NE

WS

A p u b l i c a t i o n o f M a l a y s i a n D e n t a l A s s o c i a t i o n

Apr-Jun 2020

Prof Dr Rosnah Mohd Zain on leading dental research

FINDINGYOUR NICHE

08MDA Safety Advisory to Dental Practitionerson COVID-19 Infection

25World Oral Health Day 2020

28War Against COVID-19

37Oral White Lesions: What to Look For?

NE

WS

A p u b l i c a t i o n o f M a l a y s i a n D e n t a l A s s o c i a t i o n

Apr-Jun 2020

Prof Dr Rosnah Mohd Zain on leading dental research

FINDINGYOUR NICHE

08MDA Safety Advisory to Dental Practitionerson COVID-19 Infection

25World Oral Health Day 2020

28War Against COVID-19

37Oral White Lesions: What to Look For?

April-June 2020

Editor:Assoc Prof Dr Mas Suryalis Ahmad

Contributing authors:Dr Leong Kei JoeDr Lynn Ko Wei LinDr Sylvia Lim Sze WeiDr Cindy Chong Ei YenDr Chun Jie NgDr Jeannette WongDr Alia GhazaliDr Neoh Ein YauLt Col Dr Atina Najhan Md IdrisDr Sharon Tay Hui WenAssoc Prof Dr Mas Suryalis AhmadAssoc Prof Dr Nik Mohd Mazuan Nik Mohd Rosdy

Ex-officioDr Ng Woan Tyng

TreasurerDr Wong Chin Mee, Angie

Advertisement LiaisonDr Wong Chin Mee, AngieDr Ng Su Chin, JanicePuan Razana Abdul Karim

MALAYSIAN DENTAL ASSOCIATIONMalaysian Dental AssociationD-5-1, Pusat Komersial Parklane,Jalan SS7/26, Kelana Jaya,47301 Petaling Jaya, Selangor.

Tel: 603-7887 6760 603-7887 6762Fax: 603-7887 6764E-mail: mdaassoca@mda.org.my mdentalassoc@gmail.comWebsite: www.mda.org.my

Conceptualised & Produced byPaul & Marigold (DeCalais Sdn Bhd)

Email: arvind@paulandmarigold.comWebsite: www.paulandmarigold.com

Note:Views expressed are not necessarily those of The Malaysian Dental Association. The Malaysian Dental Association takes no responsibility for the consequences of any action taken based on any information published in MDA News and neither shall it be held liable for any product or service advertised in the same. No part of this publication may be reproduced without the permission of the publisher.

Messagefrom the Honorary Publication Secretary

Hello everyone! I would like to take this opportunity to wish everyone Selamat Hari Raya Aidifiltri, Maaf Zahir Batin.

Hari Raya was a totally new and interesting experience this year, being under movement control order. Nevertheless, I should be grateful for the good health, and for having the opportunity to celebrate the meaningful event with my loved ones.

I wish to express my greatest respect and gratitude to the country’s front liners, be it in the healthcare and non-healthcare sectors, who have been working tirelessly to ensure that all of us could continue living our daily lives healthily and productively. I must thank the Ministry of Health, and all relevant parties, for their upmost perseverance in curbing the spread of the disease and managing diagnosed patients, especially those requiring intensive care intervention.

Absence of COVID-19 cases related to dental practice thus far reflects the commitment of the profession in ensuring strict adherence to the standard operative procedure (SOP) and evidence-based guidelines. I am certain that everyone looks forward to safely getting back to their dental practices, with an established SOP and new norms for us to abide by.

Last but not least, I would like to wish my Muslim friends Selamat Hari Raya Aidil Adha. To many of us, enjoy going back to work. Be safe and stay healthy, everyone!

Regards, Associate Professor Dr Mas Suryalis Ahmad Honorary Publication Secretary & MDA News Editor-in-Chief Malaysian Dental Association 2019/2021

Activities

12 MDAEZ’S 10th Anniversary: A Year of Wows and Woes

14 MDAEZ CSR Activities During Movement Control Order

17 Contribution by Dentists During the Movement Control Order in Kuching

19 MDASZ’S AGM cum CPD Event 2020

21 MDANZ’S AGM cum CPD Event 2020

23 MDANZ’S Disposable Face Shield Project

25 World Oral Health Day 2020 Activities – Malaysia

27 MDA Private Practitioners Section (MDAPPS) Report

28 War Against Covid-19: A Redeployment from the Armed Forces Dental Clinics to the Frontline

Inside33 Finding Your Niche

37 Oral White Lesions: What to Look For?

Features

5Dear beloved members and colleagues,

The impact of COVID-19 has indeed hit the world really hard and Malaysia is of no exception. At the time of writing, 8 May 2020, the World Health Organisation (WHO) has reported over 3.7 million cases globally and almost 260,000 death

worldwide. The government of Malaysia has taken an unprecedented move through enforcing a Movement Control Order (MCO) since 18 March 2020 in order to control the escalating number of cases in the nation, also known as flattening the curve, so as to ensure that the outbreak is well under control and does not overwhelm the capabilities of our health facilities. Yes, we have done it with many phases of the MCO in place and with the recent relaxation of MCO or Conditional MCO being enforced since 4 May 2020. We have seen the numbers of new cases reduce to well below 100 cases a day over the last few days.

The Malaysian Dental Association first noticed the potential issue with COVID-19 and its consequences to the practice of Dentistry way back in January 2020. China has issued a lockdown in many areas just before and after Chinese New Year. I must also personally thank a member from the MDA Southern Zone who further alerted us the seriousness of COVID-19 and to push for an immediate release of a safety advisory to our members. The first MDA Safety Advisory was issued in 2 February 2020, before the implementation of MCO, and has undergone many revisions since then. During the MCO, statements were also issued to members on the need to observe the need to restrict dental treatment to only emergency care during the height of the pandemic outbreak in Malaysia and also dissemination on public statements for this matter.

The Association understands the great impact the pandemic has on many sectors in the country, including dental services, be it directly or indirectly. The sudden increase in the demand and cost of PPE has been challenging to all dental clinics. The shortage of raw material for surgical face masks in the earlier months of the year has increased the cost of production and makes some of the suppliers difficult to meet the ceiling price set. During the MCO, patients flow has greatly reduced in all clinics with some resorting to close their clinics and this has affected the income of these practitioners while at the same time having to fulfil many financial commitments, such financing loans, payment of staffs and many others.

Hence, over the past 4 months, MDA has taken various actions amidst the COVID-19 outbreak in Malaysia:

1. Issuance of statements and advisories for clinical practice that are revised from time to time, from before MCO, during MCO and during Conditional MCO.

2. Assistance to members in the procurement and rationing of surgical face masks.

Message from President of MDA 2019/21

Dr Leong Kei JoePresident Malaysian Dental Association

MALAYSIAN DENTAL ASSOCIATION

April-June 2020

MDA News

6

3. Issuance of supporting letters to members to request waiver or reduction of rental from landlords.

4. Issuance of supporting letters to members for negotiation of repayment of loans from respective leasing companies as these leasing companies do not enjoy the same benefit as banks who are able to offer moratorium on loan repayments.

5. Preliminary engagement with MDA Private Practitioners Section and an online poll/survey was also conducted among private dental practitioners to study the economic impact of the MCO in the private sector.

6. Appeal letter to Ministry of Finance to request for similar moratorium of loan repayments to be extended to leasing companies. Unfortunately, we have yet to hear reply from the Ministry.

7

April-June 2020

7. Letter to Malaysian Dental Council to seek advice on appropriate actions required of dental practitioners to avoid possible litigation following declining of dental treatment in patients who falls under the high probability risk of being infected by SAR-COV-2.

8. Issuance of public statements for the general public on social media and press during MCO. This is necessary so that the general public understands why there is limitation to only emergency dental treatment.

9. Letter to Malaysian Dental Council to re-look at the accreditations of CPD points for online lectures under category A8 during the times of restriction in mass gathering. In fact, during the MCO, MDA has organised one webinar under World Oral Health 2020 and another 2 more webinars are in the planning.

10. Worked with affiliate, Malaysian Endodontic Society, in the production of Endodontic guidelines for use during the COVID-19 outbreak.

11. Sharing of information, guidelines and experiences with other National Dental Associations during the COVID-19 outbreak.

The course of the COVID-19 is long, and COVID-19 is highly contagious even during the incubation period. Once Malaysia exits fully from MCO, we will be entering a different phase of managing the contagion in the country. Precautions will still need to be in place as we head towards a “new-norm” in our life. The fact that social distancing needs to be observed and avoidance of unnecessary mass gatherings, will continue to affect the Association. This “new-norm” will in many ways bring uncertainties to running of the Association. On

the 16 March 2020, the Registrar of Societies (RoS) has banned all societies from holding any activity, including annual general meetings (AGM) until the end of June 2020. We are also awaiting instructions and advice from authorities if our largest annual scientific meet, Malaysian – International Dental Exhibition and Conference (MIDEC) 2020, scheduled to be held in August 2020 at Kuala Lumpur Convention Centre on 28 – 30 August 2020, will still be able to proceed as planned. We shall keep members updated on the new date for our AGM and the progress of MIDEC 2020.

Indeed, even after the last phase of MCO, hopefully to end by 12 May 2020, it will not be a “full stop” but a “coma” in our lives. A “coma” because, we are called to continue to be on guard as COVID-19 will still be around for many months ahead and different countries will be at different level of managing the outbreak. Although, we will no longer limit our practice to just emergency dental treatment, we will need ensure that our clinics have new SOPs in place to cater for the “new-norm” of running our practices. We should take a “soft-landing” approach so as not to jam-pack our appointments during the initial phase of the relaxation of MCO. I wish all of you to continue to stay safe. We know the dust is settling and the sky is now becoming clearer. I wish to end my message by wishing all our Muslim colleagues a blessed Ramadhan month ahead and Selamat Hari Raya.

Yours in MDA, Dr Leong Kei Joe President Malaysian Dental Association

MDA News

8 MDA Safety Advisory to Dental Practitioners During the Current Concern of COVID - 19 Infection in the Initial Relaxation Phase of Movement Control Order (Updated: 01.05.2020)

Preamble

We generally agreed that the COVID-19 pandemic (cause by virus known as SARS-CoV-2, formerly known as nCoV-2019) will still be of concern despite our nation seeing a reduction of daily new infected cases below 100 for almost 2 weeks now. In the 4th phase of Movement Control Order (MCO), we are seeing some gradual relaxation of this order. Nevertheless, we need to continuously keep ourselves updated on the local and international progress of this pandemic and to play our part to maintain Universal Infection Control Precaution in our daily practice as this profession works in close proximity to the oral cavity. Hence, the nature of our work renders this profession at high risk of exposure to COVID-19 infection. The “new-norm” of our lives will be here to stay for many months ahead and this calls for adjustment or modification on how we operate our clinics. It is generally agreed that dental treatment for COVID-19 positive cases/Person Under Investigation (PUI)/Person Under Surveillance (PUS) are best treated at the respective facilities that cater treatment for these patients.

1. STAFFS AND GENERAL AREAS. Do keep all your staffs aware and updated of the current situations. All staffs, patients and accompanying persons are to observe proper hand hygiene and to always practice cough and sneeze etiquette (provide good visual signage). Staffs who are unwell should seek medical attention. Keep the clinic waiting area well-ventilated. All public areas of the clinic and contact surface area including door knobs, handles and desks are to be cleaned regularly (3 – 4 times a day) with standard disinfectants. Practice social – distancing of at least 1 metre at waiting area and other general areas. Cleaners are to be equipped with a surgical mask, long sleeved plastic apron, eye protection and boots.

2. SCHEDULING APPOINTMENTS. Schedule appointments well to avoid overcrowding of waiting area. Patients can also wait in their cars until called by the receptionist. Limit the number of accompanying family members or friends and if possible, avoid bringing children or the elderly as companion. You may consider calling your patients in advance before their appointment to enquire on their health status, travel history and possible contact with COVID-19 patients. As we are still under MCO, where only emergency services are provided during the height of the outbreak in Malaysia, it is advisable to gradually increase the flow of patients over the weeks during the initial relaxation of MCO. It is important to keep ourselves updated on advice from Ministry of Health Malaysia, as there may be a need to limit back our workload again if necessary.

3. SCREENING AND TRIAGING. Screen (including temperature taking) all your patients and their companions as they arrive. Visitors are to put on a surgical mask when droplet precaution is needed, such as in coughing and sneezing (symptoms of respiratory tract infection). Prepare adequate hand sanitisers for patients’ use as they walk in. Provide good visual signage requesting patients to declare symptoms, travel history or contact with a confirmed case. Kindly request your patients (and accompanying person) to fill up the Health Declaration Form. Staffs at the screening & triaging area and registration counter are to be equipped with a surgical mask. Maintain physical distance and observe frequent hand hygiene.

Message from the President and Council Members of MDA

Dr Leong Kei JoePresident Malaysian Dental Association

MALAYSIAN DENTAL ASSOCIATION

9

April-June 2020

4. WHEN SHOUD YOU SUSPECT COVID-19? Remember that it is not always possible to identify patients with COVID-19 early because some have mild or unusual symptoms. COVID-19 is to be suspected when a patient presents with the following:

(a) Acute respiratory infection (sudden onset of respiratory infection with at least one of: shortness of breath, cough or sore throat) with or without fever.

AND

(b) Travelled to/resided in foreign country within 14 days before the onset of illness OR close contact1 in 14 days before illness onset with a confirmed case of COVID-19 OR attended an event associated with known COVID-19 outbreak.

1close contact defined as:

i. Health care associated exposure without appropriate PPE (including providing direct care for COVID-19 patients, working with health care workers infected with COVID-19, visiting patients or staying in the same close environment of a COVID-19 patient).

ii. Working together in close proximity or sharing the same classroom environment with a COVID-19 patient.

iii. Traveling together with COVID-19 patient in any kind of conveyance.

iv. Living in the same household as a COVID-19 patient.

If all the criteria above are met, kindly request them to PUT ON A SURGICAL MASK (if patients’ condition permits) and wait in an area more than 1 – 2 metre away from those in the waiting area (do explain why this is necessary). The dental practitioner on duty should be informed immediately if such patients are received. It is advisable to request that they postpone their appointments and refer them to seek medical attention as soon as possible or if they are in need of urgent dental treatment. The area should be disinfected after the patient has left.

If only criteria (a) is met kindly request them to PUT ON A SURGICAL MASK and advise patient to seek medical attention if this has not been made and consider postponing non urgent dental procedure (remember that we are dealing inside the oral cavity most of the time). Advise them to be responsible by taking measures/practices:

- Stay at home and monitor body temperature to look out for fever (> 38oC), symptoms of cough and/or breathing difficulty for the next 14 days. Seek medical advice immediately if not feeling well.

- Be contactable at all times by their family/friends.

- Limit visitors to their house.

- List the names of those who comes to visit.

- Always practice good cough and sneeze etiquette.

- If develop any symptom, always wear facemask. If they do not wear face mask, close their mouth and nose with tissues when coughing or sneezing. Throw the tissues into closed dustbin and immediately WASH HANDS with soap or hand sanitiser.

- Limit distance with healthy person (s) to at least 1 metre.

- Wear face mask when going out of their room and avoid contact with others.

- Open all windows in their house to ensure good ventilation.

- Do not share utensils, tableware and personal hygiene items.

The dental practitioners’ discretion on this matter is prudent (we do not want to miss a case of acute odontogenic infection that may also present with fever and sometimes with shortness of breath). Please refer the Code of Professional Conduct published by MDC, if such decision of not treating a patient is made. On this note, do ensure proper explanation to the patient is made and document the discussion in the records.

5. IN THE DENTAL SURGERY. Always maintain a high standard of Universal Infection Control Precaution (hand hygiene, management of aerosol generating procedures, sterilisation of instruments and handling of sharps and injections. Dental practitioners and the dental surgery assistants need to don appropriate PPEs when examining or treating patients. In the context of COVID-19, airborne transmission may be possible in specific circumstances and settings in which procedures or treatments that generate aerosols are performed. In the dental settings, 90% of aerosols produced are extremely small, less than 5 micron, in fact as small as 0.3 – 0.5 micron or probably even smaller9,10. Standard Personal Protective Equipment for dental treatment includes:

• Surgical masks

• Isolation gown (water proof)

• Gloves

• Goggles/face shield

• Head cover. Kindly refer to Appendix A for the Donning & Doffing procedure (adapted from https://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf)

MDA News

10

Although AGPs are best avoided during a pandemic, additional considerations to be observed to minimise the hazards of aerosols during AGPs includes:

• During the height of the pandemic, many experts and authorities have spoken on the appropriate usage of surgical masks and respirators. Dental practitioners need to be aware that these PPE may not provide full proof protection against SARS-CoV-2. A good seal/fit is necessary when donning surgical masks or respirators and best removed after leaving the operatory room. Kindly refer to Appendix B technical specifications of the various level of surgical masks and N95 respirator.

• Rubber Dam isolation where appropriate7.

• High vacuum suction/High – volume evacuators7.

• Pre-operative mouthwash suggested pre-operative antimicrobial mouth – rinse include the use of 1% hydrogen peroxide1, or 0.2% povidone1,2. Although other antimicrobial mouth-rinses such as 0.12% or 0.2% Chlorhexidine were suggested3,4, some claimed that chlorhexidine may not be effective to kill 2019-nCoV1.

• Study on aerosol produced by certain AGPSs showed that aerosol can reach a distance of up to 2 – 3 feet and stays airborne for 20 – 30 minutes5,7,8. Hence, taking into consideration of this fact, there is a need to observe a reasonable turnover time between patient and disinfection of clinical contact surfaces. As coronaviruses have a lipid envelope, a wide range of disinfectants are effective. It can be efficiently inactivated by surface disinfection procedures with 62 – 71% ethanol, 0.5% hydrogen peroxide or 0.1% sodium hypochlorite within 1 minute. Other biocidal agents such as 0.05 – 0.2% benzalkonium chloride has also been suggested but were reported by some to be less effective11,12. Some of these disinfectants are also mentioned in the Guidelines on Infection Control in Dental Practice (2017), published by Malaysian Dental Council.

• Improving the ventilation in the dental surgery, such opening windows, ventilation fan, air cleaner, High-Efficiency Particulate Air Room Filter has also been suggested6,7,13.

General Statement

IMPORTANT: Please kindly read our advisory together with:

i Guidelines on COVID-19 Management in Malaysia No. 5/2020 updated 24 March 2020 from the office of Director – General of Health Malaysia.

ii Garis panduan pengendalian isu-isu berhubung penularan jangkitan wabak COVD-19 di Perkhidmatan Kesihatan Pergigian Bil. 3/2020, from Oral Health Program, Ministry of Health Malaysia.

iii Guidelines on Infection Control in Dental Practice, 2017, from Malaysian Dental Council.

Appendix A

11

April-June 2020

iv Code of Professional Conduct, 2014, from Malaysian Dental Council.

This advisory is only for guidance to members, who should stay up-to-date about all local developments and guidelines in regard to the COVID-19 pandemic and apply accordingly based on their clinical judgment, experience and clinical facilities, specifically patient evaluation, and treatment during this trying times. The intention is to minimise any possibility of transmission of the coronavirus to patients and/or the dental team to the best extent possible, and to ensure safety of our family members. MDA cannot be held responsible for any oversight and will continue to update the advisory as best as we can.

References:1. Peng et. al. 2020. Transmission routes of 2019-nCoV

and controls in dental practice. International Journal of Oral Science 12:9

2. Maren et. al. 2018. In vitro bactericidal and virucidal efficacyof Povidone Iodine gargle/mouthwash against respiratory and oral tract pathogens. Infect Dis Ther 7: 249-259

3. Kohn et. al. 2003. Centers for Disease Control and Prevention. Guidelines for infection control in dental health-care settings—2003. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm

4. Marui et. al. 2019. Efficacy of preprocedural mouthrinses in the reduction of microorganisms in aerosol: a systematic review. J Am Dent Assoc. 150(12):1015–1026

5. Veena et al. 2014. Dissemination of aerosol and splatter during ultrasonic scaling. A pilot study. Journal of infection and Public Health. 8(3): 260-265

6. Chun Chen et. al. 2010. The effectiveness of an air cleaner in controlling droplet/aerosol particle dispersion emitted from a patient’s mouth in the indoor environment of dental clinics. J. R. Soc Interface 7 1105-1118

7. Harrel and Molinari. 2004. Aerosols and splatter in dentistry. A brief review of the literature and infection control implications. JADA Vol. 135 (April 2004): 429-437

8. Chuang et. al. 2014. Investigation on the spreading characteristics of bacterial aerosol contamination during dental scaling treatment. Journal of Dental Science (2014) 9: 294-296

9. Baumann et. al. 2018. Dental Aerosols: The infection connection. Dimensions of Dental Hygiene 16(10):12,14,16-17 10. Liu et. al. 2019. Removal

efficiency of central vacuum system and protective masks to suspended particles from dental treatment. PLoS ONE 14(11): e0225644. https://doi.org/10.1371/journal.pone.0225644 11. Sandle. 2020. COVID-19 and dental practice. Dental Nursing. https://www.magonlinelibrary.com/doi/pdf/10.12968/denn.2020.16.4.194

12. Wu et. al. 2020. The outbreak of COVID-19: An overview. J Chin Med Assoc. Vol. 83 (3): 217-220

13. Meng et. al. 2020. Coronavirus Disease 2019 (COVID-19): Emerging and Future Challenges for Dental and Oral Medicine. Journal of Dental Research. https://doi.org/10.1177/0022034520914246

Serving Together With You President and Council Members Malaysian Dental Association

Appendix B

MDA News

12MDAEZ’S 10th Anniversary: A Year of Wows and Woes

Reported by:Dr Lynn Ko Wei Lin,MDAEZ Exco 2019/2021

17 March 2019 10th BDC: First LOC Meeting.

Greetings from the Malaysian Dental Association Eastern Zone!

A year ago, a group of enthusiastic dentists came together, and hence the inception of a celebration to come: “MDAEZ 10th Anniversary Celebration”, scheduled for 26 – 31 March 2020 in Kuching.

We acknowledged that passion is the force which drives us to constantly better ourselves and overcome challenges. It is the fuel which propels us forward in the face of adversities and guides us to excel at what we do. Hence, “Passion” was dubbed the theme of the celebration, in hopes to stroke the flames of passion in all our delegates!

The event is significant to commemorate MDA Eastern Zone’s milestones as the youngest zone under MDA to have reached their 10th year mark. The 10th Anniversary event line-up included:

1) Community Social Responsibility (CSR) Forum Passion: Pass It On

2) 10th Borneo Dental Congress and Trade Exhibition cum 11th MDAEZ AGM (10th BDC) – It’s Passion!

3) 10th Anniversary Celebration Dinner Passion, The Occasion

The three events were planned to reflect what MDAEZ is passionate about, having always placed importance on continuous professional development programmes and community outreach programmes.

This year’s event was particularly challenging because in order to cater to the different events, the team was very big. With the COVID-19 issue looming, it was not any easier.

13

April-June 2020

The CSR Forum team, headed by Dr Then Poh Kiun, successfully pulled off the event (featured in MDA’s Jan-Mar 2020 Newsletter) on Leap Day this year, indeed a leap for the Zone as the event was the first-of-its-kind in the Zone. In this event, various organisations and associations in the region passionate about carrying out community outreach programmes were gathered for a forum with focus on the dental component of outreach programmes, followed by a hands-on experience of an actual programme at a village 2 hours away from Kuching. The event was designed such that participants received both theoretical and practical input of the dental component of outreach programmes, which will lay the path for them to get a Dental team on board in their future programmes.

The 10th Anniversary team, led by Dr Ignatius Niap, had their fair share of flying around the region, interviewing past chairmen, delving deeper into MDAEZ’s decade-long story to showcase in various media during the celebration. With the event postponed, I can only say...Stay Tuned!

On the 10th BDC end, the committee had been working tirelessly to bring an interesting scientific programme for dentists and dental auxiliaries alike, with an array of topics and speakers who are experts in their fields, as well as a remarkable trade show. Souvenirs had been designed and fabricated. Venue arrangements had been done. Sponsors had been making preparations.

As the date of the event drew near, current issues revolving around COVID-19 had in particular led to alternative arrangements and changes for speakers as there were restrictions for those travelling in from Italy, Japan, New Zealand and Taiwan. With the emergence of clusters within Malaysia, discussions for venue precautionary measures to be put in place were ongoing. However, the volatility of the situation and current developments such as Brunei and Sabah recording their first positive cases, and WHO’s declaration of COVID-19 as a pandemic, led the MDAEZ Executive Committee to have a meeting on 12 March 2020. Following the meet, the EXCO came to the hard decision of postponing the remaining events of the 10th Anniversary Celebration and the MDAEZ AGM. We would rather not make these choices, but as an association, we should act in the best interest and safety of all our Congress participants (organising committee, speakers, judges, traders, delegates) and the nation.

I must commend the Organising Committee, who has been exemplary in this situation. For the past year, they have been putting out their best efforts to bring a good congress for the delegates. The intensity of workload peaked extraordinarily towards the final weeks as numerous changes in plans and cancellations were brought about by the pandemic. Although the team knew in their hearts that the fate of 10th BDC was uncertain, they still fought very hard to keep up with these changes and were determined to keep the congress running. These are unusual circumstances and we are in uncharted waters. I hope this experience has strengthened and enriched everyone.

In adversity lies opportunities.

The unprecedented circumstance may well be the kickstarter to spur us to rethink how we have been doing things, open doors to new horizons, a way to mark our 10th anniversary. May we walk out of this stronger and more resilient as a Zone!

We wish all our members good health and keep safe.

1 March 2020: Community Social Responsibility (CSR) Forum participants.

MDA News

14MDAEZ CSR Activities During Movement Control Order

Reported by:Dr Sylvia Lim Sze Wei,MDAEZ Exco 2019/2021

3D printed face shields for distribution to front-liners.

Year 2020 began with the pandemic hit of Covid-19. Sabah was under the Malaysian Movement Control Order (MCO) since 18 March 2020. Kota Kinabalu became a covid red zone on 17 April 2020, after positive infections rose up to 40 cases.

What Can We as Dentists Do?In the midst of uncertainties, MDAEZ has decided to obey our calling in serving our members and community.

3D Printed FaceshieldsOn 25 of March 2020, I was invited by Dr Jimi Lie to join a group named 3D printing Malaysia Community to help COVID-19 frontliners. In Kota Kinabalu, there was a group of printing volunteers who printed and distributed face shields for frontliners, who needed to know where to donate the item and to make sure that the items reached the frontline immediately.

The MDA Eastern Zone was the intermediary body who helped to distribute 1800 pieces of face shields to Jabatan Kesihatan Negeri Sabah, Jabatan Kesihatan Kawasan Kota Kinabalu, Hospital Ibu dan Kanak kanak Likas, Hopsital Queen Elizebeth 1 and 2.

Besides that, we also distributed 500 pieces of face shields to our dental colleagues (Dentists and Nurses) in Kota Kinabalu.

15

April-June 2020

Other Than Face ShieldsWe also received a call from Dr Lynnora Patrick Majawit (Orthodontic Department HQE2) who request for help to sew hood covers for the frontliners. Hence, we helped to prepare hood covers and other Personal Protective Equipment (PPE) template for the team and also engaged Epal Pusat Latihan Kraftangan to help in the PPE making.

Within a week, 32 volunteers from Epal Pusat Latihan Kraftangan Kota Kinabalu completed over 1200 pieces of hoods covers and donated them to Hospital Ibu dan Kanak kanak Likas, Hopsital Queen Elizebeth 1 and 2.

3D printed face shields distributed to Jabatan Kesihatan Negeri Sabah.

1200 pieces of hood covers made in Epal Pusat Latihan Kraftangan Kota Kinabalu.

Dr Sylvia (MDAEZ Exco) helped as the coordinator for the donation and distribution of PPE. 3D printed face shields distributed to Jabatan Kesihatan Kawasan Kota Kinabalu.

3D printed face shields distributed to Dentists and Nurses in Kota Kinabalu.

MDA News

16

myppehub.commyppehub.com is a platform created to coordinate donation of PPE to the emergency unit of hospitals by request. Through invitation by Dr Timothy Cheng, the MDA Eastern Zone has become the official partner of myppehub.com on the 16 April 2020.

3D printed face shields distributed to Queen Elizabeth Hospital 2.

3D printed face shields distributed to Dr Lynnora’s team in Queen Elizabeth Hospital 2.

On 17 April 2020, we have donated 540 pieces of hood covers and 50 pieces of face shields to the Hospital Queen Elizabeth emergency unit.

Supply of Hand SanitisersDuring MCO, there was a shortage of hand sanitisers in East Malaysia due to shipment difficulty from West Malaysia to the eastern region. Therefore, we engaged a local company, Syarikat Jaya Kimia to supply 75% Isopropyl alcohol hand sanitisers with the price as low as 280 MYR/ 5L with free delivery to all of our members in Kota Kinabalu.

Strike Against War, for Without You No Battles Can Be FoughtAs our battle against Covid19 continues, I believe that our profession can fight against this invisible enemy and win this war. As we have always been in the frontline, we have always been prepared and we have always been trained throughout the years in the most prudent protocols in infection control.

We as the EXCO of MDA Eastern Zone will continue to serve the members, until we win this war together.

17

April-June 2020

Contribution by Dentists During the Movement Control Order in Kuching

Reported by:Dr Cindy Chong Ei Yen,MDAEZ Secretary 2019/2021

Malaysia was hit by Covid-19 pandemic in February 2020 and the eastern part of Malaysia was not spared either. On 23 March 2020, the Malaysian Dental Association Eastern Zone received a request from the Federation of Chinese Association Sarawak to

support their Disaster Response Committee.

The MDAEZ donated a number of 363 oral hygiene kits and 372 units of Sensodyne toothpaste (sponsored by GlaxoSmithKline Consumer Healthcare Sdn Bhd) for the use of frontline medical personnel in Sarawak General Hospital and designated quarantine centres.

Apart from that, some of our dentists have risen to the call to help in PPE production, of which Tanoti House was one of the main coordinators in Kuching, to answer the Sarawak General Hospital’s cry for help due to shortage of PPE. During the initial stages, Dr Lynn Ko, MDAEZ EXCO, helped Jacqueline Fong, founder of Tanoti House, with the pattern and piecing of different PPE items such as hood covers, boot covers, shoe covers and isolation gowns, providing useful insights to the feasibility for use as a healthcare worker herself. Due to the sudden increase in global demand of PPEs, the raw material - SMS Grade non-woven cloth was also hard to come by. They had to make do with the sizes available and plan the usage and layout properly in order to maximise the usage of each piece and avoid wastage. An Architect, Peggy Wong, also came on board to digitise the patterns, and these have been made available globally with the link bit.ly/KuchingPPE which has recorded 573 clicks to date, from Malaysia, Germany, America, Australia, Thailand, Armenia and other countries.

Dr Sim (MDAEZ Chairman) and Dr Lynn Ko (MDAEZ Exco) handing over Oral Hygiene Kits (sponsored by GlaxoSmithKline Consumer Healthcare Sdn Bhd) to Disaster Response Committee of Federation of Chinese Association Sarawak.

MDA News

18The patterns have then been used by the public who came forward to volunteer to sew PPE, from fashion designers, tailors to home sewists and even dentists, from professionals to amateur sewists. It was amazing to see the Kuching community come together. The efforts were further expanded to other areas by Tanoti House when the supply was sufficient, sending aid to places such as Miri, Lawas, Sibu, Betong etc.

We hope that the situation improves soon. The MDA Eastern Zone will try our best to support the needed communities in these unprecedented times of pandemic to fight the war.

Fixing the collar hem & tie for isolation gowns.

Gowns in the making.

Due to shortage of PPE, some frontliners had to make do with gloves that were loose. Thus, the addition of thumb loops to gowns to prevent the cuffs from slipping.

Dr Mary Chieng and her team at Grace Chieng Dental Clinic contributed to the public PPE Project efforts by Tanoti House.

Dr Lynn Ko (left) & Peggy (right) posing with the mannequin at Tanoti’s PPE Project hub.

19

April-June 2020

MDASZ’S AGM cum CPD Event 2020

Reported by:Dr Chun Jie Ng

Malaysian Dental Association Southern Zone Annual General Meeting cum CPD Event Year 2020 was held on 13 March 2020 at a.b.c Dental Center, Johor Bahru. The meeting was well attended with 45 members.

After the Annual General Meeting, we had an Evening Lecture Series ‘Periodontal-Endodontic Lesions: Periodontitst and Endodontist’s perspective on the choice of treatment’ delivered by Dr Saw Woon Ling and Dr Chung Tze Onn followed by ‘Management of Anterior Open Bite’ given by Dr Alex Hong.

Dr Saw Woon Ling and Dr Chung Tze Onn taught us in the decision-making process to retain or replace the tooth by discussing treatment strategies for various interesting cases. Dr Alex Hong shared with the passionate audiences on the do’s and dont’s of managing AOB as well as recap the etiology of AOB.

We ended the night by 10 pm, with certificates of appreciation presented to all our speakers. It was indeed a very fruitful session and we appreciate our dear participants for their support in making this event a success.

MDA News

20

Donation of Hand Sanitizers, Face Shield, Hydrogen Peroxide-Containing Mouthwash, to the Public Health Facilities.To support the Ministry Of Health Malaysia’s effort to combat the outbreak of Covid-19, volunteers at the Malaysian Dental Association Southern Zone gathered together to prepare 430L of hand sanitizers, 2000 protective face shields and hydrogen peroxide mouthwash for donation to the public healthcare facilities. The materials were prepared and donated in batches, in March 2020 and May 2020 respectively.

Donation of Hand Sanitizers, Face Shield, Hydrogen Peroxide-containing Mouthwash, to the Public Health Facilities.

21

April-June 2020

MDANZ’S AGM cum CPD Event 2020

Reported by:Dr Jeannette WongMDANZ Honorary Secretary 2019/2021

MDA Northern Zone’s AGM cum CPD 2020 was held on 15 March 2020 at G Hotel Gurney, Penang. A total of 59 attendees were present for the programme. In light of the ever growing health and safety concerns surrounding the Covid-19 pandemic at the

time, participants who wished to attend remotely were able to do so as the programme was made available via Zoom.

The programme started with Oral Maxillofacial Surgery specialist Dr Lee Chee Wei presenting his lecture titled “Coronectomy: Indications, Technique and Its Management”. After a short tea break, Dr Lee continued with his second lecture about the Role of Oral Maxillofacial Surgeon in Managing Orthodontic Patients.

The MDA Northern Zone Annual General Meeting was then called to order by MDANZ Chairman Dr Tan Sock Hooi. The minutes of the last MDANZ Annual General Meeting held on 10 March 2019 were presented by MDANZ Honorary Secretary Dr Jeannette Wong. After the minutes were passed, the MDANZ Secretary Report 2019/2020 was presented to the floor and subse-quently passed. Honorary Treasurer Dr Choo Wan Ling then presented the MDANZ Financial Report 2019/2020, followed by the Zone Budget 2020/2021. Both Financial Report and Zone Budget were passed accordingly. There were no elections carried out this year as the current office bearers are to serve a 2 year term ending in 2021.

MDANZ Chairman Dr Tan Sock Hooi presenting a token of appreciation to Dr Lee Chee Wei.

MDA News

22

Left to right: MDANZ Chairman Dr Tan Sock Hooi presenting a token of appreciation to Dr Nigel Pong and Dr Yuhaniz Ahmad Yaziz.

The afternoon portion of the programme commenced after lunch. Endodontist Dr Nigel Pong presented his lecture titled “Endodontics Made Easy” followed by a tea break. Periodon-tist Dr Yuhaniz Ahmad Yaziz concluded the afternoon session with a lecture titled “Peri-Implant Diseases - What We Need To Know”

This year’s AGM cum CPD was carried out under extraordinary circumstances amid Covid-19 concerns. The safety of all parties involved were of the utmost priority. It was made sure that the venue was able to provide temperature checks and put hygiene protocols in place. Seatings were spaced to be at least 1 metre apart from each other to comply with social distancing requirements. Participants who registered for the programme were advised to refrain from attending if they

had any history of travelling to affected countries listed at the time, were experiencing Covid-19 symptoms or had come into contact with confirmed/suspected cases. Nevertheless, those who could not attend physically were able to listen to the lectures and participate in the AGM at home via Zoom teleconferencing, which is a first for an event organised by MDANZ. This alternative was well received and allowed more participants to attend with ease.

Nevertheless, the programme was able to go on smoothly without much obstacles. With this, MDANZ would like to take the opportunity to thank the speakers, participants and the venue staff for their kind cooperation and understanding in making this programme a success.

23

April-June 2020

MDANZ’S Disposable Face Shield Project

Reported by:Dr Jeannette WongMDANZ Honorary Secretary 2019/2021

Face shields delivered to Hospital Pulau Pinang.

The Covid-19 pandemic has proved to be a challenging time for many, with the role of frontliners being more critical than ever. Healthcare workers in particular have been braving the pandemic with barely enough Personal Protective Equipment

(PPE) to keep themselves and those around them safe. Times like these call for action, thus prompting MDA Northern Zone to contribute to the fast depleting supply of PPEs by coming together and constructing disposable face shields for hospitals in Penang.

With the help of MDANZ members, volunteers from the Penang Tourist Guides Association, as well as good samaritans who have donated materials required to construct these face shields, this project took flight in just a matter of days of planning under the leadership of MDANZ Chairman Dr Tan Sock Hooi.

As the Movement Control Order implemented by the Malaysian government was just in its first phase, those involved in the project had to be vigilant and adhere to the SOPs as recommended by the Ministry of Health. Materials were disseminated to volunteers so that they could construct the face shields in the confines of their homes. Meanwhile other volunteers worked in small groups at spacious premises, courtesy of kind owners who offered to utilise their spaces as production centres.

MDA News

24All volunteers adhered to hygiene and social distancing guidelines, and with a production line established, we were able to produce 2,600 pieces of disposable face shields in 4 days. 2,400 of these face shields were delivered to Hospital Pulau Pinang, and over 120 pieces were directed to Hospital Seberang Jaya. The remaining face shields were given to officers conducting road blocks and to volunteers delivering food to the frontliners.

While our contribution may not be on a large scale, we are indeed grateful that we are in a position to give. It has been inspiring to see citizens from all walks of life come together and contribute in any way they can, all in the name of humanity. We hope this positive energy and united spirit continues to live throughout this pandemic and beyond, as together we can overcome even the most difficult of times.

Production line in a spaced-out environment.

Face shields received by Dr Fenky on behalf of the ENT Department, Hospital Seberang Jaya.

Completed face shields are inspected and sanitised before packing them up.Volunteers at production centres while maintaining social distancing.

25

April-June 2020

Activity Responsibility Report

Oral health screening at identified Project Perumahan Rakyat (PPR) – Peoples’ Housing Project

MOH (Dr Cheng Lai Choo)

7 March 2020 – PPRT Sri Kiambang, Serendah by Oral Health Division, Selangor State Health Dept., MOH (PIC: Dr Mohamad Nor bin Sairi)

Various activities and programmes were organised by the Hulu Selangor District to make the program a success including the line-up of Hulu Selangor Dental Icons (Ikon Gigi- iGG) and the Mobile Dental Bus as attraction for visitors.

More than one hundred visitors have undergone dental check-up and dental treatment were rendered to those in need. In addition, activities such as colouring competition, interactive games, exhibitions, quizzes and singing songs were held to enliven the event. https://www.facebook.com/203454779802473/posts/1631932240288046/

Oral health promotion MOH (Dr Salleh Zakaria)

• 4 March 2020- Radio interview IKIMfm: Jom Bersama Kita Jaga Gigi. Guest: Dr Doryalisa binti Zakaria (MOH) https://www.facebook.com/ikimfm/videos/191520195448114/

• 5 March 2020 – Live TV telecast on Malaysia Hari Ini TV3: Pentingnya Menjaga Kebersihan Gigi dan Mulut. Guests: Dr Salleh bin Zakaria (MOH) and Dr Mas Suryalis binti Ahmad (MDA). https://youtu.be/rvo18zlA7oo

• 12 March 2020 – Live TV interview on Selamat Pagi Malaysia (TV1): Doktor dan Anda - Sambutan Hari Pergigian Sedunia 2020. Guest: Dr Doreyat bin Jemun (MOH) https://youtu.be/0j-0IdHYwp0

• 10 April 2020 - Facebook Live Program Kesihatan Pergigian KKM: COVID 19 dan Rawatan Pergigian. Guest: Dr Syed Iqbal bin Syed Husman (MOH) https://www.facebook.com/pergigiankkm/videos/ 2673746922840211/

World Oral Health Day 2020 Activities – Malaysia

MDA News

26Activity Responsibility Report

Photo competition MDSA https://www.officialmdsa.com/wohd2020

Launching video production

MDSA MDSA has collaborated with various notable associations namely Malaysian Dental Association, Program Kesihatan Pergigian KKM, Dental Services of Malaysian Armed Forces, Dental Dean’s Council and 3M Oral Care Malaysia who have come together to share their messages on the theme of this year’s WOHD “Say Ahh, Unite for Mouth Health” and general advice to the public on the importance of looking after our oral health! The video also features activities that we have conducted for WOHD 2020 in Malaysia such as live interviews on TV1 and TV3, radio interviews, public dental screening which was conducted prior to the COVID 19 outbreak and not forgetting, the WOHD photography competition organised by MDSA. https://youtu.be/7jcqdynue7I

Webinar session 3M • 15 April 2020 – 3M Malaysia IG Live: Leading and Contributing in Times of Uncertainty. Guest: Associate Prof. Dr Firdaus Hariri (University Malaya)

27

April-June 2020

MDA Private Practitioners Section (MDAPPS) Report

Reported by:Dr Neoh Ein Yau

The COVID-19 pandemic has its grip in every part of the world, an infectious disease caused by SARS-CoV-2. Up to 1 June 2020, we have 5.9 million reported cases worldwide with 360,000 reported death. It is contagious enough to cripple businesses and to bring

the economy to a complete standstill.

The healthcare sector including dentistry was allowed to operate throughout the MCO period. Some private dental clinics were closed while many stayed open, limiting their work to only emergency cases. This is to ensure a continuing support of the healthcare system and not to overwhelm the public facilities during the outbreak with dental emergencies.

Given the long period of MCO and this unprecedented public healthcare crisis, many clinics have experienced a drop in patients flow and ultimately, a reduction of revenue between 70-90% since the pandemic. The MDA has written both to MOF and leasing companies, requesting extension of loan moratorium to dental clinics that have loans with leasing companies. We do hope to obtain a favourable reply from MOF. At such, clinic owners who wish to restructure their loan are advised to contact his/her respective financial institution for details. It is important at this point that private dental clinics should maintain healthy cash flows to sustain this challenging time.

Given that Malaysia has close to 4000 private practitioners in the private sector, the economic impact of COVID-19 has unfolded tremendous uncertainty. These sudden impactful crisis may put many of us in financial/mental stress. The MDAPPS wishes that some form of grant or assistance can be made available by MDA to help this vulnerable group in the future.

At the early stage of the pandemic, many private dental clinics were plagued with an acute shortage of personal protective equipment especially the surgical mask. The association appealed to the government to lift the extremely low ceiling price of the surgical mask. In addition, MDA was working with industry players through Southern Zone and Oral Health Program to ration surgical mask, ensuring adequate supply of mask to private dental clinics. These action plans will allow private dental care to function to its optimal standards.

We should be proud that dentistry has long been the forefront of practicing high standard of infection control due to the nature of close proximity between operator and patient’s oral cavity. The SARS-CoV-2 has not changed the universal infection control protocol. In fact we are improving the patient’s screening protocol prior to their appointment, reducing crowds while observing proper social distancing at waiting halls, practicing 4 handed dentistry effectively and taking extra steps to decontaminate the treatment room after every patient. Perhaps this could be the new norm of practice in the future. Thus we shall adopt and adapt to this new workflow.

Lastly, MDA will continue to issue safety advisory to members with the latest information based on guidelines by the Ministry Of Healthy. Together we can break the SARS-CoV-2. Stay safe and stay healthy.

MDA News

28War Against Covid-19: A Redeployment from the Armed Forces Dental Clinics to the Frontline

Reported by:Lt Col (Dr) Atina Najhan binti Md IdrisRestorative Dental Specialist Armed Forces Dental Centre Kem Sirusa, Negeri Sembilan.

Scientists have always warned us about the inevitability of an impending outbreak of a global proportion. It is just a matter of where and when. That ‘where and when’ took place in December 2019, when a new viral outbreak sprung on us by surprise, wreaking

havoc in Wuhan, a city in the Hubei Province, with clusters of its residents falling ill to pneumonia. Not a great start for 2020. COVID-19, the novel coronavirus responsible for the outbreak is believed to have a zoonotic origin, with a link to a wholesale food market selling wild animals in Wuhan. Reports of human-to-human transmission of the virus have led the WHO to announce a state of global health emergency on 30 January 2020. Despite the strong international response to COVID-19, it did not take long for the virus to spread across continents and eventually made its way into Malaysia. On 11 March 2020, the WHO officially declared COVID-19 a pandemic after the spread escalated through 114 countries in three months, infecting over 118,000 people and killing more than 4000 lives.

The surge of COVID-19 cases in Malaysia saw the government impose an unprecedented Movement Control Order (MCO) nationwide to curb the spread of the virus. The burden of healthcare workers (HCW) of the Ministry of Health (MOH) working on the frontline is grueling. While many work endless hours in the hospital caring for infected patients, other frontliners work under the tropical heat in the field, carrying out active screening on potential carriers. Despite all the work, the viral spread is anywhere but finished. As the war is far from over, the Director-General of Health Malaysia, Datuk Dr Noor Hisham Abdullah, solemnly called upon the Dental Services of the Malaysian Armed Forces (DSMAF) to rally with our MOH brethren in the war against COVID-19, and we obligingly were up for the task.

As a trained military dental personnel, from fighting cavities and gingivitis in the comfort of a dental office to combatting an enemy of a similar spectrum in the open field, we were honored to be a part of something bigger than ourselves. This is how our story unfolds.

Arriving passengers going through health surveys at KLIA. Major (Dr) Aminah bt Jalil is obtaining an OPS sample from a passenger at KLIA, as two assistants watch over her.

29

April-June 2020

To prevent the spread of COVID-19 via imported cases, the MOH recognised the necessity to implement health screenings on individuals returning to Malaysia through its entry gates, KLIA and KLIA2. On 9 April 2020, the DSMAF had mobilised a group of seven dental specialists, four dental officers, and 12 dental auxiliaries as the DSMAF COVID-19 Support Team - to be deployed to KLIA to collect swab samples from passengers arriving on international flights. In addition to our team, another support group comprising of dental diploma trainees from the Armed Forces Health Training Institute (INSAN) were also deployed to KLIA to conduct health surveys on every passenger upon arrival.

Facing an invisible biological threat commanded the DSMAF COVID-19 Support Team to be equipped with the knowledge and correct sample collection techniques. To accomplish this, the team underwent a half-day boot camp held at the Airport Management Centre, KLIA. The training, delivered by the National Public Health Laboratory (NPHL), was preceded with a briefing by the Crisis Preparedness and Response Centre (CPRC). NPHL trained us to collect nasopharyngeal swab (NPS) and oropharyngeal swab (OPS) samples by having us take swabs of each other. At first, the mere sight of the long NPS stick was harrowing. What could go wrong with a stick that long up in your nose? Brain perforation? Luckily, taking an NPS sample was not as horrible as I thought it would be. The experience prepared me mentally and perhaps made me empathic towards the people at the end of the receiving sticks in our ensuing assignments.

When dealing with the highly transmissible pathogen, ensuring safety, and preventing cross-infection is a personal responsibility of every HCW in the frontline as it is a group responsibility. Proper donning and

doffing of the Personal Protective Equipment (PPE), and appropriate handling of samples - from disinfecting to tagging and packing, were essential parts of the training. Subsequently, we deliberated to divide our team into two main groups. Whilst the specialists and dental officers would perform sample collections, the auxiliary staff would be responsible for handling the samples. We were ready to join the battlefront.

As a bunch of ‘rookies,’ we were eager to see some actions on our first assignment at KLIA. We divided the team into three working shifts: morning, afternoon, and night. Our excitement was short-lived when we received a last-minute change of modus operandi, where we were instructed only to collect samples from asymptomatic passengers with known comorbidities, instead of every passenger disembarking at KLIA. Passengers exhibiting respiratory symptoms or fever were immediately isolated and examined by the medical officer on duty, whereas healthy passengers were taken straight to quarantine centers. The number of flight arrivals at KLIA had already reduced significantly due to the worldwide air travel restrictions. Consequently, our presence at KLIA was not fully utilised as we had hoped. The highest number of samples we collected from a single flight was a little over 30. Even that was a rare occurrence during our tenure at KLIA, as most flights that landed were empty or had very few passengers with underlying disease. We collected both NPS and OPS samples for every passenger indicated.

We barely passed a week at KLIA when we received news of a major assignment under the Kuala Lumpur and Putrajaya Health Department (KLPHD). Targeted testings on workers at the Kuala Lumpur Wholesale Market (KLWM) indicated a high number of COVID-19

Major (Dr) Ahmad Asyraff bin Azil waits in line as Staff Sergeant Kharme Nadia bt Sahar goes through a decontamination spray before doffing.

Lieutenant Colonel (Dr) Atina Najhan is taking a throat swab from a KLWM worker at Batu Muda Community Hall, Selayang.

MDA News

30positive cases that prompted the district health authority, the Kepong Health Office (KHO) to organise a mass sampling. One-third of our team would remain on duty at KLIA. Conversely, the rest of us were redeployed to KLPHD to assist KHO to achieve its mission of testing all households within the vicinity of the market, which amounted to an estimate of 15,000 residents within five days. But the mass sampling could only be commenced if the Senior Minister of Security announced an Enhanced Movement Control Order (EMCO) for the zone.

While waiting for the green light, we found ourselves doing odd jobs of packing PPE sets to kill time. We also had the opportunity to join small-scale targeted samplings at the Batu Muda Community Hall, Selayang, where we met other COVID-19 support groups. Under the administration of KLPHD, district health offices organised testings for COVID-19 on targeted high-risk groups within their local domain. The health department recruited numerous public volunteers from various governments and non-governmental organisations due to the larger population involved in such testings. The COVID-19 support groups, formed by these volunteers were personnel of the Dental Services of MOH, Cheras Rehabilitation Hospital, State Health Department of Negeri Sembilan, Selangor, Kelantan & Terengganu, MERCY, IMARET, private medical and dental practitioners and many more.

At this time, my expectation of the ideal working arrangement that we had in mind, where the doctor collects samples and the auxiliary handles the samples was thrownout of the window. In the hustle and bustle of a sampling centre, our position or rank at our original workplace became almost irrelevant and hardly determined the job we would get. We would take whatever job was available. It was a reality that I initially

Colonel (Dr) Liana Ma bt Abdullah is interviewing an occupant of a shophouse at Chow Kit Market during ACD.

The ACD team, accompanied by the Royal Malaysian Police, head towards a construction site at Chow Kit.

“We are ready to serve!”- the DSMAF team at Pusat Bandar Utara Selayang.

A frontliner in full PPE suit is supervising the queue line to the Chow Kit Sampling Center under the hot sun.

31

April-June 2020

had trouble grasping. Later, I realised that all of us came from across Malaysia with diverse backgrounds and credentials to accomplish a common goal: to win against COVID-19. Everybody in the team has a role, and it does not matter which role we play as long as we play as a team.

Accordingly, our job scope expanded beyond sample collection and handling. We did all kinds of tasks. Each day members of the team would randomly rotate between various functions - operating the registration desk, conducting sampling jobs, serving the home surveillance desk, runner duty, controlling the traffic flow, or updating the sampling database. This rotation would go on throughout the rest of our tour of duty.

We were all primed to go when the KLWM was finally gazetted under EMCO on 20 April 2020. Our comrades at KLIA had finally reunited with us just in time for this assignment. The sight of barbed wire fence encompassing the surrounding areas of KLWM was surreal and somewhat disturbing. It symbolised the war the country was in, only this time the enemy was lurking among us but nowhere to be seen. It is the unsettling truth of the biological enemy we are engaging with.

Unlike at KLIA, the swab samples we collected under the KLPHD sampling programs were either OPS or NPS. The collected swabs were transferred to laboratories where they were processed using the Reverse Transcription Polymerase Chain Reaction (RT-PCR) and may take up two days or more to yield a result. Another type of test, the COVID-19 antibody rapid test (ART) was reserved for cases requiring immediate repeat testing, for instance, cases with dubious results. Since ART is not a confirmatory test, a positive result generated by it warrants the submission of a new swab sample for another RT-PCR analysis. Some of our DSMAF members were lucky to have the opportunity to conduct

A scene of the registration process at Istana Negara.

Lt Col (Dr) Muhammad Hidayat and Major (Dr) Mohd Najib bin Mohd Razi are responsible for keying in demographic data into the sampling database at the Pudu Plaza sampling center.

An overview of the Pudu Plaza sampling center.

The DSMAF team, led by Colonel (Dr) Liana Ma bt Abdullah.

MDA News

32ART, which involves drawing a small amount of blood from a finger prick and placing the blood into the sample well of a test cassette. The test result is observable by the presence or absence of colored lines on the cassette.

We landed upon a new exciting job during the final stages of the KLWM EMCO: mopping. Mopping involves going from house to house in search of residents who have not had their swabs taken. A Health Inspector from the MOH led each mopping team to allocated shophouses at the Pusat Bandar Utara Selayang. Dressed in a full PPE gear, we plowed on through the unrelenting hot weather and intense thirst, climbed flights of dark, claustrophobic staircases, and endured strong odors of what seemed to be of rotten onions, to get the job done. Immigrants occupied most of the houses that we mopped, and these homes, small as they are, somehow managed to accommodate 20-30 people. I found most of them were cooperative, although often the language barrier was trying my patience. Overall, I consider that day an impressive feat, given that we were also observing Ramadhan’s fasting month and managed to stay fasted.

Apart from the hot weather, dealing with diverse humans was among the challenges we faced. During the registration process, we commonly encountered immigrants who were unable to provide a complete home address. As a result, we recorded their address based on adjacent landmarks described by them. Home address and phone number are vital information to ensure the people are contactable should their results came back positive. Additionally, their lack of command of Bahasa Malaysia and English rendered it difficult for us to communicate. Being coughed or sneezed at while taking a swab was not pleasant either, but thankfully we had our PPE to protect us.

After days of laborious work, a desk job in the air-conditioned operational room was a nice change of pace. Our task entailed tracking the lab results of the swab tests and updating the sampling database with the results. Those tested positive for COVID-19 would be retrieved by the health authority from their home and sent to a designated COVID-19 hospital for isolation and treatment.

Our next big assignment was the mass sampling at Chow Kit, which was cordoned off on 5 May 2020. After having multiple working experiences at sampling centres with no untoward events, I was pretty confident that nothing could go wrong. Little did I know, our stint at Chow Kit would be at a whole different level. The mass sampling at Chow Kit was comparatively like that of the KLWM sampling, except the days at Chow Kit were unforgivingly hot, particularly when wrapped up entirely in a PPE suit. My PPE suit consisted of a coverall with a plastic-like texture, which trapped heat and turned it into a portable, walking sauna. Over an hour of wearing the coverall, I

found myself having trouble breathing to the point of suffocating that I had to remove myself from my task immediately, lest I faint. The proverb, “Dehydration is a soldier’s worst enemy,” is as real as can be. I broke my fast by 10.30 a.m., chugged three cans of 100-plus, and hoped to hold out till the end of the shift. Despite the harsh working condition affecting many of us, our sampling comrades persevered and successfully tested over 3,000 residents in three days.

We also conducted a task known as Active Case Detection (ACD) at Chow Kit. ACD is a proactive approach involving visits to housing areas, construction site in the targeted zone and the Chow Kit Market to carry out a census of occupants living in every site. Subsequently, the ACD team instructed every occupant to get tested for COVID-19 at the sampling centre. The exception being for young children, pregnant women and immobile persons who are to be tested at designated health clinics via an appointment. The information provided by the census enables the health authority to screen, test, and monitor the targeted population actively.

Our closing assignment at the end of our deployment brought us to a place where most of us can only imagine ever going: the Istana Negara. The palace’s exterior facade, embellished with bright yellow wainscoting, was a majestic sight to behold. We collected swab samples from the staff members of the palace. Compared to previous assignments, this one was relatively a breeze, and it made for an unforgettable and pleasant ending for the last day of our tour. Or so we thought.

The following day, we received news of a coming mass sampling at Pudu. Invariably, we were ready to serve, and so we did. The sampling was held at the semi-EMCO area of Pudu and the Pudu Plaza, withover 1,300 samples collected in two days. Finally, on 18 May 2020, the sampling at Pudu Plaza concluded our tour.

The act of fighting a war while enduring the hot tropical climate in PPE suits is undoubtedly a challenging endeavor and a test of perseverance, even more during the fasting month. Hence, I was in awe to witness the unwavering hard work and high spirits displayed by fellow frontliners throughout our month-long collaborative fight against COVID-19. This endeavor would also be impossible without the order and security provided by the Royal Malaysian Police, Malaysian Armed Forces, RELA, and Jabatan Pertahanan Awam Malaysia (JPAM). Recently, the MOH has been reporting a significantly lower number of new positive cases in Malaysia. This declining trend signifies the favorable effect of the MCO and targeted approach to population sampling- an achievement partly attributable to the highly dedicated people of the COVID-19 support team, if I may say so. DSMAF is proud to be a part of that team.

33Finding Your Niche

Prof Dr Rosnah Mohd Zain, MAHSA University’s dean of its dentistry faculty, shares her academic achievements and thoughts on the dental profession.

Interviewee: Prof Dr Rosnah Mohd Zain, Dean of MAHSA University

By: Khaw Chia Hui

April-June 2020

MDA News

34Before becoming a dean, how was your early career?After six years in an all-girls boarding school, I headed to Australia to pursue a five-year dental degree programme at the University of Queensland.

I joined Universiti Malaya as a trainee-lecturer during which I had the opportunity to spend three years as an oral pathology resident at the University of Michigan in Ann Arbor, USA.

After my residency, I obtained a degree in Oral Pathology and Diagnosis. I then returned to UM and enjoyed a career of more than 30 years, first as a lecturer, then an associate professor and lastly a professor in oral pathology and oral medicine.

I was also the founder and adviser of UM’s Oral Cancer Research and Coordinating Centre.

Why is dentistry your field of choice?I have always been interested in the field of medicine but I often associate it with unfavourable working hours. So, dentistry presents a happy medium as I could continue my passion for medicine while securing a future of working regular hours.

My passion for the medical disciplines led me to oral pathology, which is a branch of pathology in medicine and also includes dentistry.

Much of your career is spent in academia. Why do you think it suits you?I came to a realisation during my undergraduate dental training that my passion was not in routine dentistry. I have always liked being able to share knowledge and having keen interest in research. I also believe in creating different teaching methods to suit the various groups and capabilities of students.

You’ve been a dean in a public university and now a private university. Could you share with us your thoughts on both positions?In a public university, being dean is all about developing and maintaining quality of programmes without having to worry about having sufficient number of students to support the programme.

Meanwhile, in a private Institution, there is a need to develop and maintain quality programmes while also having to be involved in promoting them as part of business development to ensure sufficient student intake.

What are the similarities and/or differences of running a faculty in public and private universities? Curriculum development and coming up with innovative teaching methods are what I found to be similarities. For deans in private institution, they are very much involved in areas that will increase revenue for their university.

What are your views on Malaysia’s current dental health?Our current dental health seems to be improving in urban areas rather than rural ones. I feel there is a crying need for more dental professionals in those areas across Malaysia.

35

April-June 2020

Where does Malaysia stand in comparison to other developing countries in the region? We have done well to advance the dental practice and we have a very good oral health programme that is developed by the Health Ministry.

The programme includes planning and increasing dental services throughout the country. Malaysia is now moving into more specialisations while maintaining a good pool of general dental practitioners with additional skills.

Could you share with us your challenges in developing OralDETECT, now used in Malaysia and Cambodia?OralDETECT is a structured training and competency assessment tool that incorporated three powerful key as educational learning tools – Test enhanced learning, Spaced repetitive learning and Corrective feedback.

OralDETECT has been copyrighted by UM’s Oral Cancer Research and Coordinating Centre. This training tool has been successful to achieve competency in early detection of oral cancer by health professionals.

The challenges in this training tool when used in Cambodia is the need to do it in English and then translating it to the Cambodian language.

Since part of the training is to improve diagnostic skills through discussion on enhancing the correct answers and/or giving corrective feedback of the incorrect answers, it is still better to have the entire training done by an expert in their own language.

Despite the language barrier, OralDETECT is still able to ensure the success of the training where the majority trained finally achieved the desired skills required. OralDETECT has also been successfully introduced in Indonesia, Nepal and India.

Your other area of research is in oral cancer. What are the latest developments in the field?Like other cancers, research activities in oral cancer are mainly in the development of drugs and vaccines towards successful management of the disease.

However, success in management of oral cancers requires collaborative efforts in all aspects of prevention, diagnosis and management that includes patient support care. Thus, there is equally increased activities in research in these aspects of oral cancer.

Is this now a growing area of concern in Malaysia? The main concern with oral cancer is detection at a late stage due to delay in diagnosis or delay in treatment. More than 50% of oral cancer are detected at stages 3 and 4, thus leading to poor prognosis.

Even though oral cancer is not among the top 10 cancers in Malaysia, especially with advanced oral cancer, it will affect the patient’s self-esteem as the disease affect his or her facial aesthetics before and/or after treatment.

So, advances in research in this area is also moving into early detection and increasing knowledge and awareness of not just dental professionals but other health professionals as the public tends to first seek a medical doctor when having soft tissue lesions in the mouth or seek advice from a pharmacists for over-the-counter remedies.

The early detection research advances includes the development and testing of a mobile app (MHealth) and the use of artificial intelligence to better detect potentially malignant lesions in hopes of extending early detection to areas without good dental specialists support.

How do you juggle between research and dean duties? It is about time management and sharing. It is about collaborating. It is about not being individualistic and it is about developing the younger group of staff members/students to be team players.

Thus, as dean, it is about giving confidence to younger staff members to lead projects while sharing with them my experience in research, teaching and management strategies.

This way, I am naturally involved with a number of projects, especially in this late stage of my career, to be able to assist less experienced staff members to always look at things positively, as many things are possible by just taking opportunities wherever they arise.

MDA News

36You have also garnered recognition for your contribution to dentistry. How can Malaysia encourage more research into dentistry? One must always remember that you need to earn recognition. Therefore, credibility of all that you do is important. Thus, research whether with funds or not, must always be done following good protocols that are ethically sound.

My experience is never to allow shortage of funds as a barrier to research. I started research by doing the ones that I can do using my own small funding. Next is to meet up with people of different backgrounds from different parts of the world even if you need to use your own funds.

Then move into team approach in research requiring each members of the team to be transparent instead of being suspicious of each other. Team approach in research and publications would be the best way for future recognition by professional from different parts of the world.

What are your thoughts on the new generation of dental surgeons?The new generation is very keen to move into the advances of dentistry. That is good but a word of caution as it is always good to be attached to seniors as mentors to learn other aspects of managing the discipline before plunging into your own private endeavours at too early a stage.

Seeing that we are currently in the midst of a pandemic, what roles can dental surgeons play in the public healthcare system? The Covid-19 pandemic has taught all professionals to be more diligent in exercising their infection control procedures. While the risk of transmission in dental practice is real but knowledge and understanding of transmission of the virus should be the basis for all the precautions to be taken.

Dental professionals must also educate their patients in being honest in giving information while not causing a lot of fear among them by ensuring that they understand their role and the dentist’s role in prevention of transmission of the virus.

In your opinion, what contributions/roles professional associations such as MDA can help in improving the field of dentistry? MDA must always use all of its expertise to be in the forefront of providing the best knowledge to health professionals and the public.

MDA could be the body that ensures public awareness be given in relation to all disciplines of dentistry, preventing the public from being cheated by fake dentists.

I think that MDA has been doing very well in upgrading the knowledge and skills of the dental professionals.

More can be done to enhance awareness to other health professionals in understanding the different fields or specialties in dentistry. This way, we will be working with them towards a better oral and systemic health of the population.

What are some of the lessons you impart to your dental students? I am always trying to get the students to think out of the box. Many students are still very comfortable with conventional teaching methods where they are dependent on notes and expects to work towards passing exams even to a stage of memorising questions and having their own question banks.

This is not the way to have lasting knowledge. I would always go for student directed learning where they are expected to simulate teachers, i.e. creating problems, assessing themselves through creating their own questions and answers but always to work as a group, challenging each other with their questions and answers.

37

April-June 2020

Oral White Lesions: What to Look For?

By:Dr Sharon Tay Hui WenOral and Maxillofacial DepartmentHospital Kuala Lumpur.

Assoc Prof Dr Mas Suryalis Ahmad Specialist in Special Care Dentistry,Deputy Dean (Student Affairs and Alumni), Faculty of Dentistry, Universiti Teknologi MARA.

Assoc Prof Dr Nik Mohd Mazuan Nik Mohd RosdySpecialist in Oral Medicine,Faculty of Dentistry, Universiti Teknologi MARA.

Frictional Keratosis – Local CausesFrictional keratosis is a benign white lesion of the oral mucosa caused by chronic mechanical irritation or trauma. Most patients are asymptomatic, however they may complaint of discomfort due to its interference during chewing and/or talking. This condition is most often caused by sharp edges of teeth or restorations, dental prostheses, abrasive food, vigorous tooth brushing and parafunctional habits such as cheek biting. Common areas include lower lip, buccal mucosa, retromolar pad and edentulous alveolar ridge. Frictional keratosis may be extensive in some patients, involving almost the entire buccal mucosa and extending to the lips. It may appear as macerated areas of ill-defined area greyish-white lines, papules or plaques and may be associated with peeling, rough tags, ulcers or erosions.

Clinical findings and history taking alone are generally adequate in determining the aetiology and diagnosis of frictional keratosis. Hence, biopsy is usually not required for diagnostic purpose However, in instances where the cause is unidentified, or if the lesion persists after elimination of aetiological factors or if the lesion is in a high-risk area such as the lateral border of the tongue, it may be prudent to take a sample of the questionable lesion to rule out malignancy.

Key points for Frictional Keratosis:

• Benign oral white lesion

• Usually resolve upon cessation of habits or removal of cause

• Retromolar pad and edentulous alveolar ridge are common sites of occurrence

Frictional Keratosis Lichen planus.

MDA News

38Leukoedema - CongenitalLeukoedema was first described by Sandstead and Lowe in 1953. It is a normal variation of unknown aetiology. Leukoedema affects the buccal mucosa bilaterally and appears as an opalescent, filmy grey to white lesion that characteristically disappears upon stretching. No treatment is required except for reassuring the patients.

Key points for Leukoedema:

• Congenital

• Unknown etiology

• Normal variant

Oral Candidiasis – Infective Oral candidiasis, also known as oral thrush, is a fungal infection of the oral cavity caused by Candida sp. It presents as white patches or plaques on the buccal and labial mucosa, tongue, palate and oropharynx area that can be scraped off. However, some types of oral candidiasis are not ‘scrapable’. Candida is a normal commensal of the oral cavity, skin, gastrointestinal tract, and genitourinary tract and will cause an infection when an individual’s immune system is compromised. Some predisposing factors such as immunosuppression in the forms of diabetes, HIV/AIDS, infant or newborn, dentures and poor oral hygiene, malnutrition or vitamin deficiency, prolonged steroid use and prolonged antibiotic use often lead to the development of oral candidiasis.

There are a few clinical presentations of Oral Candidiasis:

1. Acute pseudomembranous candidiasis. White patches that can be rubbed off leaving an erythematous raw area which causes a lot of pain.

2. Acute or Chronic Atrophic Candidiasis. Smooth red shiny patches which causes soreness even without any stimulus.

3. Chronic Hyperplastic Candidiasis. Characterised by thick, white plaques on the mucosa or tongue that are hard to scrape off.

Candida may also cause a secondary infection on other conditions such as oral lichen planus, geographic tongue or angular cheilitis.

Key points for Oral Candidiasis:

• Can be scraped off

• Commonly found in patients with immunocompromised or immunosuppressed conditions.

• Chronic hyperplastic candidiasis has a potential for malignant transformation.

• Usually resolve with oral suspension Nystatin 400,000 units qid for 10-14 days.

Oral Lichen Planus – AutoimmuneOral Lichen Planus is an immunologically mediated mucocutaneous disorder. It affects about 1–2% of the adult population (usually >45 years), and is more common in women. It presents in a wide range of clinical forms, such as unilateral reticular, popular, plaque-like, erosive, atrophic or bullous types unilaterally or bilaterally. The commonly involved sites are the buccal and labial mucosa, tongue and the gingiva. The reticular type of oral lichen planus is often asymptomatic. Similarly, the reticular form has a better prognosis where 40% of cases has spontaneous remission while the erosive type is more long standing with frequent flare ups and pain or soreness.

About 15% of oral lichen planus patients have coexisting skin lesions, presenting as flat-topped or papular purple pruritic rash seen on the wrist and flexor surfaces of the forearms and knees.

Many studies have revealed that the malignant transformation of this condition is 5.3% with highest rate of malignant transformation in the erythematous and erosive type. Hence, regular follow-up is of vital importance.

Treatment including the use of topical corticosteroid is the first-line therapy and most effective. Topical calcineurin inhibitors, such as tacrolimus and pimecrolimus (Elidel), are second-line therapies that may be helpful. Studies have shown that improvement in oral hygiene may help to improve the symptoms. Patients should also be advised to avoid or cease deleterious habits such as use of tobacco, alcohol or betel quid and to consume a healthy diet such as fresh fruits and vegetables.

Key points for OLP:

• Interlacing white striae known as Wickham’s striae appearing bilaterally on the posterior buccal mucosa is often pathognomonic.

• The diagnosis of oral lichen planus is often made clinically though histopathological examination could give more information including dysplastic changes (if presence).

• A biopsy may be required for more atypical cases or to confirm the diagnosis.

39

April-June 2020

Leukoplakia - NeoplasmOral Leukoplakia is one of the common oral potentially malignant disorders. It is defined by the World Health Organization as “flat, white plaques of questionable risk that cannot be wiped off and cannot be characterised as any other entity.”

Most cases occur in men who are between the ages of 50 and 70 years old. The predisposing factors for Leukoplakia include smoking, tobacco and betel quid chewing and high alcohol consumption. The exact aetiology is still unknown. Reports have shown that 17%–25% of cases of Leukoplakia transform to dysplasia, carcinoma in situ or carcinoma.

Clinically, leukoplakia can be presented as homogenous or non-homogenous. A biopsy is recommended in all cases to determine any dysplastic changes. The histopathological findings range from hyperkeratosis without epithelial dysplasia to various degrees of epithelial dysplasia. In the case of lesions with moderate to severe dysplasia, erythroleukoplakia or proliferative verrucous leukoplakia, surgical excision should be the treatment of choice. After excision, recurrence is not uncommon, especially for smokers. Patients should be advised to eliminate causative or pre-disposing factors such as tobacco consumption. Regular monitoring and follow-up are required and the recommended time interval as reported in the literature varies from several months up to 1 year.

Key points for Leukoplakia:

• The high risk sites are the lateral border of the tongue and floor of the mouth

• Prompt referral to oral medicine and pathologist/oral maxillofacial surgeon

• Spontaneous regression of oral leukoplakia is rare

References1. Müller S. Frictional Keratosis, Contact Keratosis and Smokeless Tobacco

Keratosis: Features of Reactive White Lesions of the Oral Mucosa. Head Neck Pathol. 2019;13(1):16–24.

2. Kumar A, Cascarini L, MaCaul JA, et al. How should we manage oral leukoplakia? Br J Oral Maxillofac Surg. 2013; 51:377-83

3. Neville B., Damm D., Allen C., Chi A. Oral and Maxillofacial Pathology. 4th ed. Elsevier; Amsterdam, The Netherlands: 2016

4. Müller S. Update from the 4th edition of the world health organization of head and neck tumours: tumours of the oral cavity and mobile tongue. Head Neck Pathol. 2017;11(1):33–40.

5. Madani FM, Kuperstein AS. Normal variations of oral anatomy and common oral soft tissue lesions: evaluation and management. Med Clin North Am. 2014;98(6):1281–1298.

Patients should also be advised to avoid or cease deleterious habits such as use of tobacco, alcohol or betel quid and to consume a healthy diet such as fresh fruits and vegetables.

For Medical & Healthcare Professionals only.

GlaxoSmithKline Consumer Healthcare Sdn Bhd (3467-X)Lot 89, Jalan Enggang, Ampang / Hulu Kelang Industrial Estate, 68000 Ampang, Selangor Darul Ehsan, Malaysia

PM-M

Y-PA

D-2

0-00

020

HELP PATIENTS STOP THE CLOCKON GINGIVITIS NOW

A4 size