Moritz Kebschull is the new president of the European Federation of Periodontology (EFP), a nonprofit federation of 38 national societies for periodontology (gum diseases). In addition to its European core, the EFP, with members from Argentina to Australia, has a global agenda to promote awareness of periodontal science and the importance of gum health.

Professor Kebschull holds the Chair of Restorative Dentistry at the University of Birmingham, UK and an adjunct professorship at Columbia University, US. He succeeds Dr Darko Bozic (University of Zagreb, Croatia) as EFP president. He is a specialist periodontist trained in Germany and the United States. His award-winning translational research explores the links between the clinical features and molecular foundations of periodontal and peri-implant diseases and other systemic diseases. At Birmingham, he is running a significant portfolio of externally funded research programmes, including leading a module of the NIHR funded Birmingham Biomedical Research Centre.

Having served on the boards of both the British and German national societies, and as a member of the EFP’s Executive Committee for the last three years, Professor Kebschull has been driving the development of evidence-based clinical practice guidelines for the treatment of gum diseases in Europe, in the UK and in Germany. 

Prof Kebschull’s priority during his presidency will be to further the EFP’s global impact as the largest periodontal federation world-wide by expanding its lead in guideline development in the field of dentistry; by opening pathways for educating the clinical workforce for periodontics; and by driving periodontal science by empowering young, internationally mobile researchers.

The EFP is at the forefront of the development of evidence-based clinical practice guidelines in dentistry world-wide and can demonstrate that these guidelines have already had measurable “real world impact” for patients and practitioners alike in several major economies. Prof Kebschull and the EFP team will add to the existing portfolio of guidelines to fully cover the entire field of periodontology and focus on the national implementation of these guidelines across its global membership to further the impact for our patients.

To fully facilitate the opportunities opened up by the guidelines, the EFP recognises that in addition to a strengthened undergraduate curriculum and its prestigious specialist-level education programmes, a “third pillar” of education is necessary to develop a clinical workforce that can treat the very significant number of patients with periodontal diseases – one of the most prevalent non-communicable diseases. Specifically, as outlined in an upcoming special issue of the EFP’s Journal of Clinical Periodontology, the EFP will strengthen vocational education and training in Europe, a process of flexible life-long learning for professionals following the principles of the Bruges-Copenhagen-Process that is envisioned to lead to a high number of dental professionals with significant additional skills.

Lastly, Professor Kebschull recognises that, in order to further drive clinical impact, the promotion of high-quality research is an absolute necessity. He therefore proposes to strengthen this by fostering international mobility of promising young periodontal researchers from all EFP member countries to further push collaboration and fruitful interactions – and by enabling smart talents for the future. 

“To keep improving periodontal education for students and professionals, and stimulating the progress of periodontal researchers is not only in the interest of the EFP or the dental profession,” explains Prof Kebschull. “These advancements are critical for the sake of periodontal science and practice, so that current and future dental patients will be better served. I’m also honoured to serve the EFP as president, and to help advance preparations for future milestones, including EuroPerio11 in Vienna in May 2025.”

The future of education on periodontology (dentistry applied to gums and teeth-supporting tissues) and how to make it more effective and more modern were the topics addressed at Perio Workshop 2023, a meeting of periodontal scientists organised by the EFP (European Federation of Periodontology) in collaboration with Dentaid which took place in La Granja, Spain until 8 November.

Approximately 70 leading experts from 22 countries met at Perio Workshop 2023 to discuss and reach a new consensus, after the success of the 2009 workshop on the same topic. It is time to identify the changes that are needed in periodontal education at all levels (undergraduate, postgraduate, continuing education), affecting learning outcomes and competences, methods of learning and training, and evaluation.

Chaired by David Herrera, Perio Workshop 2023 brought together a selection of specialists from the EFP and ADEE (Association for Dental Education in Europe). Sessions were organised in four working groups, which discussed guidance on the scope and limits of periodontal education at all levels.

“Discussions at this year’s workshop were especially exciting since we identified relevant factors that are impacting education in periodontology since 2009,” announced David Herrera, chair of Perio Workshop 2023 and the EFP Workshop committee. “Those factors include the recommendations of the World Health Organisation after its 75th World Health Assembly; the new framework for the undergraduate curriculum in dentistry proposed by the ADEE; the impact of teaching and evaluation methods of the Covid-19 pandemic; and the recent Perio Workshops on the classification and on the management of periodontal and peri-implant diseases and conditions (S3-level clinical practical guidelines),” explained Prof Herrera.

The outcomes of these four days reviewing the latest studies available on this field will be published as a consensus paper in the EFP-edited Journal of Clinical Periodontology in spring 2024, and are set to shape how periodontology and therapeutics with dental implants are taught in the coming years by any public or private organisation teaching periodontics around the world, including the EFP-accredited postgraduate programmes in periodontology and implant dentistry imparted by 23 universities in Europe, the Middle East, and the Asia-Pacific region.

According to Cristina Ballesteros, head of Dentaid’s medical department: “Generating knowledge is a pillar of Dentaid. We work day by day hand in hand with professionals, co-creating and sharing knowledge to contribute to the improvement of dental practice. Collaborating in this workshop is consistent with our purpose, as improving and updating the training of periodontics professionals facilitates the advancement of oral health research and allows for improved patient outcomes”.

Organised annually by the EFP, Perio Workshop brings together world-class periodontists for a high-level scientific meeting aimed at reaching a new consensus on state-of-the-art, emerging topics relevant to the science behind gum health and gum disease by examining and discussing the latest research-based knowledge available.

An ongoing and open exchange between oral-health providers and family physicians can effectively improve the quality of their patients’ treatment and wellbeing, and in certain cases even save lives. The closer the collaboration between dental and general practitioners, the bigger the improvement in their patients’ treatment standards, particularly in relation to serious chronic conditions such as diabetes, and cardiovascular and respiratory diseases. Family doctors should be informed about gum diseases and their consequences, while oral health professionals should be made aware of the significance of non-communicable diseases (NCDs) and their associated risk factors.

This lies at the core of the new outreach campaign Perio & Family Doctors, an initiative jointly developed by the EFP (European Federation of Periodontology) and WONCA Europe (European branch of the World Organisation of Family Doctors), and sponsored by Curasept, an EFP partner. 

In 2022, 18 experts from the EFP and WONCA Europe examined the role of family physicians and the oral-health team and formulated a series of recommendations for both groups of clinicians. Their conclusions were published in a scientific consensus report published earlier this year in the EFP-edited Journal of Clinical Periodontology.

“This groundbreaking campaign marks a giant leap forward in enlightening family doctors, periodontists, and other oral health providers about the potential for closer collaboration. Together, we can proactively tackle and manage prevalent systemic health conditions that impact patients worldwide, such as cardiovascular disease (CVD), hypertension, obesity, diabetes, smoking, and hyperlipidaemia,” explains Darko Bozic, EFP president. “Our campaign is also addressed to the general public, as patients should be aware of the advantages and benefits of good oral health,” Prof Bozic indicates.

“In light of our recent findings, it is imperative to recognise that periodontitis transcends its localised origins in the oropharynx,” highlights Shlomo Vinker, president of WONCA Europe. “Instead, it emerges as a condition intimately intertwined with broader systemic disease states. To address this paradigm shift, the collaboration between dentists and family doctors becomes paramount. Together, we must institute proactive strategies for the early identification of periodontitis within primary care centers and, conversely, of cardiovascular diseases and diabetes within dental settings.

Prof Vinker adds: “Strengthening the bond between oral health professionals and family doctors is instrumental not only in the early detection and management of NCDs but also in fostering healthier lifestyles. The development and evaluation of pathways for early case detection of periodontitis in family medicine practices and NCDs in dental practices marks the next frontier in our collective pursuit of comprehensive healthcare.”

The Perio & Family Doctors campaign materials include infographics and other digital content available at the EFP website at efp.org/periofamilydoctors/. “Our aim with these materials is to make visual and intuitive the core messages of the consensus report, which thoroughly examined the latest scientific evidence available supporting that periodontal disease, in particular periodontitis or chronic inflammation of the gums, is independently associated with cardiovascular diseases, diabetes mellitus, and respiratory diseases, such as chronic obstructive pulmonary disease, sleep apnoea, and Covid-19 complications,” explains Prof Anton Sculean, chair of the EFP’s Projects committee.

“Research shows that severe periodontitis is the sixth most common disease globally and yet its impact on general health is still so little known,” says Giulia Giovannardi, International Business Development Manager at Curasept. “We at Curasept have always been committed to finding new innovative solutions to improve oral care. Oral care plays an important part in the general wellbeing of a person. For this reason, we are proud to support the research of our scientific partners to advance the level of awareness and treatment of patients.”

Perio Master Clinic conferences are about to become a more global affair with three editions in three continents being organised in less than a year. Perio Master Clinic, the brand created by the EFP (European Federation of Periodontology) in 2014 for providing career-boosting training to dental clinicians on the best periodontal techniques, is about to take place in Europe, the Americas, and Asia.

Dental practitioners from all around the world can take part in Perio Master Clinic 2023 in Antwerp, Belgium in March, in International Perio Master Clinic 2023 in León, Mexico next May, and in International Perio Master Clinic 2024 in Singapore in January 2024. In principle, Perio Master Clinic is a triennial conference held in Europe with the global leading speakers, followed by a non-European updated edition the following year with some additional local experts. The coming series of three iterations in a row is due to calendar changes caused by the Covid-19 pandemic.
Bringing Perio Master Clinic conferences to three different continents in such a short period illustrates the global scope currently reached by the EFP, which brings together 37 national scientific societies of periodontology and implant dentistry not only from Europe but from six continents.

Monique Danser

The philosophy of Perio Master Clinic is based on a distinctive practical, hands-on approach to improve the skills and understanding of dental clinicians, be they experienced or relatively newly qualified. It aims to deliver teaching on the latest and most advanced techniques in key practical areas of gums-related dentistry. That is why, unlike EFP’s EuroPerio congresses, each Perio Master Clinic conference focuses on a specific topic.

‘Perio-ortho synergy’ is the topic chosen for Perio Master Clinic 2023 in Antwerp, Belgium on 3-4 March, which will be led by chair Peter Garmyn and scientific chair Virginie Monnet-Corti. The conference will focus on how patients with periodontitis can be treated to improve aesthetic and functional outcomes by taking a combined periodontal and orthodontic treatment approach. This is the first time that the common ground between periodontology and orthodontics is systematically addressed in an international major conference.

Led by conference chair Álex García and scientific chair Anton Sculean, International Perio Master Clinic 2023 will be held on 5-6 May in León, Mexico, marking the first time that this EFP conference has ventured to the Americas. The topic will be ‘Hard- and soft-tissue aesthetic reconstructions around teeth and dental implants – current and future challenges’, with an outstanding faculty including leading international speakers, including some from the US and Latin America. Registration is possible at the EFP’s website.

Finally, International Perio Master Clinic 2024 will take place in Singapore on 19-20 January, 2024 and will address the perio-ortho synergy just as Perio Master Clinic 2023. Featuring Philip Preshaw as conference chair, Jonathan Phua as co-chair, and Virginie Monnet-Corti as scientific chair, International Perio Master Clinic 2024 will bring the brand to Asia for the second time, following the success of International Perio Master Clinic 2019 in Hong Kong.

“We are particularly proud of the global impact that our Perio Master Clinic conference brand is making among the dental clinicians around the world, and we see the organisation of these major events in Europe, Latin America, and Asia as a natural consequence of the worldwide scope of EFP’s projects and publications,” sums up Monique Danser, member of the organising committee of all three conferences and EFP treasurer. “The interests, challenges, and knowledge of dental practitioners are quite similar everywhere, and so is our determination to upskill and improve their technique at the dental practice, so they can offer the best possible treatment to their patients and periodontal health can make everyone’s life better.”

The first European guideline for the treatment of advanced (stage IV) periodontitis has just been published in the Journal of Clinical Periodontology (1), official publication of the European Federation of Periodontology (EFP). This groundbreaking S3-level clinical practice guideline (1) has been announced today during the press presentation of EuroPerio10, the world’s leading congress in periodontology and implant dentistry taking place until 18 June in Copenhagen, Denmark (2).

“Periodontitis has a huge impact on people’s lives, with bleeding gums, loose teeth, halitosis, and substantial, or even complete, tooth loss if left untreated,” said author Professor David Herrera of University Complutense of Madrid, Spain. “Those affected can experience difficulty eating and speaking clearly and some feel ashamed, frustrated and vulnerable. However, as today’s document shows, most advanced disease can be successfully treated and teeth maintained in the long-term.”

Approximately 1.1 billion people worldwide had severe periodontitis (stages III and IV) in 2019, making it the most common chronic inflammatory non-communicable disease.

Periodontitis, a chronic form of gum disease, is caused by bacteria that accumulate on the teeth. Inflammation starts in the gums, then progressively destroys the ligament and bone supporting the teeth, causing the teeth to loosen and fall out. This guideline focuses on stage IV periodontitis, which is the most advanced stage. In addition to the inflammation and loose teeth in stage III, patients with advanced disease have some of the following: loss of five or more teeth due to periodontitis, teeth moving out of position, flaring (“buck”) teeth, and difficulty in chewing.

Clinical assessment of advanced “gum disease” includes five components. One, evaluate the extent of breakdown of structures supporting the teeth, aesthetics, and the ability to chew and speak. Two, establish the number of teeth already lost due to periodontitis. Three, determine which remaining teeth can be saved. Four, assess all factors in the mouth which could hinder or enable retention of teeth and/or placing dental implants, such spaces without teeth and the availability of bone. Five, ascertain the patient’s overall prognosis, including the probability of disease progression or recurrence, considering the possible presence of risk factors such as smoking and diabetes.

Professor Maurizio Tonetti of Shanghai Jiao Tong University School of Medicine, Shanghai, China, co-author of the guideline, explained: “This detailed diagnostic process is crucial as it enables us to design a multidisciplinary treatment plan based on what is technically and biologically feasible, cost-effective, and in line with the patient’s preferences and expectations.”

Treatment aims to control inflammation and prevent further damage of the supporting tissues of the teeth, and to restore tooth function. Therapy begins with the recommendations for stages I to III periodontitis which include good oral hygiene, not smoking, controlling diabetes, and professional cleaning of the teeth above and below the gum line to remove bacteria, as stated in the previous guideline published in 2020 (2). Additional treatments for stage IV disease can involve orthodontic therapy to straighten or move teeth, and construction of prostheses to replace missing teeth, either supported by teeth or by dental implants. Professor Herrera said: “Extracting teeth to place dental implants is not a reasonable option if teeth can be retained.”

He added: “Behavioural change is one of the pillars of therapy and the patient’s motivation and compliance are extremely important for success. This includes toothbrushing, cleaning between the teeth, sometimes using a mouth rinse to reduce inflammation, not smoking, and controlling blood sugar for those with diabetes. The benefits of periodontal therapy extend beyond the mouth to improved nutrition, quality of life, and systemic health, as, for example, better control of blood sugar in patients with diabetes due to the two-way relationship between diabetes and periodontitis.”

Professor Andreas Stavropoulos, EFP president, said: “This guideline for stage IV periodontitis complements that for stages I to III (3), meaning that for the first time in history we now have European recommendations for the interdisciplinary and evidence-based management of all stages of this disease. Application of the guideline is expected to improve the quality of periodontal treatment in Europe and worldwide. The EFP will be working with national periodontology societies to translate and adapt the guideline to the local context.”

EFP, global benchmark in periodontology

The European Federation of Periodontology (EFP, ww.efp.org) is a non-profit organisation dedicated to promoting awareness of periodontal science and the importance of gum health. Its guiding vision is “periodontal health for a better life.”

Founded in 1991, the EFP is a federation of 37 national periodontal member societies that represents more than 16,000 periodontists, dentists, researchers, and oral-health professionals from Europe and around the world. It supports evidence-based science in periodontal and oral health, and it promotes events and campaigns aimed at both professionals and the public.

The EFP organises EuroPerio, the world’s leading congress in periodontology and implant dentistry, as well as other important professional and expert events such as Perio Master Clinic and Perio Workshop. The annual Gum Health Day on May 12, organised by the EFP and its member societies, brings key messages on gum health to millions of people across the world.

The EFP also organises workshops and outreach campaigns with its partners: projects to date have covered the relationship between periodontal disease and diabetes, cardiovascular disease, and caries, as well as women’s oral health during pregnancy.

The EFP’s Journal of Clinical Periodontology is the most authoritative scientific publication in this field. The federation also publishes JCP Digest, a monthly digest of research, and the Perio Insight magazine, which features experts’ views and debates.

The EFP’s work in education is also highly significant, notably its accreditation programme for postgraduate education in periodontology and implant dentistry.

The EFP has no professional or commercial agenda.

References

1. David Herrera, Mariano Sanz, Moritz Kebschull, Søren Jepsen, Anton Sculean, Tord Berglundh, Panos N. Papapanou, Iain Chapple, Maurizio S. Tonetti. Treatment of stage IV periodontitis –The EFP S3 level clinical practice guideline. J Clin Periodontol. 2022. doi:10.1111/jcpe.13639
2. At EuroPerio10, the session “The multidisciplinary treatment of stage IV periodontitis” will take place on 16 June at 16.30 h at the Hall A of the Bella Center in Copenhagen. More details at https://europerio10.abstractserver.com/program/#/details/sessions/20
3. Mariano Sanz, David Herrera, Moritz Kebschull, Iain Chapple, Søren Jepsen, Tord Berglundh, Anton Sculean, Maurizio S. Tonetti. Treatment of stage I-III periodontitis –The EFP S3 level clinical practice guideline. J Clin Periodontol. 2020;47(Suppl 22):4–60. doi:10.1111/jcpe.13290.