As we floss and brush, most of us think we’re just helping our teeth and gums—we rarely consider how our oral health affects the rest of our body. But Hend Alqaderi has shown repeatedly that our mouth and the balance of bacteria within it are critical for our whole body’s health. 

Alqaderi is an assistant professor in the Department of Public Health and Community Service at Tufts University School of Dental Medicine and holds a joint appointment at Tufts Institute for Artificial Intelligence. Her research focuses on prediction and prevention—trying to head diseases off before they can take hold. Her examinations of the oral microbiome could help us predict the likelihood of a severe COVID-19 infection or spot the early stages of diabetes and its complications, and could lead to new treatments for these and other systemic diseases. Her new work with AI-powered prediction tools could help catch dental disease at the earliest stages. 

“If we can find these risk factors early on, we can intervene and prevent the disease and improve our health overall,” Alqaderi said. 

Stopping COVID-19 at the mouth

Our mouth serves as our first line of defense against disease-causing bacteria and viruses. When the COVID-19 pandemic hit, Alqaderi noted that some people had very severe cases of the disease, while others suffered only mild symptoms. She started looking to the mouth for answers. 

“People tend to overlook the immune cells in the oral cavity, but they are the first to fight bacteria and viruses, particularly respiratory pathogens,” Alqaderi said. These immune cells are constantly interacting with our mouth’s natural microbiome, a combination of helpful and harmful bacteria that reside there. Alqaderi led a study examining the relationship between bacteria in saliva and the severity of COVID-19 symptoms and found that people with severe symptoms had very different oral bacteria than those who had mild symptoms or were not infected. 

Her work confirmed that the oral microbiome is linked to the immune system, and can potentially affect whether a virus like the one that causes COVID-19 is able to spread within the body and cause damage to the body’s organs. She is continuing to investigate the specific balance of oral bacteria that supports our immune system. If we can identify the bacteria that help us fight off COVID-19 or other diseases, we may be able to create treatments that shift our oral microbiome to help prevent severe infections. 

Saliva to predict diabetes

Alqaderi is also looking at saliva samples to understand and predict Type 1 diabetes in children. Working with the Dasman Diabetes Institute in Kuwait, Alqaderi and her colleagues collected saliva from 8,000 children, building the largest cohort of saliva samples in the Middle East. They are studying the differences between the oral microbiomes of children with and without Type 1 diabetes.

Type 1 diabetes is a disorder in which the body’s immune system destroys the cells that produce insulin, an important hormone that regulates sugar in the bloodstream. Researchers aren’t sure about exactly what causes the disorder, but there seem to be both genetic and environmental factors, as well as links to the gut microbiome. Alqaderi’s research has shown that children with Type 1 diabetes also have distinct changes in their oral microbiome, where the process of breaking down carbohydrates into sugars gets started. 

“Digestion and metabolism start in the mouth,” Alqaderi said. “What happens in the oral cavity will influence the gut.” Alqaderi and her colleagues have found biomarkers in saliva that can predict the risk of children developing Type 1 diabetes. This is a significantly less invasive method than drawing and analyzing blood repeatedly. They hope further research will show that the oral microbiome is a promising avenue for new treatments. 

Using AI to identify patterns of disease

Through her joint affiliation with the AI institute,  Alqaderi is working to develop tools that will use the predictive power of AI to assist dentists and oral researchers. She is leading a project using photos and X-rays of teeth to train AI-powered tools to spot signs of cavities and periodontal disease. The goal is to help dentists catch problems earlier, before damage is irreversible. 

Alqaderi and her colleagues also hope that, once they have enough data over an extended period of time, they will be able to use AI tools to identify long-term patterns and risk factors that have been previously overlooked. Some medications taken years earlier, for example, may increase the likelihood of cavities or other issues. If the AI can spot these connections, it could help dentists recommend the best care for individual patients.

“It’s not going to diagnose patients—it’s providing a risk assessment,” Alqaderi said. “If we can predict dental cavities or periodontal disease through AI, we can prevent the disease.”