Economic Impact of Periodontitis: Global, Regional and National Estimates of Periodontal Expenditure, With Forecasts to 2050

AIM: To estimate the global, regional and national economic impact of periodontitis in 2021 (including expenditure on prevention, diagnosis, treatment, maintenance and rehabilitation), and to forecast expenditures through 2050 under two utilisation scenarios: continuation of current treatment coverage trends and an illustrative expanded coverage scenario. METHODS: A cohort-based gross-costing Monte Carlo model was developed to estimate global, regional and national expenditure on periodontitis in 2021. Model estimates were validated against known national periodontal spending and aggregate dental expenditure. The model was then applied to generate forecasts for 2025-2050 at five-year intervals under two utilisation scenarios: (i) continuation of current utilisation patterns of periodontal care and (ii) an illustrative expanded coverage scenario in which 80% of the population receives periodontal care by 2030. RESULTS: In 2021, global expenditure on periodontitis was US$168.1 billion (95% UI: 133.8-202.4), with marked regional disparities; five countries (the United States, China, Germany, Japan and France) accounted for more than two-thirds of global spending. Under current utilisation trends, global expenditure is projected to increase modestly to US$174.9 billion by 2050 (95% UI: 137.4-212.3), despite a projected 44.3% increase in severe periodontitis prevalence. Under the expanded coverage scenario, expenditure would instead increase threefold to US$500.6 billion (95% UI: 389.2-612.1) by 2050, implying an annual financing gap of US$325.7 billion. Global per-capita expenditure was US$21.32 (95% UI: 16.97-25.67) in 2021, projected to decline to US$18.36 (95% UI: 14.43-22.29) in 2050 under current utilisation, but to rise to US$52.56 (95% UI: 40.86-64.26) under the expanded coverage scenario. CONCLUSION: Periodontitis imposes a substantial and unequally distributed economic impact worldwide. Under current utilisation patterns, the projected rise in prevalence by 2050 will primarily translate into unmet care needs. Achieving universal coverage under WHO targets would require tripling global periodontal expenditure-a level unlikely to be feasible-highlighting the need to rethink current models of periodontal care delivery.