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Fluoride research: changes to national and international policy and practice in dental health

Summary of the impact

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.

  1. Peterson PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risk to oral health. Bulletin of the World Health Organization 2005;83:661-669
  2. Peterson PE. Priorities for research for oral health in the 21st century — the approach of the WHO global oral health programme. Community Dental Health 2005; 22:71-74.

Submitting Institution

Teesside University

Unit of Assessment

Allied Health Professions, Dentistry, Nursing and Pharmacy

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Dentistry, Public Health and Health Services

Development of new guidelines for antibiotic prophylaxis for dental procedures in patients at risk of infective endocarditis

Summary of the impact

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.

Submitting Institution

University College London

Unit of Assessment

Allied Health Professions, Dentistry, Nursing and Pharmacy

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Clinical Sciences, Dentistry, Public Health and Health Services

Cochrane Oral Health Group leads the international evidence base for oral health: Antibiotics for the prevention of bacterial endocarditis. (ICS-07)

Summary of the impact

Life-threatening bacterial endocarditis occurs on previously damaged cardiac valves. Established dental practice has been to administer antibiotics to patients who are at risk. This practice has been linked with increased antibiotic resistance, which represents one of the greatest threats to public health.

Researchers at the University of Manchester (UoM) evaluated the evidence for this practice by undertaking a high quality systematic review (initially published 2004). The review has informed multiple international guidelines. Publication of the NICE guideline led to a fall in the unnecessary prescription of antibiotics from 10,727 to 2,292 per month, an approximate annual saving of £174,580.

Submitting Institution

University of Manchester

Unit of Assessment

Allied Health Professions, Dentistry, Nursing and Pharmacy

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Public Health and Health Services

Advocating the use of Powered Toothbrushes

Summary of the impact

Our research showed that powered rotation oscillation toothbrushes were superior to manual toothbrushes for the removal of plaque and reduction of gingivitis. This information has had impacts on national public policy, on commerce and on society.

  1. The findings were used by the Department of Health in its evidence-based guidelines for preventing oral disease, which is NHS policy on preventive dentistry in England and Wales.
  2. The research has also been used in worldwide marketing by Procter and Gamble (the manufacturers of the leading brand of powered rotation-oscillation toothbrush), and by another manufacturer as part of its marketing strategy for a new toothbrush.
  3. Finally, as a result of this work there have been critical reviews of the research and of the toothbrushes in the media that have enabled more informed consumer choice for oral hygiene.

Submitting Institution

University of Sheffield

Unit of Assessment

Allied Health Professions, Dentistry, Nursing and Pharmacy

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Public Health and Health Services

The Hall Technique as a non-invasive method for managing caries in children’s primary teeth

Summary of the impact

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.

Submitting Institution

University of Dundee

Unit of Assessment

Allied Health Professions, Dentistry, Nursing and Pharmacy

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Dentistry, Public Health and Health Services

An effective national strategy for the prevention of tooth decay

Summary of the impact

University of Aberdeen research directly led to a change in the Scottish Dental Contract which has doubled the number of children receiving fissure sealants. The University of Aberdeen's Health Services Research Unit (HSRU) conducted a randomised trial looking at the effectiveness of a strategy to improve adoption of fissure sealants — known to reduce decay in children's teeth but which were rarely administered. The trial examined a fee-for-service intervention in primary dental care where each dentist received £6.80 per tooth sealed. It demonstrated that fee payment was associated with an increase in fissure sealant placement in dental primary care. This led to a change in the Scottish Dental Contract which now includes a fee-for-service for the placement in fissure sealants in children over 11 years old. From 2008, guidance documents from the NHS Department of Health and the Scottish Dental Clinical Effectiveness Programme have recommended placement of fissure sealants on children above 11-years-old. These guidance documents are provided to some 10,000 dentists throughout the UK. Since the introduction of the fee, over 37,000 children per year in Scotland have received fissure sealants. This is double the number of children receiving sealants compared to before the policy change and equates to some 150,000 children receiving the sealants since January 2008.

The claimed impact, as defined by REF guidance, is therefore on public policy and services; practitioners and professional services; society and economically.

Submitting Institution

University of Aberdeen

Unit of Assessment

Public Health, Health Services and Primary Care

Summary Impact Type

Political

Research Subject Area(s)

Medical and Health Sciences: Dentistry, Public Health and Health Services

Knowledge into Action: Increasing the translation and use of research evidence in dental practice

Summary of the impact

This programme of research has, through producing national guidance and improving understanding of professional behaviour, enabled delivery of evidence based practice by dental practitioners in primary care. Its impacts include:

  • International clinical recommendations focusing on fundamental issues such as caries management, dental prescribing (antibiotics) and oral care for patients with cancer (production of systematic reviews and guidelines).
  • Involvement of dentists and patients in understanding and valuing the importance of research and building capacity for future research (research culture).
  • Policy change in education and service to improve patient safety (decontamination) and promote better oral health and public wellbeing (caries).

Submitting Institution

University of Dundee

Unit of Assessment

Allied Health Professions, Dentistry, Nursing and Pharmacy

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Public Health and Health Services

Enduring Impact on Global WHO Guidelines for Malaria Treatment

Summary of the impact

The World Health Organization (WHO) estimate 3.3 billion people are at risk of malaria, with 219 million cases and over half a million deaths annually. The Liverpool School of Tropical Medicine (LSTM) has applied new methods of research synthesis to malaria, and the results of this work have directly influenced important global decisions on malaria policies, including the adoption of new antimalarial drugs. In this case study, we report on the influence of the LSTM on malaria control over the last 15 years by preparing rigorous, up-to-date, timely systematic reviews on malaria. This work has also contributed to substantive improvements in the methodological rigor and transparency of the WHO malaria policy group in evidence-based policy formulation and guideline development.

Submitting Institutions

University of Warwick,Liverpool School of Tropical Medicine

Unit of Assessment

Public Health, Health Services and Primary Care

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Clinical Sciences, Pharmacology and Pharmaceutical Sciences, Public Health and Health Services

Millions of people worldwide and leading companies benefit from novel approach to developing and evaluating products designed to protect against tooth-wear and dentine hypersensitivity

Summary of the impact

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.

Submitting Institution

University of Bristol

Unit of Assessment

Allied Health Professions, Dentistry, Nursing and Pharmacy

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Dentistry

The London atlas of dental development and eruption

Summary of the impact

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.

Submitting Institution

Queen Mary, University of London

Unit of Assessment

Allied Health Professions, Dentistry, Nursing and Pharmacy

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Dentistry, Public Health and Health Services

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