Study reports low dental care attendance in Denmark

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Irregular dental visits and deteriorating periodontal health in Denmark

Low dental care attendance in Denmark could lead to untreated periodontitis and other diseases and result in extra costs for the healthcare system, a new study says. (Image: UCPH)

COPENHAGEN, Denmark: In a recent study, researchers aimed to examine periodontal care behaviours among dental patients in Denmark. Additionally, the researchers sought to assess the economic burden of periodontal care in the country. The study found that a large part of the population do not go to the dentist regularly and subsequently suffer from varying forms of periodontitis which, when left untreated, results in extra costs for the healthcare system in the country and may lead to the development of other health conditions.

“My research area of interest is epidemiology and health service research, so when Christian asked whether we could investigate dental service utilisation for periodontitis patients, it fitted well with my line of work,” co-author Dr Kasper Rosing, a postdoctoral scholar in the Department of Odontology at the University of Copenhagen, told Dental Tribune International (DTI).

“Periodontal treatment has been reported to significantly improve glycaemic control in patients with diabetes as well as to lower blood pressure in patients with hypertension. Providing periodontal treatment will thereby improve the quality of life for a wide range of patients and reduce long-term societal healthcare expenses related to periodontitis and its comorbidities,” co-author Dr Christian Damgaard, associate professor in the Department of Odontology, added.

In the study, the researchers mapped the number of dental visits between 2012 and 2016 in the Danish adult population and looked at the number of people who had received treatment for periodontitis. They discovered that around two million adult Danes, 40% of the adult population, do not visit the dentist annually and may suffer from varying degrees and stages of periodontitis. Additionally, they reported that total expenditure for periodontal care in Denmark had increased by 13% during the period, from €78 million to €88 million.

“Too few of us receive treatment for periodontitis. We have found that around 12–14% of the Danish population are treated for the condition, and that is nowhere near the number of Danes we estimate to be suffering from the disease,” he added.

Discussing the findings, the researchers said they were surprised at how seldom periodontal surgery was performed in the country and also surprised that the number of periodontal surgery services provided had decreased during the five years under review. According to Dr Damgaard, this indicates that there is a need for international periodontal societies to convince the Danish Health Authority to recognise periodontics as a specialty in Denmark.

However, the researchers noted that Denmark is not the only country where the population suffers from periodontal disease, and that periodontitis prevalence is even higher in other countries. In the US, for example, 46% of the population suffer from periodontitis, and studies in Norway, Sweden and Germany show similar figures, the researchers argue.

Early identification and prevention

To help tackle deteriorating oral health in the Danish population, prevention is key. That is why early detection of periodontitis should not be neglected. Commenting on the issue, Dr Damgaard explained: “It is a problem when periodontitis is not diagnosed and treated in time, as untreated periodontitis will lead to extensive infection and accelerated loss of the bone in which the teeth are rooted as well as to the spread of bacteria and infection from dental pockets to the blood.”

When left untreated over an extended period, periodontitis could lead to other diseases and result in extra costs in other parts of the healthcare system, Dr Damgaard noted. For example, DTI has recently reported on a study that highlighted a link between periodontitis and Type 2 diabetes and cardiovascular disease.

“It is time to take periodontitis seriously and to emphasise the importance of periodontal treatment”
— Dr Christian Damgaard, University of Copenhagen

In light of the findings, the researchers suggested that more research is required to examine periodontal therapy outcomes in daily practice in order to assess the efficiency of existing periodontal care systems as well as to identify both barriers to, and facilitators for, attending dental care in the country.

Periodontal care and social inequality

The study has not inquired into the rationale behind irregular dental visits. However, Dr Damgaard noted that Denmark ranks highly compared with other European countries when it comes to good oral health in children and youth but that this is not the case with adults and senior citizens. According to him, this discrepancy in oral health could be explained by treatment costs, as dental patients who are over 18 years of age have to pay 60% of their dental appointment and treatment fees in Denmark, and only the remaining 40% are covered by state subsidies. “Periodontal patients in Denmark have relatively large out-of-pocket expenses for periodontal care,” Dr Rosing noted.

Additionally, Dr Damgaard explained that social inequality in dental care is still a great issue in the country and that those with higher incomes tend to see a dentist more often. “The most marginalised citizens are also the ones having the greatest dental issues and the ones who generally do not go to the dentist,” he commented and noted that, in order to tackle the issue, everyone in Denmark should have equal access to dental care and proper dental treatment. “It is time to take periodontitis seriously and to emphasise the importance of periodontal treatment,” he concluded.

In a similar study reported by Dental Tribune International, researchers examined the dentate status and the frequency of preventive dental visits of Danish adults over a period of 30 years. The findings indicated that Danes now show a vast improvement in their oral health behaviours. Fewer people suffer from complete loss of natural teeth, and there is an increase in preventative dental visits. However, there are still social inequalities in dental health across the population.

The study, titled “Periodontal care attendance in Denmark in 2012–2016—a nationwide register-based study”, was published online on 9 November 2021 in Acta Odontologica Scandinavica.

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