P&G Oral Care has announced the publication of a first-of-its-kind life cycle assessment (LCA) study in the Journal of Dentistry, revealing that managing advanced periodontal disease may be associated with up to 10 times greater environmental impact than maintaining periodontal health through effective at-home prevention.
The peer-reviewed paper, “Quantifying the Environmental Impact Potential from Periodontal Health to Disease: Findings from a Life Cycle Assessment Study”, is the first to quantify the environmental burden associated with periodontal disease, its progression and the clinical care required to manage it.
Developed by sustainability and oral health experts in collaboration with Procter & Gamble (P&G), the research complies with ISO 14040/14044 standards and applies a whole-system life cycle assessment approach to oral healthcare. It evaluates environmental impacts across the continuum from periodontal health to advanced gum disease, encompassing both daily home care and professional clinical interventions.
A broader perspective on sustainability in oral healthcare
Discussions around sustainability in oral healthcare have traditionally focused on environmentally friendly products, manufacturing processes and waste reduction. This study broadens the conversation by examining the environmental impact of entire care pathways, including preventive measures and clinical treatment.
Key findings include:
• Clinical interventions account for approximately 90% of the total environmental impact across the periodontal care pathway modelled in the study.
• Within at-home oral care routines, water consumption was identified as the largest contributor to environmental impact.
• Under the study’s parameters, no significant difference was observed between manual and powered toothbrushing in terms of total environmental impact associated with daily oral care routines.
Prevention as the most effective lever
By linking oral health outcomes with the environmental impact of care pathways, the study reinforces the value of prevention. Effective daily oral hygiene can help prevent the progression of gum disease, reducing the need for more intensive and resource-intensive clinical interventions, benefiting patients, healthcare systems and the environment.
Alongside professional recommendations to brush twice daily with fluoride toothpaste and clean between teeth, evidence suggests that powered toothbrushes can improve plaque control and gum health. Studies have also shown that oscillating-rotating powered toothbrushes can provide significant long-term oral health benefits.
Gum disease remains a global challenge
According to analyses based on Global Burden of Disease (GBD) 2021 data, more than one billion people worldwide were living with severe periodontitis in 2021.
In England, the Adult Oral Health Survey (AOHS) 2023 reported that:
• 93% of adults with natural teeth showed at least one sign of periodontal disease.
• Approximately 28% exhibited early signs of gum deterioration, identified by periodontal pockets greater than 3.5mm, where plaque accumulation and disease progression often begin.
Industry and expert perspectives
“Healthy habits at home matter, and using the right tools can make prevention more effective,” said Michael Grieff, senior vice-president of R&D oral care at P&G. “Plaque accumulates in hard-to-reach areas such as along the gumline and between teeth, and effective daily cleaning helps prevent problems from developing. In a meta-analysis of more than 20 randomised clinical studies involving over 2,600 participants, 88% of people with early gum disease regained healthy gums using Oral-B iO. Four times as many people returned to healthy gums using iO powered toothbrushes compared with a manual toothbrush.”
Prof Brett Duane, honorary professor at the University of Dundee and associate professor (visiting) at Trinity College Dublin, said: “What is important about this LCA is that it places products within the real-world context of oral health, demonstrating that prevention at home and reducing the need for high-impact clinical care offer the greatest sustainability benefits.”
Prof Nicolas Martin of the University of Sheffield and chair of the FDI Sustainability in Dentistry Task Team added: “As periodontal disease progresses, treatment becomes increasingly intensive. Prevention reduces the lifetime need for treatment, which benefits patients, healthcare systems and environmental sustainability.”
Dr Steven Mulligan of the University of Sheffield and a founding member of the FDI Sustainability in Dentistry Task Team noted: “Around 90% of the environmental impact arises from clinical treatment, and the impact can be up to 10 times higher for advanced periodontal disease. Prevention is one of the most powerful measures available to us.”
Prof Andrea Pilloni, professor of periodontology at the Sapienza University of Rome, emphasised the wider health implications of gum disease: “Periodontal health is not solely about oral health; it is closely linked to overall wellbeing. Strong clinical associations exist between gum disease and systemic conditions such as diabetes and cardiovascular disease. Effective plaque removal at home, particularly along the gumline and between teeth, helps control inflammation and supports long-term health.”
