.

Immunization is very important, malaria eradication is essential. Tuberculoses needs priority, HIV, AIDs, addiction, smoking and Huqqa alcoholic drinks all effect the health of the population.   Economics is a basic factor, after will of policy makers. Very less amount of budget is reserved for professionals, nurses, LHVs, para medical staff are few in number and they are not happy.

Public health campaigns by experts through personal contacts, through print media, through electronic media is very important for the dengue virus and other diseases. Health education should start in primary classes. Every school, college, teaching institution should have playground and exercise should be compulsory. 

This Institute of Public Health has got environmental department to teach the postgraduate classes because environment pollution is very dangerous for the health of population. This side is not being taken care of by the Government or City Government. Auto rickshaws, motorcycles, big cars emit poisonous gases and according to WHO report 8% of deaths occur due to Environmental Pollution in third world countries and these deaths are attributed to air pollution. In the developed world no vehicle emitting smoke can be on the road. Look at garbage accumulation in front of hospitals.   Department of Food and Nutrition can guide the people about health food. If we talk about cardiac problems, it is estimated 10% of adult population of Pakistan and 50% of those above 50 years suffer from hypertension. Similarly about 12 million adult Pakistanis are diabetic and 20 million suffer from renal disease and TB kills 40, 000 people each year. All these diseases are preventable to quite an extent. Diet and exercise have direct effect. Quality of drinking water and cigarette consumption are related factors. 

CHECK ON SOURCES OF SPREAD OF DISEASES.

It is an established fact that unhygienic chicken, beef and mutton are the source of food-borne diseases. In the year 2000 it was reported that food borne diseases caused almost 2.1 million people to die, specially in the developing countries from diarrhoea which resulted from taking contaminated food, such as meat, and drinking unclean water.   Most chicken vendors slaughter the chickens in the open area at the roadside without paying heed to hygiene, and inviting the harmful bacteria to catch the meat. It is said that the administration has not shown any interest in encouraging the set up of processing industry for sale of hygienic chicken meat to public. This affected meat contains various types of bacteria. E.coli is widely distributed in nature thus Shigella consists of ten antigen types but its presence in food or water is indicative of the faecal contamination most probably through unhygienic and crudely slaughtered birds. Nobody checks and examines slaughter houses or environment. In the developed world meat is sold in a very clean and hygienic way. Similarly, many ailments can occur due to infected water and prevention is the only way to control diseases. 

 
UNQUALIFIED HEALER

We have got quacks here and there. They are spreading diseases in society and are a threat to the lives of people. It is an unpleasant fact that untrained, unqualified persons are dealing with the health and quacks are flourishing because proper health facilities are not available to the public. The government has not opened sufficient clinics, dispensaries for the ailing population especially in rural areas. Some rural areas have got such centres but medical manpower is not available and mostly LHVs are working as doctors. The data released by the federal health ministry for 2006-07 is quite dismal. With the ratio of one doctor to population being 1,475 and one health facility catering to the need of 11,413 people. We cannot really expect the scenario to be satisfactory.

 
WHO Declaration

The world health defines, right to health as a fundamental human right in article 25 of the Universal Declaration of Human Rights. The UN also incorporated the right to health as a basic human right in articles 55, 57 and 62 in varying forms and with different emphases. Day by day the GDP expenses are lesser. Pakistan is such a country on the globe where T. B., poor hygiene, dengue and flood related diseases are very common. There is dire need for health reform and balance of budget for health education and this institute of Public Health may be well developed with staff, modern machinery. Foreign qualified teachers may also be invited.  

 
Teaching Staff

This institute should have proper well trained teaching staff for each department. Most of the departments are now without a head especially that Department of Dental Public Health which had lot of contribution in postgraduate teaching and research. The head of this institute should be always a public health person. All staff should be appointed on merit and a sub-department for anticipatory cure should be created. I served this institute for about 17 years (1973-1991) as Demonstrator, A. P, Associate Professor, Professor and created Department of Dental Public Health for this purpose. Institute of Public Health is producing medical professionals who after training are capable of maintaining or restoring the status of health through prevention. This speaks of their attitude, knowledge and skills which is recognized by WHO.

 

MCH Department and Child Protection

This is a very important department of Mother and Child Health, it was created by Dr. Mrs. A. K. Awan and she has produced many postgraduates who acquired diploma DMCH which is an authentic guidelines for saving the mother and child. This Institute is being headed at present by the country’s most capable and experienced child specialist Prof. Dr. Yaqoob Kazi who can build up this department to the extent that “premature birth of child can be checked up when mothers are not looked after well”, standard period of pregnancy, 42 weeks is not completed and baby is born before 42 weeks. It carries many ailments. Infants born prematurely have an increased risk of death in the first year of life (infant mortality) with most of that occurring in the first month of life (neonatal mortality). Known causes for preterm births are: -

            Pre-eclampsia

Intrauterine growth restriction or

Maternal illness.
 

Many preterm babies suffer from low blood pressure, which reduces the oxygen supply to their brain. This makes them much more vulnerable to a range of neurological problems such as blindness, deafness, low IQ levels and hyperactivity. Sadly, of the four million neonatal deaths that occur every year, 98 per cent are in the poorest countries of the world. Nearly 27 percent of these four million newborn deaths worldwide are due to preterm delivery. Out of every 100 deaths in Pakistan in year 2004, 57 were due to neonatal causes. So, the child speciality can be highlighted in this Institute to save the children from various illnesses.

 

We loose many children due to diarrheal infection. Diarrhoea in children is being caused by several types of microbes which include bacteria and virus. This ailment can be prevented in children. Death occurs due to dehydration. Proper care and assessment is not made by parents and medical men. Diarrhoea is the second leading cause of death of children under age of 5 years, after pneumonia.   It is estimated that over 2 million children die each year due to diarrhea. Out of them two-thirds live in the developing countries. Diarrhea needs check up and public awareness to prevent death. It is also observed that another common cause is that mothers don’t feed their children and bottle fed children don’t get natural protection and immunity against the diarrhoeal disease. The bottles are not sterilized. Similarly dental arches of bottle fed children are not developed like those of breast fed children. They face orthodontic problem. There are some other factor as well, unhygienic atmosphere and infected food. The MCH Department may be further expanded to train more health physicians, LHV and Nurses to educate the mother and thus deaths due to diarrhoeal diseases can be reduced.

 

Dengue virus has created a lot of problems for your administration.   It was discovered in 2006 in one of your hospitals and in 2007. I wrote an article pointing out that next year there shall be more deaths (a copy is attached herewith). I have sent you copy. Anticipatory care was taken by Health Department, Government of Punjab and for this virus there is no vaccine. Most of vaccines against viral diseases such as polio, smallpox and measles contain either whole killed viruses or live, attenuated viruses (modified viruses that do not cause serious infection). The injection of these harmless viruses tricks the body’s immune system into producing specific antibodies and immune cells which become ready to attack the virus, penetrating into the body. Live attenuated viruses stimulate both the humoral and cell mediated pathways of the immune system. Humoral immunity is medicated by the soluble antibodies which are dissolved in blood. These antibodies are synthesized by cells derived from B lymphocytes. In contrast, cell mediated immunity is carried out by T lymphocytes (they are capable of recognizing and killing virus infected cells of the body). During this time, it was agreed that a vaccine against the Acquired Immuno Deficiency Syndrome (Aids) based on a killed or attenuated virus would be unsafe.

For dengue virus, Health planning is important for next year with the will to face the challenges:

1.    Separate extra wards for admission of serious patients. The present wards of all Hospitals are meant for other ailments. Due to this virus, other patients could not have access to wards. 

2.    To provide health care facilities to dengue virus patients, there is need of special services of extra trained staff, nurses, LHV and para medical staff, doctors and sprayers. 

3.    Blood examination machines and experts should be available in all Medical Care centres.

4.    Public awareness through lectures, electronic and print media by senior professors and doctors of public health field as public health education is very important.

5.    Extra budget by the government may be allocated for treatment of such cases.


 

Building of Institute of Public Health Bifurcated in 1973.

Originally, it was an institute of Hygiene and Preventive Medicine. In 1973, the then Chief Minister, Government of Punjab, Mr. Haneef Ramey alongwith Brig. (R) Sahib Dad khan, Health Minister visited this institute and asked Prof. A. H. Awan, the then Dean, who was a dynamic administrator and in order to start Medical College was devoted to the cause and promotion of Public Health, “to give some portion of this building” in order to start Lahore Medical College (later on Allama Iqbal Medical College). He agreed and I was witness to this design. Prof. Awan gave some portion of this building and Lahore Medical College started. Later on PGMI, which was established in KEMC, was brought over here and in this way, Public Health could not expand and half building is being occupied by curative medicines experts.

Need for creation of Department of GERIATRICS

There is need to set up this Department of Geriatric to train public health workers for care of elderly people, as there shall be a greater need for treatment of large number of this population, there shall be need to address their medical and social needs to help them. This help is essential. How to prevent different ailments, in elderly people through counseling? According to the reports of 2005, 20% population of elderly people is above 80 years in the developed world and it was estimated in 2050, it shall be 5% and in developing countries elderly population is 8 % and it will be 20 % in 2050. These growing numbers require the process of proper social and medical infrastructure to adequately fulfill the requirement. They are more at risk of certain unique conditions such as osleoporois and various typical symptoms. So health care for elderly is important. Medical manpower should be trained for this branch of science and the whole building may be returned to Institute of Public Health. Let PGMI be shifted to campus of its own College.

Department of Dental Public Health

Department of Dental Public Health was established in 1974 with a post of Demonstrator, prior to this post, Lectures on dental hygiene were delivered in the form of external lectures. Assistant Professor post was advertised in 1975 and the department was created and in 1977, it was raised to Associate Professor. Keeping in view of success and need for public dentistry post of Professor of Dental Public Health was created on 4th December, 1983 and Prof. Dr. M. A. Soofi was promoted in this rank on 30th March, 1986. The department is engaged in teaching of Dental Hygienist and DPH, DMCH alongwith clinical services to patients. Department has made comprehensive plans for dental department at new campus of AIMC and Children complex and teaching are given to students of AIMC on Dental Health. Postgraduate Courses for dental Surgeons are organized. Research and seminars are common practice of this Department. Now it is pivot of activities of oral health program of WHO in Pakistan:  

 


 

 

Some activities of the Department of Dental Public Health National and International Conferences:

Papers were read in 50 National & International Conferences. Some of them are as follows:-

1.        Bleeding of gums and management with Tinidazole, 8th International Conference on Dental Hygiene 27 to 31st July, 1981, London.

2.         Oral Bacteria, Culture and Sensitivity Report. )1st Pakistan International Dental Congress, Karachi 17-19 December, 1981).

3.         Bleeding is a bacterial disease (5th Alumni International Symposium, King Edward Medical College, Lahore 16-18 December, 1985).

4.         Islam and Health. First International Congress of World Islamic Association of Mental Health, 5-8 December, 1985.

5.         Oral Identification of cancer importance of early detection. International Symposium 125 years Celebration of King Edward Medical College, Lahore 14-18 December, 1985.

6.         Current Aptitude of oral health in Pakistan . 10th International Symposium on Dental Hygiene, Oslo, Norway, 26-29 June, 1986.

7.         Water Fluoridation and prevention of dental disease. International workshop cum conference on Fluoride and Dental Health, Madras, India 5-8 January, 1987.

8.         Clinical and Bacteriological effects of Tinidazole (Fasigyn) in Gingival Bleeding. 3rd International Conference of Dental Surgeons Karachi 26-29 November, 1987.

9.         Comparison in vitro of Penicillin, lederamycine, cephaloridin, neomycin and Flagyl isolated colonies of Fusiformis Bacil: from acute necrotizing Ulcerative Gingivitis Cases. Read in 3rd meeting of International Academy of Periodontology, Koyto, Japan 14-16 April, 1988.

 

Drug addiction in young.

Addiction is becoming very common in cities among young generation. There is more consumption day by day. It needs check up and anticipatory care. It will be a great health problem in the future. Anti-narcotics day is observed on 25 June each year and Narcotics are becoming a global threat. It was estimated in 2007 that there are 200 million addicts in the world. 13.4 million take cocaine, 15 million opium and 112 million are taking other drugs and now their number will increase. According to analysis 39% of population of many countries including Pakistan, has fallen victim to other drugs within 3 years to 15 years of use. There is need to train medical, para medical staff to fight against addiction. In Lahore students of many colleges are victims. They started with smoking in the company of a friend, who was using marijuana, and were then introduced to other drugs. Some students smoke cigarettes filled with “hashish”. Students living away from parents, in hostels, easily become victims due to the company of hostel fellows. Girls too have became victims. They get introduced to drugs through friends and are then unable to get rid of this habit.   Marijuana and hashish are drugs commonly used by the youth, both male and female. We need youth with healthy minds. People with addiction have got many other problem of fear, paobibs, prolonged episodes of depression and anxiety. There is need for workshops, training and counseling to youth. The government should approve budget to finance this department at this institute in order to help the educated youth who are becoming victims of drug addiction. 

Control of Hepatitis and AIDs.

Hepatitis is a serious disease of liver. Due to this infection the cells of liver stop functioning properly. The liver is the second largest organ of human body. Liver is a very important organ for digestion of food, storage of nutrients including iron, synthesis of proteins, synthesis of clotting factor and getting red of toxins. When inflammation of liver (hepatitis) happens, we have to look for viruses, bacteria, drugs and body’s autoimmune condition. In our society major common cases of acute and chronic hepatitis are virus. Hepatitis A, B & C are common in our population. A&E viruses can cause acute illness that resolves on its own, it does not remain for a long time. Virus B&C can cause chronic illness which leads to cirrhosis and other complications. According to WHO previous data in Pakistan 10-12% of population is suffering from Hepatitis B and 4 % from Hepatitis C. It is alarming as actual figures will be much more. So there is need to expand this section and to prevent these diseases whose treatment is costly. Liver transplant system may also be introduced.

 

Suggestions:

1.    The status of Institute of Public Health should be independent in order to provide effective teachings.

2.    Re-organization of all departments with expansion of modern equipments to have link with world and WHO for improvement of service to community.

3.    Change of attitude of teacher be initiated through resolution or letter or personal counseling to staff and to research workers.

4.    Instantly status of teacher, research worker and other attached employees’ status be well defined and pay scale be increased. There is need of additional financial grants.   

5.    There is need that the head should monitor the plan, after approval, it should be effective according to schedule.

6.    There should be re-organization of preventive care with health care.

7.    Health Department should find out the problem of population. The need and demand of every medical problem may be predicted.

8.    Awareness of prevention of disease should be achieved through electronic and print media. 

9.    Government should provide standard budget and should identify issue and problem like dengue virus or epidemic after flood.

10.Preventive measures are easily to provide better solution for better results.

11.Institute building occupied by other Institute may be relocated to Institute of Public Health. So that it should organize additional activities.

12.No existing department may be curtailed as all departments had long history of struggle and efforts. The inefficient staff, doctors may be shifted. It is not the fault of department if something that of research or teaching has not been produced, it is doctor incharge who have neglected their duty of teaching and research. Sardar Abdur Rab Nishtar, President of Pakistan Muslim League in Lahore said: