A report commissioned by the EFP and published by the Economist Intelligence Unit (EIU), the research and analysis division of the Economist Group, provides a comprehensive analysis of the financial and human cost of gum disease in six Western European countries.
The report, Time to take gum disease seriously: The societal and economic impact of periodontitis, was published on June 14 and explains how more effective prevention of gum disease could save billions in healthcare costs and lead to healthier lives. The six countries included in the study are France, Germany, Italy, the Netherlands, Spain, and the UK.
As the report makes clear, periodontitis is largely preventable with good oral hygiene and regular dental check-ups. However, it shows how in Western Europe little progress has been made in the prevention and management of periodontitis, with prevalence remaining largely unchanged over the last 25 years. One key factor highlighted by the report is that many people visit a dentist only when they have a problem and avoid regular appointments because of the cost.
It notes that in Spain and Italy, most if not all periodontitis treatment is paid for by patients or private insurance, so “periodontitis treatment for a low-income family is therefore rendered almost unaffordable”. Furthermore, while dental care appears to be “free on paper” in the UK and France, “only part of the dental procedures for treating periodontitis are covered and the remainder is paid for out-of-pocket.”
After providing evidence that professional management of periodontitis is cost-effective, the study argues that “publically covered dental care for periodontitis deserves a review from policy makers and commissioners Europe-wide”.
The report therefore seeks to “capture the attention of policy makers” in the six countries studied, emphasising 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 national level.”
The EIU report makes four key recommendations:
- The prevention, diagnosis, and management of periodontitis is cost-effective:
- The role of home care by patients is of paramount importance to prevent gingivitis and periodontitis.
- Making efforts to eliminate gingivitis, thus preventing progression to periodontitis, would save considerable costs over 10 years compared with “business as usual” – ranging from €7.8bn in the Netherlands to €36bn in Italy.
- Neglecting to manage gingivitis can significantly increase costs and reduce healthy life years, so “an emphasis on self-care and prevention is critical from both an individual and a societal perspective.”
- Better integration of dental and general healthcare is required:
- Sharing information across disciplines may both improve 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.
- 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 is needed:
- One without the other would exacerbate oral-health inequalities both within and across countries.
- Societal-level prevention is of crucial concern to the prevention of periodontitis, as it is a disease that 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 centres (for the prevention of gum disease).
- The affordability of dental care needs to be improved:
- For many people, the cost of accessing a dentist is a barrier to receiving early treatment and, as a result, they are more likely to access the dentist when there is something wrong rather than for check-ups or preventative treatment that is essential for avoiding periodontitis.
- In the UK and France, not all procedures for treating periodontitis are covered by the public-health system and the remainder is paid for by the patient. In Spain and Italy, most (if not all) periodontal treatment is paid for by the patient or via private insurance.
- As a result, periodontitis treatment for a low-income family is rendered almost unaffordable.
- Professionally managed periodontitis is cost-effective and policy makers and commissioners Europe-wide should review publicly covered dental care for periodontitis.
Few studies have modelled the economic burden of periodontitis and the return on investment (ROI) of treatment and the report’s authors developed a model to examine the ROI of preventing and managing periodontitis, with separate modelling performed for France, Germany, Italy, the Netherlands, Spain, and the UK.
The model used in the study was based on EFP treatment guidelines that outline four intervention points in the progression from (1) health to (2) gingivitis, (3) undiagnosed periodontitis, and (4) diagnosed periodontitis. The estimates for the current national situation in each of the six countries 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 (periodontitis is thereby prevented).
- 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 in the Netherlands to €96.8 billion 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.
The authors noted that both 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. They called for greater emphasis on self-care and prevention at the individual and societal level, including nursery-based dental care and tooth-brushing workshops in schools. While the latter would primarily target caries prevention in children, instilling good oral-hygiene regimens into the daily routine from a young age should also benefit periodontitis prevention in adult years.
The EFP’s current and former secretaries general, Nicola West and Iain Chapple, contributed to the report and the EIU also carried out interviews with 17 other leading periodontists. The economic modelling was performed by health economists David Tordrup and Tim Jesudason of Triangulate Health.
“It is hugely challenging to determine the 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 modelling,” said Iain Chapple, professor of periodontology at the University of Birmingham, former EFP treasurer and secretary general, and member of the EFP Workshop Committee. “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.”
Nicola West, professor of periodontology at Bristol University and EFP secretary general, said: “I am delighted with the analysis presented by the EIU, highlighting the benefit to healthcare providers of treating gum disease early to realise gains in healthy life years, advancing the European Federation of Periodontology’s purpose of promoting periodontal health for a better life.”
The EIU report was sponsored by Oral-B, part of the Procter & Gamble Company. “Dental diseases, including periodontitis, are a burden both on an individual and societal level; fortunately, they can be prevented through oral health maintenance,” said Leslie Winston, vice president of global oral care professional and scientific relations at Proctor & Gamble. “Key factors are mechanical and chemical plaque control, e.g., using an electric toothbrush with an antibacterial fluoride toothpaste and interdental cleaning. Another important element is to visit dental healthcare providers regularly to ensure that any emerging issues are addressed while they still can be reversed.”