LESSONS LEARNT FROM TODAY'S CLASS

Well, let's look at what I have learn on one fine Thursday afternoon.

THE TOPIC OF TODAY is "FACIAL INJURY and MOTOR VEHICLES ACCIDENT (MVA)"

MVA is so common in Malaysia because of the rate and number of road traffic accidents in Malaysia is on an alarming high. Dozens fatality occur each day and it makes it to around 7000 each year. Press those throttle speed and move your car to above 110 kmph, but be aware, that even at modest speed of 60 can kill you once an impact occurs.

Much said, MVA, along with assaults and domestic violences, are one of the three most common attributors for facial injury (or maxillofacial trauma). Maxillofacial trauma involves fracture of bony structure of the face bone, bleeding into the tissue and may eventually lead to less commonly severe life-threatening conditions. From the aspect of MVA, my lecturer suddenly talks about the differences in local and imported car. He reasoned that types of car can influence the type of severity in injury and prognosis.

Imported cars - with the names like Mercedes, Honda, Toyota and so on has flourished in our streets for ages. The same goes with our national cars of Proton and Perodua. Automobile industry in Malaysia is still relatively new and any high technology engineering incorporation will takes time. Its been 3 decades but the impact of such booming industry was so imminent. In general perception, a middle class will buy a local product while the rich can go with an AP (Approved Permit) and to grab one of those fancy imported car.

Now for comparison, let us look at a Mercedes 230C and a Proton Perdana...some of those popular classy sedan vehicle of all time among the Malaysian. Mercedes 230C can be bought at a price of exceeding RM 350k while a Proton Perdana costs around RM 100k. Now as a Malaysian with an ordinary salary of RM 3k per month, which one would you buy? It is easy to say that one will pick the Proton Perdana for its cheaper price tag.

Well, let us go deeper.

• In Malaysia, the local automative industry was well-protected by imposing strict and higher sales and import duty on the imported cars. 200% import duty and you will get a Mercedes 230C at a price of RM 350k, whereas the real price for it is USD 40k or about RM 150k.
• In overseas, people usually do not buy cars, either first or second hand via bank loans. They usually buy their cars via direct full cash payment. However in Malaysia, loans are available everywhere and it makes any Tom, Dick and Harry can own a car. Now the problem of finance and debts, Malaysia has a high amount of car-loan debt in the world!!
• There is some question why AP is such an issue. You can freely imports a car. Not surprisingly, some civil servant can even afford such a car. I wonder where they get their finance to support their ambition. Corruption or ah long?
• The imposing of seemingly unfair price over the same types of sedan has created an unfair environment of both cars to compete in the market. with the consumer power with an average incomes, it seems that as easily predicted, one will prefer Perdana over a Mercedes because it is cheaper. With such, the local car manufacturer will have an upper hand of advantage with more sales and profit compared to the imported one. Thus, the market value becomes uncompetitive for the locals.
• Local cars are not that local anyway. Technology from overseas, components from overseas but been assembled locally. That is what defines it as a local made car?
• Due to lack in competition, one can easily sees a decrease in quality making of the subsequent batches of car. Proton over the years, have trouble in producing such a good-quality car. In its earliest years, a Proton Saga is like a Mitsubishi engine contained in an aluminum body work! Because of the quality issues, safety issues will arise.
• To proof this, I have an experience when I was in my brother-in-law's car few years back - his 90's batch of Proton Saga. Upon the traffic light, the Proton Saga slowed down as the light had already turn red. Out of nowhere...."Boom", and looking at the front mirror, a Mercedes at the back with its handsome driver on his mobile phone on one hand and a document on one hand (I wonder how he drive) hit the bumper of our car. It seems like he was not able to stop his car in time because he is apparently busy. Now, with such a light impact, guess which car suffered more damage?
• Another proof of safety concern, there was a test in the past where we have an experiment to see at which car can brakes into zero in the shortest time. Again, a Proton model with a Toyota model. Not surprisingly, Toyota can brakes into zero in a shorter time than a Proton, enough for it to stop and to avoid an experimental cone located 200 metre from its starting point.
• Now for most of us, a car can be troublesome, besides of its price and difficulty to endure a city traffic jam. The option is a motorcycle. Now, you do not need to be a genius to figure out how dangerous this vehicle with no surrounding barrier to protect you from a direct impact in an accident. You can easily fly a few dozens metre once get bumped over by a car.
• In a car accident, you either survive with minimal injury, or get killed...less likely a severe injury.
• In a motorcycle accident, you either survive with very bad injury or an instant kill.
• Not surprisingly, with the fact that a low quality cheaper cars and million of motorcyclists roaming on the streets across the country, now you know why MVA is so common.

Was it hard to figure it out!! Once my lecturer touched on this, it becomes clearer to me now!!

What I Got From This Week

This morning (on 08/01/09), I was in this cold-refrigerator-room. Well - not really, but that is what Dewan Kuliah 4 (DK 4 in short) is always been referred as. DK 4 is a super-duper cold lecture hall in my campus, as if it gives you some kind of cold environment, similar as if like you are studying in England. Anyway, back to the business on what I learnt on this week.

One: I found out that one of my lecturer have read my blog before and I'm wondering on what occasion was that. She is an expert in endodontics. She was mentioning something about this website called Nicenet, a website dedicated to encourage more interaction and intellectual discussion between students and teachers, regardless of age, level and background. Suddenly she looked straight at me and said, "Yeah you as well, I have been to your website (meaning this blog) before. So how long have you been writing it?" I was startled but I was still able to give a simple answer, "Since two years". Then the other eyes inside the hall were either staring at me as well or giving me some surprise look. You see, since I started this blog, I have never introduce, advertise or promoting it within my fellow course-mates.

Two: I found out that been a dentist is not human enough. While pointing out the lecture slides that discussing on how to take a proper history on a patient, she also said,"You guys as a future dentist should be more 'human'." This is not the first time I heard of such statement. All these while, dentist is not been like a normal person when they try to communicate or examine their patient which indicated that we are not so 'human' at all! Taking history from a patient may seems troublesome but that is how we derive a proper diagnosis, treatment and prognosis. History taking requires a substantial amount of knowledge, good communication and examination.

"You should be like Sherlock Holmes or just nice to be like the CSI," she added later. It is true, the concept of investigation and examination are important in dentistry as an overall. Sometimes we do misdiagnosed a certain disease or condition because of lack of information, improper technique and so on. This does not only applied to myself but also to others. Been a human does not made you perfect. Sometimes we do made mistakes but all of these are part of our life. Therefore, I believe in that we should prepare ourselves even in what ever we do. But in a nutshell, does been a dentist seems 'inhuman' enough?

On the next day, I have a clinical session. 

Three: I came across a patient with tooth crack syndrome. She complaint of the tooth (47 - Lower right second molar) been in pain while biting but relief after release the biting. Therefore, she felt very uncomfortable when eating. There is a large tooth-coloured (composite) filling on that tooth that is large and extended from a side to another (Mesi0-occluso-distal) restoration. My partner and I conducted a few examination over her problematic tooth.

First, a radiographic features a widening of PDL area with no signs of caries and dislodged previous restoration seen. Following pulp sensibility testing reveals the tooth is still on vital with delayed exaggerated response to electrical pulp test, suggesting a dying pulpal tissue. Last but not least, we applied a blue-coloured dye called Canal Blue which detects the crack line on the tooth.

Treating a cracked tooth is not simple. The list of treatment options are as follows - crown, root canal treatment or removed the tooth. But we just leave her tooth untreated since she does not have much time and seldom came for an appointment. She also refused a molar band around the tooth to protect the tooth from further cracking. What I learned from this case? Simple, people will never visit a dentist if he or she feels nothing wrong about it, at least YET!!

In next post, I would like to discuss a matter that one of my reader did complaint about her difficulties she had when she done a dental treatment under my junior last time. Well, another classic example of tales from people undergoing dental treatment!!