The economic and societal impact of periodontal and peri-implant diseases

Abstract

Periodontal and peri-implant diseases result from a chronic inflammatory response to dysbiotic microbial communities and are characterized by inflammation in the soft tissue and the ensuing progressive destruction of supporting bone, resulting in tooth or implant loss. These diseases' high prevalence, multifactorial etiology, extensive treatment costs, and significant detriment to patients' quality-of-life underscore their status as a critical public health burden. This review delineates the economic and sociocultural ramifications of periodontal and peri-implant diseases on patient welfare and healthcare economics. We delve into the implications of diagnosis, treatment, supportive care, and managing destructive tissue consequences, contrasting these aspects with healthy patients.

Keywords: diagnosis; economic burden; non‐surgical therapy; periodontitis; peri‐implant diseases; prevention; regeneration; resective surgery; societal burden.

FIGURE 1

Socioeconomic burden of periodontal and peri‐implant diseases.

FIGURE 2

The two‐way relationship between periodontal and peri‐implant diseases and its socioeconomic impact.

FIGURE 3

In Quadrants I or III, the choice between the programs is clear. In Quadrant I, the intervention of interest is both more effective and less costly than the alternative. That is, it dominates the alternative. In Quadrant III, the opposite is true. In Quadrants I and III, the choice depends on the maximum cost‐effectiveness ratio one is willing to accept. The choice between II and IV is a function of the magnitude and clinical relevance of the effect, as well as the economic burden on patients. Adapted from Black, W.C. The cost‐effectiveness plane: a graphic representation of cost‐effectiveness. Medical Decision Making, Volume 10, Number 3, pp. 212–15, Copyright © 1990 by Society for Medical Decision Making. Reprinted by permission of SAGE Publications.

FIGURE 4

Eight opportunities to decrease the economic and societal impact of peri‐implant diseases: (1) Primary prevention, including management of risk factors and promoting healthy behaviors; (2) Active periodontal therapy; (3) Supportive periodontal therapy, the secondary prevention of the disease; (4) Implant risk assessment and site development, a primordial prevention approach that focuses on individuals who do not have yet received dental implants, avoiding risk factor exposure; (5) Prevention and control of risk factors, that is, primary prevention in individuals with healthy tissues but exposed to risk factors; (6) Treatment of peri‐implantitis; (7) Supportive care and control of risk factors to prevent disease recurrence, the secondary prevention of the disease; (8) Tertiary prevention, that is, prevention of disease complications by delaying the progression of the disease to avoid implant loss.