An evidence-based oral health promotion programme: Lessons from Leicester.

OBJECTIVES: To provide an overview and draw lessons from the establishment of a local oral health promotion programme for preschool children in Leicester, England (2013-2017). The article provides information on the strategic approach taken in Leicester, one of the most ethnically diverse cities in England, and also one of the most deprived. Over a third of children aged 3 years, and half of those aged 5 years, have experience of obvious dental decay. METHODS: A description of the evolution and development of the programme is provided along with commentary by the authors. This includes the origins, design and evaluation of the programme. RESULTS: Progress so far has been promising. There has been a statistically significant 8% decrease in the proportion of 5-year-old children in Leicester with dental decay from 2011/2012 to 2014/2015. This will need to be sustained and further developed to deliver the 10% reduction required within the strategy. CONCLUSIONS: The successful implementation of a local oral health improvement programme in Leicester has required leadership to coordinate a multiagency partnership approach to embedding effective concepts and realising opportunities collaboratively. However, longer term sustainability remains a concern.

Chondrogenic differentiation of human bone marrow-derived mesenchymal stem cells in a simulated osteochondral environment is hydrogel dependent.

Hydrogels pose interesting features for cartilage regeneration strategies, such as the option for injectability and in situ gelation resulting in optimal filling of defects. We aimed to study different hydrogels for their capability to support chondrogenesis of human bone marrow-derived mesenchymal stem cells (hBMSCs). hBMSCs were encapsulated in alginate, alginate with hyaluronic acid (alginate/HA), fibrin or thermoresponsive HA grafted with poly(N-isopropyl acrylamide) side-chains (HA-pNIPAM). Glycosaminoglycan production and cartilage-related gene expression were significantly higher in hBMSC-alginate and hBMSC-fibrin constructs than in the other constructs. Supplementation of alginate with HA was not beneficial. hBMSC-alginate, hBMSC-fibrin and hBMSC-HA-pNIPAM constructs were placed in simulated defects in osteochondral biopsies and cultured in vitro for 28 d. Biopsies containing hBMSC-alginate and hBMSC-fibrin were implanted subcutaneously in nude mice for 12 weeks. hBMSC-alginate constructs had significantly higher cartilage-related gene expression after 28 d of culture as well as significantly more safranin-O positive repair tissue after 12 weeks in vivo than hBMSC-fibrin constructs. Although initial experiments with hBMSC-hydrogel constructs suggested comparable results of hBMSC-alginate, hBMSC-fibrin and hBMSC-HA-pNIPAM constructs, culture in the osteochondral biopsy model in vitro as well as in vivo revealed differences, suggests that chondrogenesis of hBMSCs in an osteochondral environment is hydrogel-dependent.

Evolutionary divergence of the necroptosis effector MLKL.

The pseudokinase, MLKL (mixed-lineage kinase domain-like), is the most terminal obligatory component of the necroptosis cell death pathway known. Phosphorylation of the MLKL pseudokinase domain by the protein kinase, receptor interacting protein kinase-3 (RIPK3), is known to be the key step in MLKL activation. This phosphorylation event is believed to trigger a molecular switch, leading to exposure of the N-terminal four-helix bundle (4HB) domain of MLKL, its oligomerization, membrane translocation and ultimately cell death. To examine how well this process is evolutionarily conserved, we analysed the function of MLKL orthologues. Surprisingly, and unlike their mouse, horse and frog counterparts, human, chicken and stickleback 4HB domains were unable to induce cell death when expressed in murine fibroblasts. Forced dimerization of the human MLKL 4HB domain overcame this defect and triggered cell death in human and mouse cell lines. Furthermore, recombinant proteins from mouse, frog, human and chicken MLKL, all of which contained a 4HB domain, permeabilized liposomes, and were most effective on those designed to mimic plasma membrane composition. These studies demonstrate that the membrane-permeabilization function of the 4HB domain is evolutionarily conserved, but reveal that execution of necroptotic death by it relies on additional factors that are poorly conserved even among closely related species.

Evaluation of Cartilage Repair by Mesenchymal Stem Cells Seeded on a PEOT/PBT Scaffold in an Osteochondral Defect.

The main objective of this study was to evaluate the effectiveness of a mesenchymal stem cell (MSC)-seeded polyethylene-oxide-terephthalate/polybutylene-terephthalate (PEOT/PBT) scaffold for cartilage tissue repair in an osteochondral defect using a rabbit model. Material characterisation using scanning electron microscopy indicated that the scaffold had a 3D architecture characteristic of the additive manufacturing fabrication method, with a strut diameter of 296 ± 52 µm and a pore size of 512 ± 22 µm × 476 ± 25 µm × 180 ± 30 µm. In vitro optimisation revealed that the scaffold did not generate an adverse cell response, optimal cell loading conditions were achieved using 50 µg/ml fibronectin and a cell seeding density of 25 × 10(6) cells/ml and glycosaminoglycan (GAG) accumulation after 28 days culture in the presence of TGFß3 indicated positive chondrogenesis. Cell-seeded scaffolds were implanted in osteochondral defects for 12 weeks, with cell-free scaffolds and empty defects employed as controls. On examination of toluidine blue staining for chondrogenesis and GAG accumulation, both the empty defect and the cell-seeded scaffold appeared to promote repair. However, the empty defect and the cell-free scaffold stained positive for collagen type I or fibrocartilage, while the cell-seeded scaffold stained positive for collagen type II indicative of hyaline cartilage and was statistically better than the cell-free scaffold in the blinded histological evaluation. In summary, MSCs in combination with a 3D PEOT/PBT scaffold created a reparative environment for cartilage repair.

The dental practitioner's role in protecting children from abuse. 2. The orofacial signs of abuse.

The types of prevalence of the various orofacial injuries that may be sustained in child abuse have been presented. Table 2 gives the dental practitioner a summary check-list of five questions they must ask themselves and five observations they must make whenever doubts and suspicions of child abuse arise.

The dental practitioner's role in protecting children from abuse. 3. Reporting and subsequent management of abuse.

The third and final article of the series covers the mechanism a general dental practitioner should follow when alerting the authorities to a child at risk, and the subsequent investigations and actions that follow such a report.

The dental practitioner's role in protecting children from abuse. 1. The child protection system.

The last British Dental Journal article on child protection was in 1986. Since then there have been major changes in both legislation and approaches to child protection. A local authority child protection specialist and a consultant in paediatric dentistry outline the development of child protection and the dental practitioner's role in the inter-agency child protection system in this, the first of three inter-related articles.

General dental practitioners' perception of their role within child protection: a qualitative study.

AIM: This was to assess general dental practitioners' knowledge, attitudes and practice regarding their role within child protection in relation to child abuse. METHODS: Structured interviews with seven key informants from general dental practice (2), local dental committees (1), social services (2), paediatric dentistry (1) and community child health (1), together with five focus groups comprising 23 general dental practitioners (GDPs) on Health Authority Lists in Tyne and Wear and Northumberland (UK). RESULTS: GDPs reported feelings of isolation with little communication with other health professionals or local authority services. The majority had scarcely considered child protection issues in their clinical practice although those qualified for less than 15 years were more aware. GDPs acknowledged a lack of awareness of signs and symptoms of physical abuse and even less confidence in dealing with emotional or sexual abuse. Dentists expressed concern, even fear, about the outcomes of reporting suspicions, and had little knowledge of the local Child Protection mechanisms. CONCLUSION: GDPs in Tyne and Wear and Northumberland feel unprepared to undertake a role in the child protection process with confidence. National and local initiatives may be required to address existing barriers.

MRI evaluation and measurement of the normal odontoid peg position.

AIM: To measure the normal distances (and range) from the tip of the odontoid peg to the different reference skull baselines (Chamberlain's, McGregor's, and McRae's line) using magnetic resonance imaging (MRI). MATERIALS AND METHODS: We retrospectively evaluated midline sagittal MRI brain images of 200 adults chosen randomly. Patients did not have symptoms or signs suggestive of basilar impression, spinal trauma, vertebral collapse or disease. Using SPSS data analysis program histograms, mean and standard deviation (SD), median and range values were calculated. These findings were then compared with previous plain radiograph measurements. RESULTS: The mean position of the odontoid peg was 1.2 mm (median 1.5 mm, SD 3 mm) below Chamberlain's line; 0.9 mm (median 1.1, SD 3 mm) below McGregor's line; and 4.6 mm (median 4.8, SD 2.6) below McRae's line. CONCLUSION: Based on the current population, these results provide the mean and range of normal distances from the odontoid peg to the most frequently used skull baselines using MRI.

Polyethylene glycol solution as an oral contrast agent for MRI of the small bowel in a patient population.

AIM: To assess the efficacy of polyethylene glycol solution as an oral contrast agent in a patient population. MATERIAL AND METHODS: Patients were fasted from 12.00 am. Administration of the oral contrast medium commenced 15 min before imaging and comprised one sachet of Norgine (Klean-prep, Middlesex, UK) reconstituted in 1 l water of which the patient took between 500-750 ml. Norgine is a balanced mixture of polyethylene glycol and electrolytes, which when added to water produces a clear colourless, iso-osmotic solution. RESULTS: In total 38 candidates were identified retrospectively covering a 2-year period. Visualization of the jejunum, ileal loops and ileocaecal region was excellent or sufficient in 87, 95 and 89%, respectively. The time taken to obtain complete visualization of the small bowel, from the jejunum to the ileocecal region varied from 15-240 min with an average time of 65 min and 73.7% of patients necessitating delayed imaging. CONCLUSIONS: Polyethylene glycol was demonstrated to be an excellent oral contrast medium in distending the small bowel. However, small bowel transit times were significantly delayed and problematic necessitating repeated imaging within the patient population. As result of theses findings longer examination time should be expected within a patient population and this should be borne in mind when scheduling patients.