The European Federation of Periodontology (EFP) and the European Association of Dental Public Health (EADPH) have published a joint white paper arguing that oral health should no longer be managed in isolation but integrated into general health strategies. The document — launched at the 2026 Oral Health Research Congress in Lisbon — synthesises evidence from periodontology, medicine and dental public health and sets out recommendations for clinical practice, education, research and policy.
Common risk factors and vast burden of disease
The white paper emphasises that oral diseases affect around 3.5 billion people worldwide, and that many share modifiable risk factors with major non-communicable diseases (NCDs). These include consumption of free sugars, tobacco and alcohol, along with social and commercial determinants of health. Inadequate oral hygiene is identified as an additional oral-specific risk factor.
Authors argue that this overlap provides a rationale for a common risk factor approach, recommending integrated prevention and care rather than separate, siloed management of oral and systemic conditions.
Evidence on periodontitis and systemic health
Among oral conditions, the paper highlights periodontitis as having the most substantial evidence for interactions with systemic health. While associations have been reported between gum disease and a number of systemic conditions, the paper notes that the strength and nature of the evidence vary by outcome.
Importantly, the authors cite randomised and observational research showing that treatment of periodontitis has been associated with improved glycaemic control in people with diabetes, and with improvements in certain inflammatory and vascular surrogate markers. They caution, however, that evidence of an effect on major clinical events — such as heart attacks or strokes — remains limited.
"Oral health deserves a place within
Action across multiple levels
The working group proposes action across a number of domains, from upstream policies addressing wider determinants to community prevention and individual clinical care. The white paper sets out recommendations for:
- Policy-makers to integrate oral health into NCD prevention and health promotion strategies
- Clinical services to develop closer collaboration between dental, medical and social-care professionals
- Training and education to include oral-systemic links for health professionals
- Research agendas to focus on mechanistic pathways and robust trials evaluating clinical end-points
The document was produced by a joint EFP/EADPH working group and supported by Oral‑B. It will be presented at the symposium "Oral and systemic health - A call to action!" during the congress.
Implications and caveats
The white paper provides a coherent argument for policy and service reform, drawing on biological plausibility and clinical trial evidence for some outcomes. However, it also appropriately highlights limitations: while surrogate markers and glycaemic measures improve after periodontal treatment, direct evidence that treating gum disease prevents major systemic events remains limited. That distinction matters for health systems considering where to prioritise resources.
For national health services and commissioners, the paper reinforces the potential value of integrated prevention efforts—for example tobacco control, sugar reduction and alcohol policy—which could yield benefits across oral and systemic health. It also points to the need for more high-quality research linking periodontal interventions to hard clinical outcomes and for practical models that enable collaboration between dental and medical teams.
| Fact | Detail |
|---|---|
| Global burden | ~3.5 billion people affected by oral diseases |
| Shared risks | Free sugar, tobacco, alcohol, social and commercial determinants |
| Strongest oral-systemic evidence | Periodontitis — treatment linked to improved glycaemic control and surrogate inflammatory/vascular markers |
The white paper's recommendations, if acted upon, could reshape prevention programmes, clinical pathways and education for health professionals. Policymakers will need to weigh the evidence carefully, invest in coordinated services where appropriate, and support further research to clarify long-term clinical benefits of integrated approaches.
