A first for the Caribbean

Ja-based endodontist presents paper at European Society of Endodontology congress

BY KIMONE THOMPSON Features editor Sunday thompsonk@jamaicaobserver.com

Sunday, October 02, 2011

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SURE, you've heard of a dentist, and in all likelihood, you've visited one at least once. But you've probably not heard of an endodontist — the professional who specialises in root canals. So rare are they, at least in Jamaica, that only two practise in the island.

One of them is Dr Sashi Nallapati, who just returned from Rome where he was the sole guest presenter from the Caribbean at the European Society of Endodontology's 15th biennial congress which attracted over 30 dentistry clinicians, researchers and academicians from around the world.

His discourse: 'Three-Canal Premolars: Diagnosis and Treatment Strategies', was based on a condition which, while apparently uncommon in the rest of the world, is not so in Jamaica.

"You have in Jamaica, a peculiar condition in the anatomy of teeth. Any normal pre-molar normally has one to two canals, but in the Jamaican population you have a very high per cent of three-canals in that particular tooth, which is not very common around the world. So we do have a, maybe genetic [predisposition]. It's hard to say, but the Jamaican population seems to have a higher percentage of three-canals in their pre-molars and because I practise here I do see that a lot in my practice," he said.

"I have heard clinicians, say for instance working in North America or elsewhere in the world, they would have performed maybe three or four patients in their lifetime, or one patient a year, the most. I tend to see five or six a year so I have accumulated a lot of these cases," he told the Sunday Observer.

The incidence doesn't appear to be life-threatening, but requires research to determine the cause and the potential anatomical effects.

Asked about his invitation to address the European Society of Endodontology congress, Dr Nallapati said: "I (was) very excited because it was a great opportunity to showcase what we're doing in the Caribbean, because the fact that I'm the first Caribbean dentist to speak there suggests that they normally don't have anybody representing the Caribbean at these large meetings. But to be able to go there and show that we are capable of doing First World dentistry here in countries like Jamaica or elsewhere in the Caribbean, it's something that I (was) excited to present."

He has presented in Europe before, as a guest of the German and Spanish endodontist societies, and has also made presentations to the societies in the USA, India, Venezuela, and Costa Rica. "But as a European body that encompasses the entire Europe where 28 countries (came) together to have this meeting, it (was) a much larger audience for me to showcase what we are doing in the Caribbean, especially in Jamaica. People tend to think we have third-class or Third World dentistry being performed in Jamaica, which is not true," he stated emphatically, noting that while "bad" or "average" dentistry do exist here, excellent dentistry, on par with the First World, is practised here as well.

Nallapati said that he was the first to introduce the surgical operating microscope in Jamaica and stressed that he uses an endodontic speciality software which allows him to issue detailed reports to referring dentists and their patients as the patients are leaving his office.

"The photographs are all taken through the operating microscope. It has a camera on it and it acquires pictures as we are working, so at the end of the treatment we can show patients what has been done. So the digital office, which is the software that we use, really helps us to have patients' information, patients' medical records, patients' pain information and they can send all this information to us online. They don't have to be here. When they call my office we send them an e-mail and they log into my website where they are given a password and a username by e-mail, so they use that and they log into the website," he said.

"So when they walk in, it's just like they come in and they walk straight into the room to get their treatment. So there is no filling forms and waiting and that sort of stuff. We call it online registration of patients, the software allows us to do that."

The very widely published Nallapati has been a practising dentist since 1996, shortly after emigrating to Jamaica from his homeland India. He obtained his dental degree from the Government Dental College and Hospital in Hyderabad, India, and practised general dentistry in Ocho Rios until 2004.

Dr Nallapati completed his post-graduate training in endodontics at Nova Southeastern University in Florida in 2006, after which he returned to Jamaica and set up the Caribbean Institute of Endodontics, which, in addition to performing root canals, trains dental professionals in the science and art of endodontics.

"I always wanted to have some sort of international exposure," he told the Sunday Observer. "That was my first intention on leaving India and completing my graduation in dentistry. I went to a really good school in India. We were really in very good demand because there were few dentists back then where I was, but I wanted an international exposure to what I had already learned and I also wanted to study in the US to become a specialist.

"But it's not very not easy to obtain a position in the US schools. (They) were very, very picky about the candidates, particularly for post-graduate programmes. They won't give a post-graduate programme just to some foreign resident from a foreign (school) because you're competing with American graduates. It's almost impossible to get it. So for me, I was looking at other opportunities to work elsewhere and get some exposure and experience in practice before I could go and do my residency in the US. That's when I came to Jamaica," he explained.

Dr Nallapati, whose wife Prerena is a general dentist, said when he decided after his residency in the US to return to Jamaica, several of his professors and friends called him "crazy" and tried to talk him out of it. But he didn't yield.

"I really wanted to come back," he told the Sunday Observer. "I really fell in love with the country and I really enjoy every minute of my stay here, and even though I never really meant to stay so long when I came -- I thought maybe two or three years -- but the fact that I fell in love with the country, the natural beauty and the people, people were so respectful, I essentially never felt like leaving."

His parents, who still reside in India, weren't too happy with his decision to relocate to Jamaica either, but he said they have come to accept it, especially since they travel back and forth every year.

"There is one regret (however). The regret is that when you see your own family members needing that sort of quality of care that I provide and they're not able to get that, that's a sad thing for me because they have to resort to seeing whoever they're seeing there. It would have been nicer if I was around; I would have taken care of them," he said.

He could have gone back to India after his residency because, as he puts it, there is not a single American-trained endodontist in the whole of India, but he had already been smitten by Jamaica's charms. That, plus, there was a need for endodontists in the island as well.

Prior to his entering the field, Nallapati said patients needing specialised root canal had to fly to Miami where the cost is more expensive, given the price of airfare alone.

General dentists can and sometimes do perform root canals — which can last between one and three hours — but specialised training in the field is more effective.

"For those patients who could afford to go to the USA, they were being referred to an endodontist in [the] Miami area. A lot of patients were actually travelling to Miami to get their root canals done, but now since the specialists are here, patients who previously were going to Miami can now be treated here and there are quite a few patients here," he said.

"Part of the problem is the really good programmes where you do train are all in the First World countries. When you go to the First World countries, it's a one-way ticket unfortunately because people are not coming back. So that's the reason why we don't see that many specialists in the island," said the doctor.

Nallapati, who is also the father of a five-year-old girl, has always felt passionately about endodontics, and while working as a general dentist performing sundry procedures, he became increasingly focused on the speciality.

Dr Nallapati is a member of Jamaica Dental Association, a specialist member of the American Association of Endodontists, and is eligible for the American Board of Endodontics. He serves on the faculty of Nova Southeastern University's college of dentistry as a visiting associate professor in the department of Post-Graduate Endodontics.

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