Beruflich Dokumente
Kultur Dokumente
12687
2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd S85
S86 Jepsen et al.
Results: Key findings included the following: (i) prevalence and experience of University, Amsterdam, The Netherlands;
18
dental caries has decreased in many regions in all age groups over the last three Oral Hygiene School, Hogeschool
decades; however, not all societal groups have benefitted equally from this Inholland, Amsterdam, The Netherlands;
19
decline; (ii) although some studies have indicated a possible decline in periodonti- Clinic of Dental and Oral Pathology,
Lithuanian University of Health Sciences,
tis prevalence, there is insufficient evidence to conclude that prevalence has chan-
Kaunas, Lithuania
ged over recent decades; (iii) because of global population growth and increased
tooth retention, the number of people affected by dental caries and periodontitis Sponsor Representative: Irina Laura
has grown substantially, increasing the total burden of these diseases globally (by Chivu-Garip (Colgate-Palmolive Europe)
37% for untreated caries and by 67% for severe periodontitis) as estimated
between 1990 and 2013, with high global economic impact; (iv) there is robust
evidence for an association of low socio-economic status with a higher risk of
having dental caries/caries experience and also with higher prevalence of peri-
odontitis; (v) the most important behavioural factor, affecting both dental caries
and periodontal diseases, is routinely performed oral hygiene with fluoride; (vi)
population-based interventions address behavioural factors to control dental car-
ies and periodontitis through legislation (antismoking, reduced sugar content in
foods and drinks), restrictions (taxes on sugar and tobacco) guidelines and cam-
paigns; however, their efficacy remains to be evaluated; (vii) psychological
approaches aimed at changing behaviour may improve the effectiveness of oral
health education; (viii) different preventive strategies have proven to be effective
during the course of life; (ix) management of both dental caries and gingivitis
relies heavily on efficient self-performed oral hygiene, that is toothbrushing with a Key words: chemical plaque control; clinical
fluoride-containing toothpaste and interdental cleaning; (x) professional tooth recommendations; consensus conference;
dental caries; evidence-based medicine;
cleaning, oral hygiene instruction and motivation, dietary advice and fluoride
fluoride; gingivitis; interdental cleaning;
application are effective in managing dental caries and gingivitis. mechanical plaque control; oral hygiene;
Conclusion: The prevention and control of dental caries and periodontal diseases periodontitis; prevention; systematic review
and the prevention of ultimate tooth loss is a lifelong commitment employing
population- and individual-based interventions. Accepted for publication 21 December 2016
Dental caries is an ubiquitous plaque) exposed frequently to sugars most important risk factor is
process defined as the result of a (Fejerskov et al. 2015). the accumulation of a dental plaque
localized chemical dissolution of the Periodontal diseases (gingivitis biofilm at and below the gingival
tooth surface caused by acid produc- and periodontitis) are inflammatory margin, which is then associated
tion by the dental biofilm (dental diseases of microbial origin. The with an inappropriate and
2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Prevention of caries and periodontitis S87
2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
S88 Jepsen et al.
Is there a correlation between occurrence age. However, it has to be recognized health care. The alternative requires
of both dental caries and periodontitis? that the onset of periodontitis likely changing their environment (Shei-
There is a surprising paucity of precedes the point at which diagnostic ham et al. 2011). Strategies target-
robust studies analysing the co- criteria for severe periodontitis are ing social change need political
occurrence of dental caries and met by years. Likewise, the onset of action.
periodontitis, with no evidence dental caries precedes the clinical
from systematic reviews. A recent detection of a cavitated lesion. What are the most important socio-
report from a national survey in The prevention of the two most behavioural factors that have an impact
Finland found a significant positive common dental diseases and the pre- on both dental caries and periodontal
association between both diseases vention of ultimate tooth loss is diseases?
in adults (Mattila et al. 2010), and therefore a lifelong commitment. In general, social background is
data from a recent national survey strongly associated with risk for den-
in Germany indicated that in Socio-behavioural Aspects in the tal caries and periodontitis. Further-
adults, there were significantly Prevention and Control of Dental more, social background heavily
higher attachment loss and probing Caries and Periodontal Diseases at influences the behaviour of individu-
depths at sites with caries experi- an Individual and Population Level als. The most important behavioural
ence compared to sites without car- factor, affecting both dental caries
ies experience (Jordan & Micheelis Socio-behavioural factors may be and periodontal diseases, is routinely
2016). However, no attempts were regarded as behaviours finding their performed oral hygiene with fluoride
made to explore to what extent this origin in the individuals social back- toothpaste either by the individuals
association was explained by com- ground. They will be determined by themselves or by caregivers.
mon risk factors. the individuals peer groups, which There is clear evidence of diet hav-
will be related to ethnicity, religion, ing a strong influence on caries, and
family traditions, socio-economic there is some evidence that it affects
Is there evidence that there are gender status, education, labour and others periodontal diseases (Hujoel &
differences in prevalence of dental caries (Bouchard et al. 2016). The social
and of periodontitis? Lingstrom 2017). However, to date,
determinants of health are the condi- the size of this effect on periodontal
There is robust evidence from sys- tions in which people are born, diseases has not been clarified. There
tematic reviews that the prevalence grow, live, work and age (WHO is clear evidence that smoking influ-
of periodontitis is lower in females 2016a). Health determinants are also ences periodontal diseases (S alzer
compared to males (Shiau & Rey- strongly associated with environmen- et al. 2017) and some indication that
nolds 2010). There is little evidence tal factors including all the physical, exposure to smoke is associated with
for a difference in the prevalence of chemical and biological factors caries (Chapple et al. 2017).
dental caries between males and external to a person and all the An individuals perception of
females. related factors impacting behaviour control (locus of control) is regarded
(WHO 2016b). as an important socio-behavioural
Recent insights into socio-eco- factor in general. There is some evi-
Is there a difference in the peaks of the nomic inequalities in health show
incidence of dental caries versus dence that having a strong internal
that the most important aspect is the perception of control contributes to
periodontitis with regard to age?
effect of social gradient on health the prevention and control of dental
There is a wealth of data on the inci- (Marmot 2003). Worldwide, non- caries and periodontal diseases
dence of untreated cavitated dentine communicable diseases including (Acharya et al. 2015).
carious lesions across age suggesting dental caries and periodontal dis-
that there is a major peak in incidence eases remain a major public health
in young children, followed by a sec- problem. Health-promoting beha- Which population-based interventions
ond, lower peak in adolescents and address behavioural factors to control
viours become more difficult to sus-
dental caries and periodontitis?
young adults. There is a nadir at tain further down the social ladder
around 40 years of age, followed by a (Heilmann et al. 2016). Existing population-based interven-
gradual increase in incidence in older Although it is essential to know tions in some countries mainly
age (Kassebaum et al. 2015). Never- about the socio-behavioural back- address prominent risk factors for
theless, the disease is incident at all ground in order to identify risk both dental caries and periodontitis.
ages. In contrast, there is a dearth of groups, there is no evidence how They include legislation (antismok-
data on the incidence of periodontitis; to address these issues in order to ing legislation, legislation to reduce
however, the methods employed in promote prevention and control of the sugar content in processed foods
the Global Burden of Disease study dental caries and periodontal dis- and drinks; free dental care for chil-
(Kassebaum et al. 2015) allowed esti- eases. To date, therefore, studies dren up to the age of 18), restric-
mation of incidence data from preva- on interventions target primarily tions (taxes on sugar and tobacco),
lence data using a number of strong behaviour. However, they have guidelines (e.g. rinsing with water
assumptions. Whilst these estimated proved to have had limited success after every meal in senior homes by
incidence data have to be cautiously in reducing health inequalities. caregivers) and public campaigns
interpreted, the data suggest that They fail to address social determi- (antismoking and antiobesity cam-
there is a major peak of severe peri- nants for changing peoples beha- paigns, promotion of fluoride use).
odontitis between 30 and 50 years of viours, including attendance to oral These interventions are designed
2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Prevention of caries and periodontitis S89
using underlying evidence. However, How should the preventive strategies Individuals undergoing orthodontic
the efficacy of these interventions on change during the course of life? treatment with fixed appliances are
oral health remains to be confirmed. Early childhood at higher risk for developing dental
Promoting periodic comprehen- caries (Sundaraj et al. 2015) and
sive oral health assessments to allow In early childhood, strategies address- gingivitis (Liu et al. 2011, van der
early detection and preventive man- ing behavioural factors to control Kaaij et al. 2015) and require extra
agement of dental caries and peri- dental caries and periodontal diseases attention for oral hygiene and diet
odontal diseases is important. are mostly population-based cam- and additional use of fluoride when
Individualized risk-based recalls paigns targeting parents starting carious lesions are present (Benson
should then be initiated (Tonetti already during pregnancy (S alzer et al. 2013, van der Kaaij et al.
et al. 2015). et al. 2017). These should be comple- 2015).
There is evidence from cohort mented by regular preventive medical
efficiency studies that group prophy- and dental check-ups for early identi- Adults/young seniors
laxis (e.g. supervised brushing with fication of children at risk and paren- In adults (young seniors), preventive
fluoride toothpaste) is beneficial in tal counselling on drinking habits, strategies aimed at promoting
reducing the incidence of dental car- diet, brushing the childs teeth and healthy dietary and oral hygiene
ies (Salzer et al. 2017) and one RCT use of fluoridated toothpaste. These habits mainly target the individual
has shown benefits of group prophy- actions should be integrated into the needs. The use of interdental brushes
laxis on plaque and gingivitis (Hugo- healthcare programme of the Mother is recommended. Caution should be
son et al. 2007), whereas an effect and Child Health Clinic. exercised in recommending interden-
on periodontitis has not been Schoolchildren tal brushes at healthy sites where
demonstrated yet (S alzer et al. 2017). attachment loss is not evident and
There is evidence that a combined For children and adolescents, a high trauma may result. The use of dental
population- and individual-based profile of community, in office and floss may only play a role in this sit-
prevention programme is effective in individual preventive measures, has uation (Chapple et al. 2015). High-
early childhood caries (S alzer et al. been implemented in many devel- risk subgroups should be addressed
2017). oped countries for many decades through guidelines increasing aware-
(Splieth et al. 2016). In order to suc- ness of oral health.
cessfully reach the less privileged
Which individual-based interventions children, school-based prevention
address behavioural factors to control
programmes have proven to be effec- Mechanical and Chemical Plaque
dental caries and periodontitis?
tive (Anopa et al. 2015. In this age Control in the Simultaneous
There is evidence from systematic group, parents are responsible to Management of Gingivitis and Dental
reviews indicating that psychologi- ensure toothbrushing with a fluori- Caries
cal approaches aimed at changing dated toothpaste twice a day, yet
behaviour may improve the effec- parents should check and complete A systematic review analysed the
tiveness of oral health education brushing their childrens teeth. Regu- effect of mechanical or chemical pla-
(Newton & Asimakopoulou 2015, lar dental check-ups for identifica- que control procedures in the man-
Werner et al. 2016). These tion of children at risk and detection agement of gingivitis and dental
approaches include the health belief of early signs of disease as well as caries. The main strength of this
model, the theory of planned beha- parental and child counselling to study relies on being the first system-
viour, the self-regulatory model and promote healthy dietary and oral atic review addressing simultane-
social learning theory. Evidence hygiene habits are recommended. ously both diseases.
from one systematic review sup- Given the particularities in con-
ports the benefit of computer-aided Adolescence/young adults cepts and definitions used by the lit-
learning interventions (Ab Malik From the age of adolescence, the erature in the specific areas of
et al. 2017). focus of public health campaigns lies cariology and periodontology, the
Specific professional support on antismoking, promoting healthy following terms are defined:
based on, for example caries risk
assessments, supportive periodontal
lifestyle through, for example sports
programmes and diet programmes
Self-performed oral hygiene
toothbrushing with fluoridated
therapy and patient counselling are and campaigns to improve health toothpaste and interdental clean-
shown to be effective in the preven- awareness in general. In the main, ing.
tion and control of dental caries and
periodontal diseases, and they may
oral hygiene and dietary habits in
the individual have become estab-
Professional tooth cleaning
(PTC) removal of supragingival
promote beneficial behaviour (Axels- lished. Individuals at risk of devel- plaque with or without calculus
son et al. 2004). oping caries or periodontal diseases removal.
The use of interactive devices to
aid oral hygiene such as electronic
should be targeted to improve their
existing behaviour. This requires an
Structured prophylaxis pro-
gramme PTC plus oral hygiene
support systems for power tooth- individual approach. Improvements instruction, motivation, dietary
brushes and timers is currently pro- of behavioural habits may include advice, fluoride application, etc.
moted, but evidence of long-term
successful change in behaviour is not
interdental cleaning in addition
to efficacy and frequency of tooth-
Motivational programme infor-
mation and motivation about
yet available. brushing with fluoride toothpaste. oral health and disease, oral
2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
S90 Jepsen et al.
hygiene instruction and super- management (Sambunjak et al. 2011, What is the role of adjunctive chemical
vised oral hygiene procedures, all Poklepovic et al. 2013). plaque control in the simultaneous
given on a regular basis. management of gingivitis and dental
caries?
What is the evidence of professional
Also, given the distinct use of fluo- tooth cleaning in the simultaneous There are only limited data on the
ride compounds for caries manage- management of gingivitis and dental role of chlorhexidine in the simulta-
ment and for plaque control, the caries? neous management of gingivitis and
group felt it was important to stress Professional tooth cleaning as part caries (Figuero et al. 2017), that
that the fluoride ion per se does not of a structured prophylaxis pro- showed that chlorhexidine rinses are
reduce plaque accumulation. How- gramme including oral hygiene only effective in managing gingivitis,
ever, it is extremely effective in the instruction and motivation, dietary whilst no effect on caries increment
management of dental caries when advice and fluoride application is was observed (Lang et al. 1982). It is
available in the oral fluids (i.e. saliva, effective in managing dental caries possible that 6-month trials to assess
plaque fluid), by shifting the deminer- and gingivitis. As there is limited evi- the effect of chlorhexidine on both
alizationremineralization process dence to determine the most appro- gingivitis and dental caries are insuf-
towards remineralization (Cury & priate intervals between recall ficient to determine the effect on den-
Tenuta 2008). appointments (Figuero et al. 2017), tal caries increment. Nevertheless,
an individualized risk-based pro- the studies assessing the effect of
What is the role of self-performed gramme is recommended. chlorhexidine on gingivitis and dental
mechanical plaque control in the caries separately have demonstrated
simultaneous management of gingivitis a significant effect on dental plaque
and dental caries? What is the evidence of motivational and gingivitis control (Chapple et al.
programmes in the simultaneous 2015, Serrano et al. 2015), but no
There was consensus in the group management of dental caries and
effect of chlorhexidine rinses on den-
that self-performed oral hygiene is of gingivitis?
tal caries control (Twetman 2004). In
uttermost importance. Whilst there
The evidence suggests that motiva- another systematic review, inconclu-
is a wealth of evidence on manage-
tional programmes alone without sive evidence for the effect of
ment of gingivitis and dental caries
PTC tested in studies assessing chlorhexidine varnishes and gels on
in isolation (Chapple et al. 2015,
simultaneously gingivitis and dental dental caries was reported (Walsh
Kumar et al. 2016), the information
caries showed no significant benefits et al. 2015). Other adjunctive chemi-
on simultaneous effects on both dis-
for dental caries and gingivitis (Fig- cal plaque control agents, for exam-
eases is limited. There are indeed
uero et al. 2017). Oral hygiene ple triclosan/copolymer, have
methodological differences (i.e. study
instruction and motivation may lead demonstrated a consistent effect in
design, follow-up intervals, sample
to a small but significant reduction dental plaque and gingivitis control
sizes) that make development of evi-
in plaque and gingivitis after (Riley & Lamont 2013, Serrano et al.
dence difficult. Nevertheless, man-
6 months (Chapple et al. 2015). 2015), but their effect on dental car-
agement of both diseases relies
ies increments is either very small or
heavily on efficient self-performed
yet to be determined (Twetman 2004,
oral hygiene, that is toothbrushing What is the role of fluoride in the
simultaneous management of gingivitis Riley & Lamont 2013).
and interdental cleaning.
In schoolchildren, daily super- and dental caries?
Thus, the use of adjunctive che-
vised flossing in addition to tooth- In studies assessing the simultaneous mical plaque control agents proven
brushing reduced gingivitis, management of both diseases, it has effective in controlling gingivitis
compared to no self-performed oral been found that fluoride (sodium flu- should be recommended based on
hygiene at school. Although caries oride or sodium monofluorophos- the individual patient needs, in addi-
increment was lower in the former, phate in toothpastes or rinses) is only tion to daily self-performed mechani-
it did not reach significance by the effective in the management of dental cal plaque removal for dental caries
end of a 3-year trial (Suomi et al. caries. No significant effect of fluoride control, either in the same formula-
1980). on plaque and gingivitis was noted. tion (e.g. toothpastes with fluoride
In adults, systematic reviews of Other fluoride compounds, such as and plaque control agents) or sepa-
interdental brushing/flossing for the stannous fluoride or the combination rately (e.g. fluoride toothpaste plus
management of periodontal diseases of amine and stannous fluoride, have chlorhexidine mouth rinses or gels).
and dental caries have shown some demonstrated a relevant impact on
evidence that interdental flossing/ plaque and/or gingivitis (Serrano
brushing in addition to toothbrush- et al. 2015). Although this systematic Clinical Recommendations
ing reduces gingivitis compared to review did not assess dental caries,
toothbrushing alone. None of the
studies included in these reviews
fluoride has a widely recognized effect
on dental caries management (Mar-
Both dental caries and periodon-
tal diseases are preventable. Den-
reported interproximal caries as an inho et al. 2003, 2013, 2015, 2016). tal practitioners are encouraged
outcome, and therefore, it was not Therefore, products containing such to educate and motivate patients
possible to demonstrate the effective- fluoride compounds are likely to be to reduce intake of free sugars
ness of interdental flossing/brushing effective in the simultaneous control and to practice proper dental pla-
plus toothbrushing for dental caries of both diseases. que control.
2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Prevention of caries and periodontitis S91
2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
S92 Jepsen et al.
Anopa, Y., McMahon, A. D., Conway, D. I., national incidence, prevalence, and years clinical trial. Journal of Periodontal Research
Ball, G. E., McIntosh, E. & Macpherson, L. lived with disability for 301 acute and 17, 101111.
M. (2015) Improving child oral health: cost chronic diseases and injuries in 188 coun- Listl, S., Galloway, J., Mossey, P. A. & Marcenes,
analysis of a national nursery toothbrushing tries, 19902013: a systematic analysis for W. (2015) Global economic impact of dental
programme. PLoS ONE 10, e0136211. the Global Burden of Disease Study 2013. diseases. Journal of Dental Research 94, 1355
Axelsson, P., Nystr om, B. & Lindhe, J. (2004) Lancet 386, 743800. 1361.
The long-term effect of a plaque control pro- Heasman, P. & Nyvad, B. (2017) Gingival reces- Liu, H., Sun, J., Dong, Y., Lu, H., Zhou, H.,
gram on tooth mortality, caries and periodon- sion and root caries in the ageing population: a Hansen, B. F. & Song, X. (2011) Periodontal
tal disease in adults. Results after 30 years of critical evaluation of treatments. Journal of health and relative quantity of subgingival Por-
maintenance. Journal of Clinical Periodontology Clinical Periodontology 44:S18, 178193. phyromonas gingivalis during orthodontic
31, 749757. Heilmann, A., Sheiham, A., Watt, R. G. & Jor- treatment. Angle Orthodontics 81, 609615.
Benson, P. E., Parkin, N., Dyer, F., Millett, D. dan, R. A. (2016) The common risk factor Marinho, V. C., Chong, L. Y., Worthington, H.
T., Furness, S. & Germain, P. (2013) Fluorides approach an integrated population- and evi- V. & Walsh, T. (2016) Fluoride mouth rinses
for the prevention of early tooth decay (dem- dence-based approach for reducing social for preventing dental caries in children and
ineralised white lesions) during fixed brace inequalities in oral health. Gesundheitswesen 78, adolescents. Cochrane Database of Systematic
treatment. Cochrane Database of Systematic 672677. Reviews (7), CD002284.
Reviews (3), CD003809. Holtfreter, B., Schutzhold, S. & Kocher, T. (2014) Marinho, V. C., Higgins, J. P., Sheiham, A. &
Bj
orndahl, L. & Mj or, I. (2001) Pulp-dentin biol- Is periodontitis prevalence declining? A review Logan, S. (2003) Fluoride toothpastes for pre-
ogy in restorative dentistry. Part 4: Dental of the current literature. Current Oral Health venting dental caries in children and adoles-
cariescharacteristics of lesions and pulpal reac- Reports 1, 251261. cents. Cochrane Database of Systematic
tions. Quintessence International 32, 717736. Hugoson, A., Lundgren, D., Askl ow, B. & Borgk- Reviews (1), CD002278.
Boillot, A., El Halabi, B., Batty, G. D., Range, lint, G. (2007) Effect of three different dental Marinho, V. C., Worthington, H. V., Walsh, T. &
H., Czernichow, S. & Bouchard, P. (2011) Edu- health preventive programs on young adult Chong, L. Y. (2015) Fluoride gels for prevent-
cation as a predictor of chronic periodontitis: a individuals: a randomized, blinded, parallel ing dental caries in children and adolescents.
systematic review with meta-analysis popula- group, controlled evaluation of oral hygiene Cochrane Database of Systematic Reviews (6),
tion-based studies. PLoS ONE 6, e21508. behaviour on plaque and gingivitis. Journal of CD002280.
Bouchard, P., Carra, M. C., Boillot, A., Mora, F. Clinical Periodontology 34, 407415. Marinho, V. C., Worthington, H. V., Walsh, T. &
& Range, H. (2016) Risk factors in periodon- Hujoel, P. P. & Lingstr om, P. (2017) Nutrition, Clarkson, J. E. (2013) Fluoride varnishes for
tology: a conceptual framework. Journal of dental caries, and periodontal disease: a practi- preventing dental caries in children and adoles-
Clinical Periodontology Nov 12. doi: 10.1111/ cal overview. Journal of Clinical Periodontology cents. Cochrane Database of Systematic Reviews
jcpe.12650. [Epub ahead of print]. 44:S18, 7984. (7), CD002279.
Chapple, I. L. C., Van der Weijden, F., Doerfer, Jordan, A. R. & Micheelis, W. (2016) F unfte Marmot, M. G. (2003) Understanding social
C., Herrera, D., Shapira, L., Polak, D., Madi- Deutsche Mundgesundheitsstudie (DMS V). inequalities in health. Perspectives in Biology
anos, P., Louropoulou, A., Machtei, E., Donos, Institut der Deutschen Zahn arzte (Hrsg.), and Medicine 46 (3 Suppl.), S9S23.
N., Greenwell, H., Van Winkelhoff, A. J., Eren Deutscher Zahn arzte Verlag DAV, ISBN 978- Mattila, P. T., Niskanen, M. C., Vehkalahti, M.
Kuru, B., Arweiler, N., Teughels, W., Aimetti, 3-7691-0020-4, K oln, 2016 M., Nordblad, A. & Knuuttila, M. L. J. (2010)
M., Molina, A., Montero, E. & Graziani, F. van der Kaaij, N. C., van der Veen, M. H., van Prevalence and simultaneous occurrence of
(2015) Primary prevention of periodontitis: der Kaaij, M. A. & ten Cate, J. M. (2015) A periodontitis and dental caries. Journal of Clini-
managing gingivitis. Journal of Clinical Peri- prospective, randomized placebo-controlled cal Periodontology 37, 962967.
odontology 42 (Suppl. 16), S71S76. clinical trial on the effects of a fluoride rinse on Newton, J. T. & Asimakopoulou, K. (2015)
Chapple, I. L., et al. (2017) Interaction of life- white spot lesion development and bleeding in Managing oral hygiene as risk factor for peri-
style, behavior or systemic diseases with dental orthodontic patients. European Journal of Oral odontal disease: a systematic review of psycho-
caries and periodontal diseases. Consensus Sciences 123, 186193. logical approaches to behaviour change for
report of group 2 of the joint EFP/ORCA Kassebaum, N. J., Bernabe, E., Dahiya, M., improved plaque control in periodontal man-
workshop on the boundaries between caries Bhandari, B., Murray, C. J. & Marcenes, W. agement. Journal of Clinical Periodontology 42
and periodontal diseases. Journal of Clinical (2014a) Global burden of severe periodontitis (Suppl. 16), S36S46.
Periodontology 44:S18, 3951. in 19902010: a systematic review and meta Patel, R. (2012) The state of oral health in Eur-
Cury, J. A. & Tenuta, L. M. (2008) How to main- regression. Journal of Dental Research 93, ope. Report commissioned by the Platform for
tain a cariostatic fluoride concentration in the 10451053. Better Oral Health in Europe. Available at:
oral environment. Advances in Dental Research Kassebaum, N. J., Bernabe, E., Dahiya, M., www.oralhealthplatform.eu, accessed on 7
20, 1316. Bhandari, B., Murray, C. J. & Marcenes, W. November 2016.
Fejerskov, O., Nyvad, B. & Kidd, E. (2015) Den- (2014b) Global burden of severe tooth loss: a Poklepovic, T., Worthington, H. V., Johnson, T.
tal caries, what is it? In: Fejerskov, O., Nyvad, systematic review and meta-analysis. Journal of M., Sambunjak, D., Imai, P., Clarkson, J. E. &
B. & Kidd, E. (eds). Dental Caries: The Disease Dental Research 93 (7 Suppl.), 20S28S. Tugwell, P. (2013) Interdental brushing for the
and its Clinical Management, 3rd edition, pp. Kassebaum, N. J., Bernabe, E., Dahiya, M., prevention and control of periodontal diseases
710. Oxford, UK: Wiley Blackwell. Bhandari, B., Murray, C. J. & Marcenes, W. and dental caries in adults. Cochrane Database
Figuero, E., N obrega, D. F., Garca-Gargallo, (2015) Global burden of untreated caries: a sys- of Systematic Reviews (12), CD009857.
M., Tenuta, L. M. A., Herrera, D. & Carvalho, tematic review and meta-regression. Journal of Riley, P. & Lamont, T. (2013) Triclosan/copoly-
J. (2017) Mechanical and chemical plaque con- Dental Research 94, 650658. mer containing toothpastes for oral health.
trol in the simultaneous managing of gingivitis Kinane, D. F. & Attstr om, R. (2005) Advances in Cochrane Database of Systematic Reviews (12),
and caries: a systematic review. Journal of Clin- the pathogenesis of periodontitis. Group B con- CD010514.
ical Periodontology 44:S18, 116134. sensus report of the fifth European Workshop S
alzer, S., Alkilzy, M., Slot, D. E., Dorfer, C. E.,
Frencken, J. E., Sharma, P., Stenhouse, L., in Periodontology. Journal of Clinical Periodon- Schmoeckel, J. & Splieth, C. (2017) Socio-beha-
Green, D., Laverty, D. & Dietrich, T. (2017) tology 32(Suppl. 6), 130131. vioural aspects in the prevention and control of
Global epidemiology of dental caries and sev- Klinge, B. & Norlund, A. (2005) A socio-eco- dental caries and periodontal diseases at an
ere periodontitis a comprehensive review. nomic perspective on periodontal diseases: a individual and population level. Journal of
Journal of Clinical Periodontology 44:S18, 94 systematic review. Journal of Clinical Periodon- Clinical Periodontology 44:S18, 106115.
105. tology 32 (Suppl. 6), 314325. Sambunjak, D., Nickerson, J. W., Poklepovic, T.,
GBD 2015 Disease and Injury Incidence and Kumar, S., Tadakamadla, J. & Johnson, N. W. Johnson, T. M., Imai, P., Tugwell, P. & Wor-
Prevalence Collaborators (2016) Global, regio- (2016) Effect of tooth brushing frequency on thington, H. V. (2011) Flossing for the man-
nal, and national incidence, prevalence, and incidence and increment of dental caries: a sys- agement of periodontal diseases and dental
years lived with disability for 310 diseases and tematic review and meta-analysis. Journal of caries in adults. Cochrane Database of System-
injuries, 19902015: a systematic analysis for Dental Research 95, 12301236. atic Reviews (7), CD008829.
the Global Burden of Disease Study 2015. Lan- Lang, N. P., Hotz, P., Graf, H., Geering, A. H., Sanz, M., B aumer, A., Buduneli, N., Dommisch,
cet 388, 15451602. Saxer, U. P., Sturzenberger, O. P. & Meckel, H., Farina, R., Kononen, E., Linden, G.,
Global Burden of Disease Study 2013 Collab- A. H. (1982) Effects of supervised chlorhexi- Meyle, J., Preshaw, P. M., Quirynen, M., Rol-
orators (2015) Global, regional, and dine mouthrinses in children. A longitudinal dan, S., Sanchez, N., Sculean, A., Slot, D. E.,
2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Prevention of caries and periodontitis S93
Trombelli, L., West, N. & Winkel, E. (2015) Shiau, H. J. & Reynolds, M. A. (2010) Sex differ- Twetman, S. (2004) Antimicrobials in future car-
Effect of professional mechanical plaque ences in destructive periodontal disease: a sys- ies control? A review with special reference to
removal on secondary prevention of periodon- tematic review. Journal of Periodontology 81, chlorhexidine treatment. Caries Research 38,
titis and the complications of gingival and peri- 13791389. 223229.
odontal preventive measures: consensus report Splieth, C. H., Christiansen, J. & Foster Page, L. Walsh, T., Oliveira-Neto, J. M. & Moore, D.
of group 4 of the 11th European Workshop on A. (2016) Caries epidemiology and community (2015) Chlorhexidine treatment for the preven-
Periodontology on effective prevention of peri- dentistry: chances for future improvements in tion of dental caries in children and adoles-
odontal and peri-implant diseases. Journal of caries risk groups. Outcomes of the ORCA cents. Cochrane Database of Systematic
Clinical Periodontology 42(Suppl. 16), S214 Saturday afternoon symposium, Greifswald, Reviews (13), CD008457.
S220. 2014. Part 1. Caries Research 50, 916. Werner, H., Hakeberg, M., Dahlstrom, L., Eriks-
Sanz, M., et al. (2017) Role of microbial biofilms Sundaraj, D., Venkatachalapathy, S., Tandon, A. & son, M., Sjogren, P., Strandell, A., Svanberg,
in the maintenance of oral health and in the Pereira, A. (2015) Critical evaluation of incidence T., Svensson, L. & Wide Boman, U. (2016)
development of dental caries and periodontal and prevalence of white spot lesions during fixed Psychological interventions for poor oral
diseases. Consensus report of group 1 of the orthodontic appliance treatment: a meta-analysis. health: a systematic review. Journal of Dental
joint EFP(ORCA workshop on the boundaries Journal of the International Society for Preventive Research 95, 506514.
between caries and periodontal diseases. Jour- Community Dentistry 5, 433439. WHO (2016a) Social determinants of health.
nal of Clinical Periodontology 44:S18, 511. Suomi, J. D., Peterson, J. K., Matthews, B. L., Available at: http://www.who.int/social_determi
Schwendicke, F., D orfer, C. E., Schlattmann, P., Voglesong, R. H. & Lyman, B. A. (1980) nants/sdh_definition/en/.
Foster Page, L., Thomson, W. M. & Paris, S. Effects of supervised daily dental plaque WHO (2016b) Environmental health. Available
(2015) Socioeconomic inequality and caries: a removal by children after 3 years. Community at: http://www.who.int/topics/environmental_
systematic review and meta-analysis. Journal of Dentistry and Oral Epidemiology 8, 171176. health/en/..
Dental Research 94, 1018. Tonetti, M., Chapple, I. L. C., Jepsen, S. & Sanz,
Serrano, J., Escribano, M., Rold an, S., Martn, M. (2015) Primary and secondary prevention
C. & Herrera, D. (2015) Efficacy of adjunctive of periodontal and peri-implant diseases. Intro-
anti-plaque chemical agents in managing gin- duction to, and objectives of the 11th Euro- Address:
givitis: a systematic review and meta-analysis. pean Workshop on Periodontology consensus Sren Jepsen
Journal of Clinical Periodontology 42(Suppl. conference. Journal of Clinical Periodontology Department of Periodontology
16), S106S138. 42 (Suppl. 16), S1S4.
Operative and Preventive Dentistry
Sheiham, A., Alexander, D., Cohen, L., Marinho, Tonetti, M., et al. (2017) Age-related effects on
V., Moyses, S., Petersen, P. E., Spencer, J., oral health, dental caries and periodontal dis-
University of Bonn
Watt, R. G. & Weyant, R. (2011) Global oral eases. Consensus report of group 4 of the joint Welschnonnenstrasse 17
health inequalities: task groupimplementation EFP/ORCA workshop on the boundaries 53111 Bonn Germany
and delivery of oral health strategies. Advances between caries and periodontal diseases. Jour- E-mail: jepsen@uni-bonn.de
in Dental Research 23, 259267. nal of Clinical Periodontology 44:S18, 135144.
Clinical Relevance necessitates renewed and enhanced Practical implications: The consen-
Scientific rationale for the study: professional efforts towards preven- sus has developed a series of rec-
Prevention and control of the highly tion at individual and population ommendations for practitioners,
prevalent dental caries and peri- level. Despite socio-behavioural researchers and public health bod-
odontal diseases continue to pose an inequalities within/between popula- ies to improve prevention and con-
enormous challenge for the dental tions, control of dental biofilm activ- trol of dental caries and
profession and public health bodies. ity is the key factor to prevent periodontal diseases.
Principal findings: Persistence of a progression of dental caries and peri-
high global burden of disease odontal diseases.
2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd