The global strategy and teamwork for periodontal health

& overall health

Prof. L.J. Jin

Modern Dental Laboratory Professor in Clinical Dental Science

Professor of Periodontology

Faculty of Dentistry, The University of Hong Kong

Hong Kong SAR, China

FDI Council Member

Hot topic session – Periodontics

AWDC 2016, Poznan

September 7, 14:30 – 17:00

Outline

Global oral/periodontal disease burdens and impacts

Preventive strategies and global perspectives

Dentists’ role and responsibility in periodontal care

The Health in our mind!

Aiming for optimal oral & general health!

Oral functions

Eat, drink & bite

Taste

Breath

Speak

Lick, suck & spit

Express, attract & kiss

Whistle & make musicBeaglehole et al 2009

Quality of life & well-being!

Prevention’ and ‘Health’

Global oral/periodontal disease burden

The High-level Meeting of the UN General Assembly on

the Prevention & Control of NCDs (2011):

Oral diseases remain one of the major global health burdens!

Bulletin of the World Health Organization 2005; 83:661-9

It is particularly high in the disadvantaged & poor

populations in both developing/developed countries

Documenting the burden of premature death & morbidity, due

to 291 diseases/injuries, 1,160 sequelae and 67 risk factors from

187 countries (1990-2010)

Untreated decay in adults - the most prevalent disease!

Severe periodontitis - the 6th most prevalent disease

Untreated decay in children - the 10h most prevalent disease

(Lim et al. 2012; Murray et al. 2012; Marcenes et al. 2013; Kassebaum et al, 2014)

Global Burden of Diseases Study (2010)

The overall burden of

periodontal disease,

oral cancer and caries

increased by 45.6%!

DM: 69%

Neoplasms: 27%

CVD: 23%

(Murray et al. 2012,

Jin et al 2016).

Conclusions:

Oral disease remains a major public health burden worldwide.

It is of great importance to integrate oral health into global health agenda via the common

risk factor approach.

The long-term sustainable strategy for global oral health should focus on health promotion

and disease prevention through effective multidisciplinary teamwork.

“Time is now right for developing a new model to

promote oral health and integrate the oral health strategy

with those being implemented for other NCDs.

This approach will expand strategies and the role of the

dental profession substantially and provide better oral

health outcomes for our patients.”

A new population-based model for promoting oral and general health

Action at 3 levels: Incorporating oral health into the HiAP agenda because oral diseases share risk factors and

upstream determinants with other NCDs.

A substantial integration of oral health with both the health promotional aspects of HiAP and

the medical care infrastructure, via bridging with other health care professionals/researchers,

and interprofessional Ed & practice.

Shifting approaches used by OHCPs to manage oral diseases in a manner similar to that of

the long-term care model that is used for other NCDs.

Sheiham, Williams, Weyant, Glick, Naidoo, Luc Eiselé & Selikowitz, JADA 2015; 146:861-4

Periodontitis- major cause of multiple tooth loss/edentulism

- masticatory dysfunction

- ↓nutrition, quality of life & self-esteem

Periodontal – General Health link (* - ****)

Cardiovascular disease (CVD) and stroke ***

Diabetes mellitus (DM) ****

Adverse pregnancy outcomes (e.g. LBW/pre-term infants) *

Pulmonary disease (e.g. COPD, aspiration pneumonia) *

Stomach disease (e.g. peptic/gastric ulcers/Helicobacter pylori) *

Chronic kidney disease */**

Rheumatoid arthritis **

Cognitive impairment *

Cancer (e.g. orodigestive and pancreatic cancers) **

Obesity **

Metabolic syndrome (e.g. dyslipidemia, hyperglycemia & HP) *

- Infection, inflammation and dysbiosis -

-Healthy living and prevention

-Early detection and management

-Strengthening inter-professional

collaboration

-Integrated disease surveillance

Oral Health Atlas Task Team:

Chief Editors:

Habib Benzian (USA)

David Williams (UK)

Lijian Jin (Chair, Hong Kong)

Kevin Hardwick (USA)

Fannye Thompson (Barbados)

Tania Severin (FDI)

Claudia Marquina (FDI)

Jean-Luc Eisele (former ED, FDI)

http://www.fdiworldental.org/publications/oral-health-atlas/oral-health-atlas-(2015).aspx

Published in September 2015

Task Team:

Lijian Jin (Chair)

Habib Benzian

Kevin Hardwick

Fannye Thompson

Valerie Robison

Naryttza Diaz-Fortier

Data source: World Bank and WHOhttp://www.fdiworldental.org/data-hub/atlas.aspx

Launched in September 2014

Oral diseases: Socio-economic impacts

$$$$$$$$

The mouth is one the most expensive parts of the body to treat in

Japan (Ministry of Health 2008), Australia (Rogers 2011) and

Germany (Robert Koch Inst. 2009).

In the EU, the annual spending on oral care is about 79 billion €

(2008-12), and it may reach 93 billion € in 2020 (Patel 2012, Listl

et al 2015)

p. 57

The annual time lost from school, work or normal activities

due to oral problems/treatment of the average Canadian was

3.5 hours; for adults aged 20-69 years that equated to

4.14 million days lost (Hayes et al 2013).

Huge financial burden involved in periodontal care

(Chapple 2014, BMJ; Chapple et al 2015)

J Dent Res 92:209 – 211, 2013

Major barriers for implementation of

effective strategies and preventive measures

to control periodontal disease

- Poor public awareness of perio. disease/consequences

- Lack of effective OH-care schemes and availability of qualified OHCPs*

- Lack of well-defined and proven OH promotion strategies & policies

- Inadequate continuing professional development programs

- Limited attention to controlling risk factors for the disease

(Jin et al. 2011)

*Lack of access to oral care services in early adulthood as a key element in

disease development (Tonetti et al., Perio Focus Green Paper 2015/16)

Ora/periodontal Health: A big challenge worldwide

Global oral/periodontal disease burden: huge

Public awareness of oral/periodontal health: low/very low

Oral/periodontal care: focusing on Tx, not on prevention

How to take this Challenge?

Editorial, The Lancet

Vol 373, Jan 3, 2009

The expanded role of dentists: new opportunities

How to tackle this ‘silent’ disease?

Periodontal disease

Gingival redness, swelling & bleeding

Jin 2015

The common ‘Symptom-driven dental visit’ problems:

Seeking tx for the outcomes/complications of the diseases

NOT for control of the ‘Roots’ of their problems!

Tackling this ‘silent’ disease!

Periodontal disease

New opportunity!

The United Nations High-level Meeting on Non-Communicable Diseases

made a ground-breaking Political Declaration in September 2011 –

"that renal, oral and eye diseases pose a major health burden for

many countries and that these diseases share common risk

factors and can benefit from common responses to

non-communicable diseases”.

http://www.un.org/en/ga/president/65/

issues/ncdiseases.shtml

Sheiham & Watt 2000

The Common Risk Factor Approach for

optimal Oral/General Health & Healthy Aging

OHI/oral health education – Key targets

- Effective plaque control

- Controlling periodontal/peri-implant inflammation

- Controlling risk factors & promoting healthy life style!

http://www.arthritis.org/living-with-arthritis/arthritis-diet/

anti-inflammatory/eat-to-beat-inflammation.php

1. Good Oils

2. Fish

3. Nuts and Fruits

4. Garlic

5. Herbs

6. Chocolate

7. Tea Time

‘Foods reducing inflammation’

http://www.healthline.com/health/rheumatoid-arthritis/

foods-that-reduce-inflammation

Healthline

Gut microbiota as a mediator of dietary impact on host metabolic

status

Sonnenburg & Bäckhed

Nature 2016; 535:56-64.

(7 July, 2016)

• Oral and general health

• The common risk factor approach

• Quality of life and wellbeing

• Healthy aging

Dental

professionals

Medical

professionals

Communication and promotion

Co-management scheme / teamwork

Two-way referral

Patient-centered care

Cost-effectiveness for optimal health

World Dental Federation (FDI) Istanbul Declaration: ‘Oral Health and General Health: A call for collaborative approach’

Signed on Aug 27, 2013 by over 130 member countries!

Calling upon national, regional and global health leaders “to

recognize oral health as an essential component of global health

and promote a reinforced inter-professional collaborative approach

in the development of global and national policies”.

Jin, Internal Dental Journal 2013; 63:281–282.

2015 FDI Policy Statements, e.g.

-Oral health for healthy aging

-Oral health and quality of life

Ongoing activities of FDI, e.g.

-World Oral Health Day

-Global Periodontal Health Project

-Oral health for aging population

‘Healthy Mouth.

Healthy Body’ 2016

World Oral Health Day Task Team (2015-2016)

Chaired by Edoardo Cavalle

The global actions - NOW! A new FDI definition of Oral Health - 3 key elements

- Disease and condition status

- Physiological function

- Psycho-social function

Vision 2020 Think Tank: Michael Glick & David Williams

Vision 2020 Task Team (2015-2016)Patrick Hescot (Chair, FDI President)

Jack Cottrell

Kathryn Kell

Jaime Edelson

Lijian Jin

Nermin Yamalik

E. Bondioni, C Jagait & C Marquina (FDI)

The new initiative:FDI Global Periodontal Health Project

The 1st Task Team meeting

in Nov 2015, Amsterdam

Task Team (2015-2016):

- Patrick Hescot (FDI President)

- Sally Hewett (Chair, FDI Education Committee Chair)

- Lijian Jin (FDI Council Member)

- Ward Van Dijk (FDI Dental Practice Committee Chair)

- Jo Frencken (FDI Public Health Committee Chair)

- Harry-Sam Selikowitz (FDI Science Committee Chair)

- Nikolai Sharkov (FDI Membership Liaison and

Support Committee Chair)

- Maurizio Tonetti (European Federation of Periodontology)

- Gary Armitage (American Academy of Periodontology)

- Hiroshi Ogawa (WHO)

- Virginie Horn Borter (FDI)

Vision: Achieving Global Periodontal Health

Mission: Reducing the Burden of Periodontal Disease

Aim: To achieve Global Periodontal Health by

reducing the burden of periodontal disease.

Objectives:

Increase global awareness of periodontal health

Raise the priority of periodontal health via health promotion & disease

prevention

Integrate oral/periodontal health into policies of general health & NCDs, via

the common risk factor approach and engaging key stakeholders (e.g.

Ministries of Health and CDO to implement UN’s Declaration on NCDs.

Maurizio Tonetti, Søren Jepsen, Lijian Jin & Joan Otomo-Corgel

http://www.efp.org/

A global teamwork of EFP, AAP & APSP!

Aiming to draw the global attention of oral healthcare

professionals, medical practitioners, educators, health officials and

the public to the opportunities to enhance the awareness

of periodontal health and improve periodontal care.

Forming the new global consensus.

Prevention

Diagnosis

Treatment

Tonetti, Jepsen, Jin & Otomo-Corgel 2015

Prevention (9 key points)

Gingival bleeding (an early disease sign) labeling in public campaigns,

professional info leaflet & oral-care products. Control of gingival bleeding!

Patient motivation paired with detailed instruction on the use of mechanical

plaque control aids (e.g. tooth brushing and inter-dental cleaning)

Individualized periodontal assessment of risk factors and attitudes to

determine the appropriate preventive care/Tx need (Personalized dentistry)

A need of periodontal screening by the oral health care team

Professional plaque removal is important, but cannot serve as the sole

element of professional preventive care. Education and behavior change

are fundamental to sustained improvements in periodontal health status.

Professional preventive care alone is inappropriate in subjects with

periodontitis and/or peri-implantitis. Effective treatment is a MUST

Self-medication with chemical plaque control agents may mask serious

underlying disease, and seeking professional advice and care is crucial.

Long-term success of periodontal Tx requires participation in a secondary

prevention program to meet the needs of high-risk patients.

For optimal long-term tooth retention, patients participating in secondary

prevention programs require completion of an active phase of periodontal

therapy that achieves individually set treatment goals.

Tonetti et al. 2015

Diagnosis

3-step approach:

Self-detection of symptoms/signs to promote awareness and perio exam

Perio. screening to segment subjects into health, gingivitis & periodontitis.

Comprehensive examination/diagnosis for appropriate Tx of periodontitis.

An assessment of risk factors for periodontitis.

Screening and monitoring of systemic conditions, e.g. obesity, diabetes

and hypertension, which may reshape/expand dentists’ role to improving

pts’s oral/general health while enhancing their roles (Glick et al 2012).

Tonetti et al. 2015

“… expand the role of existing oral healthcare professionals.”

Screening for and monitoring of NCDs (e.g. glycemic control)

Playing a leading role in patient education and disease prevention

Guiding and supervising teams of oral healthcare workers.

Genco et al, 2014. Screening for diabetes mellitus in dental

practices: a field trial. JADA 2014;145:57-64.

In 1022 dental pts (≥45 yrs, not aware of DM status) screened,

416 (40.7%) with an HbA1c ≥ 5.7% were referred for diagnosis.

DM: 12.3%， Pre-DM: 23.3% No DM: 64.4%

Dentists’ role in screening & monitoring medical status

‘Screening for DM and pre-DM in the dental office may provide an

important benefit to patients and encourage inter-professional

collaboration to achieve a chronic disease care model in which health

care professionals work together to care for a panel of patients’.

Staging the extent/severity of periodontitis and masticatory

dysfunction in a given subject with different Tx needs

1) Mild to moderate Periodontitis - Characterized by gingival inflammation

and a degree of periodontal destruction compatible with function.

2) Severe Periodontitis - Characterized by gingival inflammation and

advanced destruction (e.g. vertical defects and/or furcation involvement).

Function may be preserved, with high risk of progression and tooth loss

3) Severe periodontitis complicated by masticatory dysfunction -

Characterized by gingival inflammation, advanced periodontal destruction

and loss of masticatory function due to tooth hypermobility and/or tooth loss

Tonetti et al. 2015

Treatment

To control periodontitis, avoid resultant tooth loss, retain a

functional dentition for a lifetime preservation of self-esteem,

and improve quality of life.

Primary care by GP; and secondary care by specialists via

referral/co-management scheme for the pts with advanced

periodontitis, poor response to Tx and co-morbidities (e.g. DM).

Tonetti et al. 2015

‘Perio Focus Green Paper’

Conclusions

Periodontology with a strong scientific evidence can identify

appropriate preventive, diagnostic and therapeutic strategies

to manage the enormous disease burden, including periodontitis,

its health, wellbeing, social and economic consequences.

This paper calls for a renewed global effort for specific

preventive, diagnostic and therapeutic actions, and the

implementation requires consideration of the specific national

scenarios in terms of resources/healthcare model.

Tonetti, Jepsen, Jin & Otomo-Corgel 2015

Key messages

Oral/periodontal diseases remain a major global health burden,

and oral health & healthcare are crucial for general wellbeing and

quality of life.

Oral/periodontal diseases share many risk factors with NCDs,

e.g. tobacco usage, excess sugar consumption, obesity and

unhealthy lifestyle.

It is time to incorporate oral/periodontal care into total health

care, and its integration with prevention and control of common

NCDs, via the common risk factor approach.

The new strategy and expanded role of dentists are crucial for

future development of dental professionals, aiming for prevention

and control of all diseases for optimal oral and general health!

A global action should be undertaken, through an effective

global teamwork (e.g. WHO, FDI, WHPA, IADR, ICD, EFP, AAP,

APSP, IAP, other NGOs and the global public…)!

Thank you!