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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.
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.
Researchers in the Dental Institute, working with Periproducts Ltd, have developed a toothpaste and mouthwash based on nano-hydroxyapatite that can treat dentine hypersensitivity and repair dental caries. It is marketed as UltraDEX® Recalcifying, and sold in Boots and major UK supermarkets. The researchers have also developed novel bioactive glasses for treating hypersensitivity. When they come into contact with saliva and water, these bioglasses release calcium, phosphate and fluoride ions, forming fluorapatite that binds to and protects the tooth surface. In 2012, Queen Mary signed an IP licensing agreement with a global healthcare company to commercialise the new glasses that form apatite faster than the bioglasses currently on the market. For a sense of the commercial potential of this development, the market for re-mineralizing hypersensitivity toothpastes is in excess of £6 billion per year.
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).
"One in 10 adults in Wales has no natural teeth" (BBC News), "Cost puts off some going to the dentist" (BBC News) and "Overall improvement masks dental health concerns", (British Dental Association, Press Release). These are examples of the sensational headlines which accompanied the publication of the findings of the 2009 Adult Dental Health Survey (ADHS). Researchers at Birmingham's Dental School were key members of the research consortium that carried out both the ADHS as well as the 2003 Child Dental Health Survey (CDHS). The findings from these surveys demonstrated an overall improvement in the nation's oral health but also highlighted areas of inequality. The Government regards these surveys as being of vital importance in providing gold-standard information about the nation's oral health and uses the findings to inform oral health policy in the areas of workforce planning, the provision of, and access to, dental services. The impact of these internationally-leading studies is reflected in Government policy documents and in public debates about the future provision of dentistry.
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.
University of Glasgow researchers have played a pivotal role in developing and evaluating the pioneering Childsmile oral health improvement programme. By the late 1990s, more than 50% of 5-year-olds in Scotland showed evidence of dental decay. Since implementation of Childsmile in 2006, this has decreased to 33% and, within this population dental decay in children from the most severely deprived backgrounds has experienced a striking reduction (from 79% to 55%). In 2011, Childsmile was formally incorporated into the primary care dental contract and subsequently in 2012, into the universal child health surveillance programme in Scotland. Since its introduction Childsmile's community-based, preventive approach has revolutionised dental healthcare from birth for all children up to 12 years of age in Scotland resulting in delivery of Childsmile to over 730,000 children per year.
Research carried out at Newcastle University in the mid-1990s showed that the dental health profile of older people was changing rapidly: the number of people with no natural teeth was falling and a cohort of people with complex restoration needs had emerged as an important patient group. Those trends were confirmed by analysis of the 1998 Adult Dental Health Survey data, with further changes shown in children in 2003. It became clear to policymakers that substantial reform of NHS dental services in England would be required if the projected future needs of the population were to be met. The 2009 Steele review of NHS dentistry analysed the problems with the existing dental contract, from which a set of recommendations for public policy reform were put forward, which have now been adopted into a prototype NHS dental contract which is currently being piloted.
The Hall Technique offers non-invasive treatment for decayed baby teeth, sealing the decay under preformed metal crowns and thus avoiding injections and drilling. At Dundee, we brought the technique to the dental profession's attention, providing an evidence base showing: increased treatment acceptability for children, parents and dentists; improved outcomes over standard fillings; economic viability; and reduced general anaesthesia requirement. The Hall Technique is now taught and used throughout the UK, recognised Europe-wide, and increasingly adopted in Australasia and the Americas. Its inclusion in national guidelines and a Cochrane review have driven change from invasive surgical to non-invasive biological management of tooth decay in children.