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The regulation of dental surgery developed slowly during the nineteenth surgery. Warrants for licence to practice as surgeon dentists were initially issued by the Government on the recommendation of the Medical Board. The University by the new Statute of 1907 was empowered to examine and award a Diploma in Dental Surgery. John Eskdale Fishburn, a student from Guy's Hospital serving in the Royal Navy was the first to be awarded the Diploma.Dental.Surgery. Recent contacts with his family have produced details of this colourful and remarkable person. It is likely that the practise of dentistry in Malta during the early nineteenth century was not much different from that of the rest of Europe. The European picture of dental treatment in Europe at that period is now being carefully studied and many old misconceptions are being clarified.1 Dental treatment was mainly surgical, predominantly dental extractions, together with the use of herbal and patented medicines, mostly of spurious value and at about this time there were the initial steps in the development of prosthetic and restorative dentistry. Persons attending to diseases of the teeth and mouth did not comprise one single professional group but were persons of varied background, training, and capability including graduate physicians, surgeons, apothecaries and semi-professionals such as dentists and surgeon dentists, phlebotomists, tooth-drawers, charlatans and quacks. ; peer-reviewed

A survey was carried out in the summer of 1966 of the oral condition of all male patients over 60 years old, at Saint Vincent de Paul Hospital Malta, a government geriatric institution. All the patients were examined with regards to the number and condition of the teeth, the presence of calculus and periodontal disease, and the degree of dental attrition. A questionnaire was completed on the drinking and smoking habits, masticatory ability, dry feeling of oral mucosa and subjective evaluation of dentures, when present. Further related subjects discussed following this survey are leukoplakia, pigmentation and other lesions. The geriatric patient tends to respond to noxious stimuli in an atrophic rather than in a productive manner so that dental and oral symptoms of disease are not prominent. This was evident in this survey and very few of the patients had any specific oral complaints. The dental surgeon has an important role in the health team looking after geriatric patients and should keep his patients under constant surveillance rather than wait for specific complaints. ; peer-reviewed

There is the need for a legal instrument that would first and foremost establish the executive powers of a new entity with overarching responsibilities and powers over all the authorities that have sectoral responsibilities for climate change. Such a legal instrument should also identify these sectoral authorities and their responsibilities, preferably within an Annex which could be amended and adjusted in a flexible manner. This instrument should be managed by a new unit on climate change within MRA and it should ensure integration without causing fragmentation between the sectors. At the same time, retaining the sectoral input would ensure that there is no duplication of roles, that the institutions are specialised within their own field and that the overarching institution does not becomes a bottle neck. In other words, different competent authorities responsible for the different sectoral policies and obligations should remain, but these must be answerable to an institution that has executive powers to ensure compliance and to coordinate long and short term planning with respect to climate change targets and impacts. By way of recommendation therefore, a legal instrument of this sort should seek to intervene as little as possible in the daily running of the sectoral policies and only apply its powers in situations of emergency when non compliance by the different sectors stalls the fulfilment of Malta's obligations. Its main role should be to ensure implementation of a National Strategy on Mitigation and Adaptation. This legal instrument would not duplicate the role of public institutions that are already regulators for various sectors on climate change. It would however empower the new entity to take enforcement measures against the said institutions if they fail to do so. It would also ensure the implementation and enforcement of existing legislation that regulates the various sectors in order to rationalize their sustainable use and provide for conservation measures. This would benefit both the implementation of mitigation and adaptation measures. An entity entrusted with the overall responsibility for climate change law and policy must be legally empowered to ensure the implementation of national adaptation programmes. It must also coordinate the various sectors to carry out the necessary research to adopt and implement mitigation and adaptation measures. It must necessarily be supported by a parallel capacity building process in the various entities that run the day-to- day implementation functions. On an administrative level, without necessarily being included in a legal instrument, memoranda of understanding and stakeholder dialogue are indispensable tools to ensure cooperation. This will facilitate reaching mitigation and adaptation targets within the stipulated time frames. The mainstreaming of climate change impacts in national policies ensures the adoption of mitigation and adaptation measures and guarantees synergy and linkages amongst various public plans and programmes. Response to climate change should take place at a strategic level to assess beforehand the socio-economic impacts of any mitigation and adaptation measures adopted as a consequence prior to mainstreaming into national policy making. The existing Regulations on the Strategic Environment Assessment already include climate change impacts as one of the issues that needs to be taken into consideration in an SEA. Furthermore, for all those situations where an SEA is not required, Maltese authorities should promote pro-active adaptation measures such as, for example, in development planning, rather than take reactive adaptation measures. The new climate change legal instrument must ensure effective monitoring and stakeholder engagement, particularly the involvement of NGOS and Local Councils which increases public awareness on climate change issues. The new law should also take into consideration national security issues relating to climate change when formulating mitigation and adaptation strategies. The new law should also target the development of a research programme for climate change, including access to funding programmes. It is vital that Investment in research and development in all sectors should not remain on a voluntary basis. It will provide local industry with the necessary technology and it will generate specialised local expertise in a rapidly growing sector that is assuming a tremendous economic potential. Procrastination is detrimental on two main fronts. First because Malta will miss out in securing a place in this niche-market and second because we will keep relying upon foreign technology and expertise. Since Malta can rely on and pool from the scientific and technical advice of the European Environmental agency, it is best to concentrate on investing in scientific and technical research that addresses the local scenario. This should be earmarked as a priority for EU funded projects and care should be taken not to duplicate research conducted by EU agencies to which Malta has access, but rather to build upon it and apply it at the local level. It is also essential to include as a legal obligation the publication to civil society of information acquired as a result of research conducted at the EU level or carried out locally. It must be ensured that all sectors surmount the constraints due to the lack of a sound knowledge base on local ecosystem dynamics. Filling such a gap would serve to build local scientific evidence that would identify to what extent marine, terrestrial and aquatic flora and fauna groups are vulnerable to the impacts of climate change. Emphasis should be placed on minor and already vulnerable groups. All sectors should be legally bound to maintain a Geographic Information System to integrate data related to climate change, and any other data required apart from spatial information. Adopting and implementing the recommendations suggested by the National Sustainable Development Strategy for Malta would greatly enhance the implementation of adaptation measures relating to climate change, both on a cross-sectoral and sectoral level. At present it is envisaged that the government is currently preparing a new Bill on sustainable development, in the meantime the applicable provisions of the EPA by virtue of which the sustainable development strategy was published should continue to apply. Malta should also endeavour to promote more regional cooperation in the Mediterranean under the Barcelona Convention framework and Euro Med, to identify the adaptation needs of the Mediterranean littoral to the impacts of climate change. Authorities should initiate immediately, even at the regional Mediterranean level, studies to assess vulnerability due to climate change, how new opportunities may be tapped, how to meet with the negative consequences of climate change in the sector, how to ensure that local operators adapt to the shift in tourism trends as a result of climate change. There is the need of systematic and sustained awareness building programmes to educate all. This will intensify awareness and promote a change in behavioural patterns to improve adaptation to climate change. Increasing awareness of climate change impacts within the government, industry, and community sectors will support cultural change transitions that are required for the adoption of more climate change friendly technologies, designs, and operations by public and private operators. The new climate change law should also obligate the various sectors to formulate contingency plans. This serves to: address the negative impacts envisaged as a result of climate change particularly upon vulnerable groups. assess socio-economic implications, with increased insurance covers for risks resulting from the likely impacts of climate change. identify financial guarantees and incentives amongst the various stakeholders in all sectors. ; peer-reviewed