Experience based dentistry-empowering dental nurses to improve periodontal health of care home residents.

​In October 2024, a research paper was released suggesting that “Sugar rationing during and after World War II in the UK reduced the risk of type 2 diabetes and hypertension in later life, particularly for those exposed to sugar restrictions during pregnancy and early childhood. The study leverages a "natural experiment" by comparing the health outcomes of individuals conceived before and after the end of sugar rationing.”(1)
On April 1 2025, politicians worldwide sprung into action. They stipulated that the food industry had to remove added sugar from all food products for the under fives for the long-term health benefits in sixty years. They announced a sugar tariff of 200% worldwide, except in the USA, where they decided to remove fluoride from the water to help protect vulnerable dentists.


Dental disease, including tooth decay and gum disease, is the most prevalent disease and is related to our general well-being.
In 1906, The “Father of Dentistry”, GV Black, advised the use of silver nitrate to treat tooth decay, and it worked. However, removing the disease surgically and restoring the missing tooth tissue with dental fillings became the norm. (2)


Silver diamine fluoride (SDF) has been used in Japan for over 70 years. The silver destroys the bacteria that cause the disease, and the fluoride hardens the damaged tooth tissue. It has been used in the States for over 10 years, and is available in the UK, but clearly underused.
The problem is as stated in the 2019 research paper on “Evidence-Based DentistryUpdate on. Silver Diamine Fluoride”(3)


6. Equitable—Its application is equally effective and affordable; with the medicament costing less than $1 per application, it is a viable treatment for lower-income groups.
The only apparent drawback is that as the caries lesions become arrested, the precipitation of silver byproducts in the dental tissues stains the lesions black, which can deter its use in visible areas.


This is incorrect. When given the choice, young children and frail adults would prefer a black tooth as opposed to a dental extraction. The problem is that it’s too cheap. A trained dental nurse can apply a black tooth in under two minutes in care homes and schools with suitable consent.


SDF (Silver Diamine Fluoride) has been used extensively now in care homes, with photos taken of the black staining that occurs when treating active disease. More interesting is the improvement in gum health, as poor mouth health is directly linked to more serious general health diseases such as pneumonia. The mode of action was in the 2001 research paper 2001 “Antimicrobial activity of silver nitrate against periodontal pathogens”(4), and more recently in 2023 “Effect of silver nanoparticles associated with fluoride on the progression of root dentin caries in vitro”.(5)


To learn more about SDF and other health options, see my YouTube channel, Teeth4life, and search DHS, SDF, or the care home playlist.(6)
There are one-day courses available to become proficient in taking blood. For trained dental nurses, there is a fourteen-month Oral Health Practitioner (level 4) course (7). There are seven sites for the 60,000 dental nurses, but they are underused for a variety of reasons, such as the distance of travel, little financial incentive for the nurse, and the dentists needing the nurses in the surgery.


I will set up some free online dental nursing courses on the dentalhealthservice.net website.
The registration page should be available by the end of the month so that all the dental team members can be visible on the website and the DHS App later in the year.


If you have before-and-after photos of cervical caries being treated with SDF, please look at the gingivae. We don’t need to do the research; we need to promote experience-based dentistry, just as we did for Halls crowns. This is the link that prompted my visit to the American Mobile and Teledentistry Alliance meeting in Portland in February 2025.

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References

1. https://www.nih.gov/news-events/nih-research-matters/early-life-sugar-intake-affects-chronic-disease-risk
2. https://en.wikipedia.org/wiki/Greene_Vardiman_Black 
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC6500430/ 
4. https://pubmed.ncbi.nlm.nih.gov/11327077/
5. https://pmc.ncbi.nlm.nih.gov/articles/PMC9858332/
6. https://www.youtube.com/@teeth4life/playlists
7. https://findapprenticeshiptraining.apprenticeships.education.gov.uk/courses/422