Millions worldwide are affected by oral diseases, making oral hygiene a critical component of overall health. On March 20th, World Oral Health Day aims to raise global awareness about the importance of preventative care. This year, the initiative ‘Principles For Oral Health’ hosted an international webinar on March 19th, titled “Global Experts grab on The Periodontal Disease Crisis,” to address the growing concern of periodontal disease.
During the webinar, doctors Mariano Sanz and Elena Figuero (Spain) and Iain Chapple (United Kingdom) discussed some of the most debated aspects and remaining challenges in the field. The experts focused particularly on how oral health, especially periodontal health, has evolved in recent decades and where preventative trends are heading.
Reflecting on his career, Dr. Sanz noted that the shift in focus has been key to progress. “More than specific knowledge, I believe the difference has been the focus of what we are doing,” he said. “When we began teaching and researching in the late 1980s and 90s, we focused on treating the disease. We were obsessed with knowing the effectiveness of different interventions for treating periodontitis.”
He likewise recalled that, “We gave a lot of importance to plaque control, but more in its influence on the treatment outcome than in how to prevent the disease from appearing.” According to Dr. Sanz, “The change occurred in the 1990s, when the association between periodontitis and different diseases began to come to light. And more and more evidence began to emerge, gradually convincing the profession of this.” This shift coincided with a change in focus at the turn of the century. “We focused on prevention, and this has a positive impact on systemic health,” Dr. Sanz explained.
He added that, “Many people did not go to the dentist or hygienist for treatment because the idea was that the worst thing that could happen was losing a tooth or suffering a minor health problem if you didn’t take care of your gums or teeth.” This perspective changed “tremendously” with the knowledge gained. “I think we have witnessed a fantastic evolution of how periodontics has evolved in the last 30 years,” the specialist insisted.
Iain Chapple added that, “People see prevention as if it were a single entity, something linear, and This proves not.” He emphasized that there are many different types of prevention. “Primary prevention, for example, refers to stopping the appearance of risk factors before the disease appears. Let’s say we already have the risk factors, but we are going to correct them before the pathology appears.”
Secondary prevention, is used when the pathology is already present, and consists of “how You can avoid recurrence.” As for tertiary prevention, “it refers to preventing complications, transmission to dental prevention and also the consequences for systemic health, which we now know are associated with prevention,” explained the British expert.
He also mentioned a relatively new concept: quaternary prevention, which comes from the world of medicine and refers to overtreatment, over-prescription. “Not prescribing too many drugs due to all the side effects. And I think that is also essential in our specialty, not to over-treat and focus on prevention without over-treatment. Those were the key elements for me and I think that’s where we need to go now,” he reflected.
This is particularly important given the increasing prevalence of periodontitis. In 2017, it was around 11.2% globally; in 2011 it was already at 12.5%; and estimates indicate that it will exceed 13% incidence before 2013. Mariano Sanz believes this trend is partly due to focusing on treating the disease. He also considers that, “the problem is that most patients only go to the oral health professional when things have already progressed a lot, they have come very far. And when we treat a severe infection, it often requires complex treatments.”
Iain Chapple distinguishes between pre-warming and disease burden. “Currently, severe periodontitis is one of the pathologies that are at the highest points on the list with respect to disease burden. And this can also be translated into economic impact. What are the consequences for public health of having such a high prevalence? There are two dimensions: one at the population level, the other, at the individual level, and the consequences for that affected patient, in terms not only of the possibility of losing their tooth, but also the impact on their phonetics, their nutrition, their self-esteem, their quality of life, etc. This is an impressive burden. And the only way to fight this epidemic is to change our focus to prevention,” he elaborated.
To achieve this, “we need good diagnostic tools to identify early forms of the disease, but we must also do a lot of work educating different professionals to identify the pathology in early stages.” However, he insists, “if we adjust the focus of attention, we can fight this pathology. We often talk about behavioral changes in our patients, but we also have to change our own behaviors. And that is a challenge.”
Elena Figuero focused on key treatment points, stating that “treating gingivitis is the best way to prevent periodontitis.” She also pointed out that “the best way to treat gingivitis is with biofilm control, but sometimes this is not enough and there are some general and local factors that affect that specific patient.”
she indicated that “sometimes we must add some coadjutant agent.” In this sense, “when we talk about additional antiseptics, not all have the same efficacy.” And “we must remember that mouthwashes with essential oils are able to reduce plaque and gingivitis, which is what we ultimately want: to prevent periodontitis.”
