EFP: Teach a child to cook? Teach a child to brush and floss!

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 Andreas Stavropoulos, current treasurer of the EFP, chair of EuroPerio 12, and Professor of Periodontology at Malmὂ University in Sweden.

The EFP is the overarching body of periodontology and thus has a really good overview of the industry.  It hovers like a drone above a beautiful landscape seeing the whole range of issues and developments.  So, does Professor Andreas Stavropoulos confirm what all dental professionals are starting to think, that there is an inextricable link between oral and systemic health?

“Yes, absolutely!  The evidence has been tremendously increasing during the last years, both from association studies showing the link between periodontal diseases and different systemic diseases, but also in terms of mechanistic studies where we identify mechanisms that can explain these associations that we see in the clinic.”

What sort of systemic diseases might be linked to what’s going on in your mouth?

“The strongest, maybe, is with diabetes and cardiovascular diseases”, he says, but adds: “Evidence seems to be emerging for several other conditions, for example for inflammatory bowel disease and that makes a bit of sense because it is the same canal.”

He doesn’t stop there though, adding the potential for links with cancer, particularly pancreatic, and even Alzheimer’s.

The role of inflammation

The common explanation for these connections is inflammation. Professor Stavropoulos elaborates: “It just accumulates from the various systems, and what I say to my patients is, if you have a little bit of inflammation in the mouth, then a little bit in the stomach, in the guts, in your joints, this inflammation goes around your entire body. And with time, as we get older that adds up.”

Inflammation is an enemy, but so too is bacteria, and the mouth is full of bacteria, and it can travel.

For Andreas Stavropoulos it is vital that education of the population is at the forefront of fighting periodontitis, and it must start in schools.  He looks at the country where he lives, Denmark, and the country where he works, Sweden.

In Denmark, there are dentists within many schools, and they are all connected to a dental clinic. In Sweden, they no longer have school dentists as such, but every school is connected to a dental clinic. Children get regular (once-a-year) checkups, while dental hygienists visit the schools and inform students about oral hygiene and nutrition. On top of this, dental care is largely free for children in both countries. So, awareness of the importance of oral health is relatively high here.

Even so, one could do better.  “You know they have cooking classes in my son’s school once per week. Cooking classes!  Why can’t you add 15 minutes of weekly toothbrushing classes?  It doesn’t even cost that much. It frustrates me because it doesn’t make sense to me.”

So, there is evidence linking systemic and oral health, and more should be done early, in schools, to educate children.  What about lifestyle changes, though, things like diet, smoking, etc.?

Andreas Stavropoulos is rather sceptical here too.  “If one does not, let’s say, quit smoking, considering how much we have all been overwhelmed with information that it is a risk factor for cancer and heart disease, then one may expect that it is not likely people would quit because it’s also bad for the teeth! Yet, we need to insist and inform about life-style factors that play a negative role on oral health, and promote behaviour changes”

So far, we have explored the link between bad oral health and periodontitis and the effect it has on other parts of the body. Can it work the other way round though?  Could a systemic disease play havoc with oral health?

The answer is yes. As he explains: “Diabetes for sure has an impact on periodontitis, it is defined as a sixth complication of diabetes. It isn’t an aetiological factor, but for sure a true risk factor.”

Without getting too scientific, diabetes results in a dysregulated immune response, so the body’s response against bacteria is less effective and causes more damage than good.

Andreas Stavropoulos adds that many people with inflammatory bowel diseases often have flare-ups in the mouth, so there is evidence of body-to-mouth problems and not just the other way around.

Another parameter is diet, which definitely affects many of these disorders, according to Professor Stavropoulos.

"Absolutely, it's a connection with what you eat and your overall health. Why shouldn't it have an impact in one particular part of the body system, which is the mouth? I think it's just logical, isn’t it?”

The EFP's work

Finally, what of the EFP itself, and how it can help spread the message on systemic and oral health?

“We need to educate our colleagues, especially our medical colleagues”, opines Professor Stavropoulos, who adds: “We should organize more joint meetings with cardiology, with diabetes and home doctors, to try to increase their awareness of the connection.”

Andreas is also extremely keen on acknowledging the role the various EFP partners can play in education of the public and cites advocacy white papers.

“We have published many white papers supported by our partners (and also have ongoing studies) addressing various topics, including the financial burden of oral diseases and the economic benefit of prevention and good oral health within various aspects of our modern societies. A few examples of published papers are: Curasept (The impact of oral health on athlete performance), Oral-B (Socioeconomic impact of periodontitis) and Haleon (Burden of caries and periodontitis).” More will be published in the coming months.

As treasurer of the EFP, as well as a practicing periodontist, Professor Stavropoulos is extremely keen on the need for advocacy and lobbying of governments and organizations to promote better oral health and is grateful to partners who are so helpful in this regard.

“We couldn’t have done it without the support of the partners.”