Periodontal diseases remain among the most common health conditions around the world. Despite their largely preventable nature, a recent report from the Economist Intelligence Unit (EIU) has highlighted that prevalence has remained largely unchanged over the past 25 years. Further, the EIU notes that a growing evidence base connects periodontal disease with diabetes, cardiovascular disease, and at least 50 other non-communicable diseases. Here, we discuss the economic impact of this persistent public health issue.
The economic burden of periodontal disease
The EIU reports that the direct cost of treating dental diseases amounts to $298 billion per year worldwide, representing an average of 4.6% of global health expenditure. A study that looked specifically at periodontal disease in the US and 32 European countries estimated that in 2018, the direct costs were $3.49 billion and €2.52 billion respectively.
The indirect cost of periodontal disease is thought to be much higher. This includes costs related to complications of untreated periodontal disease, such as edentulism and root caries, and those related to lost productivity, e.g., time off work to recover from surgery. In 2018, these costs amounted to $150.57 billion and €156.12 billion in the US and the 32 European countries respectively.
The intangible costs of periodontal disease
Periodontal disease — and its side effects — can also result in intangible costs to the patient. From a functional perspective, sensitivity, loss of gingival and periodontal tissue, and loose or lost teeth may impair the patient’s ability to properly chew or speak. These, along with side effects like bleeding gums and halitosis, can cause the patient shame, embarrassment or anxiety, negatively impacting their self-confidence and their social and emotional wellbeing.
It is also important to note growing evidence of the strong links between periodontal disease and systemic diseases, such as diabetes and cardiovascular disease, via shared disease pathways and common risk factors. Professor Philippe Bouchard (Professor and Chairman of Periodontology, U.F.R. d’Odontologie, France), quoted by the EIU, notes that the chronic inflammation characteristic of periodontitis can increase the risk of type 2 diabetes and cardiovascular disease. Thus, periodontitis can be said to contribute to the health burden of these diseases, albeit to an unquantifiable degree.
The benefits of prevention and proactive perio care
Periodontal care tends to be more reactive than proactive. The early signs of gingivitis are often missed, minimized, or ignored by patients, who may attend routine check-ups infrequently and only be moved to see a dentist when their symptoms start to become painful or disruptive. By this point, periodontitis may be well-established, necessitating more invasive treatment.
One very common barrier to seeking regular preventative oral care and/or early gingivitis treatment is affordability. The patient may not feel able to justify the upfront cost of a dental appointment unless they have a tangible problem, and may not perceive the milder symptoms of gingivitis to be such. However, the EIU modeled various approaches to periodontal diseases and found that this approach is actually more expensive in the long run.
Of the five scenarios modeled, one focused on the elimination of gingivitis — and consequently the prevention of periodontitis — through improvements in home oral care. In this scenario, costs related to periodontal disease were significantly reduced in every country studied when compared to the cost of continuing the current “business as usual” approach. Further, healthy life years substantially increased.
In another scenario, in which 90% of periodontal disease was diagnosed and all cases were treated, the cost of dental treatment increased, but so did the number of healthy life years. The result was a net positive return on investment.
A simple solution
Reassuringly, the EIU report indicates that the most impactful results can be gained from educating the patient on gingivitis and promoting simple home oral care. This includes mechanical plaque removal with twice-daily brushing and daily interdental cleaning, using products formulated to treat/prevent gingivitis, such as Colgate PerioGard toothpastes. This can be supplemented with chemical plaque control, using mouth rinses such as Colgate Savacol Antiseptic Mouth & Throat Rinse, meridol Toothpaste, and meridol Med CHX 0.2% Mouth Rinse.
These positive behaviors can be presented to patients in cost-benefit terms by comparing the time and expense associated with advanced periodontitis treatment — more complex treatments, time off work, etc. — to the relatively small cost of bi-annual check-ups, cleanings, and inexpensive oral care products. Of course, the intangible personal cost of side effects like pain and tooth loss should also be mentioned. With many patients unaware of the oral-systemic connection, these behaviors can also be framed as a simple, accessible way to reduce the risk and associated costs of conditions like heart disease and type 2 diabetes.
All things considered, the patient should come away from the discussion knowing that despite the small upfront cost, proactive and diligent oral health care is always the most financially sensible option in the long term.
