25 September is Dental Health Day. This year, the motto of the day of action is “Healthy starts in the mouth – right from the beginning!”. We spoke to PD Dr. Ghazal Aarabi, MSc NAKO scientist at the Polyclinic for Periodontology, Preventive Dentistry and Tooth Preservation at the University Medical Centre Hamburg-Eppendorf. She reports on how dental health is closely linked to physical illnesses and how oral health literacy can be strengthened in the population. Ghazal Aarabi is also a member of the “Dental and Oral Health” expert group in the German National Cohort (NAKO) and head of the PAROCARD project.
What fascinates you about the field of dentistry?
My interest in dentistry began while I was still at school, when I completed an internship with my family dentist. I found the manual work and the interface with medicine very exciting. I then decided to study dentistry in Freiburg.
I discovered my passion for scientific work during my doctoral thesis. The variety of everyday life at a university hospital, the contact with students and patients and the interdisciplinary collaboration ultimately persuaded me to take up my position at the UKE.
How did you get from research at the University Hospital to the German National Cohort?
One of my main areas of research is epidemiology. We have two large epidemiological studies in Hamburg, the German National Cohort (NAKO) and the Hamburg City Health Study (HCHS). In various projects, I am researching the connection between chronic inflammation of the oral cavity and dementia as well as heart disease.
How can the oral health competence of people with a migration background be strengthened?
During my master’s thesis, I realised that both the oral health literacy and oral health of people with a migrant background are often worse than those without a migrant background. The available data is limited. The few existing studies, such as the KiGGS study, show that children and adolescents with a migrant background brush their teeth less frequently than children and adolescents without a migrant background. My aim was to find out why oral health and oral hygiene behaviour differ and which socio-cultural factors are responsible for this. The MuMi project “Promotion of oral health competence and oral health of people with a migration background” is investigating these correlations, among other things, and aims to promote oral health competence in this population group. To this end, we have developed a multilingual app application as part of the project to sustainably improve oral health in this population group.
“My aim was to find out why oral health and oral hygiene behaviour varies and which socio-cultural factors are responsible for this,” says PD Dr. Ghazal Aarabi.
A person’s oral health depends on their health knowledge, health behaviour and motivation. These are key dimensions of oral health literacy.
How exactly does the MuMi app work and what content does it convey?
The MuMi app is a training and prevention programme that is structured in three pillars. The first pillar, “What should I do?”, teaches the classic pillars of prevention – oral hygiene, fluoride, nutrition and utilisation. The second pillar, “What should I know?”, explains topics such as the structure of a tooth or relevant risk factors for oral health. The third pillar, “Who can help me?”, provides users with provides users with information about the German healthcare system, which is sometimes very complex. Users of the app can access various links that lead them to important institutions. The content is available to users in German, English, Turkish, Arabic and Russian.
What are you investigating in the PAROCARD study?
The PAROCARD study is an additional project that utilises the structures of the German National Cohort (NAKO) and investigates whether periodontitis, a chronic inflammation of the oral cavity, is associated with atherosclerotic vascular changes. Some of the participants in the baseline examination of the NAKO also underwent an examination of the intima-media thickness, i.e. the inner thickness of the vessel wall of the carotid artery. In addition, the dental examination was extended in this project to identify the severity of periodontitis. In addition, it is now possible to analyse the oral microbiome of the test subjects, which will help us to better understand the role of the microbiome.
What is the connection between periodontitis and cardiovascular disease?
There are two ways in which periodontitis can affect vascular changes: systemic inflammation and the spread of oral bacteria. Periodontitis triggers chronic inflammation in the body, which causes the immune system to work at full speed, similar to Crohn’s disease or other systemic diseases. In addition, bacteria from the oral cavity can enter the bloodstream and accumulate in the blood vessels. These mechanisms illustrate how strongly the health of the oral cavity is linked to the entire organism.
Are there any initial results yet?
The descriptive cross-sectional data of the PAROCARD study showed associations of intima-media thickness (IMT) and periodontitis in all age groups. However, the PAROCARD study sample was characterised by a low mean age and good oral and vascular health. In our models, we were able to show that IMT was predominantly modelled by age (increased IMT) and gender (decreased IMT in females). In contrast, in the Hamburg City Health population, which included middle-aged to older subjects, we were able to show associations between periodontitis and IMT in the adjusted models independent of age, gender and other known risk factors such as diabetes or smoking. It is important to mention that these are initial results and that long-term clinical studies are needed to speak of clear associations and make statements on the significance for care.
What can you recommend to prevent periodontitis?
Regular check-ups at the dentist are important in order to recognise and treat periodontitis at an early stage. In addition, risk factors such as smoking should be reduced and attention should be paid to a healthy diet. Oral hygiene at home plays a crucial role, as patients can do a lot themselves to prevent and treat the disease.
PD Dr. Ghazal Aarabi, MSc NAKO scientist at the Polyclinic for Periodontology, Preventive Dentistry and Tooth Preservation at the University Medical Centre Hamburg-Eppendorf
What recommendations do you have for those affected?
Early diagnosis of periodontitis by a dentist is important in order to reduce the burden of inflammation in the body through treatment. Tertiary prevention in particular, i.e. all measures that prevent the progression of the disease and the occurrence of concomitant and secondary diseases, is very important for patients. This includes measures such as regular check-ups, but also, for example, a healthy dental diet. This also means that these patients require lifelong aftercare.
The general aim is to keep your teeth for as long as possible. Above all, teeth are also important for a healthy and balanced diet. And this in turn not only plays an important role in the prevention of periodontitis and the development of tooth decay, but also in the prevention of other diseases such as cardiovascular disease and dementia.
Dental Health Day on 25 September was founded in 1991 by the Verein für Zahnhygiene e.V. (VfZ). The working meeting of the action group with around 30 members from the health sector and politics focuses on a different target group every year. This year, the motto “Healthy starts in the mouth – right from the beginning!” focusses on oral health during pregnancy.
Publications
- Weil MT, Spinler K, Lieske B, et al. An Evidence-Based Digital Prevention Program to Improve Oral Health Literacy of People With a Migration Background: Intervention Mapping Approach. JMIR Form Res. 2023;7:e36815. Published 2023 May 11. doi:10.2196/36815
- Spinler K, Kofahl C, Ungoreit E, et al. Access Barriers to Dental Treatment and Prevention forTurkish Migrants in Germany – A Qualitative Survey Front. Public Health 2022; 10:862832. doi: 10.3389/fpubh.2022.862832
- Valdez, R., Spinler, K., Kofahl, C. et al. Oral Health Literacy in Migrant and Ethnic Minority Populations: A Systematic Review. J Immigrant Minority Health 2022, 24, 1061–1080 doi.org/10.1007/s10903-021-01266-9
- Spinler K, Valdez R, Aarabi G, et al. Development of the Oral Health Literacy Profile (OHLP)-Psychometric properties of the oral health and dental health system knowledge scales. Community Dent Oral Epidemiol. 2021;49(6):609-616. doi:10.1111/cdoe.12688
- Spinler K, Weil M-T, Valdez R, et al. Mundgesundheitskompetenz von Menschen mit Migrationshintergrund – Erste Auswertungen der MuMi-Studie. Bundesgesundheitsbl. 2021,64:977–985, doi.org/10.1007/s00103-021-03371-4
- Holtfreter B, Samietz S, Hertrampf K, et al. Design und Qualitätskontrolle der zahnmedizinischen Untersuchung in der NAKO Gesundheitsstudie. Bundesgesundheitsbl. 2020, 63(4):426-438. doi.org/10.1007/s00103-020-03107-w
Further information in the internet
- MuMi – Förderung der Mundgesundheitskompetenz und Mundgesundheit von Menschen mit Migrationshintergrund – G-BA Innovationsfonds
- MuMi+ – Gesunde Zähne für Alle: Förderung der Mundgesundheitskompetenz von Klein bis Groß – G-BA Innovationsfonds
- PAROCARD: Eine bevölkerungsrepräsentative Untersuchung zur Assoziation zwischen oraler Gesundheit und Surrogatmarkern kardiovaskulärer Erkrankungen – NAKO Gesundheitsstudie