research

The University of Salford to collaborate with ICE Postgraduate Dental Institute & Hospital to research aerosol treatments during a pandemic

The University of Salford and the ICE Postgraduate Dental Institute & Hospital are collaborating in a research project to gain an insight into strategies to mitigate the effect of Covid-19 during dental treatments requiring aerosol generating procedures (AGPs).

When treatment is carried out using aerosol generating procedures, dentists are often put in a position where they are in close proximity of patients’ mouths and upper respiratory tract. As the virus transmission occurs mostly by aerosols and droplets generated during such episodes, both the dental team and the patients are at a high risk of contracting Covid-19.

The study will be a partnership between the ICE Postgraduate Dental Institute and Hospital, and the University of Salford. The aim of  the research is to create a lower risk of transmitting Covid-19 during treatments by controlling the dental environment when conducting AGPs, while additionally considering patient welfare. 

Professor Ghasem Nasr and Dr Martin Burby from the University are members of the Spray Research Group (SRG), an innovation and technology group that invented an aerosol spray to reduce the risk of harmful omissions.  Professor Nasr said: “Mitigation and removal of the viral load of Covid-19 within the dental environment requires different innovative technology under both laboratory and realistic conditions. The collaborative team of experts from both institutions here are determined to unlock this pertinent problem which inevitably would lead to the protection of both staff and patients within day to day dental practice.”

The team from ICE will be led by Professor Cemal Ucer, Director and Clinical lead, with the support of Dr Rabia Khan, Education and Research Director and Professor Simon Wright, Director & Academic lead. 

ICE is a purpose-built educational institute which hosts a portfolio of educational programmes in partnership with the University of Salford, including an MSc in Dental Implantology and Non-Surgical Facial Aesthetics, Dental Primary Care and a short course in Dental Radiography. 

Professor Cemal Ucer said: “This is a very exciting collaboration for both parties involved. As Covid has affected not only dentistry but all healthcare sectors profoundly, in terms  of clinical safety, infection control has become harder to regulate and so research like this is even more imperative for the future.”

Research begins in autumn of 2020 and will last for approximately one year.

The BES awards three COVID-19-related research grants

The British Endodontic Society (BES) recently invited proposals from UK-based applicants wishing to undertake immediate research to address the impacts of Aerosol Generating Procedures (AGPs) in dentistry during the COVID-19 pandemic. The Society had an excellent response and has subsequently increased its funding by more than 100%, awarding it to three separate research groups.

“We are delighted to have received such great feedback to our research call having received many, high quality, fundable submissions” said Dr Phil Tomson, Chair of the BES Research Committee.

“Due to the unique circumstances and potential tangible outcomes we have taken the decision to award three grants that offer different qualities. These will provide robust reassurance around the safety of carrying out AGPs with conventional mitigating factors whilst investigating new opportunities to improve things further.”

“The research committee and judging panel felt that there was urgent need for this research and took the longer term view to combine our 2020 and 2021 research funding allocation. COVID-19 is having far-reaching effects so we are keen to invest to improve things for our members and the dental sector. The projects have tight timelines so we hope that the outcome of the work has a significant effect on clinical practice as we navigate through these challenging times.”

The BES has allocated an £85,000 grant between three research groups:

Project 1 – “Quantifying dental aerosol generation and its mitigation in a generalisable way through visualisation and numerical modelling”

Jointly led by Professor Owen Addison, Chair of Oral Rehabilitation/Honorary Consultant in Restorative Dentistry and Dr Shanon Patel, Consultant in Endodontics Dental Directorate, Guy’s and St Thomas NHS Foundation Trust. Kings College London.

Co-investigator Professor Yannis Hardalupas, Imperial College London, Mechanical Engineering Department

Project 2 – “Dental aerosol generating procedures: assessment of risk and mitigation strategies”

Applicant: Mr James Allison, Clinical Fellow in Oral Surgery, School of Dental Sciences, Newcastle University

Co-Investigators at School of Dental Sciences, Newcastle University: Dr Richard Holliday; NIHR Clinical Lecturer in Restorative Dentistry; Miss Charlotte Currie; NIHR Doctoral Research Fellow; Mr David Edwards; NIHR Academic Clinical Fellow, Honorary Specialty Registrar in Endodontics; Dr Nicholas Jakubovics; Senior Lecturer; Dr Christopher Nile; Senior Lecturer in Translational Oral Biosciences; Dr Nadia Rostami; Research Associate; Professor Justin Durham; Head of School, Professor of Orofacial Pain, Honorary Consultant Oral Surgeon

Mrs Charlotte Bowes; Clinical Fellow in Restorative Dentistry

Project 3 – “An investigation into aerosol production during endodontic procedures and its potential mitigation; a simulation study with bioaerosols”

Applicant: Professor Brian Nattress, Clinical Professor/Honorary Consultant in Restorative Dentistry, Leeds Dental School and Hospital.

Co-Supervisor: Professor David Wood, Director of Research and Innovation, School of Dentistry, University of Leeds.

Co-Investigators: Dr Louise Fletcher, Lecturer in Waste Management, Aerobiology and Environmental Microbiology, Department of Civil Engineering, University of Leeds, Leeds; Professor Deirdre Devine, Professor of Oral Microbiology, School of Dentistry, University of Leeds; Mr Peter Nixon, Consultant in Restorative Dentistry, York District Hospital, York

 

“We are pleased to support this vital research” explained BES President, Sanjeev Bhanderi. “The quality and track records of the successful research groups and the standard of their research proposals will go a long way in bringing much-needed clarity and a robust evidence base for dentistry that has been lacking since the return to clinical practice. If at any time we were going to call upon the BES research fund for our members, this was the time to do it.”

GDC publishes findings from ‘professionalism’ research

The findings from independent research, which was designed to inform a better shared understanding of professionalism, have been published today by the General Dental Council (GDC). This publication marks a major milestone in the regulator’s programme to develop new ‘principles of professionalism’, which will also see extensive engagement with stakeholders.

Some key findings include:

  • Professionalism is a multifaceted and context-dependent concept, and therefore, not easily defined for every circumstance or individual.
  • ‘Professionalism’ is viewed differently by members of the public and dental professionals in some instances. For example, views about professionalism in personal time, experience during the appointment, and whether the exchange of money for dental care plays a role. Dental professionals also typically framed professionalism in negative terms (i.e. what not to do).
  • These differences have important implications for the relationship between patients and professionals – and are likely to continue because professionals form their understanding of professionalism largely through observation.
  • Good communication and involving patients in decision-making is a key element of professionalism and an essential foundation of trust.

Executive Director, Strategy, at the GDC, Stefan Czerniawski, said: “Professionalism is important both to patients and to dental professionals themselves – but they don’t always mean the same thing by it. This new research makes an important contribution to the shared understanding of what it means to be a professional and to the development of principles of professionalism. It is also a crucial part of our increased focus on upstream regulation, which aims to prevent harm from taking place. I look forward to discussing the research findings with patients and professionals as the work continues.”

To read the full report visit gdc-uk.org.

Study links gum disease to dementia

New research, conducted by a team from the University of Minnesota in Minneapolis and published in Neurology, has found that gum disease is associated with double the risk of being diagnosed with dementia. The team, examined more than 4,500 adults who initially did not suffer from the memory deteriorating condition and, 18 years later, discovered that more than one in five of those with no teeth (23%) or severe gum disease (22%) had developed dementia. In comparison, only 14% of the participants with good oral health at the start of the study had developed dementia.

“We looked at people’s dental health over a 20-year period and found people with the most severe gum disease at the start of our study had about twice the risk for mild cognitive impairment or dementia by the end,” said the study’s lead author, Dr Ryan Demmer, epidemiologist at the University of Minnesota. “The good news was people with minimal tooth loss and mild gum disease were no more likely to develop thinking problems or dementia than people with no dental problems.”

Dementia is a syndrome comprising various conditions that ultimately cause the ongoing loss of brain functionality, affecting a patient’s memory, thinking, behaviour, and motor skill. Dementia affects 850,000 people in the UK, a number that is expected to rise to 1.6 million by 2040.

To gain an understanding of just how dental health can affect the risk of dementia, the Minnesota team began by looking at more than 8,000 people, whose average age was 63 and who did not have dementia. The subjects underwent a full dental examination, measuring bleeding, gum recession and plaque, before being grouped by the severity and extent of their gum disease, and number of lost teeth. A follow-up was conducted an average of 18 years later on each patient to reassess their situation.

The results, which were published in Neurology, showed that, overall, almost one in five (19%) had developed dementia. Only 14% of those who had healthy gums and all of their teeth at the startof the experiment were diagnosed with dementia. For those with mild or severe gum disease, 18% and 22%, respectively, had developed it. The highest rate of 23% was from those with no teeth, including cases in which they had been replaced by implants.

Those with no teeth were therefore around twice as likely to develop dementia or mild cognitive impairment than those with healthy gums and all their teeth in tact. Those with intermediate or severe gum disease, but who still had some teeth, showed a 20% higher risk.

These results reportedly remained true when adjusting for other factors that can affect the risk of dementia, such as diabetes, high cholesterol and smoking.

“Good dental hygiene is a proven way to keep healthy teeth and gums throughout your lifetime,” said Dr Demmer. “Our study does not prove an unhealthy mouth causes dementia and only shows an association. Further study is needed to demonstrate the link between microbes in your mouth and dementia, and to understand if treatment for gum disease can prevent dementia.”

BES announces new Covid-19 research grant

The British Endodontic Society (BES) has announced a new research grant of up to £40,000 in response to the current Covid-19 pandemic. The Society is inviting proposals from UK-based applicants wishing to undertake short-term research that addresses or mitigates the impacts of Aerosol Generating Procedures (AGPs) during the Covid-19 outbreak.

“The impact of Covid-19 on dentistry has been significant and as we begin to return to the ‘new normal’, we face a complex and evolving situation” said Dr Sanjeev Bhanderi, BES President. “There is an abundance of guidance available, but a common theme is the lack of robust evidence to guide the adoption of behaviours in practice. Many questions surround AGPs in dental practice and the interaction of these with Covid-19 so the BES is investing in research that will lead to a better understanding” he finished.

Applicants do not need to be BES members and the closing date for submissions is 15 July 2020. The application process is outlined on the BES website and all applications will be considered by the BES research panel appointed by the BES Council. Due to the immediacy of this research, the successful applicant will be notified by July 31st 2020. https://britishendodonticsociety.org.uk/profession/grants/call-for-research-to-address-the-impact-of-aerosol-generating-procedures-in-dentistry-with-respect-to-covid-19/

Bacteria in Chinese Pickles Can Prevent Cavities, According to Researchers at Ben-Gurion University and Sichuan University

Can a probiotic derived from Chinese pickles prevent cavities? That seems to be the case, according to a study by researchers at Ben-Gurion University of the Negev and Chengdu University in China.

Pickles are an integral part of the diet in the southwest of China. When fruits and vegetables are fermented, healthy bacteria break down the natural sugars. These bacteria, also known as probiotics, not only preserve foods but offer numerous benefits, including immune system regulation, stabilization of the intestinal microbiota, reducing cholesterol levels, and now inhibiting tooth decay.

According to the study published in Frontiers in Microbiology, a strain of Lactobacilli (L. plantarum K41) found in Sichuan pickles reduced S. mutans by 98.4%. Dental caries (cavities) are caused by Streptococcus mutans, (S. mutans) commonly found in the human oral cavity as plaque and is a significant contributor to tooth decay. 

Prof. Ariel Kushmaro of the BGU Avram and Stella Goldstein-Goren Department of Biotechnology Engineering and the Chinese research team evaluated 14 different types of Sichuan pickles from southwest China. They extracted 54 different strains of Lactobacilli and found that one, L. plantarum K41, significantly reduced the incidence and severity of cavities. K41 was also highly tolerant of acids and salts, an additional benefit as a probiotic for harsh oral conditions. It also could have potential commercial value when added to dairy products.

According to Doug Seserman, chief executive officer of American Associates, Ben-Gurion University of the Negev based in New York City, “the researchers currently have no plans to evaluate Jewish deli pickles.”

Kushmaro participated in the research along with a group of researchers at Sichuan University in Chengdu, China. They included: Guojian Zhang, Miao Lu, Viet Ha Vu,  Yuqing Li, Rongmei Liu, Yuanyuan Tian, Yang Li, Bao Liu, and Qun Sun.

The research was supported by grants from the National Natural Science Foundation of China (31870065), the National Key Research and Development Projects (SQ2019YFE010495), and the Key Research and Development Program of Sichuan (2018HH0030 and 2017FZ0018).

New study finds water fluoridation reduces the number of children admitted to hospital for dental treatment under GA

Children living in greatest deprivation have most to gain from having a fluoridated drinking water supply, according to new research. Fluoride is added to water in order to prevent tooth decay and the new study demonstrates that community water fluoridation is particularly beneficial for the youngest children in the poorest communities.  

The research was carried out in New Zealand and published in the International Journal of Epidemiology. It adds to the body of research demonstrating that community water fluoridation (CWF) reduces dental health inequalities.  The key findings of the research are:

  • Children from the most deprived areas are more likely to be admitted to hospital for the treatment of pain or sepsis (abscesses) caused by dental decay
  • Fluoridation of the water supply reduces the number of children being admitted to hospital for dental extractions under a general anaesthetic
  • The youngest children in the 0-4 age category in the most deprived areas benefit most from water fluoridation

In New Zealand, around 60% of the population benefits from fluoridated water, mostly city-dwellers. The team from the University of Canterbury in Christchurch compared the number of hospital visits of children in 0-4 and 5-12 age categories from both fluoridated and non-fluoridated areas.

Professor Mike Lennon, a member of the British Fluoridation Society’s executive, said: “This paper shows the evidence supporting the benefits of fluoride in drinking water is getting stronger. It demonstrates that you can reduce the risk of negative dental experiences for children from poor homes. Without fluoride in the water, they are more likely to end up in hospital with toothache.”

The role of water fluoridation in reducing health inequalities was identified in the UK in the University of York Systematic Review of 2000.  Since then, the evidence base has continued to grow with more research undertaken in the UK as well as Israel, Korea and Australia.

Professor Lennon said the data collected by the team from the University of Canterbury had been rigorously analysed. Their focus was ambulatory sensitive hospitalisation (ASH) which are hospital outpatient admissions for preventable conditions, in this instance for tooth decay and infection.

Comparisons were carried out between different census areas and then adjusted for factors which could negatively influence the result, such as living miles away from a dental practice. The overall conclusion of the study is: “As deprived areas have the highest incidence of dental ASH, caries and poor oral health, those who live in the most deprived areas have the most to gain from CWF. In summary, our study supports evidence linking CWF to better health in children. Variation in CWF contributes to structural inequities in oral-health outcomes for children.”

Simon Hearnshaw, the Chair of the Local Dental Network for North Yorkshire and Humber and coordinator of the National Community Water Fluoridation Network, welcomed the research, saying: “This paper provides more support for the argument that fluoridation is effective and reduces the social-health gradient. The challenge now is to implement schemes to bring these important benefits to deprived communities.”

The latest research is entitled: Area-level deprivation, childhood dental ambulatory sensitive hospitalizations and community water fluoridation: evidence from New Zealand https://doi.org/10.1093/ije/dyaa043

Mouthwash use could inhibit benefits of exercise suggests research

Exercise is known to reduce blood pressure – but the activity of bacteria in our mouths may determine whether we experience this benefit, according to new research.

An international team of scientists has shown that the blood pressure-lowering effect of exercise is significantly reduced when people rinse their mouths with antibacterial mouthwash, rather than water – showing the importance of oral bacteria in cardiovascular health.

The researchers now suggest that health professionals should pay attention to the oral environment when recommending interventions involving physical activity for high blood pressure.

The study was led by the University of Plymouth in collaboration with the Centre of Genomic Regulation in Barcelona (Gabaldon’s lab), Spain, and was published in the journal Free Radical Biology and Medicine.

Lead author Dr Raul Bescos, Lecturer in Dietetics and Physiology at the University of Plymouth, said: “Scientists already know that blood vessels open up during exercise, as the production of nitric oxide increases the diameter of the blood vessels (known as vasodilation), increasing blood flow circulation to active muscles.

“What has remained a mystery is how blood circulation remains higher after exercise, in turn triggering a blood-pressure lowering response known as post-exercise hypotension.

“Previous research has suggested that nitric oxide was not involved in this post-exercise response – and only involved during exercise – but the new study challenges these views.

“It’s all to do with nitric oxide degrading into a compound called nitrate, which for years was thought to have no function in the body. But research over the last decade has shown that nitrate can be absorbed in the salivary glands and excreted with saliva in the mouth.

“Some species of bacteria in the mouth can use nitrate and convert into nitrite – a very important molecule that can enhance the production of nitric oxide in the body. And when nitrite in saliva is swallowed, part of this molecule is rapidly absorbed into the circulation and reduced back to nitric oxide. This helps to maintain a widening of blood vessels which leads to a sustained lowering of blood pressure after exercise.

“We wanted to see whether blocking nitrate’s ability to convert into nitrite by inhibiting oral bacteria would have any effect on post-exercise hypotension.”

Twenty-three healthy adults were asked to run on a treadmill for a total of 30 minutes on two separate occasions, after which they were monitored for two hours.

On each occasion at one, 30, 60 and 90 minutes after exercise they were asked to rinse their mouths with a liquid – either antibacterial mouthwash (0.2% chlorhexidine) or a placebo of mint-flavoured water. Neither the researchers nor the participants knew which liquid they were rinsing with.

Their blood pressure was measured and saliva and blood samples were taken before exercise and at 120 minutes after exercise. No food or drink except water was allowed during exercise and the recovery period, and none of the study participants had any oral health conditions.

The study found that when participants rinsed with the placebo, the average reduction in systolic blood pressure was -5.2 mmHg at one hour after exercise. However when participants rinsed with the antibacterial mouthwash, the average systolic blood pressure was -2.0 mmHg at the same time point.

*Systolic blood pressure refers to the highest blood pressure level when the heart is squeezing and pushing the blood round the body.

These results show that the blood pressure-lowering effect of exercise was diminished by more than 60% over the first hour of recovery, and totally abolished two hours after exercise when participants were given the antibacterial mouthwash.

Previous views also suggested that the main source of nitrite in the circulation after exercise was nitric oxide formed during exercise in the endothelial cells (cells that line the blood vessels). However, the new study challenges this. When antibacterial mouthwash was given to the participants, their blood nitrite levels did not increase after exercise. It was only when participants used the placebo that nitrite levels in blood raised, indicating that oral bacteria are a key source of this molecule in the circulation at least over the first period of recovery after exercise.

Craig Cutler, study co-author who conducted the research as part of his PhD at the University of Plymouth, said: “These findings show that nitrite synthesis by oral bacteria is hugely important in kick-starting how our bodies react to exercise over the first period of recovery, promoting lower blood pressure and greater muscle oxygenation.

“In effect, it’s like oral bacteria are the ‘key’ to opening up the blood vessels. If they are removed, nitrite can’t be produced and the vessels remain in their current state.

“Existing studies show that, exercise aside, antibacterial mouthwash can actually raise blood pressure under resting conditions, so this study followed up and showed the mouthwash impact on the effects of exercise.

“The next step is to investigate in more detail the effect of exercise on the activity of oral bacteria and the composition of oral bacteria in individuals under high cardiovascular risk. Long-term, research in this area may improve our knowledge for treating hypertension – or high blood pressure – more efficiently.”

The full study, entitled Post-exercise hypotension and skeletal muscle oxygenation is regulated by nitrate-reducing activity of oral bacteria is available to view now in the journal Free Radical Biology and Medicine (doi: 10.1016/j.freeradbiomed.2019.07.035).

New research finds link between gum disease and erectile dysfunction

More time in the bathroom could lead to extra hours in the bedroom:

Don’t go soft on your oral health routine – that’s the message from the Oral Health Foundation after new research finds a link between gum disease and erectile dysfunction.

The study, published in the Journal of Periodontology, reveals that men with severe gum disease are more than twice as likely to suffer from impotence compared to those with healthy teeth and gums.1

The first study of its kind that involved a European population examined more than 150 men, and researchers were able to determine that three in four (74 per cent) with erectile dysfunction also had poor oral health.

In response to the findings, the Oral Health Foundation wants to emphasise the links between advancing gum disease and issues in other parts of the body and believes the benefits of taking better care of your gums can go far beyond a healthy mouth.

Dr Nigel Carter OBE, CEO of the Oral Health Foundation, said: “As startling as these findings may be, it may turn out to be a wake-up call for men to start paying greater attention to their oral health, particularly their gums.

“In recent years, gum disease has been linked with conditions like diabetes, stroke and heart disease but an increased risk of coming up short in the bedroom may be the final straw for men who might have been reluctant to spend a little extra time looking after their gums.”

Gum disease happens when the tissues supporting the teeth swell and become sore or infected. If you fail to treat it in it’s early stages, the disease will continue to worsen, and can result in tooth loss.

Finding blood on your toothbrush or in the toothpaste you spit out after brushing is a common symptom of the condition. Your gums may also bleed when you eat, leaving a bad taste in your mouth.

“Fortunately, gum disease is an entirely preventable and treatable disease but avoiding it and lowering the risk of poor performance in the bedroom requires an effective and consistent oral health routine,” Dr Carter added.

“Brushing twice a day with a fluoride toothpaste, cleaning in between your teeth once a day using interdental brushes and maintaining regular visits to the dentist are the best way to avoid or treat gum disease.

“It takes a relatively small amount of time to give your teeth and gums the care they need and falling short of that can really leave you in a difficult position later in the day.”

The research also says that treating gum disease by reducing inflammation of the gums can result in improved erectile function.

As well as being able to treat any signs of gum disease before it develops into a more serious issue, regular dental visits can also remove plaque and tartar from your teeth, as well as give your mouth a fresh bill of health.

For more info or advice visit www.dentalhealth.org.

  1. Martin A, Bravo M, Arrabal M et al. (2018) Chronic periodontitis is associated with erectile dysfunction. A case-control study in European population. Wiley: Journal of Clinical Periodontology. 2018;45:791-798.