A society to cell approach to oral health that puts the mouth back in the body

Photograph of Dr. Noha Gomaa
By Crystal Mackay, MA

During the course of her studies in oral pathology and public health, Dr. Noha A.E. Gomaa was struck by the stark difference in health and health outcomes that seemed to be tied to a patient’s social environment. She noticed that patients from challenging social backgrounds had higher levels of disease and often responded more poorly to treatment. The nagging question for her was, ‘why?’

This question has led her to a career of research and education focused on oral pathology and understanding how the social determinants of health specifically impact oral disease and overall health.

“I had always been interested in oral pathology because of the puzzle-solving involved in reaching a diagnosis. I was very interested in understanding the underlying causes of disease and why some people are more vulnerable than others to getting sick,” she said.

Dr. Gomaa, an Assistant Professor who joined the faculty at Schulich Dentistry in 2020, grew up watching her father, a Professor of Engineering, teach rooms full of students. She knew from a young age that she wanted to do the same one day. She would sit at the back of the classroom on her days off of school and watch her father interact with the class. This early love for academia combined with a growing interest in health spurred her to pursue an academic career in dentistry.

She studied oral pathology specifically because of the speciality’s focus on understanding the underlying mechanisms of disease. After completing her dental and specialty training in oral pathology at Alexandria University, Egypt, she went on to obtain her PhD from the Faculty of Dentistry at the University of Toronto, as well as a fellowship in public health, and completed a postdoctoral fellowship at the Hospital for Sick Children.

“The discussions I had with my professors and colleagues at the University of Toronto on health inequities, advocacy, and the realities of changing public policy, not only influenced my academic vision and research direction, but also largely contributed to my worldview,” Dr. Gomaa said. “It was then I knew I wanted to zoom out of the microscope a bit and answer the questions I had through a population health lens.”

Dr. Gomaa takes what she calls a ‘society to cell’ approach in her research into oral health and says this approach means understanding the role of the social environment in determining why we get sick, why we get periodontal disease or dental caries and also how it impacts response to treatment.

One focus of her lab is combining biological biomarkers with social risk factors to study the ramifications of the social and psychosocial environment and how that may put people at higher risk for inflammatory diseases such as periodontal disease.

She’s found through her research that people from lower socioeconomic backgrounds, for example, have higher cortisol levels and have a pro-inflammatory profile in the cells, which makes them more prone to infections.

She says this approach can also help to develop precision health approaches to public health.

“If we can predict the risk of acquiring oral disease, and potentially responses to treatment, by combining biological and social risk factors, we can potentially deliver the right intervention to patients who need them most.”

She has already started employing the society to cell approach in her teaching at Schulich Dentistry. She says that while in medicine she has seen a shift in recent years to emphasize the social determinants of health, including approaches to identifying high-risk individuals and groups of the population, it has been a slower shift in Dentistry.

“It is our job as educators to prepare students to become health care providers who see their patients holistically, and to provide tailored treatment that take into consideration an understanding of social determinants of health,” she said. “I believe that when we talk about health, we need to put the mouth back in the body. This requires not only an understanding of how oral health impacts other major health conditions, but also a consideration of the context in which people grow, live, and work, which all act as common risk factors to oral and overall health.”

What is the Society to Cell Approach? from Canadian Dental Association on Vimeo.