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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.
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).
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).
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:
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.
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.
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.
"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.