05 November 2014

Svante Twetman - the democratic dentist


Svante Twetman is Professor of Cariology at the Faculty of Health and Medical Sciences, University of Copenhagen. Svante graduated from dental school back in 1974, started his career as a clinician and then specialized in pediatric dentistry. Today, his research focus is fluoride and microbial aspects on oral ecology and caries prevention in childhood with a focus on clinical trials.

The 64 year-old Dr. Twetman has authored over 200 peer-reviewed papers and was awarded the IADR Distinguished Scientist Award in 2010 and the EW Borrow Memorial Award in 2011.

Why did you choose to become a dentist?

I applied for both the medical and dental school In Stockholm but was only accepted at the dental school. Thus, I did not have the option to choose but I do remember after a few months I knew that I had made the right decision as this profession suited my curiosity and demanded an obvious skill-mix. And there were so many interesting questions waiting to be answered.

I started my professional career as a clinician as a hospital-based pediatric dentist dealing with referred children, so the step to clinically oriented preventive research was quite natural.

How different is dentistry since you first started?

In the clinical context, the issues and challenges are still much of the same as forty years ago. The diseases are definitely the same as before which still has a big impact and burden on the less privileged in society. Where there has been a dramatic change is with the different kinds of technologies and materials we use today; for example, we have stopped using amalgam as a restorative material. Regarding the way we respect and treat children there has been a seismic change with the introduction and recognition of the UN convention on the rights of the child.

There has also been a fundamental shift in research. Forty years ago people believed the more plaque or bacteria, the more severe oral diseases, especially caries and tooth loss. Yet over the last ten years we have a new understanding on the role of bacteria (biofilm). Today we know bacteria basically does more good than harm. Each of us has our ‘own’ oral microbiota that may be disrupted and altered by environmental factors. So the focus today is not to eliminate all the oral bacteria but to support and maintain diversity and stability in the oral microbial community.

Why is your research area important to society?

For the last forty years my main focus has been regarding caries prevention and to help reduce inequality. Today worldwide there are over 3.3 billion people walking around this planet with untreated caries. The problem is that both the disease and the dentists are unevenly distributed, both from a geographic and socioeconomic point of view. When you have figures like this you realize there is no chance to start treating all of them from a restorative position. So the only way to deal with this is upstream prevention. The most important way forward is to catch children in their early years because if you can prevent disease early on then, they have every chance of success to have healthier lives, so that is why we focus on small children.

It’s also important from a democratic point of view. All children from whatever backgrounds should have access to prevention, independent of their parents income. This ‘Scandinavian’ approach has finally, after forty years, started to resonate with other countries that now understand and adopt the long-term benefits of community-based prevention.

What is the highlight of your career?

I think we are moving towards a growing international consensus that children should have a cavity free future. It sounds easy, but we have a long way to go. And I am proud of the fact that we brought the concept of ‘beneficial bacteria’ into oral science. Although not unique in this approach, we were still very early on the case of taking this concept and bringing it into clinical trials. Of course, receiving prestigious awards is nice at the time, but they very rapidly become history.

What do you do in your spare time?

When I was younger I was a very active skier and I also used to be an instructor, so skiing is an integral part of my life. I take at least two ski holidays each year, and I also try to sneak one in if I am attending an international conference.
When I am physically active (jogging, biking, swimming) it’s not just a question of getting fitter but I find it gives me the mental space and time to think. I find that bright ideas come when you are doing something else because you “get oxygen to the brain”. Apart from that I do what everybody else does, watch movies and play with my grandchildren. One thing I do avoid is spending my time on fine dining etc. - that is simply not my cup of tea.

Why did you decide to come to the school of dentistry in Copenhagen?

I was professor in pediatric dentistry at Umeå University in Northern Sweden and had a very good life up there. Then the family decided to build a permanent house on the beach in southern Sweden, which meant that commuting became a bit of challenge. So I looked for opportunities closer to home and could choose between working in Sweden or Denmark. Copenhagen and this faculty sounded like a better deal and a bigger challenge. I thought the resources and the environment here would give me a lot more opportunities to make a difference. But if we had not built that house then who knows, maybe I would have stayed up north.