Periodontal disease and its impact on general health in Latin America. Section I: Introduction part I

Abstract:

A high level of general and oral health are invaluable assets, a factor not always considered a basic human right for their better life quality. The mouth is a critical point of contact with the external environment, which is established when we talk, chew, swallow and when food digestion begins. From a perspective of the human condition, the mouth is crucial for the integration of sound, social appearance of the individual, and is one of the fundamental components of overall health. Therefore, not having an adequate level of oral health affects self-esteem, quality of life and people's general well-being.

Keywords:
Global Burden of Disease; Periodontal Diseases; Public Health

Introduction

Periodontal disease is a public health problem, socially determined and major cause of tooth decay, leading to greater impact on the quality of life of people, exacerbated by their association with chronic non-communicable diseases (NCD). Periodontal treatment and traditional actions of promotion and prevention carried out in the dental unit not enough to control of periodontal diseases and access to health care systems is unfair, which reinforces health inequities and maintains the current situation of oral diseases around the world.

In oral epidemiology, understanding the causal association between lifestyle practices such as oral hygiene, smoking or diet, and caries, erosion and periodontal disease, does not explain why individuals and communities choose to engage in such practices and the historical dimension of such behavior and its change over time.¹

The WHO Commission on Social Determinants in Health established by the Organization in 2006 complements this work for equity in health through support to countries and global health partners to address the social factors leading to ill health and inequities and lack of access to health services. The commission initiative also incorporates analysis of the social determinants in oral health.²

Oral diseases as a public health problem and the global burden.

A high level of general and oral health is an invaluable asset, a factor not always considered a fundamental human right for a better life quality for the individuals.³ From a perspective of the human condition, the mouth is crucial for the integration of sound, social appearance of the individual, and is one of the fundamental components of overall health.⁴ Therefore, not having an adequate level of oral health affects self-esteem, quality of life and people's general well-being.³

Oral diseases (caries and periodontal diseases, such as gingivitis and periodontitis) are now recognized as being both an epidemic and one of the most important public health problems in the world.¹ In 2015, 3,500 million people were suffering from untreated dental conditions; 2,500 million people with untreated decay in permanent teeth; 573 million children with untreated decay in temporary teeth; 538 million people with severe periodontitis; and 276 million people with total loss of teeth.^6,7 We also know that as populations continue to age, the number of people affected by periodontal diseases will increase even further,⁷ and their prevalence will be concentrated on the most vulnerable groups (and segments of society), thus becoming a significant source of social inequality.⁸

A significant contribution made by the Global Burden of Disease (GBD) study was to develop the Disability-Adjusted Life Year (DALY) for use as an indicator in cost-effectiveness studies.⁹ The DALYs represent the years of life lost due to death or disability. Interestingly, in the 2015 GBD report, it was stated that during the 25-year period 1990-2015, there was minimal change among the 10 most critical diseases causing impairment or death, except for one significant point: the rise in oral disease caused it to be ranked among the 10 most important diseases causing disability in the world.¹⁰

Periodontitis as a chronic non-communicable disease and impact on health

Periodontitis is now considered a chronic non-communicable disease (NCD), among others such as cardiovascular disease, diabetes, cancer and chronic respiratory diseases, since all of them share the same social determinants and risk factors of NCD, which in turn are responsible for about two-thirds of world's deaths.^4,11 Smoking, obesity and malnutrition (both in terms of caloric intake and quality of nutritional components) hyperglycemia (with or without diabetes) and physical inactivity have been associated with an increased risk of periodontitis, among others.¹² Clinical studies have shown the effects of periodontal treatment on the reduction of systemic inflammation, improvement in biomarker levels of cardiovascular disease and endothelial function, and decrease in blood glucose levels in patients with type 2 diabetes mellitus.¹³ The close relationship between periodontitis and systemic diseases results in exacerbation of the inflammatory response with an altered immune response.¹⁴ There are close to 57 systemic conditions with presumed possibility of being associated with periodontal diseases, confirming that the associations are established via a common pathogenic mechanism.¹⁵

In 2010, worldwide treatment costs were estimated at US $298 billion, an average of 4.6% of the global health expenditure.¹⁶ In the European Union, annual expenditure on oral disease treatments was approximately €79 billion (annual average expenditure 2008-2012) and if this trend continues, this figure could rise to 93 billion by 2020. These costs (€ 79.0 B) outweigh the costs incurred in the treatment of neuromuscular diseases (€ 7.7 B), multiple sclerosis (€ 14.6 B), cancer (€ 51.0 B), respiratory diseases (€ 55.0 B) and Alzheimer's disease (71.1 million euros).¹⁷ In addition to significant financial implications both for the Government and individuals, there are other costs affecting the population and incumbent on the government, considering the time lost at school and at work.^12,18,19

Proposal for comprehensive intervention in periodontal diseases

This type of intervention requires a conceptual change towards the type in which social determinants underlying oral health have greater explanatory value.²⁰ These determinants, defined as the conditions in which people are born, grow, live, work and grow old, are currently understood as “causes of the causes” of health events and include various structural factors, such as income and education. This proposal sets forth that people's lives are affected not only by their personal characteristics but also by characteristics of the social groups to which they belong, which would determine the effects of attributes at the individual level. These could be the result of norms, values and beliefs that prevail in the social context of people or certain characteristics of the physical environments in which they live.²¹ Therefore, to be able to study the characteristics “of a population” or “of a grouping area”, a geographical or territorial approach is made, based on the individuals' place of residence, such as the neighborhood, commune, region or country, or based on the location of the dwelling (i.e., in an urban or a rural area). This approach assumes that individuals who live in the same geographic area share a series of socioeconomic, environmental, and cultural variables and a socio-political context.^22,23

Current global trends: The European Federation of Periodontology call to action

Periodontitis is a disease that can be often prevented and usually easily diagnosed; it can be successfully treated and controlled in the long term, provided that appropriate care is taken by the patient and dentist. In the contemporary scenario, there are diverse cultural and socio-economic obstacles hindering professional dental care for the population and the development of preventive approaches.⁸ Our proposal is aligned with the call for action from the European Federation of Periodontology, with a comprehensive intervention plan that aims to improve periodontal and general health. This includes the participation of dental surgeons, dental specialists, physicians, educators, teachers, technical health teams, institutions that hire professionals as well as the same target population, with strategies for the health promotion, diagnosis and treatment of periodontal diseases.²⁴

Opportunities in prevention, diagnosis and treatment of periodontal diseases.

The European Federation of Periodontology proposes to identify preventive programs to be developed on a large scale, with specific actions for the purpose of reducing the prevalence of periodontal diseases.²⁵ We must work on the effective management of gingivitis by promoting healthy lifestyles at both population and individual levels.²⁶ This can be achieved through: (i) professional instruction for effective oral hygiene, such as tooth brushing and interdental cleaning, and (ii) an integrated and population-based approach to health education, supported by a common approach to risk factors.²⁷ A critical element is that through the diagnosis and development of risk profiles, prevention must be tailored to the needs of each individual. We emphasize that all individuals should play a proactive role in raising awareness of their oral health, self-care measures, health promotion and disease prevention, for optimal oral and general health during the course of their lives and develop strategies for oral hygiene that would be considered a healthy lifestyle by WHO and other organizations.

Only oral health public policies, based on evidence, with adequate financial support, with specific laws and rules, will be able to reverse the current epidemiological indicators of oral health, always considering aspects like comprehensive care, quality of life, health promotions and preventions of diseases.^28,29 Organizations such as World Health Organization (WHO) and Pan-American Health Organization (PAHO) can be important agents of change in practice and can inspire policymakers and stakeholders to take decisions to build public policies that address oral health in the context of the general health of individuals and populations.

Conclusions

Periodontitis is a chronic non-communicable disease with impact on health and quality of life. Periodontitis and gingivitis are diseases socially determined. Therefore, only public policies, focused on health equity and comprehensive care will be able to modify the epidemiological indicators.

Acknowledgments

This paper was prepared for the consensus meeting entitled “Periodontal disease and its impact on general health in Latin America - Latin American Consensus”, promoted by the Latin American Oral Health Association (LAOHA) and Colgate Palmolive Co., with participation of experts from the region, including representatives of the Periodontal Societies of Latin America. All participants had the opportunity to review the content, and eventually make their own contributions. Consensus Report was based on this paper. The author (JG) was supported by a grant provided by the Fondef I+D, N°ID18I10034. The authors point out that they have no conflicts of interest.

References

• ¹
  Popay J, Williams G, Thomas C, Gatrell A. Theorising inequalities in health. Sociol Health Illn. 1998;20(5):619-44. https://doi.org/10.1111/1467-9566.00122
  » https://doi.org/10.1111/1467-9566.00122
• ²
  Petersen PE. Challenges to improvement of oral health in the 21st century: the approach of the WHO Global Oral Health Programme. Int Dent J. 2004 Dec;54(6 Suppl 1):329-43. https://doi.org/10.1111/j.1875-595X.2004.tb00009.x
  » https://doi.org/10.1111/j.1875-595X.2004.tb00009.x
• ³
  Glick M, Silva OM, Seeberger GK, Xu T, Pucca G, Williams DM, et al. FDI Vision 2020: shaping the future of oral health. Int Dent J. 2012 Dec;62(6):278-91. https://doi.org/10.1111/idj.12009
  » https://doi.org/10.1111/idj.12009
• ⁴
  United-Nations. General Assembly. Political declaration of the high-level meeting of the general assembly on the prevention and control of non-communicable diseases. 19 Sep 2011 [cited 2012 Jan 24]. Available from: https://www.who.int/nmh/events/un_ncd_summit2011/political_declaration_en.pdf
  » https://www.who.int/nmh/events/un_ncd_summit2011/political_declaration_en.pdf
• ⁵
  FDI World Dental Federation. The challenge of oral disease: a call for global action: the oral health atlas. 2nd ed. Brighton: FDI World Dental Federation; 2015.
• ⁶
  Jin LJ, Lamster IB, Greenspan JS, Pitts NB, Scully C, Warnakulasuriya S. Global burden of oral diseases: emerging concepts, management and interplay with systemic health. Oral Dis. 2016 Oct;22(7):609-19. https://doi.org/10.1111/odi.12428
  » https://doi.org/10.1111/odi.12428
• ⁷
  Kassebaum NJ, Smith AG, Bernabé E, Fleming TD, Reynolds AE, Vos T, et al. Global, regional, and national prevalence, incidence, and disability-adjusted life years for oral conditions for 195 countries, 1990-2015: a systematic analysis for the global burden of diseases, injuries, and risk factors. J Dent Res. 2017 Apr;96(4):380-7. https://doi.org/10.1177/0022034517693566
  » https://doi.org/10.1177/0022034517693566
• ⁸
  Jin LJ, Armitage GC, Klinge B, Lang NP, Tonetti M, Williams RC. Global oral health inequalities: task group—periodontal disease. Adv Dent Res. 2011 May;23(2):221-6. https://doi.org/10.1177/0022034511402080
  » https://doi.org/10.1177/0022034511402080
• ⁹
  Murray CJ, Lopez AD. Measuring the global burden of disease. N Engl J Med. 2013 Aug;369(5):448-57. https://doi.org/10.1056/NEJMra1201534
  » https://doi.org/10.1056/NEJMra1201534
• ¹⁰
  The L; The Lancet. GBD 2015: from big data to meaningful change. Lancet. 2016 Oct;388(10053):1447. https://doi.org/10.1016/S0140-6736(16)31790-1
  » https://doi.org/10.1016/S0140-6736(16)31790-1
• ¹¹
  Jin L. The global call for oral health and general health. Int Dent J. 2013 Dec;63(6):281-2. https://doi.org/10.1111/idj.12085
  » https://doi.org/10.1111/idj.12085
• ¹²
  Chapple IL, Bouchard P, Cagetti MG, Campus G, Carra MC, Cocco F, et al. Interaction of lifestyle, behaviour or systemic diseases with dental caries and periodontal diseases: consensus report of group 2 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. J Clin Periodontol. 2017 Mar;44 Suppl 18:S39-51. https://doi.org/10.1111/jcpe.12685
  » https://doi.org/10.1111/jcpe.12685
• ¹³
  Lalla E, Papapanou PN. Diabetes mellitus and periodontitis: a tale of two common interrelated diseases. Nat Rev Endocrinol. 2011 Jun;7(12):738-48. https://doi.org/10.1038/nrendo.2011.106
  » https://doi.org/10.1038/nrendo.2011.106
• ¹⁴
  Loos BG. Periodontal medicine: work in progress! J Clin Periodontol. 2016 Jun;43(6):470-1. https://doi.org/10.1111/jcpe.12550
  » https://doi.org/10.1111/jcpe.12550
• ¹⁵
  Monsarrat P, Blaizot A, Kémoun P, Ravaud P, Nabet C, Sixou M, et al. Clinical research activity in periodontal medicine: a systematic mapping of trial registers. J Clin Periodontol. 2016 May;43(5):390-400. https://doi.org/10.1111/jcpe.12534
  » https://doi.org/10.1111/jcpe.12534
• ¹⁶
  Listl S, Galloway J, Mossey PA, Marcenes W. global economic impact of dental diseases. J Dent Res. 2015 Oct;94(10):1355-61. https://doi.org/10.1177/0022034515602879
  » https://doi.org/10.1177/0022034515602879
• ¹⁷
  Patel R. The state of oral health in Europe. Report Commissioned by the platform for better oral health in Europe. 2012 [cited 2012 Sep 5]. Available from: http://www.oralhealthplatform.eu/our-work/the-state-of-oral-health-in-europe/
  » http://www.oralhealthplatform.eu/our-work/the-state-of-oral-health-in-europe/
• ¹⁸
  Casamassimo PS, Thikkurissy S, Edelstein BL, Maiorini E. Beyond the dmft: the human and economic cost of early childhood caries. J Am Dent Assoc. 2009 Jun;140(6):650-7. https://doi.org/10.14219/jada.archive.2009.0250
  » https://doi.org/10.14219/jada.archive.2009.0250
• ¹⁹
  Chapple IL, Van der Weijden F, Doerfer C, Herrera D, Shapira L, Polak D, et al. Primary prevention of periodontitis: managing gingivitis. J Clin Periodontol. 2015 Apr;42 Suppl 16:S71-6. https://doi.org/10.1111/jcpe.12366
  » https://doi.org/10.1111/jcpe.12366
• ²⁰
  Watt RG. From victim blaming to upstream action: tackling the social determinants of oral health inequalities. Community Dent Oral Epidemiol. 2007 Feb;35(1):1-11. https://doi.org/10.1111/j.1600-0528.2007.00348.x
  » https://doi.org/10.1111/j.1600-0528.2007.00348.x
• ²¹
  Baelum V, Lopez R. Periodontal epidemiology: towards social science or molecular biology? Community Dent Oral Epidemiol. 2004 Aug;32(4):239-49. https://doi.org/10.1111/j.1600-0528.2004.00159.x
  » https://doi.org/10.1111/j.1600-0528.2004.00159.x
• ²²
  Celeste RK, Nadanovsky P, Ponce de Leon A, Fritzell J. The individual and contextual pathways between oral health and income inequality in Brazilian adolescents and adults. Soc Sci Med. 2009 Nov;69(10):1468-75. https://doi.org/10.1016/j.socscimed.2009.08.005
  » https://doi.org/10.1016/j.socscimed.2009.08.005
• ²³
  Espinoza I, Thomson WM, Gamonal J, Arteaga O. Disparities in aspects of oral-health-related quality of life among Chilean adults. Community Dent Oral Epidemiol. 2013 Jun;41(3):242-50. https://doi.org/10.1111/cdoe.12001
  » https://doi.org/10.1111/cdoe.12001
• ²⁴
  Tonetti MS, Jepsen S, Jin L, Otomo-Corgel J. Impact of the global burden of periodontal diseases on health, nutrition and wellbeing of mankind: A call for global action. J Clin Periodontol. 2017 May;44(5):456-62. https://doi.org/10.1111/jcpe.12732
  » https://doi.org/10.1111/jcpe.12732
• ²⁵
  Tonetti MS, Eickholz P, Loos BG, Papapanou P, Velden U, Armitage G, et al. Principles in prevention of periodontal diseases: consensus report of group 1 of the 11th European Workshop on Periodontology on effective prevention of periodontal and peri-implant diseases. J Clin Periodontol. 2015 Apr;42 Suppl 16:S5-11. https://doi.org/10.1111/jcpe.12368
  » https://doi.org/10.1111/jcpe.12368
• ²⁶
  Jepsen S, Blanco J, Buchalla W, Carvalho JC, Dietrich T, Dörfer C, et al. Prevention and control of dental caries and periodontal diseases at individual and population level: consensus report of group 3 of joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. J Clin Periodontol. 2017 Mar;44 Suppl 18:S85-93. https://doi.org/10.1111/jcpe.12687
  » https://doi.org/10.1111/jcpe.12687
• ²⁷
  United-Nations. The 2030 agenda for sustainable development. New York: United-Nations; 2015.
• ²⁸
  Oliveira APC, Dal Poz MR, Craveiro I, Gabriel M, Dussault G. Fatores que influenciaram o processo de formulação de políticas de recursos humanos em saúde no Brasil e em Portugal: estudo de caso múltiplo. Cad Saúde Pública. 2018 Mar;34(2): e00220416. https://doi.org/10.1590/0102-311×00220416
  » https://doi.org/10.1590/0102-311×00220416
• ²⁹
  Pucca Junior GA, Gabriel M, Araujo ME, Almeida FC. Ten years of a national oral health policy in Brazil: innovation, boldness, and numerous challenges. J Dent Res. 2015 Oct;94(10):1333-7. https://doi.org/10.1177/0022034515599979
  » https://doi.org/10.1177/0022034515599979

Publication Dates

• Publication in this collection
  09 Apr 2020
• Date of issue
  2020

History

• Received
  03 Sept 2019
• Reviewed
  22 Sept 2019
• Accepted
  16 Oct 2019