He collaborates with WHO to advance evidence on oral health and diabetes

It did not require much deliberation when, in late summer 2024, Fernando Valentim Bitencourt was given the opportunity to initiate a collaboration with the WHO’s Oral Health Programme. The work was rooted in a field with which the researcher from the Department of Dentistry and Oral Health is highly familiar - namely, the relationship between oral health and diabetes.

This time, however, the perspective was different.

“I have worked in this research field for a long time, but it was only through dialogue with WHO that I truly realised how our research can have an impact beyond the academic world and make a difference globally,” he explains.

Oral diseases affect around 3.5 billion people worldwide and are closely linked to other chronic conditions such as diabetes. Nevertheless, oral health is still insufficiently integrated into diabetes care and prevention strategies.

“We identified a fragmented and uneven evidence base on oral health and diabetes, particularly regarding interventions and their implementation in low- and lower-middle income countries, which guided the focus of the project,” he explains.

From Danish research to global health collaboration

At the request of WHO, an international research group, of which Fernando Valentim Bitencourt is a collaborator, initiated an extensive effort to gather and assess the existing evidence in the field - among other approaches, through a systematic review, a mapping review and dialogue with international experts.

One outcome of this work is a study published in The Lancet, in which researchers analysed data from more than 300,000 individuals across 16 countries.

The researchers identified a clear bidirectional relationship: individuals with the oral disease have an increased risk of developing type 2 diabetes, and individuals with diabetes similarly have an increased risk of severe oral diseases such as periodontitis and tooth loss.

“The study underlines that we can no longer view oral health and diabetes as two separate disease areas. They are interconnected both biologically and through shared risk factors,” he says.

At the same time, the research group published another study in the journal Community Dentistry and Oral Epidemiology. This study maps existing interventions and highlights significant gaps, particularly at the population and policy levels.

These studies form the basis for the next step in the collaboration with WHO: the preparation of a so-called technical brief synthesising the available evidence on oral health and diabetes, highlighting effective clinical and population-based interventions to inform healthcare professionals and policymakers, which can be used by healthcare professionals worldwide.

Social factors play a major role

Fernando Valentim Bitencourt is proud and pleased that several years of Danish and international research have now led to international attention and a forthcoming WHO technical brief.

“I have a background not only in Periodontology (Dental Speciality) but also a background in public health from Brazil, and that has greatly influenced how I view the relationship between oral diseases and social conditions,” he explains. 

Social conditions play a central role in the collaboration with WHO.

“We can see that socioeconomic inequality significantly exacerbates the consequences of diabetes - among other things, in the form of an increased risk of severe tooth loss. It is not only about biology, but about a wide range of factors, including social and economic ones.”

Evidence must work worldwide

According to Fernando Valentim Bitencourt, contributing as a consultant to WHO that are to be communicated to health systems around the world is very different from publishing a scientific article.

“In our collaboration with WHO, we should not only demonstrate what the gaps. We must also consider what is actually feasible in primary health care across very different health systems,” he says.

One of the major challenges is that much of the existing research originates from high-income countries, while the technical brief is intended for global use.

“This requires a constant balancing of evidence with real-world conditions. The evidence must be both scientifically robust and practically applicable in areas with limited resources, where the burden of disease is often the greatest,” he says. 

When research has global perspectives

Fernando Valentim Bitencourt quickly realised that the collaboration with WHO had a much broader reach than he had initially expected.

“This is no longer just a publication. It has developed into an ongoing effort to strengthen the evidence base and support more integrated approaches to oral health and diabetes,” he says.

The experience has also changed his view of his own role as a researcher.

“It has undoubtedly made me more aware of my responsibility. When our work contributes to global discussions, it is crucial that it is communicated clearly, is relevant across different contexts - and that it can actually be used by people in the real world.”

Research that makes a difference

The ambition is that the forthcoming WHO technical brief will lead to closer integration of oral health and diabetes, both clinically and from a public health perspective.

This could include improved prevention, and closer collaboration between healthcare professions.

“If we become better at integrating these areas, we can improve treatment while also making health systems more efficient,” he says.

At the same time, the work has shaped the direction of Fernando Valentim Bitencourt’s future research.

“I have become even more focused on how we can translate evidence into practice - also in parts of the world where the need is greatest and resources are most limited,” he says.

Contact

Postdoc Fernando Valentim Bitencourt
Aarhus University, Department of Dentistry and Oral Health
Email: fvbitencourt@dent.au.dk