The economic case for the prevention and management of gum disease was outlined on 15 June in a report by the Economist Intelligence Unit (EIU).1

The most comprehensive analysis on the financial and human cost of gum disease in six Western European countries was commissioned by the European Federation of Periodontology (EFP) as an independent study and sponsored by Oral-B.

Severe periodontitis affects around half of the world's population. It can cause tooth loss and difficulties chewing, speaking, and smiling, and is associated with nearly 60 other health conditions including heart disease and diabetes.2

Periodontitis is largely preventable with good oral hygiene and regular dental check-ups. Yet the report states that in Western Europe, developments in prevention and management appear stagnant. The prevalence of periodontitis has remained largely unchanged over the last ten years and its awareness among the general public and non-oral health professionals is poor. The document describes a situation in which many people only see a dentist when they have a problem and avoid regular appointments due to the cost.

Few studies have modelled the economic burden of periodontitis and return on investment (ROI) of treatment, particularly across different countries. The authors developed a model to examine the ROI of preventing and managing periodontitis.

To measure the impact of prevention and treatment, the model used the EFP treatment guidelines which outline four intervention points in the progression from health to gingivitis, undiagnosed periodontitis, and diagnosed periodontitis. The estimated current national situation determined the number of individuals starting at each stage of the model.

The authors modelled the transition between the different health and disease stages during a ten-year period according to five scenarios: 1) baseline: current prevention and treatment situation continues; 2) rate of gingivitis management falls from 95% to 10%; 3) incident gingivitis is eliminated through improved oral homecare (periodontitis is thereby prevented); 4) no periodontitis is managed; 5) 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 baseline. The cost of continuing with the baseline scenario ranged from €18.7 billion in the Netherlands to €96.8 billion in Italy over ten 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. 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.

Report contributor Professor Iain Chapple, EFP Workshop Committee member, said: '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. Their data clearly demonstrates that by far the biggest ROI comes from the prevention of periodontitis, ie by treating gingivitis, something traditionally regarded as trivial and ignored, with treatment being directed at periodontitis - which is of course too late'.