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Lookup NU author(s): Professor Philip Preshaw
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2026 The Author(s). Journal of Periodontal Research published by John Wiley & Sons Ltd. Periodontal diseases are among the most prevalent noncommunicable diseases (NCDs) worldwide, with advanced stage contributing to disability, impaired nutrition, frailty, and reduced quality of life. Despite this burden, periodontal care remains weakly integrated into global NCD strategies, limiting public health advocacy and healthy aging. We conducted a conceptual and policy-oriented analysis to identify opportunities for repositioning periodontal care as a public health function. Key domains examined included (a) preventive healthcare through the common risk factor approach; (b) case identification and diagnosis designed to serve both clinical care and population surveillance; (c) de-implementation of care with limited incremental benefit at scale, including the role of payment incentives in shaping utilization. To evaluate long-term affordability, projected global periodontal healthcare expenditure through 2050 was modeled using a cohort-based Monte Carlo simulation, comparing current utilization patterns, expansion to 80% population coverage, and an alternative capitation-informed scenario. Reorienting periodontal care toward proactive, cost-effective prevention and integrating case identification within primary care and NCD platforms offer greater potential for equitable population health gains than simply expanding procedure-intensive treatments. Risk-stratified care pathways based on patient-important outcomes, combined with de-implementation of low-value practices, can preserve oral function while reducing avoidable service volume and costs. Expenditure modeling indicates that achieving high coverage under prevailing fee-for-service delivery would substantially increase global financial burden, whereas a capitation-informed scenario reduced projected expenditure by 30% at the same coverage level, suggesting alternative incentives could expand access with less cost escalation, including in low- and middle-income settings worldwide. Aligning periodontal care with public health principles—prioritizing prevention, value, and equity over treatment volume—is a paradigm shift essential for achieving sustainable improvements in population health, healthy aging, and long-term health-system affordability.
Author(s): Peres MA, Jin L, Nascimento GG, Preshaw PM, Raittio EJ, Chow DY, Tay JRH
Publication type: Review
Publication status: Published
Journal: Journal of Periodontal Research
Year: 2026
Pages: Epub ahead of print
Online publication date: 18/06/2026
Acceptance date: 19/05/2026
ISSN (print): 0022-3484
ISSN (electronic): 1600-0765
Publisher: John Wiley and Sons Inc
URL: https://doi.org/10.1111/jre.70133
DOI: 10.1111/jre.70133
Data Access Statement: The data that supports the findings of this study are available in the Supporting Information of this article.
