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Dental Tribune United Kingdom Edition | 9/20148 In a report, researchers of the Global Bur- den of Diseases, Injuries, and Risk Factors Study have recently shed light on the global dimensions of severe periodontitis, which now affects over 700 million people world- wide. This study is a major effort involving more than 1,000 scientists to systematically producecomparableestimatesoftheburden of 291 diseases and injuries and their associ- ated 1,160 sequelae in 1990, 1995, 2005 and 2010. Dental Tribune UK had the opportu- nity to speak with lead author Prof. Wagner MarcenesfromBartsandTheLondonSchool of Medicine and Dentistry in London about thefindingsandwhytheyareacauseforcon- cern. DentalTribune: Prof.Marcenes,the prevalence ofsevereperiodontitisonaglobalscalehasnot increasedsignificantlyinthelasttwodecades, accordingtoyourreport.Whyarethenumbers worrying nevertheless? Prof. Wagner Marcenes: Having more than 700 million people suffering from se- vere periodontitis is really worrying. Al- thoughtheproportionremainedthesamein 1990 and 2010, the number of people need- ingperiodontaltreatmenthasincreaseddra- matically. This is because worldwide more thanoneintenpeoplesufferfromseverepe- riodontitis and the world population grew from 5.3 billion in 1990 to 6.9 billion in 2010. Moreover, severe periodontitis tends to de- velop during adulthood, showing a steep in- crease between the third and fourth decades oflife.Withmorepeoplelivinglongerandre- tainingtheirteethforlife,theriskofdevelop- ing severe oral health-related problems, par- ticularly periodontitis, will be high. The world’s population is expected to almost double by end of this century, implying that the number of people with severe periodon- titis may at least double. How do the results compare to the situation prior to the surveyed period? We have updated the data from the first Global Burden of Disease (GBD) study and generated comparable figures in 1990 and 2010.Therefore,wewereabletocomparethe currentandtheprevioussituationtooursur- vey in 2010. Since the study is unique, we do not have global data before the first GBD study. However, we know that oral diseases have decreased significantly in most indus- trialisedcountries,suchastheUKandtheUS, in the last five decades. Severeperiodontitisappearstobemostpreva- lent in South America and east sub-Saharan Africa.What could be the reasons for that? Ourstudywasnotactuallydesignedtotest risk factors of periodontal disease, but based on pure reasoning, I would say that, in addi- tion to demographic changes, smoking and poororalhygienemaybethemainfactorsas- sociated with it. This is speculation, but what weseeatthemomentisagrowingnumberof people smoking in developing regions con- trary to the trend in most developed coun- tries.Nearly80 percentofthemorethanone billion smokers worldwide live in low- and middle-income countries. With 1,500 new cases every year, Argentina for example has thehighestincidenceofsevereperiodontitis, which is almost double the global average, and high tobacco consumption. We cannot establish a cause and effect relationship, but Ibelievethatthehighincidenceofperiodon- titisintheseareasismostlikelyrelatedtothe habit of smoking. Inyoureport,youmentionhowdifficult it is to determine disease prevalence owing to differ- ent classification systems. Is your representa- tion of the situation therefore a realistic one? Iamconfidentourreportprovidesarealis- tic, comprehensive assessment of the global burden of severe periodontitis. After much consideration, we used a Community Peri- odontalIndexofTreatmentNeedsscoreof4, a clinical attachment loss of greater than 6 millimetresorapocketdepthofmorethan 5 millimetres as indicators of periodontitis. We used the measurements adopted by the World Health Organization, which are con- sidered by most as the most reliable indica- torsofsevereperiodontitis.Weendeavoured toreflectthemeasuresadoptedbythelarger community of public health dentistry. The choice of including only severe peri- odontitis and not less severe forms of peri- odontaldisease,suchasmildormoderatepe- riodontitis and gingivitis, was because of their low impact (disability weight) on qual- ity of life. Since periodontitis tends to progressfrommildtosevereifuntreated,our numbersreflectonlythetipoftheiceberg,in- dicating the seriousness of the challenge to health professionals. Why is the situation so little addressed by the dental community,and how could it be better addressed? The fact that a preventable oral disease is the sixth most prevalent of all 291 diseases and injuries examined in the 2010 GBD is quitedisturbingandshouldcauseallofusto redoubleoureffortstoraiseawarenessofthe importanceoforalhealthamongpolicymak- ers.Itisreasonabletoprioritiselife-threaten- ing diseases that have a greater impact on quality of life; however, it is unacceptable to neglectsevereoraldiseases.Untreatedcaries in the permanent dentition is the most prevalent of all oral diseases and periodonti- tis the sixth, and untreated caries in the pri- mary dentition is the tenth most prevalent disease in the world. Itispossiblethatthepreventionandtreat- ment of periodontitis are neglected because most health strategies target children at school and severe periodontitis is uncom- monbeforetheageof20.Ibelieveweneedto seriously consider a change in strategy and target the adult population. Also, we should focus on determinants of health rather than the disease itself. We call this the common risk factor ap- proach. For example, many dental practices in the UK run smoking cessation pro- grammes.Thiswillnotonlyreducethenum- berofcasesofperiodontitisbutalsohelppre- ventlife-threateningdiseases,suchascancer and cardiovascular disease. Adopting the common risk factor approach would lead to the inclusion of oral health in the top five most relevant diseases. This is because oral diseases and serious life-threatening dis- eases share the same determinants, for ex- ample smoking, hygiene and diet. Thank you very much for the interview. WORLD NEWS “It is unacceptable to neglect severe oral diseases” An interview with Barts and The London School of Medicine and Dentistry Professor Wagner Marcenes, London. Prof.Wagner Marcenes Aerial view of Buenos Aires,the capital of Argentina.The South American country has the highest incidence of severe periodontitis in the world. (Photo Celso Diniz) “With more people living longer and retaining their teeth for life,the risk of developing severe oral health-related problems,particularly periodontitis,will be high.”