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Chaptar-8

HISTORY OF DENTAL PUBLIC HEALTH DEPARTMENT
Institute of Dentistry in Pakistan

There are 5 Institutes for undergraduate teaching in Dentistry in Pakistan. The curriculum is of 4 years duration after Pre-Medical (F. Sc) at de'Montmorency College of Dentistry, Lahore, Liaquat Medical College, Jamshoro, Dental Section Khyber Medical College, Peshawar, Dental Section Nishtar Medical College, Multan and Dental Section Bolan Medical College, Quetta.

The Postgraduate Medical Institute, Lahore, had provided the opportunities for obtaining Postgraduate Degree of Master in Dental Surgery in various specialities, which has been ceased with and now, willing candidates for obtaining MDS degree can seek the assistance of teachers at de'Montmorency of Dentistry, Lahore like in the past. This institute is mother institution and had the status of being prime importance in the sub-continent. It was established in 1934 and since then it is imparting knowledge at undergraduate level and top few postgraduate level to the sons of this soil and those who seek the dental education from any part of the globe. This institution has attained significance by producing many postgraduate teachers and graduates which have created name in the world of Dentistry. Most of them have earned their fame and earning their livelihood by establishment of their practices and clinics abroad specially in United Kingdom and United States of America where they have to get Practicing License in addition to their own Degrees from their mother-land. To get a Practicing License in those countries is not less than a hard nut to crack. Certain Graduates of this College had helped the Muslim countries for purpose of delivery of dental treatment to the public at large.

Almost all heads of departments of various teaching institutions mentioned above are the postgraduates of this Almameter including the Department of Dental Public Health, College of Community Medicine, Lahore. This College has the ability to share the pride conferred upon her graduate an honorary degree of Master by the International College of Dentist – a rare award (for Dr. M. A. Soofi). The College had 4 professional chairs in the past but out of the circumstances of non-availability of postgraduate doctorate or Masters in Dental Surgery, only 2 chairs are left at present. It is feared in a shortest limit of time one senior chair of Professor of Prosthetic may get retire and after this one chair of Oral Surgery shall be kept by the present Principal, who also possesses M. Sc. in addition to his Master Degree (without thesis).

At present no evidence is available for recognition of Master Degree (without thesis) by the P.M.D.C and there is no Master Degree regular courses at Post-graduate Medical Institute, Lahore or elsewhere. Certainly there is no regular course of any Postgraduate Diploma in any of the specialities of the Dentistry. With the result a phenomenon of the teachers in Dentistry has cropped up. The institution at Jamshoro and College of Community Medicine are headed by diplomat in Public Dentistry from abroad whereas Dental Section at Nishtar Medical College is headed by a Graduate of Punjab University. Three diplomats in Public Health Dentistry are fulfledge Professors at Dental Section Liaquat Medical College, Jamshoro, and Dental Section Khyber Medical College, Peshawar.


National Seminar on Dental Public Health

A national seminar on dental public health was held under the auspices of public health association of Pakistan on June, 24, 1973 at P. C. Hotel, Federal Min. Health Sh Rasheed inaugurated it was attended by DG Health, Minister for Health, Govt. Punjab (Medical Gazette PMA 1973). It was very successful function; it was attended by large number of dental surgeons, public health workers, among the dental surgeon, Saleem Cheema, Dr.Atar ur Rehman, Dr. M.Z. K.Niazi, Dr. Muhammad Rafique Chatha, Dr. Amir Ali and Dr. Shuja ud Din Qureshi.


DENTAL HYGIENIST – QUALIFICATION AND JOB DESCRIPTION

Introduction of 2 years Dental Hygienist Course at College of community medicine, Lahore in 1978. Dr. M. A. Soofi expert in Dental Public Health introduce 2 years course of Dental Hygienist at department of Dental Public Health at College of Community Medicine, Lahore with following by-laws: -

ADMISSION QUALIFICATION:
Basic qualification for admission to the course of Dental Hygienist is matriculation. However, F.Sc (Pre-Medical) are preferred.
COURSE DURATION:
Duration of the course is two years, which involves basic subjects i.e. Anatomy, Physiology, Pharmacology, Pathology and Buio-Chemistry in general. Particular stress is given to the Oral Cavity. The clinical subjects are taught Operative Dentistry, Public Health Dentistry, Oral Surgery, Oral Anaesthesia and Radiology for practical training. The students have to attend the some quota of the patients of various specialisties for practical.
JOB DESCRIPTION:

  • To assist Dental Surgeon and to work under his supervision and guidance.
  • To do the scaling and polishing of the teeth.
  • To extract shaky and ilk teeth under the local infiltration anaesthesia.
  • To do the filling of the children and simple cavities with silver amalgam.
  • To give health education and demonstration to the mothers and children and to emphasis on the need of balance food and type of the food to prevent the dental diseases.
  • To apply topically fluoride to the teeth.
  • To assist in the research and epidemiological survey under the advice of Dentists.
  • To reduce the workload of the Dental Surgeon, who can do operative work in efficient way and can save the time of the Dental Surgeon.

RECOMMENDATION:

  • NPS-12 is recommended on basis of training and experience.

DENTAL PUBLIC HEALTH

DENTAL ANATOMY, HISTOLOGY AND PHYSIOLOGY
Anatomy of teeth, Jaw and associated parts. Muscles of mastication – ligaments, Saliva – Salivary glands and its importance to dental health. Enamel – Dentine – Cementum, pulp, periodontal membrane and gums Development of teeth, tissue and jaw eruption and absorption of teeth. Different type of teeth.
DENTAL PATHOLOGY
Disease of mouth, muscles, face tumours – congenital, deformities like cleft palate, changes in teeth caused by general diseases. Inflammatory conditions – gingivitis, pericoronitis, periodontitis dental alveolar abscess. Dental caries – Pulp involvement – Granuloma – and apical involvement.
ORAL MEDICINE
Oral sepsis and general health, blood dyscrasias and oral tissues nutritional deficiencies and oral disease. Skin disorders and oral health. Psychological manifestations and dental tissues. Allergic manifestation in teeth. Alcholism and addiction and oral health. Hormonal disturbances and oral tissues. Mental intoxication and occupational disorders of teeth. Virology in oral diseases. Fusiformus baccilli infection and bleeding gums. Stomatitis – various forms: Gingivitis, periodontitis.

BACTERIOLOGY
Role of bacteria in dental disease, laboratory technique to get a sample for tests growth of bacteria and sensitivity testing against antibiotics qualitative and quantitative method (MIC).
PHARMACOLOGY
Role of broad spectrum antibiotics, antiseptics – lotions, gargles – tooth paste and common drugs used in dentistry. Anaesthetics, analgesic antipyretic – anticonvulsant drugs and their manifestation in oral tissues. Astringents and anodynes. Tranquilizer and their necessity in dentistry. Vitamins and iron in teeth & staining of teeth drugs not to be used in pregnancy. Drugs used in root canal therapy –apisectomy – periodontal surgery.
PREVENTIVE DENTISTRY
Epidemiology of periodontal diseases – dental decay, fluorides and malocclusion. Aetiology of periodontal diseases:

  • Acute disease
  • Chronic disease
  • Stomatitis
  • Fungus
  • Fusospirocheatal. Infection and bleeding gums.
  • Prevention of dental disease, diet and dental disease, fluoridation of water supply and other uses of fluoride in dentistry. Genetics and tooth.

PUBLIC HEALTH DENTISTRY
Role of public health services. The public health aspect of dentistry. School Dental Health service. Maternity child health and its management – coordination of dental health services – dental health services in other courses. Dental health Education – Dental health planning.

PREVENTIVE ORTHODONTICS
Normal occlusion and its variation – occlusion in various nations. Incident of malocclusion and problems associated – provision of orthodontic treatment. Public health centres. Diagnosis and Preventive Orthodontics.
PREVENTIVE JURISPRUDENCE
Law and ethics applied to public health dentistry. Ethics of epidemiological studies and research projects. Out-line of forensic odontology, dental investigation like mass disasters – Recognition of bodies – general law of negligence law relating to consent. National health services – in Pakistan and medical and Medical and Medical Dental Council Regulations.
DIPLOMA – MATERNAL AND CHILD HEALTH (DMCH)
Genetics and teeth – Racial characteristics of teeth. Early development of teeth, jaw, line of exposition of mail teeth, permanent teeth, born defects in teeth, effects of drugs during pregnancy and teeth – nutrition during pregnancy, general consideration – neonatal teeth.

Nutrition during childhood, first feeding and malocclusion drugs during childhood. Dental care during pregnancy of mother, dental sepsis and general health of mother, treatment during pregnancy -–need of extraction of tooth during pregnancy, dental disorders of mother and their prevention.

PREVENTION OF ORAL CANCER

Prof. Dr. M. A. Soofi, Former Principal College of Community Medicine, Assistant Treasurer PHAP proposed on the PHAP Executive Committee meeting held on 24th May, 1992 that the PHAP should organize a symposium and a walk on 31st May 92 the day designated by WHO to be the International No Tobacco Day.

The Committee agreed to the proposal and decided to sanction Rs. 5000/- from the PHAP accounts for the purpose. In addition, Dr. Akram Sheikh, MS Sir Ganga Ram Hospital, Member PHAP Executive Committee, kindly offered to arrange a donation of about Rs. 5000/- for the same cause.
PRESS CONFERENCE
27th May 1992 at 11.30 AM at Flaties Hotel, Lahore.
A press conference was held in connection with the International “No Tobacco Day” on 27th May at Flaties Hotel, Lahore.

Lt Gen (Retd) Fahim Ahmed Khan (President PHAP), Prof. Dr. M. A. Soofi (Chief Organizer No Tobacco Day), Dr. Akram Sheikh addressed the Press Media, apprising the significance of the Day.
WALK
29th May, 1992 at 6.00 AM from Aitchison College Lahore to Faisal Chowk the Mall Lahore.

A Walk against the use of Tobacco was arranged on Friday the 29th May 1992, Malik Saleem Iqbal, Minister for Information and Broad Casting, Govt of the Punjab was the Chief Guest on the occasion. The number of participants was about one hundred.

The Walk was given coverage by all the National Dailies. Besides, Lahore TV gave it a very good coverage in the Urdu and Punjabi News.
200 soft drinks bottles were obtained for the walkers from the Pepsi bottlers free of any cost. No member of thePHAP Executive Committee except Dr. Akram Sheikh and Dr. Shaheena Manzoor could participate in the Walk.

DENTAL HEALTH PLANNING IN PAKISTAN
Read in 1st Pakistan Dental Convention held at International Hotel, Lahore
on 27th-28th February, 1972

DENTAL HEALTH

Dental Health is concerned not with information about the oral health of the public in general, but with matters relating to provision of dentistry by the State and representatives of the public, concerning the treatment and prevention of the disease. Doubtless this is unavoidable. A complacent attitude of the Government of the “People”, towards large amount of dental diseases hitting all types of rural and urban population, will, of course, minimize the distresses. It is encouraging that N.H.S. might embark some racial changes in the existing system. And a system, which so far, we can judge, on the evidence, is full of step-motherly treatment to the dental profession. The prevailing system with specific injustice, is not only based on less remuneration, status, seniority and privilege to dental service; but more than 86% of rural population of the country has been kept deprived of routine maintenance of dental fitness, dental health education and courses and mechanisms of dental public health in the country through organised efforts; with the result, a “dentist” however, could not undertake responsibility to see his patients, emergencies fairly were neglected, which increased socio-economic liabilities to the families and normal working hours of the sufferers suffered and ultimate loss to the economy of the State, these were maximum and multiple losses.

 

DENTAL SURGEON

A Dental Surgeon plays an important role in diagnosis, treatment and re-habilitation of oral-cancer, blood dyscrasia and oral-handicapped children. A Dental Surgeon being a member of healing profession, is keen to elevate the dental health, standard of the community and being a public health worker, he explains the value of early prevention and treatment of dental ills. A Dentist is a health educator, provided he is provided opportunities. A Dentist in a district is hardly ideal Dentist for population due to over work, and thick population (see the chart) and he simply has no hopes for senior post or senior scale, thus looses interest both for a healing and prevention.

IGNORANCE OF DENTISTRY

Through dental aid is an essential and integrated part of all medical programmes in the country, but in planning and organizing the health services, dentistry is simply ignored. The ignorance is partially due to improper channel of administration and partially may be of some intention.

No provision for dental public health, no facilities for dental attention of the people, no care for schools, no attention towards the rural community – unlikely to the modes of Medical Public Health.

There is no senior post of Dental surgeon except at Centre or in teaching institution. No chance to promotion as a senior scale Dental officer or administration unparallel to the medical colleagues. The Dental Officer is a team of medical organization, why such attitude? Once he joins the service he holds the same status till he retires.

CONSEQUENCES OF IGNORANCE:

Dentist looses responsibilities:

  • of his parents
  • to his community
  • to himself

A Dentist, during his dental education, acquires two major attributes, which company him throughout his career, i.e. ego/humility and humility, both offers him stature in achieving success in his elevation of pain and suffering and materially fostered the health standard. And, confidence of his ego, vanishes, in absence of his responsibility as a result of improper attention by the authorities, his humility suffers when he has not got sufficient chance to be honest and renders finest service of which i.e is capable. Suffering of the people and community is evident.

A Dentist has needs for comforts of ACCOMMODATION, PRACTICE, POSITION, SENIORITY AND SENIOR RESPONSIBILITY IN SERVICE, AND POST-GRADUATE TRAINING. This shall provide a chance to test his ability, personality and potentialities.

 

DENTISTRY

Dentistry, is an ever growing profession, expanding in knowledge and technique. The Dentist cannot stop learning. His skill and knowledge should continue to improve and it should not be allowed to stagnate or becomes relatively out of date. A dentist cannot become specialist of all fields of dentistry. LET ALL THE DENTISTS BE TRAINED IN PUBLIC HEALTH AND OTHER SPECIALITIES EITHER AT HOME OR ABROAD. If at home, a curriculum of post-graduate training may be stated for: -

  • to encourage a dentist to have his ego,
  • to benefit the population,
  • to help the dental science in expansion.
  • To evolve modes and methods of research.

 

PREVALENCE OF THE DENTAL DISEASE

Dental disease ranks as one of the greatest affliction of mankind today and affects all countries of the world. However, it affects mostly civilized mankind, which has dictated an artificial and soft diet. In our country, the periodontal problems are common, but incidence of dental decay is not less than any country.

Day and Tandan (1940), Day & Shourie (1947) carried out studies at Lahore and found high incidence of periodontal disease among the younger age group. Similar studies of Metha et al (1953), (1955) carried out in India reveal the high incidence of this disease. Ramf Jord (1961) investigated the rural and urban population of Bombay (India) and found 100% prevalence of the periodontal disease. Soofi (1962) studied school children at Quetta and found 85% of the population having periodontal disease. Likewise studies of McCell (1933) who observed 90% of disease in U.S.A. Westin et al (1937) found 86.5% of gingivitis in Swedish school children. Saunders and Taylor (1938) noted 94% of gingivitis with Maori children in New Zealand. In the United Kingdom the incidence of the disease is likewise high, King (1940), (1945), Parfitt (1957), McHugh et al (1964), Sutcliffe (1968) and Sheiham (1959).

This has proved that the country is facing problem of periodontal diseases, especially in younger group which is evident from the epidemiological studies mentioned above. There is likelihood of increase of periodontal disease, if proper programme is not chalked out, to check the disease either by preventive methods or by curative means.

CONTROL OF DENTAL DISEASES

Health is a major asset of a nation and dental Public Health is equally important. There are two methods by which a disease maybe controlled by: -

  • prevented from occurring
  • once established, it may be prevented or controlled by appropriate treatment

Some curative methods are available in district headquarter hospitals of West Pakistan and some of the tehsils provide such treatment. Teaching institutions at Lahore, Hyderabad and Peshawar are better sources for treatment. A few places, Red Cross and other special organizations render dental services to the public, but PREVENTIVE METHODS ARE NIL ALL OVER THE COUNTRY. Since the large population cannot afford dental treatment at private level and 86.1% of the population i.e. rural population cannot reach the dental clinic for dental check up or treatment until and unless there is emergency so the preventive methods are must for our economy and need of the population. No country in the world could afford curative treatment without preventive methods.


PREVENTIVE METHODS: OR DENTAL PUBLIC HEALTH: is an art and science for:-

  • preventing the (incidence of the dental disease).
  • Prolonging the life Spam of dentition
  • Promoting dental health and efficiency through the organized community efforts
  • Providing the real picture of the prevalence of the dental diseases
  • Helping to adopt the methods to check up the disease
  • Providing the statistical data and research opportunities.

And Dental Public Health should be arranged in each Province to conduct: -

  • mass dental health education programme
  • school education programme

These programmes: -

  • shall reduce the servity of the disease
  • lessen the rapidity of destruction
  • prolong the national dentition, and correct the remediable dental defects
  • it shall regularise the habits of the oral hygiene and methods of the children and masses.

RESOURCES AND TYPE OF DENTAL CLINICS

It is impossible for Pakistan at the stage of development to indulge in luxury, of offering full arranged dental clinics and covering to all the people as this venture is too costly and beyond our resources. Priorities in dental care should be established and a programme may be organized preferably for meeting the needs of the people. With experience of 15 years service at district headquarter hospitals, my observations show that major need of the public is: -

  • relief and prevention of toothache
  • prevention of oral pepsis, and cure for bleeding gums
  • proper guidance and education

With this need we can work with simple dental clinics and arrangements for the time being. In order to : -

  • provide services to the unemployed dental surgeons
  • to provide the dental cover and dental aid to the 86.1% of the population of Pakistan
  • to assist and help the Government

Knowing the population and its problems due to lack of dental man power; limited resources of the Government; unemployment problem of the dentists and inadequate staff in the teaching institutions. We therefore, suggest that all tehsil headquarters and rural health centres may be provided with immediate dental clinics (non luxurious) under Junior Class I Dental Surgeons as Incharge of Dental Clinic. The Dental Surgeons at the Tehsil Headquarters should visit the schools of the area for giving dental health education and acquiring data for prevalence of the disease whereas dental surgeons at rural health centres should visit sub-centres on alternate days as an integrated team of the medical organization. There are 52 tehsils and 42 primary rural health centres in Punjab which makes 104 and we have got about 100 un-employed dentists with this scheme all can be employed with minimum expenditure of emergency need. Similar adaptation to other provinces of West Pakistan.

 

SUGGESTIONS FOR MODIFICATION OF EXISTING HEALTH SERVICES AND EXPANSION OF DENTAL SCIENCE

Since there is no technical personnel in the field of dental science either at Centre or at Provincial or at Directorate level, therefore, for proper planning and development of dental science and its administration remained handicapped. Therefore:

  • the existing pattern of medical service, my immediately be modified having a Joint Secretary, Dental Public Health at each Province of West Pakistan. These Joint Secretaries shall act as Ex Officio (Advisers) on Dental Health to Govt of Pakistan, Ministry of Health. There shall be liaison between the teaching Institutions and the Government for dental problems.
  • In each region of the province, senior cadre post of Dental Surgeon with rank of Assistant Director, Dental Health should be created at parallel with medical service. The senior dentist of the province with better record of service, postgraduate work, initiative and keenness to serve the country may be considered as qualifications for such posts. This shall provide a better chance to dentists to think that there is no step motherly treatment with this profession and each dentist will work more for such type of incentives.
  • Or person with at least seven years service be raise to Class I cadre and be nominated for postgraduate work by rotation either abroad or in the country.
  • From the next Five Year Plan, the District Headquarter post of the Dental Surgeon be raised to Senior Class I rank and additional post of Lady Dental Surgeon be created for each district.
  • Preventive dentistry like preventive medicine may immediately be introduced to prevent the incidence of the dental diseases. All the schools and other teaching institutions should be equipped with preventive programme health education should be given to all the country-men.
  • A post of Section Officer at Centre and in the Provinces should be created to deal with dental cases.
  • Dental Surgeons should be provided with accommodation and other facilities off and on offered by the Government at par with Medical Service.
  • All the tehsil headquarter hospitals and rural health centres should have a dental clinics.
  • Teaching Institutions to be controlled by the Government should have a staff with postgraduate qualifications irrespect of zones, regions and domicile restriction.
  • A senior dental surgeon may be given chance to serve in senior post.

 

Effects of changes in Service

  • This change for a dentist to work for planning and development and promoting of the cause of dentistry.
  • Dental services in the Provinces shall be controlled and guided properly by a technical man and the Govt shall be benefited by the channel of services in the interest of the public.
  • There shall be coordination and quality pattern of all the dental clinics in the Provinces of West Pakistan.
  • The problems of the dental surgeons, and their needs shall be properly met with and listened to.
  • The service shall be controlled by medical service as an amalgamated service. Separate dental service cannot serve the proper purpose.
  • Refresher and re oriented courses will help the dental surgeons to expand their knowledge to be conducted by new system.
  • The preventive dentistry shall flourish and have better influence over the public.
  • Last but the least it shall help the introduction of Dental Act which is must for our country.

In the end I am grateful to Dr. Saeed Ahmed Malik, Prof. of Dental Surgery, Liaqat Medical College Hyderabad for providing me the information and suggestion. I also owe thanks to Prof. Dr Haider Trimizi, Principal, de'Montmorency College of Dentistry, Lahore and other friends for providing me help and guidance in preparation of this plan.

ACKNOWLEDGEMENT

I am glad to have the opportunity of expressing my views on the Dental Health Planning and Administrative Aspects of Dental Public Services in Pakistan. I wish to express my thanks to the Convention Committee, especially Dr. M. Z. K. Niazi, the Secretary of the Convention for the invitation to do so.


NAWA I WAQT DAILY – FORUM held on 30th May 92 at
11. 00 AM

A Forum was held on the subject at Aiwan e Iqbal, Nawa i Waqt Daily, Prof. Dr. M. A. Soofi, Dr. Mrs. M. A. Soofi, Dr. Akram Sheikh, Dr. M. Aslam Khan, and Miss Sanila Taj participated. The Forum Report was published in the Nawai Waqt Daily of Friday 5th June, 1992 because the Friday Paper is published and distributed at national level.
FREE DINNERS AT AVARI HOTEL
A draw was held and four lucky winners were given coupons to take free lunch in Avari Hotel.

SYMPOSIUM AT PAKISTAN NATIONAL CENTRE -
NO-TOBACCO DAY

31st May, 1992 at 5.00 PM, Pakistan National Centre Alfalah Building Lahore. A Symposium was held on the occasion of the International No—Tobacco Day, at Pakistan National Centre, Lahore. Ch. Muhammad Iqbal, Minister for Agriculture, Government of the Punjab, was the Chief Guest on the occasion. Prof. Dr. M. A. Soofi, Dr. Shaheena Manzoor, and Dr. M. Aslam Khan spoke on the occasion. Lahore TV and Press media covered the occasion well. No member of the PHAP Executive Committee could attend the Symposium.
T. V. PROGRAMME
On 27th May, 1992 a 30 minutes talk was delivered on PTV in Punjab, by Dr. Shehryar Sheikh, Director Institute of Cardiology and Prof. Dr. M. A. Soofi, former Principal College of Community Medicine, on the subject of “Smoking and Heart Problems”. The talk was telecasts at national level. Objectives, activities and achievements as well as the future plans of the Public Health Association of Pakistan were brought to light by the speakers in the programme.
VIDEO FILM
A video film has been made to record all the celebrations of the Day. A questionnaire was prepared to collect data pertinent to the smoking habits and awareness of its hazards among people. Besides a good coverage by the National Press, certain magazines and journals also published research papers written by Prof. Dr. M. A. Soofi: It includes Herald, Punjab Medical Tribune (PMA) and Medical Tribune Karachi, Islamabad.
I highly appreciate the assistance and cooperation extended by Miss Sanila Taj, Executive Director (PHAP) and the PHAP Office staff in making the celebrations of the day a great success.

DENTAL HEALTH WEEK 14TH TO 20TH APRIL, 1993 LECTURES & DEMONSTRATION TO THE STUDENTS

Dental diseases are enormous and they are very costly to be treated. In addition, there is lot of wastage of time. At the same time due to advanced modern technology through the electronic media, a lot of wrong propagation is being dispelled out contributing towards the spread of the dental diseases. PDA decided to fulfill its obligation in order to inform the population about the dangerous effects of the bad oral health to general health and damages of the wrong propaganda to the younger population through lectures.

Lectures were given supported with slides and video film was displayed. Questions regarding oral health, drug addiction and oral cancer were replied. Discussion with teachers were also arranged. An epidemiological proforma for oral health was distributed.

 

FIFTY YEARS OF DENTISTRY

It is a long story I joined de'Montmorency College of Dentistry Lahore 1952, and was graduated from University of Punjab after passing four professionals examination 1956. Medical (MBBS) or Dentistry (BDS) was not my option or choice, I was given admission in Dhaka Medical College (East Pakistan). Later on Muslim League Leadership of my Province NWFP, thought that there is dearth of Dental Surgeons, therefore, I was advised to join dentistry in order to fill up dearth and gap. The Govt. of NWFP paid my dues was also given stipend Rs. 50/- PM for Hostel expenses. I if we go back, I was student of 8th class in Sanatan Dharm High School Haripur Hindu School. I was enthusiastic worker of Muslim League and M.L. National Guard, my job was to make slogans at the arrival of Muslim League Leaders or anti slogan in Congress's meeting. I participated in Civil disobedience movement and Referendum of NWFP 6th July to 17th July 1947. There used to be one muslim teacher in my school, Maulana Abdur Rehman, who used to write speeches for me, one day he asked me Aslam Soofi, now Pakistan will be reality you must take science in 9th Class, because after departure of Hindu and Sikh to Bharat there shall be dearth of scientists, 14th August, 1947 was day of joy and I was promoted to 9th class, under that advice of my teacher I opted science in 9th class, and thus passed matriculation exam in 1949 from Punjab University in first Division, though I left for Kashmir as a volunteer in Jehad, on my return I appeared at matric, Dental Science was chosen for sake of Pakistan and Al Hamdu Lillah I have served the profession in best way.

Syllabus was designed by American Professor and it was sufficient as demands for dental care of patients. Teachers were dedicated and we have learnt a lot practical training at prosthetic laboratory conservation and surgery was sufficient high and orthodontic was not so developed. Basic sciences and medicaleducation was reasonably good, there was good relationship between students and teachers. It was that syllabus, that I become most successful dental surgeon at Quetta/Kalat I have not done House Job, it used to be for a few people, I was posted in Quetta 23rd Nov. 1956 to June, 1961 as a dental surgeon Quetta, Kalat Division and whole of Province, there was no equipment there was no sign of dentistry. I have managed all types of fracture jaw cases, extractions filling up cavities and many case of oral cancers. I do propose 5 years course of Dentistry by adding full basic subjects Community Dentistry. Expectation was to become a complete dental surgeon and we have passed out as a sufficient complete dental surgeons.

There was no infrastructure of Dental Surgeons at that time I was first or Pioneer at Quetta my first appointment was honorary dental surgeon, later on grade 17 or Class-II was given. There was one dental surgeon in NWFP Dr. Rashid A. Malik he might have must started his clinic in 1954, Dr. Yousaf Ali my class fellow was appointed in B.K. Bahawalpur hospital and Dr. Syed Abdur Rouf was relieved in Quetta in 1961. He was class-III officer at Bahawalpur. There was no dental surgeon at Mayo Hospital, Dr. M.Z. K. Niazi after his return from USA he was appointed as a Honorary dental surgeon at Mayo Hospital perhaps in 1959 or 1960 similarly when Prof. Ahmed Iqbal returned from Germany he started working as a honorary dental surgeon at Service Hospital. Later on he left for Peshawar to start dental section.

Many of our class fellows left U.K. for higher studies. Practice was so Rs. 5/- was fee. Major work in practice was extractions or filling and scalling. There was no awareness. Private practice was in the hands of quacks. Quacks were members of PDA as well, there was dearth of Dental Srugeon for example. Prof. B. A. yazdanie and Prof. H. Trimzi graduated in Sept 1947. Hindu and Sikh left for India and they were later demonstrators. Dr. Abbas Haider was alone who passed BDS in 1948. Prof. M. Saleem Cheema passed in 1952 all became teachers at the college. After partition Dr. Abdul Haq MBBS and BDS was appointed as Principal till 1953. Dr. H. R. Shah, B. A, BDS was the 2nd Principal till his death 1969. We were Afzal Mujtaba Khan, Nasir Ahmed, Arif Raza Bilal Ahmed, Ahmed Iqbal, M.A. Soofi, Ahmed Saud, Abdul Jabbar Khan, Ghulam Abass Mali, Saeed Ahmed Malik, Yousaf Ali, Khalid Saifullah, David Shaukat, Bashir, Dara,Mazhar Ali Khan wo graduated in 1956. Prior to us 1955 Niazi, Riaz Shafi, Sattar Awan, Fakhar uz Zaman, Aqeel and Qazi, Imdad Shah, Iqbal Saeed Malik remain in Pakistan. Niazi set up a surgery at Lawrence Road later on medicalcare Gulberg, we started awareness program in Radio News papers, schools and colleges. I remember every as a student I have delivered lectures in almost all schools of Lahore, Quetta, Bahawalpur and NWFP. This provided a source to establish practice, M.Z. K. Niazi and M. A. Soofi are reknown Dental practitioners.

Dental equipment for that era was available. Punjab Dental Department was our source. We used to drill the cavity with foot dental engine, sterilization was with boiling water in prosthetic sprit lamps were source to do the wazing so as oil stoves were used denture work. No modern equipemtn were available. The quality of instrument was very good. Even scallers, dental sytinge and dental for sealer amalgam plugger of student are with me, they are in good conditions. When I started my practice along with service I purchased a full dental chair (Iran) Rs. 150/- from Sh. Sultan the head Technica took a having flexible table lamp and dalda tin as a spittoon possessed that instrument mentioned above and started my practice at Quetta. I had trated Mr Jaffar Jamali, Talib ul Moula, Nawab Col. Of Hoti, M. H. Sufi, M. Masood Commissioner of Quetta Kalat in that chair.

The quality of silver amalgam was excellent, people turned up after 12-16 years. They praise my fillings as all are intact steel burs were good. I used to open the canal with steel burs. Every act of dentistry I have been doing Fracture case wire was a good source of unified jaws. Anesthesia was given with either and alcohol. We too have done implantation of tooth so many cases are in our record that their tooth were explode out and we refixed we replaced it tighten with wire still the tooth are vital. Crown, inlays and bridges of mine remain successful. I did lot of prosthetic work and later on 1966 changed to periodontology after my one year training at London Unive4rsity. I have learnt the art and science of making cavity after my return from London 1966. The Late Dr. H. R. Shah was principal and he was teaching dental anatomy and conservation Dr. Sibtain was his demonstrator. He gave me this assignment to make the cavities for Museum I was replaced by Sibtain in 1968-69 as demonstrator.

Postgraduate opportunites were rare Dr. H. R. Shah was LDS not a dental graduae, butwas dean of Punjab University, some of clever graduates working as demonstrators conspired him to start MDS dentistry and rules were framed. MDS without thesis only written examination. So Dr. M. SaleemCheema was first to be blessed with MDS without thesis 1956, thenH. Trimzi, Sibtain, Col Mahmood, B. A. Yazdanie after perhaps 1960 rules were changed to have thesis small size. Those who got without thesis they are Saeed Malik, Atta Barki so this was story at College, there used to postgraduate courses abroad and visits abroad but there was no M. Sc diploma except FDS examination.

I did postgraduate training in Perio there was no examination 1966, Abbas Haider attended one year training in children dentistry at London University but no degree. Similar situation was with medical side postgraduate training in dermatology, cardiology, nureology, later on examination started. Locally the degree of MDS was in the hands of dr. H. R. Shah and later with M. Saleem Cheema. Private practice was not influenced by degree. It was your own skill that you can use drill, the cavity and extract, m yself was the same. For practice BDS is sufficient if he known art and science of Dentistry and he is potential to Pakistan.

Dental Association was framed perhaps in 1951 PMA was formed in 1948. There was dearth of dental surgeons. Dr. Shah was the president, Dr. Cheema was the Secretary, it was United Pakistan, 3 members from unqualified practioner were member of executive it celebrated dental health work in 1953 at dental college Lahore. Mr. Iqbal Sheikh of Punjab Dental Depot was office Secretary who also started publishing Pakistan Dental Review an organ of Dental Profession. Thus Review is available in all most all universities of the World. I was appointed as convener of PDA at Quetta when M. Aslam unqualified dentist was representing Peshawar. I became Secretary General 1968-70 and 1970-71. Later on President of PDA United Pakistan.

I handed over Association to Mr. Zia after election at Jinnah Hall, LMC Lahore 1971 and that was end of it. As president I visited Iran, Turkey to form RCD Dental Association, 1973 leaders including seniors like Muhammad Saleem Cheema, Dara, Chatha, Aslam Ch. Dr. Shuja, Shamim and Akhlaq they elected me again President of PDA Lahore the only active branch which I handed over in a ceremony in 1996 at Lahore to Aslam Ch. Activities are included in brochure.

There was dental surgeons conference at Rawalpindi in 1981, I wrote letters to all big guns of dentistry, that there is a need for formation of central body, Karachi Dental Surgeon opted for election thus Dr. Khalid Mansoor was elected as a President. There is death of leadership a leader should have the following conditions. He should have name in profession by his skill and knowledge. He should have good intention and must possess integrity and lastly above to himself. There is lot need to be done in education postgraduation sub specialities and practice or public awareness is important.

Dentistry has changed a lot we were in rudimentary now with advent of laser, restoration dentistry implantology, periodontology, public dentistry, oral surger children dentistry things are much different, so as the equipment material.

There is a computer age, look at X-rays, equipment, air dentistry space dentistry and much is expedited.

Dental caries is becoming a risk factor in Pakistan due to change in diet, that should be controlled Oral Cancer possess a great problem it is ranked amongst 3rd most common form of cancer in the developing world our people are Snuff users, smokers, and betal chewers. They need health education, periodontal disease is a common, it can act as risk factor for coronary hear disease (CHD). There is need for public education, pregnant mothers need balanced food to avoid poor resistance in host tooth in embryonic life.

DENTISTRY IN THE FUTURE

Keynote Address by Regent Prof. Dr. M. A. Soofi
4th Convocation of International College of Dentists, 2000.

Sir let me provide you some information regarding the dentistry in the future. Prof. John C. Keller comments that in the future, restoration of the form, function, and esthetics of oral tissues likely to include regenerative materials thus he said in his commentary Tissue Engineering relationship to the evolution of dentistry. He is of the opinion that the dental profession shall enter with new techniques and skills in the 21st century that the dentists will treat the craniofacial and other disease and disorders through tissue engineering and the new materials will surpass and replace the previous one. (Dental abstracts Vol. 45 Issue 1, 2000 USA).

There is a lot of encouragement for the new devices and manufacturers are improving many other things, e.g. High Speed had pieces and heir sterilization with many new things like hot air dry sterilization used in oral cavity. Sterilization with radiation which means the removing of all pathogenic germs through this method.

Aesthetic dentistry is gaining lot of popularity in removing the stains with latest filling materials. Lasers are gaining high reputation in dental treatment in restoration, cutting and other surgical procedures. Maxillofacio surgery unlike in the past.

Dentistry of today is world wide scientific technology. There are many research project which have been emerged through exciting technologies in the field of dentistry and previous conventional method used by us is becoming obsolete and a think of the past or chapter of history. Now, the computer design restorations and treatment even the technology of the implants and imaging dental tissue with accuracy and lessor exposure to the radiation through such advance method.

There are many new advances in the diagnostic techniques computers and laboratories are equipped to such answers. X ray equipment and images have become accurate diagnostic value. Digital radiology have become reality to expose the area and image is store and transmission on screen while treating patient. Computer store such manipulations.

In dentistry there are certain issues which needs visualization like the image Tempro Mandivular Joint TMJ the Tomography has become considerable tool of diagnosis of TJM dysfunction and it can also help in the field of implantology. This system of tomography has enormous advances in the biotechnology of implants in the recent years.

Computer generated restoration is the most dramatic and easy marveled advancement in the dental field. The CAD CAM and manufacturing is being run by Professor Francois Duret University of South Carolina.
Now, Dentistry is practical subject for the patients and the scientific discoveries are applied for the well fare of patients for improving their health care. This is the humanitarian profession and there is no more frustration now. It is medical science dealing human body for improving the health of individual and that of community.

The systematic system is effected thorough bad dental restoration and germs in the gums through infection is know and established facts because pathogens get into the general blood supply thus cause pathological damages and changes in the local area and general health. Many investigations have been carried out to prove that the oral infection has become risk factors for cardiac (heart disease). Therefore there is a need to study in the prospective of future of this science. In recent years for health care of community there is need to know whole of the body and thus, time has come to change the curriculum of BDS for modernization as future hope of saving health and teeth of the community.

Many surveys have been carried out since after inception of Pakistan 1947. I have conducted several surveys in Balochistan, NWFP and Punjab. The population of all ages sex, high and low have been evaluated dental disease oriented population from mild, moderate to severe dental ailments. Data shows the early age group has got more cavities in their teeth 60 % to 70% due to modern sweet and beverages. The younger group has got disease of the gums 70% to 80% for which the treatment is essential. There is malformation of teeth in both jaws, of course due to western food and life style. Since the population growth is very high, dental man power person ratio is very low 1 : 40,000 to 50,000 against WHO ratio is 1: 700. Services are rarely available in the rural area and above to that there is no importance given to dentistry given at national or provincial level. There are health is basic area for preventing the disease and saving the health of the population. There is a need for awareness for the dental care of entire population of Pakistan. The awareness and treatment should not only be fate of privileged. Oral health should be established for all the people and on sound basis. We do appreciate the government initiation of service structure of the dental surgeons, but many dental surgeons with sound knowledge are with out job because either is no vacancy available and budget available. So the planner at the federal government should consider some this for dental trained man power create new posts to utilize their specialized and expanded services for the betterment of the population of Pakistan.

The teaching side is also neglected because of old tradition. This old system is to be taken away. According to new modern trend of this science new opportunities may be created for the young experts in this field and environment of under graduate training may be altered. The dental college Lahore was established in 1934 status is the same even teaching professor are reduced. Nothing has come out as research or invention or distinction any where because better persons are compelled to leave the country and this way dentistry is brain profession.

Let me conclude that International College of Dentist is honorary organization for knowledge and to appreciate the individual efforts of significant dentists from all over the world. The 4th Convocation is an attempt to honour the outstanding dentists from various parts of Pakistan. This encouragement will lead to them for an international forum for their professional development through continuing awareness to the latest developments. Pakistan being a developing country needs more international collaboration for promotion of dental profession. Recent advances in biomedical science are difficult to comprehend by individuals, therefore, a teamwork is needed to utilize these information through international forum and ICD is one of the most outstanding forum for such activities. The old fellows, the organizers and the Regent wish every success to recipients of International College of Dentists and that of Pierre Fauchard Academy. It is assumed that they will work with enthusiasm and unity for the mutual benefits of dental profession in Pakistan.

PUBLIC HEALTH PROBLEMS IN RURAL AREAS

By
Major A.Q.B. Rahman
Provincial Chief Malaria Eradication Prog

Rural areas of East Pakistan are faced with innumerable public health problems. These problems result in the poor health of our villagers which in turn results in the loss of vitality and energy to work. In a country like ours with agricultural economy most of the population living in the rural areas earn their livelihood by agriculture. Lack of energy and vitality leads to less production and the famous adage “Health is Wealth” comes to light. To ensure more agricultural output these stupendous public health problems need to be effaced. All the assertions that I have made in this respect is gathered from my experiences on personal contact with more than five lac people after living seven tenable years here and visiting more than 4000 villages in about 370 Thana of total 411 in East Pakistan. These are only a few salient sublime problems and there are many more which will meet the revealing eyes of each and every individual in every village of East Pakistan. A very common sight in our rural areas is row of children with pot bellies: fissures in lips and watering eyes in uncountable numbers. What leads to this state of affairs? Pot bellies happen due to enlarged spleen, intestinal worms, rickets and malnutrition. Deficiency of vitamin B complex causes fissures. Watering eyes and various skin diseases are due to infections. Our orthodox villages are completely ignorant of the basic hygienic principles. Only a few common rural health problems are being discussed hereunder.

OLD DISEASE

Smalpox is a disease of great antiquity in our rural areas. This extraneous disease is outmoded in this modern age and can easily be prevented if proper law is enforced and action taken. Each person should be instructed to take vaccination and those who refuse to take it should be punished. Persons responsible for vaccination and other duties sometimes submit fabricated reports of having vaccinated so many persons although the number of persons shown as vaccinated sometimes exceeds the actual population. This is beyond the hallucination of the big bosses staying in the urban areas who take the report to be true and never bother to question its genuineness. In some cases the potency of vaccine due to long storage has also been questioned. Some persons should have sufficient powers to deal with such situation ruthlessly whenever it arises without loss of time to bear fruitful results.

Malaria is another disease of our rural areas. Although emaciated pot bellied, stunted growth figures are not much in evidence now a days but still malaria poses some problems in the foot hills of the Garo ranges and South East portions of East Pakistan including Cox's Bazar and Chitagong Hill Tracts. In the rest of the province, eradication of malaria is so far progressing very satisfactorily, as a result, everywhere in the province especially in Dinajpur one can find happy, smiling active individuals.

PROMOTING ORAL HEALTH THROUGH SYMPOSIUMS

Prof. M. A. Soofi, felt the necessity and need for Preventive Dentistry and was instrumental in having inaugurated the public health dentistry department at College of Community Medicine in 1978, his aim being of expanding educational programme to post graduation level and a two year programme for Dental Hygienists. His dynamic approach led Dr. Soofi, Chairman of Dental Department, to have a professorial chair created and thus he played an important role in dental health promotion, prevention of the disease and caring of the patients. In addition to the research and publication, Prof. Soofi has represented Pakistan in many international gatherings and has the honour of being referred to in international literature. He has to his credit two books based on his research work.

Prof. M. A. Soofi has said that the medical and dental education has undergone an evolutionary process and thereby has created a new hope of service to aiding the member of our community. He too thoroughly discussed the framework of research and procedures for attainment to this level of education. And, he also narrated all the difficulties faced in the creation of dental section in the Finance Department which is one of its own kind in Pakistan as there is no such cell anywhere. He said the foremost and important factor is the interest and dedication and efforts with strength of integrity and honesty which brings reward. He said, the dentistry is a specialized branch of medicine, and is increasingly becoming urgent need of community.

Prof. Soofi further added that due to advances being brought in by modern technology in the sub-specialities of dentistry, it is easy to spread knowledge and information through the electronic and print media, the need has emerged all the more polgnantly for providing educational material and health education towards prevention of various dental diseases both in urban and rural areas of Pakistan. The educated class needs more knowledge about causation and prevention of such diseases in order to restrict their onslaught. With the modern food galore, the population of Pakistan has become exposed more increasingly to dental problems. Treatment for all diseases is time consuming and costly. However, the dental community has to a great extent met its obligations to inform the people about the dangerous effects bad oral health might bring to the erring people whether it be through negligence on their part or for their resorting to cheap toothpaste or toothpowders.

Promoting the value attached to oral health care is the need of corrective cooperation and efforts in the light of modern development in the sphere of science and discipline about prevention and control of dental problems. Dentistry is therefore assuming the character of popular profession. Students topping in the FSc exams are getting more inclined to taking admission to dental education. Male and female are alike in their choice of having dental education. A sizeable number of students are also taking interest in getting admission to the premier dental institution of Lahore and elsewhere which at once shows how people are getting fond of dental knowledge and oral health.

Dentistry is a science and art and is an industry setting trend to the creation of better equipment for a beter oral service. It is interesting to know that all the students of this trade do not better understand their position as a healer of an important human malady even after completing four professional examinations with two compulsory subjects They must of necessity devote themselves to the preventive science as well.

Lahore Metropolitan Corporation can play an important role. The PDA has launched a walk on the issue of drugs and on oral diseases and their prevention. Leaflets, posters articles may be published. Speeches at electronic media may be recorded for further disseminating knowledge to the public at large.

With collaboration of the Department of Radio Therapy and Oncology, K. E. Medical College, symposiums on oral cancer, a devastating disease can be held for people to know what oral cancer means. Management of oral cancer through chemotherapy and radio-therapy, needs to be discussed.

Other senior doctors may be invited to speak their experiences. It is also suggested that visits to schools and teaching institutions be organized, where members of Pakistan Dental Association should deliver lectures and education and apprise the students of oral hygiene. They may examine the students and take upon themselves to impart training to the teachers that they may in turn tell the students what importance dental and oral hygiene carries.

In Pakistan the College of Community Medicine possesses department which is working all along for preventive dentistry to flourish. The guiding spirit behind all this is dr. Soofi who has now focused his attention on setting up department of preventive dentistry at children complex. He had been advisor to Pakistan Science Foundation and University Grants Commission and authored a chapter on community medicine for MBBS and has produced books, booklets and articles.
Ref: Dental News Supplement, Nov. 27th -30th, 1996.

ORAL CANCER AND ITS PREVENTION

According to Binne (1972) Oral cancer is a malignant disease with poor prognosis. All the cancer cases registered in England and Wales about 2% are from Oral Cavity and death account is one in every 100 cancer deaths. Mostly such cases of Oral Cancer present themselves at a late stage of the disease for treatment and consequently they have a poor prognosis. In Indo-Pakistan and South Asia, the incidence is reported higher, being about 25% to 47% of all cancers. Binnie et al (1972) reported that about 40% of the patients of Oral Cancer are dead within a year of commencing treatment.

INCIDENCE OF ORAL CANCER

Rachanis (1978) reported that the squamous cell, carcinoma of oral mucosa accounts for 95% include those of the salivary glands and the primary malignant mesanchymal tumours. Carcinoma in the jaws is rare to occur. Mostly the adjacent structures involve the jaw bone through direct extension or though secondary deposits.

According to Rachanis (1978) the peak incidence of the carcinomas in the U. K. and the USA is approximately during 55 to 75 years of age, whereas the age incidence in Indo Pak ranges from 40 to 50 years. In our own cases in Pakistan occasionally oral cancer have been observed in our clinics below 30 years of age. The carcinomas are preponderance in males in whom it occurs at lips, with male and female ratio being 14: 1 and 4: 1 for lesions in the floor of the mouth. In Scandinavia, the higher proportion of females suffer from carcinoma of the tongue and pharynx. This may be related to prevalence of the Pater-son-Kelly Syndrome in those countries.

WHO (1980) observed that in most of the countries in Northern America, Europe, and Oceania, cancer is the second leading cause of death. Among 27 selected countries the proportion of all deaths in 1971, that were classified as malignant neoplasms, ranged from 13% to 24% with a median of 19%. Standardized death rates for cancer in 1972 at 45 years of age and over ranged from 411 to 843 per 1,00,000 for males and from 313 to 600 per 1,00,000 among females, with an average level of cancer mortality in these countries of 600 of males and 450 for females.

In the developing countries whee the proportion of the population age wise is lower, cancer is considered fifth or sixth leading cause of death. In 1971 the madian of all death that were due to malignant neoplasms in 11 selected countries of developing zones was 11 % compared to the median for heart disease which was 13.5%. Whereas in the USA over one million persons have been diagnosed as having cancer (In 1977 including 3,00,000) new cases of non, Melanms skin cancer and 38,500 persons would die of the disease). Out of the total malignant neoplasms 20611.6 cases cared for short stay in the Hospitals during calendar years 1975, 394.5 wee from Buccal cavity and Pharynx. Similarly out of 370.6 total deaths from Neoplasms and percentage in 1975, 8.1 percent deaths were reported due to neoplasms of buccal cavity and pharynx. Similarly person years lost per death due to Neoplasms reported in 1975 out of 16.1% both the sexes 16.0 deaths were due to malignant tumours in Buccal Cavity and Pharynx. As direct expenditures distribution by type of expenditure during 1975 out of the total expenses, 7.5% of the expenses were spent on Dentists Services.

WHO further reported that out of the number of the deaths in 1975, 20% was more in males than the females.

In Pakistan unfortunate disease is common in the areas of North Western Frontier Province, Baluchistan and urban population like Karachi and Lahore. In the frontier area it is observed that people smoke or chew the tobacco and in the latter areas the people chew betal leaves. Similarly such areas of the oral cavity do not possess the natural defences. Patients visit the Hospitals for conventional treatment, chemothrapy has been observed that the patients visit the Hospital in the later stages of the disease and therefore among 1 in 1000 the death happens due to oral cancer.

LABORATORY FACILITEIS.

In the foreign countries like USA comprehensive pathology Lab: facilities are available for early diagnosis, even then 1:1000 over 45 years of age and a substantial number of women become victim of oral cancer. John (1963) observed that out of every three such victims, two may be expected to die of the disease, and yet most of the deaths could be averted by early detection and proper treatment.

Day (1964) also stressed upon need for early cancer detection and he said that the cure rate of Oral cancer from 35% to 40% could be increased and deaths can be prevented due to early diagnosis followed by prompt treatment. He said daths due to cancer are increasing by more than 5,000 each year, and said that about 800 cases of oral cancer are reported in New York City.
SNUFF AS AN AGENT FOR ORAL CANCER
In our observation at DHQ Hospital Mardan and DHQs Hospital Quetta, snuff induced oral leukoplakia and oral carcinomas have been seen. The oral use of snuff is a cultural habit among the people of NWFP where both the men and women place quid of snuff in the lower alveololabial sulcus. In almost over 300 patients of oral leukiplakias one third of the patients were users of heavy and strong snuff. The leukoplakia, in the users of snuff developed after 40 years and such users akepotential for malignancy.

The leukoplakia patch white in colur about 5mm in diameter could not be removed by rubbing out in certain cases of encroachment of teeth a thin line has been observed on the cheek side. However, it is observed that snuff associated carcinoma takes many years to develop and its brands add components play major role for the development of carcinomas. Some of the snuffis added with ashes and Soda Caustic. In such cases as it has been observed in lower labial mucosa buccal mucosa and it vestibular groove. Pindborg et al 1973 observed that malignant transformation occurred in one out of 31 patients who were snuff dippers. He also observed that out of 450 patients with oral lekuplakia 31 were snuff users.

Similarly study by Sundstrom et al (1982) on Oral Carcinomas with snuff dipping on Swedish males. In this study the risk of the snuff dipper to contract oral cancer in interior vestibular part of oral cavity in males was studied where 41 cases out of 375, were observed with malignancy who wee snuff dippers. In such cases squamous cell carcinoma was found.

CHILDHOOD MALIGNANCY.
In my days at Mayo Hospital I recall a male of 9 years from District Sargodha with Leukmia and oral complications. The child used to bleed from the gums and it could only controlled with blood transfusion. The malignant disease could not be controlled and child with such disease could not live in this world. The parents related the family history as well. Scully et al (1983) have observed oral manifestations in childhood leukemia. They observed the patients with leukemia or lymphomas could move easily develop oral herpetic infection or ulcers than those with other malignancies. It has been further observed that those with lymphomas were particularly predisposed, to heretic infections. In this study it was also observed oral ulceration in 38.6% of the patients and in this way the child under our observation was suffering from ulcer, in the gums which used to bleed.

Ref: Medicoment June, 1-15, 1985.