Periodontal Diseases as a Public Health Challenge: Rationale, Prevention, Equity, and Sustainable Care-A Global Call...

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.