Periodontal and Peri-Implant Oral Diseases as a Public Health Crisis

Tooth decay, periodontal disease, and more recently peri-implant disease are the most common oral diseases. Periodontal and peri-implant diseases are widespread oral health conditions that affect a significant portion of the population and have systemic ramifications.1The data collected from the 2009 and 2010 National Health and Nutrition Examination Survey cycle was derived from 3742 adults of the civilian, noninstitutionalized population aged 30 years and older with 1 or more natural teeth.2 More than 47% of the sample, representing 64.7 million adults, had periodontitis, distributed as mild (8.7%), moderate (30.0%), and severe (8.5%). Demographically, by 2030, all baby boomers will be 65 and older and will have become one of the largest population groups—up to 23% of the population—by 2060.3 For adults aged 65 years and older, 64% had either moderate or severe periodontitis.2Many patients are choosing to replace the loss of teeth due to periodontal disease with dental implants. As we all know, implants are like teeth in that they too are susceptible to the same bacterial-induced inflammation found in the soft and hard proximal tissues. Zangrado et al found in a systematic review that a diagnosis of well-controlled periodontal disease was an indicator of long-term dental implant success.4 However, long-term natural tooth or dental implant success is reduced if the patient has a history of periodontal disease and does not have a well-controlled periodontal disease state. The presence of periodontal pockets, failure to maintain effective periodontal disease control, and smoking habits may be considered negative factors for implant success.4 Barring occlusal or prosthetic issues, healthy peri-implant tissues are usually synonymous with dental implant success. Thus, uncontrolled periodontal disease will adversely affect periodontal and implant treatments. Controlling periodontal and peri-implant disease is integral to the longevity of natural teeth and dental implants. Proper periodontal and peri-implant treatments are always essential.This editorial highlights the importance of addressing periodontal and emerging peri-implant diseases as a public health issue. It proposes key strategies for preventing and managing these oral diseases, including replacing lost teeth with dental implants. By prioritizing oral health and implementing effective interventions, patients can (1) mitigate the burden of periodontal and peri-implant diseases, (2) improve natural teeth and dental implant outcomes, and (3) improve public health. Dental professionals can modify as needed and distribute the following to their patients and local community centers to educate the public regarding this public health issue.Periodontal and peri-implant diseases are chronic inflammatory conditions that affect the supporting structures of the teeth and dental implants, including the gums, periodontal ligament, and alveolar bone proximal to teeth and implants. These two diseases are caused primarily by bacterial infections resulting from the buildup of dental plaque, which triggers an immune response and leads to tissue destruction over time. If left untreated, periodontal and peri-implant diseases can cause tooth and dental implant loss. Periodontal disease has been linked to various systemic health conditions, such as cardiovascular disease, diabetes, rheumatoid arthritis, adverse pregnancy outcomes, and Alzheimer, and with the recent pandemic COVID-2, patients with periodontal disease exhibited more severe symptoms.1,5–8Periodontal and peri-implant diseases are prevalent public health issues with significant implications for individuals and communities. Today, people have a longer lifespan and keep their teeth longer. Patients desire fixed or stable teeth instead of removable dentures, which can be loose or uncomfortable. Because periodontitis is a chronic disease that accumulates in individuals during their lifetime, it is reasonable to speculate that there are increasing numbers of people who have teeth or dental implants with periodontitis8 or peri-implantitis. According to the Centers for Disease Control and Prevention, approximately 47% of adults aged 30 years and older in the United States have some form of periodontal disease.3 The burden is even higher among older adults with nearly 70% of those aged ≥65 years being affected by the disease. Periodontal disease affects the impoverished regions of the United States.2 Elk et al found in a 2012 survey that periodontitis was most frequently present in current smokers.2Unfortunately, there is a steady increase in the likelihood of periodontitis occurrence with increasing poverty with the most significant occurrence of periodontitis observed among the poorest (at <100% of the federal poverty level).8 Adults with less than a high school education were more likely to have severe periodontitis. However, the probability was also sizeable for nonsevere periodontitis compared with those with more than a high school education.8Heitz-Mayfield found that individual risk factors significantly increased the prevalence of peri-implantitis.9 Asgtolfi et al found in 2022 that patients with periodontitis have an increased risk of also having peri-implantitis compared with patients without periodontitis.10 If the etiology for tooth loss was a previous history of periodontal disease, the risk of peri-implantitis increased compared with tooth loss due to caries or trauma. Patients who have implants and coexisting periodontitis have a 50% likelihood of also having peri-implantitis, and patients who did not have periodontitis had a 23.9% incidence of peri-implantitis. Patients who did not attend regularly scheduled maintenance therapy appointments had a 61.4% occurrence of peri-implantitis compared with 27.3% in those who attended regular maintenance appointments (p < .0001). Smokers have a higher incidence of peri-implantitis (72.7%) compared with nonsmokers (27.3%) (p < .0005).10 The risk factors for peri-implantitis include the patient's previous history of periodontal disease, smoking habits, poor oral hygiene, diabetes, and genetic factors.9Looking at all these data and the correlation of periodontal and peri-implant diseases to different systemic comorbidities, if left unchecked, periodontal and peri-implant disease will contribute a substantial cost to the health care economy, making it a public health urgency.To address periodontal and peri-implant diseases as a public health issue, the following policy recommendations are proposed: Health education and promotion: Develop and implement comprehensive oral health education programs targeting individuals of all ages. Promote proper oral hygiene practices, including regular brushing, flossing, and routine dental visits. Emphasize the importance of early detection and timely treatment of periodontal and peri-implant diseases.Community outreach: Collaborate with local communities, schools, and health care providers to raise awareness about periodontal disease and its impact on overall health. Conduct free or low-cost dental screenings and preventive interventions in underserved areas to ensure access to care for all individuals.Integration into primary care: Integrate oral health screenings and preventive services into routine primary care visits, including periodontal assessments. Encourage health care providers to incorporate oral health discussions and referrals to dental professionals for comprehensive patient care.Access to dental care: Address barriers to dental care access, such as cost, lack of insurance, and geographic disparities. Explore innovative approaches, such as mobile dental units and volunteer-based missions, collaborating with dental colleges or other nonprofit organizations to improve access to underserved populations and remote areas.Workforce development: Strengthen the oral health care workforce by supporting dental professionals' education and training, particularly in underserved areas. Provide incentives to attract and retain oral health professionals in areas with limited access to care.Encourage more Hispanic and Black dentists to specialize in periodontics or implant dentistry and serve their communities.Research and surveillance: Allocate resources for research on periodontal and peri-implant diseases, including their etiology, prevention strategies, and optimal treatment approaches. Enhance surveillance systems to monitor periodontal and peri-implant disease prevalence, incidence, and impact at national, state, and local levels.Encourage all dentists providing dental implant treatments to instruct patients on the need for proper daily oral hygiene, periodontal/peri-implant maintenance, and smoking cessation to ensure that patients' financial investments in these treatments will be successful in the long term.Adequate funding should be allocated to oral health programs and initiatives at the federal, state, and local levels to implement the proposed policy recommendations effectively. Collaboration between government agencies, dental professionals, community organizations, and other stakeholders is crucial for successfully implementing and evaluating policy interventions.Periodontal and peri-implant diseases are significant public health issues that require attention and action. By recognizing their impact on overall health, implementing preventive strategies, and ensuring access to dental care, we can reduce the oral disease burden and improve individuals' and communities' oral health and well-being.