Colgate: The times they are a-changin’ (or doctors and dentists must talk to each other)

In this year’s series of interviews for the EFP Partner newsletter, the EFP is looking at the link between lifestyle, nutrition, and oral-health synergies and systemic health, which is now hardly disputed. From diabetes to cardiovascular problems, what goes on in the mouth does matter for the rest of the body. So how are the EFP and its partners dealing with this?

In this interview we talk to Dr Marie Ryan, executive vice president and chief clinical officer at the Colgate Palmolive Company and Dr Irina Laura Chivu, Head of Scientific Affairs, Europe and Africa-Eurasia with the company.

The 1964 Bob Dylan song “The times they are a-changin’” comes to mind when you hear Dr Marie Ryan talk about the absolute link between systemic and oral health.

“Times are changing, thank God, and it's important for that to happen. We do know that oral health is inseparable from whole person health, and it is the gateway to systemic health. There’s more and more data emerging every day looking at the connections between oral health and overall health and wellbeing.”

Maria has watched this develop over her years as a periodontist.

“I have been very involved in perio research throughout my career. And we know that the infection and inflammation in the oral cavity, with periodontal disease being the most common chronic inflammatory disease in the world, can impact overall health.”

Statistics back this up. Evidence now shows oral disease can increase the risk of heart attack twofold, a stroke threefold and, if you have diabetes and periodontal disease, controlling sugar levels is harder.

Maria Ryan adds: “Periodontal disease increases your risk of having adverse pregnancy outcomes, and increases the risk for respiratory diseases, even Alzheimer’s. So, inflammation has a very significant impact on overall health and people need to recognise that.”

How to educate both clinicians and the public?

“The problem”, thinks Dr Ryan, is “that it's not visible to patients, so they're not aware of it unless we talk to them about it. We show them the disease that they have. Most people look at teeth very aesthetically. They look at white teeth and straight teeth, a beautiful smile.”

That doesn’t get to the root of the problem.  So much so that Maria Ryan created a little quiz called Know Your Oral Health Quotient.

“One of the first questions is what is the most common disease that people face globally? It happens to be caries, and they will pick anything but caries as they don’t recognise it as a disease.”

Is part of the problem that dentists and doctors are such separate wings of healthcare and don’t really talk to each other?  Yes, believes Maria though she has been referring some patients to their doctor when she suspects a systemic problem.

“In medical school they get very little training on oral health and disease, it is minimal. So, when we talk about the issues we face with oral-health literacy, we're trying to help with something like Know Your Oral Quotient going out to the general population, we also need to educate our medical colleagues, the nurses.”

Vital work

Colgate Palmolive supports a programme called the 100 Million Mouths Programme which was started by a GP who understood medics must be across oral health.

Irina Chivu thinks the work the company is doing with the FDI (World Dental Federation) is also vital.

“We work together with FDI on an education platform to increase accessibility to the latest state of the evidence substantiating those connections between oral health and systemic health and deliver that to dental professionals to facilitate education either within the profession or towards patients.” 

She adds enthusiastically: “We have this tool that is available online for free for everyone to consult, on understanding what's the latest status evidence in oral-systemic health connections, giving some tips and guidance on how to communicate that to patients. It is called ‘whole body health’.”

Maria chips in: “It's really cool. I mean, they show a body and you can click on it, and it will give you the data on those connections we talked about before.”

Maria is particularly proud of the work Irina’s team has done working with the National Health Service in the UK. You can see why.

“The number one reason for children being hospitalised (in the UK) is dental decay. So, they are actually providing oral-health products to over 100,000 children!”

Irina explains: “We are providing free toothpaste and brushes for the children to brush within the school because there is a lot of evidence supporting the fact that in-school brushing is very effective in acquiring the habit.”

She adds: “There are different games and elements to engage the children in understanding more about oral health, understanding about diet, how to control caries, and then there's also a leaflet for parents at home to get more information to them.”

Lifestyle changes

Of course, lifestyle plays a part. From diet, sleep patterns to smoking cessation and eating less sugar, educating the public on lifestyle is vital. So too is lobbying governments and other organisations.

Maria Ryan again. “We put out a white paper entitled An Economic Rationale for a Global Commitment to invest in Oral Health. And within that paper it talks about the economic burden globally of poor oral health.  And it is $710 BILLION.”

Whether it is the cost of treatment, or loss of productivity that cost is enormous.

Maria ends with a spot of praise for the EFP itself.

“We work with EFP, who had the report on perio and caries, and I'm very proud of EFP for doing that because most perio organisations will only talk about perio, but they talked about both. They've done a great job with that. They also have ‘the Journey to a Healthy Smile’ which is all about behaviour change.”

She adds: “We have these programmes like Bright Smiles, Bright Futures and Know Your Oral Health Quotient.  We do the research to see what the impact is of educating people about the oral diseases they face. We have changed people’s knowledge. We changed their attitudes!”