Webinar goes into depth on social and economic costs of gum disease

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The EFP-commissioned report Time to take gum disease seriously: The societal and economic impact of periodontitis, published by Economist Intelligence Unit (EIU), was presented on 14 September in a webinar which is now available for viewing on the EFP website and on YouTube.

The webinar featured a presentation by Chrissy Bishop (EIU project manager) on the methodology and findings of the report on the societal and economic costs of gum disease in six Western European countries. It also modelled costs, healthy life years and returns on investment over a 10-year period for various intervention scenarios, modelled for people with stage 2 (moderate) periodontitis using the steps of care outlined in the EFP S3-level treatment guidelines.

Bishop explained how the EFP had four objectives in commissioning this research:

Raise awareness on periodontitis and drive policy and behaviour change on gum health.
Develop new ways of thinking about gum health to drive engagement.
Increase commitment and action at the European level.
Improve patient outcomes.

To address these objectives, the EIU proposed an economic model that would capture the socioeconomic burden of periodontitis and asses the evidence that links better periodontal health with improved overall health outcomes in six European countries. The six countries selected for the research were France, Germany, Italy, the Netherlands, Spain, and the UK.

Chrissy Bishop explained that severe periodontitis is more prevalent than cardiovascular diseases and respiratory infections, commenting, “I don’t think that’s as commonly known as periodontal experts might think. For public-health experts, this might come as a shock.”

She added that periodontitis, along with caries was responsible for more years lost to disability than any other human disease, that its association with diabetes and cardiovascular diseases meant that it was a threat to general health, and how it was the third most costly disease. The costs of periodontitis were estimated at €90 billion per year, behind only diabetes (€119 billion) and cardiovascular diseases (€111 billion).

A social disease

Bishop also emphasised how periodontitis is a social disease because its prevalence is clustered in groups with higher levels of deprivation. As a result, the mouth is “a marker of people’s social position and future disease risk.”

She said that the report highlighted the importance of developing integrated general and oral “healthcare pathways” to assess future disease risk and the need for better access to dental care in lower socioeconomic groups.

Despite the problems, she emphasised that 95 percent of cases of periodontitis can be diagnosed and treated by primary-care general dental practitioners.

She highlighted the research’s findings that, despite improvements in the quality of oral-health services and increased awareness of the importance of oral hygiene, there has been very little change in the prevalence of periodontitis in the six countries studied.

Methodology and modelling

The research methodology involved four phases:

A literature review to evaluate the prevalence and burden of periodontitis and to review the clinical pathways and policy that prevents periodontitis.
An expert panel was convened to discuss and help understand the critical issues for policy change to help prevent poor oral health.
Quantitive analysis was conducted to assess the health and indirect economic costs associated with periodontitis is each of the six countries in the study.
A white paper was written and published providing a summary of the findings of the literature review, expert panel discissions, and quantitive analysis.

The EIU’s cost-effectiveness analysis focused on establishing a return on investment (ROI) for the treatment of periodontitis and the management of gingivitis, based on the recognition that preventing and managing gingivitis is essential to the prevention of periodontitis.

Bishop explained how the modelling approach adopted by the EIU estimated the impact of five scenarios against five different outcomes.

The scenarios were (1) business as usual, (2) 10% management of gingivitis, (3) elimination of gingivitis, (4) no periodontitis management, (5) 90% of periodontitis is diagnosed and managed.

The outcomes were (1) the number of healthy life years gained, (2) the total costs (3), the cost per healthy life year, (4) the incremental cost-effectiveness ratio, (5) return on investment.

Bishop explained the research’s key finding was that the extreme scenario of eliminating gingivitis led to cost savings of €10 billion in most countries (more in Italy and the UK) compared to the business-as-usual approach, while the 90% managed-periodontitis scenario led to an increase in costs but still provided a positive return on investment over the 10-years.

“Our economic analysis shows that both eliminating gingivitis and increasing the rate of diagnosis and management of periodontitis to 90% has a positive return on investment in all of the European countries in the study,” explained Bishop.

In contrast, “neglecting to manage gingivitis can significantly increase costs and reduce healthy life years. Therefore, an emphasis on self-care and prevention is critical from both an individual and a societal perspective.”

Improving access to dental care

She emphasised that better integration of oral and general health is needed as well as “a synergy of societal and individual public-health campaigns.” In addition, dental care needs to be more affordable to the public because the cost of accessing a dentist is “a barrier to receiving treatment early for many.”

Responding to the presentation, Iain Chapple (professor of periodontology at the University of Birmingham in the UK and former EFP secretary general) highlighted how the research had shown the “tremendous differences in how periodontitis and periodontal care is funded in different countries across Europe.”

He noted that costs are quite significant in countries like Italy and Spain where periodontal treatment is predominantly provided privately but “equally in France and to a greater extent in the UK, despite public-funding models, there is still a considerable amount paid out of pocket by the patient.”

A lively question-and-answer session followed, which covered topics including:

Some of the more surprising data in the research, such as the high costs of treatment in Italy and the surprisingly low prevalence of periodontitis among older people in Spain.
A call for industry to develop toothpastes and mouth rinses against gingivitis, just as the addition of fluoride to toothpastes had contributed to the reduction of caries.
How to reach the people who do not visit the dentist.
The effectiveness of power toothbrushes compared with manual brushes.

Summing up, Prof Chapple said that the research “provides solid evidence that prevention is cost-effective and that the return on investment is high.”

EFP president Lior Shapira thanked the organisers of the webinar and called on industry to do more to help in terms of developing new products.

“Maybe the industry needs to change its view and try to find something different because it is still trying to develop products according to maybe old-fashioned views regarding periodontitis,” he said. “All of [the products] are antibacterial and today we know that the disease is caused by a dysbiosis and also the immune response. So maybe they need to find something different to put into toothpaste and mouth rinses to help combat disease using the new knowledge we have got in the last 20 years. And I hope it will be done soon.”

Finally, EFP secretary general Nicola West commented, “These data support our EFP data and our workshop data. It’s our role now is to continue to raise awareness and use this important paper to champion our cause.”