A Dental Public Health master’s student and immunology graduate, Grace upgraded her silver medal from the Tokyo 2020 Paralympic Games in what proved to be a bumper night for the Team GB swimming team on 1 September.

Three more golds were secured in the pool by Brock Whiston in the SM8 200m individual medley, Maisie Summers-Newton in the SB6 100m breaststroke and the S14 mixed 4x100m freestyle relay squad.

Grace now adds Paralympic gold to her impressive medal collection, with the swimmer already the current European champion in the 100m breaststroke (SB5), collecting gold at the 2024 Championships in Madeira and silver in the 100m freestyle (S6). She also won gold at the World Para Swimming Championships in Madeira in 2022, and silver in the 91ֱ�� event in 2023.

Following her dramatic win in the French capital, Grace : “It means more than anything. To say I’m Paralympic Champion, I’ve never dared imagine that I would ever be in this position. I was always like ‘I just want to go out and do my own race’ but to finally finish first, it feels amazing.”

Grace, who has cerebral palsy, was previously a backstroke specialist before deciding to race breaststroke in early 2021. She has come a long way in her swimming career, having started the sport for physiotherapy and joining her first swimming club at 9 years old.

James Marenghi, Head of Sport & Physical Activity at The University of Manchester, said: “A huge congratulations to Grace on her Paralympic Gold medal in the SB5 100m breaststroke, what a fantastic swim and exciting race to be a part of! She has worked so hard in and out of the pool to achieve the pinnacle in her sport and all of us at The University of Manchester couldn’t be more proud of her.

“I am extremely grateful to the all the sport scholarship support given to her from academic colleagues that have enabled her to successfully balance her sporting and academic ambitions, alongside the services delivered by our Sport practitioners. Grace is a true example of how excellence can be achieved in sport and in the classroom when balancing a dual career, and she deserves all the success that has come her way. Well done Grace!”

Paralympic cyclist Archie Atkinson, the youngest member of Team GB’s cycling squad, also won a silver medal in the C4 4,000m individual pursuit final on 31 August. A member of the Talented Athlete Scholarship Scheme (TASS), a Sport England initiative, Archie has been supported by The University of Manchester on his path to the Paralympics.

Paris marks Archie’s Paralympic debut, with the talented athlete already the proud recipient of gold in the MC4 individual pursuit at the UCI Para-cycling Track World Championships this year. He also secured gold in the MC4 scratch race at the UCI Cycling World Championships - Para-track, and bronze in the MC4 road race at the UCI Cycling World Championships - Para-road.

The Paris 2024 Paralympic Games will run until 8 September.

It  is the largest ever study of the effects of water fluoridation on the dental health of adults.

The National Institute for Health and Care Research funded data study of 6.4 million UK adults and adolescents across England and published in Community Dentistry and Oral Epidemiology estimated the public sector saved £16.9 Million between 2010 and 2020 as a result of water fluoridation.

People receiving optimally fluoridated water in the study experienced a 3% reduction in NHS invasive dental treatments such as fillings and extractions, and a 2% reduction in the numbers decayed, missing, and filled teeth, when compared to the non-optimally fluoridated cohort over 10 years.

The research team found no compelling evidence that water fluoridation reduced social inequalities in dental health and the numbers of missing teeth between the cohorts were the same.

Around six million people in England live in areas that receive drinking water with fluoride added to prevent tooth decay, including those in Birmingham and Newcastle. Water containing enough fluoride to prevent tooth decay is known as ‘’optimally fluoridated’’.

Most research on the benefits of water fluoridation was carried out before fluoride was added to toothpastes in the 1970s, and only included children, showing water fluoridation had a large impact on dental health – almost halving levels of tooth decay.

New research was needed to investigate the dental health benefits in people who have access to fluoride in toothpastes. More people now keep their teeth into old age, so understanding the benefits for adults was also a priority.

Over the 10-year period studied, optimal water fluoridation cost £10.30 per person. NHS treatment costs were £22.26 lower per person (5.5%) and patients paid £7.64 less (2%) in dental charges.

Using the data, the researchers estimate if 62% of the adults and teenagers in England attended NHS dental services at least twice within 10 years, the total return on investment would have been £16.9 Million between 2010 and 2020.

The findings echo the recently published NIHR CATFISH prospective cohort study in UK children which showed smaller than expected health benefits of water fluoridation in children.

Lead author Dr Deborah Moore, an honorary lecturer at The University of Manchester, said: “This study is the first in the UK to capture health and economic effects of water fluoridation on adults with widespread access to fluorides in toothpastes, mouthwashes and dentist-applied varnishes. 

“The patients who received optimal water fluoridation had very small positive health effects.

“But as the costs of NHS dentistry are much higher than the costs of water fluoridation, the relatively small observed reductions in visits to the dentist still resulted in a positive return for the public sector.

“This return should be evaluated against the projected costs and lifespan of any proposed capital investment in water fluoridation, including new programmes.”

The capital costs of setting up a new scheme covering a similar number of people in 2009 have been estimated at around £50 million in today’s prices; which would take 30 years to recover in NHS dental treatment savings.

Cost-recovery for new schemes, say the researchers, may not be guaranteed in future generations, as children’s teeth are in much better condition than their parents, and they may not need as much dental treatment as they reach adulthood.

Dr Moore added: “Fluoridation of drinking water is justifiably recognised as one of the twentieth century’s greatest public health achievements.

“But as fluoride toothpastes became available in the mid-1970s -   considered to be the key factor in the dramatic decline in the prevalence and severity of dental decay – the context of water fluoridation has changed.

“There is no doubt that population-level, mass preventive interventions for tooth decay are still required.

“Tooth decay remains almost universal by adulthood, even in populations that have had access to fluoride toothpastes and fluoridated water from birth.

“However, in high income countries, we may be reaching the limit of what can be achieved through fluorides alone.

“The relationship between sugar consumption and tooth decay is very clear: average consumption of sugars in the UK is more than double the recommended level for adolescents, and is almost double for adults.

“Managing sugar consumption is another area of policy that needs to be investigated.”

• A video explaining the study is available
• The paper How effective and cost-effective is water fluoridation for adults and adolescents? The LOTUS 10-year retrospective cohort study is available

The study was led by Professor William Shaw on behalf of the University of Manchester and on behalf of the University of Liverpool, along with senior co-investigators from the Universities Gothenburg, Copenhagen, São Paulo, and Edinburgh.

The study found that surgery on medically fit infants across 23 specialized cleft centres at 6-months of age reduced the risk of velopharyngeal insufficiency (VPI) at 5 years in comparison with cleft repair at 12-months.

Published in the prestigious New England Journal of Medicine today (30 August) and funded by the National Institutes of Health in the United States, the study could have major implications on current treatment pathways.

VPI happens when the soft palate does not close tightly between the mouth and the nose during speech, causing air to escape from the nose during speech and difficulties in producing specific speech sounds.

Conducted over nearly 20 years, the TOPS trial is the culmination of the life work Professor Bill Shaw  and Gunvor Semb from The University of Manchester, who are now both retired.

235 out of 281 (84%) babies randomly allocated to receive their surgery at 6 months stayed in the study until their age 5-year assessments and provided video and audio recordings of their speech assessments. In the group randomly allocated to receive their surgery at 12-months it was 226 out of 277 (82%).

The results of the international trial found:

• Randomization to primary surgery for cleft palate repair at age 6-months compared to age 12-months was associated with better speech outcome at 5 years of age. At 5 years, insufficient velopharyngeal function was observed in 21 (9%) and 34 (15%) of infants randomised to the 6- and 12-month age groups, respectively.
• There were 3 serious adverse events in the 6-month group and 1 in the 12-month group. All were resolved at follow up.
• Other safety events were uncommon and similar between groups. Rates of secondary surgery were similar between groups, but reasons varied. More infants in the 6-month group required a secondary surgery for VPI, while more infants in the 12-month group required secondary surgery for fistula.
• At 1 year, hearing and middle ear function were poorer in the group awaiting surgery. These differences, however, were not apparent at ages 3 and 5.
• Though there were no notable differences between groups for growth at 1 year, dentofacial development outcomes at 5 years were poorer for the group randomised to surgery  at 6-months. However, the difference between the two groups was not thought to be clinically meaningful.

Isolated cleft palate is a condition where the roof of the mouth is not closed properly, leaving a gap or hole and affects 1 to 25 newborns per 10,000 births worldwide.

Depending on the type and severity of the defect, cleft palate may result in communication difficulties arising from speech development and hearing loss, feeding problems, issues with dental development and facial growth, and psychological difficulties.

Professor Gamble, who led trial design and analysis, from the Institute of Population Health at the University of Liverpool said: “TOPs is a great example of the Team Science approach to research required to successfully deliver this complex and challenging trial. The analysis of the speech recordings required 41 speech and language therapists from participating sites to travel to the UK to assess the speech recordings at 1, 3, and 5 year assessment time points. This resulted in a rich and complex data for analysis.

 “This study shows us that overall the outcomes for children are better if they undergo corrective surgery earlier.

“If medically fit babies with a nonsyndromic isolated cleft palate have surgery at 6 months it limits the disruption it can cause to future key developments particularly linked to speech and hearing.

“These important findings will allow clinicians to make informed decisions about infant patient treatment and reduce the amount of further medical care they may need.”

Professor Tanya Walsh, from The University of Manchester who now co-leads the research with Professor Kevin Munro said: “There has been limited evidence from high quality randomised controlled trials on the optimal age to undergo cleft repair surgery to achieve better outcomes

“Surgery is carried out between 6 and 14 months in the many specialist cleft centres in Europe and the US. The results of this important trial will greatly support parental and clinical and decision- making.”

She added: “This research was led by our 91ֱ�� colleague Prof Bill Shaw, who has since sadly retired through ill health. Bill dedicated much of his life to cleft research.

“We are all immensely proud of Bill’s passion for and dedication to cleft research, which has been nothing short of inspiring. His kindness, empathy, and genuine interest in others will be long remembered by his colleagues and friends.”

Orthodontist Dr Ross E. Long, a long-time cleft research collaborator and friend of Bill Shaw said: “A hundred years of research has not been able to answer such basic questions in cleft care, like: ‘what works best?’.

“This study is a fitting tribute of Bill Shaw’s efforts to answer that question, and the support he received from colleagues around the world, and especially at The University of Manchester.

“Such an effort would never have been possible without his vision and commitment to quality research.

“He is truly a friend to all of us who strive to improve the lives of the patients we treat. Our memory of him and what he has accomplished to identify best practices in cleft care, will surely guide our thinking for years to come.”

The paper, ‘Timing of Primary Surgery for Cleft Palate’ is published in The New England Journal of Medicine  is available.

More details on the TOPS trial are available .

The trial was sponsored by the University of Manchester and data sharing requests should be sent to LCTC@liverpool.ac.uk.

Image by By Felsir (talk) - Own work (Original text: self-made),

Grace Harvey, a University of Manchester immunology graduate and now taking a  Masters in Public Health (Dental Public Health). , will be represent the British Para-Swimming team’ at the championships across three events.

The  University of Manchester  Sport Scholar who has cerebral palsy, began swimming when she was 4 to go on to win world gold in 100m Breaststroke (SB5) in 2022 and Paralympic (Tokyo 2020) & Commonwealth (Birmingham 2022) Silver medals.

She will be taking part in the womens 100m backstroke S6 (31st July), the womens 200m Individual Medley - SM6 (2nd August) and the womens 100m Breaststroke - SB5 (4th August).

From Ware in Hertfordshire, she has broken 11 British records and  swam for the University at the 2018 British Universities and Colleges Sport championships.

After watching the 2004 and 2008 Paralympic Games, she decided she wanted to compete and joined a club at age nine.

The swimmer follows a gruelling training regime: 8 pool sessions – around 16 hours, 3 gym sessions and 2 indoor rowing sessions.

She said: “I’m really looking forward to worlds starting, I woke up this morning thinking ‘oh my goodness we actually get to race!’ – this is the meet we’ve trained for all year and I think it’s so exciting that it’s in my home training pool as well so I’m really familiar with the facilities. Especially post the refurbishment as well it’s a really welcoming environment to have international competition in.”

“I definitely wouldn’t be able to study my master’s if I didn’t have the support from the sport scholarship team. They were incredibly instrumental in my switching my full-time study to part-time study because the demands of a masters and training for a world championships are intense. I did start off the year thinking I could manage both but I didn’t want to have a subpar performance in either so they were really key in giving me the support I needed to say ‘you know what I am struggling here’ and so I could actually succeed in both.”

She added: “It’s so exciting! When you see all the tickets and it’s saying ‘final few tickets remaining’ and then they’re coming down because all the sessions are selling out – it is just so exciting for para-sport, for the competitors racing and it’s nice knowing people want to come and support us at our local world championships in 91ֱ��.”

The competition will be at 91ֱ�� Aquatics Centre, jointly owned by The University of Manchester, 91ֱ�� City Council and 91ֱ�� Metropolitan university, built ahead of the Commonwealth Games in 2002.

The centre has just undergone the first stage of a significant refurb in time to host the Para-Swimming Championships next week.

Dr Lucy O'malley,  Lecturer in Health Services Research in the Division of Dentistry and Grace's supervisor said: “When I first met Grace, I was struck by her passion and enthusiasm for her studies. She is working extremely hard on the programme and has achieved some outstanding grades. That she can do this alongside her busy training schedule is testament to her dedication and commitment. Grace is multi-talented and an inspiration, we here at the University of Manchester are incredibly proud of her and wish her all the best for the Championships.”

James Marenghi, senior sports manager at The University of Manchester  said: “We are really excited to have the world's best para-swimmers competing on our campus. It is also a proud moment for us to have one of our student athletes represent the British team as well as the University. 

“Everyone at the University wishes Grace the very best of luck for the meet and we will all be supporting her to win more World championship medals!”

You can watch the championships live on the but check out Channel 4’s one-hour highlights programme on 20/08/23 at 8.30am.

The . Heats start at 9am each day with finals start from 5.30pm.

However, the benefits are smaller than shown in previous studies - carried out 50 years ago - when fluoride toothpaste was less widely available in the UK.

The CATFISH study, funded by the National Institute for Health and Care Research, is published today (14/11/2022) in the journal Public Health Research.

The research was led by a team from the University’s Division of Dentistry, and is the first contemporary study of the effects of initiation of a water fluoridation scheme in the UK since fluoride toothpaste became widely available in the 1970s.

The study also showed it was likely that water fluoridation was a cost effective way to help reduce some of the £1.7 Billion a year the NHS spends on dental caries.

Other collaborators on the study included Cambridge University, Kings College London, Salford Royal Foundation Trust and the specialist dental services at North Cumbria Integrated Care NHS Foundation Trust.

The study assessed the dental health of two cohorts of young children over a six year period in West Cumbria  - where water fluoridation was reintroduced in 2013, and the rest of Cumbria, which remains fluoride free.

In West Cumbria, the younger cohort were born after water fluoridation was introduced (this meant they had the full effect of water fluoridation).

The older cohort was aged around five when fluoride was reintroduced into the water supply – which meant they mainly received the benefit for those teeth already in the mouth.

At the end of the study, 1,444 five year olds who were part of the younger cohort and 1,192 eleven year olds who were part of the older cohort had taken part.

Dental teams carried out examinations on the children at regular intervals and took images of their teeth which were blinded to the fluoridation status of each participant to remove bias.

They also collected information about the children’s diet, brushing habits and dental attendance.

In the younger cohort, 17.4% of the children in fluoridated areas had decayed, filled or missing milk teeth; the number was 21.4% for children in non-fluoridated areas, amounting to a modest 4% reduction in incidence of caries.

In the older cohort, 19.1% of the children in fluoridated areas had decayed, filled or missing permanent teeth; the number was 21.9% for children in non-fluoridated areas. There was insufficient evidence as to whether water fluoridation prevents decay in older children with a difference of 2.8%.

Over the last 40 years the proportion of children affected by decay has fallen dramatically.

But because tooth decay falls disproportionately on more disadvantaged groups,  fluoridation should be considered alongside measures targeted at vulnerable populations, the team argue.

Professor Mike Kelly, senior member of the research team from The University of Cambridge said: “Health inequalities are a feature of all societies, including the UK.  The poor dental health of children from the most disadvantaged communities and the excess number of children having general anaesthetics each year still needs to be addressed.  We need to continually look at measures which can help prevent the unnecessary burden of pain and suffering”.

Dr Michaela Goodwin from The university of Manchester, senior investigator on the project said: “While water fluoridation is likely to be cost effective and has demonstrated an improvement in oral health it should be carefully considered along with other options, particularly as the disease becomes concentrated in particular groups.

“Tooth decay is a non-trivial disease which is why measures to tackle it are so important. The extraction of children’s teeth under general anaesthetic is risky to the child and is the most common reason for children between the ages of 5 and 9 to have a general anaesthetic.”

“Decayed teeth are painful and can impact on sleep patterns, learning, attention and many aspects of general health.”

“But more questions remain  and we hope to follow up on these children in the long term”.

The full paper, Evaluation of water fluoridation scheme in Cumbria: the CATFISH prospective longitudinal cohort study, is available

The results of the study were based on an analysis of NHS dental antibiotic prescribing data in England from before and during the pandemic, and an online survey in 2021 of 159 NHS dentists across England.

The paper is published in the British Dental journal today (28 October) ahead of World Antimicrobial Awareness Week (18-24 November) which aims to tackle the global emergency of antibiotic resistance.

Lead author Dr Wendy Thompson a practising NHS dentist and clinical researcher at The University of Manchester said: “We show that Covid-19 restrictions caused widespread frustration among dentists who know that procedures rather than prescriptions are generally the safest and quickest fix for toothache.

“Though dental infections can be dangerous, most toothache is not caused by infection, so is not helped by antibiotics at all. Even small infections are best treated without antibiotics.”

When lack of high-grade PPE masks meant initially dental practices were forced to close, NHS officials told dentists to perform diagnosis and management remotely by phone.

It was only rarely that dentists could refer patients to specially set up urgent dental centres (UDCs) for hands-on treatment.

Half of the dentists surveyed from across England’s regions reported that, during the first phase of COVID-19 restrictions from March to June 2020, their referrals to a UDC had been rejected because the patient had not first taken antibiotics.

One dentist told the research team: “I lied a lot. When patients had pulpitis [toothache caused by inflammation not infection], I told them to say that I'd prescribed antibiotics as a means of being seen at the Hub. Antibiotic would not have been appropriate.”

Another said: “Patients were refused to be seen at an urgent dental centre for treatment until they’d had antibiotics.”

The study also found:

• In the pandemic’s first year, antibiotic prescribing increased by 12.1% in London (the lowest increase) and 29.1% in East of England (the highest).
• Fewer than half (68/140) of respondents were confident remotely diagnosing and just a quarter (35/140) were confident remotely treating patients with acute dental pain or infection.
• Over three-quarters (109/139) reported patients requesting antibiotics more often during the first year of the COVID-19 pandemic than the previous year.
• Some of the dentists suggested remote management of patients during the pandemic had had a lasting effect on patient expectations about the ability to use antibiotics to avoid a dental procedure.

Dr Thompson said: “This study highlights that during the pandemic, restricted access to face-to-face dental care was directly linked to much higher antibiotic prescribing than in previous years.

“That puts people at increased risk from adverse effects of antibiotics, such as upset stomach, severe allergy and of course the development of antibiotic resistance.

“As the dental profession contributes around 10% of antibiotic prescribing across NHS primary care, dentists are acutely aware of the need to play their part in tackling resistance by prescribing antibiotics only when strictly necessary and appropriate.

“So being forced to prescribe them when not indicated is intensely frustrating because they know the distress that unresolved severe toothache causes to patients, and they know that dental infections treated only with antibiotics are very likely to return and be harder to treat next time.”

She added: “Understanding the essential need to keep antibiotics working, and their futility for many acute dental conditions, should be fundamental knowledge for everyone involved with planning, managing and delivering dental services.

“This includes availability of dental procedures for people with toothache or infection, by ensuring urgent dental care teams are included as essential healthcare services with access to appropriate PPE during any future pandemic.”

The paper Understanding the impact of COVID-19 on dental antibiotic prescribing across England: ‘It was a minefield’ is available here

Dr Thompson is chair of antibiotics working group at the FDI (Fédération Dentaire Internationale ) World Dental Federation, a Fellow of the College of General Dentistry and its lead on antimicrobials and Fellow of International College of Dentists.

The Humanising Healthcare programme gives dentistry, pharmacy and optometry students the chance to deliver healthcare and healthcare education to poorer communities as part of the curriculum.

The MacJannet Prize for Global Citizenship, launched in 2009, recognizes exemplary university student civic engagement programs around the world and is a key element in the MacJannet Foundation’s work to build a community of global citizens.

The prize is sponsored jointly by the MacJannet Foundation and , a global association of 388 universities in 77 countries on six continents, all committed to developing student leaders who are actively engaged with society.

The Selection Committee said they were impressed by the initiative and wished to recognize and support the continued civic and community engagement work.

The scheme built on the success of a dentistry Service-Learning programme called ’, established in 2012 by Dr Senathirajah (Raj) Ariyaratnam and shortlisted for the 2018 MacJannet prize for Global Citizenship.

The work extended to pharmacy and optometry education to create the ‘Humanising Healthcare’ programme.

Dr Ariyaratnam said: “Humanising Healthcare is based on the premise that we cannot create excellent healthcare professionals of tomorrow without creating engaged ones.

“Our goal is therefore to support students to deliver essential healthcare and healthcare education to different communities as part of the curriculum.

“But it’s also about encouraging global volunteering while creating a workforce characterised by civic values and skills that have direct community benefit in meeting health challenges.”

Up to 2019, when COVID-19 struck, around 1,000 dental students treated 38,720 paediatric and 140,800 adult patients respectively over 10 years as a core part of the curriculum.

And 150 students volunteered in 15 countries across the world to provide oral health care and education to thousands of people under the supervision of the local dentists.

Working with students to co-design bespoke healthcare services in the UK, they helped refugees and asylum seekers, LGBTQ+ community members and native non-English speakers.

During the pandemic, dental students provided online support to Chinese and Tamil speaking 91ֱ�� communities which was extended to provide quality COVID information for hard-to-reach communities North Sri Lanka.

In 2019 the University hosted the UK’s first national Service Learning in Healthcare conference; as a result, a UK healthcare Service-Learning framework is now being developed.

Students organise an annual ‘DentMan’ conference to share their community experience with peers and to inspire future generation. The 2021 conference strengthened links with students and teachers at the University of Ghana.

The year three pharmacy curriculum was transformed to deliver healthcare awareness raising workshops to local 14 and 15-year-old school pupils.

Since 2017, over 400 pharmacy students have delivered 100 workshops to over 3000 pupils as part of the assessed core curriculum.

Topics include antibiotic resistance, mental health, wellbeing, diabetes, obesity and alcohol awareness. The workshops were well received by both high school pupils, teachers and the students delivering them.

Dr David Allison a Reader in Pharmacy Education at the University said: “We aim to help improve the health of the population by raising awareness of healthcare issues that start in adolescence

“It also gave our students an opportunity to give something back to society, and enhance their community engagement skills and sense of civic responsibility.

“ This is a unique, beneficial and enjoyable learning experience for our students; it is the first example of Service–Learning as a core curriculum activity in any UK School of Pharmacy”

An optometry clinic within the University has been running in 91ֱ�� as part of the optometry programme since 1913.

The clinic is a service learning centre that provides community eye care services to the local population while allowing students to gain valuable experience through providing the service.

Students and staff regularly engage with local schools and public through a series of activities. And more than 400 students have engaged with international and national charities to help raise eye health awareness.

Dr Wendy Thompson, a dental researcher from The University of Manchester, says users also reported turning to antibiotics when unable to access urgent dental services.

The findings ring true with by Dr Thompson, who discovered that dentists increased dental antibiotic prescribing by 25% in England during the COVID-19 crisis when dental services were less accessible.

“While antibiotics do not cure toothache, it is surprising that so many of the social media users had experienced taking antibiotics for toothache,” said Dr Thompson.

The study was carried out with undergraduate Rachel Emmott , now a foundation dentist.

Internationally, dentists are estimated to be responsible for 10% of all antibiotics prescribed to humans.

Studies in the United Kingdom and United States have shown up to 80% of dental antibiotic use is unnecessary, fueling antibiotic resistance.

Some users in the study, published in the International journal of pharmacy practice, reported having to wait up to a week in severe pain before access to professional treatment was available.

But conversely, the desire to avoid a dental appointment was also expressed as a reason for seeking antibiotics, often underpinned by fear of dental treatment or its cost.

People are known to regularly seek antibiotics for toothache from non-dental professionals, including general practitioners and in emergency departments. Self-medication by people with toothache is also reported.

The study examined 144 posts on Twitter and Facebook over two years, based on the search terms antibiotic, dentist, and tooth-ache.

According to the researchers, because the search criteria was tightly defined the number of entries was higher than expected, indicating that the phenomenon is likely to be common.

Dr Thompson said: “A general belief that antibiotics are an appropriate and necessary treatment for toothache exists.

“Some people believe antibiotics are always the appropriate treatment for toothache and are frustrated or disappointed when they are not prescribed.

“In this sample of social media users, the misplaced belief that antibiotics are an appropriate treatment for toothache was widespread.

“Users attributed their behaviour to poor access to professional dental care, but also avoiding dental appointments because of anxiety and the perceived affordability of dentistry.

“And a range of strategies to cope with the severe impact toothache was having on people’s quality of life were identified, from prayer to antibiotics.”

More than half of all the posts portrayed an element of physical pain of varying severity, including ‘agony’, ‘excruciating’, and ‘unbearable.

A feeling of inability to cope and issues needing to be overcome to continue daily activities was evident, including the inability to drive, lost productivity and missed social events.

She added: “Managing this behaviour through addressing people’s expectations and desire for antibiotics to cope with toothache should be part of our strategy in tackling antibiotic resistance.

“That means appropriate access to professional dental care for those with acute toothache, including for people with fear of dentistry and people on low incomes, should be integral to health services reviews of dentistry.

“Furthermore, the time is now ripe for these important issues for dentistry to be included in the government’s next UK 5-year national action plan on tackling antibiotic resistance.”

'Antibiotics for toothache: A social media review’ is piblished in the International journal of pharmacy practice

Experts from across the UK - including The University of Manchester - have carried out a rapid review of evidence to help policy makers decide how to reopen dental services after the Lockdown ends.

While the COVID-19 pandemic has resulted in the closure or reduction of dental services across the world, attention is now focussed on planning the re-opening and restructuring of dental services.

All the sources investigated by the team emphasised the need to focus on activities that minimise risk to staff, patients and the public but still support high quality clinical care.

While the review does not itself make recommendations for reopening of dental services, its key messages include:

• Most guidance sources recommend patient triage by telephone; some recommend temperature screening at reception.
• Most sources recommend avoiding aerosol generating procedures (AGPs), if possible.
• Sources include recommendations on how to reduce the risk of transmission (e.g. use of pre-operative mouthwashes; high volume suction; rubber dam; and Personal Protective Equipment [PPE]).
• All sources emphasise the need to focus on activities that minimise risk (to staff/patients/public) but still support high quality clinical care.

The group was led by Professors Jan Clarkson from The University of Manchester and Craig Ramsay from the University of Aberdeen

Professor Janet Clarkson explained, “There is now an urgent need to map out how dental services are to return to providing wider patient care. Given that we have only really known about COVID-19 for about 120 days, robust evidence to inform how to approach re-opening is scarce or non-existent.

“The same concerns exist across the world and therefore we decided to formally review the recommendations being produced in different countries as a resource for decision makers.”

Professor Ramsay added, “We identified sources from eleven countries and found relevant recommendations fell into five themes: practice preparation, personal protective equipment, management of the clinical area, dental procedures, and cleaning and disinfection.

“The review collates the range of recommendations related to each theme from the various sources identified. I would like to stress that this review is not guidance but, in the absence of robust evidence, it should assist policy and decision makers in producing national guidance for their own settings.”

Jan Clarkson added “Conducting this review has been a hugely collaborative international effort and I am extremely grateful to all those involved for working so hard to complete it in such short time.”

The review group comprised researchers and clinicians from a range of UK institutions including the Scottish Dental Clinical Effectiveness Programme, NHS Education for Scotland, the Universities of Aberdeen, Dundee and 91ֱ��, and Cochrane Oral Health.

The rapid review entitled “Recommendations for the re-opening of dental services: a rapid review of international sources” can be found at

Researchers at Central 91ֱ�� University Hospitals NHS Foundation Trust (CMFT) and The University of Manchester have been awarded more than £5 million to evaluate the timing of surgery for infants with cleft palate.

The National Institute of Dental and Craniofacial Research (), a branch of the U.S. National Institutes of Health, has contributed the follow-up grant ($7.6 million) for the TOPS (Timing of Primary Surgery for Cleft Palate) clinical trial.

The money will allow the team of researchers, led by and , to complete the TOPS trial over the next five years.

The international is looking into the timing of surgery for cleft palate in infants and compares the results of surgery performed at either 6 or 12 months. It involves data over a wide range of disciplines such as clinical genetics, speech and language pathology, audiology and orthodontics.

A review of surgical practice across the UK and Scandinavia identified differences in the timing of primary surgery in infants with cleft palate. There is currently no reliable evidence to support that either primary surgery at age 6 months or age 12 months produces better outcomes, however, it is thought that the timing of surgery may influence speech development and for that reason the best possible timing should be assessed.

More than 550 infants with cleft palate were recruited at 23 sites in the UK, Denmark, Norway, Sweden and Brazil between September 2010 and July 2015, with a grant that the NIDCR previously awarded. Babies who participated in the trial received surgery using the same technique (Sommerlad technique) and were randomly assigned to have their surgery when they are either aged 6 months or 12 months. There was a 50:50 chance of infants being in either group.

After surgery, children taking part will be followed up at age 12 months, three years and five years when speech, hearing and physical development will be reviewed.

Professor Shaw said: “The main objective of this trial is to determine whether the timing of the cleft palate surgery has an influence on speech development. We hope that through this study we will be able to offer recommendations to help shape surgical procedures for young patients with cleft palate in the future.

“We also aim to help improve early speech and hearing, and thus the social integration of affected children; to reduce the burden of remedial care and secondary surgery that they and their families presently endure and to reduce the financial costs of care associated with cleft palate.”

The TOPS site at was the first to start recruitment for the study in September 2010, and 91ֱ�� is hosting the data evaluation meetings planned until 2020.