Embedding early intervention in gingival health

In this interview, Shazad Saleem explores the barriers to early intervention in gingivitis, and how education, patient behaviour change and effective use of the wider dental team need to align, following Kenvue’s expert advisory board on dysbiotic dental plaque biofilm.

From your perspective as an educator, why is early intervention for gingivitis still so difficult to embed consistently in everyday practice?

Early intervention in gingivitis is something I have become increasingly focused on over the years, particularly as the evidence shows that managing gingivitis is the primary preventive strategy for preventing periodontitis (Chapple et al, 2015). The challenge is that, in a time-pressured clinical environment, gingivitis is often seen but not prioritised in the same way as more advanced disease.

There can be a tendency to wait until oral diseases develop before investing more time in education and intervention, rather than acting earlier when the disease is more straightforward to manage. However, earlier intervention and treatment is associated with better long-term outcomes, both for the patient and for the wider healthcare system (Watt et al, 2019).

In some areas of practice, we are now seeing incentives to see patients at a much earlier stage, for example in Wales with new NHS contract reform, the care package for assessment of a patient under one year old is remunerated at £80. Some may see this and raise questions about the value of those appointments.

However, this is where prevention is most powerful. When delivered properly, it provides an opportunity to work with parents, establish good habits around diet and oral hygiene, and embed those behaviours early before the teeth erupt and to take it one step further, before birth. This is essentially primordial prevention, supporting families with preventing risk factor development rather than when disease develops and responding once it is established.

Embedding prevention also requires a shift in how we value clinical time. Advice and behaviour change support can have a lasting impact on a patient’s health, but these elements are not always prioritised or incentivised within current models of care (Watt et al, 2019; Newton and Asimakopoulou, 2015). As a result, opportunities to intervene early and prevent disease progression are sometimes missed.

What tends to get in the way of clinical education changing behaviour in practice, particularly when it comes to acting early on gingivitis rather than waiting for disease progression?

One of the key challenges is that increasing knowledge does not always translate into behaviour change, either for patients or for clinicians. We can deliver clear messages and provide evidence-based guidance, but that alone does not necessarily lead to sustained changes in practice.

In busy clinical settings, there are also practical barriers. Clinicians are seeing large numbers of patients each day, and without structured systems in place, it can be difficult to track changes over time or assess whether previous advice has been effective. This can make it harder to tailor interventions or reinforce key messages.

Time is another important factor. Effective prevention requires time for education, demonstration and reinforcement, and this is not always readily available within standard appointment structures. Making better use of the wider dental team, including dental care professionals (DCPs), can help to address this, but it also requires appropriate funding, support and integration into practice workflows.

Where do you see the biggest disconnect between what clinicians know about plaque-driven disease and what happens chairside?

There is a clear gap between the general guidance clinicians are familiar with and how that is applied to individual patients. Public health messaging, such as brushing twice daily for two minutes, is important for maintaining health, but it may not be sufficient for patients who already present with gingival inflammation or more complex disease (PHE, 2025; Van der Weijden and Slot, 2011).

In practice, there can be a tendency to rely on these generic messages, rather than fully assessing the specific needs of the patient in front of us. A patient with a healthy mouth requires a different approach to someone with active disease, and this distinction is not always reflected in the advice given chairside.

Addressing this requires a more personalised approach to care. Clinicians need to assess the level of disease, understand the challenges the patient may face in maintaining oral hygiene, and tailor recommendations accordingly, providing a more personalised self-care plan. This may include adjusting brushing techniques, increasing the time spent on plaque removal, or, in some cases, considering adjunctive support where mechanical plaque control alone is insufficient (West et al, 2021), as well as considering how the patient can implement the advice into their daily schedule to facilitate behaviour change.

Ultimately, effective management of plaque-driven disease depends on what the patient is able to do consistently between appointments. Our role is to ensure they have the understanding, skills and support needed to achieve that, recognising that clinicians have limited time to influence oral disease each year, while patients are responsible for it every day at home.

Why is gingivitis often underestimated as a clinical priority, despite its role in disease progression?

Gingivitis is often underestimated because it is seen as reversible and therefore less urgent than periodontitis. In reality, it represents the earliest clinical stage of inflammation and a clear opportunity to intervene before progression occurs (Chapple et al, 2015).

In everyday practice, there can be a focus on treatment at a single point in time, for example ‘a scale and polish’, rather than on what is happening between visits. Patients may leave feeling that the problem has been addressed, without fully understanding that long-term control depends on what they do at home every day.

As a result, the significance of gingival inflammation can be overlooked. If greater emphasis is placed on identifying and managing it early, there is a real opportunity to prevent progression to periodontitis and improve long-term outcomes (Chapple et al, 2015).

How can education, including CPD, better support clinicians to act earlier, rather than waiting for disease to become more advanced?

Education needs to support clinicians not only in understanding disease, but in recognising its long-term implications and acting on it earlier. Gingivitis and periodontitis should be approached as part of a continuum, with early diagnosis taken seriously and managed proactively (Chapple et al, 2015; Tonetti et al, 2018).

There is also a need to focus on the long-term impact of prevention. The benefits of early intervention may not be immediately visible, but over time they can lead to improved oral health, better quality of life and reduced need for more complex treatment. Supporting clinicians to communicate this effectively to patients is key.

Education should also reflect the realities of practice. Clinicians need practical strategies that can be implemented within time constraints, alongside support to deliver consistent, effective messages. This includes understanding when additional support may be needed for patients who are not achieving adequate plaque control through mechanical means alone.

What role does the wider dental team play in reinforcing early intervention messages around plaque and gingival health?

The wider dental team plays a crucial role in delivering preventive care effectively. Making use of skill mix allows more time to be dedicated to patient education, behaviour change and reinforcement of key messages.

DCPs, including hygienists, therapists and oral health educators, are often well placed to spend time with patients, build rapport and provide tailored guidance. This can support more consistent messaging and improve patient engagement. It is important to understand when using skill mix, that the patient is on a journey to achieving optimal plaque and diet control to prevent oral diseases from occurring. Some will reach their destination quicker whilst others will require more time. It is essential to correctly reflect where the patient is on this journey when the patient is seeing different members of the dental team. Good record keeping, clinical photographs and detailed documentation of what has been advised and results achieved are crucial in this.

A team-based approach also helps to ensure that prevention is embedded throughout the patient journey, rather than being confined to a single interaction. When all members of the team are aligned, patients are more likely to understand the importance of plaque control and take ownership of their oral health.

In your experience, what makes educational messages stick and lead to sustained change in practice?

For messages to be effective, patients first need a clear understanding of their disease and risk factors. Taking the time to explain what is happening, and why it matters, can make a significant difference to how information is received.

However, understanding alone is not always enough to drive behaviour change. Patients also need practical support to implement what they have been told, including clear instruction, demonstration and opportunities to reinforce learning over time.

Consistency and focus are important. Encouraging patients to approach oral hygiene as an active, deliberate task, rather than something done automatically, can help improve outcomes. When patients begin to engage with the process and understand its importance, more sustained change is often seen.

How can professional education better reflect the realities and pressures clinicians face in busy practice environments?

Education needs to be grounded in the environments where care is actually delivered. Clinicians are working within time and system constraints, and any recommendations must be realistic and achievable within those settings.

Sharing practical approaches from clinicians who are working in similar environments can be particularly valuable. This includes examples of how prevention can be integrated into routine care, as well as strategies for working effectively within existing structures.

Ultimately, clinicians need support to deliver high-quality care within the systems they operate in. Education should help bridge the gap between evidence and implementation, ensuring that guidance can be applied consistently in both NHS and private practice settings.

Through your work with the BSP, where do you see the greatest opportunity to improve consistency in prevention messaging from education into everyday clinical practice?

There has been significant progress in developing a strong evidence base for the management and prevention of periodontal disease, including clear guidance through S3-level clinical practice guidelines (West et al, 2021). This has helped to align understanding and provide a consistent framework for care.

The continual work now is ensuring that this knowledge is embedded in everyday practice. This involves not only disseminating guidance, providing education and training, but also supporting clinicians to implement it effectively within different care settings.

Collaboration between professional bodies, educators and healthcare systems will be key to achieving this. By aligning evidence, education and delivery, there is an opportunity to improve consistency and strengthen preventive care across the profession.

The advisory board agreed that plaque-driven oral disease is preventable. From an education and implementation perspective, what needs to change for that message to translate into earlier intervention for gingivitis in routine practice?

Translating this message into practice requires a broader, more co-ordinated approach. Awareness is important, but it must be supported by systems that enable early intervention and prioritise prevention.

This includes greater emphasis on preventive care within clinical pathways, alongside improved collaboration between public health, professional organisations and the wider dental sector. Creating opportunities to intervene earlier, particularly at key life stages, can help establish long-term habits and reduce disease burden (PHE, 2025; Watt et al, 2019).

There is also a need to align incentives with prevention. When prevention is appropriately supported and valued, clinicians are better able to invest time in early intervention and behaviour change.

Ultimately, a more holistic approach is needed, one that supports patients throughout the life course and reinforces the importance of plaque control at every stage. By doing so, there is a real opportunity to reduce the prevalence of gingival inflammation and prevent progression to more advanced disease.

References

• Chapple ILC et al. Primary prevention of periodontitis: managing gingivitis. J Clin Periodontol 2015; 42(Suppl. 16): S71–S76
• Newton JT, Asimakopoulou K. Managing oral hygiene as a risk factor for periodontal disease: a systematic review of psychological approaches to behaviour change for improved plaque control in periodontal management. J Clin Periodontol 2015; 42(Suppl. 16): S36–S46.
• Public Health England. Delivering better oral health: an evidence-based toolkit for prevention. London: 2025
• Tonetti MS et al. Staging and grading of periodontitis: framework and proposal of a new classification. J Clin Periodontol 2018; 45(Suppl. 20): S149–S161
• Van der Weijden GA, Slot DE. Oral hygiene in the prevention of periodontal diseases: the evidence. Periodontol 2000 2011; 55: 104–123
• Watt RG et al. Ending the neglect of global oral health: time for radical action. Lancet 2019; 394(10194): 261–272
• West NX et al. BSP implementation of European S3-level evidence-based treatment guidelines for stage I–III periodontitis in UK clinical practice. J Dent 2021; 106: 103562.

The full expert consensus on preventing oral diseases driven by dysbiotic dental plaque biofilm can be accessed here.

This article is sponsored by LISTERINE.