New EFP clinical practice guideline addresses management of acute periodontal conditions

The EFP has published a new guideline offering clinicians a structured approach to the diagnosis and management of acute periodontal conditions, where timely treatment is crucial to control pain, infection and rapid tissue destruction.

Management of Acute Periodontal Conditions – The EFP S2k Level Clinical Practice Guideline, published in the Journal of Clinical Periodontology, addresses three conditions defined within the 2018 Classification of Periodontal and Peri-Implant Diseases and Conditions: necrotizing periodontal diseases, periodontal abscesses and endodontic-periodontal lesions.

Unlike many chronic forms of periodontal diseases, acute periodontal conditions are characterized by rapid onset and may involve pain symptoms ranging from discomfort to intense pain, and are characterized by rapid onset, rapid destruction of periodontal tissues, and risk of progression, extension and/or dissemination. Patients presenting with these conditions therefore require prompt diagnosis and immediately implemented appropriate treatment.

The new guideline provides clinicians with a clear framework organized around three successive steps:

1. Confirm the diagnosis, using the case definitions established by the 2018 classification.
2. Control the acute condition, including pain and active tissue destruction, through appropriate initial treatment.
3. Provide subsequent treatment, to manage underlying pre-existing conditions, reduce the risk of recurrence and control potential sequelae of the acute episode.

The guideline was developed following a rigorous process that included two commissioned systematic reviews which assessed the available evidence, to help in formulating specific recommendations, followed by a structured consensus process involving experts in the field and a broad range of stakeholders. In some areas scientific evidence was limited, so recommendations combine the best available evidence with structured expert consensus, leading to a guideline at S2k level.

“Acute periodontal conditions have a rapid onset and are usually painful, but the most important features are rapid tissue destruction and risk of progression and dissemination, which can even make them life-threatening (e.g., necrotizing periodontal diseases in children with severe and chronic compromised of the immune system), so clinicians need clear guidance to help them make appropriate decisions without delay,” said Professor David Herrera, first author of the publication. “This guideline brings together the available evidence and expert consensus in a practical stepwise approach, from accurate diagnosis and control of the acute episode, through to management of the underlying pre-existing condition and prevention of recurrence.”

The guideline is an outcome of the 21st European Workshop on Periodontogy, held in November 2025, which focused on clinical guidelines for gingival diseases and acute periodontal conditions. It builds on the EFP programme of evidence-based clinical practice guidelines which already includes recommendations for the treatment of periodontitis in stages I-III (Sanz et al. 2020), and in stage IV (Herrera et al. 2022), as well as the prevention and treatment of peri-implant diseases (Herrera et al. 2023).

EFP president Mia Rakić said: “Providing dental professionals with robust, practical guidance that can be applied in everyday clinical care is a fundamental part of the EFP mission. With this new guideline, we address conditions that require rapid and well-informed clinical decisions, helping us deliver timely, consistent and effective care for our patients.”

Full paper