How fear influences pain perception

The relationship between pain and emotion, especially in dental circumstances, is generally well-known but not well-understood, so a team from University of Montreal, using hypnosis, undertook a study to examine how different emotional states influence pain perception. Ratings were compared in seven conditions: a pre-hypnotic baseline and hypnotically induced neutral relaxation, depression, anger, fear, anticipation of relief, and satisfaction. They found that pain unpleasantness significantly decreased in hypnotic relaxation compared with the pre-hypnotic baseline. But the unpleasantness increased when the three negative emotional states - depression, anger and fear - were induced, confirming the investigators' hypothesis that negative emotional states relevant to pain increase pain unpleasantness.

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GDC seeks members of new Appointing Body

The General Dental Council (GDC) is launching a national recruitment campaign to find members of the public and the dental profession to form a new, independent Appointing Body.

In the future, members of the GDC will no longer sit on the committees which make judgements on dental professionals' fitness to practise.

Instead, this role will be taken on by a new, independent Fitness to Practise Panel of lay people and dental professionals. It will be the job of the Appointing Body to select and recruit the members of this new Fitness to Practise Panel.

The GDC is recruiting six people to the Appointing Body: three lay people, two GDC-registered dentists and one GDC-enrolled dental hygienist or dental therapist. The Body will be independent, so members of the GDC cannot be on it.

The recruitment campaign is aimed at people with experience of making senior level appointments; knowledge of good employment practice; a demonstrable commitment to promoting diversity; experience of working as a member of committees or panels; and good interpersonal skills.

GDC President, Professor Nairn Wilson said that he is delighted that recruitment to the Appointing Body is getting underway because members of this Body will have an important role to play in the reform of the GDC: helping to establish the Fitness to Practise Panel and selecting the people who will in future make decisions on dental professionals' fitness to practise dentistry.

Potential applicants can log on to the 'What's New' section of the GDC website at www.gdc-uk.org/whatnew to find out more about the Appointing Body and how to apply.

Dentists welcome watchdog call

A report by the Audit Commission highlighting the weaknesses of the current system of NHS dentistry received strong backing from the BDA.

John Renshaw, chairman of the BDA's Executive Board, said that the report strongly reinforces the BDA's view that the Government should get on with the job of reform. On the issue of so-called 'wastage', he says that the report is clear that this relates to the outdated 'piecework' system of reimbursing dentists. "The Audit Commission paints a picture of hardworking dentists struggling to make an out-of-date system work. But the reality, as the Audit Commission well knows, is that you can't boost quality on the cheap; and that's why Government must put its money where its mouth is to safeguard the future of NHS dentistry".

Professor Nairn Wilson, President of the GDC, also welcomed the publication of the report and said that the Council will carefully study the recommendations. He says that the GDC's reform programme will, through the introduction of a new non-NHS complaints scheme, procedures to deal with poorly performing practitioners, the registration and revalidation of all members of the dental team, and improved ethical guidance, contribute to remedying some of the deficiencies and promote high standards of care. He says that the Government's proposals in Options for Change also seek to tackle shortcomingings in NHS dentistry.

How dental bacteria swap resistance

A team led by Dr Peter Mullany, of the Eastman Dental Institute, London, has found that bacteria in the mouth and gut have identical antibiotic resistance genes.

This may prolong the useful lifetime of antibiotics. They also found that many of these genes are found on short, mobile pieces of DNA called transposons which theoretically can be transferred between different types of bacteria.

In order to test the theory, Dr Mullany's group produced artificial dental plaque in the laboratory, using bacteria from a sample of human saliva. They added a donor bacterium, Streptococcus salivarius, to the plaque, which contained a transposon with a gene for resistance to the antibiotic tetracylcine.

After a while other Streptococcal species in the plaque became resistant to tetracycline. Dr Mullany said that his team found that when a soil bacterium was used as a donor it could pass on its transposon, even though it could not grow in plaque.

In the long term, he says, by understanding how antibiotic resistance genes are transferred, we can work out how to stop or slow down gene transfer. This may prolong the useful lifetime of antibiotics. The research was presented at a meeting of the Society for General Microbiology at Loughborough University. The conference also heard that good bacteria growing in dental plaque could help fight off bacteria that cause periodontal disease and dental caries if they are given a competitive edge. Under normal circumstances, the plaque that grows on teeth contains a mix of good and harmful bacteria. However, harmful bacteria tend to thrive in the acidic environment that is created when we eat sugary foods to the detriment of beneficial bacteria, which increases the risk of tooth decay.

Similar disruptions in the delicate bacterial balance can lead to periodontal disease. Antibiotics are available to treat periodontal disease, but they work by 'wiping out' all bacteria. This gives non-harmful bacteria no opportunity to fight back, which they can do if the environment in the mouth is less made less acidic.

Professor Philip Marsh, of the Centre for Applied Microbiology and Research, Salisbury, said it should be possible to control the environment in the mouth more effectively to stop the non-harmful bacteria being killed off, and to modify the conditions that favour the growth of the harmful organisms. He says that bacteria involved in periodontal disease feed on host proteins and cannot grow in air. This could be controlled using anti-inflammatory drugs (to reduce their food supply) or redox agents (to make the gum environment more oxygen-rich). or it can be controlled by using alternative sweeteners, or stimulating saliva production we can reduce the growth of bacteria that cause tooth decay.

How crabs can help fight infection

Scientists have developed a new toothpaste made from crab's shell that helps fight infections in the mouth. The paste, which could be on sale in a year's time, contains tiny polymer particles each enclosing a speck of bacteria-killing agent. Because they are sticky, the particles lodge in areas of the teeth and gums vulnerable to infection and are not washed away by saliva. As they react with water, each particle breaks down over time to release its load of triclosan - a widely used antimicrobial chemical.

Dr John Smart developed the toothpaste with Phd student Sandra Kockisch at the University of Portsmouth. The team found that chitosan - derived from chitin, the main component of crab and beetle shells was the most effective in laboratory tests. One of the team's challenges was getting the bacteria-killing agent triclosan into the particles, because the drug is not water soluble. Another challenge was to ensure that the particles were the right size. Too large, and they would feel gritty; too small, and they would not contain enough of the drug.

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Perio treatment makes pregnancy safer

Periodontal treatment helps to reduce the risk of having a low birth-weight or pre-term baby, reports the American Dental Association.

Researchers in Chile studied 400 pregnant women aged 18 to 35 with advanced periodontal disease, half of the subjects were given periodontal treatment before the end of the second trimester while the other half were treated after giving birth.

Scaling and root planing, good oral hygiene advice and an antimicrobial mouth rinse for daily use were given to the 200 subjects receiving treatment. About 18 per cent of those also received antibiotics. Two per cent of those receiving treatment gave birth to either a low birth-weight or pre-term infant. Of those receiving treatment after giving birth, 10 per cent had either a low birth-weight or pre-term baby.

Other research has also linked advanced periodontal disease and pre-term deliveries when bacteria from the mother's mouth travel through the bloodstream to the placenta and foetus, possibly stimulating pre-term labour.

The results of the study are published in the August issue of the Journal of Periodontology.

Just use the magic Wand

A computerized injection device called the Wand could help reduce pain from injections. The Wand injects anaesthetic at the slowest possible rate, reducing pressure and 'sharp scratch' sensation. However, because the device works slowly, it increases the time spent in the chair by patients. In a study, Dr Keith Allen and colleagues at the University of Nebraska found that children administered with the Wand exhibited fewer signs of distress and discomfort. Although the Wand injection takes an average of 3 minutes to administer, compared to 15 seconds for a traditional injection, Allen suggests that reducing the extreme pain of the traditional injection and adding a period of only modest discomfort may help prevent children from developing a fear of the dentist.

New dental appointments to drive forward dental reform

Two new dental appointments to drive forward NHS dental reform have been announced by the Department of Health.

From November, Barry Cockcroft will take up the post of the new Deputy Chief Dental Officer and Tony Jenner will join the Department of Health as NHS Dentistry Change Project Leader. The posts will report to the Chief Dental Officer and will be working on the modernisation agenda for NHS dentistry.

The responsibilities will include working with stakeholders to take forward the ideas in 'NHS Dentistry:Options for Change'; improve patient experience of NHS dentistry; improve the working lives of dentists; take forward the development of IT for dentistry;

Welcoming the appointments, the Chief Dental Officer Professor Raman Bedi said that both appointments will be valuable in achieving improvements in helping to modernise NHS dentistry through changes in the way services are delivered.

Barry Cockcroft graduated from Birmingham in 1973 and started his career in a maxillo-facial unit before moving into general dental practice. He is currently a partner in an NHS dental practice in Rugby which is part of a Personal Dental Services scheme. He has been a member of the General Dental Services Committee of the BDA since 1991 and as elected to the position of Vice-Chairman in 2000. He led one of the Task Groups of the modernisation project NHS Dentistry : Options for Change.

Tony Jenner graduated from the University of Newcastle upon Tyne in 1971. After eight years in both general dental practice and the community dental service he was appointed District Dental Officer in Cheshire in 1983. In 1992 he became Regional Dental Officer in Mersey and in 1996 was appointed Regional Dental Officer and Consultant in Dental Public Health for the North West Regional Office of the Department of Health.

He is currently leading the work at national level on Information Technology in Dentistry, and is the Dental Project Lead for the Modernisation Agency's National Primary Care Trust Development Programme (NatPaCT) and is also Dental Advisor to the National Prison Health Care Task Force.