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According to the World Health Organization (WHO), 60% to 90% of school children are affected by tooth decay in industrialised countries 1,2. At low levels, fluoride can reduce tooth decay, but high levels can damage developing tooth enamel in young children. Our research has informed the revised WHO guidelines for monitoring community tooth decay prevention programmes and the UK National Fluoridated Milk Advisory Group's recommendation to increase the amount of fluoride added to school milk. The WHO guidelines are accepted and implemented internationally representing a substantial spread of influence. The recommendation to increase the amount of fluoride in school milk UK-wide is significant, as it will further control and reduce dental caries, especially in deprived areas with non-fluoridated water supply. In addition, we have established better measures of babies' and children's actual and ideal fluoride intake, including better techniques to determine the fluoride content of foods, a protocol for monitoring fluoride intake through urinary excretion, and experimentally-based models to monitor community preventive programmes.
Dr Helen Liversidge's research from 1995 to 2013 has focused on age variation in tooth formation and the use of indices of dental development to estimate a person's age. The London Atlas of Dental Development and Eruption is an original and accurate diagnostic tool for dental age estimation in individuals up to 22 years. It has proved an invaluable resource for a number of groups, notably disaster recovery workers (to identify the ages of tsunami, war and earthquake victims) and to archaeologists (who seek to learn more about archaeological remains). It has also been called on as courtroom evidence in the cases of asylum-seeking minors. The Atlas has global reach as it is freely available as a web download.
Dental hypersensitivity is a major problem for over half the population in the developed world. Researchers at the Dental Institute of King's College London (KCL) have developed a system to use bioactive glass powders to clean, seal and desensitize teeth, thus alleviating dental pain. As a result, a spinout company — OSspray — was formed in 2004 to develop and commercialise the system for dentists and hygienist to spray-clean teeth. Over £4.5 million of funding has been raised to date from institutional and venture capital investors and three product lines have been launched in the past 24 months. The products developed by the KCL/OSspray team have treated over 700,000 patients across the EU, USA and Asia. The knowledge gained by the KCL-based founders of OSspray has been used to train students in Innovation Technology.
Infective endocarditis (IE) is a rare but life-threatening disorder that may arise as a consequence of bacteraemia following invasive procedures such as those of dentistry. Research at the UCL Eastman Dental Institute has detailed the dental causes, prevalence and character of bacteraemia following dental procedures and demonstrated that everyday oral health activities are more likely to be a cause of bacteraemia than invasive dentistry. The research outcomes informed 2008 NICE guidelines that recommended that antibiotic prophylaxis solely to prevent IE should not be given to people at risk of IE undergoing dental and non-dental procedures. This has since caused a 78.6% fall in related antibiotic prescribing, a cost-saving of approximately £4m to the NHS in England and will reduce the threats of fatal anaphylaxis and antibiotic resistance.
King's College London (KCL)-led research has both underpinned and helped to develop and test an International Caries Detection and Assessment System (ICDAS) and complementary International Caries Classification and Management System (ICCMS™). Now increasingly accepted and used worldwide, these assessment and management systems are important to clinicians and researchers in detecting, preventively managing and monitoring caries as well as in framing research investigations and evaluating outcomes. They are valuable tools for public health planning and assessing incidence and prevalence of caries (tooth decay), the most ubiquitous disease across the globe. Equally importantly, they now facilitate professional curricula and public education programmes.
The use of fluoride in preventive dentistry was previously fraught with controversy despite numerous primary studies. A series of Cochrane systematic reviews by Queen Mary's Marinho et al greatly reduced uncertainty in this field and has been used extensively in the UK (eg Department of Health, Scottish Intercollegiate Guidelines Network) and internationally (eg World Health Organization) since 2002 as strong evidence to support clinical and public health decisions on preventive use of fluorides. The research provided a knowledge framework that enabled decision-makers worldwide to significantly reduce variations in practice and policy, and also reduce burden of dental caries (tooth decay). The research has prompted new, more relevant trials and important advances in systematic review methodology (new statistical approaches for meta-analysis).
Dentine hypersensitivity manifests as daily, transient, arresting tooth pain in 40% of adults. Pain is caused by toothbrush abrasion and dietary acid erosion, which combine to wear teeth, expose dentine and open dentine tubules.
For 20 years, Bristol's Dental Clinical Trials Unit has worked in partnership with industrial sponsors to develop a dental model to evaluate products designed to protect teeth from erosion and abrasion, and to test whether new toothpastes block dentine tubules, thereby reducing pain from sensitive teeth. This model is used by researchers worldwide and is the "gold standard". New toothpastes launched by GSK, Colgate, Unilever and P&G between 2008 and 2013, tested with the dental model, demonstrably reduce dentine hypersensitivity. These toothpastes are sold in advanced and emerging markets in over 100 countries, with sales of £5bn in 2012.
Patients expect and deserve safe health care, but research by the University of Glasgow Dental School in 2000-2005 identified that routine instrument decontamination processes used in UK dental practice were inadequate, with potential for residual body fluid and tissue contamination, leaving patients at risk of infection. These studies led to major changes to decontamination guidance and its implementation, resulting in major improvements to decontamination facilities, procedures and quality assurance in UK dental practice. In Scotland, the government invested £19 million in funding to upgrade equipment and premises, develop updated guidance and to train 7,893 dental staff through NHS Education for Scotland (NES). By December 2012, it was mandatory for all Scottish dental practices to comply with the new standards (`Glennie compliance') to reduce the risk of cross-infection with blood- and tissue-borne diseases such as HIV, hepatitis B, hepatitis C and variant Creutzfeldt-Jakob disease (vCJD).
Novel low-wear, high-strength glass-ceramics were developed at Queen Mary in 2000-2011 by Dr Cattell's team to prevent facture and wear of dental ceramic restorations. Over three million restorations have been provided for patients and sold in 46 countries. The product has won industry awards for clinical and cosmetic excellence from the Clinical Research Associates and Dental Advisor, who externally assess products for consumers. The product uses a 100% pain-free minimally invasive approach, saving as much as 20% enamel reduction per patient, as tooth preparation and anaesthesia are not required. We also estimate a substantial reduction in tooth enamel wear of 43-46% for this nano-scale product compared to commercial porcelain. It has high patient acceptance and satisfaction, and has received media coverage worldwide.