Interview with 2018 Eklund Foundation grantees Jan Derks and Tord Berglundh
Jan Derks and Tord Berglundh from the Institute of Odontology at the University of Gothenburg in Sweden recently received funding amounting to SEK 930,000 from the Eklund Foundation for their study “Periodontitis, Peri-implantitis and Diabetes - a registry study”. The two researchers gave an interview at their visit to TePe Oral Hygiene Products AB in Malmö, Sweden, in June 2019.
Since its establishment in 2015, the Eklund Foundation has distributed funds of approximately SEK 4.5 million to high-quality research in dentistry. The foundation was created by the Eklund family, which also owns the Malmö company TePe Munhygienprodukter. Thus, Jan Derks and Tord Berglundh were invited to hold a lecture at TePe.
Their current project focuses on the connection between periodontal and peri-implant diseases and diabetes and is based on data from several national registries, mainly SKaPa, the Swedish quality registry for caries and periodontitis, which today comprises over 7 million patients, and the National Diabetes Register, NDR, which covers about 90% of the diabetes population in Sweden. The information will also be supplemented with demographic, socio-economic, and medical data.
Your research is often at the forefront. Jan Derks, can you tell us more about this?
The connection between periodontitis/peri-implantitis and diabetes is not new; what is new in our project is the scientific approach. The opportunity of basing research on registries is something unique to Sweden–it wouldn’t be feasible in many other countries, at least not outside Scandinavia. Thanks to our unique social security numbers, which don’t exist in the same way in other parts of the world, it is possible to analyse the information in these different registries.
Together with Tord Berglundh, you have received much attention for your previous research on implants. Did it have a similar approach?
Yes, it is based on the same idea, of identifying a broad population representing routine patient care. Even though the scope of our new study is even bigger, the technical challenges are similar, and we have gathered much experience that we can apply in our current project.
Your study concerning the prevalence of and risk factors for peri-implantitis is one of the most downloaded studies from the Journal of Dental Research. Was it that controversial?
Peri-implantitis is today accepted as an important complication, but only 5–10 years ago, the discussion on the topic was more intense. Our study showed that peri-implantitis was common and a major problem in implant patients, especially in patient groups in which infection control was not achieved.
So nowadays, more focus is placed on the implant patient’s self-care?
Today, it is natural to talk to patients about self-performed infection control before the start of implant therapy. It has become part of treatment protocols as a way to prevent peri-implant diseases.
Will your new research have a similar impact?
The future will tell. It is assumed that there is a link between oral health and diabetes, but we have not been able to conclusively demonstrate that connection. Besides, it is the “chicken or the egg” question, what comes first–periodontal disease or diabetes? There may not be any clear answer to this question, as such research requires longitudinal data over considerable periods. And finally: if we can deal with the periodontal problems, may this have positive effects on diabetes? There are some investigations in this area. What makes our study unique, however, is its wide reach. By accessing these registries, we can analyse hundreds of thousands of patients.
Can your research be a bridge between dentistry and medicine?
Yes, this is a collaboration between the dental and the medical world, and working with registries focusing on dental care is new to them as well. This collaboration is very positive, as the link between oral and systemic health is relevant to large patient groups. Another interesting aspect is how dental care may participate in the prevention of systemic diseases. In Scandinavia, most people visit the dentist or dental hygienist once or twice a year, which means that dental care may also play a role in the detection of general disorders. In addition, dental care has a unique position of addressing other issues, such as diet or smoking habits.
What does the foundation’s contribution mean to you and your research?
The support from the Eklund Foundation means very much. This is a substantial grant, and considering all the competition, it is fantastic for us to have such support, which makes this project possible.
Tord Berglundh, can you tell us more about your research, especially the registry research and its significance?
Today, we are active in several fields. Our research covers aspects ranging from molecular biology to large field studies and modern registry research. It shows how unique it is to do research in Sweden, as this type of investigation cannot be easily performed anywhere else. The SKaPa registry, a quality registry in dental care, was started in 2008, and has been refined and improved over the years. Today it comprises over seven million patients.
SKaPa opens the door for research on the association between oral health and other diseases, such as diabetes and cardiovascular diseases. Patient integrity, however, must be rigorously protected. All data are anonymised and analyses are only performed on group level, never identifying any individuals.
At our research laboratory, we look at inflammatory issues, working with blood and tissue samples to examine the effect and change of, for example, epigenetic components. Registry-based research generates hypotheses that we may transfer to the lab and then take back to the clinic setting again, not least through treatment studies. Therefore, it is a great advantage to have research facilities and a clinical unit in the same building.
You do have a close collaboration within the Sahlgrenska Academy (i.e., education and research in medicine, dentistry and healthcare science at the University of Gothenburg)?
Yes, at the Sahlgrenska Academy we collaborate with the National Diabetes Register and the Centre of Registers, which are specialised in various diseases as well as registry research. Through our accumulated knowledge, we can address many topics. It is important to share this research and knowledge; that’s how things develop. Therefore, we are happy to come and lecture to you here at TePe.