Professor Igor Blum, editor-in-chief of the College’s Primary Dental Journal, has been chosen as this year’s winner of the esteemed International Association for Dental Research (IADR) Ivar Mjör Award.
Professor Igor Blum (right) being presented with the Ivar Mjör Award 2024 by Professor Richard Wierichs, Chair of the IADR Network for Practice-Based Research
Given annually, the award is named in honour of the late President of the IADR, the Norwegian dentist Professor Ivar Mjör, who was a world-renowned researcher and one of the most eminent champions of practice-based dental research in Europe, the US and elsewhere.
The highest award conferred by the IADR for practice-based research, it was given to Professor Blum in recognition of his distinguished contributions to the field, particularly the national and international importance of his translation of practice-based research findings into clinical recommendations.
His impactful publications on the management of failing dental restorations, the reasons for the placement and replacement of direct restorations, and the longevity of posterior composite restorations placed in practice-based settings were among those considered by the selection committee.
Professor Blum coined the term ‘reparative dentistry’, and the citation also notes that his contribution over a quarter of a century to the development, teaching and promotion of the repair of failing yet serviceable dental restorations, as a minimally invasive alternative to replacement, has paved the way for it to become an internationally acknowledged and recognised treatment approach.
Another notable example of his influence are his 2002 standardised diagnostic description criteria for dry socket (alveolar osteitis). ‘Blum’s definition’[i], which is widely referenced in textbooks and presentations and has become the most used definition for dry socket worldwide, has been cited in over 750 journal papers to date.
Professor Blum was also nominated in recognition of his promotion of practice-based clinical, educational and research articles through the Primary Dental Journal (PDJ), in combination with its increased international profile during his tenure as editor. The PDJ is our quarterly, peer-reviewed, professional development journal. Uniquely dedicated to primary dental care, each issue is distributed in print to our UK and international members and subscribers and made available online in over 10,500 academic institutions worldwide.
Professor of Primary Care Dentistry and Advanced General Dental Practice at King’s College London, and a consultant and specialist in restorative dentistry, Professor Blum is only the second UK-based recipient of the Ivar Mjör Award – the first being Professor Sir Nairn Wilson, the PDJ’s inaugural editor.
The award was presented in October in Bern, Switzerland.
[i] Blum IR. Contemporary views on dry socket (alveolar osteitis): a clinical appraisal of standardization, aetiopathogenesis and management: a critical review. Int J Oral Maxillofac Surg. 2002 Jun;31(3):309-17. doi: 10.1054/ijom.2002.0263.
Frances Robinson AssocFCGDent, Advanced Oral Health Practitioner and Chair of the Board of the Faculty of Dental Hygiene & Dental Therapy, reflects on The Dental Health Barometer report on preventative oral healthcare, published by the College and Haleon.
The Dental Health Barometer report, stemming from a collaboration between the College of General Dentistry and Haleon, surveyed patients and dental professionals and more recently held focus groups with dental professionals throughout the UK. The report highlights inconsistencies in the provision of preventative oral healthcare and how this type of care is understood by both the dental population and the wider public.
Due to my roles as an Advanced Oral Health Practitioner in London and as Chair of the Board in the College’s Faculty of Dental Hygiene & Dental Therapy, this piece of research with Haleon, was particularly interesting to me. I currently lead a mixed team of dental professionals and admin support to provide an oral health promotion service, through an NHS trust, contracted by the local authority. In my borough the decay rate was 39.1% for five-years olds in 2019 – I have much work to do!
I can sense clinicians are frustrated when working at the coal face of primary care seeing so much decay and periodontal issues, but dental outreach teams, like mine, and the dental public health workforce, work tirelessly to address some of the points raised by clinicians in the report.
I would like to use this blog piece to highlight some of the key summary points raised in the CGDent-Haleon report that are directly related to my role and also to explain some of the work that goes on in oral health outreach teams.
Tooth decay is preventable and inequalities are unfair, yet avoidable. Preventative dental care is proactively helping a patient to take action to maintain a healthy mouth, however, as the CGDent-Haleon report highlights, both the ability to provide preventative advice and the consistency of the advice given varies between professionals.
Greater provision of CPD
In clinical practice, clinicians are used to treating patients to a high standard according to the best available evidence base. This may be using the best materials and the selection of treatment options on a case-by-case basis. ‘TheDental Health Barometer‘ seems to demonstrate that current understanding of evidence-based population dental approaches varies in primary dental workforces. Dental public health is taught on undergraduate curriculums but clinicians may be unaware of recent updates to evidence bases. Subsequently, in order to use the primary dental health workforce to contribute to improving oral health outside the dental surgery, it is pertinent to ensure the evidence base is widely understood. There is a risk that some oral health approaches and interventions, although well intentioned, are either at best ineffective or at worst could widen oral health inequalities.
Indeed, the report calls for “greater provision of CPD on the delivery of preventative care”, in this instance it would be a good opportunity for this type of CPD to also cover community based oral health approaches, as well as those more applicable to clinical settings.
Evidence based public health dentistry
Currently, it seems many well-intentioned efforts to improve oral health on a population level don’t actually align to the current evidence base. Giving oral health ‘education’ in the form of assemblies, class room talks or at health fairs, is not proven to improve oral health outcomes. The ‘commissioning for oral health‘ document highlights that for school aged children, one-off dental health education is ineffective and therefore discouraged.
These traditional oral health approaches that focus solely on education can actually widen oral health inequalities in deprived areas. A one-off oral health session only gives knowledge to those with the means i.e. financial and social resources to act on advice, but for vulnerable families it doesn’t empower them to make sustainable change. They might want to go home and buy toothbrushes and toothpastes and healthy food for their family, but they may also have to consider the family budget, constraints on the family’s time and other social factors. Furthermore, sustained behaviour change is seldom achieved in one visit, it takes time and patience to build daily oral health habits as we know from our work on a one-to-one level with patients in clinics.
In my role as an Advanced Oral Health Practitioner, I have heard of families all using the same toothbrush because they cannot afford to buy ones for each family member, and I have met families living in temporary accommodation with limited access to cooking facilities and personal hygiene spaces. These families living in deprivation as highlighted are more likely to be the ones suffering from poor oral health.
The Association of Directors of Public Health stated in 2023, “worrying oral health findings are not a result of behaviour, poor choices or a lack of education.” But rather research, conducted by Public Health England, has called for action to tackle the underlying causes of health inequalities including “creating healthier public policies, supportive environments, strengthening community action, developing personal skills and reorienting health services towards prevention”.
Creating healthier public policies, supportive environments and strengthening community action, to improve oral health.”
Figure 1
Indeed, Professor Sir Michael Marmott poses the question on the first page of his book ‘The Health Gap‘, “why treat people only to send people back to the conditions that made them sick in the first place?”.
On a population level, the conditions in which each family lives has a bigger influence on their health outcomes than individual decisions. Research has shown that the social determinants of health account for 30-55% of someone’s health outcomes. Subsequently programmes that consider the social determinants of health, (the conditions in which children and adults can live, grow, work and age) have the best evidence-base behind them.
There is strong supportive evidence for supervised toothbrushing programmes and fluoride varnish programmes, which were mentioned in the CGDent-Haleon report. Also dental professionals suggested collaboration and oral health training for the wider professional workforce (health, education, social). This is further encouraged by the commissioning for better oral health document, as they build on existing capacity and can be targeted to high risk groups.
Why is there variation between which oral health prevention services are offered in different areas?
Oral health is designated to local authority level and subsequently there are huge variations in what is offered on a national scale. This can be confusing for dental professionals working in primary care and the public, which is shown by the recent report.
Within London, I am aware of every borough having a different approach to commissioned oral health programmes and this can result in a postcode lottery in terms of what is provided. The borough I work in has fluoride varnish programmes and supervised toothbrushing programmes in a certain proportion of targeted schools and all SEN schools. But we also provide comprehensive training for health, social and educational professionals for oral health – aligning to the evidence base around capacity building on existing services. This includes working with care homes, carers, outreach workers, social workers, health visitors, nursery staff and recruiting ‘Oral Health Champions’ in all settings we work with. This approach may not be replicated across the UK and dental professionals in primary care may not be aware of the current commissioning of an oral health team in their area.
Indeed, there are calls in the CGDent-Haleon report for a national oral health programme (similar to ChildSmile in Scotland or Designed to Smile in Wales) which creates a base level of preventative care, for both children and adults and integrates oral health into general health. It could use universal proportionalism to scale up priorities, identified by local need. If there was a national oral health programme there could be potential for local practices to assist with the running of this, for example training teachers on supervised tooth brushing programmes or visiting local care homes to provide quality assured oral health training to staff members.
Oral health was included in a recent NHS England initiative Core20PLUS5, a national NHS England approach to support the reduction of health inequalities at both national and system level. The approach defines a target population cohort of the most deprived 20%, plus inclusion health groups and identifies ‘5’ focus clinical areas requiring accelerated improvement. The Core20PLUS5 for children did include oral health as a priority so there is hope that some of our concerns as professionals are being heard on a wider level, and taken alongside the recent publication of the ‘The Dental Health Barometer’ report by the College and Haleon, there may be hope for the future!
The College and Haleon have published a report on improving the provision of preventative oral healthcare.
Preventative care is defined as proactive dental care and advice that helps a patient to take action to maintain a healthy mouth, protecting against tooth decay, gum disease and more serious issues such as tooth loss and negative impacts on general health. The new report, The Dental Health Barometer, provides recommendations based on the experience and insight of general dental professionals on how to bridge the gap between intentions and practical delivery.
The underlying research began last year with a survey of 2,000 UK dental patients and over 500 dental professionals which highlighted inconsistencies in the provision of preventative oral healthcare advice. (A poster summarising those findings is available, as is a webinar examining them in more detail). This has since been built upon with rich discussions held with 77 oral health professionals, from all dental team roles, in focus group meetings hosted at eight general dental practices throughout the UK.
The most consistent finding is that oral health professionals seek redesigned NHS contracts to allow for more time and financial support in giving preventative oral care advice. The research also finds that the profession would like to see more resources devoted to providing nationwide preventative oral healthcare education, and a national communications campaign to tackle oral health misinformation.
The report highlights wider societal barriers to improving preventative oral care, such as competing social media narratives around oral health, diet and appearance; the erosion of long-term patient relationships; a continuing professional skew in some practices towards clinical treatments; and a tendency among non-dental health professionals not to deliver basic oral health messages.
The creation of a consumer-facing version of the Delivering Better Oral Health toolkit
Working with non-dental health professionals such as health visitors and midwives to inform them of the benefits of preventative oral care
Greater provision of CPD on the delivery of preventative care
Encouraging businesses to provide dental cover to employees
Celebrating team members such as dental hygienists in the mainstream media
Better use of digital communications such as apps and video streaming platforms
Roshni Karia MCGDent, President of the College, said:
“Our focus groups found that many dentists may feel that they are conducting a lonely battle against entrenched patient habits around oral health care, and doing so within NHS contracts which are unfavourable to providing adequate preventative advice. Our work with Haleon highlights the need to take action to support oral health professionals in a real time of need.”
Bas Vorsteveld, Vice President of Haleon and its General Manager for Great Britain and Ireland, commented:
“With a new Prime Minister in 10 Downing Street, our findings could not come at a more pivotal time for the future of dentistry in the UK. Working alongside the College of General Dentistry, we outline the key opportunities, our jointly developed solutions to safeguard the future of preventative oral care provisions for UK consumers and oral health professionals alike. We welcome the new Labour government’s plan to rescue the UK’s dental sector, but we urge them to go further and make NHS contracts fit for purpose by prioritising prevention. Only by working alongside the profession and industry can the new government make the step-change that UK dentistry clearly needs.”
Haleon, formerly the consumer healthcare division of GlaxoSmithKline, is the manufacturer of well-known oral health products such as Sensodyne, Corsodyl, Aquafresh, Poligrip, Biotene and Parodontax.
The College and Haleon will continue to work together to advocate for improvements in the provision of preventative oral healthcare.
The College and Haleon would like to thank all those College members who volunteered to host a focus group in their practice, and all the members, colleagues and patients who participated in the research.
The College has endorsed a scheme offering dental professionals certified training and experience in research.
The National Institute for Health and Care Research (NIHR)Associate Principal Investigator Scheme is aimed at UK health and care professionals who would not normally have the opportunity to take part in clinical research in their day to day role, but who are interested in learning about it and willing to make a significant contribution to the conduct and delivery of a study for at least six months.
Participating practitioners work alongside the Principal Investigator (PI) of a relevant NIHR Portfolio study being carried out locally, at the same site, typically for 2-3 hours per week. Mentored by the PI, they also complete a checklist of study activities and an online learning pathway, and on successful completion of the scheme are issued a certificate confirming NIHR Associate Principal Investigator status.
Endorsement by the College has allowed the scheme to open to NIHR Portfolio studies in the institute’s Oral and Dental Specialty, and certificates issued to successful trainees will be endorsed by the College.
An introductory video is above, and details of how to become a trainee, or how to register a study for the scheme, can be found on the NIHR Associate PI Scheme website
The College would like to encourage research-interested colleagues based in the West Midlands to get involved with an active regional dental research network.
The West Midlands Dental Research Network, part of the National Institute for Health and Care Research’s Clinical Research Network, is looking for dental practices to join.
Yann Maidment, CGDent Research Lead and Kanwar Ratra, CGDent Council Member for the West Midlands, said:
“If you live or work in the region and are interested in research, have already thought about making your practice research-active or are considering involvement as a means of professional development, we encourage you to join the West Midlands Dental Research Network.”
Further details are below.
NIHR Clinical Research Network West Midlands Dental Research Network
Have you thought about becoming a research active dental practice? We are here to offer you that opportunity.
Who Are We?
The Clinical Research Network West Midlands, part of the National Institute for Health and Care Research (NIHR). We are here to help provide advice, support and assistance to allow your dental practice to take part in high-quality dental research in the clinical setting where the care is provided.
The benefits for Dental Practices and personnel taking part in research:
Research Career Development
Contributing to NICE Evidence Base
Patients given opportunity of research involvement (per NHS Constitution)
Quality Mark for CQC Inspection
Staff Learning and Development with CPD opportunities
NIHR accredited certificate
Updates on research findings to contribute to policy and practice
Expressions of Interest:
We seek expressions of interest from forward-thinking dental practices who would like to join our Dental Research Network. This will provide the opportunity to be the first to find out about high profile dental research studies taking place in your area.
Joining the Dental Research Network does not commit you to taking part in a particular study and is free.
To express your interest please contact: Anesha Chauhan, the Clinical Research Practitioner coordinating the Dental Research Network in W Midlands. Email: [email protected] or by mobile: 07823 362148.
Update October 2024: The NIHR Clinical Research Network (CRN) has now been renamed the Research Delivery Network (RDN), and the 12 regional CRNs in England have likewise been renamed Regional RDNs.
CGDent is working with Haleon (formerly GSK), to explore the opportunities for enhancing oral healthcare advice through dental practices, and supporting those members of the team on the front line for advising patients and your communities.
We are inviting interest from practices and teams around the UK that might be interested in hosting a focus group for an evening, early in 2024. It’s a great chance to spotlight the valuable work of team members and for them to contribute to a national project.
We aim for our focus groups to comprise 6-9 people, drawn from the host practice and others in your local area, that you might like to invite.
Sessions are expected to run in the evening for 1.5-2 hours, facilitated by our team. We only require a comfortable space for ten people, in a relaxed setting such as a reception room. We will bring the biscuits!
If you would like to contribute, please get in touch at [email protected] by Friday 17 November 2023. We cannot promise to take up every opportunity, but look forward to joining practices up and down the UK in developing this project.
The College and Haleon are hosting a live webinar on Tuesday 30 November at 2pm (GMT) where we will share insights from our recent study on preventative oral care and provide information about the full research programme – register your place.
General dental practitioners are being sought to support research towards the development of a clinical risk assessment tool, and the College would like to encourage members to participate.
The research is part of the RADIANT project being conducted by a team at Peninsula Dental School at the University of Plymouth, and aims to create and develop a practical, evidenced-based restorative dental risk assessment tool informed by input from clinical practitioners, rather than the classical single speciality approach.
The concept behind the new index is to objectively assess the risk of dental complications for the patient’s whole mouth, focussing on improving the accuracy and consensus between clinicians regarding diagnostic and prognostic decision-making. It is hoped that the availability of a robust risk assessment tool will then help clinicians to develop treatment plans, and will provide a common reference point to improve risk communication between clinical dentists, primarily general dental practitioners, and their patients.
The Principal Investigator, Dr Mark-Steven Howe FCGDent, is a general dental practitioner in Broadway, Worcestershire. He would like to interview about 12 general dental practitioners of varying experience over the coming months in order to incorporate their views and opinions on how they make clinical decisions into the development of the new tool.
Interviews will take place virtually and should take only 30-60 minutes.
If you would like to participate, or to request further information, please send an email with the subject line ‘RADIANT’ to[email protected]
Dental teams across the country face great challenges in providing accessible support for their patients and communities. The College of General Dentistry works to support the whole dental team in addressing these challenges, for the benefit of the nation’s oral health.
We have been working with Haleon, a global leader in consumer health with brands like Sensodyne or Corsodyl trusted by millions of patients, to conduct a survey to better understand the role preventative oral care plays in routine dental appointments.
The study, featuring insights from dental health professionals and patients, highlights the importance of preventative oral care, whilst also pointing to opportunities for its enhancement, supported by the clinical team, across the UK.
In order to unlock the findings of the survey, the College and Haleon hosted a live webinar on 30 November 2023. A recording of the webinar is available to view below.
Speakers:
Sarah Murray MBE, Board Member of the Faculty of Dental Hygiene and Therapy, College of General Dentistry
Bas Vorsteveld, Vice President and General Manager, GB&I, Haleon
Dr Kate Fabrikant, Medical Director, Northern Europe, Haleon
Membership of the College of General Dentistry is open to all registered dental professionals and dental students. Find out about our membership types and fees here.
Can you help us in the next phase of our research? We would like to hear from practices around the UK who are interested in hosting an evening focus group to explore preventative oral care advice given within practice – find out more.
General dental practices are being sought for an NHS-funded research project, and the researchers are encouraging CGDent members to apply to participate.
Following a successful feasibility study which informed the final design of the PIP study, the researchers are now looking to recruit general dental practices in Scotland and England to each support the recruitment of approximately 11 participants and follow them up at one year. Training, support and remuneration are provided.
The project is being conducted by the Universities of Dundee, Aberdeen, Glasgow, Liverpool, Sheffield, King’s College London, plus NHS Education for Scotland and the Centre for Healthcare Randomised Trials and was commissioned by the NHS National Institute for Health Research Health Technology Assessment programme.
PIP study details
Patient participants will need to be at least 16 years old with symptoms indicative of irreversible pulpitis in a pre-molar or molar tooth with deep caries and/or a deep restoration. They must be seeking treatment at an NHS dental practice and receive a full pulpotomy.
Patients whose teeth have immature roots, clinical or radiographic signs of a necrotic pulp, insufficient tissue for a restoration or a poor prognosis (e.g. internal or external resorption) will not be eligible, likewise those with presence of a sinus, tenderness to percussion, buccal tenderness, pathological mobility or evidence off pathology on a periapical radiograph. All participating patients must be able to give informed consent.
Dentists taking part in the study will receive training, with fees and verifiable CPD provided, as well as remuneration covering set up costs, the cost of administration at the start and end of the study, service support cost and attendance of the end of study conference. You would continue to claim NHS fees and any charges for private treatment in the usual way.
CGDent recorded webinar, Wednesday 7 December 2022
This lunch and learn webinar is the third in the College’s Research and Critical Appraisal of Evidence series of webinars.
This third CGDent webinar outlines the main elements and key stages of meta-analysis and how to appraise meta-analyses. We examine heterogeneity and its causes, consider the interpretation of a forest plot and look at appraisal checklists.
Speakers:
Derek Richards, Specialist in Dental Public Health, Director of the Centre for Evidence-Based Dentistry
It was free to view live for all dental professionals, and College members also have free access to the recorded webinar and can claim CPD hours for free. A £20 fee will apply for non-members who wish to claim CPD.
Membership of the College of General Dentistry is open to all registered dental professionals. Membership for dentists is available from £94, and for other registered dental professionals from £33. The full list of CGDent membership rates is at https://cgdent.uk/membership-fees/.
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