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"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.
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.
The UCL Dental Public Health Group have made a significant contribution to oral health policy in the UK and internationally through their research on oral health inequalities and the need for a reorientation of dental services towards a more evidence based, integrated preventive approach addressing common risks for oral diseases and other chronic conditions. Our work has influenced local national oral health policies and the development of clinical practice guidelines to reduce oral health inequalities and provide the opportunity for dental professionals to prevent both oral and systemic disease.
This research has led to the introduction of widely disseminated and adopted guidelines which have clearly changed practice with regard to assessing risk of oral mucositis and the interventions used. The guidelines have led to improved mouth hygiene, a significant reduction in the use of ineffective interventions, specifically use of Nystatin (estimated to save the NHS a minimum of £463,000 per annum), and the delivery of individualised care to children and young people. These measures have directly led to (i) better mouth care with less discomfort and improved quality of life for the children, (ii) reduced risk of mouth infection, and (iii) reduction in readmissions consequent to mouth infection. This has reduced the cost of treating the acute oral side effects of chemotherapy regimens used in children who have cancer.
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.
This case study highlights a body of research around health Research Priority Setting (RPS) that assists policy makers in effectively targeting research that has the greatest potential health benefit. Empirical research on RPS led to organizational changes, and new policies within the Cochrane Collaboration along with new training resources and new RPS exercises. A research gap on inequalities in the risk of oral cancer in the English South Asian population led to an evidence synthesis exercise being carried out by the National Institute for Health and Care Excellence (NICE) and the formulation of a new public health guideline.
The Greenwood Institute of Child Health is a unique collaboration between the University and public service providers such as the NHS, which aims to improve psychological outcomes for children in high-risk settings. From 1993 to 2013, Greenwood's research has highlighted the increased risk of mental health, drug dependence and criminal activity among children who suffer trauma — through abuse, living in care, homelessness or war. Greenwood's programme of research has identified the complex and persistent needs of vulnerable children and contributed to changes in policy guidelines and service provision across social care in the UK (foster care / adoption, juvenile detention and homelessness) and abroad (war). Collaboration between researchers at the Greenwood Institute, service providers and practitioners has been instrumental in the establishment of clinically relevant and cost-effective care pathways, while community engagement has led to improved service provision and outcomes for vulnerable children and their families / carers in the UK and further afield.
Research into parent-child attachment carried out by Professor Pasco Fearon and colleagues at UCL has had a major impact on clinical services, policy and wider society through the development of: 1) novel assessment tools for measuring parent-child attachment, which are used in a variety of clinical services; 2) innovative prevention and intervention programmes deployed throughout the world; 3) dissemination of research evidence and best practice, through training and policy work in the UK and internationally.
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.
University of Aberdeen research has directly impacted on clinical practice with regard to the treatment of varicose veins. The University's Health Services Research Unit (HSRU) developed and validated the Aberdeen Varicose Vein Questionnaire (AVVQ), which allows patients to self-assess the severity of their varicose veins. Current national and international guidelines now recommend that as part of the assessment of outcome for patients with varicose veins, patients' self-assessment of their veins be routinely undertaken — with the AVVQ the most commonly recommended measure. The Department of Health in England also mandated the use of the AVVQ and all patients in England are now required to complete the AVVQ before and after treatment. Results from these questionnaires are being used by individual NHS providers to assess the quality of their care, to improve their services, and for planning and commissioning of services nationwide.
The claimed impact, as defined by REF guidance, therefore includes impact upon public policy and services; practitioners and professional services and health and welfare.