Better Gum Disease Prevention Could Save Billions in Healthcare Costs

Dentistry Today


More effective prevention of gum disease could save billions in healthcare costs and lead to healthier lives, according to the European Federation of Periodontology (EFP).

The EFP commissioned the Economist Intelligence Unit (EIU), which is the research and analysis division of the Economist Group, to provide a comprehensive analysis of the financial and human cost of gum disease in France, Germany, Italy, the Netherlands, Spain, and the United Kingdom.

The report makes it clear that periodontitis is largely preventable with good oral hygiene and regular dental checkups, the EFP said. But little progress has been made in the prevention and management of periodontitis in Western Europe, with prevalence remaining largely unchanged over the past 25 years. 

Many people only visit a dentist when they have a problem and avoid regular appointments because of the cost, the report said.

Also, most if not all periodontitis treatment in Spain and Italy is paid for by patients or private insurance, so periodontitis treatment for low-income families is almost unaffordable, the report said.

And while dental care appears to be free on paper in the United Kingdom and in France, the report continued, only part of the dental procedures involved in treating periodontitis are covered, and the remainder of the costs are paid for out of pocket.

After providing evidence that professional management of periodontitis is cost-effective, the EFP said, the report argues that “publicly covered dental care for periodontitis deserves a review from policymakers and commissioners Europe-wide.”

The report then seeks to capture the attention of policymakers in the six countries studied, emphasizing the economic and societal benefits of action in the early treatment of periodontitis and arguing that “given the prevalence and preventable nature of periodontitis, new ways of thinking about gum health are needed to increase awareness and action at a national level.”

The report makes four recommendations.

First, the report says that the prevention, diagnosis, and management of periodontitis is cost-effective. It called the role of home care by patients of paramount importance in preventing gingivitis and periodontitis.

Efforts to eliminate gingivitis, preventing progression to periodontitis, would save considerable costs over 10 years compared to “business as usual,” ranging from 7.8 billion Euros in the Netherlands to 36 billion Euros in Italy, the report said.

But neglecting to manage gingivitis could significantly increase costs and reduce healthy life years, the report continued, so “an emphasis on self-care and prevention is critical from both an individual and a societal perspective.”

Second, the report says that better integration of dental and general healthcare is required. Sharing information across disciplines may improve both patient care, because of the common risk factors shared by some dental and physical health conditions, and contribute significantly to dental and general health research, the report says.

Integration also may encourage shared responsibility across healthcare disciplines to address unmet oral health needs in vulnerable and marginalized communities, the report says.

Third, a synergy of societal and individual public-health campaigns is needed. One without the other would exacerbate oral health inequalities both within and across countries, the report said. Societal-level prevention is crucial to the prevention of periodontitis, as it is highly prevalent in deprived areas.

Individual public health campaigns need to pay special attention to less affluent communities and embed prevention and early intervention in community settings such as schools for the prevention of caries and health centers for the prevention of gum disease, the report says.

Finally, the report says dental care needs to be more affordable. The cost of accessing a dentist is a barrier to early treatment for many people, the report says, so they are more likely to go to the dentist when there is something wrong rather than for checkups or preventive treatment, which is essential for avoiding periodontitis.

Not all periodontitis treatment is covered by the public health system in the United Kingdom and France, and the patient pays for the remainder. In Spain and Italy, most of not all periodontal treatment is paid for by the patient or via private insurance. Periodontitis treatment for low-income families is almost unaffordable.

Professionally managed periodontitis is cost-effective, the report says, and policymakers and commissioners across Europe should review publicly covered dental care for the disease.

Few studies have modelled the economic burden of periodontitis and the return on investment (ROI) of treatment, the EFP said. The report’s authors developed a model to examine the ROI of preventing and managing periodontitis, with separate modelling for France, Germany, Italy, the Netherlands, Spain, and the United Kingdom.

The model used in the study was based on EFP treatment guidelines that outline four intervention points in the progression from health to gingivitis, undiagnosed periodontitis, and diagnosed periodontitis. The estimates for the current national situation in each country determined the number of individuals starting at each stage of the model.

The authors modelled the transition between the stages over a 10-year period according to five scenarios:

  • Baseline: current prevention and treatment situation continues.
  • Rate of gingivitis management falls from 95% to 10%.
  • Incident gingivitis is eliminated through improved oral homecare, preventing periodontitis.
  • No periodontitis is managed.
  • 90% of periodontitis is diagnosed and managed.

The model calculated the impact of each scenario on total costs, ROI, and the change in healthy life years compared to the baseline. The cost of continuing with the baseline scenario ranged from 18.7 billion Euro in the Netherlands to 96.8 billion Euro in Italy over 10 years.

In all countries, reducing gingivitis management lowered healthy life years and had a negative ROI. Eliminating gingivitis led to rises in healthy life years, reduced costs, and a strong ROI in all countries.

No management of periodontitis resulted in reductions in healthy life years and a negative ROI for all countries. Diagnosing and managing 90% of periodontitis increased healthy life years in all countries, and despite cost increases, there was a positive ROI.

Eliminating gingivitis and increasing the rate of diagnosing and treating periodontitis to 90% had a positive ROI for all countries and gains in healthy life years compared to business as usual. Neglecting to manage gingivitis had the opposite effects.

The report calls for greater emphasis on self-care and prevention at the individual and societal level, including nursery-based dental care and toothbrushing workshops in schools. While the workshops would primarily target caries prevention in children, instilling good oral hygiene regimens into the daily routine from a young age also should benefit periodontitis prevention in adult years, the EFP said.

“It is hugely challenging to determine to economic and societal costs of a complex disease like periodontitis, which is why we needed an independent expert group like the EIU to undertake this modeling,” said Iain Chapple, former treasurer and secretary general of the EFP.

“Their data clearly demonstrates that by far the biggest ROI comes from the prevention of periodontitis, i.e., by treating gingivitis, something traditionally regarded as trivial and ignored, rather than with treatment being directed at periodontitis, which is of course too late for prevention,” said Chapple.

“I am delighted with the analysis presented by the EIU, highlighting the benefit to healthcare providers of treating gum disease early to realize gains in health life years, advancing the European Federation of Periodontology’s purpose of promoting periodontal health for a better life,” said EFP secretary general Nicola West.

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