A widening issue for gums
Periodontal disease is a growing problem for patients and dentists, writes Dr Richard Lee Kin. Early diagnosis and intervention is crucial for better care – and for avoiding complaints and litigation
The current state of gum disease in Ireland is uncertain. The last significant research by the state was carried out almost 15 years ago and few comparisons with the 1989/1990 research could be drawn due to the method of recording.
Those 2002 results suggested a high level of periodontal inflammation and disease in the population and worryingly disease levels higher among older age groups.
Epidemiologic data on periodontal diseases generally is of poor quality. A recent review on the literature on periodontal health in Europe concluded that actual epidemiological data on periodontal disease was non–homogenous and absent from several European countries (Konig et al., 2010).
Another recent review (Leroy et al., 2010) highlighted the problems with regards to the collection of reliable data on periodontal health and suggested how they could be improved.
The national data for periodontal health in EU member states that are available have been collected from relatively small samples and show very wide variations. It appears they are due to inconsistencies in methodology as much as to actual disease levels.
The World Health Organisation (WHO) plans to launch a revisited methodology for periodontal epidemiology in the future.
In 2010, severe periodontitis was the sixth most prevalent health condition in the world, affecting 743 million people worldwide. Between 1990 and 2010, the global age–standardised prevalence of severe gum disease was static at 11.2 per cent (WHO 2010)
Studies report how severe periodontitis effects 5–20 per cent of most adult population worldwide, and it is a major cause of tooth loss in both developed and developing countries (Petersen et al., 2005 Philstrom et al., 2005 Jin et al., 2011)
In the US, it has been calculated that almost half (47.2 per cent) the population suffer from either mild to moderate or severe form of gum disease (P.I Eke et al., 2012).
Closer to home, 50 per cent to 90 per cent of adults in the UK suffer from gingivitis (NICE 2012), while 54 per cent have moderate and 5 per cent have severe disease, according to the UK Dental Health Survey (Kelly 2000).
It has also been suggested that more than 50 per cent of the European population suffers from some form of periodontitis, with more than 10 per cent having severe disease (Konig et. al. 2011).
In ageing populations, the prevalence of periodontitis is even higher –70–85 per cent of the population aged 60–65 years of age (Eke PI et al ., 2012 ,Holtfreter B et al ., 2010).
Periodontal health may be deteriorating within the population of the EU. This is principally due to a large number of people who are retaining some of their teeth into old age, and an increase in the prevalence of diabetes. The recently published first WHO Global report on diabetes demonstrates that the number of adults living with diabetes has almost quadrupled since 1980 to 422 million adults (WHO 2016).
In Ireland today, there are currently more than 677,000 Irish citizens over the age of 66 and by the year 2050, there will be 1.8 million citizens over this age. In 2026, that number will be 767,300, meaning that in just 10 years from now more than 16 per cent of the population will be in retirement (www.cso.ie/en/newsandevents/pressreleases/)
A dental health survey carried out by the Irish Dental Association in February 2014 showed 80 per cent of Irish adults believed their gums were healthy. However, 80 per cent of Irish people have some form of gum disease. These findings suggest a significant disconnect, but not an unusual one. A poll of 1,000 people over the age of 35 showed that more than 75 per cent of American adults have some form of gum disease, yet only 60 per cent had any significant knowledge about the problem (Harris 2012).
Against this background, the last decade has seen some of the most significant changes in dental care in Ireland. During the recession, cutbacks severely effected 1.2 million medical card holders. Those seeking the most basic provision for gum disease care, i.e. a scale and polish, had to have prior approval by the HSE. Only a small minority – about 2 per cent – were approved for this or more protracted periodontal treatment (HSE Inspector’s Report).
It does not seem likely that this untreated cohort have remained unscathed and disease free.
In the current environment, dentists should be cognisant of the presence of the disease, as early diagnosis and appropriate intervention is crucial. Undiagnosed and untreated periodontal disease is one of the fastest growing areas of litigation and complaints in dentistry. The Medical and Dental Defence Union of Scotland says that 38 per cent of their claims are for undiagnosed gum disease, the other defence associations have similar figures. In terms of values, periodontal claims accounted for some of the top payouts –44.7 per cent (DPL 2015).
The most common allegation is that the patient was unaware of the presence of periodontal disease, or that the extent and implications of their periodontal problems had not been explained to them. This can occur when a patient sees a new dentist for the first time. This may be as a result of the retirement of a previous dentist, or simply because the dentist has left the practice. Sometimes the patient attends a different dentist in an emergency situation. On other occasions, of course, a patient will seek a second opinion because they already have concerns about the treatment being provided for them by their existing dentist.
Periodontal disease is, of course, only one aspect of oral health and oral diseases. It doesn’t only impact on the individual through pain and discomfort. There is the broader impact on their general health and quality of life (Zimmer at al. 2010) and its effect on the wider community, through the health system and associated economic costs. Managing oral health in an ageing Irish population will present a formidable challenge in the future.
About the author
Dr Richard Lee Kin, B.Dent.Sc. F.D.S.R.C.S.I., D.CH.DENT (PERIO) works in practice limited to periodontology and implantology in Dublin.
The contents of this article are necessarily expressed in broad terms and limited to general information rather than detailed analyses or dental advice. Specialist professional advice should always be obtained to address dental and other issues arising in specific contexts.
D O’Mullane et al., 1986 Children’s dental health in Ireland 1984.
H Whelton et al., Oral health of Irish adults 2000–2002.
Konig et al., 2010 European Journal of Dental Education 2010.
Leroy R, et al., BMC Oral Health 2010.
Kassebauam NJ et al., J Dent Res. 2014.
Peterson et al., Bull World Health Organ. 2005.
Pihlstrom et al., Lancet. 2005.
Holtfreter B et al., JCP 2010.
Eke PI et al., J Dent Res 2012.
Krug E, Lancet 2016. Jin et al., Adv Dent Res 2011.
Harris et al., Survey 2012.
Zimmer et al., Journal of Public Health Dentistry 2010.
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