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The low frequency of periodontal treatment in Norway could be explained by the provision of public funding and a high motivation for oral care and aestheticism. (Image: SiljeAO/Shutterstock)

Study shows sharp decrease in periodontal treatment and tooth loss in Norway

By Iveta Ramonaite, Dental Tribune International
September 21, 2020

OSLO, Norway: Periodontal disease is a global health issue, and many countries consistently report high levels of the disease among the population. The Norwegian government has attempted to address the issue by introducing certain measures, including major financial support, over the last four decades. In order to assess how successful these measures have been in reducing the level of periodontitis in Norway, a recent study examined the national treatment prevalence of periodontal disease in the country and reported that the frequency of treatment carried out was sufficient to prevent major tooth loss in the Norwegian population.

The Platform for Better Oral Health in Europe reported that more than half the European population suffers from some form of periodontitis and that over 10% have severe disease. According to the World Health Organization, dental caries and severe periodontal disease contribute greatly to the loss of natural teeth, and approximately 30% of Europeans aged 65–74 years are edentulous. The absence of natural teeth can have a significant effect on the function and quality of life. It is, therefore, crucial to highlight the importance of preventing, diagnosing and treating periodontal disease in time.

In the study, the researchers consulted the database of the Norwegian Health Economics Administration for 2013 in order to establish the present level of periodontal treatment and treatment profiles for the nation and in order to assess whether the findings are supported by long‐term clinical data. Dr Øystein Fardal, from the Section for Community Dentistry in the Institute of Clinical Dentistry at the University of Oslo, is co-author of the study. He told Dental Tribune International (DTI) that this data has provided a unique opportunity to assess total treatment prevalence and distribution of treatment between different dental health providers in Norway.

Low level of periodontal treatment in Norway

In 2013, a total of 166,707 patients were treated for periodontitis in Norway. The results showed that 4.4% of the total Norwegian population aged 20 years and older received periodontal therapy in one year. The highest prevalence, 8.2%, was found in those aged 60–70 years, whereas the lowest was recorded in those aged 20–29 years, at 0.5%. The frequency of periodontal treatment carried out for the entire nation was sufficient to prevent any major tooth loss.

Dr Øystein Fardal delivered the keynote speech at INSPIRE Aberdeen Conference 2018. (Image: University of Aberdeen)

Private general dental practitioners performed 43.8% of the total periodontal treatment, and periodontists performed 33.7%, whereas dental hygienists only performed 22.5% of the total treatment. Additionally, periodontists performed 32.8% of the total non-surgical treatment and 74.6% of the surgical treatment and spent 68.0% of their working time treating periodontal disease, whereas hygienists only spent 8.0% of their time treating periodontal disease and general dental practitioners, 2.0%.

“A number of studies have shown a decrease in the parameters, such as tooth loss, bone loss and pocket depth, used to measure periodontal disease in Norway over the last four to five decades. A lower level of periodontal disease in the population will thus require less treatment,” Fardal said.

However, since there are no comparable studies, the researchers do not know how the prevalence compares with data from other countries. Fardal explained: “Strictly speaking, it is not correct to conclude a low treatment prevalence, even though it is low compared with the prevalence of periodontal disease in international studies. It is important to keep in mind that treatment prevalence and disease prevalence are not necessarily comparable.”

High motivation for aestheticism and oral care

Fardal explained that, for nearly 50 years, the Norwegian health service has been providing contributions to periodontal therapy for all citizens, and there are no differences in benefits. This, he believes, has helped improve oral health outcomes among Norwegians. He said: “The main reasons for the lower level of periodontal disease are adequate public funding and ample supply and distribution of dental health professionals, including periodontists. This makes periodontal treatment affordable and available to almost all citizens.”

“The main reasons for the lower level of periodontal disease are adequate public funding and ample supply and distribution of dental health professionals, including periodontists”

Furthermore, he noted that Norway has one of the best dental attendances in Europe and that it boasts certified specialists in periodontics from around the world. “The evidence for high motivation for dental care in Norway is mainly based on studies showing that there is an 80% annual dental attendance for 20-year-olds and older. An additional 10% visit the dentists every other year,” Fardal explained. “A survey of adult dental services in 11 other European countries showed that only 55% had attended the dentist during the previous year. In addition, a Norwegian study on aesthetics showed that teeth were the most important facial features compared with eyes, nose, lips, skin, hair, hairline, eyebrows, chin and ears,” he continued.

Take-home message

“The main message to dental professionals and health authorities is that systematic periodontal treatment works both on a clinical practice level and on a national level,” Fardal told DTI. “Several studies from a specialist practice in Norway have documented low long-term tooth loss. This low tooth loss is also reflected in the big data from the Norwegian dental health system.”

Fardal believes that the financial contribution provided by the government gives patients added motivation for undergoing the treatment. In addition, he noted that travel is reimbursed for patients attending the nearest periodontal specialist.

Discussing the implications of the study and direction for future research, he concluded: “International epidemiological studies show that there is a high prevalence of periodontal disease in the population. More studies should be carried out to determine what level of treatment is required to control the disease on a national level. This is important for health authorities for calculating manpower requirements and thus for the training of dental professionals,” he concluded.

The study, titled “Provision of treatment for periodontitis in Norway in 2013—a national profile”, was published in the August 2020 issue of International Dental Research.

 

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