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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).
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.
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.
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.
"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.
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.
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.
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.
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).