Address at the World Congress on Prosthodontics & 31st Indian Prosthodontics Society Congress

Beautiful smile to the people

I am indeed delighted to participate in the Prosthodontics Congress. I greet all of you on the occasion of this Congress which is being held jointly by the World forum and the Indian Prosthodontics Society. I appreciate the theme of the Congress "The World of Reality in Prosthodontics - A future in excellence beyond expectation". For such a congress of specialist team, I was thinking what I could say. Medicine is the most challenging field where human miseries and pain combat with the best out of human intelligence and patience. Therefore, we need to have a mission. I would like to talk on our mission to provide "Beautiful smile to the people".

Research status

Advances in materials like composites, polymers, ceramics, and fiber reinforced composites, silicon have found their place in dentistry. By using laser technology, emerging nano technology, tele-radiology, digital imagery and virtual reality etc., the rehabilitation process will be modeled and energized for providing customized Prosthodontics treatment. Scientists from genetic engineering are working towards development of individual tissue organs through the use of stem cells. When any organ of the human body can be rehabilitated using individual's own stem cells, it will not be far off when we can see reconditioning of the teeth through stem cells used for promoting the growth of tissues and bones. Intensive research is needed for realizing this breakthrough. Very soon we may see a person having real natural teeth either replanted or repaired in place of the missing teeth.

Indigenous development experience

I would like to share the experiences witnessed in Indian soil on the development of dental implants. Maj Gen. Ravindranath, Director - INMAS, DRDO has been working on this development project for over fifteen years. He and his team have developed dental implants, bone plates, titanium mesh and bone augmentation materials. They had identified NFTDC (Non-Ferrous Technology Development Centre) as the production agency for bone plates. For implants and surgical kits, they have transferred technology to private firm. So far, they have made more than 400 implants and supplied to 14 health centres in the country both in the civil and defence establishments. Trials are taking place at four centres in south, two in north, one in east and six armed forces institutions. The oldest standing case in this test is twelve years old and the patient is extremely happy with the implants. Trials proceeding in different places have given good results. In some cases, the implants have been used as part of restoration after post cancer treatment. The development team has shown enormous perseverance in progressing this project. I am sure dental implants developed by DRDO will reach medical and business centres in-time in the world, so that it should have competitiveness of the three dimensions such as quality,cost effectiveness, and supply in-time.

Solution to development, production and induction

Even after sound development, there is no guarantee that the equipment/material will be smoothly produced and inducted into the dental care market. It may be true both in India and abroad. I have been closely associated with the development of titanium dental implants and associated fitment hardware by our laboratories. Work in the laboratory gets carried out with utmost enthusiasm but beyond that the scientists encounter hurdles at every stage. The Society can create a consortium of doctors, industrialists, hospitals and development laboratories. This consortium in consultation with the corresponding government agencies could empower the development process and enable the smooth transition from development, trial production, quantity production, multi-centric trials leading to the induction of equipment or product into the hospitals by the ethics committee. Such a forum is essential for compressing the time between concept to induction currently encountered by the development institutions and scientists.

Cost effective dental care

I understand that Prosthesis is the replacement of an absent part of human body by some artificial part such as an eye, a leg or a denture. Prosthetics is the art and science of designing and fitting artificial substitutes to replace part or missing tissues. Dental prosthetics deals with its application in oral and para oral structures. It aims at restoring and maintaining all oral functions like mastication, speech, swallowing, comfort, appearance and health of the patient by the replacement process. But the main problem in this treatment is that all the equipment and materials needed for the designing and fitments are presently imported. Even the consumables in many cases are imported. Dr Ravindranath told me the dental chair with all the connected instrumentations was imported. But as an engineer I believe, Indian industries with R&D lab assistance can build the dental chair in a cost effective way. It is my experience whenever a doctor and an engineer work together, we have witnessed many breakthroughs - for example cardiac stent and Floor Reaction Orthosis (FRO). I was told that some industries have started manufacturing few types of materials and equipment in the country. But this is not adequate.

I would recommend that the members of Prosthodontics Society should contribute 5% of their profit to an "equipment development fund". Prospective equipment manufacturers could provide a matching contribution for this development fund. Government on its part could provide income tax exemption to the extent of 200% for the contribution made to this fund. Similar exemption to an extent of 125% for income tax payers is already available for contribution to research and development in government-funded institutions. The resource generated could be deployed for the development of selected high cost dental equipment. An expert committee appointed by the Society could select the equipment and prioritize. It is also essential to establish the partners for development. Such an approach will synergise the resources and efforts of all the participants and enable us to get cost effective medical and dental equipment for treating the community.

Networking of Dental Centres

There is a need to network the dental centres particularly research centers located in different parts of the country to generate clinical database which will be useful for research. It can also be made available in the Internet for sharing of information and academic research leading to path breaking findings. This type of connectivity will enable research on different dental problems pertaining to different regions in the country. Also the clinical database of one particular surgeon will be available to other dental surgeons for deciding on the line of treatments for similar cases. The region specific research database could be used for suggesting preventive medicine or preventive care to the local community based on doctor's experience. We need to have a centralized database on Indian dental problems, cases, remedies and solutions. Also it will enable detection of related diseases arising out of water and other environmental factors in a particular region. This could help proper treatment of water and provide better health for the community as a whole. Better use of tele-medicine for the dental care in the remote villages will enable the doctors to examine the patients using intra oral X-rays through digital sensors and provide consultancies through Virtual Dental Clinics which can provide knowledge to the field centres.

Mobile Clinic

I am told mobile dental clinics are functional in certain places like Delhi, Bombay and some cities in Karnataka. They are providing treatment in certain urban slums and certain selected village areas. I suggest that this experience of mobile clinics has to spread all over the country. The Prosthodontics Society in consultation with Government and Non Government Organisations need to undertake propagation of these mobile clinics to all parts of the country, especially in rural areas. They should inculcate the knowledge among the rural population and provide proactive Medicare among the village community, which will enable them to have a better quality of life.

Educating the masses on Dental care

There is a need for educating the masses on dental care particularly in the rural areas. Many of them are in the habit of chewing pan, gutka, tobacco and smoking which have a detrimental effect on the dental health leading to cancer. For preventing such occurrences a campaign is needed to educate the rural masses on dental hygiene and suggest simple means of preventing damage to the dental system. Every doctor who takes care of oral treatment should consider himself as an educator of the society and educate the patients and the family who accompany them on preventive dental care. Families in turn should educate other people in the village leading to a mass movement towards community dental care. Like eye camps, dental surgeons could have dental camps in different regions where apart from providing simple treatment, training session can be organized for giving them exposure on methods of protecting their dental system. During the routine examination if some loss of tissue is detected, the patient can be advised treatment for restoration of the tissue.

Traditional dentalcare

In different parts of the country, there are many traditional practitioners who are providing health care products from herbal plants in the form of powders for the dental care. Still many people in the villages make use of these products and some of them are able to maintain sound dental health. My father lived for 103 years. Up to the age of 98, all his teeth were intact. He had not gone to any dental clinic throughout his life. Only during his later years I realized that he was using neem sticks for brushing his teeth both in the morning and before going to bed. It was an isolated case in my family. This practice is slowly vanishing because of the aggressive marketing of modern medical products. There is a need to identify some areas of excellence and carry out systematic research in the area using the knowledge base of the traditional practitioners. A case study could be conducted about the use of neem tree material as a cost effective solution for promoting dental care in the villages. Apart from neem, efficacy of ingredients like clove and herbs could also be studied for use in dental paste and powder. We need to examine them more critically and make use of traditional system knowledge base for the welfare of people. This could be done by having a workshop specially dedicated for assembling the traditional system practitioners and having a constructive discussion.

Conclusion

Self-reliance is very essential in the health care sector. The technologies have been conditioned to function optimally for the ambience of a particular country. The effective support services for proper maintenance of expensive medical and dental equipments are generally not readily available. The Prosthodontics Society could facilitate conduct of a special diploma course for imparting maintenance training on dental equipment. This has got tremendous employment potential. I urge the Society to be a catalyst to reinforce self-reliance effort for promoting indigenous technology and traditional health care system for dental treatment, as it is country centric. Presently 80% if our dental surgeons are engaged in looking after 20% of our urban population. PURA (Providing Urban facilities in Rural Areas) has been accepted by the Government for empowering the village clusters and economic progress. This will have education, healthcare, employment and marketing centres. Dental care with mobile clinics, treatment centres and tele-medicine will become an important addition. Initiatives has to come from the Society with the assistance of Government, philanthropists and NGOs to promote dental care units in the village clusters. This contribution towards the education and healthcare of rural community will add to the prosperity of the nation as a whole. I suggest the Indian Prosthodontics Society and world partners to start our mission to give "beautiful smile to the people".

I wish all success to the Congress.