the global strategy and teamwork for periodontal health and overall health - li-jian jin
TRANSCRIPT
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!