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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.
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:
Prior to the change in WHO recommendations which occurred following this study many patients in Africa and other developing countries were receiving an inferior regimen for the management of tuberculosis, a consequence of which meant that many had to be retreated. Since the implementation of the revised WHO Guidelines in 2010 almost all countries have now switched to the gold standard tuberculosis treatment regimen based on 6 months of isoniazid and rifampicin
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).
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.
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.
"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.
School dental screening was a statutory function of the NHS. University of Manchester (UoM) research demonstrated that the national screening programme was ineffective and likely to increase inequalities in health and service utilisation. As a direct result of UoM research, the National Screening Committee recommended that the national programme should stop. This changed Departments of Health policy resulting in new guidance to the NHS, which stopped the screening programme and redirected resources to treatment services for vulnerable groups and prevention programmes. In 2010 in England the costs of a national screening programme were estimated to be £17m per year; money released for reallocation to other dental services.
Trauma is a rapidly increasing global healthcare problem which is predicted by the World Health Organisation (WHO) to overtake infectious disease globally by 2020. The discovery of the acute coagulopathy of trauma (uncontrolled bleeding) and the subsequent establishment of the clot stabiliser tranexamic acid (TXA) as a treatment for this condition has led to a change in national and international trauma management protocols. British armed forces and the US military implemented the use of the drug soon after the results were published. Every injured British or American soldier now receives this treatment. The use of TXA has been included in national and international guidance for trauma care.
Impact: Health and welfare; a UK clinical trial of uterine artery embolisation (UAE), with five-year follow-up, defined the risk- and cost-benefit of UAE versus surgery.
Significance: The trial informed guidelines/recommendations internationally and changed clinical practice. Women worldwide can now make an informed choice about their treatment; economic factors have been quantitated.
Beneficiaries: Uterine fibroid patients, the NHS, healthcare providers.
Attribution: G. Murray, UoE, developed and delivered innovative trial methodology; clinical aspects led by University of Glasgow.
Reach: UK guidelines; worldwide (Australia, USA, Europe) effect on clinical practice that will impact up to 25% of women.