Profile 2012-13

Profile2012-13

Dental Institute at Guy’s, King’s College and St Thomas’ Hospitals

LeaDIng InternatIonaL exceLLence

www.kcl.ac.uk/dentistrywww.kcl.ac.uk/dentistry

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Contents

Education

3The scope of opportunityRichard Johnson, Dr Barry Quinn

4Leading the world in regenerative dentistryProfessor Paul Sharpe

5Oral health assessment & leprosyBella Dave

6Reaching outDr Lyndon Cabot

Clinical

9Making choicesDr Koula Asimakopoulou, Dr Sasha Scambler

10Practising dentistry the ‘MI’ wayProfessor Avijit Banerjee

11 Treatment of jaw deformityProfessor Martyn Cobourne, Dr Christoph Huppa, Mr Nigel Shaun Matthews

Research

13Fungal infectionsDr Julian Naglik

14Bioconnecting jointsProfessor Lucy Di Silvio

15Cellular therapies in cleft repairDr Jeremy Green

16Removing disabling barriers in healthcareDr Ruth Bailey

17Alumni & the Dental Circle

18News highlights

20Facts & figures 2012

EditorialLouise King Publications Officer

Dr Barry Quinn Head of St Thomas’ Dental Centre /Consultant

Jeremy Williams Director of Administration

Buchanan Davey Design

Phil Sayer Cover image

ContactDental Institute King’s College LondonGuy’s HospitalLondon SE1 9RTTel +44(0)20 7188 1164Fax +44(0)20 7188 1159Email: [email protected]: www.kcl.ac.uk/dentistry

King’s College London Dental Institute at Guy’s, King’s College and St Thomas’ Hospitals is the largest university dental hospital in Europe. Despite its substantial standing, influence, and involvement in King’s Health Partners, the Institute is committed to seeking new ways of strengthening its position as a progressive world-class centre of excellence for dental education, research and oral healthcare provision. The Dental Institute forms one of the nine schools of King’s. It has facilities at four of the five main campuses of the College: Guy’s, King’s Denmark Hill, St Thomas’ and Waterloo, together with unique facilities at the joint venture University of Portsmouth Dental Academy.

Profile 2012-13 is a synopsis of some of the exciting developments in the three key areas of endeavour within the Dental Institute: education, clinical service and research. It is aimed at the wide range of individuals who have, or may have an interest in the many, varied activities of the Institute. Further information in the respect of the Institute is available as detailed below.

The Dental Institute Welcome to Profile 2012-13

l King’s College London Dental Institute is an exciting, productive, and dynamic organisation engaged in impactful research, caring service, and dynamic education. Profile highlights some of our recent advances, giving you a taste of the breadth and depth of things we do every day. In this issue, you will be exposed to new approaches to dental education, learn about a new degree programme, find out what we’re doing to expand the excitement of dentistry to new students, and get a taste of a student’s experience of dentistry in Mumbai. You will learn about three innovations in clinical care that will significantly influence patients’ health and quality of life. And, you will discover new dimensions in research, including understanding what triggers development of palatal rugae, approaches to restoring osteochondral defects, advances in understanding fungal infections, and innovations to removing barriers in accessing health care. And that is only a start.

As the new Dean, having arrived in January 2012, it has been my great delight to watch the excitement of discovery, the reward to restoring smiles, and wonderful expression on the students’ faces as they unravel the complexities of the human body. Please check our website www.kcl.ac.uk/dentistry on a regular basis to learn about our latest accomplishments. I suspect you will be as amazed as I am about the scope – and impact – of our activities.

This and our continuing successes depends on the involvement and commitment of many. Our parent organizations – King’s College London and Guy’s and St Thomas’ and King’s College Hospital NHS Foundation Trusts create the foundation. This sound foundation is leveraged by our partnership with the University of Portsmouth for our Dental Academy and our collaboration with the General Dental Council, the London Deanery, and the Royal Colleges. This is all amplified by the great energy and investment of our staff and students – and, equally importantly, you. If you are not already engaged with us, please let us know how you would like to be. Alumni, friends, sponsors, and supporters are a critical asset, adding great value to our strategic directions and successes.

Please join us in our continuing march toward excellence and impact through your personal involvement and investment. Encourage potential students to consider the excitement of King’s for their choice of schools. And tell your family, friends, and neighbours about the remarkable difference we are making.

Dianne Rekow, DDS, PhDDean of the Dental Institute

Education


2 Education 3

Education

The scope of opportunity 3

Leading the world in regenerative dentistry 4

Oral health assessment & leprosy 5

Reaching out 6

Richard Johnson Head of Nursing & Dental Hygiene & Therapy, Honorary Senior Clinical Teacher

The scope of opportunityGiving dental care professionals the scope for extended practice

l The General Dental Council published The Scope of Practice in April 2009. The guidance document sets out the skills and abilities each registrant group should have and describes additional skills that dental care professionals might develop after registration to increase the scope of professional practice.

Extended practiceThere are a number of opportunities for the internal and external dental care professional workforce to develop their practice across the Guy’s, St Thomas’ and King’s Denmark Hill campuses. The King’s College Hospital Dental Nurse Education & Training Centre is one of the largest dental nurse training providers in the country and as such has a national reputation. Many courses for dental care professionals are available such as Fluoride Application, Impression Taking, Radiography and Mentoring in the Workplace.

These courses are also provided on the Guy’s and St Thomas’ campuses along with Complaints Handling and Ethics, Phlebotomy and Cannulation, Dementia and Dignity Training, Rubber Dam Placement and Suture Removal.

A number of Guy’s and St Thomas’ NHS Foundation Trust (GSTT) nurses have completed the King’s College London Florence Nightingale School of Nursing & Midwifery mentorship course that prepares nurses to become mentors of pre-registration students in clinical settings.

KHP Orthodontic Therapist Course The Dental Institute is working with GSTT and King’s College Hospital NHS Foundation Trust (KCH) as King’s Health Partners (KHP) to develop an Orthodontic Therapy Course, a one-year course to train individuals as orthodontic therapists.

The General Dental Council has stated that individuals can register and work as orthodontic therapists following completion of an approved course and successfully obtaining a Diploma in Orthodontic Therapy or equivalent.

The course being led by Dr Dirk Bister (Dental Institute), RDN Sarah Wiltshire (GSTT) and RDN Beverley Coker (KCH) is compromised of two parts:

l A core course delivered at GSTT and KCH.

l Workplace training in an approved orthodontic practice with the specialist orthodontist or hospital consultant being the local trainer.

Inter-professional learningThe St Thomas’ Dental Centre allows BDS undergraduate students and trainee dental care professionals to experience inter-professional learning in general dental practice setting. The Dental Centre provides an outreach evidenced based oral health promotion service for adult and paediatric inpatients allowing a unique experience for students to learn and share outcomes with general student nurses and work alongside the wider healthcare team.

Students report a greater understanding of working in integrated teams especially across the dental-medical models of care and a better understanding of ethical and professional duties of their role in the holistic general care of patients.

We hope to build upon this model of inter-professional learning with the Florence Nightingale School of Nursing & Midwifery.

Read the Report online: http://webarchive.nationalarchives.gov.uk/+/hereview.independent.gov.uk/hereview//report/

Dr Barry Quinn Head of St Thomas’ Dental Centre, Senior Specialist Clinical Teacher/Consultant in Restorative Dentistry

Advanced practice impression taking.

Education


4 Education 5

Leading the world in regenerative dentistry Dental Institute leads the way with new innovative programme

their fields based at King’s College London and will also include invited speakers from overseas.

A practical training module will provide students with basic skills in embryonic and adult stem cell culture, isolation, identification and differentiation before they embark on a key element of the programme, a research project module carried out as part of ongoing research programmes in the Dental Institute laboratories.

A fourth module is designed specifically to educate students on how to critically evaluate and interpret their own results and those presented in published papers. This knowledge will be utilised to write a grant project proposal based on the research project.

The overall objective of this new programme is to provide young clinicians and scientists with the opportunity to learn first-hand what the future of dentistry holds and be prepared both clinically and academically to embrace and further develop these new advances.

Professor Paul SharpeDickinson Professor of Craniofacial Development

l King’s College London Dental Institute will launch the first ever master’s programme directed towards the latest advances in biologically-based dental treatments. The one–year non-clinical MSc programme in Regenerative Dentistry will have its first intake of students in 2013 and will provide a detailed practical and theoretical background in the very latest developments in basic science that are applicable to new and future dental therapies.

The last five years have seen major advances in stem cell biology and bioengineering. The discovery of stem cell populations in teeth and other oral tissues and the potential uses of these cells in oro-facial tissue repair and regeneration has primed the dental field for significant changes in future dental treatments. Young dentists and other medical and science disciplines need to be aware of these advances to be able to inform patients and be ready to apply them in their clinics.

Structure of programmeThe programme begins with a taught module covering many different areas of stem cell biology including, embryonic stem cells, iPS cells, adult stem cells and their niches, tissue engineering, scaffolds and protein/small molecule delivery systems. Lectures will be delivered by experts in

Young dentists need to be aware of these advances to be able to inform patients and be ready to apply them in their clinics

Bella DaveFinal year dental student

Oral health assessment & leprosyElective to Mumbai, India

l Leprosy is a chronic, non-fatal disease caused by the acid-fast bacillus Mycobacterium leprae. Untreated the disease can cause permanent disability and disfigurement which subsequently leads to isolation and social stigma. Of the three types, lepromatous leprosy is most commonly associated with oro-facial disorders. These include intra-oral nodules and skeletal changes which can cause destruction of the alveolar pre-maxillary process associated with loss or loosening of the maxillary incisors.

The prevalence of leprosy in India is reported to be declining. However, these figures may underestimate the true prevalence due to stigma leading to reluctance in self reporting. Leprosy still remains a problem in some areas of India.

Set up in 1976 by Dr R Ganapati, Bombay Leprosy Project is based in Sion-Chunabhatti, a well-known slum area of Mumbai and home to some of Mumbai’s poorest people.

The Mumbai clinicWhen I arrived I was surprised to see how small the clinic was, considering that it was a major referral centre. The main referrals area consisted of a room with a large table in the centre and a small dispensary. Here patients are reviewed and have nerve conduction studies performed. There are also

two tents outside; one where patients sit and another where they are seen. There are no cubicles and sanitation is very basic. Nonetheless, the staff are cheerful and try to help and the patients are grateful. They have often travelled from afar to attend clinic. Unsurprisingly their oral health is not their main priority.

In advanced cases disability is a real problem as patients are unable to use their hands and often have stigmatising oro-facial features. Such cases are rarer now due to the advent of multi-drug therapy, but they can be seen in leprosy colonies. Unfortunately I did not have the opportunity to visit a colony.

The city comes aliveWhen I visited, it was the time of the Ganesha festival, when families pay homage to Lord Ganesh, the Elephant God. The city of Mumbai comes alive with the sound of drums and singing in the streets as people take their clay idols to the sea for immersion. This meant that the clinic was less busy than usual.

Overall this was an unusual but definitely eye-opening experience for me.

Above left: The Leprosy Project clinic in Mumbai Above right: The Ganesha festival.

There are no cubicles and sanitation is very basic. Nonetheless, the staff are cheerful and try to help

Education


6 Education 7

l The Enhanced Support Dentistry Programme (ESDP) is an opportunity for talented students to begin a career in dentistry who may not have considered it.

Widening participationThere are up to 20 places on this new widening participation programme. It is effectively the standard five-year Bachelor of Dental Surgery (BDS) programme with significant targeted additional support. The entry requirements for ESDP are similar to the standard BDS programme; applicants need to obtain three A-levels and a fourth AS, and they are required to sit the UK Clinical Aptitude Test (UKCAT). Application for ESDP is through UCAS in the normal way and applicants come from recognised non-traditional entry routes; in particular the widening participation list of schools linked to King’s College London.

Liaising with the associated schools, potential applicants will be identified in Year 11 and guidance will be provided by the Dental Institute with regard to A-level choices. During Years

12 and 13, support will be provided to those considering dentistry as a career. Work experience will be arranged at the Dental Institute and at supportive dental practices. During this time prospective students will receive guidance on preparation for the UKCAT, which they will sit at the end of Year 12.

Any offer to study dentistry on the programme will be conditional on an applicant achieving A-level results in the range AAA/A to BBB/C –similar to that required for the standard BDS programme. If the number of applicants exceeds the number of allocated places, entry to this programme will be by competitive entry. Students eligible for ESDP may also apply for the standard BDS programme; this will however take two of the available UCAS application choices.

On entry to the programme, students will be part of the normal normal Year 1 cohort. Each will

have a personal academic and pastoral tutor, who will be aware of the specific educational and support needs of his/her student. Students will be expected to meet this tutor weekly for the first term of Year 1. Tutors will monitor the progress of their tutees and liaise with the Year 1 teachers and if necessary arrange appropriate support. The aim is to ensure that, as far as it is possible, students on this programme are part of the normal five-year BDS cohort and are able to participate in the full range of university activities offered by King’s.

During Year 2, additional support will continue as and when necessary. Additional practical clinical skills support will also be available during this year. It is expected that by this time the students will become more independent and require less day-to-day direct support, but it will still be available as and when required. Years 3, 4 and 5 of the programme will continue in a similar manner and support will continue throughout the programme.

Students on this programme will graduate at the same time as all the other students in the BDS cohort.

Reaching outNew enhanced support undergraduate programme

The Programme is an opportunity for talented students to begin a career in dentistry.

Dr Lyndon CabotDirector of Admissions, Senior Lecturer and Honorary Consultant in Restorative Dentistry

Liaising with the associated schools, potential applicants will be identified in Year 11 and guidance will be provided by the Dental Institute

Clinical


8 Clinical

Sara Holmes MBEDirector. University of Portsmouth Dental Academy.

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Clinical

Making choices 9

Practising dentistry the ‘MI’ way 10

Treatment of jaw deformity 11

We suggest that patient-centredness and patient responsibility are weighty issues that should permeate the whole ethos of delivering care.However, rather than dentistry stumbling over the same hurdles that our medical colleagues have faced over the past 10-20 years in applying patient centredness in practice, we should perhaps carefully consider that body of evidence before assuming that meeting the GDC’s second standard is obvious and easy to effect.

Dr Koula Asimakopoulou Senior Lecturer in Health Psychology

Making choicesPatient-centred care in dentistry

l Patient-centred care, patient ‘empowerment’ and the giving of choice to patients over decisions to do with their health and healthcare have been popular ideas in medical settings for a long time. Dentistry appears to be following on, more or less, the same path, for example, in the UK General Dental Council (GDC) Standards for Dental Professionals, Standard 2 is about ‘Respecting patients’ dignity and choices’. Here it is explicitly stated that dental professionals should ‘recognise and promote patients’ responsibility for making decisions about their bodies, their priorities and their care’.

The above statement makes explicit the need for patients to have some responsibility for decision-making in a dental consultation and, in this sense, is in line with current health policy in the wider NHS context. However, although it is prescriptive in terms of aspiration, it opens up the question of how such a laudable aim can be implemented in practice?

Our medical colleagues have struggled with the ideas of patient-centredness, shared responsibility and involvement in care for some time. Empirical research has addressed the practicalities of:

l how much responsibility patients ought to have

l whether all or only some patients want, are able to and would benefit from being given responsibility for their care

l who should give responsibility to patients, how and in what practical context

l whether the healthcare professional who is being asked to be patient-centred, has been trained in a model where it is the norm to involve patients in decision-making and give them direct responsibility for their care.

Patient-centredness and patient responsibility are weighty issues that should permeate the whole ethos of delivering care

Dr Sasha Scambler Lecturer in Sociology

Clinical


10 Clinical 11

Case 1 (below) presented with a severe class II skeletal relationship associated with mandibular deficiency and a significantly increased overjet. Following orthodontic decompensation, mandibular advancement surgery was planned, but the size of the required forward movement exceeded what was likely to be stable with conventional surgery; therefore osteogenic distraction was employed.

In this technique, an osteotomy of the mandible is carried out and the dentition advanced by the patient using a fixed expandable device. This allows jaw movements in excess of what is achievable using conventional surgery.

and surgeon to plan and execute these complex cases with the utmost accuracy. However, the extent and nature of the underlying skeletal discrepancy can sometimes mean that additional techniques are also required to achieve definitive correction. Here we demonstrate three adjunctive procedures that have been used in our clinical practice to increase the envelope of what can be corrected using orthodontics and surgery.

Collectively, these techniques are increasing the scope of cases that can be corrected using orthodontics and orthognathic surgery, providing better aesthetic outcomes and enhanced stability of the correction over the long-term.

Professor Martyn CobourneProfessor of Orthodontics

Treatment of jaw deformityExpanding the limits of conventional orthognathic surgery

l Orthodontics is the specialty of dentistry concerned with the management of malocclusion. In cases with facial disharmony and a significant discrepancy in the jaw relationship, orthodontic treatment alone may not be sufficient to achieve an acceptable result and combined orthodontic-surgical correction will also be required. King’s Health Partners currently represents one of the UK’s largest centres for combined treatment of this type, co-ordinated through specialized combined clinics held on both sites within the Dental Institute and with surgery taking place at King’s College Hospital.

The use of modern fixed orthodontic appliances and orthognathic surgery allows the orthodontist

Mr Nigel Shaun MatthewsConsultant Oral & Maxillofacial Surgeon

Case 2 (above) had a class III malocclusion associated with a marked mandibular asymmetry, which had occurred as a result of a childhood unilateral condylar fracture. Here, a simultaneous unilateral total temporo-mandibular joint (TMJ) replacement and mandibular sagittal split osteotomy were carried out.

Planning this type of surgery involves the acquisition of 3D CT scans of the facial skeleton and laser scanning of the study models set to the desired post-surgical occlusion.

The TMJ implant is a two-part system, consisting of a fossa component secured to the zygomatic arch and a mandibular component fixed to the ramus of the mandible. This surgery ultimately corrected the asymmetry and provided the patient with improved bite-opening and functionality.

Case 3 (below) presented with a marked narrowing of the maxilla in association with a class III malocclusion. In order to achieve arch co-ordination with the definitive osteotomy, an initial phase of Surgically Assisted Rapid Palatal Expansion (SARPE) was carried out. In this procedure a modified maxillary osteotomy is performed which facilitates post-surgical expansion by the patient using a bone-anchored expanding device.

Dr Christoph Huppa Consultant Oral & Maxillofacial Surgeon

Professor Avijit BanerjeeProfessor in Cariology & Operative Dentistry

Practising dentistry the ‘MI’ wayA ‘Minimum Intervention’ care philosophy to manage dental disease

l The science, art and craft of conservative/operative dentistry has been, and in some dental educational establishments worldwide, still is being taught classically. Emphasis is being placed on the surgical, mechanistic approach to excising all diseased and damaged tooth structure before restoring large cavities.

This approach is dependent on the properties of the restorative materials used to repair the resulting cavities and the tooth-cutting operative technologies available to excavate tissues. Specific cavity designs and the use of non-adhesive materials are relatively straightforward and uncomplicated to teach at undergraduate and postgraduate level. However, dental disease prevention and control strategies are often included as a separately-defined module. These limitations at both undergraduate and postgraduate level potentially devalue this critical aspect of non-operative care in the preservation of oral health in all populations.

A biological approachAdvances have taken place in understanding the causes of dental diseases, their histo-pathological development, the relationship with oral bacteria (plaque biofilm) and the dentine-pulp complex bio-reaction. These factors together with advances

in operative technology and adhesive materials science make it clear that caries management must be approached biologically. The ‘oral physician’ appreciates the critical relevance of the aetiology and the effects of oral disease on the patient.

‘Minimum Intervention Dentistry’ is the holistic approach to caring for individual patients’ oral health needs. This uses a four-phase cycle of disease identification and diagnosis:

l identifying disease/at-risk patients

l lesion prevention/disease control

l minimally invasive restoration/repair/preservation of damaged tooth structure

l patient-centred recall consultations.

A team-care approachActive patient responsibility is pivotal to the success of this care strategy. All members of the dental team (dental care professionals, nurses, hygienists, therapists, oral health educators, practice managers and technicians) require the behaviour management and interviewing skills to provide educational advice and treatment where necessary. Patients presenting with cavitated carious lesions may require minimally invasive operative intervention where residual caries-affected dentine may be sealed beneath an adhesive, aesthetic restoration. Thus the process is arrested permitting the tooth to heal itself biologically.

The clinical and scientific evidence exists for such a primarily non-operative dental disease management strategy. With its laboratory-based clinical research in this broad, exciting field the Dental Insitute is leading the Minimum Intervention way forward, providing new clinical care pathways to patients. The Dental Institute offers an MI-based undergraduate curriculum, as well as developing an innovative postgraduate flexible learning master’s programme in Advanced Minimum Intervention Dentistry.

For further information about the master’s programme, please contact the distance learning team at [email protected].

Patient-centred communication is pivotal for an MI approach

The Dental Institute is leading the Minimum Intervention way forward, providing new clinical care pathways to patients

Research


Sara Holmes MBEDirector. University of Portsmouth Dental Academy.

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Dr Julian NaglikLecturer in Mucosal Immunology/Biology

identify this receptor and to determine how this fungal protein activates epithelial cells and induces protective mucosal immunity.

This work has strong medical importance as it will have implications for developing new immune-based treatments against fungal infections and more effective antifungal therapies, but also for defining new approaches to combat other mucosal diseases and to manipulate host immunity for patient benefit.

AcknowledgementsThis work was supported by the National Institutes of Health (NIH), MRC and BBSRC.

Fungal infectionsCandida recognition, epithelial activation and mucosal immunity

l The mucosal (oral, vaginal, gastrointestinal) epithelium is of immense importance in protecting humans against a multitude of infections as it is the initial tissue encountered by the majority of microbes. This microbial-epithelial encounter results in either no response in the case of harmless ‘commensal’ microbes or activation of immunity in the case of disease-causing ‘pathogenic’ microbes. When these normal responses are disrupted a plethora of complications arise, which have implications beyond infection as conditions including cancer and autoimmune disease are associated with abnormal interactions between host and microbe.

Candida and epithelial sensingThe fungus Candida albicans is an example of a microbe that exists as a commensal in healthy people but becomes a dangerous pathogen causing severe and potentially fatal disease in unhealthy people. Given that the vast majority of C. albicans infections occur on mucosal surfaces, it is of paramount importance to understand how epithelial tissues recognise this medically-important fungus and normally restrict it to the commensal state.

Our recent work has been instrumental in understanding the mechanisms by which epithelial cells detect disease-causing C. albicans and how this results in immune protection. We previously showed that C. albicans infection leads to the secretion of immune activators (cytokines and chemokines) that recruit a specific immune cell (neutrophil) to the site of infection, which then act together with epithelial cells to protect against C. albicans infection. We have now found that to activate this protective immune process epithelial cells target a specific protein on the ‘invasive’ form of C. albicans known as hyphae. The fundamentally important feature that is currently unknown is the epithelial receptor that recognises this hyphal protein and triggers epithelial activation in the first instance. Recently, my laboratory obtained funding from both the Medical Research Council (MRC) and the Biotechnology and Biological Sciences Research Council (BBSRC) to

Above: Transmission electron micrograph image of the Candida albicans cell wall and cytoplasm Left: Invasion of oral epithelium by Candida albicans.

Research

Fungal infections 13

Bioconnecting joints 14

Cellular therapies in cleft repair 15

Removing disabling barriers in healthcare 16

Research


14 Research 15

with Dr Jie Huang (University College London) and Dr Priya Kalia (Research Associate working on the project at King’s College London) are developing a continuum model for regenerating cartilage and bone simultaneously.

The novelty factor of this project is based on ‘learning from nature’ and mimicking the structural properties of bone and cartilage and using nanotechnology for designing a nano-composite gradient scaffold for the osteochondral continuum interface. This has several structural advantages including conferring substantial pore interconnectivity to provide optimal conditions for cell migration, nutrients and cell viability. Incorporation of stem cells with appropriate signalling molecules provides an integrated system, to control the challenging simultaneous regeneration of both tissue types, bone which is vascular and cartilage which is avascular.

By understanding the interactions between articular cartilage and subchondral bone, treatment options could in the future be directed to the entire osteochondral unit, rather than focusing on the articular surface only.

Professor Lucy Di SilvioProfessor in Tissue Engineering

Bioconnecting jointsRegenerating cartilage and bone simultaneously

l With increased sports injuries in young people and the global ageing population, the demand to replace, repair and regenerate tissues is increasing. Included in this, are a large number of musculoskeletal disorders causing damage to cartilage and bone. Often, these are accompanied by significant pain, restricted mobility and high socioeconomic costs.

Damaged tissues are currently replaced by synthetic biomedical implants, which often fail as a result of not fully integrating with the host tissue. Current approaches to repair cartilage and bone give unpredictable results, and are usually aimed at treating the medical conditions, rather than curing them. Where synthetic materials are used, complete integration or regeneration can only be achieved if the implant mimics the natural tissue being replaced.

Biomimetic approachBiological tissues exhibit different gradients across a spatial volume, with each tissue having specific properties and roles, and the ability to work in a synchronized biofunctional manner is necessary if tissue regeneration is to take place. Previous work has focused on repairing the individual damaged tissue, without considering the interface structure between cartilage and bone.

In a project funded by Orthopaedic Research UK, my research group and I, in collaboration

The novelty factor of this project is based on ‘learning from nature’ and mimicking the structural properties of bone and cartilage

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Illustrating the relationship between the bone, ligaments and cartilages in a knee joint.

l When you ‘burn’ your mouth with pizza that is too hot, what hurts are those little ridges in the roof of the mouth. Those ridges, known as ‘rugae’, hurt because they are full of nerve endings – useful, normally, to help us feel and manoeuvre food during eating. Unlikely as it might seem, these rugae recently told us something rather profound about how we are made during embryonic development, knowledge that is going to be useful in the coming era of regenerative cell therapies.

My group in the Department of Craniofacial Development & Stem Cell Biology has been using the rugae as landmarks – a natural ruler – to monitor facial growth in mouse embryos. Growth failure is the cause of serious birth defects including cleft lip and palate, which are among the commonest of all birth defects (about one in 800 births). Although surgical correction is available,

many cleft children require multiple surgeries and still suffer ongoing problems. The hope is that by understanding how clefts arise at the cellular level, it may be possible to direct cells to repair these defects without conventional surgery.

Self-organising stripesDuring development, the rugae arise from cells that make a protein known as Shh arranged in stripes. How do they get to be in stripes? We noticed from how the stripes branched following incisions in the tissue, that they obeyed a biological theory first proposed in 1952 by Alan Turing, the great mathematician, Enigma code-breaker and computer scientist. The theory describes how a simple system of two chemicals he called ‘morphogens’, one an ‘activator’ and the other an ‘inhibitor’, can spread out and distribute themselves in alternating stripes. Order thus arises spontaneously from an initially random distribution of morphogens. This self-organising mechanism has long been believed to

drive development from conception, but no one had experimentally linked Turing’s stripe-generating process to real morphogens. Using a combination of chemical inhibitors and mouse gene mutants, my group identified Shh itself as an inhibitor morphogen and the activator morphogen as another protein, FGF.

Turing was right. This means we have a better idea of how to use morphogens in pairs, not just to make stripes but to set up spacing generally, and can apply Turing’s principles to many regenerative therapies currently being pursued in labs around the world. Bringing such therapies to patients is still a long way off, and a glass of cold water is still the best thing when you burn your mouth. But spare a thought when you do for clefts, rugae and regeneration.

AcknowledgementsThis work was funded by the Medical Research Council.

The hope is that by understanding how clefts arise at the cellular level, it may be possible to direct cells to repair these defects without surgery

Cellular therapies in cleft repairTuring’s morphogen model is more than just a theory

Dr Jeremy GreenReader in Developmental Cell Biology

Above: Tiger stripe patterns fit the morphogen theory, but molecular proof for the molecular mechanism of stripe generation in general has been lacking. Left: Stripes of Shh gene expression in an embryonic mouse palatal shelf half palate pre-figure the rugae and help explain self-organisation during development.

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www.kcl.ac.uk/dentistry

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16 Research

The Badcock Dental Circle Lecture 2012 In May, Dr Michael Escudier gave the annual Badcock Dental Circle Lecture ‘Modern management of obstructive salivary gland disease’. He presented 10 years of research which showed that an effective, more conservative treatment is available to patients.

In October 2013, the Badcock Dental Circle Septodont Lecture will be given by Dr Salvatore Ruggiero, a prominent oral maxillofacial surgeon from New York. For more information, please contact Professor Tara Renton at [email protected]

A patient’s gratitude Both patients and students gain from free dental treatment given by students of the Dental Institute.

One of the Institute’s longstanding patients is so grateful to our students that he decided to give back to them and to the Institute. With regular anonymous donations he has set up the Patient Consideration Prize, an annual award of £100 that recognises a fourth-year dental student’s excellent chairside manner.

Furthermore, together with his wife, this grateful patient decided to leave a gift in his will to the Dental Institute. Their generosity means that skills, knowledge and attention to patients will continue to be recognised and rewarded for future generations of dental students.

If you feel this very personal way of supporting Dental Institute is relevant to you or to any of your patients, please contact Legacy Manager Elena Kuryleva on +44 (0)20 7848 4700 or at [email protected]

Alumni & the Dental Circle

The Dental Institute is proud of its alumni and is in contact with more than 7,000 former staff and students of Guy’s, King’s College and the Royal Dental Hospitals.

Dental Alumni Weekend 2012In March, 217 dental alumni, staff and students attended the Annual Dental Alumni Dinner, making it the biggest celebration yet. Guests enjoyed entertainment provided by the KCL Jazz Society and won prizes from the Dental Society raffle, which raised over £700 for the Student Endowment Fund. Professors John and Deborah Greenspan (Royal Dental, 1963; 1964) were jointly presented with the Alumnus of the Year Award and the Distinguished Service Award was received by Mr Martin Kelleher, Consultant in Restorative Dentistry at the Dental Institute. The prize for the biggest reunion went to Guy’s 25-year group.

Clinical Day on Saturday was also hugely popular, attracting over 250 attendees for a day of continuing professional development. Professor Brian Millar gave the Herbert Memorial Lecture, and Professor Saman Warnakulasuriya delivered the Rod Cawson Lecture. Three specialist sections meetings (Hygienists & Therapists, Orthodontics and Endodontics & Prosthodontics) on Friday built on the success of previous years. Next year’s weekend will take place 1-2 March.

For more information, please contact the Alumni office on +44 (0)20 7848 3053 or email [email protected]

Organising a reunion Dental Alumni Weekend provided the perfect setting for alumni who wished to reunite with their classmates. Dr Clive Debenham, President of the Dental Alumni Association, acknowledged all reunion groups in his address and displayed on reunion tables were archive photographs from their schools and classes. All reunion alumni were presented with a special gift. If you graduated in a year ending in a

3 or an 8, then 2013 is a special anniversary year. The Alumni Office will be delighted to support you in organising your reunion and can offer you special benefits. Find out more by emailing [email protected] or by calling +44 (0)20 7848 3053.

New direction for the Dental CircleThe Dental Circle now has a mission statement: ‘to engage a group of exceptional donors as advisors, providing both intellectual and financial resources to the Dental Institute, contributing to its advancement’.

Alumni, staff and friends who contribute £1,000 or more in an academic year will be recognised as Circle members and will have the opportunity help the Dean shape the future of the Dental Institute. The Dean hopes to encourage more alumni from our dental community to contribute in this way.

Alumni make a difference

Alumni and staff of the Dental Schools at Guy’s, King’s College and the Royal Dental continue to support students and staff through their generous donations. Projects supported by our alumni include: student hardship and widening participation; innovative teaching facilities and developing research.

Gifts at all levels really do make a difference to the lives of students and staff and we are grateful to all our supporters. For more information about the Dental Circle or giving to the Dental Institute, please go to www.alumni.kcl.ac.uk/giveback, or contact Helen Nicholson on +44(0)20 7848 4711 or at [email protected]

Dental Circle Dinner: Dianne Rekow (left).

Badcock Dental Circle Lecture: Michael Escudier (centre).

Removing disabling barriers in healthcare An e-learning resource for healthcare professionals

Dr Ruth BaileyResearch Associate in Social and Behavioural Sciences

l Removing Disabling Barriers in Healthcare is an e-learning resource which aims to help future and present healthcare professionals identify the access barriers disabled people experience when accessing even the most basic NHS care. It also aims to equip professionals with the skills necessary to deal with some of these barriers. This is vital because although policy change is necessary to remove some barriers, research shows that the attitudes and behaviour of healthcare professionals can make the difference between a good and bad healthcare encounter, notwithstanding barriers.

Removing Disabling Barriers draws upon the experiences of 27 disabled people who were

interviewed about their use of the NHS as part of a PhD research project. It is structured around nine scenarios, each told in the words of an interviewee and focusing upon a particular type of barrier. These barriers range from the distance someone with a mobility impairment has to walk between the hospital entrance and their outpatient clinic to an x-ray department which does not have a hoist to enable a wheelchair user to get from their chair on to the examination couch. After an exploration of each scenario, there is a discussion of what action a healthcare professional could take to remove the barrier or mitigate its effects.

Reflecting on barrier free healthcareRemoving Disabling Barriers gives general facts and figures about disabled people’s experience of using the NHS. It also has reflective questions which invite students to develop their own thinking about disability access in healthcare. In addition, background information is given about the different models used to understand disability and the statutory obligations that the NHS has to meet the needs of disabled people.

The e-learning resource is being piloted with first year dentist students from autumn 2012. It will then be developed with a view to tailoring the

resource to the requirements of the curriculum of other healthcare undergraduates. Also accreditation will be sought to make it a web based Continuing Professional Development package for practicing healthcare professionals.

Thanks are due to the ESRC (Economic and Social Research Council) for funding the development of the e-learning resource as part of a Postdoctoral Fellowship. Thanks are also due to Dr Sasha Scambler, Lecturer in Sociology, and Dr Karen Lowton, Senior Lecturer in Ageing & Health who gave much appreciated critical guidance on the project.

For further information about Removing Disabling Barriers in Healthcare, please contact Dr Ruth Bailey at [email protected]

The availability of a wheelchair dental platform overcomes the barrier of a wheelchair user needing to move on to the dentist’s chair.

The attitudes and behaviour of healthcare professionals can make the difference between a good and bad healthcare encounter

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Awards & appointments The Dental Institute’s hapTEL project won a prestigious 2012 BETT award at the London awards ceremony of the annual trade and education show. The hapTEL project, which developed a 3D virtual dentist’s chair, received the BETT award for Innovation in ICT.

Professor Raman Bedi was conferred an Honorary Fellow of the Royal College of Physicians and Surgeons of Glasgow and was appointed as the founding chair of the World Federation of Public Health Associations oral health group.

Professor Mahvash Tavassoli from the Dental Institute’s Head and Neck Cancer research group, has been successful in obtaining a National University of Singapore Partnership Award.

Dr Michael Escudier was awarded the Association for Dental Education in Europe ‘Excellence in Dental Education Award’ in recognition of his outstanding contribution to excellence as a mature educator.

Institute events

King’s-Taiwan workshopIn September 2012, the Department of Craniofacial and Stem Cell Biology at the Dental Institute hosted a three-day workshop on stem cell and cancer research, which brought together leading stem cell biologists from King’s College London and Taiwan’s National Yang-Ming University.

Topics for the presentation and group discussions included biomaterials and tissue engineering; stem cells and regenerative medicine; cancer metastasis and biomarkers; and novel approaches.

The invited speakers included Professor Paul Sharpe from the Dental Institute, Professor Oscar Lee from the National Yang-Ming University and Professor Fiona Watt, who recently joined King’s to head a new Centre for Stem Cells & Regenerative Medicine.

Going for Gold – Sports, injury, repairAn event on sports performance was organised by Lucy Di Silvio, Professor in Tissue Engineering at the Dental Institute to coincide with the 2012 Olympic and Paralympic Games.

The aim of the event was to raise awareness of the many areas associated with sports performance such as sports injuries, tissue repair and new technologies, and to bring together a multidisciplinary group including surgeons, clinicians, scientists and sportspersons.

Over 60 delegates attended the event, which was held in the Biomedical Research Centre at Guy’s Campus.

Time capsule for new outreach centre The Dental Institute was invited to contribute to a time capsule, which has been buried within the foundation of Norwood Hall, an exciting collaborative development with

Lambeth Primary Care Trust in West Norwood, London. Norwood Hall opens in Spring 2014 as a new outreach centre providing dental students new opportunities to train and practise in a community-based primary care environment.

New appointments Professor Nigel Pitts and Dr Christopher Longbottom, internationally renowned for cariology, health services and translational research have been appointed at King’s College London Dental Institute to spearhead a new focus on dental innovation, the translation of research into clinical practice, public policy, and the commercialisation of research in order to improve health and healthcare.

Joining the Dental Institute in early 2013, Professor Pitts and Dr Longbottom, currently at the University of Dundee, will develop a new Dental Innovation and Translation Centre (Dental ITC), intended to add to the continuing focus on research quality and impact at King’s College London.

Professor Nigel Pitts (above left) Dr Christopher Longbottom (above right).

The Dean of the Dental Institute (right) with guests at the King’s-Taiwan workshop.

Guests and Dental Institute staff at the Going for Gold event.

News highlightsOf the many notable news items in 2012, the following are of particular note.

Student prizes & achievementsCase contestDaniel Van Gijn, 2012 graduate dental student, won first prize in the DENTSPLY Ceram.X Case Contest 2011/12 for the UK.

John McLean award The John McLean award for the best final year undergraduate presentation of a patient’s treatment undergoing a multidisciplinary approach was presented to King’s graduate Dr Humza Sulaman Anwar at the British Dental Association in London.

Prosthodontic prizeAndreas Artopoulos, a postgraduate student on the MSc in Maxillofacial & Craniofacial Technology, was awarded with the 2012 European Prosthodontic Association Oral Presentation Prize.

Published projectUndergraduate student Dena Ettehad had her intercalated BSc research project published in the medical journal ‘The Lancet’.

Research The UK has succeeded in its bid to host 2020’s World Biomaterials Congress in Scotland thanks to a bid led by Professor Lucy Di Silvio of the Dental Institute.

Innovations in education The Dental Institute hosted the first conjoint examination in Orthodontics in April 2012 under the auspices of the Royal College of Surgeons of Edinburgh.

International linksDuring 2012, the Dental Institute

signed a Memorandum of Understanding with the Chonnam National University School of Dentistry in South Korea.

The Institute also renewed its Memorandum of Understanding with the Government of His Majesty the Sultan and Yang Di-Pertuan of Brunei Darussalam.

The hapTEL team at the 2012 BETT Awards.

Prizewinner: Daniel Van Gijn.

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Finance

King’s College London£29.5 million = Dental Institute income

King’s College Hospital NHS Foundation Trust£34.32 million = Dental Division income

Guy’s and St Thomas’ NHS Foundation Trust£33 million = Dental Directorate income

Staff members – Dental Institute King’s College London 235 wte King’s College Hospital NHS Foundation Trust 441 wteGuy’s & St Thomas’ NHS Foundation Trust 357 wte

Research Assessment Exercise 2008More than 70 per cent of the Institute’s research output from 70 principal investigators was judged to be internationally excellent. This confirmed that the Institute has one of the largest, most influential team of researchers in dental and oral health sciences in the world.

Spin-out companyA spin-out company has been launched by the Dental Institute. OSspray (www.osspray.com) is a company working on novel restorative materials.

Undergraduate education91 per cent of students who participated in the National Student Survey were satisfied with the quality of the Dentistry BDS programme. The Dental Institute achieved a response rate of 82 per cent.

Dental Hospital Activities

Dental Division Activity Plan: King’s College Hospital NHS Foundation Trust11,700 admitted patients107,250 hospital outpatients20,320 units of Dental Activity plus 28,000 other contacts (2011-12)

Dental Hospital Activities: Guy’s and St Thomas’ NHS Foundation Trust7,000 inpatients and daycases117,000 hospital outpatients (2011-12)

Students – Dental Institute740 Undergraduate261 Postgraduate (distance learning) in 39 countries144 Postgraduate (taught) 77 Postgraduate (research)147 Dental Care Professional trainees (2011-12)

Facts & figures 2012

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Profile 2012-13

Documents