New Study Reveals the True Environmental Impact of Periodontal Disease – And What You Can Do About It

Peer reviewed life cycle assessment published in the Journal of Dentistry (ISO 14040/14044-compliant) finds most impact comes from clinical care pathways, making prevention at home the biggest lever to improving outcomes for patients and the environment.

Today P&G Oral Care announces the release of a new, first-of-its kind LCA study published in the Journal of Dentistry finds managing advanced periodontal disease can be associated with up to ~10× higher environmental impact compared with maintaining periodontal health through at-home prevention.

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The peer-reviewed paper, titled “Quantifying the Environmental Impact Potential from Periodontal Health to Disease: Findings from a Life Cycle Assessment Study,” for the first time quantifies the environmental burden associated with the presence of periodontal disease, its progression and the associated clinical care.

It was developed by sustainability and oral health experts in collaboration with Procter & Gamble (P&G). The ISO 14040/14044–compliant research applies a whole-system life cycle assessment (LCA) lens to oral healthcare, quantifying environmental impacts across pathways from periodontal health through progressive gum disease, spanning both daily at-home prevention and in-clinic interventions.

A new lens on environmental sustainability in oral healthcare

The environmental sustainability discussion in oral healthcare has largely focused on so-called ‘green’ products, waste and manufacturing. This study extends to full care pathways delivered by the profession and through at-home routines.

Additional study findings (high level)

• Clinical interventions account for ~90% of total environmental impact across the modelled periodontal pathway.
• Within at-home routines, water use is the largest contributor; within the study’s parameters, no meaningful difference was observed between manual and electric toothbrushing routines for total at-home impact. (See paper for methods/assumptions.)

Why this matters: Prevention is the biggest lever, and the right tools can make it easier

By linking oral health outcomes with care pathways, the study adds significant value to the concept of prevention, showing that effective at-home routines matter. Avoiding gum disease progression may reduce the need for more intensive, resource-heavy clinical interventions, benefiting patients, healthcare systems, society, and the environment.

Alongside professional guidance (brush twice daily for two minutes with fluoride toothpaste and clean between teeth), evidence indicates that powered toothbrushes not only reduce plaque and maintain better gum health in the short term, but those that work with oscillating-rotating technology also contribute to significant long-term benefits.

Gum health challenges are widespread

• Globally, more than 1 billion people were living with severe periodontitis in 2021, based on analyses using Global Burden of Disease (GBD) 2021 data.
• In England, the Adult Oral Health Survey (AOHS) 2023 found that:
  • 93% of adults with natural teeth had at least one sign of periodontal disease, and
  • around 28% had early signs of gum breakdown, measured clinically as deeper spaces below the gumline (>3.5 mm) where plaque can build up and problems often begin.

Industry Leadership perspective

“Healthy habits at home matter, and using the right tools, can make prevention more effective. Plaque builds up in hard-to-reach areas like along the gumline and between teeth, and better daily cleaning helps stop problems before they escalate. In a meta-analysis of more than 20 randomized clinical studies (over 2,600 participants, up to six months), 88% of people with early gum problems regained healthy gums using Oral-B iO. In fact, 4x as many people returned to healthy gums using iO powered toothbrushes compared to a manual toothbrush.”

– Michael Grieff, Senior Vice President R&D Oral Care, Procter & Gamble

Reference: Zou Y, et al., Int Dent J 2023 Jul 20;S0020-6539

Expert perspectives

“What’s important about this LCA is that it places products in the real-world context of oral health, showing that prevention at home, and reducing high-impact clinical care, is where the biggest sustainability leverage sits.”

- Prof. Brett Duane, Co-author, Honorary Professor at the University of Dundee and Associate Professor (Visiting) at Trinity College Dublin

“As periodontal disease progresses, care becomes more intensive. Prevention reduces the lifetime need for treatment, which matters for patients, healthcare systems, and environmental sustainability.”

– Prof. Nicolas Martin, Co-Author University of Sheffield; Chair, FDI Sustainability in Dentistry Task Team

“Around 90% of the environmental impact comes from clinical treatment, and it is up to ten times higher for advanced periodontal disease. Prevention is one of the most powerful levers we have.”

- Dr. Steven Mulligan, Co-Author University of Sheffield; Founding member, FDI Sustainability in Dentistry Task Team

“Periodontal health isn’t only about the mouth, it’s closely linked to overall health. We see strong clinical associations between gum diseases and systemic conditions such as diabetes and cardiovascular diseases. That’s why prevention at home matters: consistent, effective plaque removal, especially along the gumline and between teeth—helps keep inflammation under control and supports long-term health.”

- Prof. Andrea Pilloni, Professor of Periodontology, Sapienza University of Rome

Read the paper

Journal of Dentistry (2026). “Quantifying the Environmental Impact Potential from Periodontal Health to Disease: Findings from a Life Cycle Assessment Study.”

DOI: https://www.sciencedirect.com/science/article/pii/S0300571226004057

Authors: Brett Duane; Nicolas Martin; Steven Mulligan; Joost Dewaele; Lauren Wedel.

Notes to editors (methodology and ISO)

This study has been conducted in accordance with the requirements of ISO 14040/14044 framework for life cycle assessment (LCA) and has been third-party verified to ensure compliance with the international standards. The analyzed system includes all activities and products associated to the functional unit of maintaining healthy gum and teeth in the patient home (preventive care), as well as all activities and products in dental clinics to maintain periodontal health or treat periodontal disease (including travel to the dental clinic). The most relevant environmental indicators are selected by using endpoint normalization which aims to focus the assessment on the 5-6 most relevant indicators for the system being studied. Relevant indicators are impact categories that cumulatively contribute to at least 80% of the total environmental impact.

About the Journal of Dentistry

The Journal of Dentistry is a leading international journal in restorative dentistry, publishing peer-reviewed research intended to influence clinical practice, research, industry, and policy internationally.

About Procter & Gamble

P&G serves consumers around the world with one of the strongest portfolios of trusted, quality, leadership brands, including Always®, Ambi Pur®, Ariel®, Bounty®, Charmin®, Crest®, Dawn®, Downy®, Fairy®, Febreze®, Gain®, Gillette®, Head & Shoulders®, Lenor®, Olay®, Oral-B®, Pampers®, Pantene®, SK-II®, Tide®, Vicks®, and Whisper®. The P&G community includes operations in approximately 70 countries worldwide. Please visit https://www.pg.com for the latest news and information about P&G and its brands. For other P&G news, visit us at https://www.pg.com/news.

About Oral-B and Crest

Oral-B® and Crest®, part of Procter & Gamble, have led oral care innovation for decades. Founded in 1950 and 1955 respectively, the brands combine science-backed expertise with a comprehensive portfolio—from electric toothbrushes and toothpaste to mouthwash, whitening, and interdental solutions. Trusted by dental professionals worldwide, they continue to advance solutions for cavity protection, gum health, enamel strength, sensitivity relief, and overall oral health.

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