Information and prevention in Germany - a misery

The prevention situation in Germany is in a sorry state. Consumer advice centers, the Ministry of Justice and insurers have identified a glaring deficiency in the maintenance of dental health. Prophylaxis and preventive treatment to maintain health are only weakly developed in the field of dentistry. As a result, tooth replacement and advanced periodontitis often dominate the picture in Germany.

According to the Fifth German Oral Health Study, more than half of middle-aged adults in Germany are affected by periodontitis (1). In the senior age group, almost two thirds even suffer from it. In contrast, although around 50 percent of people with statutory health insurance have their periodontal disease checked within two years, according to the BARMER Dental Report 2017, less than two percent of them received treatment for periodontitis (2).

The discrepancy between the disease rate and treatment is therefore enormous! "This is all the more worrying as the success of treatment becomes increasingly uncertain the more advanced the disease is," says study author Prof. Dr. Michael Walter, Director of the Polyclinic for Dental Prosthetics at the Carl Gustav Caru University Hospital in Dresden.

Periodontitis therapy needs water

BARMER comes to the conclusion that periodontitis therapy often fails to achieve its goal of preserving teeth. After treatment, a third of those treated lose teeth within four years. This finding leads to one conclusion in particular: the actual goal of periodontitis therapy, to preserve teeth, cannot be consistently achieved. The therapy obviously comes too late for many patients if teeth are no longer treatable at the time of treatment and have to be extracted.

For years, courts and consumer associations have been calling for better information and more preventive measures for dental implants. A study has shown that peri-implantitis occurs in 45% of patients nine years after the insertion of implants (3). If this is not treated professionally, it can even lead to the loss of the implant and the subsequent costs can be immense.

One fifth of patients reported that they had not been informed about the possible complications. One third were not informed about the possible follow-up costs. Courts often award patients with inadequate information high compensation claims. Patients who were already suffering from periodontitis before an implant was inserted need to be particularly well informed. In this case, careful daily oral hygiene and an individualized prophylactic treatment plan are urgently needed.

Impenetrable jungle of payment regulations

In addition, the dental health market is largely self-pay. This provides an economic incentive for dentists. At the same time, the jungle of co-payments, deductibles, treatment and cost plans is almost incomprehensible for the medical layperson. However, the fact that patients feel ill-informed is not just down to the dentists. Especially in the field of dental treatment, neutral information is difficult to obtain. The majority of information is based on brochures from manufacturers and providers, but is not immediately recognizable as such by the consumer.

Need to catch up on health literacy

In a 2016 study on health literacy, the Federal Ministry of Justice and Consumer Protection examined the health literacy of the population in Germany (4). The results are alarming! Over half (54.3%) of Germans have only limited health literacy. These people have considerable difficulties in correctly classifying and evaluating information about their state of health and making decisions. As a result, the Ministry is calling for the healthcare system to be made more information- and user-friendly and for patients to be provided with the relevant information in an understandable and neutral manner.

The DMS - Deutsche Mundgesundheitsstiftung GmbH has taken these shortcomings and the ministry's demands as an opportunity to take action in two respects:

1. She has launched the "I Love My Implant" website. The website provides patients, interested parties and dental professionals with product-neutral and manufacturer-independent information on dental implants. The foundation was able to recruit the independent medical journalist Dr. Jan Kunde as editorial director. This ensures that the information is neutral, scientifically sound and comprehensible.
2. She has initiated a study to prove the health economic benefits of earlier periodontitis diagnosis - for the patient.

The internal study was conducted by Prof. Frankenberger, dentist and professor of dental conservation at Philipps University, and the Institute for Empirical Health Economics (IFEG).

The question was quite simple: does it save patients money in the long run to invest in the early diagnosis of periodontitis? One group was treated according to the usual standard, while the other group underwent the particularly sensitive aMMP-8 test in addition to the standard procedure, which reveals the first signs of periodontitis at an early stage.

The result is clear: the longer the sensitive test is used, the greater the savings for patients. In the first ten years between the ages of 35 and 44, the additional costs for the test still outweigh the savings (930€ over ten years). However, this test pays off significantly for older people: between the ages of 45 and 54, patients already save 980€ over ten years - the test has virtually paid for itself. Between the ages of 55 and 64, the savings potential is 1884€, between the ages of 65 and 74 2920€ and between the ages of 75 and 84 4704€.

Periodontitis: routine examination = diagnosis too late

The background is obvious. As a rule, periodontitis is only diagnosed during routine examinations when it has progressed too far. The gums are bleeding or the x-ray shows that the bone has already receded. But by then it is often too late. The process can only be halted and not prevented. Sooner or later, teeth will be lost. It is well known that dentures are expensive. However, if the sensitive aMMP-8 test is used as part of the regular examination, the first degenerative processes can already be detected.

The cause is almost always a damaging biofilm of bacteria, which can also be hidden in the gums (5). The test detects these foci and can be removed in a targeted manner before permanent damage to supporting structures and bone occurs.

Incidentally, the following thought is a fallacy: "Oh - then I'll only start the test at the age of 45 and save the 930€ in the years before." This is because the savings in old age result from the fact that damage caused by inflammation is avoided at a young age.