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, you know, 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 reason for these connections is simple. Inflammation. Professor Stavropoulos explains: “It just accumulates, and what I say to my patients is you have a little bit of inflammation in the mouth, then a little bit in the stomach, in the guts, in your joints. 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 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.

While in Denmark there are school dentists, or at least a clinic connected to various schools, with children getting a once-a-year checkup as a minimum.  This is not so over the bridge in Sweden.

Even so, Denmark 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 toothbrushing classes?  It doesn’t even cost that much. It frustrates me because it doesn’t make sense to me.”

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 disheartened here too.  “If people do not, let’s say, quit smoking, considering how much they have been bombarded with information that this is bad for cancer and your heart, then they wouldn’t quit because it’s bad for your teeth!”

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, it seems to be to do with the blood in the small capillaries that go into your gums and what that blood contains in terms of bacteria.

Andreas Stavropoulos adds that many people with colitis—especially Crohn’s disease—also have a lot of flare-ups in the mouth, so there is evidence of body-to-mouth problems and not just the other way around.

Diet definitely affects these digestive 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”, opines Professor Stavropoulos, who adds: “We should do 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 and cites three advocacy white papers.

“We have three ongoing studies or white papers supported by Curasept (Economist Enterprise), Kenvue (Triangulate Health), and Haleon (Triangulate Health), all more or less looking at the financial burden of oral diseases and the financial benefit of prevention and good oral health within various aspects of our modern societies.”

As treasurer of the EFP, as well as a practising 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.”