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SANZ et al .
Ramón y Cajal s/n (Ciudad Universitaria), 28040 Madrid, Spain. Email: marsan@ucm.es
KEYWORDS clinical guideline, grade, health policy, oral health, periodontal therapy, periodontitis, stage
1 | INTRODUCTION
dental caries, is responsible for more years lost to disability than any other human disease (GBD 2017 Disease and Injury Incidence and Prevalence Collaborators, 2018). Furthermore, periodontal infections are associated with a range of systemic diseases leading to premature death, including diabetes (Sanz et al., 2018), cardiovascular diseases (Sanz et al., 2019; Tonetti, Van Dyke, & Working Group 1 of the Joint EFP/AAP Workshop, 2013) or adverse pregnancy outcomes (Sanz, Kornman, & Working Group 3 of Joint EFP/AAP Workshop, 2013). Clinical Relevance Scientific rationale for the study : Implementation of the new classification of periodontitis should facilitate the use of the most appropriate preventive and therapeutic interven - tions, depending on the stage and grade of the disease. The choice of these interventions should be made following a rigorous evidence-based decision-making process. Principal findings : This guideline has been developed using strict validated methodologies for assuring the best avail - able evidence on the efficacy of the interventions consid - ered and the most appropriate recommendations based on a structured consensus process, including a panel of ex - perts and representatives from key stakeholders. Practical implications : The application of this S3 Level Clinical Practice Guideline will allow a homogeneous and evidence-based approach to the management of Stage I–III periodontitis.
1.1 | The health problem
1.1.1 | Definition
Periodontitis is characterized by progressive destruction of the tooth-supporting apparatus. Its primary features include the loss of periodontal tissue support manifest through clinical attachment loss (CAL) and radiographically assessed alveolar bone loss, pres - ence of periodontal pocketing and gingival bleeding (Papapanou et al., 2018). If untreated, it may lead to tooth loss, although it is preventable and treatable in the majority of cases.
1.1.2 | Importance
Periodontitis is a major public health problem due to its high preva - lence, and since it may lead to tooth loss and disability, it negatively affects chewing function and aesthetics, is a source of social inequal - ity, and significantly impairs quality of life. Periodontitis accounts for a substantial proportion of edentulism and masticatory dysfunction, has a negative impact on general health and results in significant dental care costs (Tonetti, Jepsen, Jin, & Otomo-Corgel, 2017).
1.1.3 | Pathophysiology
Periodontitis is a chronic multifactorial inflammatory disease associ - ated with dysbiotic dental plaque biofilms.
1.1.4 | Prevalence
1.1.6 | Economic importance
Periodontitis is the most common chronic inflammatory non-commu - nicable disease of humans. According to the Global Burden of Disease 2010 study, the global age-standardized prevalence (1990–2010) of severe periodontitis was 11.2%, representing the sixth-most preva - lent condition in the world (Kassebaum et al., 2014), while in the Global Burden of Disease 2015 study, the prevalence of severe periodonti - tis was estimated in 7.4% (Kassebaum et al., 2017). The prevalence of milder forms of periodontitis may be as high as 50% (Billings et al., 2018).
On a global scale, periodontitis is estimated to cost $54 billion in direct treatment costs and further $25 billion in indirect costs (GBD 2017 Disease and Injury Incidence and Prevalence Collaborators, 2018). Periodontitis contributes significantly to the cost of dental diseases due to the need to replace teeth lost to periodontitis. The total cost of dental diseases, in 2015, was estimated to be of $544.41 billion, being $356.80 billion direct costs, and $187.61 billion indirect costs (Righolt, Jevdjevic, Marcenes, & Listl, 2018).
1.1.5 | Consequences of failure to treat
2 | AIM OF THE GUIDELINE
Untreated or inadequately treated periodontitis leads to the loss of tooth-supporting tissues and teeth. Severe periodontitis, along with
This guideline aims to highlight the importance and need for scien - tific evidence in clinical decision-making in the treatment of patients
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