Vitamin D, haemoglobin A1c and carbohydrate frequency should become part of modern prevention conversations, argues Tif Qureshi.
Dentistry has become too comfortable talking about prevention in black and white terms, according to Tif Qureshi. Fluoride, plaque control and localised treatment are only part of the picture, he argues. The rest sits in a patient’s wider metabolic health.
Speaking to Dentistry, Tif makes the case for testing vitamin D levels, haemoglobin A1c (HbA1c), discussing carbohydrate frequency and using simple health markers as part of prevention conversations with patients.
Tif, founder and clinical director of IAS Academy, is best known for his work in minimally invasive dentistry, progressive anterior alignment and orthodontic-restorative treatment planning. His latest focus is on how dental teams can integrate wider health markers into prevention and clinical decision-making, and he is now developing training through IAS Academy around health integration and blood testing for dental teams.
He is careful to draw a line under one thing early on: this is not an anti-fluoride argument. The point, he stresses, is not that fluoride and vitamin D sit in opposition. It is that dentistry often treats prevention as a binary argument, when both can have a place in a broader model of oral and systemic health.
‘Fluoride works, we know it works, but it did not come about because it was better,’ he says.
Tif points to work by Philippe Hujoel questioning why vitamin D became less prominent in caries prevention. But he stresses that his argument is not anti-fluoride: both fluoride and vitamin D, he says, can have a role in improving patient outcomes.
In a recent social media post, he wrote: ‘We should be seeking to optimise health outcomes, not run away from them.’
How Tif got here
Tif says his interest in metabolic health began outside dentistry. Coming from a family of doctors, and with a family history of heart disease, he had long assumed his own risk was largely inherited.
That changed after the death of a close friend in dentistry from a heart attack, and the death of a similar-aged cousin following complications linked to undiagnosed diabetes.
‘I started to read into the science of what causes heart disease and what the primary drivers are,’ he says.
He began looking more closely at diet, blood sugar, vitamin D and inflammation, before applying some of those lessons to his own health. That process, he says, also made him question how little formal training many clinicians receive on diet, nutrition and the root causes of chronic disease.
Tif says people were quick to focus on aesthetic changes as his own health changed.
‘But for me, it’s about how I feel, how I perform, and knowing that all my risk factors are coming down,’ he says.
That experience changed how he thought about dentistry. If metabolic health affects inflammation, healing, periodontal risk and caries risk, he argues, then dentists cannot ignore it.
Why vitamin D deserves more attention
The conversation started with a comprehensive review into vitamin D deficiency and oral health, looking at possible links to tooth mineralisation, dental caries, periodontal disease, inflammation and treatment outcomes. Tif sees this as territory dentistry has largely left unexplored.
‘Most dentists don’t actually know why vitamin D is important,’ he says.
He argues that the evidence base should prompt dentists to think more seriously about vitamin D, particularly in relation to caries risk, periodontal inflammation and treatment outcomes. He also points to emerging work exploring its relevance to implants and orthodontics.
Dentists do not need to diagnose or manage systemic deficiencies themselves. What they need, Tif argues, is a working understanding of when low vitamin D is clinically relevant, and when it is time to refer.
Why HbA1c matters
HbA1c, the blood marker that tracks average blood glucose over roughly three months, is the other piece of the puzzle for Tif. He points to its relevance in periodontal disease, implant planning and patients who keep running into oral health problems despite following conventional prevention advice.
‘Without us knowing the HbA1c of a patient, you are treating that patient blind,’ he says.
He is pragmatic about how practices might start incorporating this.
‘The easiest thing to do, the start point, is you add to your medical history: do you know your haemoglobin A1c and do you know your vitamin D level?’ he says.
Many patients will already have recent results sitting in their National Health Service (NHS) app or medical records, he notes. Where that data is missing, testing could be worth considering, particularly for patients heading into periodontal, implant or orthodontic treatment.
How finger-prick testing works in practice
Tif says the first step is the patient’s medical history. If patients already have recent results, often through the NHS app, he uses those as a guide. If they do not, point-of-care finger-prick testing can be carried out in practice.
The tests he has trialled use small immunofluorescence assay machines. The process is similar to a finger-prick test, with results available in around 15 minutes for vitamin D and around six minutes for HbA1c. Tif says the test can be carried out by a trained dental nurse while the patient is in for an examination or check-up.
He does not test everyone automatically. If a patient has recent figures from the last three months, he does not repeat them. For patients having orthodontic treatment, implants or periodontal care, he believes the information can be particularly useful.
If the result suggests severe vitamin D deficiency or raised HbA1c, he says he always refers the patient to their general practitioner (GP) rather than trying to manage it himself.
A broader prevention model
For Tif, this connects to a bigger frustration with how dental teams talk about diet. Patients are told to cut down on sugar, he says, but rarely given a clear explanation of how refined carbohydrates and blood glucose behave.
‘People think that sugar is just sugar. They don’t understand that refined carbohydrates, and actually all carbohydrates, are sugar,’ he says.
His aim is sharper advice on carbohydrate frequency and a better grasp of individual risk.
‘I want to bring the integration into practice in a sensible way that is not extreme,’ he says.
Tif believes the profession needs to become more confident discussing the basic drivers of dental disease and metabolic inflammation, without pushing patients towards unrealistic or highly restrictive diets. The change, he suggests, could be as simple as helping patients understand how often they consume carbohydrates, what that means for blood glucose, and how this may affect oral health risk.
Staying within scope
Tif is clear about where his and the profession’s boundary sits. Dentists should not be acting as GPs. His model runs on awareness, screening, communication and referral.
If a patient appears severely vitamin D deficient, or their HbA1c points to possible pre-diabetes or diabetes risk, the next step is a referral to their GP. Dentists need to understand why the marker matters for oral health, he says, not take on medical management themselves.
That distinction is likely to matter more as dentistry edges further into whole-body health, saliva testing, genomics and personalised prevention. The argument, Tif says, is that dentistry should start with simple, relevant information that may directly affect outcomes.
The next five years
Tif expects blood markers to become a bigger part of clinical decision-making, especially in higher-risk treatment.
‘The days of not looking at blood markers are about to disappear,’ he says.
He also believes tracking simple markers could support clearer risk discussions, particularly where raised HbA1c or low vitamin D may affect recurrent disease or treatment outcomes.
Practices carrying out implants, periodontal treatment and complex restorative work will increasingly need a read on a patient’s metabolic health before and during treatment, he argues.
For now, his ask is simple: ask better questions, understand why vitamin D and HbA1c matter, and build clearer referral pathways.
‘We have got to be looking at metabolic health now,’ he says.
Follow Dentistry.co.uk on Instagram to keep up with all the latest dental news and trends.
