Paediatric dentists across the UK returned to their clinics last week with new perspectives on the treatment of immature traumatised teeth and the care of children with the condition amelogenesis imperfecta following the British Society of Paediatric Dentistry’s sell-out conference.
Delegates heard about the work undertaken in both fields at the conference, which took place over 12-15 September in Leeds and attracted top international speakers as well as chief dental officer for NHS England Professor Sara Hurley who delivered a rousing keynote speech.
So great was the interest in the session on regenerative endodontics and dental pulp tissue engineering that an overflow lecture theatre was made available. Hosted by Professor Monty Duggal, the panel included Professors Alastair Sloan and Jacques Nor, both leading names worldwide in the field of tissue engineering and Dr Jinn Tong and Dr Hani Nazzal who have both undertaken research in the field of regenerative endodontics.
Key points that emerged included:
- There should be a move away from calcium hydroxide apexification for immature teeth
- MTA is the gold standard for the moment but more evidence is needed to support its use in the long-term
- Regenerative endodontic treatment (RET) has emerged for the treatment of immature teeth with short roots in order to achieve root development and thickening of the dentinal walls – but results are not yet predictable
- There is still no perfect solution for the immature traumatised tooth – but with the advent of dental pulp cell engineering there may be in the future.
Professor Nor said his dream was that dentists would work with dental material experts and cell biologists to develop an approach-based around dental pulp tissue engineering.
Professor Sloan predicted that in five to 10 years it would be possible for a dentist to send an exfoliated tooth to the lab and for the technician to remove and expand the cells and create an injectable matrix. A syringe would be returned to the dentist to inject into the traumatised tooth.
Both men expressed their scepticism of the marketing promises around stem cell banking. Professor Nor said he had stored his son’s stem cells because he believed it was worthwhile, but it was important that clinicians did not overstate the science.
Professor Sloan commented that he was genuinely concerned at some of the ‘fanciful’ claims. The longer you freeze stem cells, the harder they were to re-grow in the lab, he said. ‘While there is potential for these cells in spinal cord repair and muscle repair, we do not understand enough about these cells.’
Also popular among delegates was the morning dedicated to amelogenesis imperfecta (AI) chaired by Dr Richard Balmer. They were treated to a presentation by Dr Alan Mighell, a consultant in oral medicine, who described his work on genetic testing to assist in the diagnosis and management of patients with the condition.
Following Dr Mighell were Professor Tim Wright from the University of North Carolina, also an authority on AI, Mr Simon Littlewood from St Luke’s Hospital, Bradford, an orthodontist who works collaboratively with paediatric dentists and Kathy Harley, known for her clinical skill in providing restorative treatment to young people with dental anomalies.
Before a full and attentive auditorium, the speakers shared their thoughts and experiences of delivering a service to patients with AI. Dr Mighell said there was ‘under recognition’ of the burden placed by AI on patients, their families and on the NHS.
Zoe Marshman presented her new cognitive-based therapy resource to help reduce anxiety in children and young people needing dental treatment. It’s now available here: www.lltf.com/dental
On the last day of the conference delegates learned why the commissioning guide for paediatric dentistry services had not moved forward. Professor Hurley explained there was a moratorium on all the commissioning guides with the exception of those that had already been approved.
She said she was hoping to work with BSPD to roll out a guide to commissioning that, in the words of BSPD’s Robin Mills, would look a little like a ‘Haynes manual’.
She said she also hoped to work with BSPD on the development of managed clinical networks, which in her view are pivotal to the delivery of care. ‘I look to you for your wise and sage advice,’ she said.
Repeatedly using military metaphors, Professor Hurley said her policy was not ‘fire and forget’ but an implementation plan that would involve everyone: ‘The BSPD has stepped up to the crease and I am really grateful.
‘I did not take this job as a popularity contest but because I genuinely believe we can change the oral health of the children of this country. And that starts with you.’
She went on to say she believed that the BSPD could set a benchmark and a model that other specialties would aspire to. She said she had been described as a breath of fresh air but that was not enough to deliver the changes she wanted. BSPD was the beating heart of her first phase of work dedicated to improving the oral health of children.
Stephen Fayle, chair of the BSPD commissioning group, delivered a passionate presentation, providing his perspective on commissioning and the priorities for the profession. He told Professor Hurley: ‘BSPD is open for business.’
He highlighted that while children in the north and north west had higher need for treatment than in the south east, the level of decay in all children who had caries was similar. He told colleagues that all areas of the UK needed the same treatment modalities to care for these children.
He also highlighted the broad spectrum of work undertaken by paediatric specialists in the diagnosis and management of children with a range of conditions. This was not what hit the headlines, but was hugely important. He also highlighted that paediatric dentists in the Community Dental Service are a skilled repository and should be developed and he emphasised the importance of the dental team to a good service.
The theme of the conference – The Magic of Paediatric Dentistry, Conjuring up Solutions – was reflected in the forward-looking presentations as well as the themed social events. With more than 330 delegates across the three days, the event attracted more delegates than at any other previous annual conference.
Rachael Nichol, the conference chair, commented: ‘I am truly delighted with the success of BSPD 2016. The scientific aspects were world class, thanks to our discerning and passionate team of speakers who not only enlightened the audience but also offered many take-home clinical tips. They managed to do all this and thoroughly entertain us as well – amazing! Thanks also to our delegates who fully embraced the magic!’
Rosemary Bryan, the incoming president of the BSPD concluded the conference by thanking Robin Mills for his achievements as president in the previous year and telling delegates she looked forward to seeing them next year in Manchester.