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即使对世界上最富有的国家来说,应用当前欧洲牙周炎临床实践指南也是不可行的。

Applying current European periodontitis clinical practice guidelines is not feasible even for the richest countries in the world.

作者信息

Raittio Eero, Grytten Jostein, Lopez Rodrigo, Blich Carl Christian, Vettore Mario Vianna, Baelum Vibeke

机构信息

Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.

Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.

出版信息

Community Dent Oral Epidemiol. 2025 Feb;53(1):1-6. doi: 10.1111/cdoe.13003. Epub 2024 Aug 15.

DOI:10.1111/cdoe.13003
PMID:39145430
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11754149/
Abstract

Clinical practice guidelines aim to enhance the quality, equality and consistency of care but often demand more time than is available, rendering adherence impractical and exceeding feasible resources. The 2017 introduction of a new periodontal classification system by the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) sought to refine clinical and epidemiological practices by serving as the basis for clinical practice guidelines and epidemiological investigations around the world. Following this classification, the EFP recommends supportive periodontal care visits every 3-12 months for all periodontitis cases. Given that in Norway, approximately 72% of the adult population are identified as periodontitis cases under the current AAP/EFP case definition, this poses a significant demand on healthcare resources. We calculated that between 60% and 70% of all estimated available working hours available for adult dental care provided by dentists and dental hygienists in Norway in 2017 would be spent on supportive periodontal care visits alone if the recommendations were to be met. This situation calls for a reevaluation of disease definitions and clinical practice guidelines to ensure they are practical, financially feasible and patient-outcome relevant.

摘要

临床实践指南旨在提高医疗服务的质量、公平性和一致性,但往往需要比实际可利用时间更多的时间,导致难以遵循,超出了可行资源的范围。美国牙周病学会(AAP)和欧洲牙周病学联合会(EFP)于2017年推出了新的牙周分类系统,旨在通过作为全球临床实践指南和流行病学调查的基础来完善临床和流行病学实践。根据这一分类,EFP建议所有牙周炎病例每3至12个月进行一次支持性牙周护理就诊。鉴于在挪威,按照当前AAP/EFP的病例定义,约72%的成年人口被认定为牙周炎病例,这对医疗资源提出了巨大需求。我们计算得出,如果要满足这些建议,2017年挪威牙医和口腔保健员为成人提供牙科护理的所有估计可用工作时间中,有60%至70%将仅用于支持性牙周护理就诊。这种情况需要重新评估疾病定义和临床实践指南,以确保它们切实可行、在财务上可行且与患者预后相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/88ef/11754149/aafc546e8aee/CDOE-53-1-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/88ef/11754149/aafc546e8aee/CDOE-53-1-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/88ef/11754149/aafc546e8aee/CDOE-53-1-g001.jpg

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本文引用的文献

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Preventing overdiagnosis and overuse: proposed guidance for guideline panels.预防过度诊断和过度医疗:为指南制定小组提出的指导意见
BMJ Evid Based Med. 2024 Jul 23;29(4):272-274. doi: 10.1136/bmjebm-2023-112608.
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应用2018年牙周状况分类至流行病学调查数据(ACES)框架以估算美国牙周炎患病率
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Periodontal Probing Depth Trajectory in 10 Years of Follow-Up as Associated With Tooth Loss.10年随访期间与牙齿缺失相关的牙周探诊深度轨迹
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Restricting Periodontal Treatment Frequency: Impact on Tooth Loss in Danish Adults.限制牙周治疗频率:对丹麦成年人牙齿缺失的影响
Community Dent Oral Epidemiol. 2025 Apr;53(2):205-215. doi: 10.1111/cdoe.13022. Epub 2024 Dec 23.
评估 2018 EFP/AAP 牙周炎分类在监测中的应用:一项验证研究和聚类分析。
J Periodontol. 2023 Oct;94(10):1254-1265. doi: 10.1002/JPER.23-0088. Epub 2023 May 22.
4
Justification for the 2017 periodontitis classification in the light of the Checklist for Modifying Disease Definitions: A narrative review.基于修改疾病定义检查表,为 2017 年牙周炎分类提供依据:叙述性综述。
Community Dent Oral Epidemiol. 2023 Dec;51(6):1169-1179. doi: 10.1111/cdoe.12856. Epub 2023 Mar 23.
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Outcomes of periodontal therapy: Strengthening the relevance of research to patients. A co-created review.牙周治疗的结果:增强研究与患者的相关性。一项共同创建的综述。
Periodontol 2000. 2023 Feb 14. doi: 10.1111/prd.12483.
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Guidelines should consider clinicians' time needed to treat.指南应考虑临床医生治疗所需的时间。
BMJ. 2023 Jan 3;380:e072953. doi: 10.1136/bmj-2022-072953.
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Periodontal conditions in a 65-year-old population and prevalence of periodontitis according to three different bone level thresholds.65 岁人群的牙周状况及三种不同牙槽骨丧失水平阈值下牙周炎的患病率。
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Influence of case definitions on epidemiological estimates of periodontitis prevalence and its associations with smoking and OHRQoL.牙周炎患病率的流行病学估计及其与吸烟和口腔健康相关生活质量的关联受病例定义的影响。
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