“Addressing the oral disease burden requires collaboration and partnerships”

Iveta Ramonaite, Dental Tribune International

Tue. 1. October 2024

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At the forefront of innovative approaches to healthcare, Haleon is making significant strides in integrating oral healthcare with broader medical care. During the 2024 FDI World Dental Congress, Dental Tribune International had the opportunity to speak with Dr Steve Mason, global oral health medical lead at Haleon. In this interview, Dr Mason discusses the company’s presence at the event, along with its growing contributions to the oral health community. He also highlights a study being funded by Haleon, which is helping to develop a care pathway for dental teams to identify undiagnosed diabetes during routine oral health check-ups.

Dr Mason, could you explain the different approaches Haleon takes in promoting its products and engaging with the dental community?
We have two ways of working at Haleon. There is the scientific way, which I oversee as a global medical lead for the company, based in the UK, and we have the commercial way of working, evidenced by the trade exhibition downstairs. We have two booths at the congress, where we are showcasing our products and speaking to dentists about the quality of those products and the quality of the science behind them in order to assure dentists that they can confidently recommend our products to their patients.

We work with different companies and dental associations to increase the emphasis on oral disease prevention and oral health promotion strategies through advertising, science and filling knowledge gaps. No government alone can fully fund the level of oral healthcare that will be needed by 2025. Addressing the oral disease burden requires collaboration and partnerships across various industries. This is precisely what the World Health Organization (WHO) is advocating for, and we are committed to contributing meaningfully in the areas where we can make a difference.

What motivated Haleon to fund the INDICATE-2 study?
The link between periodontal disease and diabetes is well established. Academics describe this relationship as bidirectional, which means that, if you have periodontal disease, you are more at risk of diabetes and its complications, and your blood sugar is more difficult to control; and if you have diabetes, you are more at risk of periodontal disease, and healing after treatment may be impaired. However, nobody knows whether this cycle can be broken or whether the relationship is causal. So, if you have periodontal disease, that does not mean you will have diabetes, but it means you are more at risk of having or developing diabetes.

Well armed with that knowledge, what should society, governments and healthcare professionals do? The University of Birmingham suggests that dentists should be more involved in the healthcare continuum by identifying at-risk patients through questionnaires, lifestyle assessments and screenings. If a patient is identified as being at risk of having diabetes, she or he can be referred to the doctor for formal diagnosis and management—and that is basically the concept of the study.

The WHO Global Strategy and Action Plan on Oral Health 2023–2030 emphasises the expansion of the healthcare workforce. Dr Paula Vassallo from the European Association of Dental Public Health has said: “There is no health without oral health. We need to all continue to work together and advocate for oral health, put the mouth back in the body, ensuring oral health for all.” This is a very powerful statement which talks to how we can reduce the siloisation of oral healthcare and put it back into general healthcare.

INDICATE-2 is a real-world evidence study which will hopefully confirm that dental professionals can play an active role in driving improved outcomes, but it requires significant time, patience, coordination, scientific rigour and financial investment. Governments are often limited in funding oral health research, so projects like this can be difficult to get off the ground. To make this study possible, the University of Birmingham has approached this creatively by investing its resources, seeking financial support from the private sector via Haleon and leveraging the UK National Institute for Health and Care Research Biomedical Research Centre network.

Could you tell me something about the results of the pilot study on which INDICATE-2 is based?
The pilot study demonstrated the feasibility of early case detection in high street dental practices and identified significant levels of undetected pre-diabetes and diabetes in dental patients, suggesting that investing in a more extensive clinical trial would be worthwhile. There is now a need to validate the evidence in a larger trial involving 10,000 participants.

“No government alone can fully fund the level of oral healthcare that will be needed by 2025.”

In your opinion, how important is collaboration between dental professionals and other healthcare workers to improve people’s oral health?
Oral disease is largely preventable. That’s what we all believe. Improving disease prevention and health promotion information strategies is one of the key pillars of WHO’s 2023–2030 oral health strategy and oral health action plan, which includes various strategies, such as increased collaboration and cooperation across the healthcare continuum. Although electronic health records might help bridge the gap, oral healthcare tends to be independent of medicine. However, there are strong possibilities for referral and intervention.

I remember how, 20 or 25 years ago, the American Dental Association stated that dentists were often the first healthcare professionals to identify abuse between couples because of the physical signs around the face and the mouth. Similarly, there was a discussion during the COVID-19 pandemic about whether dentists could administer vaccines. These examples illustrate the potential benefits of integrating dental professionals more closely with other healthcare providers. Such integration can help reduce the taxpayer burden and address common risk factors for oral and non-communicable disease, like smoking, alcohol use and obesity.

There is a debate about whether oral health and oral disease should be considered part of the non-communicable disease spectrum, as they share common disease factors. Collaboration between dental and medical professionals is essential because tackling these issues from any angle can have a positive impact. For instance, it has been suggested that advocating for a sugar tax could help reduce dental caries and potentially decrease obesity rates, even if the evidence for the latter is less robust. This partnership is a vital goal. That’s why Dr Vassallo insists on putting the mouth back into the body of medicine.

What other initiatives or projects is Haleon working on for improving people’s oral health?
In terms of advocacy, Haleon collaborates with the European Federation of Periodontology on projects like better economic modelling of oral disease, which is complex because of factors such as life course and intervention timing. The result is a white paper that emphasises prevention. This collaboration began with a conversation at an event like this, where we identified a gap in knowledge and decided to support an initiative to fill that gap. We also partner with FDI World Dental Federation on the Vision 2030 Industry Action Group and other efforts to guide improved oral health advocacy.

FDI’s Oral Health Observatory project addresses a critical issue: only one-third of governments will fund national oral health surveillance in 2025. This reflects choices about healthcare spending priorities. While I disagree with this choice, it’s a reality that many governments have cut back on oral health surveillance systems. For example, national adult oral health surveys are only conducted every ten years in many countries, which is insufficient for ongoing monitoring. In contrast, Germany continues to fund national oral health studies.

The Oral Health Observatory offers a cost-effective, app-based alternative that focuses on patient-reported outcomes rather than relying solely on national epidemiological statistics. However, it does have limitations, such as sampling bias in countries like the UK, where only 40% of the population regularly visit the dentist. If successful, this initiative could provide continuous surveillance, rather than relying on a ten-year cohort. We are providing scientific funding to FDI to support this project.

Finally, could you provide an overview of the educational activities the company has planned for the congress?
We are conducting two types of educational activities at the congress. The first is a small programme within FDI for international delegates to review new science or perspectives, which goes through a peer-review process. We have three presentations in this area. The second involves a few educational symposiums, such as one that reviews the latest knowledge on dentine hypersensitivity, including its aetiology and epidemiology in the Middle East, and discusses the implications for products and solutions.

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