EFP reveals stunning global cost of dental caries

Jeremy Booth, Dental Tribune International

Tue. 20 February 2024

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BRUSSELS, Belgium: A white paper commissioned by the European Federation of Periodontology (EFP) has found that 4.9% of global healthcare expenditure goes towards treating preventable gingivitis, caries and tooth loss. The landmark report by global insights and advocacy platform Economist Impact found that a preventive approach that addresses caries progression in more economically deprived groups would bring substantial savings in long-term treatment costs.

The white paper, titled Time to Put Your Money Where Your Mouth Is: Addressing Inequalities in Oral Health, recognises that the combined global prevalence of dental caries and severe periodontitis has surpassed that of mental disorders, cardiovascular disease, diabetes, chronic respiratory disease and cancer, affecting roughly half of the global population. It delves into disparities in oral health, exploring contributing factors and highlighting potential opportunities to improve and equalise oral health outcomes.

Dr Nicola West, professor of restorative dentistry at the University of Bristol and EFP representative for the UK, explained at a launch event in Brussels that the report takes a new approach to addressing the inequalities of oral health. She said: “We’ve taken the economic model on periodontitis from our first white paper, and we have also combined this with our economic model for caries to give an integrated report looking at the inequalities on oral health. We have examined the inequalities, we have looked at factors contributing to that unequal burden, and we have suggested opportunities for levelling up.”

The white paper examines the direct costs of caries management for individuals aged 12–65 across different countries and socio-economic groups. Dr Iain Chapple, EFP member and professor and chair of periodontics at the University of Birmingham’s School of Dentistry, explained: “We looked at six different countries, we looked at four European countries with established economies, and we looked at Brazil [and] Indonesia, so that, essentially, what the Economist gave was, if you like, a very broad and diverse group of countries with different healthcare systems, different population sizes, different per capita incomes, different structures, etc.”

Using new modelling to estimate the long-term direct costs for managing dental caries in the global population aged between 12 and 65 years, the paper priced the annual treatment spend at US$357 billion (€331 billion), or 4.9% of global healthcare expenditure. Lost productivity associated with caries and severe periodontitis and tooth loss was estimated to cost US$188 billion annually.

Per capita, the UK was found to bear the highest caries-related costs, at US$22,910

The direct cost of treating dental caries in individuals aged 12–65 was found to range from US$10.284 billion in Italy to US$36.231 billion in Brazil, a variance attributable in part to population size differences. Per capita, the UK was found to bear the highest caries-related costs, at US$22,910, whereas Indonesia reported the lowest, at US$7,414. Except for Indonesia and Germany, where the least economically disadvantaged experienced the highest caries-related costs, closely followed by the most disadvantaged, the economic burden of caries was found to predominantly affect the most underprivileged groups in all other examined countries.

At the launch event, Prof. Nigel Pitts of King’s College London explained that the report proposes two scenarios to outline preventive strategies for the oral diseases. The first scenario proposes long-term targeted interventions. “It is all the things you could possibly throw at prevention—upstream, midstream and downstream,” Prof. Pitts said. He added that the second scenario uses a levelling up or a proportionate universalism approach, where “more attention is given to those with the greatest burden”. He said that the modelling revealed that the first scenario—aiming to lower caries progression rates by 30%—could bring about a decrease of around US$5,000 in per person treatment costs in four of the six countries. “But if we now look at the levelling up approach, you’ll see a rather different picture with dramatic maximum cost-saving decrease in cost per person for the most deprived groups,” Prof. Pitts said, pointing out that the cost-saving for these groups was particularly significant, at around US$15,000 per person for the UK, Italy and France. He said that correlations between these countries and Brazil and Indonesia were difficult, but the one consistent feature across all data was that, “for the most deprived group, that cost-saving benefit is three times bigger than the cost-saving benefit for the second-most-deprived groups in every country. So, the levelling up approach looks like it could have very significant economic benefits”.

“Our experts have suggested that we need to therefore move away from DMFT and we need to use other effective measures to allow for less invasive and more preventive care.”—Prof. Nicola West, University of Bristol

Summarising the key messages in the report, Prof. West emphasised that early caries detection is crucial for the successful implementation of preventive programmes. She explained that the widely used decayed, missing or filled teeth (DMFT) score has severe limitations. “It is easy to use, it is reproducible, but it does not pick up early caries; it picks up cavitation. Our experts have suggested that we need to therefore move away from DMFT and we need to use other effective measures to allow for less invasive and more preventive care.”

Moving towards a preventive model would also require the empowerment of populations with information to support behavioural change and the establishment of good oral health habits from childhood, Prof. West said.

The white paper can be accessed here.