Vida Zohoori, Professor in Oral Public Health and Nutrition at the Teesside University in Middlesbrough, has conducted research on caries and fluoride in many parts of the world. Her current project investigates whether milks supplemented with fluoride or probiotics could improve the oral health of older adults.
Professor Zohoori, could you please describe your study in a few sentences?
Data from large cohort studies on the oral health of older adults shows a worrying situation. Oral diseases, including dental caries and periodontitis are among the most widespread diseases globally. Poor oral health can result in inadequate nutritional intake and declining quality of life. We know that oral diseases could have significant financial consequences for societies. Therefore, we urgently need to find cost-effective population-based oral health preventive measures.
As we see, fluoride has been universally recognised as an effective and economical protective agent against dental caries. However, recent studies show that its effectiveness could be boosted when combined with other anti-caries agents such as probiotics. Our study is aimed to explore whether milks supplemented with fluoride and/or probiotics could improve the oral health of older adults.
Why are you focusing on older adults in this study?
Globally, ageing populations present significant public health implications, with non-communicable diseases (NCDs), including oral diseases, becoming leading causes of disability and mortality. Over the last 40 years, we see an improvement in the oral health of adults, which is great. This improvement has resulted in increasing numbers of people retaining some of their natural teeth into old age. However, the prevalence and incidence of dental caries (especially root caries) in older adults has increased during the same period.
Poor oral health in older adults is associated with other health conditions including malnutrition and pneumonia, particularly in settings such as care homes. A key part of supporting health, wellbeing and dignity of older people is to help them maintain good oral health and consequently general health by developing novel strategies to prevent and manage carious lesions.
Can you tell us about the team?
We are a multidisciplinary team which includes partners from the UK, Sweden and Denmark. Prof Alan Batterham is a Professor of Health sciences at Teesside University. He is also a Fellow of the Royal Statistical Society.
Dr Caroline Orr is a Principal Lecturer in Microbiology at Teesside University.
Prof Christina Stecksén-Blicks is an emerita Professor of Paediatric Dentistry at Umeå University, Sweden.
Prof Svante Twetman is a Paediatric Dentist and emeritus Professor of Cariology at the University of Copenhagen, Denmark. He is currently chairing the scientific board at the Swedish Agency for Health Technology Assessment and Assessment of Social Services.
Our goal is to expand the current extremely limited knowledge on the use of probiotic supplements as an addition to a standard fluoride programme on caries prevention and management in older adults.
The team is hoping to generate information that ultimately could guide public health policy- and decision-making for populations.
How come you chose milk as the carrier for probiotic and fluoride?
Cow’s milk is a nutritious drink. It is a good source of protein and calcium, as well as other nutrients including vitamin B12, potassium and zinc. It contributes to optimal hydration and could play a role in lowering blood pressure. Additionally, milk has low cariogenicity. Hence, it has been recommended as a convenient and cost-effective vehicle for delivering fluoride and/or probiotics.
Are you expecting any particular findings, for example, reduced root caries in the study group?
In general, previous studies (mainly in children) have reported a reduction in dental caries with milk supplemented with fluoride or milk supplemented with probiotics. One study in Sweden reported the effectiveness of a daily intake of milk supplemented with fluoride and probiotics at reversing primary root caries lesions.
We will explore the acceptability of the supplemented milk by older adults. We will perform oral examinations before and after intervention and measure root caries and gingival inflammation as well as bacterial and fungal counts in saliva. We will look at other health outcomes such as frequencies of infection such as middle ear infection, mouth thrush and acute upper respiratory tract infections and use of antibiotics and unscheduled pain killers, and urgent care appointments. Our assumption is that milk supplemented with fluoride and probiotics will improve oral and general health of older adults.