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Research key to a bright future for oral health

Why we're bringing a wide range of voices together to deliver for patients and the profession.

Justin Durham BDA Chief Scientific Advisor, Professor of Orofacial Pain, Head of the School of Dental Sciences, Newcastle University

It's an honour to write this after having recently been appointed Chief Scientific Advisor for the BDA. This role offers me a privileged position to help serve and support the dental profession through its national organisation, but also the opportunity to help the wider public with their understanding of the need for, and implications of, new science in oral health.

Time for progress

Dentistry has come a long way in terms of generating new knowledge and understanding over the two decades since I graduated and probably even further for those with more lived experience of the profession's changes over time.

Dentistry has come a long way in terms of generating new knowledge and understanding

Seminal applied health research has answered important questions around filling primary teeth, the need for routine scaling and fixed recall intervals, and the predictors of outcomes following root canal therapy. Equally, we have had cutting-edge translational science that has unpicked some of the causes of common chronic facial pain conditions, identified SARS-COV-2 in the oral cavity, and made exciting progress towards combatting caries and periodontal disease.

Despite making enormous steps forwards, it is fair to say that we still have some way to go; you only have to examine systematic reviews to see that in some areas, including my own area of interest, facial pain, evidence and new understanding is still often sadly lacking.

Facing up to the challenge

To achieve deeper understanding and generate new evidence, we need more voices in research. A good example of this is work recently published in the BDJ by O'Connor et al to ensure the whole dental team across all care settings can influence the research agenda. In this way, multiple voices across the dental profession and the settings in which it practices, can contribute a range of skills and expertise to the full breadth of a research project. I was delighted to see the depth and diversity of perspective and talent on the pre-existing Health and Science committee.

We have recently invited six new members to the committee with different perspectives and expertise, strengthening the mix of early, mid, and senior career researchers and clinical academics and adding to the variety of expertise. This will also help us to provide a stronger voice on scientific matters. It is crucial we continue to encourage patients, the public, new clinicians, researchers, and those wishing to train as clinical academics, into the field.

Encouraging new voices to get involved with research, policy and advocacy enables us to improve how we provide, resource, and organise care for the communities we serve as dental professionals. A good example of the importance in using science to advocate and lobby for change is the Health and Science Committee's role in working with non-oral health groups to secure HPV vaccination for adolescent males.

Embracing new perspectives

Upon joining the Health and Science Committee I was struck by the duality of the committee's name and wanted to spend a little time reflecting on this. Clearly, health is what we as dental professionals all try to protect, maintain, and restore. There can be no health without oral health.

Indeed, the state of oral health is often a proxy for the level of deprivation and general health risk in a community.

There can be no health without oral health.

Inequalities and factors that influence oral health combine, sometimes exponentially, to affect more than just the mouth. We must also be aware of and address intersectionality; where individuals have factors or characteristics that place them at an increased risk of ill health than one characteristic or factor would do alone. We heard some eminent experts in this area talk more about this in the inaugural Conversation of Steele (starts from 11:22 mins) event.

The second part of the committee's name is science. This word, prior to the pandemic, may have conjured up mental images of laboratories with petri dishes, microscopes, or sophisticated machinery. Science is more than that and can result in fantastic achievements in exceedingly short timespans, such as the new understanding of dental/bioaerosol that were developed in just 24 months during the pandemic.

Science is about critically appraising and adjusting according to new knowledge but also requires us to use the right tools for the right job; you wouldn't pick up a slow speed handpiece with a steel bur to cut off a crown and expect to get the outcome you wanted. Equally, if you use the wrong scientific method for the question you were looking to answer you shouldn't expect to get a robust reliable answer.

Science in dentistry is now correctly, and more routinely, embracing many more disciplines than it has ever done before including economics, anthropology, and sociology. Using the right tool for the right job is critical and we should look to continue to expand our repertoire in dentistry to help solve some problems.

Working for professionals and patients

It has never been more important for us to challenge anecdote with science and new understanding. We must translate this into new therapies providing better care and outcomes. We must then in turn ensure these new therapies are implemented within an appropriately structured and remunerated evidence-based oral healthcare system.

I hope that most dental professionals would agree these three areas are critical and something we'd all like to see happen on a regular basis.

It would be foolish to promise a utopia in such challenging times, but I can promise that I will engage and work with the widest possible group of colleagues to try and use the broadest scope of science to its best effect for all our population, patients, and profession.