The holistic view

Photo: Richard Mortimer

Joerg Eberhard has dedicated his career to proving the links between oral health and general wellness, writes Tracey Porter.

Joerg Eberhard is an academic on a mission.

For almost his entire career, Dr Eberhard has sought to ease global oral health burdens through better education—both his own and that of the broader community.

To date, his quest has seen the dental researcher journey from his native Germany to California, then back to Germany before landing in Sydney last year to become the inaugural chair of Lifespan Oral Health at the University of Sydney, Faculty of Dentistry & Charles Perkins Centre.

During that time he has spent almost 13 years in formal education, including five years at dental school, followed by eight years completing Habilitation, the German equivalent of a PhD. He also undertook a three-year program of Periodontology at the University of Kiel, followed by a two-year Master program in Medical Education at the University of Heidelberg.

And it seems the perennial student is far from done yet. “I believe education both formal and informal is a lifelong process. Currently I am learning how to run animal experiments under Australian regulations,” he says.

A member of the European Federation of Periodontology and the German Society for Operative Dentistry, Dr Eberhard graduated in dentistry from the University of Dusseldorf in 1993 and trained as a Periodontist at the University Hospital Kiel afterwards.

He spent his early years as a post grad working as clinician and researcher at the University of Kiel, a tertiary institution recognised internationally for its focus on producing excellent oral and medical research. It was through writing his Habilitation thesis, “The relevance of arachidonic acid metabolites for the initiation and progression of inflammatory reactions in the oral cavity”, in 2003 that he first become involved in projects that utilised microbiological and molecular biological methods. This prompted him to complete a postdoctoral fellowship at the Department of Biochemistry at the University of California.

“Given that I had studied dentistry, but didn’t have a solid background in molecular biology, I felt that I needed to improve my knowledge and skills in this area. That took me to the University of California, where I worked as a research fellow in chemistry, and expanded my knowledge of applying basic sciences into research.”

Between 2005 and 2007, Dr Eberhard was trained at the University Heidelberg in Medical Education.

His interest in the interactions between oral and general health through all phases of life has since seen Dr Eberhard forge a reputation for his groundbreaking work identifying the ways in which poor oral health adversely affects general health and contributes to conditions such as diabetes mellitus, cardiovascular disease and neurodegenerative diseases, and new emerging research fields like sleep apnoea and obesity.

“I am a dental clinician and have seen hundreds of patients throughout my career … therefore every research project we start will be tested to the question: ‘Does the research outcome contribute to the improvement of oral and general health of our patients?’”—Dr Joerg Eberhard

“I am a dental clinician and have seen hundreds of patients throughout my career. I saw different types and stages of oral diseases, I recognised patients needs and understood the limitations of preventive and therapeutic interventions. Therefore, every research project we start will be tested to the question: ‘Does the research outcome contribute to the improvement of oral and general health of our patients?’.

“This research must have the capacity to be translated into clinical practice, this is the heart of translational research or my work as a clinical-translational researcher.”

Through both clinical trials and in vitro experimental studies, Dr Eberhard was the first to demonstrate that even small inflammatory changes in the oral cavity induce a systemic inflammatory response and an increased concentration of risk markers of cardiovascular disease in peripheral blood.

Having been published 86 times in peer review journals, he is currently involved in studies to investigate the effects of oral health on diabetes control and on outcomes of physical activity interventions.

His background therefore makes him the perfect person to oversee the development of the new Lifespan Oral Health research centre. The centre is positioned as the first in the world to investigate all aspects of preventable dental disease and the links to whole-of-body health. Dr Eberhard says the faculty’s vision is to “put the mouth into health”.

The dental research community has a large body of evidence showing the adverse effects of poor oral health on general health, which includes conditions like cardiovascular disease and diabetes mellitus. However, several bits of information on how oral disease is linked to general disease are missing, says Dr Eberhard.

“It is the aim of my research team through the next years to add evidence to close these gaps. This holistic view on disease, its prevention and therapeutic interventions, is to my understanding the only promising and sustainable approach to ease global health burdens, including the global oral health burden.”

Dr Eberhard says he was drawn to the role because the opportunities to work in Sydney are unique.

“I have the chance to work in the Charles Perkins Centre of the University of Sydney with world-leading scientists of various disciplines. This is an extraordinary chance for myself as a dentist-researcher to participate in, and even lead research projects with high impact on public health.”

Currently he has seven “enthusiastic” students and researchers working in his team at the Charles Perkins Centre and at the Westmead Hospital for Oral Health, where his mandate includes working on projects ranging from comparative policy research to the computer-assisted screening of oral diseases for non-dental health practitioners.

“Dentistry is, without a doubt, a part of medicine, like cardiology, endocrinology or sports medicine. This concept is not made obvious by oral-health professionals themselves and therefore not recognised by large parts of the public, including policy makers.”—Dr Joerg Eberhard

Dr Eberhard says compared to Germany, he believes the integration of different cultures works well in Australia. But while enjoying the wide ethnic diversity that comes with myriad opportunities, he says he would also like to see some improvement in Australia with respect to gender equalities.

But while he can play only a small part in changing the imbalance of male versus female practitioners, Dr Eberhard is determined to set the record straight about the significance of dentistry in the broader general health sector. He says that in Australia, as with elsewhere in the world, he must battle against the perception that the fields of dentistry and medicine are not that closely aligned.

“Dentistry is, without a doubt, a part of medicine, like cardiology, endocrinology or sports medicine. This concept is not made obvious by oral-health professionals themselves and therefore not recognised by large parts of the public, including policy makers. A large part of our activities are aimed at elaborating in detail the obvious links between dentistry and medicine, in teaching, research and clinical practice.”

Dr Eberhard believes misconceptions such as this are also why oral health is underestimated by large parts of the community.

“Awareness of oral diseases and oral health literacy is very low. Do you know that research found that the number of teeth determines your capacity to socially interact with people in 65-plus age group? Do you know that chronic inflammation of the oral cavity may reduce the positive outcomes of physical activity? Are you aware that in 2011, Australians lost 100,000 years of healthy life due to the impact of oral diseases?”

Having been the recipient of several awards over the years, including the Swiss Society of Periodontology’s Hans-R. Mühlemann Research Prize, the German Society for Periodontology’s meridol-Award thrice (in 2004, 2009 and 2011), and the Dental Education Award of the Kurt-Kaltenbach Foundation, granted by the German Society for Dental Research, Dr Eberhard says positive feedback and validation of his work plays an important part in the career of every researcher.

However obtaining grants or donations for research projects and presentations is a constant struggle. While successful in obtaining competitive research funding in the past—he was funded by the Cordis Stiftung and the German National Heart Association for his research into the interactions between oral health and cardiovascular disease and has several times obtained funding via the China Scholarship Council—the biggest challenge for his team is the lack of financial resources preventing them recruiting research students, local or international, to their research group.

“This immense capital of skills and knowledge capable of improving the health of Australians is out of reach for our research programs because of very limited funding opportunities.”

Despite this challenge, Dr Eberhard says he will continue to strive to ensure the research work undertaken by him and his team will be significant enough to impact policies and public awareness towards better oral and general health.

“Our research and strategic objectives cannot be achieved in a few months or years; it will take 10 to 20 years to see changes in policies and the follow-on changes towards better oral health of the community.

“Therefore, I intend to stay in Australia for a long time,” Dr Eberhard says.

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