Dental Tribune International

Interview: Effects of COVID-19 on dentistry in Asia Pacific, Part 1

Dr Sushil Koirala noted that some developed countries around the world are maintaining higher national healthcare standards and are following stricter infection prevention and control protocols than others. (Image: Sushil Koirala)
By Iveta Ramonaite, Dental Tribune International
November 20, 2020

COVID-19 has had an enormous impact on dental business, but its effects have varied among countries around the world. In this interview, Dental Tribune International (DTI) spoke with Dr Sushil Koirala, the founder and chairman of National Dental Hospital and Koirala Dental Academy, a global dental education centre based in Kathmandu in Nepal, on how the pandemic has affected the dental industry in the Asia Pacific region, where he is based.

Dr Koirala, could you tell us a bit about yourself and how COVID-19 has impacted your work?
Professionally, I am a general dentist and I’ve been working in this field for 28 years. During this period, I have undertaken numerous responsibilities and served at various national and international dental hospitals, universities and other organisations as a visiting professor, clinical consultant, executive board member, chairman and founding president. I have been devoting my professional time to clinical teaching and have been promoting Vedic Smile Dentistry—a holistic dental care and treatment protocol based on the Vedic philosophy of consciousness, body and mind harmony.

Regarding the second part of the question, I must frankly say that this scourge has impacted our practice in both hospitals and clinics quite extensively. Presently, owing to an abrupt increase in COVID-19 cases in Nepal, we only offer treatments concerning dental emergencies, function and smile aesthetics in our hospitals and clinics. Therefore, we are utilising this low volume of clinical work to improve workplace teamwork and to take care of our emotional health.

What is the current situation in Nepal, where you are based, and in the Asia Pacific region in general? Have the restrictions on dental services changed since the beginning of the pandemic?
At present, as COVID-19 cases continue to skyrocket at a record-breaking rate, our situation is no different from that of countries in Europe. In Nepal, we are providing limited dental treatment services. Certain countries in Asia Pacific, such as Japan, South Korea, Thailand, Vietnam, Singapore, Bhutan and Sri Lanka, managed to bring the virus under control and have already started working in full swing. However, we must understand that until the psychological trauma of this pandemic fades, dental clinics cannot achieve their full potential in terms of services and income.

Vedic Smile Dentistry dental care and treatment protocol. (Image: Sushil Koirala)

In many of the Asia Pacific countries, the national health ministries and their relevant authorities have advised dental professionals to treat only dental infections or dental pain and to minimise aerosol-generating procedures. I personally believe that, within the last four to five months, many technical and safety issues related to SARS-CoV-2 have become clear to dental professionals within the region; hence, many progressive professionals are self-aware of the possible risks of aerosol-generating dental procedures, the role of a well-ventilated clinical working area and the use of proper personal protective equipment (PPE) during dental procedures.

The restrictions on dental services have become much more flexible now. However, owing to increased public awareness, patients themselves are reluctant to see a dentist, since they are well informed about the possible risks that they might be exposed to during treatment.

Is the infection prevention and control guidance for dental settings in South Asia similar to that in countries across the West, and how are you safely managing your own practice?
A very intriguing question. It is a well-perceived fact that dentistry is primarily based on science and secondly only on art. The scientific aspect of dentistry must be similar globally, and benchmarks must be set when countries adhere to the global standards of healthcare and become members of the World Health Organization (WHO) or similar healthcare quality control organisations. The role of WHO is to coordinate, support and supervise governments and professionals around the world regarding the basic standard of healthcare and to assist and bolster them with the findings of evidence-based scientific research, ensuring that every country is able to benefit from such findings in the interest of its people.

“Certain developed countries [...] are maintaining a higher level of national healthcare standard and are following stricter protocols than the basic standard set by WHO

However, certain developed countries in Europe, North America and even some in the Asia Pacific region are maintaining a higher level of national healthcare standard and are following stricter protocols than the basic standard set by WHO. Nepal, as a member of WHO, follows WHO’s standard of infection control and prevention as the benchmark criteria for all dental practices. This is similar across South Asian countries. Nevertheless, we must not overlook the sheer deprivation of resources and unwillingness to implement such healthcare and infection control protocols in most developing and under-developed countries of Asia Pacific and beyond.

An important lesson that we have learned during this pandemic is that it is always wiser to incorporate culturally accepted good health and hygiene habits into clinical practice. For example, we have reinforced the Vedic way of greeting and welcoming through “namaste”, a customary, non-contact form of Vedic greeting, instead of shaking hands, and since the very beginning, we have always requested of our patients to remove their shoes, clean their hands and rinse their mouths before sitting on the dental chairs.

Vedic infection prevention and control framework. (Image: Sushil Koirala); IPC = infection prevention and control; WHO =World Health Organization; CDC = Centers for Disease Control and Prevention.

Now, it is so fascinating to look back at how scientific those habits actually were. Our patients often thank us for understanding the scientific value of these cultural health and hygiene manners that were so deeply rooted in our practice. Frankly speaking, even after this pandemic, no big change was required in our Vedic Smile infection control and prevention protocol, as we have always followed modern science with Vedic consciousness and compassion.

I am glad to say that, in response to many pleas and requests from our friends and colleagues from around the world, my team is now publishing a book which will explain the core naturomimetic principles in the design of a post-COVID-19 dental clinic to enhance infection prevention and control activities and to effect health and happiness in day-to-day clinical practice.

There has recently been a worldwide PPE shortage. Are dental professionals in the region well equipped to slow the spread of the virus and to protect themselves and their patients from infection?
In the midst of this epidemic, aside from the rampant death toll, another problem is evident: an acute shortage of necessary medical equipment, from the very basic PPE to pricy ventilators. With the current pandemic, countries once considered to have the best healthcare systems are at their most vulnerable, scurrying to set up isolation beds and imposing complete lockdowns to contain the virus.

Certainly, when it comes to front-line health workers, appropriate PPE is well provisioned mostly by the government or non-governmental organisations, but for the dental professionals, the story takes a different turn. The level of personal protection and precaution that dental clinics and hospitals take comes down to the amount of investment they can put into it, with no external aid whatsoever. While the higher class of dental clinics are spending a fortune on precautionary measures, others are failing miserably against the hiked prices of PPE, which has nearly quadrupled in the past months. Further, while most working professionals are adequately equipped with protective measures, many have halted their diagnosis and clinical treatment altogether.

“The level of personal protection and precaution that dental clinics and hospitals take comes down to the amount of investment they can put into it

Recently, I watched a YouTube video of the US president-elect speaking with a healthcare worker in the US. The healthcare worker articulated her suffering and agony, mainly because she was not provisioned with proper protection and had to work under constant threat of becoming infected. It almost had me in tears. When developed countries have such a huge problem, one can only imagine what the situation is like in impoverished, under-developed countries. Owing to supply shortages, the prices of PPE are often raised by 500% to 600%.

I believe that people from all sectors should support healthcare workers, including dentists. After all, everyone serving in the health sector must have sufficient PPE at affordable prices so that we can provide high-quality and safe treatments to our patients.

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