Dr. Elangovan: Hello everyone. My name is Satheesh Elangovan. I'm a professor of periodontics at the University of Iowa College of Dentistry and an associate editor of the PracticeUpdate Clinical Dentistry Channel. Today, I have the distinct pleasure of talking to Dr. Akshay Kumarswamy, who is a US-trained periodontist practicing full-time in Mumbai, India. Thank you, Dr. Kumarswamy, for joining me today. Before we start, could you please give a little background about yourself?
Dr. Kumarswamy: Sure. Thank you, Dr. Elangovan, for having me, and it's a great pleasure talking to you in this format. Just a little bit of background, I did my dentistry in India, and then I went to the US. I did a one-year advanced education in general dentistry from Boston University, came down south, and then went to the University of North Carolina for the perio program. I did a three-year MS in perio there. Moved on to Fort Lauderdale for my first job as an assistant professor of periodontics at the Nova Southeastern University in Fort Lauderdale. And after spending about two and a half years there, I moved up north again, a little bit north, back to North Carolina, where I was an assistant professor at East Carolina University in Greenville, North Carolina, where I also headed the implant department for a bit.
So yeah, that's been my background. After that, I have come back to India. I returned back to India in 2016. Since then, I've been in private practice here in Mumbai. Along with that, I also teach implantology to young dentists, young and old dentists, who are interested in learning about implant dentistry and periodontics, for that matter. And along with that, I give some lectures at different conferences and keep myself abreast with the latest.
Benefits of PracticeUpdate Clinical Dentistry Channel
Dr. Elangovan: That's wonderful. That's wonderful. That's great. The regular user of PracticeUpdate Clinical Dentistry Channel, what are some of the benefits you see for a practicing dentist when they subscribe to the channel?
Dr. Kumarswamy: So again, I would like to thank you again for introducing me to PracticeUpdate. And, of course, it's such a big treasure trove of knowledge. Every single day I look forward to receiving the email summary from PracticeUpdate about some of the summaries of studies. Now, being in private practice, it kind of gets difficult for me to keep myself updated about the latest in terms of research that is going on, which is applicable to clinical dentistry. So I think that is where Practice Dentistry steps in. And PracticeUpdate gives me good information, a good, solid information about what is going on currently in the research world, which is totally applicable to me in clinical practice. And it's not just about perio or implants, it's about all other disciplines as well.
So I think that makes a huge difference for me as a clinician where I'm not thinking just about my subject or my specialty, but I'm also looking at what is happening in the rest of dentistry. And, to think of it, dentistry is pretty small in terms of a subject, and it is so interdisciplinary that we still have to keep ourselves updated about what is happening in other disciplines as well.
So I think it's helping me a lot in keeping my practice up to date, as the name itself suggests. PracticeUpdate is helping me keep myself updated as well. And it allows me to give my patients the treatment that is currently being researched and currently has been established to be standard of care. So I think that goes a long way in helping me give the best to my patients here in Mumbai.
Accessibility to PracticeUpdate
Dr. Elangovan: That's wonderful. Thank you. Thank you. And best of all, it's free to use, so completely free to access.
Dr. Kumarswamy: Exactly, exactly. I think that's the best of it. In these pandemic times, we are lapping up anything that comes online and is free. And the best thing about PracticeUpdate, the fact that it's free, and just at the click of a button in the early morning, I just open my email and I have a summary of different papers. And the best advantage is that it is a summary given by experts whom I value. So I think that goes a long way that I know that the person who has given the summary is someone who has been established in the world of dentistry for a long time. So I would certainly value their words when they say that, "Okay, this is a good paper, and this is my summary of that paper."
Applying information obtained from PracticeUpdate newsletters
Dr. Elangovan: Great. Thank you. Thank you. Can you think of any clinical situations that you recently encountered in which you were able to apply the knowledge you gained from PracticeUpdate channel? Be it for clinical diagnosis or for patient management.
Dr. Kumarswamy: Sure. I think what I would point to here is what was voted as the top story in this year by PracticeUpdate. I think it gave a good risk assessment, a perio risk assessment or implant risk assessment. So I would like to discuss this one case I remember, which you can see the picture here. So basically, this was a case where the patient came in with some periodontal disease in the lower anteriors. And, of course, we knew that the prognosis was poor. So we realized that this patient would need to lose these teeth. But this is where I think PracticeUpdate's paper or the top story helped me in understanding the risk assessment for the next step, which is the implant treatment option. So here is a patient who has perio disease, periodontal disease, and I would classify it as moderate to severe periodontal disease. So I know that I first need to eliminate this so that I can reduce the risk factor in this patient.
And again, thanks to PracticeUpdate, I probably would treat this patient by extracting those incisors, letting it heal, making sure that periodontal disease is taken care of before I proceed with my implant placement. So I automatically am helping reduce the risk factor as I proceed further with this patient's treatment.
Another case that comes to my mind is this case, which you can see on your screens now. Basically, this patient came in, she had a cantilever premolar off of her second premolar. And, again, it was loose, so we advised that she get rid of that cantilever. Now, here is how she looked with the removal of that cantilever. So we let the crown on the second premolar be there. Now, if I look at this, this is how I'm starting this case: I'm already thinking about what risks this patient will have. So I'm thinking about my restorative space, I'm thinking about how deep my implant has to be placed, and, again, all of this was in that paper or in that summary that was written, which was beautifully mentioned in PracticeUpdate. So I'm thinking forward. I said, "Okay, I need to plan for the restorative space. I need to plan for how deep my implant will be placed."
So I automatically have a plan in mind in advance of starting the treatment. Once I have that, everything is smooth. So I think this is another case which came to my mind.
And again, of course, I'll just show you another case, the last case which I have here, which is a patient who comes in and she has a failing bridge. So if you look at her CBCT, she has deep pockets, deep periodontal pockets in that premolar which is holding that bridge, a long span bridge.
So I know that thanks to the PracticeUpdate and from the risk assessment study that I've seen before, it helps to let me know that a deep probing depth is a big, big risk factor in future periimplantitis. So I need to ensure that I eliminate all of those risk factors before I proceed further with treatment.
So, in this case, if I look at the picture, there is a lack of keratinized tissue, so I'm taking it stepwise. I first probably will do a free gingival graft, get rid of that bridge, get rid of that tooth, ensure that the periodontal disease is eliminated via the treatment of extraction, and then proceed for implant placement. So in a way, I think PracticeUpdate helps me channel my treatment planning in the right way. Especially this paper, as I mentioned, helped me assess the treatment plan in a way that I reduce my risk as I go further, especially the risk of periimplantitis. So I think it's a great asset.
Dr. Elangovan: Thank you so much. Thank you. I want to thank you again for your valuable time, for sharing your thoughts in this very brief conversation. Thank you very much. We appreciate your time.
Dr. Kumarswamy: Thank you, Dr. Elangoven. Thank you so much for having me.