Leading researcher Nicola West explains the work behind the Perio & Caries project

The new Perio & Caries awareness project, launched by the EFP in partnership with Colgate, has at its centre five detailed recommendation brochures targeted at different audiences.

These evidence-based recommendations, which can be downloaded in pdf format from the Perio & Caries website, are aimed at:

• The oral-healthcare team;
• Non-dental health professionals;
• Researchers;
• Policymakers;
• The public.

All the material is based on the findings of Perio Workshop 2016, organised by the EFP and the European Organisation for Caries Research (ORCA), which was held in Spain in November 2016. This workshop produced four consensus reports from working groups chaired by Mariano Sanz, Søren Jepsen, Iain Chapple, and Maurizio Tonetti, together with 10 supporting papers.

The recommendation brochures were prepared for the Perio & Caries project by Nicola West, professor of periodontology and head of restorative dentistry and the Clinical Trials Unit at the Bristol Dental School, University of Bristol (UK).

Prof West explained that drawing out the key points from these detailed reports and formulating clear, concise recommendations aimed at different target audiences, each with its own needs, was an enjoyable but substantial task.

“Systematic reviews and consensus documents – these reports are very heavyweight, with in-depth specialist detail and understandable overlap between the reports from the four working groups.” she said.

Her first task was to go through all the papers – which were published in March 2017 as a special issue of the EFP’s impact-factor magazine the Journal of Clinical Periodontology – to compile a single scientific report that clearly explained the main findings.

This 36-page report, The boundaries between caries and gum disease, also available at the Perio & Caries website, then became the basis of the five recommendation brochures.

“It was a question of taking all these findings and focusing them in ways suitable for different audiences – the oral-healthcare team, non-dental health professionals, the public, researchers, policymakers,” she noted, adding that, as she went through the papers, she highlighted key aspects in different colours for each of the five target groups.

In each document, there are recommendations relating specifically to periodontal disease, to caries, and to both diseases.  All the documents have a common introductory infographic headed “Gum Disease and Tooth Decay: interactions and similarities between the most widespread oral conditions,” which emphasises that gum diseases and dental caries are both nearly always preventable.  

Six key facts are presented:

1. Gum disease (periodontitis) and tooth decay (caries) continue to be major public-health problems worldwide;
2. Untreated caries and periodontitis may have severe consequences and lead to tooth loss, poor nutritional status, compromised speech, and reduced quality of life;
3. One person in three is affected by caries;
4. Severe periodontitis is the sixth most common disease globally;
5. 10% of the global population is affected by severe periodontitis: 743 million people;
6. Severe periodontitis is a leading cause of tooth loss in the adult population.

Perhaps the most challenging task that Prof West faced was to find a way to edit the original words that ensured that the recommendations avoided repetition and were easy to understand, but without losing or changing any of the meaning – and to do this in different ways for each of the various target audiences.

Clear and simple statements

“For the public, we needed clear, unambiguous statements. Not too many, and they must be easy to understand and remember,” she said. “So simple messages like ‘Bleeding gums are not normal. Dental professionals should be consulted immediately’ are very good public messages.”

For policymakers, the messages can be more complex, but they need to be presented “so that they can understand the issues very quickly.” Among the key messages here are that governments should include prevention and the development of individually tailored oral-care plans for their country’s reimbursement system, and that they should develop strategies to address oral-health inequalities in areas of high socio-economic need.

For the professional audiences, the recommendations could be more detailed and scientific – although never at the expense of clarity.

Oral-healthcare professionals are given a clear list of preventive measures and treatment strategies for both dental caries and periodontal diseases that are effective at all ages, including elders.

Non-dentistry health professionals are informed about the nature of the two diseases and reminded that unhealthy gums can be associated with other general health issues such as diabetes and cardiovascular disease and that “the mouth is a vital part of the body and not a separate organ” or, as Prof Chapple puts it, “the mouth is a window on the body.”

Researchers are provided with an extensive list of areas for future investigation, of each individual disease and of the interactions between periodontal diseases and dental caries.  Areas highlighted include studies to assess the role of genetics in caries and periodontal disease initiation and/or progression, and epidemiological surveillance of caries, periodontal diseases, tooth loss, and oral-health-related quality of life in older people.

Summing it all up, Prof West said: “This was an amazing workshop bring the brightest minds in the world together to discuss recommendations for the prevention of gum disease and dental caries. I am delighted with the new guidelines and feel very privileged to have been part of this brilliant international project. Please read and implement the guidelines so that we can keep our teeth and improve the quality of life for millions of people worldwide.”