Intended for healthcare professionals


Time to take periodontitis seriously

BMJ 2014; 348 doi: (Published 10 April 2014) Cite this as: BMJ 2014;348:g2645
  1. Iain L C Chapple, professor of periodontology
  1. 1University of Birmingham Periodontal Research Group and MRC Centre for Immune Regulation, Dental School, Birmingham B4 6NN, UK
  1. i.l.c.chapple{at}

The benefits of treatment are likely to exceed the costs

Periodontitis is the most common chronic inflammatory disease seen in humans, affecting nearly half of adults in the United Kingdom and 60% of those over 65 years.1 It is a major public health problem, causing tooth loss, disability, masticatory dysfunction, and poor nutritional status.2 Periodontitis also compromises speech, reduces quality of life,3 and is an escalating burden to the healthcare economy. In the UK alone it was estimated to cost £2.8bn (€3.4bn; $4.6bn) in 2008,4 not including raised all cause mortality, an association that has been noted in several populations.5 Worryingly, the disease is often silent, being present for decades before diagnosis and treatment. It can leave a substantial pathological footprint on multiple organ systems, as well as the oral cavity.

Periodontitis follows the development of a pathogenic microbial biofilm at and below the gingival (gum) margin. In susceptible patients, this triggers an exaggerated and dysfunctional inflammatory immune response, which destroys the bone surrounding the teeth, causing tooth loss.6 The host’s immune response to the initiating microbiota is largely genetically determined, but environmental and lifestyle factors such as smoking, suboptimally controlled diabetes, obesity, poor nutrition (high intake of refined sugar and low intake of antioxidant micronutrients), and stress …

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