Time to take gum disease seriously: The societal and economic impact of periodontitis

This report describes the methods and main findings from The Economist Intelligence Unit’s research which assesses the evidence linking improved periodontal health to better overall health outcomes, and showcases the economic and societal implications associated with periodontal health across six European countries: France, Germany, Italy, the Netherlands, Spain and the United Kingdom. These countries were selected for their geographic, demographic, epidemiologic, and socioeconomic comparability.

Executive Summary

Periodontal (gum) diseases are strikingly common across the globe, but also largely preventable. Left untreated, they are the main cause of tooth loss and considered one of the main threats to oral health. In Western Europe, a region which offers some of the most advanced healthcare services to the general public, developments in the prevention and management of periodontitis appear stagnant. The prevalence of periodontitis has remained largely unchanged over the last 25 years. The evidence-base shows periodontitis, which is the severe form of gum disease, has associations with diabetes, cardiovascular diseases and over 50 non-communicable diseases. Recognition of these mutual risk factors and knowledge sharing between dentistry and general health are scarce in clinical practice. Similar to general health, poor oral health is also strongly associated with lower socioeconomic status. Unlike accessing the General Practitioner (GP), which in most of Western Europe are free at the point of access, many report avoiding dental check-ups due to the upfront costs. This avoidance only exacerbates poor oral health in socio-economically deprived neighbourhoods.

Given the prevalence and preventable nature of periodontitis, new ways of thinking about gum health are needed to increase awareness and action at national level. This Economist Intelligence Unit (EIU) report aims to capture the attention of policy makers in six European countries (France, Germany, Italy, the Netherlands, Spain and the United Kingdom), emphasising the economic and societal benefits of action and inaction in the early treatment of periodontitis.

To improve early detection and prevention of periodontitis, this report arrives at the following recommendations:

Prevention, diagnosis and management of periodontitis is cost-effective. First and foremost, the role of home care led by patients is of paramount importance to prevent gingivitis and periodontitis. Our economic analysis shows that both eliminating gingivitis (the precursor to periodontitis) using home care prevention techniques (such as tooth brushing and interdental brushing) and increasing the rate of diagnosis and management of periodontitis to 90%, has a positive return on investment in all of the European countries in this study. Making efforts to eliminate gingivitis, thus preventing progression to periodontitis, would save considerable costs over a 10 year time period compared with ‘business as usual’ (36Bn Euros in Italy to 7.8Bn Euros in the Netherlands). Neglecting to manage gingivitis can significantly increase costs and reduce Healthy Life Years (HLYs); therefore an emphasis on self-care and prevention is critical from both an individual and a societal perspective.

Better integration of dental and general healthcare. The value of integrating these systems in practice is still developing. Being able to share information across disciplines may both improve patient care due to the common risk factors shared between some dental and physical health conditions and contribute significantly to dental/general health research. Integration may also encourage shared responsibility across healthcare disciplines to address unmet oral health needs in vulnerable and marginalised communities.

A synergy of societal and individual public health campaigns are needed. One without the other would exacerbate oral health inequalities which we see both within and across countries. Societal level prevention is of crucial concern to the prevention of periodontitis, especially as it is a disease highly prevalent in deprived areas. Individual public health campaigns need to pay special attention to less affluent communities and embed prevention and early intervention interventions into community settings such as schools (for the prevention of caries) and health centres (for the prevention of gum disease). 

Improving the affordability of dental care. The cost of accessing a dentist is a barrier to receiving treatment early for many of the general public. Because of these costs, people are more likely to access the dentist when there is something wrong rather than for check-ups or preventative treatment which is essential for avoiding periodontitis. Although dental care appears ‘free on paper’ in countries such as the UK and France, only part of the dental procedures for treating periodontitis are covered and the remainder is paid for out-of-pocket. In countries such as Spain and Italy, most if not all periodontitis treatment is paid for out-of-pocket or via private insurance. Periodontitis treatment for a low-income family is therefore rendered almost unaffordable. In this study we have provided the evidence that professionallymanaged periodontitis is in fact cost-effective and therefore publically covered dental care for periodontitis deserves a review from policy makers and commissioners Europe-wide. 

To access the white paper, click here.