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According to Dr Sushil Koirala, the clinical inactivity brought about by the pandemic has caused skill decay and a loss of professional interest among some dentists. (Image: Anton Balazh/Shutterstock)
Iveta Ramonaite, Dental Tribune International

By Iveta Ramonaite, Dental Tribune International

Tue. 8. December 2020


Dental Tribune International (DTI) recently had the opportunity to speak with Dr Sushil Koirala, the founder and chairman of National Dental Hospital and Koirala Dental Academy, a global dental education centre based in Kathmandu in Nepal. Koirala spoke about how the pandemic had affected the dental industry in the Asia Pacific region. In the second part of the interview, he shared his thoughts on the second wave of COVID-19 and discussed the possible long-term post-pandemic changes to the provision of dental care in the region. He also discussed the best course of action for dental professionals who want to overcome the current health crisis and even benefit from it.

The number of new COVID-19 cases are steadily rising. How have dental professionals across the Asia Pacific prepared for the second wave of COVID-19?
The second wave of SARS-CoV-2 has taken Europe by surprise, and the current situation there is no better than it was initially. We must take this as a warning and endorse precautions to mitigate the impact of the second wave if it is to strike the Asia Pacific region. Those who have already resumed their business should be cautious and keep themselves, their patients and their families safe because, unless a vaccine becomes available, the only option is to maintain distance, shelter in place and adopt mitigation measures.

Our experience in South Asia has shown that SARS-CoV-2 cross-infection is more rapid and rampant through reception areas, restrooms, staff rooms, administration sections and canteens—much more so than in clinical treatment areas. Many dentists and clinic staff members in the region have become infected, either through contact with their own family members or by visiting places such as banks, government offices and public service centres.

As dental practitioners, we have the dual responsibility to protect ourselves from possible clinical cross-infection as well as to stay away from community-level infections. For now, the precautions remain the same as before, with no added preparations or safety measures. Although the second wave is likely to come, at the moment people are still busy handling and trying to overcome the effects of the first wave.

Our experience in South Asia has shown that SARS-CoV-2 cross-infection is more rapid and rampant through reception areas, restrooms, staff rooms, administration sections and canteens

What impact did the pandemic have on your fellow dentists working in the region, and do you expect any long-term changes in the provision of dental care in the Asia Pacific region?
There are three domains in which the pandemic has had a heavy impact on our lives—financial, professional and that of mental health. We can all come to terms with how this epidemic has burdened us financially, but professional hardship is difficult to express, and skill decay is one of the major problems among good clinicians.

When you stop using your hands-on skills in the dental practice for nearly six months, you start losing interest in the job. Many of my colleagues in Europe and the Asia Pacific have said that they would like to quit clinical work and become teachers or treatment planners.

Another area involves mental health problems, including depression and anxiety, which arise in response to excessive stress and outstanding financial obligations that are difficult to meet owing to low income and high expenditure. Since business volume is low, many dentists have started to cut down on business expenses by closing multiple branches or clinical outlets and by reducing the number of dental chairs and staff within the clinic.

Dr Sushil Koirala participating in a live case demonstration on the management of temporomandibular joint pain at the Thammasat University in Thailand. (Image: Sushil Koirala)

As our lives move into cyberspace, online dentistry will be preferred and become more successful in the market. It cuts down on avoidable doctor–patient interactions and also helps to reduce clinic management expenses. Small clinics will start to merge in order to have a better profit ratio by reducing common expenses.

Many dental professionals would agree that 2020 has been a challenging year for the dental industry. In your opinion, has anything good come out of the pandemic as it relates to dentistry?
Naturally, it has been a tough time for all dental industries, and dental business and associated profits have plummeted globally. However, the pandemic has revealed a new area of dental business that has not yet been fully explored—online dentistry. At various levels, such as dental consultation, preventive oral care, follow-up visits, case planning and design, provision of second opinions, knowledge training, and virtual trade shows and conferences, online dentistry will provide a more comprehensive, more convenient and altogether more affordable dimension to dental treatment. Dentists will start investing in digital devices and online services in order to reduce their management costs.

“When you stop using your hands-on skills in the dental practice for nearly six months, you start losing interest in the job”

Another sector that will evolve is preventive dentistry, where many dental industries will start focusing more on innovative dental products that patients can use themselves under the supervision of their family dentists through online dentistry. This will allow dentists to cater to many patients in their community and reduce the overall number of visits to the clinic.

What do you suggest dentists do during the pandemic when there is less clinical work and income is not up to the mark? How could they utilise this time more productively?
Since the entire globe is under the shadow of this predicament, we are all going through the same problems, dentists and others alike. However, it is undeniable that we need to continue doing our work despite the hurdles and troubles that remain ahead.

I was brought up to respect Mother Nature and her phenomena and to accept hardship. As the saying goes, every adversity brings an opportunity. Therefore, we must accept this crisis and explore ways in which we can better adapt to the current situation instead of succumbing to it.

Hence, my first suggestion is to stay safe from this ruthless virus. Following public health measures and encouraging others to do so must be a part of our lives now. Regarding dental business, not much can be done until people feel safe in society. As I have mentioned before, we are reopening our clinics and hospitals, but we do not have enough patients to meet our expenses.

Now is the time to plan for the future with a calm and conscious mind. We need to sharpen our axes and use this time of leisure for clinic management, for adopting new and suitable standards, for rearranging old files and manuscripts, for properly documenting patient information and, if possible, for engaging in hobbies that are on our bucket list.

Small clinics will start to merge in order to have a better profit ratio by reducing common expenses

Another recommendation is that, if you have writing ability, you could start writing or compiling e-books and educational manuals in order to share your expertise. It might be that your skills, knowledge and experiences can prove beneficial for your colleagues. During this lockdown, my team and I have assembled a small group of like-minded colleagues who have taken the name “Knowledge charity authors”. This group writes multiple e-books as a charitable activity in order to share skills and knowledge.

I have recently joined a dental software planning team, and I am now working with a dynamic, vibrant group of young software engineers in Nepal who are developing an exciting new platform for dentists. So, let us take a positive approach to life. Although this pandemic has affected us in every dimension imaginable, it cannot change our pursuit of learning and desire to improve. Time is powerful because, with it, the world changes. What is most important is how we react to the change.

Asia pacific Dental industry Dental practice Practice management

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