Dr. Bhuvan Nagpal : Dentists and oral pathologists have a shared ethical duty to act in the best interest of the patient at every step of the care pathway from the moment a potential problem is noticed, through diagnosis, to the follow-up after treatment. Let’s break down those responsibilities:

• Vigilance and Early Detection (Duty of Care): Ethically, if a dentist observes a suspicious lesion (even incidentally during a routine check or if the patient came for something else), they are obligated to address it, not ignore it. We often say, “if you see something, say something.” This means the dentist should inform the patient about the finding in an honest yet sensitive manner and recommend the appropriate next steps (like investigation or referral). It can be tempting for a practitioner to avoid mentioning a possible cancer sign because they fear alarming the patient or maybe they feel it’s outside their scope, but not informing is a breach of duty. In fact, from an ethical and medicolegal standpoint, practitioners must utilize all appropriate diagnostic means to detect conditions like oral cancer early. If a dentist has the training and tools available, it’s their responsibility to use them, for instance, doing a proper examination, maybe using a toluidine blue test if they have it, or at least making a clear note and referral. As oral pathologists, our ethical duty is to provide an accurate and timely diagnosis. If I see an alarming feature on a slide, I will not downplay it. I have to clearly report what it is and often I personally call the referring dentist or surgeon if it’s something like a new malignancy so that the information is conveyed rapidly. In essence, the ethical principle of beneficence (doing good) and non-maleficence (do no harm) applies, by being vigilant and proactive, we do good by catching disease early; by ignoring or delaying, we could do harm.

• Informed Consent and Patient Autonomy: When it comes to counseling and procedures like biopsies, it’s our ethical responsibility to obtain informed consent and respect the patient’s autonomy. This means we need to explain to the patient, in understandable terms, why we recommend a biopsy or further tests, what it entails, and what could be the consequences of doing or not doing it. We must ensure they understand the situation enough to make their own decision. For example, if I suspect a lesion might be cancer, I’ll tell the patient something like “I’m concerned about this spot; it’s important we test it to rule out serious conditions. Here’s what a biopsy involves…” etc. Some patients might initially refuse a biopsy out of fear. Ethically, we should respect their choice but also have a duty to thoroughly inform them of the risks of not diagnosing. It can be a fine line between persuasion and pressure but our role is to advocate strongly for what’s medically best, while ultimately honoring the patient’s decision.

• Non-Discrimination and Compassion: Every patient, regardless of their background or habits, deserves the same quality of care and concern. Dentists and oral pathologists should approach issues like tobacco use or an oral lesion without judgment. Ethically, we don’t scold or shame a patient for chewing tobacco; instead, we empathetically counsel them on the health implications and help them. If a patient feels judged, they might not return for follow-up. We also maintain confidentiality – if someone has a potentially embarrassing condition or habit, we discuss it privately and professionally.

• Counseling and Health Education: Part of our ethical role is being an educator to our patients. A dentist should counsel patients on how to prevent oral diseases (like advising a smoker about quitting, or a patient with leukoplakia about avoiding irritants). If a biopsy comes back precancerous, ethically we must take the time to explain what that means and the importance of regular monitoring or additional treatment. Sometimes dentists find it hard to break bad news or serious news, but, ethically, truth-telling is important. We shouldn’t hide a diagnosis or use euphemisms that downplay it too much. There’s a concept of “veracity” in medical ethics: being truthful to the patient. Of course, we deliver news with empathy and support, but we give the patient the truthful information they need to make decisions.

• Follow-up and Continuity of Care: After a diagnosis is made, say an oral pathologist diagnoses a patient with dysplasia or early cancer, the ethical responsibility is to ensure the patient doesn’t fall through the cracks. For the dentist, this means following up if the patient does not come back with results or doesn’t show up for referred appointments. A simple phone call or message - “We haven’t seen you, you had an important biopsy result, please come in”, can make a huge difference. It shows we care and it might prompt the patient to take the next step. Oral pathologists typically convey results to the referring clinician, but I often think ethically we are part of the team managing the patient, so if there’s a critical result and I’m worried the patient might not understand its importance, I’ll urge the clinician to call the patient ASAP or sometimes I speak to the patient with permission. The idea is, we don’t just hand over a report and wash our hands of it. We have a duty to do what we reasonably can to ensure that the patient gets appropriate next care.

• Collaboration and Referral: Ethically, dentists should acknowledge when something is beyond their expertise and make proper referrals. For example, if a general dentist finds a lesion they suspect is cancer, ethically they shouldn’t attempt to treat it themselves (say, just prescribing some vitamin tablets hoping it will go away). They should refer to a specialist (oral surgeon or oncologist) in a timely manner. Similarly, if an oral pathologist identifies something unusual that might need further molecular tests or a second opinion, it’s on us to suggest that rather than just give a vague report. This collaborative approach ensures the patient gets the best possible chance.

• Avoiding Negligence: From a legal-ethical perspective, missing an oral cancer that should have been caught can be considered negligence. I mention this not to focus on the legal side, but it reinforces that ethically, not performing an adequate exam or not following up abnormal findings breaches our professional responsibility. The American Dental Association and other bodies emphasize that oral cancer screening is a part of a dentist’s obligation. So ethical practice means staying up-to-date with knowledge (continued education) so we don’t miss signs out of ignorance, and maintaining diligence in examinations.

• Emotional Support and Guidance: Telling someone “you might have cancer” or even “you have cancer” is daunting. Ethical responsibility includes providing or arranging psychological support. Dentists and oral pathologists should approach these conversations with empathy, ensure the patient has the information and resources needed (like contacts for oncology centers, support groups, etc.), and ideally follow the patient’s journey in some capacity. For example, after referring a cancer patient for surgery, a dentist might ethically follow up to see if they got it and invite them back for oral rehabilitation or check-ups post-treatment. It shows compassion and ensures the patient isn’t lost once the immediate problem is addressed.

In a nutshell, the shared ethical responsibilities are about diligence, honesty, compassion, and advocacy. We must be the patient’s advocate when it comes to early detection, that means doing everything in our power to catch problems early and guide the patient through the steps. We treat patients as whole persons not just a “case”, respecting their rights and feelings throughout. By upholding these ethical principles, dentists and oral pathologists together can significantly improve patient outcomes and trust in the healthcare system.

Dr. Bhuvan Nagpal : My advice to young dentists or students interested in oral pathology or research is enthusiastic encouragement - we need more of you! Here are a few thoughts based on my own journey and observations:

• Follow Your Curiosity and Passion: If you have that spark of curiosity about the “why” behind diseases, nurture it. Oral pathology and research often don’t get as much glamour as, say, surgery or cosmetic dentistry, but they are incredibly rewarding fields for the intellectually curious. I remember when I was finishing dental school, many classmates were gearing up to start clinics or do an MDS in clinical subjects, but I was deeply interested in pathology. I chose that route and it was somewhat unconventional at the time, but it was driven by passion and I have never regretted it. So, if you find joy in looking through microscopes, writing papers, or investigating problems, don’t be deterred by the fact that it’s not the mainstream choice. Your genuine interest will carry you through the challenges and make the work feel worthwhile.

• Build a Strong Foundation: Focus on getting a solid foundation in general dentistry and basic sciences during your BDS. Even if you plan to specialize in pathology or go into research, understanding clinical dentistry is important. It helps you frame research questions that are relevant to patient care and communicate with clinician colleagues effectively. If you proceed to MDS in Oral Pathology, immerse yourself in learning histopathology techniques, cytology, microbiology, whatever you can. Similarly, learn the research methodology, statistics, how to design studies, etc. A research-oriented career will require those skills. Use your student years to attend workshops or online courses on research methods or lab techniques.

• Seek Mentors and Opportunities: Mentorship is invaluable. Identify professors or professionals who are active in oral pathology or research and reach out to them. Express your interest, ask for guidance, or see if you can assist in their projects. Many breakthroughs in career happen because a mentor opened a door or provided insight. If possible, get involved in a small research project while in dental school or during internship, even something like a case report or a survey study will teach you how to frame a question and see a project through. When I was starting, I benefited a lot from mentors who guided my first research experiences and encouraged me to publish and present. Also consider connecting with professional bodies, for example, the Indian Association of Oral and Maxillofacial Pathologists, or research forums. Networking with like-minded peers and seniors will keep you motivated and informed about opportunities (like conferences, scholarships, etc.).

• Be Persistent and Resilient: A career in pathology or research has a different pace and set of challenges compared to clinical practice. Research, especially, can sometimes be slow and involve failures - experiments might not work, a hypothesis may turn out wrong, papers might get rejected by journals. It’s important to stay persistent. Every failure teaches you something. Keep your long-term vision in mind that you’re contributing to scientific knowledge and patient care in a unique way. Over time, your contributions will  have a far-reaching impact, even if the day-to-day sometimes feels tedious. I often say, celebrate small wins - like when a stain finally works correctly, or when you identify a tricky pathology case correctly, those are victories that build up.

• Stay Updated and Embrace Interdisciplinary Learning: Oral health research is evolving fast, especially with technology. Try to stay updated with the latest developments. Read journals (the fact that you’re research-oriented likely means you enjoy reading). These days, fields overlap, which means you have oral pathologists working with biotechnologists on genetics, or with AI experts on imaging analysis. Don’t hesitate to learn beyond traditional dentistry. If you have a chance to learn basic coding, statistics, molecular biology techniques, etc., go for it. These additional skills can make you a more versatile researcher. For example, I pursued additional qualifications in biochemistry and even law/management because I found them relevant to healthcare and diagnostics, and that broadened my perspective immensely. While you don’t need to replicate all that, certainly having some multidisciplinary knowledge will set you apart. The future of oral pathology might involve things like genomic data analysis, so a bit of data science knowledge could be useful (as an illustration)

• Contribute and Collaborate: Look for opportunities to contribute to research publications or conferences. Start with simple things, maybe co-author a case report or present a poster at a student conference. These experiences build your confidence and resume. Collaborate with colleagues; if you’re more pathology-oriented, maybe team up with a classmate who’s clinically oriented to do a joint study (for instance, study the correlation of a clinical finding with histology outcomes). Collaboration is key in research; you rarely work in isolation. Being a team player and learning to coordinate with others (be it clinicians, lab scientists, or even communities for public health research) is very important.

• Consider Higher Studies or Fellowships: If you want a heavy research career, consider pursuing a PhD or specialized fellowship after your MDS. A PhD is research-intensive and can open doors in academia and high-level research positions. There are also short-term research fellowships (even abroad) where you can learn specific skills. Plan ahead for these. If possible, try to have a strong CV with some publications by the time you finish your basic studies, as that helps in securing positions or scholarships.

• Balance it with Clinical Insight: Even as a pathologist or researcher, maintaining some clinical touch is helpful. If you’re an oral pathologist, maybe spend a little time in an oral medicine clinic or interact with patients during screening camps. If you’re doing lab research, occasionally observing surgeries or talking to patients whose tissue you’re studying can give you context and motivation, it reminds you of the human angle and can spark new ideas relevant to patient care.

• Ethics and Integrity: Uphold high ethical standards in your research. Unfortunately, research can be an area where people might be tempted to cut corners or even plagiarize. Don’t. Be honest in your data and methods. It might take longer to do things the right way, but your work will have credibility and you’ll build a solid reputation. This also means treating any patient samples or data with respect and confidentiality, and following all ethical guidelines for studies. Good science and good ethics go hand in hand.

• Passion for Lifelong Learning: A research-oriented career is a continuous learning journey. You won’t stop studying after your degrees. In fact, that’s when the real learning begins! If you love that prospect, you’re in the right field. Keep feeding your curiosity - attend workshops, online courses, read widely (not just in dentistry, sometimes related medical or tech fields have ideas you can bring over).

• Impact and Purpose: Remember the purpose of why you’re doing this. Oral pathology and research directly or indirectly saves lives. When I diagnose an early cancer correctly, I know I’ve helped that patient get the right treatment. When I publish a paper on, say, a new finding or push for a policy change (like recognizing oral pathologists as signatories), I know I’m contributing to a larger change. That sense of impact is fulfilling. Keep that in mind during tough times! It helps to know that your work, though sometimes behind the scenes, is critical to the health system. We often say “Diagnosis is the backbone of treatment”, so you’ll be that backbone.

Finally, I’d say don’t be afraid to be a pioneer. Oral pathology and oral health research in India need champions. If you have ideas, pursue them. When I started certain initiatives, like our oral pathology association or legal fights for recognition, some thought it was too ambitious but with a supportive network, it worked out. So, even as a young professional, your fresh perspective can lead to innovations. Maybe you’ll develop a new screening method, or find a gene marker, or set up a world-class oral pathology lab, the possibilities are endless.