Global Periodontal Health

Published on FDI World Dental Federation (https://www.fdiworlddental.org)

Global Periodontal Health [1]

September, 2018 Buenos Aires Argentina

Context
Periodontal (gum) diseases, including gingivitis and periodontitis, are among the most common diseases in
humans. They begin with an imbalance of the plaque biofilm-host interaction and the breakdown of microbe-host
homeostasis, and progress due to dysregulated immuno-inflammatory responses in susceptible individuals with
various environmental and host risk factors (e.g. tobacco use and diabetes mellitus). Periodontitis is a leading
cause of severe tooth loss/edentulism in adults worldwide. It is also closely linked to other non-communicable
diseases (NCDs) and disorders (e.g., diabetes, cardiovascular disease, pulmonary diseases, rheumatoid arthritis,
kidney disease and cognitive impairment), through the underlying plausible mechanisms and pathways of infection
(e.g. bacteremia), inflammation, dysbiosis and common risk factors. As a major global health burden, periodontal
diseases profoundly affect people’s oral and general health, quality of life, welfare and self-esteem, causing
enormous socio-economic impacts and healthcare costs. In response to these challenges, the major international
periodontology organizations have reached the first consensus on preventive, diagnostic and therapeutic strategies
to promote periodontal health and general health. The new classification of periodontal and peri-implant diseases
and conditions (2018) further facilitates and enhances the prevention and management of periodontal diseases and
related research for global periodontal health. [2]

Scope
This policy statement identifies the major challenges in addressing these problems, and highlights new
opportunities to promote periodontal health and effective healthcare through implementing a global strategy and
collaborative actions.

Definitions
Periodontal diseases: the chronic inflammatory conditions due to microbial dysbiosis and dysregulated host
response that affect tooth-supporting soft and hard tissues.

Gingivitis: an inflammatory condition initiated by plaque biofilms and characterized by gingival redness, oedema,
changes in contour and bleeding upon gentle probing, without attachment loss and alveolar bone resorption.

Periodontitis: a chronic multifactorial inflammatory lesion due to microbial dysbiosis and dysregulated host
response, characterized by progressive destruction of tooth-supporting tissues with attachment loss and alveolar
bone resorption.

Principles
Global awareness of periodontal health remains low, owing to the relatively silent nature of periodontal diseases,
poor oral hygiene habits, limited professional education and care, and a lack of an overall oral/periodontal health
strategy and policy. There is insufficient proactive promotion of periodontal health by oral health professionals and
policymakers. Further, there are shortages in the provision of effective healthcare. It is of utmost importance to
build a global consensus, encourage interprofessional and interdisciplinary collaboration, and craft an effective
strategy of periodontal health promotion to address the burden of these serious diseases and uphold periodontal
health and general well-being.

Page 1 of 3
Global Periodontal Health
Published on FDI World Dental Federation (https://www.fdiworlddental.org)

Policy
FDI supports the following statements:

Periodontal diseases, especially periodontitis, represent a major global disease burden with devastating
effects on oral health and a close link with general health, and account for huge socio-economic impacts
and massive healthcare costs worldwide.
Periodontal health awareness among the general public is low. Neglecting periodontal diseases and their
care in daily practice poses critical problems and challenges to healthcare professionals. Therefore,
increasing periodontal health awareness and literacy is fundamentally crucial to address the global burden
of periodontal diseases.
Periodontal diseases are preventable and manageable through effective daily self-care and appropriate
professional care.
Primary and long-term secondary prevention strategies are crucial to promote periodontal health and
effective oral/periodontal care. They should address individual needs and risk profiles.
Periodontal screening and diagnostic procedures should be undertaken for all patients by oral health
professionals.
Oral/periodontal diseases share a number of modifiable risk factors with other NCDs (e.g., tobacco use and
obesity), and the common risk factor approach should be proactively implemented via inter-professional
teamwork.
Global population ageing poses an increasing burden, placing further demands on proactive periodontal
care for healthy ageing.
Education in periodontology needs to be reinforced in dental curricula and continuing professional
development programmes.
There is a great need for further basic, translational and clinical research into periodontal health and
disease, such as oral symbiosis and dysbiosis in healthy and medically compromised groups. Evidence-
based datasets, updated guidelines/toolkits, and healthcare decision support systems should be
established.
It is important to engage and collaborate with other stakeholders, such as medical professionals, healthcare
NGOs, government authorities and agencies, and third-party funders, to advocate periodontal health in
public communities (e.g., educational systems and service networks for pregnant women, the elderly and
medically compromised individuals).
Oral/periodontal health should be integrated into all national health strategies, policies and programmes for
optimal health and well-being.

Disclaimer
The information in this policy statement was based on the best scientific evidence available at the time. It may be
interpreted to reflect prevailing cultural sensitivities and socio-economic constraints.

References
1. Herrera D, Meyle J, Renvert S, Jin LJ. White Paper on Prevention and Management of Periodontal
Diseases for Oral Health and General Health. Geneva: FDI World Dental Federation; 2018.
2. Jepsen S, Blanco J [3], Buchalla W [4], Carvalho JC [5], Dietrich T [6], Dörfer C [7], 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; 44: S85-S93.
3. Jin LJ, Armitage GC, Klinge B, Lang NP, Tonetti M, Williams RC. Global oral health inequalities: Task group
- periodontal disease. Adv Dent Res 2011; 23:221-226.
4. 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; 22:609-619.
5. Kassebaum NJ [8], Bernabé E [9], Dahiya M [10], Bhandari B [11], Murray CJ [12], Marcenes W [13]. Global
burden of severe periodontitis in 1990–2010: a systematic review and meta-regression. J Dent Res 2014;
93:1045-1053.
6. Lancet (Editorial). Oral health: prevention is key. Lancet 2009; 373:1.

Page 2 of 3
Global Periodontal Health
Published on FDI World Dental Federation (https://www.fdiworlddental.org)

7. Listl S, Galloway J, Mossey PA, Marcenes W. Global economic impact of dental diseases. J Dent Res
2015; 94:1355-1361.
8. Meyle J, Chapple I. Molecular aspects of the pathogenesis of periodontitis. Periodontol 2000 2015; 69:7-17.
9. Tonetti MS [14], Jepsen S [15], Jin L [16]J, Otomo-Corgel J [17]. Impact of the global burden of periodontal
diseases on health, nutrition and wellbeing of mankind: A call for global action. J Clin Periodontol 2017;
44:456-462.
10. World Health Organization. Oral health: What is the burden of oral disease?
http://www.who.int/oral_health/disease_burden/global/en/ [18]
11. Caton JG, Armitage G, Berglundh T, Chapple ILC, Jepsen S, Kornman KS, Mealey BL, Papapanou PN,
Sanz M, Tonetti MS. A new classification scheme for periodontal and peri-implant diseases and conditions
– Introduction and key changes from the 1999 classification. [2] J Periodontol 2018; 89 (Suppl 1):S1-S8.

Classification: General health [19]

Health policy [20]
Noncommunicable diseases (NCDs) [21]
Periodontal [22]

Source URL: https://www.fdiworlddental.org/resources/policy-statements/global-periodontal-health

Links
[1] https://www.fdiworlddental.org/resources/policy-statements/global-periodontal-health
[2] https://www.ncbi.nlm.nih.gov/pubmed/29926489
[3] https://www.ncbi.nlm.nih.gov/pubmed/?term=Blanco%20J%5BAuthor%5D&cauthor=true&cauthor_uid
=28266120
[4] https://www.ncbi.nlm.nih.gov/pubmed/?term=Buchalla%20W%5BAuthor%5D&cauthor=true&cauthor_
uid=28266120
[5] https://www.ncbi.nlm.nih.gov/pubmed/?term=Carvalho%20JC%5BAuthor%5D&cauthor=true&cauthor
_uid=28266120
[6] https://www.ncbi.nlm.nih.gov/pubmed/?term=Dietrich%20T%5BAuthor%5D&cauthor=true&cauthor_ui
d=28266120
[7] https://www.ncbi.nlm.nih.gov/pubmed/?term=D%C3%B6rfer%20C%5BAuthor%5D&cauthor=true&cau
thor_uid=28266120
[8] https://www.ncbi.nlm.nih.gov/pubmed/?term=Kassebaum%20NJ%5BAuthor%5D&cauthor=true&cauth
or_uid=25261053
[9] https://www.ncbi.nlm.nih.gov/pubmed/?term=Bernab%C3%A9%20E%5BAuthor%5D&cauthor=true&c
author_uid=25261053
[10] https://www.ncbi.nlm.nih.gov/pubmed/?term=Dahiya%20M%5BAuthor%5D&cauthor=true&cauthor_u
id=25261053
[11] https://www.ncbi.nlm.nih.gov/pubmed/?term=Bhandari%20B%5BAuthor%5D&cauthor=true&cauthor
_uid=25261053
[12] https://www.ncbi.nlm.nih.gov/pubmed/?term=Murray%20CJ%5BAuthor%5D&cauthor=true&cauthor_
uid=25261053
[13] https://www.ncbi.nlm.nih.gov/pubmed/?term=Marcenes%20W%5BAuthor%5D&cauthor=true&cautho
r_uid=25261053
[14] https://www.ncbi.nlm.nih.gov/pubmed/?term=Tonetti%20MS%5BAuthor%5D&cauthor=true&cauthor_
uid=28419559
[15] https://www.ncbi.nlm.nih.gov/pubmed/?term=Jepsen%20S%5BAuthor%5D&cauthor=true&cauthor_u
id=28419559
[16] https://www.ncbi.nlm.nih.gov/pubmed/?term=Jin%20L%5BAuthor%5D&cauthor=true&cauthor_uid=2
8419559
[17] https://www.ncbi.nlm.nih.gov/pubmed/?term=Otomo-
Corgel%20J%5BAuthor%5D&cauthor=true&cauthor_uid=28419559
[18] http://www.who.int/oral_health/disease_burden/global/en/
[19] https://www.fdiworlddental.org/policy-statement-classification/general-health
[20] https://www.fdiworlddental.org/policy-statement-classification/health-policy
[21] https://www.fdiworlddental.org/policy-statement-classification/noncommunicable-diseases-ncds
[22] https://www.fdiworlddental.org/policy-statement-classification/periodontal

Page 3 of 3