Dr Priyal Shah talks diet and teeth

Estimated reading time: 6 minutes

With diet and subsequent poor health leading to periodontitis and other oral health problems (and vice-versa), Dr Priyal Shah hopes to get a dialogue going between dentists, nutritionists and other allied health professionals that ultimately benefits patients. By Kerry Faulkner 

Recent research confirms that diabetes and periodontitis are two major diseases affecting Australians and the overlap between the two is an area that Perth’s Dr Priyal Shah is uniquely placed to work, with her qualifications as a dentist and dietitian and her passion for chronic disease management.  

Dr Shah says the link between diabetes and periodontitis is bi-directional. That’s backed by research which shows individuals with poorly controlled diabetes are at greater risk of developing periodontal disease, and periodontitis has been shown to lead to suboptimal glycaemic levels and greater risk of complications in people with type 2 diabetes. 

However, Dr Shah says this bi-directional link between diabetes and oral disease is not well recognised by health professionals or patients. That problem is compounded by the fact dentists are often not included or considered in the allied health care space. 

“For some reason, dentistry has always been a little bit separate to medical and allied health, but I think we need to join forces and work together more,” says Dr Shah.   

“We now know that oral health is very much linked to general health, whereas I suppose 50 years ago, we probably didn’t realise how much.”

Marrying the two 

It’s this disconnect she is aiming to bridge in a collaboration with Diabetes WA to deliver a professional development course in 2025 for dentists, bringing the worlds of nutrition and dentistry together. 

In Australia, the prevalence of diabetes has tripled over the past three decades affecting an estimated 1.3 million people in 2020–2021. 

A further 500,000 people are estimated to be living with undiagnosed diabetes, and one in six Australians older than 25 years is at high risk of developing diabetes based on a diagnosis of impaired glucose tolerance or impaired fasting glucose.  

Diabetes places an enormous burden on individuals and society in general, costing more than $15 billion annually in direct and indirect healthcare costs with complications doubling that cost.

Diabetes WA tele-services manager Jessica Weiss says as diabetes educators, the organisation advocates for awareness and prevention of the risks associated with the disease and the importance of a multidisciplinary approach towards the diabetes annual cycle of care. 

However, she agrees, oral health is not widely included in national recommendations.

“Dr Shah reached out to Diabetes WA identifying this gap in the healthcare space, where there is a divide between the dental and the allied health space,” she says.

“Utilising our approach of teaching person-centred care and empowerment towards self-management of diabetes, with her expertise on the physiological link between oral and metabolic health, we hope to bring something new to the health professional development space.” 

Pursuing her passion

Dr Shah says the professional development program with Diabetes WA follows presentations she’s given for the Australian Dental Association WA. She says she thrives on opportunities like this, to teach colleagues what the big issues are and closing the knowledge gap.  

This labour of love she says, grew from her lifelong interest in nutrition which led to her completing a one-year bridging course after her dentistry degree, to complete a two-year Master of Dietetics at Perth’s Curtin University.  

Her professional placement during her studies was with Diabetes WA, a collaboration that birthed the new CDP Program scheduled for March 2025.  

The qualification was another in a long line of challenges for Dr Shah. 

She was already working across two practices, one public and one private, when she enrolled, having earlier in her career worked at a practice specialising in treating people with disabilities. 

However, she explains “life got in the way”, prompting her to take some time off between the bridging course and entering the master’s program. 

In the break she married her childhood sweetheart Rushil, whom she’d left in Kenya when she moved to Australia as a 15-year-old.  Her parents had enrolled her in a Perth school until they could join her a year later and she says that experience, of parachuting into a white, elite girls’ school halfway through Year 11, was one of the hardest in her life.  

An effervescent personality who laughs easily, she survived, went on to study dentistry at the University of Western Australia where she “found her people”. She even reconnected with Rushil while on holiday in America (where he was living after leaving Kenya), who subsequently moved to Australia to be with her. They have been married seven years. 

However, her unfinished master’s degree beckoned. 

She explains that just a couple of years ago she decided she did want to pursue the master’s degree driven by a strong desire to discuss nutrition with her patients but feeling she lacked the credentials. 

“I didn’t want to be yet another person spouting nutrition information,” she explains. “I think we get enough of that on social media; people just saying what they think healthy lifestyles should be, but advice like this needs to be evidence-based.” 

Dr Shah says she’s always had an interest in nutrition generally and this intensified as she grew older. 

“As you get older, you think about your health more and what you can do to prevent disease. I’d started noticing lots of links between diet and chronic disease, and of course, as dentists we see chronic disease and lots of comorbidities in many of our patients. Diabetes is a big one, and heart health is another,” she adds. 

In these areas dentists often find themselves at odds with dietitians. “Dietitians often recommend a high-energy, high-protein diet to prevent weight and muscle loss, encouraging foods high in sugar and fat, or suggest oral nutrition supplements that can be cariogenic,” she continues.  

“This approach can clash with dental advice, which typically warns against those same foods due to the increased risk of caries and other potential complications.

“Instead of recommending high-sugar and high-saturated fat foods, I’d suggest opting for high-energy options through unsaturated fats, such as avocados, nuts, seeds, and cooking oils. 

“As dentists, we need to be mindful of the significant consequences of malnutrition and manage caries risk using strategies beyond diet alone. We do a lot of that motivational interviewing in dietetics, which we didn’t really do in dental school, a technique to help patients change behaviours. 

“It’s not just about saying, for example, ‘You need to brush twice a day, floss once a day’—but about motivating patients and working out what works for them in terms of individual dental care and health care, because people need to change their own behaviours. Simply telling them what to do is not enough.”

Dr Shah says she hadn’t really consolidated these connections until she did her master’s degree and it became clear that this was very relevant to her work as a dentist.

“I think about my patients in a more holistic way now, paying closer attention to their nutritional needs and the risks of malnutrition. I also strive to be mindful of how I give dietary advice to avoid inadvertently contributing to disordered eating.”

Never one to sit still for very long, Dr Shah says she’d like to take her unique expertise across dentistry and nutrition to children in the future. “It would be fulfilling to incorporate evidence-based dietary advice that addresses long-term eating habits into our education about oral health for children.”