Professor Dr. Toh Chooi Gait
Professor Toh Chooi Gait is the founding Dean of Dentistry and Professor of Restorative Dentistry at the International Medical University (IMU) in Kuala Lumpur. She has also been promoted to the post of Pro-Vice Chancellor (Development) starting from 1 January 2016. Prior to joining the IMU, she was a professor in the Faculty of Dentistry, University of Malaya and had served in various capacities including Deputy Dean and Head of Department of Conservative Dentistry.
She is a member of the editorial boards of Operative Dentistry, the European Journal for Dental Education and had served as a reviewer for other local and regional journals including Malaysian Dental Journal and Asian Journal of Aesthetic Dentistry. She is a member of various governmental technical committees including Chairman of the Protem Examination Committee for the Professional Qualifying Examination of the Malaysian Dental Council, Joint Technical Committee for the Evaluation of Dental Specialist Committee of the Malaysian Qualification Agency, Malaysian Dental Deans Council, and Specialist Sub-Committee on Restorative Dentistry.
When I started out in dentistry, I did not think that I would be in the academic line. Back then when I was a student, my friends had always teased me, ‘One day, you will be a professor.’ Then I had replied, ‘No, I will not be a professor.’
At first, all I wanted was to be a specialist working in my own clinic. To be a specialist, I needed to go for further training which my family could not afford. So I said to myself, I would go into academia as I love learning new information and receive training to be a specialist prior to opening my own clinic. Hence, as soon as I graduated, I applied and was accepted in the University of Malaya as an assistant lecturer. The university provided an enriching academic environment. In the public university service, after acquiring my postgraduate academic and professional specialist qualifications through the Commonwealth Scholarship, there was opportunity to take sabbatical leave of 9 months after each period of 5 years of service to increase research and publication activities. This is a time where academic staff takes time to enrich their mind with research. I find research very stimulating and it attracted me to stay in academia because of the opportunity to be involved in finding new information. Just the process of it and knowing how things work and respond to various environments/stresses is very exciting for me. If there is to be progress in any society, it is through research. Now as you learn more, you can appreciate how research has evolved in every area. How our lives has changed and that is the result of research from people who had ideas and explored them through research.
I found academic career surprisingly very exciting. When I was a student, I was never exposed to the academic lifestyle. As a student, I always thought that after graduation I would start work in a dental clinic and earn my money through patient treatment and no longer have to take anymore examinations. However once in academia, I understood that it was not about examinations but knowledge and skills acquired. I find that a university is a place to explore new knowledge and to nurture a thinking mind. It does not only gives you skills but actually enriches your mind. My eldest brother who was very wise and knowledgeable once told me, ‘All material riches that you possess, people can take away from you but not things that you have in your mind.’ When you enrich your mind, the richness of the mind belongs to you. Your experience is uniquely your own. It is actually how you want to nurture your mind. Money cannot buy the wealth of experience.
When I first graduated from the University of Singapore, I was offered a job in Singapore by the dean to stay back. However I wanted to come back to Malaysia because I am a Malaysian. At that time, Malaysia was having its first dental school. I thought it would be quite interesting and exciting to start my career in the University of Malaya. From working there, I had seen the first batch through. There were times I had asked myself whether I would like a change of environment and meet new challenges. I was seriously thinking of going to private practice because I had been in academic line and I felt that I was confident of my clinical specialty skills but I had never been exposed to the private practice challenge. Would I do well in private practice? There was once a comment by somebody, ‘Those who cannot do, teach. When you think you cannot be successful in private practice, then only you teach.’ That generally irked me. If I was not able to perform clinically well, how could I teach well? So I said to myself I should go out and get some private practice experience before I come back to academic line. Now in academia, they also have private practice. When nurturing students, one should not concentrate too much on theoretical matters unless they had clinical significance. As in the past, I always thought if I am in academia, I must stay relevant when I share knowledge and experience with my students. I should not behave like trapped in an ivory tower of ideas and teaching things that are theoretical only and would be left behind in the university once the students leave school. I want people to have skills and knowledge that they can make use of and teach them how to learn. That is education. If the university experience is just about acquiring current knowledge and improving one’s technical skills, that can be outdated in the near future, then that is not education. Education must be more than that. Hence, we need to learn how to educate ourselves. When I was in the University of Malaya, I always had that desire to change the practices in education. Sometimes when we saw students who were not inspired, we would be thinking, ‘How can we get them to learn? How shall we change our techniques to keep their interest?’ Hence, I used to experiment and try to make changes. It took a lot of effort to change. For some they thought it was not worth the effort. They thought students should adapt to us (the lecturers) and not us to the students. That was the old traditional way. I could not do much to change the learning environment. I spoke to colleagues who were thinking alike and we tried our best.
There was one year when I was near to retirement age, I was approached by IMU. I was asked whether I would like to have a change of environment. IMU was starting a new dental school and I had been recommended to IMU to be the founding dean. At that moment, I was concerned, that IMU as a private university, whether there is investment in quality and not just emphasis on making profits. My main motivation is how to enrich people’s mind in the best way and there must be quality in the provision of education. It was reassuring when the Provost responded to my query with “IMU is all about quality”.
I went to IMU to check out the private university environment. I looked for research facilities. To enrich the mind, it was not about learning from the books. It was about the discovery of new knowledge. I was surprised that IMU had some well equipped research facilities. Not many private universities would invest so much in research and development. Dentistry is not just about training technically competent practitioners. It needs to include training leaders of the future. I like the IMU mission to train caring profession of the future and that includes training dentists of the future.
It was quite a challenge to set up a new dental school. I decided to take up the challenge. It was a fantastic opportunity for me to introduce all the things that I wanted to include in dental education but could not quite successfully introduced in my old place of work due to various challenges. I have the opportunity to do it now.
I had a lot of self-confidence at that time until I joined IMU and month after month, I was the only person in the dental school. I had no students anyway. So I planned out the whole curriculum to submit for approval. Sometimes I was a little bit anxious as I did not have any staff. How could I carry out the planned activities? Later on, I started getting staff. I had Professor David Francis Wilson who reviewed the Dental Science curriculum. He gave very good and positive feedback. Associate Professor Theuns Gerhardus Oberholzer joined us later on. He provided good input too. I had international staff joining and it was exciting. The three of us could really work well together and we managed to exchange ideas to make a difference in dental education. We had to develop a curriculum of global standards for our international partners from established universities to firmly believe that our students are good enough to be given credits for transfer to their universities. That was a big challenge but I thought that if IMU could do it with the medical programme, then why not dentistry. However, dentistry had a separate challenge. In the dental training, students do need to be sufficiently competent to treat real patients. There is need to develop their skills sufficiently prior to transfer. Hence, I was of the opinion that our students must have a strong foundation. So anywhere they go in this world whether to universities with traditional or contemporary curriculum delivery, they would be able to adapt. If the students learned how to learn and knew how to practice supported by current evidence, anywhere they go they will be accepted because the best practice is to use current evidence to deliver what we want to do for the best of care for the patients.
In January 2008, we had our first group of students that we interviewed and it was really exciting. We recruited all students for the first cohort in just one month to start our programme in February 2008. Many people liked the partner transfer track. The challenge was the local IMU track. In IMU, we aim for quality. People tend to think that only overseas universities will have international global standards. To be of international global standard, we need to have quality in our local programme. Our curriculum is very different because we want to prepare a patient centred professional. To do that we have designed an integrated environment instead of discipline based and even our staffs need to change their mindset. We all need to learn how to give effective feedback and learn how to receive feedback. It is a learning process. You are empowered what you want to learn. We organised for our students to visit commercial dental laboratories and clinics in the first year so that they can experience how it is like to be a dentist.
Dentistry is actually interesting where you not only need skill in treatment techniques but also in diagnosing patients and repairing the damage to their teeth and tissues besides taking steps to control the disease. You should not visit a dentist when you have a problem but a dentist needs to be with you all the time through your life to make sure you are healthy. In Malaysia, we are unique because we are the first dental school to introduce ICDAS in full and we managed to persuade all dental schools and the oral health divisions of the ministry of health and ministry of defence in the country to agree to adopt ICDAS. In future, every dentist will be using this system for earlier management of the disease and for promoting wellness.
Now our graduates are young and we hope to see them successful. I am pleased to follow the progress of those who went to our partner schools. When you have been in IMU, you will always be part of IMU because you are carrying the IMU reputation overseas even when you transfer to other universities midway in the course. Different universities have different support systems. The vision I hope in future is that everyone is connected and come back to build a greater IMU.
Our next plan is introducing postgraduate programmes that are different from everybody else and unique in being flexible to cater for the needs of dentists at work. Our first programme will be Implant Dentistry. We selected implant dentistry not because it can bring much more income. Implant Dentistry is the best option for replacing teeth and one needs to do it well. Now we want to structure this programme to bring people to understand the science with the pros and cons. We benchmark our programme to the Royal College of Surgeons of Edinburgh Diploma in Implant Dentistry. So after we launch this programme, we plan to organise the Royal College implant dentistry examination here as well. Besides getting an IMU degree and for all practitioners of implant dentistry, if so wished, one can get a Royal College qualification by passing the examination. The Royal College does not run any formal training courses but only examinations. By having a Royal College qualification, it is testimony of the standard of professional knowledge and skills acquired.
My dream is to have a multi-storey dental hospital with the latest technology that serve as an academic health centre where research and postgraduate trainings can be conducted.
My father was a pensioner when I was born. I had 2 brothers in Singapore. My education was sponsored by my brother. The idea of becoming a dentist never crossed my mind. I was offered superfresh science course in the University of Malaya after completing my sixth form in school. Superfresh science which is direct entry to second year of the course was only given to students who achieved good results. My brother told me that science degree course was too general and I should take up a professional course. The University of Singapore offered me accountancy but I did not really like to deal with numbers. Then, they offered me engineering. I was thinking that engineering should be for guys and I wanted to reject that offer. My brother scolded me and said I should accept it because it was a good profession. Beyond my limited knowledge, I found that the engineering course was actually quite interesting and enjoyable when I studied in the Faculty of Engineering for two weeks. I think young people need to be guided. It is good that nowadays there are education fairs to provide more information for the students to select their course of study. As I grew up from a poor home, I had nobody to guide me. Everyone kept telling me that I should be a medical doctor. I put medicine as my first choice and dentistry as my second choice to transfer from engineering if there was a place. Medicine was so popular at that time and they required very high grades. I did not achieve them. In the past, everyone wanted to study medicine, they would put dentistry as second choice. Those in dentistry would apply to transfer to medicine if vacancy arose. Later, the University of Singapore offered me a place in dentistry.
Dentistry did not give me a positive impression prior to entry to university but when I was in the dental school, I enjoyed it so much. I did well in dentistry. It occurred to me that we need to teach and promote dentistry in a different way. People had the misconception in the past that dentists are those who failed to enter medical school and media likes to make fun of dentists. So IMU is going to change dentistry to value based education. If you have strong values, your values will influence everything you do. We sometimes fail to inculcate values in education. We just assume the values must be there. These basic values must be strong in students.
That research was in the area of implant dentistry. We were the first to study the influence of implant design on tissue reactions to immediate loading. At that time we were evaluating the ANKYLOS system that was designed by a German professor, Nentwig with his colleague Moser, who was an engineer. The design was unique then and different in concept from the conventional dental implants that were widely used. They did all the final element studies but they did not have any animal studies. They were Germans and all their publications were in German journals. It was a good system but it was not well marketed nor widely used. At that time, Degussa bought over its rights to the implant system. They changed the name of Nentwig-Moser implant into ANKYLOS. This company needed more good research to evaluate the system and publications in English language to reach a wider dental community. They came to collaborate with University of Malaya. We worked together with an agreement and collaborated in carrying out the research on Macaca fascicularis monkeys as we had animal research facilities. They have smaller mouth so all procedures in those monkeys were more challenging and required more precision. We conducted controlled clinical trials on the monkeys to evaluate hard and soft tissues reactions to immediate loading in the lower posteror quadrants and how reactions were influenced by implant designs to the loading stress. We were the first to come out with the concept of immediate loading in the posterior segments. The design of the abutment, and how it connected to the implant had influence on tissue reactions. With the way the ANKYLOS abutment recess in from the edge of the implany fixture surface was important as we found that there was bone gain instead of bone loss when compared to the butt joint of the conventional implant design. In the past, there would be initial bone loss that was then considered normal and acceptable as after that bone loss would be minimal in healthy subjects. Slight bone loss at crystal bone was considered acceptable. However, in our studies, we found that if the design was different, there would not be bone loss. In the experimental design, we treated one side of the mandible with the conventional protocol whereby after extraction of the teeth, the sockets were allowed to completely heal for 3 months prior to placement of implants. Then healing of the implant were allowed to occur while embedded in bone for three months. Then, the implants were exposed and the abutments connected and temporary bridge restorations placed. On the same day, on the contralateral side of the mandible, we extracted the teeth and place the implants with abutments connected and temporary bridge restorations placed on the same visit. This was a controlled clinical trial on monkeys. We could see that it worked but we placed the temporary acrylic bridges for one month to prevent transmission of too heavy masticatory forces onto the healing tissues surreounding the implants before we replaced them with the permanent metal bridges. As the monkeys had tiny teeth, we could not contruct porcelain fused to metal bridges. The placement of metal bridges was delayed for one month and it worked. We published the research results and the concept was new at that time.
During mastication, the chewing forces would be transmitted from the temporary acrylic bridges to the underlying implants. However the force transmitted would not be as high as metal prostheses which were rigid. We controlled the force transmitted through temporization with acrylic prostheses. The bone healed even faster with more bone deposition on the immediate loading site than the conventional loading site. We concluded that micromotion if controlled within a certain limit, it would stimulate the bone to form.
We presented our work at the 32nd Geneva International Exhibition of Inventions, Innovations & New Techniques in 2004. The judges came and evaluated what we did. We did not only win a gold medal but it was in the highest category of a gold with felicitation (commendation) from the judges.
No, we are still very far from oversupply. Currently, dentist to patient ratio is about 1:6000 in Malaysia. In Japan, the dentist to patient ratio is about 1:800. Comparatively we are still far away. However, it is not just about the number of new dentists joining the workforce in the country. In your whole life, you would possibly not treat more than one thousand patients. We are very short of dentists. There are too many people losing their teeth in our Malaysian population and many people are with dentures. There are not enough dentists to save teeth and educate the people on ways to have better oral health. It is not the number of dentists that are getting too many causing oversupply but where they are distributed to work. There is need to change the mindset of the role of a dentist and where we can place the dentists. If you are going to be a developed nation, there must be easy access to healthcare professions even in small villages. Now, most of the dentists are concentrated in the big capital cities.
As a student, this is the best time to let your mind expand through learning and develop the dreams to be future goals. As when you start working, you will be limited with many new responsibilities. So this is the time for you to prepare for your career and wherever you are, you want to be the best that you can be. All the time, you should get out of your comfort zone. Always be ready to meet new challenges. New challenge is to make you better. If you see new things and you are not used to it, you need to learn. This is the time to learn and to develop your capability to help you reach the next level.