EFP calls dental professionals to unite in prevention

Dental Tribune International

Thu. 30. January 2025

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Oral health, being a cornerstone of well-being, is a critical factor in public health systems. The substantial economic burden of managing oral disease has been highlighted by a recent white paper, titled Time to Put Your Money Where Your Mouth Is: Addressing Inequalities in Oral Health, commissioned by the European Federation of Periodontology (EFP) with support from consumer health company Haleon. In this interview with Dental Tribune International, EFP experts Profs. Moritz Kebschull, Iain Chapple and Nicola West offer practical strategies for dental professionals to drive improved oral health outcomes worldwide and reduced costs of oral disease treatment, including advocating for policy reforms, implementing preventive care models and bridging access gaps for underserved populations.

Prof. Moritz Kebschull is the president of the European Federation of Periodontology and chair of restorative dentistry at the University of Birmingham in England. (Image: EFP)

Prof. Kebschull, the longitudinal cost analysis in the white paper highlights the economic burden of caries management. What role can dental professionals play in advocating for policy changes to reduce these costs?
It is time to take decisive action to encourage better oral health globally. The white paper showcases the need for stakeholders to invest in and collectively champion preventive measures, thereby promoting better alignment between policy, public health, payment systems and clinical practice.

Dental professionals are central to this effort. They can use their expertise to advocate for preventive strategies such as early caries detection, fluoride treatments and improved access to care for underserved populations. By engaging in public health campaigns, collaborating with policymakers and providing data-driven evidence, dental professionals can help shape policies that prioritise prevention, reducing long-term treatment costs and promoting better oral health outcomes.

In addition, the Platform for Better Oral Health in Europe, which the EFP is a member of, is very active and effective in advocating for policy changes at the European level. It is a public health-focused group, and its mission is closely aligned with the prevention of oral non-communicable diseases (NCDs).

The EFP also now holds global influence over policymakers through its S3-level guidelines, which set the standard for state-of-the-art care provision.

Finally, a recent milestone for oral health was the World Health Organization’s global oral health conference in Bangkok in Thailand held in November 2024. This event underscored the importance of integrating oral health into broader healthcare systems. This global momentum reinforces the need for dental professionals to advocate for policy changes at local and international levels.

Prof. Chapple, what strategies would you recommend for dental care providers to address disparities in access to care and enhance preventive measures for underserved populations?
The key to this is to employ a skill mix of dental hygienists, therapists and nurses too. It is thus necessary for these occupations to be recognised in the various countries. We also need to engage other medical professionals, such as community midwives and pharmacists, as well as religious groups and community leaders, to help reach those who lack access to care, including individuals from the poorest backgrounds. This collaboration is essential to provide accessible education and affordable care.

In England, flexible commissioning via the more forward-looking integrated care boards is a real opportunity, as are the new community interest companies in which local partners such as universities work with local authorities and non-governmental organisations to help leverage bespoke services to improve access in their areas. There is currently a consultation active on the ten-year National Health Service plan. It is critical that all oral healthcare professionals actively contribute by advocating for prevention over intervention, focusing particularly on periodontal health and caries prevention. The oral care industry is also crucial, because its goals align with ours. However, as they need to sell effective healthcare products to sustain their businesses, companies’ business models differ.

Prof. Nicola West is the secretary-general of the European Federation of Periodontology and chair of restorative dentistry at Bristol Dental School in England. (Image: EFP)

Prof. West, what are the practical steps clinicians can take to transition from a restorative to a preventive care model?
To transition from a restorative to a preventive care model, clinicians should focus on measures directly within their practice to proactively address dental caries at early and manageable stages. The emphasis should be on implementing preventive strategies such as improving access to quality fluoride toothpaste, patient-specific oral hygiene education and fissure sealants to reduce the likelihood of caries development. Evidence-based interventions such as fluoride varnish should be used promptly at the first sign of caries to arrest progression and prevent the need for invasive treatments.

Also, since the remuneration of many oral health professionals continues to incentivise an invasive approach, it is essential to revise these payment systems to better align with preventive care. Additionally, preventive measures should be started early, focusing on lowering the incidence of early childhood caries, and continue throughout life.

These steps not only improve patient outcomes but also reduce the financial and time burden associated with advanced restorative care. By placing greater emphasis on prevention at the patient level, clinicians can contribute significantly to improving oral health outcomes across all socio-economic groups.

Prof. Kebschull, could you elaborate on how targeted interventions such as fluoride varnish can be scaled in resource-limited settings to maximise their impact?
I would like to begin by highlighting some significant costs associated with oral health. The white paper introduces a new caries prevention and care cost calculator, revealing direct treatment costs of US$357 billion (€331 billion^*) yearly. This figure represents 4.9% of global health expenditure. Additionally, productivity losses due to caries, severe periodontitis and severe tooth loss amount to an estimated US$188 billion annually. Evidence from systematic reviews demonstrates socio-economic inequalities in oral health: low educational attainment is associated with an 86% increased risk of periodontitis and a 44% higher risk of caries.

I mention these figures to emphasise that scaling targeted interventions in resource-limited settings should focus on prioritising the allocation of resources to those most at risk. This approach means that individuals who are most at risk will receive more preventive interventions than those with less risk and more possibility of looking after themselves. Focusing efforts on areas of greatest need yields the most significant impact, as evidenced by our models.

Prof. Iain Chapple has served as the treasurer, scientific chair and secretary general of the European Federation of Periodontology and is currently the director of the UK Oral and Dental Research Trust. (Image: EFP)

Prof. Chapple, what metrics or tools would you recommend for clinicians to assess and monitor the early stages of caries effectively?
While I am not a cariologist, it is evident that modern imaging tools—both light-based and ionising radiation technologies—must be utilised alongside artificial intelligence to detect white spot lesions and early demineralisation. This approach represents true prevention, and the necessary technologies are already being developed to make this a reality. Saliva biomarkers may also play a role. Also, an industry with smart toothbrushes that connect to dental practices to flag potential risk events during home care oral hygiene regimes will help oral healthcare teams access this data at a subsequent patient visit to the practice. This can facilitate professional confirmation of early demineralisation, allowing a truly preventive approach to be implemented in the surgery.

Prof. West, is there anything else you would like to share about the present paper or any upcoming research you are excited about?
Oral disease impacts on nearly half the world’s population, surpassing the burden of most common NCDs. Considering that dental caries affects more than two billion people globally and severe periodontal disease ranks second, at over one billion cases, this white paper emphasises the pressing need for action. By targeting common risk factors such as diet, tobacco use and alcohol use, it unveils a transformative opportunity to mitigate not only oral disease but also NCDs such as diabetes, heart disease, cancer and stroke, all of which are linked to oral disease.

I am also delighted to share that a new academic paper based on the white paper has just been published by BMC Public Health, further advancing this crucial area of research. It is titled “Inequalities in oral health: Estimating the longitudinal economic burden of dental caries by deprivation status in six countries”.

Finally, the EFP is committed to promoting periodontal science and practice, as well as awareness of periodontal health and disease. Our body of work, including recent studies and reports, forms a key part of our strategy to drive evidence-based solutions and advocate for better public health policies that integrate oral health into overall health strategies. We plan to continue research in this area to deepen the understanding of the links between oral and systemic health.

Editorial note:

^*Calculated on the OANDA platform for 13 February 2024.