Remembering Professor Ramakrishnan Nair: A Legacy in Plastic Surgery

–who left us for his heavenly abode

Professor Ramakrishnan Nair is known to me for more than four decades. He headed the department of plastic surgery for a significant period of time. During that period, I was working as a teaching staff in the Dental college and he used to visit us and discuss cases of mutual interest. Even though he was a very senior professional colleague, he was very affable, pleasant and suave. He could easily win over each and every person he met irrespective of the cadre. Personally, he has encouraged me to develop maxillofacial prostheses using commonly available dental materials. In those days, silicone prosthetic devices were not commonly used in the dental department. Because of his encouragement, we could restore many patients with disfiguring facial defects. On follow up visits he made the patients visit us in the dental department for any modifications required. Very often he used to remind us quoting “It is the God given right of every human being to appear human”. This reflected his work ethic. He once asked me to present all the maxillofacial prosthetic cases in a national conference of plastic surgeons which was held at Trivandrum and I feel it was a rare honour extended to a dental professional and a model behaviour exhibiting interdisciplinary collaboration.

Prof. Ramakrishnan Nair is the son of illustrious surgeon Prof. Kesavan Nair who was considered as a legend in the early years of the Trivandrum medical college. Dr. Nair will be survived by the innumerable number of plastic surgeons who got trained under him. We all will miss you.

The Role of Oral Microbiome in Dental Health and Disease

Antonie van Leeuwenhoek, a Dutch microscopist, wrote a letter
to the Royal Society stating as follows: “I didn’t clean my teeth for
three days and then took the material that had lodged in small
amounts on the gums above my front teeth… I found a few living
animalcules”. He made the observations on the plaque which was
collected from the front teeth using a self designed single lens
microscope. He could see different microorganisms and later drew
them in a note book (1670).
From that point of time, the microorganisms caught the
attention of many thinking individuals. As the time progressed,
these organisms were named differently. Oral microflora and oral
microbiota were the synonyms popularly used. Lederberg and
Mccray coined the presently popular term oral microbiome that
signifies the ecological community of commensals – symbiotic and
pathogenic microorganisms that share the human body space.
Oral microbiome consists of a huge community of
microorganisms that include bacteria, fungi, viruses, archaea and
protozoa. Oral cavity provides a number of distinct habitats
where the microorganisms get harboured viz. teeth, gingival sulcus,
dorsum of the tongue, palate and nearby contiguous areas like
tonsils, oesophagus, pharynx, eustachian tube, middle ear, trachea,
lungs etc. The oral surfaces usually get coated with the widely
discussed bacterial biofilm. Mouth has a favourable environment
of temperature 370C and pH 6.5-7 which can nurture bacterial
growth. Gut associated microbiome is the most complex
microbial community in the human body and the second one is
the oral cavity. Oral cavity is constantly exposed to both inhaled
and ingested microbes which amounts to nearly 700 species of
which 54% were identified and cultivable, 14% not identified but
cultivable and 32% not identified and cultivated.
The foetus in the womb is considered as sterile but recent
observations have established the presence of oral microorganisms
in the amniotic fluid of majority of the pregnant women. When
the baby is delivered, maternal transmission of microorganisms
happens at the uterus. Mouth of the baby is usually sterile but
the baby gets inoculated from the first feeding and from the
atmosphere. Eruption of teeth that happens subsequently, provide
ecological niches with diverse characteristics and acquisition of
microflora begins.
Under healthy conditions oral microbiome maintains a
commensal relationship with its environment just like other
body parts such as gut, skin or vagina. Certain opportunistic
microorganisms belonging to the microbiome can turn into
pathogens and can cause various oral and systemic diseases.
Dental caries, periodontal diseases, endodontic disease, osteitis
and tonsillitis thus caused can contribute towards disruptions in
the balance of oral microbiota which is known as dysbiosis. By
definition it is an imbalance in bacterial composition, changes in
metabolic activities or changes in bacterial distribution within
the microbiome. The effect of dysbiosis can be listed as follows:

1. loss of beneficial bacteria, 2. overgrowth of pathogenic bacteria
   and 3. Loss of bacterial diversity. Dysbiosis can extend its effect
   in initiating and worsening various systemic conditions viz.
   metabolic, cardio vascular, oral mucosal and respiratory diseases.
   Pre term childbirth, obesity, colon cancer and psychiatric diseases
   are also included in the list of systemic diseases.
   Evolution of oral microbiome
   Oral microbial residents have not colonised in a random
   fashion but in fact they have co-evolved with humans for millions
   of years. The relationship between the microbiome and the host
   is influenced by the life style factors such as diet, tobacco, stress
   etc. Change in the environment that has happened during human
   evolution has influenced the microbiome composition. To be
   specific, use of fire, beginning of agriculture, processing of food,
   use of refined sugar and antimicrobial therapy are factors that have
   changed the composition of microbiome in due course of time. Oral
   hygiene practice that has become popular towards the last decade
   of 19th century, adequately supported by the findings of Miller as
   well as the modern life style of consuming acidic drinks, alcohol
   consumption and cigarette smoking are all factors that changed the
   oral eco system. Increased intake of dietary carbohydrate
   favoured streptococcus mutans and it eventually promoted dental
   caries. Consumption of processed food which was considered as a
   sign of sophistication, enormously increased and finally ended up
   with dysbiosis and oral diseases.

Intra oral scanning and CAD/CAM complete dentures

CAD CD requires conventional impressions which are scanned and incorporated in the designing process. Use of intra oral scanning started in the 1980s. This was initially used in the fabrication of fixed dental prosthesis but later adapted to complete dentures. A few cases were reported by Goodacre., et al. in 2018. Intra oral camera (Trios 3, 3Shape A/G) was used to scan both maxillary and mandibular residual ridges. No contrast medium was used because, they found that there is no particular improvement in the quality of scanning. Scanning of maxillary ridge was satisfactory. While scanning soft tissues were adequately stretched to get an accurate border extension. Branemark retractors were used for soft tissue management. The sequence of scanning for maxilla was as follows: crest of the ridge, palate and the vestibule. Mandibular ridge scanning was not satisfactory because of the difficulty in tongue retraction. In mandibular ridges, trial denture was made by milling/ printing and it was border moulded and lining impression was made. Other steps were similar to that followed in CAD/CAM dentures. Retention values of maxillary bases fabricated from conventional border moulded impressions and intra oral scanning (milled and printed bases) were compared by Najla Chebib., et al. They have found that maxillary bases made by conventional border moulded impressions showed better retention than those madethrough intra oral scanning (both milled and printed). At present we have to accept the fact that intra oral scanning has limitations in ensuring retention of maxillary complete dentures. Till we find an advanced scanning system which can copy functional borders, integration of conventional impressions with the digital format will remain as the successful option in fabricating digital complete dentures.

References

1.Goodacre BJ and Goodacre CJ. “Using intraoral scanning to fabricate

complete dentures: first experiences”. The International

Journal of Prosthodontics 31 (2018): 166-170.

2.Najla Chebib., et al. “Fit and retention of complete denture

bases: Part II- conventional impressions versus digital scans:

A clinical controlled crossover study”. Journal of Prosthetic

Dentistry (2022).

3.Chandrasekharan Nair K., et al. “CAD/CAM Complete Dentures for the Present and for the Future-a Descriptive Review”.Acta Scientific Dental Sciences 8.3 (2024): 22-30.

Prof. B R R Varma – a gentleman professor

Prof. B R R Varma, a towering guru in Periodontics, left for his heavenly abode, two days ago. In my preclinical student days, I do not remember him seeing closely. In the third year, my posting as clinical student started with periodontics. We had postings lasting for three months. One after the other, we were asked to scale the teeth which belonged to oral cavities of different hygiene standards. ‘Varmassar’ used to sit in the undergraduate clinic from 9 to 12 and we used to show him each patient at the end of the scaling session. He used to locate a small speck of calculus and showed us in the mouth mirror. Sometimes I felt defeated that I could not find out the same spot which would have brought me an A grade. He used to demonstrate each and every clinical step which an undergraduate student should learn. I still remember the meticulous way; he handles the tissues during gingivectomy and flap operations. I have already fallen in love with Prosthodontics, otherwise I would have specialized in Periodontics. I remember him as professor of periodontics and later as the Director of Government Dental college. By the time, I have become a staff of the GDC in the department of Prosthodontics. During his tenure in Trivandrum, we have celebrated the silver jubilee of GDC. I worked in the organizing committee as the editor of the souvenir released to commemorate the occasion. We sat together to discuss the contents of the souvenir and I could get some anecdotal details of his postgraduate student days at Nayar Dental College, Bombay. Professor Varma was the topper in MDS periodontics of Bombay University.

Prof. Varma was the special officer of the newly proposed Kozhikode Dental College and later the director. His illustrious academic career was continuing after the retirement from government service. He served as professor of Manipal Dental College and Yenepoya Dental College, Mangalore. While serving the Kerala Government, Prof. Varma was deputed to Liberia for a short stint.

For everybody who knew him, studied under him or worked with him, Prof. Varma was a gentleman professor and an authority in Periodontics. His classes were meticulously prepared and we all learned the basics of periodontics from him. Professor Varma leaves behind his loving wife and son Balagopal who is presently heading the Amrita Dental School, Cochin.

‘Varmassar’ we will miss you. You will be remembered as a gentleman teacher.

Prof. George Jacob – an affable teacher of Orthodontics

Prof George Jacob left for his heavenly abode yesterday. We were colleagues at the Government Dental College, Trivandrum for more than two decades. Dr. Jacob was a graduate of R. Ahmed Dental College, Calcutta. I acquainted with him first when he joined as a postgraduate student of Orthodontics at GDC, Trivandrum. Later he joined as a faculty member of the same department and in due course of time he headed the department. Because of the affable nature, he has won the love and affection of all the generations of staff and students.

Prof. George Jacob has become the Principal of the GDC and within a short span of time he proved himself to be a sincere and hard working administrator. He daringly took steps to clear the junk of old and non functional instruments which were dumped in the old store house of the college. I remember him literally pushing the old instruments along with workers and students. In fact, he took great personal risk while condemning the old equipments under the prevailing government rules. Later his initiative was greatly appreciated by both his colleagues and superiors. His career in the government came to an end when he retired from the government service as the Joint Director of Medical Education.

Prof. Jacob’s demise is a great personal loss for me. I remember him as a loving husband and father. He has nurtured the literary pursuits of his wife Dr. Shanta Jacob who has authored a book of history. He personally supervised the editing and printing of the manuscript. He has a son and a daughter and both of them are well placed.

We all will miss you Prof. George Jacob. It is unbelievable that you are no more with us. I feel sad.

Dr.K.Govindan Nair – a life dedicated to Indian Dental Association

Dr.K.Govindan Nair who is fondly known as K G Nair (or even KG) amongst the dentists of Kerala passed away yesterday. He was very senior to me at the Government Dental College, Trivandrum. He started his professional career as a Dental Surgeon of the FACT hospital, Cochin. Later he shifted to Trivandrum to join the VSSC in their medical service.

KG started the association activities with the erstwhile Cochin Dental Society and he was very popular amongst the colleagues. Later, when the Indian Dental Association (IDA) was formed in Kerala, he took keen interest in its development. I had an opportunity to associate with him when he was the secretary of the state branch of IDA. I was his treasurer for three years. During that period, I came across his dedication and commitment to the IDA. He made all of us to participate in the National conference of IDA. My first national conference was held at Guntur and I presented a paper. It was held after a calamitous flood which made many people homeless. They crowded around the conference venue and the organizers provided them with food. KG was president of the state IDA and later he expanded his activity to national level. He had an opportunity to work in the national executive for a long period of time. He later worked in the national level in the capacities of Vice President and the President. KG was the first Keralite to become national president of IDA. His ascendence to national level stimulated many youngsters to work at the central executive in different capacities. One of his significant contributions is the relaunch of Kerala Dental Journal and I had the good fortune to work with him as its editor. His organizational capacity was evident in conducting the state conferences. In the initial stages, to get a registration of hundred participants was a Himalayan task. I remember him sitting in the printing press at Trivandrum waiting to get the bound volumes of Souvenir. He brought a van to spread the souvenirs without sticking to each other because the ink was not dry. In the night, we drove to Cochin before the state conference. Many a time, he personally funded the printing. He was the founder member of the IDA Trivandrum branch and keenly nurtured it.

Dr.K.G. Nair was the son of the illustrious surgeon Prof. R. Kesavan Nair. He is survived by his wife and two children.

May be the new generation of dentists may not know him well. He loved his profession very much. He will be remembered for his school dental health activities.

We will miss you KG. Salutations to you.

Prof P P Jacob, a principled teacher

I joined Government Dental College at Trivandrum as a BDS student in 1967and there were only very few students and staff. Patients were also not many. The college was a very silent place. Prof. Subramanyam was the Director who used to stand in front of the college; monitoring the arrival of students and staff. In 1968, Prof. Subramanyam completed his term and left for his parent department – GDC Bombay. We students were not knowing the administrative system and one day Dr. P P Jacob took over as the Superintendent of the Dental College. He was there in the office for two years because it was a rotatory posting.

I reached the second year and we had preclinical classes on Orthodontics. We called it as wire bending exercises and occasionally Dr Jacob used to come to the lab and observe the way we were performing. He had a gigantic figure and we never dared to look at him. Even though he appeared very tough, I do not remember even a singular occasion of scolding students. When I reached the clinical classes, we were asked to observe the process and discussed one or two cases. Once I was asked to make an appliance which had a labial bow and two Adam’s clasps. My skills were far away from acceptability. Prof Jacob saw that appliance and asked the staff technician to remake the clasps. I was actually expecting a dressing down but he understood a third BDS student’s predicament. He was a kind teacher. He used to take lecture classes for us observing strictly the timings.

When I was posted as a house surgeon, I had a chance to observe his sense of discipline. If the staff reported late in the morning, in the attendance register he used to mark in the column with a red pen. One day I observed that his own column had a red mark. He himself has marked it, giving us the message that rules are equal for everyone. Great model behavior!

Prof Jacob maintained decorum without any overt expression. His dignified presence was enough to maintain discipline. After his retirement from government service, he served as a consultant in Abu Dhabi and a few corporate hospitals in Trivandrum.

Thank you for teaching us the basics of Orthodontics and introducing us to the Walther’s notes and White and Gardener, the text books of those times.

We all miss you P.P. Jacob Sir.

Could I cope with the fast pace of Dentistry?

The beginning

The word dentistry has come to me even before I joined the Government Dental College, Trivandrum because I was born to a dentist who started practicing in the pre-independent India and continued till early 1960s. As a first-year student, when I was exposed to dental plaster and impression compound, it did not appear strange because I have seen it many times with my father. Initially I had a feeling that impression compound was the only impression material. Within a month we were exposed to alginate and zinc oxide-eugenol impression paste. Till my graduation I have not seen elastomers. Though blue colored dental stone was shown to us occasionally, harder varieties of model materials like die stone was not familiar to me other than in the text books. During 1972, the blue colored dental stone withdrew from the scene and a yellow-colored stone appeared which was also replaced by a green colored stone. It was beyond my imagination that one day all the impressions and casts will be digitally replaced. The virtual replacements, though intellectually accepted, I don’t claim that I have fully digested the idea.

Tooth preparation and the phantom

The drill and fill technology was instructed to us in the second year. First, we had to prepare the cavities on extracted teeth mounted in a phantom jaw.  For a few years I could not find the reason for using the term ‘phantom’ whom I met only in the comics. We had steel or possibly brass phantom jaws and I thought phantom had strong jaws and my young immature logic found an answer for that peculiar name. For many of my classmates, the foot engine was a shock and coordinating the movements was a Himalayan task. Cavities from Class I to V, we have prepared many times on the extracted teeth till the instructor approved them. Preclinical laboratories with phantom heads having plastic teeth are very common now. With the introduction of the latest generation of virtual reality simulators, students and dental practitioners can make digital impressions of their patients in virtual reality models and practice procedures in virtual reality before clinically performing them.

When we reached the third year, electric motors and belt driven triple sections were provided. Contra angle handpieces and the connecting slip joints were added to our vocabulary. The steel burs we used were made in Russia and those burs lasted for one or two teeth. Sometimes the shanks of the burs also served as burs but most of the time the teeth burned because of the pressure we applied to compensate for the sharpness of the bur. Burned dentine produced a peculiar aroma which attracted the teachers’ attention who use to rush to the spot to stop the student operator who continues without recognizing the burned dentine aroma. I started operating with ‘airotor’ only in 1981, even though I graduated in 1971. For me air abrasion and lasers remain as ‘recent developments’, a common terminology that remains stationary in question papers for decades together. I feel sympathy for the patients who suffered at our foot engine which could turn the burs anywhere between 500 to 1500 rpm. Airotor diamonds never turn below 100,000 rpm and the present-day graduates may find these facts more astonishing than a fairy tale.

Entry to Perio through scaling

As fresh clinical students, we were all enthusiastic in doing scaling. Without much risk, we could complete many patients and finish our quota. Teachers were very meticulous in examining all the possible surfaces of teeth and showed us even the smallest spicule of calculus which we could not find. Though we had full set of supragingival scalers, we hardly used two sickle scalers to finish the job. Ultrasonic scalers have come much later and in the initial stages, it was a rare commodity and students use to look at it with awe. During the undergraduate days we were allowed to do gingivectomy and flap surgeries under strict supervision. While administering local anesthetic injections, I was much scared whether the patient will pass to the stage of syncope. It is actually a panic situation and the operator student use to yell “deep breath, deep breath, open your eyes, open your eyes”. Making the patient smell ‘spiritus ammonia’ was considered as the panacea for such emergency situations. No training is given on the use of spiritus ammonia, and hence students use to squeeze a drop of it to the nose. No wonder patients use to wake up.

Local anaesthetic administration

Postings in oral surgery gave us confidence towards the end of it. Initially we were not allowed to administer local anesthetics especially the nerve blocks. How the professors locate the exact point where the needle penetrates remained a wonder to me and it is a matter that decides pass or failure in the practical examinations. Regular clinical practice with a quota of hundreds of extractions gave us precision and in most of the cases, successful anesthesia to the patients. Use of electronic anaesthesia, which doesn’t cause slurring of words or accidental biting of the tongue, still remains under the class of ‘recent advancements.’

 During the time of Horace wells, nitrous oxide was a party toy. A friend of a dentist took too much of the stuff at a laughing-gas stage show and injured his leg. But did not realize that he’d hurt himself. Nitrous oxide has become an anesthetic thereafter. The most successful local anesthetic used in dentistry, Procaine, was introduced in 1904 by Alfred Einhorn. Before that it was Cocaine. All these stories, I came across much later by that time I have become a Prosthodontist.

Wire bending to straighten

Orthodontic training for us remained in wire bending exercises and making of different clasps. Our skills were put to test not in bending the wire but in straightening the 4inch piece of steel wire cut from a coil. The universal plier was efficient only for a few weeks and afterwards, its narrow tip started bending and it generously allowed the wires to slip off much to the annoyance of the students. During the undergraduate days, I always wondered why the ortho clasp went deep into the undercut and the prostho-clasp refrained from that. Those days we have never clarified doubts with teachers because they were not approachable. Now the clear aligners, aligns the teeth without clasps and may be the computer invasion has made it possible.

Carving that can make you pass

Basics of tooth morphology was instructed in the department of Oral Pathology. First it was through detailed drawings of different surfaces of teeth including the roots. Later in the second year we bought yellowish rectangular wax blocks and using a Lecron wax carver started carving full form of the teeth. It was an examination practical technique that decided the pass or fail. Carving through reduction technique was ok from the student’s point of view but I realised later that an addition technique would have helped us more in the years of composite dental restorations. My carving never had roots that was similar to tooth root instead tapioca roots.

From IOPA to CBCT

In our time, dental radiography was part of Conservative dentistry. I never received instructions on radiographic techniques. But we were shown small sized radiographs known as IOPAs but I never felt comfortable with identifying the ‘periodontal widening’ which some specialists use to claim. OPG has come much later which made us observe the ‘condyles’ clearly along with the flattened jaw bone details. During our instructional period, I have never seen a bite wing radiograph (except in books) but it has become almost irrelevant to me once the OPG has become popular. Digital OPGs and Digital IOPAs have made many dental clinics upgraded. CBCTs have upgraded the dental diagnostics in general and dental implantology in particular. Virtual planning of surgical treatment was never even dreamt of in our student days. The story of technology is like that. Once new technology comes in, either it may upgrade the prevailing technology or replace it totally: experts would say sustainable technology or disruptive technology. Dentists have to move with the advancements; or else we have to face the branding of ‘outdated’. Can we think of the belt driven handpieces to be used in the clinic now? Have you seen a pager with any of the youngsters now? It was introduced in 1995 but died out with the entry of mobiles. Digitisation should definitely be added to the dentists’ vocabulary.

Tooth paste

Being a dental student/ dentist people used to ask me which is the best tooth paste. I use to tell them “any white colored tooth paste is good and brushing has to be done twice a day”. I was not sure whether my answer satisfied them. Documented history dates back to 4 AD when Egyptians used, crushed rock salt, mint, dried iris flowers and pepper for tooth cleaning. That practice was there for thousands of years before the documented history. In India Ayurveda described the use of sticks which were crushed and used as brush. The stipulation is that the herb sticks should be either ‘kashaya’ (astringent), ‘katu (acrid), or ‘tikta’ (bitter) in taste.

Colgate made the nice smelling tooth paste and it was sold in a jar (1873). Washington Sheffield, an American dentist thought, it is unhygienic for multiple people to dip their toothbrushes into one jar of toothpaste and he developed tooth paste contained in collapsible tubes (1892). In 1987, edible toothpaste was invented by NASA for the astronauts to brush in space without spitting. It had continued application in children while they are still learning the brushing technique. However modern toothpastes are highly complex formulations which contain many different agents for the prevention of caries and periodontitis, e.g., fluorides (sodium fluoride, amine fluoride etc.), chlorhexidine, stannous, zinc salts and calcium phosphates such as hydroxyapatite or amorphous calcium phosphates, and surfactants as well as different abrasives for an efficient plaque removal. Tooth brushes are available in multiple designs, textures, directions and colours. Manufacturers make the brushes and introduces them through TV advertisements and dentists have to explain the rationale of the design even if it is not there. In the shops, soft brushes are available in plenty. Maybe it is a marketing strategy. Dentists and patients are at a loss to distinguish the texture. We have to believe what is printed on the carton. Medium-bristled toothbrushes fall somewhere between soft and hard bristles. They are stiff enough to remove debris, but soft enough that they don’t damage tooth enamel. However, we have to be careful with the gums when using a medium bristle. As age advances, electric tooth brushes are better. This from my own experience.

Loupes

Once I reached forty years, I felt that I am not seeing the teeth clearly especially the gingival termination. Now even during the student days ‘loupes’ or surgical telescopes are being used. It not only helps in seeing closer, but improves the posture of the dentist and avoids future cervical problems. Endodontists have gone ahead further in using microscopes and slowly its use is getting popular with other specialities. I always had a doubt whether dentists have sought the help of the technologist or technologist has unintentionally come to dentistry while they were widening the scope of interdisciplinary cooperation.

Bright smiles

Towards the end of the last century, brightening the smiles through bleaching has become a fashionable treatment. High concentration of hydrogen peroxide was used to bleach the teeth, in spite of its harmful effect on soft tissues. Along with this, fancy heat lamps were also used. Dentists did this process with great care under the name ‘in office bleach’. Use of light irradiation along with 35% hydrogen peroxide and the efficiency of this system in providing bleaching did not receive much attention of the professionals possibly because of lack of adequate evidence on clinical efficiency and the common complaint of sensitive teeth. In many clinics, the lamps were kept as a show piece for a long time possibly reminding us that technological failure is not a rare thing.

Flexibility replaces rigidity

In removable partial denture classes, professors use to remind us that the components must be rigid. In a cast RPD, only the tip of the retainer is expected to be flexible to a maximum of 0.25mm. The entire text book describes the design and intricacies of cast RPDs but we got rarely one or two cases in a year. Dentists in those days made a living with acrylic partials. From the patients’ point of view, it is a great service and costs less money. Fitting an acrylic partial requires more than reasonable skill. Young dentists do not find time for acrylic RPDs but skilful technicians adequately support them. Flexible dentures made of polyamide resins; concept wise are against the old belief of rigidity but they received wide acceptance amongst patients. If a flexible RPD remains in good function for three years, it is acceptable. People change even expensive mobiles every three years; then why can’t an RPD be changed?

Photography

Use of photography in the 1980s was very rare in a dental clinic. Main reason was the affordability of a good quality camera and the subsequent processing. Years ago, when Sam Pitroda said that you can see and make calls through telephones, I thought it is possible because I was always optimistic about scientific advancements. I was a little pessimist also because I thought these gadgets would be too expensive. Now mobile cameras give beautiful pictures which are acceptable even for scientific journals. Very convincing pictures are shown to patients through intra oral cameras and which make them happy. This scenario I never thought will happen during my life time.

To end with futuristic thoughts

The entry of dental implants was watched with great excitement and I thought this is the ultimate. Very soon CAD/CAM techniques were added along with improvement in quality of dental treatment. When a surgeon is placing an implant very few can observe the procedure in close proximity. Now Virtual and Augmented reality has made it possible to watch the surgery even if you are sitting in the comforts of the home. Artificial Intelligence can analyse the health data of an individual and based on the genomic data, the most appropriate treatment can be decided. The possibilities are growing beyond my intellectual capabilities. I should be happy that I am witnessing the fast growth of my profession. But future dentists have to race against time.

Prof. Joy Phillip – a passionate teacher of Medicine

Joy Phillip was my senior by two years in the medical college when I joined the Dental College in the year 1967. He was a pleasant young man who used to get many medals for the excellent academic performance and that is how I noticed him. Very seldom we could see him without a smile. After the postgraduation we both joined the respective colleges as academic staff. Our colleges were situated in the same campus of Trivandrum Medical College.

In the later half of eighties, I was selected to undergo a teachers’ training programme conducted by the Centre for health professions’ education situated in the Trivandrum Medical College which was in its infancy. Joy Phillip was a faculty member of the centre and he impressed every participant by his communication skills. Like a magician, he used to operate the overhead projector and convinced us the usefulness of the visual aid in medical education. Whatever he taught us, he used to practice in his classes for the MBBS students. Later I too joined the same training centre as a faculty member and we worked together as colleagues for many years. I used to astonish seeing his skills in handling multiple subjects related to medical education.

Dr.Joy Phillip got trained exclusively in medical education at the Centre for Medical education at the University of Dundee, UK. He was a good blend of professional acumen and highly rated teaching skills. Students liked him because he was approachable to all of them equally.

When he gets free time, he visited me at my office and discussed different subjects and time used to fly past. He was a good conversationist too but without malice to anyone. Prof. Joy Phillip I will miss you badly. May God give courage to your children to withstand this unimaginable loss. May your soul rest in peace.

Some questions answered – 7

25. What anatomical landmark to be taken for determining mandibular occlusal plane when the lower lip loses its tone?

Angle of the mouth and midpoint of the retromolar pad can serve as good guideline for marking the mandibular occlusal plane when lower lip line is not reliable because of poor tonicity. Make sure that the mandible is at rest and both the lips are competent. Marking can be done on wax occlusal rim.