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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.
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.
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.
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.
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.
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).
King's College London (KCL) researchers contributed to the discovery that increased C fibre nerve activity in the bladder is a major cause of overactive bladder (OAB) syndrome. Based on this insight, KCL researcher Professor Dasgupta, a surgical urologist at Guy's Hospital, and his team pioneered a new surgical technique for micro-injecting Botulinum Toxin-A (BTX-A) directly into the bladder to suppress C fibres and improve bladder control. The KCL team then conducted the world's first successful clinical trials into the minimally invasive injection of BTX-A n OAB patients. These trials received significant international media coverage. This cost-effective OAB therapy is now licensed by the EU and FDA, is recommended in national and international guidelines, and has significantly improved the treatment of a common health problem.
Researchers at King's College London (KCL) have established new surgical interventions, including coronectomy, to prevent nerve injuries resulting from wisdom teeth extraction, the most common surgery on the NHS and worldwide. These interventions have been adopted worldwide, for instance coronectomy is now a billable procedure in the US, and are also incorporated into a number of guidelines, for example those by the Royal College of Surgeons and the British Dental association. The KCL team have developed a website aimed at providing information for those with trigeminal nerve injuries, which they can gain both through online content and by directly emailing the specialist team.
Neurons in the central nervous system do not normally regenerate following injury, due in part to the presence of `inhibitory' molecules that actively prevent the growth and/or collateral sprouting of axons. King's College London scientists identified myelin associated glycoprotein (MAG) as the first myelin inhibitory molecule and demonstrated that inhibition of MAG function with a monoclonal antibody promotes axonal regeneration. They have gone on to promote MAG and its receptor (called the NgR1) as druggable therapeutic targets. Their discovery has led the UK's largest pharmaceutical company — GlaxoSmithKline — to develop monoclonal antibodies to MAG and a second myelin inhibitor as clinical drug candidates. The anti-MAG therapeutic successfully completed Phase I and II clinical trials in humans for stroke during 2008-2013.
Novel low-wear, high-strength glass-ceramics were developed at Queen Mary in 2000-2011 by Dr Cattell's team to prevent facture and wear of dental ceramic restorations. Over three million restorations have been provided for patients and sold in 46 countries. The product has won industry awards for clinical and cosmetic excellence from the Clinical Research Associates and Dental Advisor, who externally assess products for consumers. The product uses a 100% pain-free minimally invasive approach, saving as much as 20% enamel reduction per patient, as tooth preparation and anaesthesia are not required. We also estimate a substantial reduction in tooth enamel wear of 43-46% for this nano-scale product compared to commercial porcelain. It has high patient acceptance and satisfaction, and has received media coverage worldwide.