Ceremony 8
Academic Oration
Thursday 28 November 2013 at 1630hrs
JESUITS’ CHURCH – VALLETTA
Professor Nikolai J Attard
B.Ch.D. (Melit.), M.Sc.(Tor.), Ph.D.(Tor.)
Distinguished guests, welcome to this graduation ceremony in honour of our graduands from the Faculties of
Dental Surgery and Medicine and Surgery. Today we salute the graduands’ hard work during their years of study
and also pay tribute to their loved ones. Over these past years, as I walked through this congregation during the
processional entry, I have never failed to observe individuals who are justifiably elated and proud of the
graduands’ achievements. And it is right that you celebrate on this occasion, for the graduands’ achievements are
also yours.
Permit me to share with you changes that have revolutionised my profession- that of dentistry. In recent years, it has
undergone major strides from a traditionally despised profession classically associated with pain to one that has served
as a pioneer in the major discovery of osseointegration. Through the vision of one man, Per-Ingvar Brånemark, it has
become possible to do what everyone believed to be impossible to achieve, that is, to physically unite a metal with
living bone, not for a short period but for a lifetime. It all centres on an accidental discovery that permitted the ultimate
trickery; that of deceiving bone to accept a material alien in substance, so completely, that it becomes an integral part of
the human skeleton. This process of osseointegration is all a matter of balance that exemplifies how unique and
rewarding Mother Nature can be when respected. Osseointegration has given people all over the globe a renewed hope
for a better future by allowing the restoration of lost or mutilated body parts such as a depleted dentition, a third
dentition to patients who have lost all their teeth, a new nose, ear, eye and indeed even a new face.
Osseointegration became so widespread in dentistry due to one of our own alma mater’s sons, George Zarb.
Through his wisdom and genuine enterprise, Professor Zarb determined, through well-documented clinical
research, that Brånemark’s technique was indeed revolutionary and enduring. True to his altruistic nature, he then
went ahead with sharing the technique in the early eighties with his fellow academics in the North American
continent and eventually to the rest of the world. The rest is history and the concept of osseointegration spread to
other disciplines especially in orthopaedics where the provision of osseointegrated limbs are a reality of our
present, not a distant dream in the future.
This one single discovery also led to an exponential increase in research, with a number of scientific journals and
meetings dedicated exclusively to certain aspects of it. Many dental specialities have metamorphosed and revised
their modus operandi; indeed techniques that were central to a speciality’s philosophy are today relegated to
history. Incredibly today we readily do away with teeth in an attempt to preserve their supporting bone.
The same exponential increase witnessed in research has been well matched, if not surpassed, by the dental
industry’s commercial activities in the area. Make no mistake: osseointegration like any other field in the medical
and pharmaceutical disciplines is today a multi-million euro business. Whilst acknowledging the role of industry
in promoting research, one must also caution against the relentless drive in improving its economic profile on the
stock market. Although this is not necessarily a negative milestone, many times we observe initiatives that are
definitely not focused on the patient’s well being. Many dentists subscribe to this idea and view osseointegration
as a fast and guaranteed way of lining their pockets. In fact some members of our profession have gone as far as
shedding their skin of dentists and rebranding themselves in so-called “implantologists”. It’s a classical case of not
seeing the wood for the trees.
It is apropos that we stop and reflect on this relationship between our professions and industry. Many times this
association strays from one that is symbiotic, and therefore mutually beneficial to all parties involved, to one that
is opportunistic, with research activity that is dependent on funding, becoming subservient to the industry’s diktat.
I am sure that many of you, academics, professionals in the different fields, have come across situations that leave
one dubious on the true motive of research, and also on the true benefit of an intervention to our patients. This
imbalance impacts on all the parties involved, that is the researcher or health care provider, the profession and
academia, and patients. Aren’t we all aware of the pricing of medications, or of interventions that are exorbitantly
priced, or of recent events where companies sugar-coated their research with profound implications on the wellbeing of patients?
Having said this, research and innovation of new interventions require considerable funding. In the prevailing
economic climate, independent researchers are many times disadvantaged from securing the necessary funding to
conduct their activities. This problem is multifaceted. On one hand, academic institutions may not be fiscally resilient
enough to promote and support all its academics in their research endeavours. On the other hand, academics’ time is
already occupied by other activities such as clinical teaching and the ominously ever-increasing administrative
commitments.
Moreover it may be a daunting task for novel researchers to establish themselves in circles that historically were at
the forefront of research and therefore with a solid track record of attracting funding. This means that independent
researchers and their activity will invariably suffer. I still remember receiving a communication from a major
implant company with whom I had applied for funding. The letter that should have secured me some monies for
clinical research was not to be. Instead it courteously informed me that: “although your research proposal is
scientifically sound and valuable, it is counter-productive to the economic needs of the company”.
So what should we do?
University should unify and strengthen its strategies in identifying and securing research funding. It should
provide proper training to help academics source research funding opportunities. It should lobby government to
provide more flexibility in its funding opportunities since many times researchers are excluded from funding due
to their inability to secure collaboration with local industry, which in the case of dentistry, is practically non
existent.
University should also rethink the way it assesses the output of its academic body. Surely every department will
have a blend of academic members that are more inclined in the areas of research or teaching. Both activities are
important and should be recognised as potential routes for tenure within the institution. Indeed systems that
evaluate both streams, independently or maybe in combination, are already in existence in foreign institutions. The
University of Malta should consider following this path since this would mean that research funding and the
academics’ activities are better focused according to their predilection.
Revisiting the delicate balance between industry and profession, one must unfortunately highlight instances where
the professions emulate industry and discount the patient’s views. At times it seems that in our quest for more
focused and technique-driven interventions, we run the risk of dehumanising our own professions. In dentistry, we
have a collective conceit that if we provide more technologically advanced interventions we will improve the
patient’s overall health. For example, some academic groups have gone as far as suggesting that the standard of
care for the management of edentulism should always be a minimum of two implants and a removable prosthesis,
not anymore a complete denture. This so called “standard of care” is a legal term that crept into medical and dental
language. Ideally the standard of care should be determined by a regulatory body or courts of law to define a
reasonable clinical standard by a reasonable practitioner in a defined geographical setting and within a defined
population. When used in the medical and dental literature it often implies a universal imperative, which of course
does not take into account the spectrum of professional, financial, patient and cultural resources and variations.
This distortion of facts and greed can lead to inequalities in health care provision. Indeed we are observing trends
where a profession becomes more urbanised due to the affluence associated with city-dwelling people.
Accidentally this means that ratios between health-care providers and patients become meaningless, as they do not
portray the true geographical effectiveness of a service.
Obviously one might not relate these repercussions to the local scene due to the size of our country. However the
Faculty is aware that certain members of our society are left behind, even in the area of oral health care. We are
concerned with the fact that as a Faculty we still do not have a clear and complete picture of parameters that are
recognised in the international community and which are expected from us as a modern society.
For example, we are aware that although in recent years we have seen great progress in the prevention of dental
decay in children, broken, missing, or filled teeth are still the norm rather than the exception in Europe. In fact
when one examines public spending in health, oral related disease remains one of the highest economic burdens.
This is attributed primarily to dental decay, periodontal disease and oral cancer. With these, we have to also add
inequality in health and social problems that are increasingly becoming a serious threat for certain groups in our
society. This trend must be reversed and indeed the Faculty has reconsidered its philosophy by updating its
activities, courses and by pursuing research activity that will result in meaningful treatment modalities that are
more cost effective for the patient and the state as a health care provider.
Scientific studies have clearly demonstrated the benefits of direct interventions in society. With these facts in hand
it is obvious that the Faculty of Dental Surgery, as a principal stakeholder in the field of oral health, would embark
on programmes in our community notably outreach clinics in socially deprived areas and launch the Mobile
Dental Unit along with sponsors from private industry. This project will allow us to take our students out in the
community so they understand the complexity of our society. It will enable us to deliver our message in an
effective way in our society by establishing preventive interventions especially in children, our future generations.
We will also collect epidemiological data on a regular basis, permitting us to participate in international research.
It is our intention to provide a basic service to those communities that are underprivileged, especially our members
of society with special needs and our geriatric patients.
I take this opportunity to remind certain elements in our community who are very critical of university, that the
University of Malta is an active member of the Maltese community. Its activities result in tangible benefits for our
country by training tomorrow’s professionals at undergraduate as well as postgraduate levels and improving our
people’s quality of life by engaging them directly in their towns and villages.
The Faculty of Dental Surgery has expanded over these past few years with the introduction of new undergraduate
courses such as Dental Technology and Dental Hygiene and postgraduate courses. Today the Faculty’s efforts
come to fruition as we celebrate our postgraduate students’ outstanding results in their studies. This year we
launched the restructured dental degree that will lead to a Master in Dental Surgery. Although still a five-year
course, it will provide a more comprehensive approach to our discipline. This restructuring is the result of an
extraordinary amount of work by a number of people and I take this opportunity to publicly thank them for all
their efforts.
Today the Faculty views the word “dental student” as an all-inclusive term that embraces all students following
the different courses it delivers. Our aim is to foster a positive environment that allows students to study and train
together throughout their academic years in preparation for their future careers, as part of a multidisciplinary team
in the field of oral health care.
It’s worth noting that the dental surgery course shall focus more on the geriatric patients. The ageing of the
Maltese population poses new scientific challenges in the management of complex health issues including oral
health related concerns. Increasingly, professionals within the dental field are also serving in institutions for the
elderly and the mentally and physically disabled, in hospitals and in public health clinics, where they reach a
larger segment of the population regardless of their socio-economic background. It is also the Faculty’s intention
to organize further postgraduate courses in the field of Geriatric Dentistry.
The introduction of these courses also means that the Faculty requires further facilities to conduct its teaching
activities. In fact the Faculty has, for the very first time in its existence, acquired space on the main campus of
University for preclinical teaching and additional clinical space at Mater Dei Hospital. The Ministry for Health
generously made the latter available. Besides recognizing the importance of investing in the infrastructure needed
for our clinical teaching activities, it also donated teaching equipment to the Faculty. This stimulus will further
bolster the field of Dentistry and will be of benefit to our country. I state this because I am a strong believer that
this synergy will not only benefit the educational institutions such as the University of Malta, but also the Ministry
responsible for Health that will ultimately require well trained professionals to provide the necessary services to
our nation.
Graduands, irrespective of the future career you will pursue, remember that changes in our fields are inevitable,
but learning is optional. Rest assured that throughout your professional career and personal life, you will
encounter situations that challenge your principles. You must be vigilant and ask the necessary questions on the
validity of what will be proposed to you. Otherwise you risk being sidelined, or worse, becoming a minion for
others. Show true leadership and always strive to make the right choices, even if at times, it will involve personal
hardship. I conclude by reminding you all that you will always be part of this vibrant university. Never forget this
university’s efforts in providing you with your tertiary education. It has allowed you to follow your dreams, career
and hopefully attain a privileged lifestyle in the future. Participate and support its efforts and make sure that the
University of Malta will always be close to your heart.