The mouth: our gateway to good health and happiness

Over the past 20 years or so there has been quite a profound shift in healthcare, away from simply treating the most obvious symptoms of disease towards improving overall quality of life and well-being. The World Health Organisation now defines health as ‘a state of complete physical, mental or social well-being and not merely the absence of disease or infirmity.’

One area of health which arguably influences quality of life more frequently and perhaps more directly than anything else is that of oral health. That’s perhaps not surprising when we think about how the mouth is involved in so many processes that define us as humans and bring us meaning. Eating is of course necessary for survival; but taste elevates it to a great pleasure and in most cultures communal eating is an important social rite. The mouth also initiates speech as well as non-verbal cues and interactions such as smiling and kissing (recent research suggests we’ve been kissing for at least 4500 years).

“The public perception of oral health care is that it’s ‘all about teeth’,” says Professor Stephen Porter, Director of the UCL Eastman Dental Institute. “That’s partially correct, since the most common disorders of the mouth are dental decay (caries) and gum disease (gingivitis/ periodontitis) each of which are essentially caused by dental plaque. But, alas, oral disease is much more than that, as the mouth also comprises a lining – the oral mucosa – as well as muscles for speech and swallowing, salivary glands and a nervous innervation that is possibly one of the most complex of the body outside the central nervous system. In addition, almost any pathological process can affect the mouth: for example genetic disease, infection, immunologically-driven disease and cancer.”

A global challenge

The single most common non-communicable disorder of our species is periodontal disease, or gum disease, which is caused by a build-up of bacteria which slowly gives rise to inflammation. Even in a mild form it can cause bad breath, leading to loss of confidence and social isolation, as well as a strange taste in the mouth lessening enjoyment of food – all impacting overall quality of life. Eventually it destroys the periodontium – the link between the tooth and the bone – causing teeth to become loose, leading to difficulty eating. Recent research from UCL even suggests that periodontal disease may worsen cardiovascular disease and diabetes or make it more difficult to treat these complex disorders.

Earlier in life, the most common reason for children requiring a local or general anaesthetic in the UK and many other countries is dental caries, or dental decay, caused by a diet high in sugar and a failure, or inability, to keep levels of dental plaque under control.

Not surprisingly, the demand for dentistry and oral healthcare is increasing around the world. This is partly driven by people in low- and middle-income countries demanding better overall quality of life and well-being, with oral health being a key focus. Therefore, there’s a real need to train and educate more dentists and oral health practitioners and to pursue research and innovation to deliver oral care as effectively and resource-efficiently as possible.

The UCL Eastman Dental Institute is a genuinely world-leading academic centre for postgraduate dentistry and translational research and is led by Professor Porter. He comments:

“There are many disorders which can affect the mouth, and if mouth function falters, then, of course, the patient's general well-being will be compromised, but also, importantly their enjoyment of life. In some cases the duration of life can actually be shortened. So, for us, delivering research and education that ensures that people have good oral health to enjoy life throughout life’s course is terribly important. That is the focus of our research and education.”

Skills and best practice underpinned by research

The Institute's recent relocation to UCL's Bloomsbury campus forms part of one of the world's greatest investments in education, research and clinical care in oral health in the past two decades. Its state-of-the-art facilities ensure its students, researchers and academics have exceptional access to patients and opportunities for education and research. The Institute is also closely aligned with the UCLH Eastman Dental Hospital, itself part of the largest hospital in Europe specialising in complex oral health care and advanced ear, nose and throat treatments. 

Indeed, while rapid clinical translation and ‘bench-to-bedside’ are current hot topics in medicine, the Eastman Dental Institute has been quietly doing this for many decades – owing to its unique model of education.

The Institute helps to train postgraduates from over 56 different countries in the world – from Masters level through to clinical doctorate and in all the main subjects allied to oral health care, spanning paediatric dentistry to prosthodontics (crowns, bridges, implants). Programmes are delivered in a flexible manner, sometimes involving postgraduates coming into the Institute once a week over the course of a year. They learn skills and best practice underpinned by the latest research at the Institute and many go on to become specialists and future leaders in oral healthcare provision.

Professor Porter comments: “The facilities are frankly, out of this world. They're so good that this hospital was probably the first in the UK to return to normal clinical service, following COVID lockdowns. But importantly [our postgraduates] are taught by the best around. All the staff that we have here, particularly senior staff are national or international leaders in their fields, be it clinical, educational or research. And they appreciate that they are not teaching undergraduates. They're guiding postgraduates who themselves are in many instances already professionals, and have come to the UK for the first time often with families. Staff have an appreciation of that.”

Driving innovation in oral health

As well as world class education, the Institute has really ramped up its research in recent years – In 2017, the UCL Eastman Dental Hospital and Institute were awarded £2 million in funding from the National Institute for Health Research (NIHR) (part of the £111.5 million award won by the UCLH Biomedical Research Centre BRC) – the first time that money had been allocated specifically to an oral health and disease theme. The success of this initial funding has led to a further £2.1 million award for the next 5 years as part of the new UCLHT/UCL NIHR BRC award.

One exciting research collaboration at the Institute with potentially the greatest patient impact, coming at an early stage in life, is led by Professor Anne Young in the Department of Biomaterials and Professor Paul Ashley in the Department of Paediatric Dentistry.

They are developing a new technique and material to treat childhood dental caries without the need for anaesthetic or the use of a dental drill. The tooth requires minimal preparation, basically the scooping out of the dental decay, and then the insertion of a novel restorative material. The effects of the material are essentially threefold: it binds to the tooth and remains there; is able to reverse any remaining dental carries present; and exerts an antibacterial effect on the microbes that actually give rise to caries in the first place. Following successful in vitro studies of the material itself, the entire technique is now moving into human clinical trials.

Professor Porter comments: “There’s a notion, perhaps overemphasised, that dental care can be unpleasant or indeed painful, which results in children not having deciduous teeth – or milk teeth –restored but rather extracted. This new agent will change all that. Notably, it would have made an enormous difference in the time of Covid, as lockdown meant that all dental procedures were suspended, because dental drills give rise to aerosols, thus children with caries were unable to have any dental treatment done. If we were to have another quarantine situation, and this agent was available, children with caries could easily have treatment and their quality of life would be assured.”

Another area of active innovation at the Institute is aimed at tackling an issue that tends to arise later in life – that of xerostomia, or oral dryness. There are a number of causes, but one of the main ones comes as a side-effect of prescribed drugs and medication. With many people now taking multiple tablets for various conditions (especially in later life) this ‘polypharmacy-induced xerostomia’ is on the rise and impacts people's ability to speak, to swallow, to taste and again, as with so many of these oral conditions, to fully enjoy life. Other notable causes of mouth dryness are radiotherapy treatment of head, neck and mouth cancers which can inadvertently damage the salivary glands – as can Sjogren’s syndrome, a connective tissue disorder which leads to immunological destruction of the glands.

There have been attempts to reverse oral dryness, but none have been particularly successful to date. Recently though, a technique developed by the Institute’s Professor Stefano Fedele has shown promise, particularly in reducing radiotherapy-induced oral dryness. It involves patients wearing a small appliance just a few times each day, which sends electrical signals to stimulate neurological networks to make the glands slightly overwork.

Professor Porter comments: “This has enormous promise because it has been shown not just to objectively increase the wetness of the mouth, but the patient’s quality of life, which really is the main target.”

Facilitating collaboration

The Eastman Dental Institute’s move to the heart of UCL’s Bloomsbury campus is likely to lead to even more innovative research and education by enabling collaborations with world-leading specialists from other parts of UCL – particularly UCL Medical School (for education) and the Division of Medicine (for clinical research), as well as the rest of the Faculty of Medical Sciences.

Given the pervasive nature of oral health there might even be opportunities to work with other disciplines including engineering, psychology, humanities and the Institute of Education.

“Because we are in the heart of Bloomsbury Campus, it means that educational and research collaborations are easier than ever before. The postgraduates now truly feel part of UCL and realise that they’re in this wonderful university. Also, the Eastman Dental hospital is in the heart of University College London Hospitals, which is the largest NHS trust in the United Kingdom and possibly the most modern. And as a result, the postgraduates work in an environment which is first rate and they realise that they have opportunities for clinical care and clinical experience which are unique to the UK and probably the globe.”

Links

• Professor Stephen Porter’s academic profile
• UCL Eastman Dental Institute
• UCL Faculty of Medical Sciences

Images

• Credit: Alejandro Walter Salinas Lopez/UCL. Title image credit: fizkes on iStock.

Media contact

Matt Midgley

Tel: +44 (0)20 3108 6995

Email: m.midgley [at] ucl.ac.uk