Periodontology: A Blooming Flower of Dentistry in Bangladesh

Periodontology (EFP) is a field of Dentistry that deals with the health and diseases of the hard and soft tissues surrounding a tooth. All these tissues which are important for the health of the tooth are called ''Periodontium".

If there is one field of Dentistry that receives the least attention in Bangladesh, that undoubtedly is Periodontology. As much as it is heartening to see the number of practicing dentists increasing in the past 20 years, it's sad to see that the number of specialists Periodontists remains dreadfully low. With over 36 dental College/Unit all over the country, the postgraduate opportunities for Periodontology in Bangladesh are absent.

Elaborating on the aforementioned concern, I would like to experientially analyze the reasons which contribute towards the neglected state of the field of Periodontology. Along with that, I would like to propose a few suggestions which will help in furthering the cause of increasing the interest in the particular field.

Despite the mushroom growth of dental colleges/units over the past last two decades, there are no O institutions throughout the country which are carrying out the clinical PG course in the field of Periodontology.

Talking about the undergraduate curriculum of dental colleges/units’ periodontology as a subject warrants a massive upgrade. Yet, the subject was taught in combination with Oral Pathology and oral medicine because of dearth of subject specialists in the field. Inevitably, Periodontology lost its weightage as a completely separate and a very important field. Now that BSMMU have developed departments for starting PG courses.

Furthermore, periodontology as a field is extensive and so is the recommended course for the undergraduates. Cognitive overload, unbalanced division of the curriculum coupled with the basic, unrealistic and outdated clinical quota requirements fail to spark any interest for the subject in the undergraduates. We are pushing them to be "test-wise" rather than promoting a "learn-wise" concept. Most clinical dentistry subjects are taught in both the 3rd and 4th year and although these subjects remain non examinable in the 3rd year, the students gain the exposure to the subject none the less. Periodontology however is taught only in 3rd year with no practical and/or clinical reinforcement in 4th year. Which inevitably results in fading of the concepts by the time dental graduates’ step into their house job.

Over the years as a clinical instructor and a post graduate trainee in the field, following are the reasons observed that contribute to the neglect of the subject. These are not only my personal reflections but also may be applicable to all the scenarios/institutions.

• Dearth of expert/trained teachers.

• Impractical course division. The subject should be taught in both the 3rd and 4th year where non-surgical and surgical components must be divided respectively. This will help in better understanding of the subject and avoid cognitive burden.

• Joint assessment of periodontology and Oral Pathology & Oral Medicine where periodontology does not even hold the same weightage as oral Pathology & Oral Medicine. Both these subjects are two very different specialties and should be dealt as such. It is widely accepted and observed that assessment drives learning (Wood 2009). Undervaluing periodontology as a subject both in the undergraduate curriculum as well as the clinical training year favors neglect to the subject.

• Most of the clinicians/lecturers/teachers are unaware of the extent of periodontology. To most of them, periodontology revolves around scaling and polishing only. Whereas in reality, periodontology encompasses complex soft tissue and hard tissue rehabilitation/regeneration procedures along with non-surgical periodontal treatment.

• Shortest clinical rotation during house job. Periodontology is not given equal credits in house job rotation compared to the other clinical subjects. Unintentionally, we are reinforcing that this rotation is not as important as other subjects are. Furthermore, not letting the graduates have enough opportunity to explore the field.

It is often argued that the ignorant patient pool also contributes to the poor procedural work-up. The concern can be addressed if majority of the academicians start educating the masses on the problem. It has been positively observed that since the provision of periodontal procedures at our institution, more patients have become aware of the treatment modalities and seek periodontal care if explained to them properly.

There is an urgent need to address the vacuum that exists in the field of Periodontology. It is suggested that the local statutory body, governing medical and dental curriculum, facilitate the availability of sustainable specialist training programs. Arranging faculty training with international subject experts can be funded and the trained faculty should then spread the knowledge locally, thereby initiating and sustaining a cycle of learning. The local body can look into dividing the curriculum over the two clinical years. The teachers should be trained for appropriate periodontal referrals. Students should be encouraged to develop interests via observation and vicarious experiences.

Following the suggested revisions, it is expected that the interest in the subject will substantially peak leading to production of subject experts who will inspire the young dental graduates and students for the field.

Writer: Dr. Anupam Podder, Principal, Khulna Dental College, Bangladesh

References:

Jawaid SA. 2020. Plight of Dentistry in Pakistan. Pakistan Journal of Medical Sciences. 36(3). doi:10.12669/pjms.36.3.2278.

Khan FR. 2019. What Makes A Dentist, Good Dentist: Expectations of Peers, Profession and Patients. Journal of the Pakistan Dental Association. 28(03):101- 102.

Wood T. 2009. Assessment not only drives learning; it may also help learning.

Medical Education. 43(1):5-6.

FAQs. European Federation of Periodontology. [accessed 2021 Feb 2]. https://www.efp.org/ gum-diseases/faqs/