Research funding to fight childhood tooth decay
Wednesday, July 18, 2007
The Australian Dental Association welcomes the recent announcement by the Queensland Government that Brisbane paediatric dentist, Dr Kerrod Hallett has received research funding to trial a unique test and mouth rinse to prevent childhood dental caries.
Dr Hallett from the Children's Oral Health Service at the Royal Children’s Hospital, Brisbane is working with researchers from the USA, to develop an enzyme that may help to reduce levels and activity of mutans streptococci (MS) and lactobacilli, the most common oral bacteria implicated in the development of childhood dental caries. Tooth decay in non-fluoridated Queensland continues to be the most prevalent childhood disease. Clinical observation and testing of children with chronic renal failure noted they secreted high saliva levels of a protein, which we have termed urease, and that they did not have tooth decay.
"We believe the urease may prevent the growth of decay-causing oral bacteria. Because the children's kidneys do not function properly, they are unable to excrete urea and other waste products from the body effectively. Consequently, the levels of urease in their saliva increase because the body has to get rid of waste products and the next best avenue is to secrete them in saliva," Dr Hallett said.
Dr Hallett has been awarded $300,000 through a Queensland Clinical Research Fellowship from the department of State Development for three years to evaluate a bacterial test and mouth rinse program to treat dental caries in high-risk children attending school dental clinics. “Those children most at risk were from low socio-economic, indigenous, new immigrant and socially-disadvantaged families,” he said.
Dr Hallett hopes to start clinical trials of the mouth rinse in five to 12-year-olds at Gold Coast and Townsville schools next month. He has been working with Oral Biotechnologies, a company in Portland, Oregon, to develop a mouthwash containing a synthetic version of urease. The first treatment rinse will contain 0.05% sodium fluoride, sodium hypochlorite, polyphenols, xylitol and anthocyanidins to improve the taste.
The clinical trial involves 250 children with active tooth decay from Musgrave Hill State School on the Gold Coast and 250 from Vincent State School in Townsville. Half the children will receive the experimental mouthwash once a day by a dental therapist for a month and half will be given a placebo rinse containing 0.05% sodium fluoride only.
Dr Hallett explained that dental therapists will test the plaque of the children's teeth before treatment and afterwards for levels and activity of MS. They will be re-tested and retreated every four months for three years and their decay rates will be compared.
“I believe tooth decay should be managed medically like other infectious diseases of the human body, such as a chest infection, which use antibacterial treatments to treat the infection and prevent spread of further disease” Dr Hallett said.
The research conducted by Dr Hallett could help improve public dental health in Queensland. It could reduce the burden of chronic tooth decay by addressing the cause of the problem early-on. “If high-risk children can be identified early and an effective intervention used, future disease progression by bacterial spread can be significantly controlled.”
Dr Hallett said this medical approach was more cost effective for public health services than the traditional surgical intervention such as removing caries and placing fillings in teeth. The research was essential as about half of all Queensland children had varying degrees of tooth decay when they started school and it is estimated that approximately 2000 pre-schoolers a year need a general anaesthetic before the age of four to remove decayed baby teeth.
Signs that the decay experience among young children is increasing is further supported in the latest national survey, The Child Dental Health Survey, Australia 1999: Trends across the 1990s. Decay rates of primary teeth (baby teeth) across children of all age groups increased during the period from 1996-1999, reversing the trend which saw a decline in rates of decay during 1991-1996. The trend since 1996 was most significant for five-year old children who experienced a 21.7% increase in decay during this period. These statistics are disturbing given that untreated decayed teeth can cause infection and other dental problems later in life and given that 90% of all dental disease is preventable.
It is hoped that if Dr Hallett’s clinical trials are successful, the treatment protocol to reduce future tooth decay risk would be universally adopted by other state school dental services. The ADA expresses its best wishes to Dr Hallett and every success in his battle to combat childhood tooth decay.