ROOT CAUSES Three contrasting King James IV Professorship lectures

ROO T C AUSES

Philip Taylor introduces the King James IV Professorships, while Gerry McKenna gives an overview of his inaugural lecture

ing James IV of

KScotland, who confirmed this College’s Seal of Cause in 1506, had an interest in all matters scientific, including medicine and surgery, and was particularly proud of his skill as a dental surgeon, adopting the unusual practice of paying patients on whom he operated.

To mark the millennium, the

RCSEd, with the Faculty of Dental

Surgery, proposed that lectureships be awarded annually in open competition to practitioners of surgery or dental surgery who have made a significant contribution to the clinical or scientific basis of surgery. Her Majesty Queen

Elizabeth II gave permission for the College to use the title King

James IV Professorship.

They are the most senior academic awards made by the

College and are intended to recognise a substantial body of work by an individual not less than five years from substantive appointment as a consultant or an equivalent position. The courtesy title of Professor is given to King

James IV lecturers for the duration of the College year in which their lecture is delivered.

This year’s lectures took place at the College during September and featured three thought-provoking themes. Gerry McKenna, who reprises his lecture here, discussed preventative and operative care for caries in older adults. Barry Quinn considered the rise of simulated dental practice, while the dental management of oncology patients was the subject of Douglas

Peterson’s lecture.

Gerry McKenna Clinical Professor and Consultant in Restorative Dentistry, Queen’s University Belfast School of Medicine, Dentistry and Biomedical Sciences

LECTURE 1

RETHINKING ORAL CARE FOR OLDER ADULTS

Significant changes in the oral health of older adults have given rise to a partially dentate ageing population. While increasing levels of natural tooth retention is a very positive development, it now presents the challenge of managing chronic dental diseases, particularly caries, into old age. As with younger generations, caries management should follow the principles of minimal intervention in older adults, with a strong emphasis on The use of resinprevention. bonded bridgework Studies have successfully to restore patients to demonstrated an SDA improves that atraumatic restorative patient satisfaction treatment can be successfully utilised in this patient group, including for those patients living in nursing homes1 .

Given patients’ dislike of removable dentures, their biological cost and high levels of non-compliance, other treatment options should be considered when planning tooth replacement for partially dentate older patients. The use of resin-bonded bridgework to restore patients to a shortened dental arch (SDA) has been shown to significantly improve patient satisfaction. In a randomised controlled clinical trial, patients were restored to an SDA using resin-bonded bridges. Patients reported significant improvements in oral health-related quality of life compared with those provided with removable dentures2. This study also demonstrated that provision and maintenance of an SDA for partially dentate older patients was significantly more cost-effective than partial dentures3 . Patients expressed their strong preference for SDA treatment through qualitative interviews and also in their maximum recorded willingness to pay for the treatment4 . Poor oral health and loss of natural teeth can impact on the quality of life

of older people, as well as their systemic health, diet and nutrition. While prosthodontic rehabilitation has been shown to improve masticatory ability in partially dentate older patients, this does not translate to improvements in nutritional status.

These findings demonstrate the need for dietary intervention alongside tooth restoration to improve nutritional status in older adults. One successful approach to changing food behaviours in the long term is that of habit formation.

In order to test this approach in partially dentate older adults, a randomised controlled clinical trial was developed. This work demonstrated that through development of automaticity, a tailored dietary intervention coupled with prosthodontic rehabilitation improved older adults’ consumption of three targeted food groups: fruit and vegetables, wholegrains and healthy proteins. These improvements were demonstrated at six weeks, four months and eight months after treatment intervention5 . LECTURE 2 CAN WE SIMULATE DENTAL SURGERY IN VIRTUAL WORLDS AND HOW REAL DOES THE SIMULATION HAVE TO BE?

Modern-day dentistry requires our students to gain high levels of manual dexterity and excellent eye-to-hand control. Lord Darzi once stated: “Never first time on a patient.” Today it is essential that students are safe to practise before treating their first patients.

Barry Quinn described how simulated practice and the technology itself is rapidly moving forward, with students now being taught in immersive environments that are haptically enabled.

These developments provide the opportunity for scanning patients, haptically rendering the images for surgery rehearsal before the student operates on the real patient. This lecture reviewed the new haptically enabled simulators, but also posed the question ‘how real does the simulation have to be?’

At the University of Liverpool, Quinn leads the integrated teaching of restorative dentistry for the interprofessional education of dental and dental therapy students.

Douglas Peterson’s lecture highlighted the value of high-quality researchbased guidelines in clinical interprofessional oncology practice. He provided a summary of the process leading to creation, dissemination and utilisation by healthcare professionals, and described the impact of guidelines on clinical outcomes and the relationship with enhanced financial outcomes. He emphasised the importance of dental professionals in contributing to the guideline process when caring for oncology patients.

Peterson’s primary academic and clinical responsibilities throughout his career have been directed at oral management of the medically complex patient, with an emphasis on oral complications in oncology patients.

LECTURE 3

DENTAL MANAGEMENT OF THE ONCOLOGY PATIENT: TRANSLATING RESEARCH INTO GUIDELINES FOR CLINICAL PRACTICE AND IMPROVED PATIENT CARE

Barry Quinn Chair in Restorative Dentistry and Dental Education, Academic Lead and Head for Restorative Dentistry, School of Dentistry, University of Liverpool

Douglas Peterson Professor, Oral Medicine, School of Dental Medicine, UConn Health, Connecticut, US

Lecture 1 references

1. DaMata C, McKenna G, Anweigi L, Hayes M, Cronin M, Woods N, O’Mahony D, Allen PF. An RCT of atraumatic restorative treatment for older adults: 5 year results. J Dent 2019; 83: 95–99. 2. McKenna G, Allen PF, O’Mahony D, Cronin M, DaMata C, Woods N. The impact of rehabilitation using removable partial dentures and functionally orientated treatment on oral health-related quality of life: a randomised controlled clinical trial. J Dent 2015; 43: 66–71. 3. McKenna G, Allen PF, Woods N, O’Mahony D, Cronin M, DaMata C, Normand C. Cost-effectiveness of tooth replacement strategies for partially dentate elderly: a randomised controlled clinical trial. Community Dent Oral Epidemiol 2014; 42: 366–374. 4. McKenna G, Tada S, Woods N, Hayes M, DaMata C, Allen PF. Tooth replacement for partially dentate elders: a willingness-to-pay analysis. J Dent 2016; 53: 51–56. 5. McCrum LA, Watson S, McGowan L, McGuinness B, Cardwell CR, Clarke M, Woodside JV, McKenna G. Development and feasibility of a tailored habit-based dietary intervention coupled with oral rehabilitation on the nutritional status of older patients. Pilot Feasibility Stud 2020; 24: 120.