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Dec 15

Innovation in Oral Health for 21st century challenges - Sandpit Event

Georgina Cade

in News

How can novel biomaterials, imaging techniques and computational modelling be applied to solve the current clinical challenges in the field of oral healthcare?

  • Sandpit_Discussion
  • These ideas were explored at a multidisciplinary Sandpit event hosted by the UCL Institute of Healthcare Engineering’s Innovation in Oral Health for 21st century challenges Flagship programme on Wednesday 29 November 2017.

    Oral health has an incredibly high impact on human health, with tooth decay being the most prevalent disease worldwide and associated with 5-10% of global health expenditure. The mouth also offers a wonderful opportunity for biomedical research, since all the tissues of the body are present and easily-accessible.

    Following an introduction from the Flagship programme’s engineering lead, Dr Ben Hanson and clinical lead, Professor Francesco D’Aiuto, clinical challenges were highlighted from five specialisms; Periodontology, Prosthodontics, Oral Medicine, Endodontics and finally Paediatric Dentistry. Clinical experts presented what they perceived to be the most pressing challenge facing their specialist field and potential ways that engineering technologies could be used to help solve these issues.

  • Periodontology

    Professor Francesco D’Aiuto spoke about clinical challenges within periodontology. Periodontitis, commonly known as ‘gum disease’, represents a major cause of tooth loss globally and is a major challenge for every economic system. Approximately 5-10% of the UK population suffer from it and around 45% suffer from some kind of gum inflammation.

    One of the challenges outlined by Professor D’Aiuto was the difficulty in diagnosis and assessment using conventional 2D images obtained through radiographic assessment as they have limited sensitivity and lack specificity. Alternative advanced imaging technologies such as optical coherence tomography (OCT) could offer a potential solution to this, however they have not yet been engineered with an oral probe so are not designed to image inside the mouth.

    Prosthodontics

    Dr Lambis Petridis specialises in replacing or restoring missing teeth using dental implants. This can be challenging as the mechanical components which keep the crown screwed in place are made by many different companies in a largely unregulated market. This means that the exact configuration of the connections often varies slightly, a problem worsened by the prominence of non-original components sold by ‘copycat’ companies. Incompatibility can cause stress on the parts and lead to cracks. The application of engineering principles to ensure micro-precise compatibility or analytical imaging to help measure and match existing components could help prevent this.

  • Oral medicine

    Professor Stefano Fedele presented clinical issues surrounding diagnosis and monitoring of oral diseases and providing treatment for them. Oral cancer has an extremely high mortality rate of 80% as it is often diagnosed far too late. The mortality rate is drastically reduced to about 20% with early diagnosis and intervention, meaning that an improvement of diagnostic techniques could have huge patient impact.

    Conventional diagnosis is through biopsy, which is often delayed until it is too late. If cells could be collected in a quicker, non-invasive procedure then this may enable easier and more frequent detection. Professor Fedele proposed a potential solution for this could be to develop a brushing technique to remove cells which could then be stained and viewed by an expert.

    Paediatric dentistry
  • Dental caries, also known as tooth decay, is the most common disease globally and accounts for 5-10% of total global health expenditure. Preventing, detecting and treating childhood caries comes with its own additional challenges. Notably, most dental decay in children goes untreated and only 12% of 5 year olds with caries in the UK get fillings.

    One reason for this as suggested by Dr Paul Ashley is that the pain and injections associated with dental fillings can be particularly frightening and emotional for a young child. If there was a method developed to anaesthetise teeth without using injections, then Dr Ashley pointed out that this may be less anxiety-inducing for a young child and enable treatment to be delivered more effectively and frequently.

  • Endodontics

    Endodontics is concerned with the study and treatment of the dental pulp and, as Dr Georgios Milesis stressed, is a complex environment that presents its own particular clinical challenges. Root canal treatment is one of the most common procedures in this area and is designed to remove diseased or infected pulp tissue.

    The fluid mechanics of root canal irrigation can be hard to predict as the flow is occurring within such a confined space. However, researchers can use scale models and mathematical models to recreate the natural anatomy of root canals and simulate the flow of fluids through them. This will help ensure that the fluid irrigates every part effectively and does not leave a biofilm behind that may re-infect the pulp.

  • Working towards interdisciplinary project proposals
  • These challenges were then opened up to everyone and participants grouped together into multidisciplinary working groups to produce viable engineering solutions. £10,000 pump-priming funding was available from NIHR UCLH Biomedical Research Centre (BRC) for the winning proposal.

    We are pleased to announce that the winning project is “SensOral”, a proof-of-concept study of a non-invasive electrical impedance spectroscopy (EIS)-based Point of Care device in the diagnosis of oral cancer. As highlighted by Professor Fedele in the challenges around oral medicine presentation, early detection of oral cancer is limited by the invasive diagnostic method of biopsy. This project aims to develop a non-invasive alternative that will help enable early diagnosis and treatment. The project will be led by Professor Richard Bayford and Professor Stefano Fedele. All other projects will receive support and advice from the Institute’s Research and Development Manager, Dr Rahima Begum and BEAMS to help them move forward.

    If you are interested in finding out more or would like to be involved, please contact Dr Ben Hanson, b.hanson@ucl.ac.uk or Professor Francesco D’Aiuto, f.dauito@ucl.ac.uk.