Interview: "Our research shows that early identification of signature genes could prevent oral cancer."

DT SEA: Dr. Rao, Congratulations on completing 15 years of Implant Education in India. What moments of this journey do you cherish the most?
Dr. Girish Rao: My passion has been to teach youngsters to embrace the latest technology and empower them to deliver their best. Implant Study Group was born out of this philosophy, “Knowledge shared is knowledge grown”. After completion of my post graduation in Oral & Maxillofacial Surgery 25 years back, our specialty was still in it’s infancy. We had to go to the United Kingdom to train, expand our knowledge base and learn advanced surgery. I was always very keen to come back to India and make a difference in our specialty. One of the greatest joys is when a dentist from Briton came over to Bangalore to learn both the basic and advanced implantology from us. This reversal of trend gives us a lot of satisfaction that our specialty has matured in India and there is a lot more we can show to the world at large.

As a founder mentor of Implant Study Group (ISG), you have trained over 500 dentists in the field of Implantology. Tell us about the advanced training programmes of ISG?
At Implant Study Group we have three levels of training program. The basic training program is “The Foundation to Oral Implantology” which ignites the minds of the budding dentists. Our signature program is “The Fellowship in Oral Implantology” which comprehensively trains any practitioner to confidently incorporate implantology into his/her practice. We have completed 33 batches and would like to hit a century! The advanced programs of Implant Study Group are the “Mastership Programs in Surgical & Prosthetic aspects of Implantology”. The Surgical Mastership Program trains the practicing Implantologists to take his practice to the next level of carrying out more advanced procedures such as Bone Grafting, Ridge Splits, Sinus Lifts, Connective Tissue Grafts, PRF and Bone Regeneration. This is probably the only program in the country where practitioners get the full gambit of training on animal heads and specially preserved human cadavers for both hard and soft tissue procedures.

You are an academician and a clinician. Which role do you relate to the most?
When I am with the students I am an academician and when I am with patients I am a clinician. I love playing both these roles equally and they go hand in hand with me like the two sides of a coin.

You were recently elected to the post of Vice-President of AOMSI. What tasks lie ahead for you?
Our specialty of Oral & Maxillofacial Surgery in India has evolved over the years. Today we stand shoulder-to-shoulder with any of the Maxillofacial surgeons in the World. The tremendous leap which we have had by embracing cutting-edge technology and the indigenization of equipment has enabled us to deliver quality surgical care at affordable prices. We still have a huge burden of oral cancer in India which can be fully cured if detected early. Unfortunately, we see these conditions at a very late stage and the key is to detect early and prevent oral cancer. We as Maxillofacial surgeons have a huge responsibility in training dentists and medical practitioners to detect pre-malignant lesions and early oral cancers so that the out comes can be far better.

Your article on Role of areca nut induced JNK/ATF2/Jun axis in the activation of TGF-β pathway in pre-cancerous Oral Sub-mucous Fibrosis was recently published in Scientific reports of Nature. Tell us about the research project.
In the last decade I have been closely working with Professor Kondiah who heads the Genetic Department of Indian Institute of Science, Bangalore. Oral cancer is one of the most common cancer in India (65%) due to the habit of chewing tobacco and pan masala. Oral cancer is preceded by pre-malignant conditions such as Oral Sub-mucous fibrosis, Leukoplakia or Erythroplakia. I have a passion not only to treat but also to understand the molecular mechanism of transformation of pre-malignant lesions to cancer. One of our critical findings is activation of the TGF-β pathway in Oral sub-mucous fibrosis with Arecoline.

How does this research data translate to effective treatment?
We have been looking at the molecular changes of transformation of oral pre-malignant to malignant lesions. We are working on several signature genes which can help in identifying the high-risk patients several years before they develop clinical oral cancer. This signaling pathway would pave way in gene modification and thereby prevent transformation to oral cancer.

What lies ahead in the field of Oral cancer management?
With the advent of micro-vascular surgery we could successfully transfer hard-and-soft tissue from several parts of the body to the oral cavity. This has given a big leap in our reconstruction techniques. Dental Implants have further given an impetus in not only reconstruction but also rehabilitation of the jaws and extra-oral organs like cancer-removed or congenitally missing ear, eye and nose.

Regenerative biology where in tissues and organs are grown in the lab would be the next giant step. Gene modification could completely transform the disease expression and in all probability prevent the disease manifestation itself.

Thank you for the interview.