Aubrey Sheiham & Gopalakrishnan Netuveli. Periodontal diseases in Europe. Periodontology 2000, Vol.29,2002; 104–121.
This article discusses the distribution of different degrees of periodontal disease in Europe and the implications that these may have on overall health.
The literature has shed light on the fact that the most severe forms of periodontal disease affect a minority and that normal progression of the disease is usually quite slow. Also, as treatment goals, rather than discussing the presence or absence of disease, we should ideally talk about maintaining a minimum number of functional teeth throughout our lifetime even with certain levels of disease.
With regard to periodontal disease progression, it is agreed that most gingivitis cases will not progress to periodontitis, and therefore signs of gingival inflammation are weak predictors of disease. Moreover, the rate of bone loss with age is also very low but may increase in older populations.
In Europe, gingivitis has a very high prevalence in all age groups. By contrast, periodontitis and particularly its more severe forms have a very low prevalence in western countries and a slightly higher one in eastern countries. In addition, the presence of deep pockets is concentrated in just some certain patients and teeth.
The historical trend of periodontal disease illustrates an overall improvement, although as people who age retain more teeth, and therefore edentulism decreases, periodontal disease becomes more prevalent because more teeth are present.
The role of microbial plaque has been well established as a cause of periodontal disease, and therefore, the focus is on promoting oral hygiene measures for controlling plaque. However, promoting oral health does not seem to quite have the desired effect, most likely because of a poor approach to the social aspects that are involved when periodontal disease exists.
The models used for promoting oral health must be adapted to the different situations and individuals to which they are targeted in order to be effective. Often times, the message of oral health professionals fails to bear any positive effect on people because it is unrealistic and is not habit-changing.
For public health strategies to be effective in controlling periodontal disease, treatment should focus on three main factors:
- Target population
- Secondary prevention
- High risk patients
In regard to the target population, oral health needs to be included as part of overall healthcare, and its education should be promoted in all areas. For secondary prevention, it is important to stress improving the effectiveness of oral hygiene techniques. Lastly, we must pay close attention to people with systemic diseases, as these can worsen already existing periodontal problems.