​The European Federation of Periodontology (EFP) has published the first formal evidence-based guidelines for treating periodontitis in a move that will help dental teams around the world provide treatment to their patients.

The S3-level clinical practice guideline (S3 CPG) has been published in the Journal of Clinical Periodontology and provides oral health care professionals with precise therapeutic pathways – based on the patient’s diagnosis – and recommendations on specific interventions to treat the different stages of periodontitis.

The guideline was drawn up at the EFP-led Perio Workshop 2019 in November last year, where 90 experts from 19 countries evaluated 15 systematic reviews on different forms of periodontal therapy.

It provides evidence-based recommendations for therapy in relation to the first three stages of periodontitis, according to the new classification of periodontal and peri-implant diseases and conditions. Recommendations for therapy in relation to periodontitis stage IV, the most advanced manifestation of the disease, will be drawn up at Perio Workshop 2021 in July next year.

The guideline approaches the treatment of periodontitis stages I, II, and III using a pre‐established stepwise approach to therapy that – depending on the disease stage – should be incremental, each including different interventions.


The guideline, recommends four sequential steps to periodontal therapy:

  1. Good oral hygiene and a healthy lifestyle to reduce inflammation is the foundation for an optimal response to treatment and long-term control of the disease. This step also includes professional removal of supragingival bacteria (plaque and tartar).
  2. Thorough professional cleaning of root surfaces below the gum line, and additional therapies if needed.
  3. More complex treatments, such as surgery, may be needed in some patients.
  4. Long-term supportive care to prevent relapse, with healthy lifestyles, good oral hygiene, and regular check-ups that include cleaning.

Mariano Sanz, who chaired Perio Workshop 2019, said: 'This guideline will ultimately benefit the patient who would receive the best possible treatment under its provisions. Periodontitis is a devastating condition, which leads not only to pain and soreness in the gums, but also to chewing problems, unpleasant changes to tooth length and position, poor self-esteem, withdrawal from social activities, and an increased risk of other inflammatory conditions including diabetes.'

He added that the four steps overlap, and that good oral hygiene is essential throughout the whole process: 'Professional cleaning is only effective if patients clean their teeth thoroughly, and surgery is not recommended in those with poor oral hygiene.'

Guideline chair Iain Chapple added: 'Successful treatment transforms people’s lives: they become more confident, smile, and go out more. It also improves overall health by stopping oral bacteria from entering the blood and raising inflammation levels throughout the body, which negatively affects other conditions like diabetes.'