Hypodontia care in the UK: working together to achieve better clinical outcomes

This is the last of four themed issues related to the delivery of specialist restorative dentistry, alongside other dental and medical colleagues, within multidisciplinary (MDTs) teams. Previous issues have focused on Head and Neck Cancer,¹ Tooth Wear² and Cleft.³ This issue explores the delivery of care to patients affected by hypodontia, a term we use throughout the issue, (although it is described variously as hypodontia, oligodontia and partial anodontia), and denote mild, moderate or severe to identify the number of teeth that fail to develop.

Hypodontia is one of the most common dental anomalies, with prevalence (excluding third molars) of 6.4%.⁴ It therefore affects a large number of patients attending for dental care, and is a significant proportion of the demand on services for restorative dentistry and orthodontic specialists. Treatment is often complex, provided over several years, and usually requires the involvement of a MD team. It is not possible to reduce the number of patients affected by hypodontia, but it is important to improve our understanding of the condition and to design services that deliver high standards of care to those who need it most. This themed issue aims to assist with these goals.

Numerous hypodontia papers have been published, many by UK clinicians, often in the BDJ. Perhaps the opportunity for delivering NHS state-funded, MDT specialist care has allowed these services to flourish. Approaches to managing these patients have been refined, with advances in treatment planning, restoration design and dental materials all leading to improvements in clinical outcomes.

RD-UK is an association for consultants and specialists in restorative dentistry. RD-UK has national Clinical Excellence Networks (CENs) for hypodontia and developmental disorders, for cleft, and for head and neck cancer. The Hypodontia CEN has over 40 consultants, with over 500 years of collective experience, gained from managing tens of thousands of patients, and is therefore a unique clinical network. As well as being willing to share learning, members collaborate, agree hypodontia care pathways, and develop consensus views for the management of each common hypodontia presentation. Many of these discussions are reflected in the content of this themed issue.

The GDP will usually be the first to recognise hypodontia and, if referral to another colleague is required, will continue to provide clinical care for the patient both during and after any specialist care offered.

It is important to improve our understanding of the condition and to design services that deliver high standards of care to those who need it most.

The discussions and treatment planning agreements will usually take place when the patient is a child or young adult, and yet the impact of these decisions may affect the patient and their family for many years. Recognising and involving the patient in the decision-making is increasingly important.

The majority of hypodontia patients will be considered suitable for orthodontic treatment and the ideal delivery will either avoid the need for subsequent tooth replacement or facilitate the provision of an acceptable and reliable restoration. Similarly, many patients will require oral surgery for the removal of deciduous or permanent teeth, exposure or removal of impacted teeth and placement of dental implants. This MDT approach requires a high standard of coordination and communication between specialist and general practitioner colleagues. Dental technicians are involved in the orthodontic and restorative management of almost all hypodontia patients and are also recognised as important MDT members, with expertise that is required to achieve an acceptable treatment outcome.

Each author demonstrates their knowledge, skills and experiences from working in hypodontia MDTs in the UK and their knowledge of international research. I am deeply grateful to them for contributing these papers and I do not underestimate the time and effort required to do so. I am confident that we have delivered a breadth and depth of content to support clinical teams when managing these patients.

As this is the last of these four restorative dentistry and MD team themed issues, I also thank and congratulate my colleagues Dr Lorna MacNab, Dr Sandip Popat, Dr Johanna Leven and Professor Philip Preshaw and his colleagues at the BDJ, for their considerable effort and support, from the original conception of the four issues, to delivery of such high-quality content.