Dental Asia September/October 2024

Dental Asia is the premium journal linking dental innovators and manufacturers to its target audience in the Asia-Pacific. For two decades, we have been showcasing the latest updates in the industry including market insights, dental innovations and evidence-based clinical philosophies to equip the dental practitioners with knowledge and information necessary to keep up with the challenges in modern-day practice. Our combined portfolio of print and digital allows us to reach a broader market and facilitate global interactions, securing our position as the leading dental media in the region.

www.dentalasia.net

SEPTEMBER / OCTOBER 2024

Under The Spotlight: Running the marathon of a dental career Clinical Feature: Troubleshooting common problems in case finishing for clear aligner treatment Behind The Scenes: Tradition meet technology at Hexa Ceram: The digital evolution of dental craftsmanship in Chiang Mai

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CONTENTS

TRENDS 14

DENTAL PROFILE 25

Understanding mental health

The celebration of a century

28 30

The business of sleep

The sweet spot of data analytics

UNDER THE SPOTLIGHT 17 A lifetime of trust 20

CLINICAL FEATURE 32

Running the marathon of a dental career

The concept of a tooth bank in dental clinics: Turning waste into a future resource Troubleshooting common problems in case finishing for clear aligner treatment Systematic, individual prevention concept for a cigarette smoker with dental erosions: Case report

The priority of mental health

2 DENTAL ASIA SEPTEMBER / OCTOBER 2024

USER REPORT 42

Called into action

BEHIND THE SCENES 46

Tradition meet technology at Hexa Ceram: The digital evolution of dental craftsmanship in Chiang Mai

IN DEPTH WITH 50

Occlusal instability: Hybrid ceramic VITA ENAMIC in the virtual articulator

SHOW PREVIEW 58

Dentistry Show London

Dental World 2024: Growing opportunities in Central Eastern Europe

Dental-Expo 2024

SHOW REVIEW 61

Outstanding Kiwi dentists honoured at NZDA Awards 2nd Asia Pacific Dental Sleep Medicine Fellowship Day

REGULARS 4

Editor’s Note

Dental Updates

53 63 64

Product Highlights Events Calendar Advertisers’ Index

3 DENTAL ASIA SEPTEMBER / OCTOBER 2024

EDITOR’S NOTE

Main character? Or NPC?

Over a recent lunch with colleagues, the discussion centred on the upcoming 2024 US elections; in particular, how the moment slang words are adopted in the “corporate” world, it marks a decline of the word’s colloquial use. At the risk of doing the same, I found the two terms in the title remarkable apt when thinking about the topics raised in this issue. First, a quick summary. “Main character” is used to describe scenarios where one is placed at the centre of attention, while “NPC” refers to the lack of agency and control one experiences through the course of life. Do these words feel relatable in the dental profession? Sometimes, the stress and expectations tied to the profession leads to undesirable strains in one’s mental health. With the Medical Protection Society (MPS) gearing up to turn the spotlight on mental health in October for World Mental Health Awareness Day, chair of council Graham Stokes Dr Stokes encouraged practitioners to always think long- term, looking beyond immediate gains but at the overall trend of one’s career (p.21). Similarly, stigma about mental health is another pervasive issue in the profession, at times posing a barrier to seek help and support when needed. Assoc Prof Hopcraft believes that mental health should be cared for in the same vein as physical health, where open conversations should be encouraged and normalised in both personal and professional settings (p.23). At the other end of the spectrum, 2024 sees VITA Zahnfabrik with “main character energy” as the company celebrates its centennial anniversary with a year-long calendar of activities. Schnakenberg Bernd, global head of Sales and Marketing, reflected on the company’s milestones and affirmed its commitments to users for the next 100 years (p.25). Monikaproy Meekiatichaikun, CFO of Hexa Ceram Dental Lab, shared about the intricate dance between heritage and innovation that has enabled the company to the forefront of the digital dental laboratory revolution in the culturally rich province of Chiang Mai (p.46).

Regardless of “main character” or “NPC” moments, highs and lows are to be expected in both our professional and personal lives. Personally, I find “The Rule of Thirds” useful in navigating this journey. Taught by her coach, Greek Olympian Alexi Pappas puts it nicely in her 2021 autobiography Bravery : “When you are chasing a big goal, you are supposed to feel good a third of the time, okay a third of the time, and crappy a third of the time...and if the ratio is roughly in that range, then you are doing fine.”

James Yau Assistant Editor James Yau

CORRECTION

Due to a translation error, an error was made for the article ‘Future dentists in Hong Kong will face difficult challenges’ in the Dental Asia July/August 2024 issue . The paragraph in the second column which reads “Second, one licensed dentist in Hong Kong … in a wide variety of treatments.”, should correctly have been translated to the following: “Second, patients in Hong Kong are protected as they can only be treated by licensed dentists whereas in China, some treatments are allowed to be performed by trainees who are under the supervision of a licensed dentist.”

The correction has been reflected in the e-book of the issue.

www.dentalasia.net

SEPTEMBER / OCTOBER 2024

Front cover credit Top image: freepik Bottom image: Hexa Ceram Dental Lab

LET’S CONNECT @dentalasia

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4 DENTAL ASIA SEPTEMBER / OCTOBER 2024

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ADVISORY BOARD

Dr William Cheung

Dr Choo Teck Chuan

Dr Chung Kong Mun

Dr George Freedman

Dr Fay Goldstep

Dr Clarence Tam

Dr Anand Narvekar

Prof Nigel M. King

Dr Kevin Ng

Dr William O’Reilly

Dr Alan Kwong Hing

Dr Wong Li Beng

Dr Adrian U J Yap

Dr Christopher Ho

Dr How Kim Chuan

Prof Alex Mersel

Dr Derek Mahony

All rights reserved. Views of writers do not necessarily reflect the views of the Publisher. No part of this publication may be reproduced in any form or by any means, without prior permission in writing from the Publisher and copyright owner. Whilst every care is taken to ensure accuracy of the information in this publication, the Publisher accepts no liability for damages caused by misinterpretation of information, expressed or implied, within the pages of the magazine. All advertisements are accepted on the understanding that the Advertiser is authorised to publish the contents of the advertisements, and in this respect, the Advertiser shall indemnify the Publisher against all claims or suits for libel, violation of right of privacy and copyright infringements. Dental Asia is a controlled-circulation bi-monthly magazine. It is mailed free-of-charge to readers who meet a set of criteria. Paid subscription is available to those who do not fit our terms of control. Please refer to subscription form provided in the publication for more details. Printed by Oxford Graphic Printers Pte Ltd

5 DENTAL ASIA SEPTEMBER / OCTOBER 2024

DENTAL UPDATES

Straumann Group announces sale of DrSmile aligner business

execution which led to winning new customers and gaining market share … On the consumer side, selling DrSmile to Impress Group will give this company the necessary scale and patient journey expertise to further strengthen patient care to succeed in the European direct- to-consumer clear aligner market. Due to this new situation, we restated the figures and updated our outlook for 2024,” said Guillaume Daniellot, CEO of Straumann Group. DA

The Straumann Group announced on 13 Aug the signing of a definitive agreement to sell its DrSmile business to Impress Group. The transaction will see Straumann Group receive a minority shareholding of 20%, on a fully diluted basis, in the company. In December 2020, the Straumann Group has acquired DrSmile, a start-up company that was formed 2017 in Berlin and which developed into one of the leading providers of aligner treatment in Europe. Founded in 2019 and headquartered in Barcelona, Spain, Impress Group is a leading provider of clear aligners in Europe and operates a network of clinics in

countries such as Spain, the UK, Italy and Portugal. With the acquisition of DrSmile, Impress Group is said to be aiming to build a leadership position in the direct-to- consumer clear aligner space in Europe, by combining quality clinical treatment with consumer marketing expertise at scale. The news of the sale was made under an ad hoc announcement by Straumann Group where the company also shared its second quarter performances highlighting strong growth in key markets and sectors. “We are very pleased with the half-year results. Our double-digit revenue growth reflects the team’s continued strong

(Image: Straumann Group and DrSmile)

Penn Dental Medicine researchers exploring the regenerative properties of oral tissue

According to news shared by Penn Dental Medicine, results from researchers support an emerging concept that fibroblasts are actively involved in supporting the body’s immune response. These results are said to contrast with the traditional view that these cells are featureless building blocks for maintaining structure. “The potential of this finding is significant not only for periodontal regeneration — for instance, the ability to take grafts from tissues enriched with pro-healing fibroblasts — but also for its implications in other parts of body that heal sub-optimally. Regeneration over scar formation in response to injury is a huge topic,” said Dr Kang Ko, Assistant Professor in the Department of Periodontics. Researchers at Penn Dental Medicine pondered why scars rarely form in the mouth. To get a better handle on the exceptionally accelerated wound healing in

the oral cavity, Dr Ko's lab is investigating different populations of oral fibroblasts. These types of cells form connective tissue, and work from Dr Ko's studies is revealing they may play important roles in the wound healing process. “Oral tissues exhibit remarkably regenerative properties, unlike many other organs in the human body,” said Dr Ko. “The goal is to understand the cellular and molecular mechanism by which this occurs in the oral cavity, with the hope of employing therapeutics to enhance oral soft and hard tissue healing, as well as translating these unique healing properties to other body parts to promote regeneration over repair.” In a Journal of Experimental Medicine paper, the researchers reported finding a unique subset of oral fibroblasts that is primed to promote rapid wound healing. The team studied what happens to wounds

(Image: Penn Dental Medicine)

in mice in two different parts of the palate — the front, or anterior, region that heals rapidly and the back, or posterior, palate that heals more slowly. In the study, they identified a distinct population of cells called paired-related homeobox-1+ (Prx1+) fibroblasts in the anterior palate that are missing from the posterior section, and they showed that these cells are responsible for quick wound healing observed in the mouth. Transplanting these cells to the posterior palate sped up healing, and deleting the cells in the anterior section delayed the process. In human gingival samples, these Prx1+ fibroblasts were in the same locations and expressed the same genes. DA

6 DENTAL ASIA SEPTEMBER / OCTOBER 2024

DENTAL UPDATES

Envista announces key leadership appointments

Envista Holdings Corporation announced key leadership appointments which will see Eric Hammes joining Envista as CFO, Stefan Nilsson joining Envista as president of Nobel Biocare, and Veronica Acurio joining Envista as president of Ormco. “It is a pleasure to welcome this trio of successful leaders to Envista. Each brings experience in dental along with a proven track record of continuous improvement, leading with purpose, and creating value for all stakeholders. Today’s announcement positions Envista even more strongly to advance our mission of partnering with dental professionals to improve patient lives,” said Paul Keel, CEO of Envista. First, Hammes has been appointed as CFO effective 8 Aug 2024. He succeeds Stephen Keller who has served as interim principal

Last, Acurio is appointed president, Orthodontics effective 2 Aug 2024. Acurio joins Envista from Solventum, a global medical device business recently spun off from 3M Company. Acurio has extensive experience in profitably growing global healthcare businesses. Envista is a global family of more than 30 trusted dental brands, including Nobel Biocare, Ormco, DEXIS, and Kerr united by a shared purpose: To partner with professionals to improve lives. Envista’s portfolio, including dental implants and treatment options, orthodontics, and digital imaging technologies, covers a wide range of dentists’ clinical needs for diagnosing, treating, and preventing dental conditions as well as improving the aesthetics of the human smile. DA

(Image: Envista)

financial officer since September 2023. Keller will return to his previous role leading investor relations. Next, Nilsson has been appointed president of Nobel Biocare, effective 15 Jul 2024. Most recently, Nilsson served as CEO of Colosseum Dental Group, which grew to be one of Europe’s largest DSOs under his leadership. Prior to Colosseum, Nilsson was CEO of GrandVision Brazil, a leading eyecare service provider. Further, he had a distinguished career at Nestle in a variety of operations, marketing, and general management roles around the world.

Dental students honoured in Global Clinical Case Contest 23-24

Dentsply Sirona has announced the winners of its Global Clinical Case Contest (GCCC) 2023-24, which aims to empower dental students to do their best for patients and confidently advance their skills. This latest edition saw over 411 students from a total of 127 universities in over 20 countries taking part in this year’s global competition by participating in regional preliminary rounds. The regional winners came together for the final in Constance, one of Dentsply Sirona’s sites in Germany, where 10 dental students from 10 countries presented their case studies on clinically challenging restorations using Dentsply Sirona products at the final of the annual GCCC. The cases submitted were challenging anterior and posterior restorations that were implemented either directly or indirectly in the CAD/CAM workflow. Only

Dentsply Sirona products were used, for example CEREC Tessera, Calibra Ceram and Prime&Bond. The winner was N Movina Wu from the National Cheng Kung University, Taiwan. She presented the case of a fractured upper right central incisor. After confirming the tooth’s vitality, a minimally invasive direct composite restoration was chosen. “It was a privilege to be part of a competition with such talented young dentists from all over the world. The award confirms my ambition to foster dental health and provide patients with state-of- the-art treatments,” said Wu. Second place was awarded to Qinyang Li from the Sichuan University, China, with the case of a patient who needed diastema closure after completing orthognathic and orthodontic treatment. Third place

GCCC judges, students and Dentsply Sirona team at Dentsply Sirona Site in Constance, Germany (Image: Dentsply Sirona)

was received by Mayar Mostafa from the Alexandria University, Egypt, for a patient case in which a 23-year-old female sought treatment for poor aesthetics of her upper anterior teeth after orthodontics, showing decalcification and staining. The jury praised the high standard of the cases submitted. “The restorations presented were produced by the students with great personal commitment and technical skill,” said jury member Dr Britta Hahn. DA

7 DENTAL ASIA SEPTEMBER / OCTOBER 2024

DENTAL UPDATES

JCU helps dentists address patients experiencing domestic and sexual violence

As dentists are treating an increasing number of patients who are experiencing, or have experienced, domestic and sexual violence (DSV), acquiring knowledge and skills to recognise, respond and refer appropriately is crucial. DSV is widely recognised as a pervasive, and preventable problem with significant health impacts. Thanks to a range of industry-leading tools developed by James Cook University (JCU), dentistry students and practitioners across Australia will now be equipped with the skills they need to recognise and respond to patients harmed by DSV. Officially launched in August by experts from JCU’s Dentistry and Social Work fields, the educational videos and related documents cover several role-playing scenarios, the use of trauma-informed care, legal and ethical considerations, working with First Nations Australians, and how

to avoid unintended consequences when providing assistance to victim-survivors.

JCU Dentistry Adjunct Associate Professor Felicity Croker said that as a significant number of JCU students had treated patients with indicators of DSV, additional skills were needed to deal with those scenarios. “One of the things we hope has come out of the launch of these resources is that we will also be able to bring on board the clinical supervisors, dentists in practice and make it available to other dental schools,” she said. The JCU programme now extends to third year Dentistry students onwards and is also used by JCU-affiliated dental practitioners, with the Australian Dental Council having since made it a graduate requirement that all students have competency in recognising, assessing, and responding to domestic and family violence.

(Image: James Cook University)

JCU Social Work senior lecturer Dr Ann Carrington said dentists were in a unique position and had to manage what could be an awkward environment for victim- survivors to speak up and seek support. “We want students and practitioners to be able to listen in, make some risk assessments, and build the perfect tools to address DSV where necessary, but dentistry can be a really triggering experience for survivors of trauma,” said Dr Carrington. DA managers, and support staff and with this additional funding they will now have the latest equipment,” minister Park added. ACCHOs are incorporated Aboriginal organisations initiated by and based in local Aboriginal communities. They deliver holistic and culturally appropriate health services to their communities. The NSW Government said that it remains committed to its partnership with the Aboriginal health sector and funds 25 ACCHOs to provide dental care for patients across the state. “We are committed to ensuring people can continue to have access to oral health services that are culturally responsive, safe and of high quality. This targeted funding ensures services meet the unique needs of the local Aboriginal communities they are within,” said minister for Aboriginal Affairs and Treaty David Harris. DA

Aboriginal communities in New South Wales receive funding boost

According to news shared by the New South Wales Health authorities, patients at 15 Aboriginal Community Controlled Health Organisations

“Oral health can influence general health. A healthy mouth ensures people can eat, speak and socialise without discomfort and embarrassment. A targeted funding boost to allow ACCHOs to update or replace their equipment helps address disparities experienced in vulnerable population groups and will have a positive impact on the overall population’s health and wellbeing,” said minister for Health Ryan Park. The additional funding will ensure ACCHOs can tailor their services as needed, allowing them to both improve and increase their ability to provide holistic health care to the community now and into the future.

(Image: NSW Health)

(ACCHOs) across New South Wales (NSW), Australia, will benefit from improved dental services following a funding boost worth AU$1,705,000. These one-off grants will see selected metropolitan, regional and rural ACCHOs replace, update or purchase additional dental equipment such as an intraoral camera, prosthetist services dental chairs and x-ray machines.

“The oral health teams working in ACCHOs are highly skilled dental practitioners,

8 DENTAL ASIA SEPTEMBER / OCTOBER 2024

DENTAL UPDATES

Perceptive AI-driven robotic system completes first fully automated dental procedure on a human Perceptive, a company in AI-driven automated dental technology, has announced the completion of what is said to be the world’s first fully automated dental procedure on a human using its advanced robotic dentistry system. This milestone reportedly marks a significant leap forward in dental care, integrating advanced imaging, AI, and robotics to set a new standard of care in dentistry, according to the company. The Perceptive dental robotics system integrates AI-driven 3D imaging software with a robotic arm designed to perform dental procedures, starting with restorative dentistry, with unparalleled speed and precision. The proprietary system aims to complete tasks such as crown placements in just 15mins, a major reduction from the current method that requires two office visits of at least one hour each. According to Perceptive, its AI robotics system uses 3D volumetric data for diagnostics and treatment planning, enabling early and highly accurate diagnoses. The procedure begins with an optical coherence technology (OCT) scan of the patient’s tooth and mouth using Perceptive’s handheld intraoral scanner. This advanced scanner captures 3D images beneath the gum line, through fluids and under the tooth surface, offering great imaging capabilities. Patients can clearly visualise their dental conditions through these detailed images, helping them better understand their need for care, according to the company. The system then uses Perceptive’s AI algorithms to analyse the 3D data and plan the procedure with efficiency and high precision. By automating these procedures, Perceptive is said to enable dentists to diagnose and treat more patients with higher quality care in less time, reducing the need for manual labour and minimising the chances of human error. DA

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9 DENTAL ASIA SEPTEMBER / OCTOBER 2024

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DENTAL UPDATES

HKU OMFS studies reveal dental anxiety linked with adverse childhood experiences

Dental anxiety is a widespread issue that affects countless people globally, causing them to avoid dental care and suffer from poor oral health. A study by the Division of Oral and Maxillofacial Surgery (OMFS), Faculty of Dentistry, the University of Hong Kong (HKU) revealed both dental-related factors and non-dental factors: Adverse childhood experience, attributed to dental anxiety. By combining insights from two academic papers, OMFS researchers probed into both dental-related and non-dental factors, particularly adverse childhood experiences (ACEs), which contribute to dental anxiety. Oral and Maxillofacial Surgery clinical professor Mike YY Leung, who led the project, said: “Our aim is to enhance awareness of the significance of these factors in evaluation and addressing dental anxiety, inspire more research, and foster interdisciplinary cooperation to help individuals conquer their fears and get the essential dental care they need.” The first study by the OMFS research team, published in December 2022 in the International Journal of Environmental Research and Public Health, titled ‘Qualitative Evaluation of YouTube Videos on Dental Fear, Anxiety, and Phobia’, analysed 145 YouTube videos to assess their quality and content. The study discovered that these videos, produced by various sources, covered numerous factors, symptoms, and interventions but lacked information on defining or diagnosing dental fear, anxiety, and phobia. Many videos had high view counts, including patient testimonials. The aetiology of dental fear, anxiety, and phobia mentioned in the videos can be broadly categorised into two groups: Cognitive and behavioural factors.

like, “The dentist made me feel powerless.” Behavioural factors, including direct trauma and conditioning through modelling and verbal instructions, contributed to dental anxiety with statements like, “My sister was crying on the dental chair” and “My parents told me that my uncle died at the dentist.” While patient testimonials from the first study have been extensively documented in prior research, exploring the causes of dental anxiety requires going beyond dental-related factors. In another study ‘Adverse Childhood Experiences and Dental Anxiety Among Chinese Adults in Hong Kong: A Cross-sectional Study’, published recently in Frontiers in Psychology, the researchers investigated the correlation between ACEs and dental anxiety. In this study, 171 participants completed online questionnaires (using the Adverse Childhood Experiences International Questionnaire – ACE – IQ) assessing their ACEs and dental anxiety levels (using the Modified Dental Anxiety cale – MDAS and Dental Fear Survey – DFS). The results revealed a significant association between ACEs and dental anxiety, with higher cumulative ACEs positively correlating with increased dental anxiety scores. Specific ACEs, such as emotional and physical neglect, sexual abuse, and household substance abuse, were found to significantly influence the likelihood of experiencing heightened dental anxiety.

(From left): Prof Mike Leung, Prof Colman McGrath, Ms Natalie Wong and Dr Andy Yeung (Image: Faculty of Dentistry, the University of Hong Kong) revealed a need for accurate information and collaboration between dental professionals and mental health experts to ensure reliable content is available to the public. On the other hand, to address the significant associations between dental anxiety and adverse childhood experiences, it is essential for dental professionals to consider early life experiences when examining the causes of dental anxiety and adopt a more comprehensive approach to assessment and treatment, considering both dental-related and non-dental factors. In addition, working with mental health experts may facilitate the development of targeted interventions addressing both dental and psychological aspects. Raising awareness and promoting education on dental anxiety, including its potential causes, are also vital. The research team encourages further research on the underlying mechanisms linking ACEs to dental anxiety and evaluating the effectiveness of interventions addressing both dental and non-dental factors. Taking these steps will aid in managing dental anxiety and enhancing patient care. The project also included Dr Andy Yeung, tutor in Radiography, and Prof Colman McGrath, Clinical Professor in Dental Public Health, as co-investigators. DA

Implementation of comprehensive assessment and treatment Dental fear, anxiety, and phobia are

common concerns that significantly impact individuals’ oral health and overall well- being. The two studies’ findings shed light on the importance of considering both dental-related and non-dental factors when examining the causes of dental anxiety. The analysis of YouTube videos

Cognitive factors, such as perceived lack of control, were evident in testimonials

10 DENTAL ASIA SEPTEMBER / OCTOBER 2024

DENTAL UPDATES

APDIA and TDTA signs MOA to host 2024 APDIA Conference with Taiwan World Dental Show The Asia Pacific Dental Industry Association (APDIA) and the Taiwan Dental Traders Association (TDTA) have signed a Memorandum of Agreement (MOA) over a virtual ceremony on 23 Jul to collaboratively host the 2024 APDIA Conference in conjunction with the Taiwan World Dental Show (TWDS), scheduled to take place from 9-10 Nov 2024 in Taipei, Taiwan. The collaboration between APDIA and TDTA aims to promote both local and international business opportunities, drive innovation in the dental industry, foster international partnerships, and provide professional development opportunities for members of both organisations. Under the MOA, APDIA will co-organise and co-ordinate international elements of the event, including regional meetings, buyer group missions, visits to key dental industry areas in Taiwan, and networking events. In return TDTA will support APDIA’s presence at the event as co-organiser and exhibitors to make this event an international platform for the dental fraternity. “This MOA signifies our dedication to building a future where dental professionals can thrive, innovate, and collaborate across borders. We are excited to partner with TDTA to bring together industry leaders and professionals in Taipei,” said MA Lourdes Jimenez-Villaroman, president of APDIA. Officially formed on 14 Jul 2023, APDIA aims to foster co- operation among dental industry associations in the ASEAN and Asia Pacific regions. The association is governed by dedicated council members with membership open to Asia Pacific countries. Currently its members comprise of Malaysia, the Philippines, Taiwan, Indonesia and Australia. Under the leadership of MA Lourdes Jimenez-Villaroman as its first president, APDIA strives to drive innovation and collaboration for dental industry growth throughout the Asia Pacific region. DA

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Members of the APDIA, TDTA, and TWDS present at the virtual ceremony to witness the signing of the MOA

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11 DENTAL ASIA SEPTEMBER / OCTOBER 2024

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DENTAL UPDATES

Mandatory internships and foreign- trained dentists for Hong Kong as new bill passes

Moreover, the new bill also mandated local dentistry graduates to undergo a one-year internship before obtaining full registration. “In recent months the one-year internship arrangement for local dental graduates has been a subject of concern. As the statutory body responsible for the registration of dentists in Hong Kong, the dental council has conducted several accreditation exercises of The Bachelor of Dentistry program of the University of Hong Kong since 2012,” said Secretary Lo. Local dental graduates will be regarded as registered dentists in law when they take up internships and rotate through different service units. The arrangement will the new graduates in attached to different areas of work under the government secottr including general, school dental care, emergency, hospital and community dental services. He added: “The council has repeatedly pointed out its concerns about clinical training of the programme and has even advised the government at one point that it would seriously consider whether it would still be appropriate to continue accepting the program as a recognised programme.” The arrangement will apply to local dental students graduating in the summer of 2025 and onwards. DA

The Legislative Council (LegCo) of Hong Kong passed the ‘Dentists Registration (Amendment) Bill 2024’ in what Health Secretary Lo Chung-mau described as a “historic” moment. “The bill aims to update the legal framework which has been in use since so as to bring the regulatory framework of dental practice in Hong Kong up to date and in line with the latest development in the demand for dental manpower and services for the benefit of the general public,” said Secretary Lo to lawmakers on 10 Jul in the Legislative Council Complex. “It is now a historic moment for Hong Kong. This is the most comprehensive Amendment to the Dentists Registration Ordinance in Hong Kong in over 60 years.” Under the new bill, the Department of Health will start hiring non-locally trained dentists to address the shortage of dentists in Hong Kong. Secretary Lo said that as of 1 Jul 2024, 110 out of the 370 posts of dental officers in the Department of Health were vacant.

Health Secretary Lo Chung-mau addressing lawmakers in Hong Kong on 10 Jul as the Dentists Registration (Amendment) Bill 2024 was passed (Image: Screengrab from Legislative Council of HKSAR/YouTube) “Taking into account also the impending wave of retirements in the next few years, we must expeditiously address the shortage of dentists in the short to medium term so as to avoid affecting the dental health of members of the public,” said Secretary Lo. The government said that the first batch of non-locally trained dentists are expect to arrive here in Hong Kong by the first quarter of 2025 under the new pathways created in the bill. The shortfall is also expected to persist until 2040 before easing slightly.

Medit appoints Han Ryu as new CEO

Medit has announced the appointment of Han Ryu as its new CEO. “I am truly honored to lead Medit as CEO. Medit’s open innovation model and unwavering passion for care improvement perfectly align with my vision. We will accelerate the digital dental revolution with a customer-centric approach,” said Ryu. According to the news shared by The Korea Herald, Medit plans to strengthen its professional management system with the appointment of Ryu. The launch of the Medit i900 intraoral scanner in

April is said to have impacted the market with its innovative features and excellent performance. Since 2023, Ryu has led Medit North America, spurring growth in the market while overseeing sales and marketing activities. He also has over three decades of senior management experience in global medical device and health care companies. Moreover, with Ryu’s global management leadership, strategic vision development and achievement, along with his expertise

Han Ryu, Medit’s new CEO (Image: Medit)

in driving innovation and growth, Medit said it is expected to focus more on customer-centred innovation, enhance strategic partnerships and strengthen new product development. DA

12 DENTAL ASIA SEPTEMBER / OCTOBER 2024

DENTAL UPDATES

First 3D-printed ceramic subperiosteal jaw implant placed in patient Lithoz has announced the successful placement of a 3D-printed ceramic subperiosteal jaw implant in a patient for the first time ever. A patient at Kepler University Hospital, who had lost multiple dental implants and bone grafts in the past due to his compromised health, was unable to receive further conventional surgical strategies as a result of significant scarring and thus received the new implant as a compassionate use case. As one of the partners in the project, Lithoz has been researching the optimal fusion of various biomaterials with the advantages of 3D printing since 2021. The surgery, led by Dr Christoph Staudigl, was a successful world first use of a ceramic subperiosteal jaw implant in a compassionate use case on a patient. Despite some expected wound healing issues after surgery, the superior soft tissue compatibility of zirconia compared to titanium played its role spectacularly. The implant showed clinical stability after 60 days, representing a decisive breakthrough for the treatment of severely atrophic jaws according to Lithoz. Made of biocompatible high-strength zirconia using Lithoz LCM technology, the implant did not require any bone augmentation and required only one procedure, reducing healing time by an estimated 75% and avoiding excess trauma for the patient. Thanks to this synergetic innovation in design and material, all the necessary surgical procedures were completed in a single operation. The design of the customised implant was pioneered by the Centre for Medical Physics and Biomedical Engineering at the Medical University of Vienna in collaboration with Dr Staudigl. The implant will be patented and adopted as a medical device by BioMed Centre spin-off Agensmed GmbH and will be manufactured using Lithoz 3D printers. A clinical trial is being prepared to systematically validate its efficacy. DA

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13 DENTAL ASIA SEPTEMBER / OCTOBER 2024

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Understanding mental health Dental Asia speaks with Dr Adrian Loh , senior consultant psychiatrist at Promises Healthcare, to understand the determinants of mental health.

Could you share your background and expertise as a psychiatrist? Dr Loh: I am currently a psychiatrist at Promises Healthcare, working in the private sector. Before this, I worked for about fifteen years in the public sector, doing clinical work at the Institute of Mental Health, different psychiatry departments in restructured hospitals, and with the Singapore Armed Forces. I have also had the privilege to treat a handful of dentists as patients; beyond that, I have also had the opportunity to get to know many more as colleagues and had the chance to understand their unique concerns. Could you break down the determinants of mental health and how stress in the profession can contribute to poor mental health? Dr Loh: Mental health issues and stress in the dental profession have been increasingly recognised as significant concerns, driven by the intrinsically demanding nature of the job and exacerbated by recent global events such as the Covid-19 pandemic. National and international dental organisations have responded with initiatives aimed at addressing these growing concerns. Below is a breakdown of the determinants of mental health in dentistry and an explanation of how stress within the profession can contribute to poor mental health. Singapore is notorious for a fast pace of living, a country where your career helps to define you. With career advancement already firmly ensconced within our list of priorities for the average citizen, many tend to devote a good part of their waking hours to work, with less and less time being set apart for leisure and recreation. It makes sense, then, that we should look to the workplace as a concept just as deeply implicated in our happiness, or lack thereof, as home and family.

Multiple determinants of mental health in dentistry exist, such as work-related stress. Dentistry involves high-stakes work requiring precision and a deep understanding of complex procedures. The fear of making mistakes and the need to maintain a high level of concentration for long stretches of time are significant stressors. The demanding workload, including both clinical and administrative responsibilities, often leads to long hours and fatigue. Time pressure, especially in busy practices, can compromise the quality of care and increase stress levels. As it stands, many dentists are highly conscientious by nature and this personality trait can predispose them towards having exacting standards of themselves as well as their colleagues. Managing anxious or difficult patients is a common challenge that adds emotional strain to the dental practice. 1 This stress can contribute to burnout, especially when coupled with the fear of patient dissatisfaction and potential litigation. The financial aspects of running a dental practice, such as overhead costs and debt management, are significant stressors. The Covid-19 pandemic further exacerbated these pressures by reducing patient flow and increasing operational costs due to heightened infection control standards. Dentists may struggle to balance the demands of their practice with personal life, leading to work-life imbalance and neglect of personal health. This imbalance is a significant contributor to stress and burnout. The pandemic was also large with the introduction of new stressors, including the risk of viral exposure and the strain of adhering to new infection control protocols. 1 A post-pandemic survey of Welsh dentists found that one-third of participants increased their alcohol consumption frequency,

highlighting the detrimental coping mechanisms that can arise under prolonged stress. 2 These stresses can lead to poor mental health by influencing conditions such as burnout, anxiety depression or, in extreme cases, suicidal ideation. Heavy use of social media, for both personal and professional purposes, can also encourage users to develop an unhealthy habit of comparing their lives with others. Constant exposure to social media posts emphasising visible signs of success amongst peers may contribute to anxiety that they are not doing well enough. Dental professionals are vulnerable to burnout, characterised by emotional exhaustion, depersonalisation, and a reduced sense of personal accomplishment. Burnout progresses through stages, starting with fatigue and emotional exhaustion and potentially leading to severe mental health issues like depression and anxiety. Fortunately, in Singapore, the reported prevalence of burnout is comparatively low. As seen in a survey published on Pubmed, overall, low to moderate levels of burnout were reported by the 210 survey respondents. 3 Since effective measures to prevent burnout exist, efforts should be made to implement these strategies and prevent any attrition due to burnout. Addressing these issues requires a concerted effort from dental organisations, beginning with dental schools and extending to major dental employers and professional bodies. These efforts should include increasing awareness, reducing stigma, and providing better access to mental health resources. The evidence strongly supports the need for proactive stress management strategies to safeguard the health and wellbeing of dental practitioners.

14 DENTAL ASIA SEPTEMBER / OCTOBER 2024

TRENDS

What are some common symptoms when someone is affected with poor mental health? Dr Loh: Common symptoms that someone affected by mental health may exhibit can be categorised into emotional symptoms, physical symptoms and behavioural symptoms. Emotional symptoms can include burnout, anxiety, and depression, as mentioned above. Typically, we see this as characterised by detachment from work, excessive worry, hopelessness, and being overwhelmed. As for physical symptoms, we usually see fatigue and sleep disturbances, which can be due to the long hours of work in demanding conditions. In dentistry, these symptoms can severely affect their work performance along with their overall health. Dentists often report musculoskeletal pain, particularly in the back, neck, and shoulders, which the physical demands of the job can exacerbate. According to Admetec, studies indicate that 33-87% of dentists suffer from musculoskeletal pain and/or musculoskeletal disorders (MSDs) in their back, neck, and shoulders. 4 Over time, these physical issues can impair productivity and even compel some practitioners to leave the profession prematurely. Behavioural symptoms are most often seen as decreased work performance and social withdrawal. 5 Decreased work performance could be a decline in productivity and an increase in mistakes; these are often telling indicators of mental health issues in a practitioner. Dental professionals may additionally begin to withdraw from colleagues and patients, exhibiting a lack of interest in social interactions and professional engagements. To help colleagues who exhibit these symptoms, it is important to be able to recognise the signs of poor mental health. Encouraging an open and non-judgmental conversation with the colleague is crucial, and it is important to approach the topic with empathy, offering support rather than criticism.

very important to establish a supportive peer network. Establishing peer support groups within the dental community in Singapore can provide a safe space for professionals to share experiences and coping strategies. Finally, promoting mental health awareness and reducing the stigma associated with seeking help can go a long way. It is advisable for well-meaning colleagues to try their best to seek a stressed colleague’s assent before speaking to supervisors regarding their condition or trying to “ease their burden” by lessening their workload. What are some preventive actions that professionals can adopt to address common mental health risks? Dr Loh: Integrating stress management techniques and practices into daily life, including while at work can be very helpful. Examples of these include mindfulness, relaxation techniques and spiritual practices into daily routines which can significantly reduce stress levels. 6 Studies have shown that mindfulness-based stress reduction (MBSR) programmes can improve mental wellbeing and decrease burnout rates among healthcare professionals, including dentists. Conducting regular workshops on mental health awareness can help dental professionals recognise early signs of stress, anxiety, and burnout. These workshops can also teach coping mechanisms and resilience-building strategies. In Singapore, initiatives like these are becoming more common as awareness of mental health issues in high stress professions increases. These workshops should be implemented for a wide range of dental professionals,

Peer support groups do not need to be formal or specifically focused on mental health. For dentists trained in Singapore, many are already accustomed to a strong tradition of mentoring, where juniors are paired with seniors from their time in dental school. This tradition can be expanded so that seniors take a more active role in supporting the mental wellbeing of their juniors. Encouraging flexible work arrangements, such as adjusted work hours or reduced patient loads during particularly stressful periods, can help manage work-related stress. When long working hours are common, such flexibility can be crucial in preventing burnout. There is growing recognition of the importance of regular physical activity in maintaining mental wellbeing. Dentists should be encouraged to prioritise making time for exercise to support their mental health.

Dr Adrian Loh

across all levels of seniority, to help the community better understand the prevalence of mental health concerns. Establishing peer support groups within the dental community can provide a platform for professionals to share their

experiences and challenges, reducing feelings of isolation. This is especially relevant in Singapore, where the stigma around mental health can sometimes prevent individuals from seeking help.

Colleagues should encourage the affected individual to seek professional help. It is also

TRENDS

Regular mental health assessments can help identify early signs of mental health issues among dental professionals. 7 Incorporating these assessments into routine health checks could be a proactive approach to combating the issues that the stigmatisation brings with workers choosing against voluntary disclosure. This can encourage them to be transparent. Implementing Employee Assistance Programmes (EAPs), that provide confidential counselling, financial advice, and stress management support can be highly beneficial. Such programmes are becoming more prevalent in Singapore as organisations recognise the importance of supporting the mental wellbeing of their employees. Could you speak to the psychiatry behind burnout and suicidal ideation, and what steps can be taken to support those who are impacted by it? Dr Loh: In the context of dentistry, burnout can be exacerbated by factors such as a high patient load, clinical demands and isolation. 8 Dentists often face long hours and the pressure of treating many patients in a single day can lead to physical and emotional exhaustion. The need for precision and the fear of making mistakes can create a high-stress environment. Finally, many dentists work in solo practices, which can lead to feelings of loneliness and lack of peer support. That said, there are a number of factors that can contribute to burnout and sucidal ideation in dentistry. Chronic stress can lead to constant ruminations and worrying, which in turn increase the risk of burnout, depression and even suicidal ideation. Maladaptive coping mechanisms is also a pressing cause for concern, dentists may turn to unhealthy coping strategies such as behavioural addictions and substance abuse, which can exacerbate feelings of hopelessness and lead to suicidal thoughts. Various levels of support can be provided, ranging from peer-support initiatives, such as mental health advocates within the professional community, to external counsellors and psychotherapists through EAPs, and even formal psychiatric care.

What advice do you have at the personal, organisational, and national level to normalise mental health discourse and action? Dr Loh: Stigma surrounding mental health remains a significant barrier for dental professionals, who often hesitate to seek help due to fear of judgement. 9,10 At Promises Healthcare, we believe that normalising mental health discourse requires co-ordinated efforts at the personal, organisational, and national levels. At the personal level, dentists should actively seek mental health education and self-awareness. 11 This involves recognising symptoms of burnout and anxiety early. Encouraging open conversations with colleagues about mental health experiences can also help reduce stigma. Dentists must prioritise seeking help when needed, viewing it as a sign of strength rather than weakness. At the organisational level, dental practices should implement clear mental health policies, including access to counselling and mental health days. Regular training and workshops on mental health awareness can equip staff with tools to manage stress and recognise mental health issues in themselves and others. Creating a supportive culture where mental health discussions are normalised and encouraged is crucial. Senior dental professionals should help step forwards to recognise that such concerns are not trivial and provide a safe space for such views to be heard.

foster an environment where mental health is prioritised, leading to better wellbeing for dental professionals and improved care for patients. DA REFERENCES 1. Carla Cruvinel Pontes, PhD, MSc, DDS; Kyle Stanley, DDS; and Shervin Molayem, DDS. Understanding the Dental Profession’s Stress Burden: Prevalence and Implications. Compendium of Continuing Education in Dentistry. May 2024 Issue. 2. Owen C, Seddon C, Clarke K, Bysouth T, Johnson D. The impact of the COVID-19 pandemic on the mental health of dentists in Wales. Br Dent J. 2022 Jan;232(1):44-54. doi: 10.1038/s41415- 021-3756-7. Epub 2022 Jan 14. PMID: 35031746; PMCID: PMC8758985. 3. Arora S, Knight A. Questionnaire Survey of Burnout Amongst Dentists in Singapore. Int Dent J. 2022 Apr;72(2):161-168. doi: 10.1016/j. identj.2021.08.054. Epub 2021 Oct 1. PMID: 34602256; PMCID: PMC9275171. 4. Ltd, P. P. P. (2023, November 19). My Journey to a Pain-Free Practice: Dr Nijam Latiff. Progressive Practice Pte Ltd All Rights Reserved. https://www. admetec.com.sg/ergonomic-loupes-singapore- review/ 5. Westgarth D. Mental health in dentistry: Has the profession opened up through the years? BDJ In Pract. 2022;35(6):18–22. doi: 10.1038/s41404-022- 1182-4. Epub 2022 Jun 6. PMCID: PMC9168629. 6. Kriakous SA, Elliott KA, Lamers C, Owen R. The Effectiveness of Mindfulness-Based Stress Reduction on the Psychological Functioning of Healthcare Professionals: a Systematic Review. Mindfulness (N Y). 2021;12(1):1-28. doi: 10.1007/ s12671-020-01500-9. Epub 2020 Sep 24. PMID: 32989406; PMCID: PMC7511255. 7. Søvold LE, Naslund JA, Kousoulis AA, Saxena S, Qoronfleh MW, Grobler C, Münter L. Prioritizing the Mental Health and Well-Being of Healthcare Workers: An Urgent Global Public Health Priority. Front Public Health. 2021 May 7;9:679397. doi: 10.3389/fpubh.2021.679397. PMID: 34026720; PMCID: PMC8137852. 8. Jiménez-Ortiz JL, Islas-Valle RM, Jiménez- Ortiz JD, Pérez-Lizárraga E, Hernández-García ME, González-Salazar F. Emotional exhaustion, burnout, and perceived stress in dental students. J Int Med Res. 2019 Sep;47(9):4251-4259. doi: 10.1177/0300060519859145. Epub 2019 Jul 16. PMID: 31311371; PMCID: PMC6753538. 9. Ahad AA, Sanchez-Gonzalez M, Junquera P. Understanding and Addressing Mental Health Stigma Across Cultures for Improving Psychiatric Care: A Narrative Review. Cureus. 2023 May 26;15(5):e39549. doi: 10.7759/cureus.39549. PMID: 37250612; PMCID: PMC10220277. 10. Knaak S, Mantler E, Szeto A. Mental illness- related stigma in healthcare: Barriers to access and care and evidence-based solutions. Healthc Manage Forum. 2017 Mar;30(2):111-116. doi: 10.1177/0840470416679413. Epub 2017 Feb 16. PMID: 28929889; PMCID: PMC5347358. 11. Plessas A, Paisi M, Bryce M, Burns L, O'Brien T, Hanoch Y, Witton R. Mental health and wellbeing interventions in the dental sector: a systematic review. Evid Based Dent. 2022 Dec 7:1–8. doi: 10.1038/s41432-022-0831-0. Epub ahead of print. PMID: 36477677; PMCID: PMC9735078.

Finally at the national level, national campaigns, led by organisations like

Singapore's Health Promotion Board, or even the Singapore Dental Association, can raise awareness about the importance of mental health in healthcare professions. Policymaking should focus on integrating mental health education into dental training programmes and increasing funding for mental health services targeted at healthcare professionals. Where feasible, local research on mental health in dentistry should be promoted to provide data that informs policy and practice. This research can play a crucial role in reducing stigma and improving mental health outcomes within the profession.

By addressing stigma at these three levels, the dental community in Singapore can

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