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Eke PI, Dye BA, Wei L, Thornton-Evans GO,
Genco RJ.. Prevalence of periodontitis in adults
in the United States: 2009...

Article in Journal of dental research · August 2012
DOI: 10.1177/0022034512457373 · Source: PubMed

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sagepub.J.Sep 18.1177/0022034512457373 The online version of this article can be found at: http://jdr.Aug 30. 2013 For personal use only. B. Genco J DENT RES 2012 91: 914 originally published online 30 August 2012 DOI: 10. © 2012 International & American Associations for Dental Research . Thornton-Evans and R.sagepub.sagepublications. 2012 What is This? Downloaded from jdr.com/content/91/10/914 Published by: http://www. Eke.nav >> Version of Record .com/journalsPermissions.nav Permissions: http://www.com/journalsReprints.sagepub. No other uses without permission. 2012 OnlineFirst Version of Record .A.I.sagepub.sagepub.com/cgi/alerts Subscriptions: http://jdr. Wei.com On behalf of: International and American Associations for Dental Research Additional services and information for Journal of Dental Research can be found at: Email Alerts: http://jdr.com/ Prevalence of Periodontitis in Adults in the United States: 2009 and 2010 P.sagepub. Dye.com/subscriptions Reprints: http://www.com by guest on February 19. Journal of Dental Research http://jdr. G.O. L.sagepub.

ment of 3 sites (mid-buccal. Roy Page (University of Washington. Attachment loss (AL) U.. Thornton-Evans3. Gary Slade (University of North Carolina. With respect to extent of disease. and odontitis. with data eriodontal disease is an important public health problem in the United from the 2009 and 2010 National Health and Nutrition States. and. 2007. Health Examination Survey.7 million adults. Eke1*. and severe periodontitis. 1987. and extent P of periodontitis in the adult U. the need to establish “true” baseline data on tronically only at http://jdr. Mexican Americans. distributed as 8. and distal sites) in NHANES 2001- 2004. moderate. Taylor (University of Michigan. 2012. Wei3. at the Centers for Disease Control and Prevention (CDC). on NHANES. surveillance. NY. The earliest of these surveys [1960-1962 the sample. This led to the inclusion © International & American Associations for Dental Research of the full-mouth periodontal examination (FMPE) protocol.sagepub. Genco4 Prevalence of Periodontitis in 1 Division of Population Health. and R. while mild.S. population. NHANES III 1988-1994. Atlanta. Because periodontitis is not evenly distributed in the mouth. American Academy of Periodontology). had peri. and 8. population (Healthy People 2020). National Center for Chronic Adults in the United States: 2009 Disease and Health Promotion.com/supplemental. 1988. population (Eke and Genco. USA). Dye2. adults below 100% Federal Poverty Levels (FPL). 2012. 1996. tively.742 adults aged 30 years and include periodontal disease as part of Healthy People 2020 by focusing on older.. several national probability surveys have assessed the peri- tooth on all teeth (except the third molars). subsequent surveys (NIDCR Survey of Employed Adults and Seniors 1985- erate or severe periodontitis. *corresponding author. population (Hunt.S. mesio-buccal. G. USA). 3Division of Oral Health. and NHANES 1999-2004) have used probe or more teeth with AL ≥ 3 mm and PD ≥ 4 mm. Chapel Hill. to the assess- high burden of periodontitis in the adult U. representing 64. Seattle. George W. Kingman et al. peke@cdc. 2Division of and 2010 Health and Nutrition Examination Surveys. USA). population. USA. respectively. Centers for Disease Control and Prevention (CDC). severity.5% with Examination Survey (NHANES)] assessed periodontal status visually. Chapel Hill. respectively. Estimates were derived from a sample of 3. National disease surveillance and health promotion activities Examination Survey (NHANES) cycle.com by guest on February 19. The PMPE protocols used by NHANES have evolved. RESEARCH REPORTS Clinical P. USA). monitoring the reduction of moderate and severe periodontitis in the adult having 1 or more natural teeth. 2012 nity to advocate why a full-mouth periodontal examination should be utilized A supplemental appendix to this article is published elec.J. This survey has provided direct evidence for a mesio-buccal sites) in NHANES III and NHANES 1999-2000. and on behalf of the participating members of the CDC Periodontal Disease Surveillance workgroup: James Beck (University of North Carolina.0%. Activities and find- Received June 6.S. 2010). Hunt and Fann. prevalence estimates from surveys using PMPE protocols underestimate disease in the KEY WORDS: NHANES. and current assessment of PD and attachment loss (AL) at 2 sites per tooth (mid-buccal and smokers.. USA. A strategic objective of the CDC Periodontal Disease Surveillance DOI: 10.O. Wenche Borgnakke (University of Michigan. © 2012 International & American Associations for Dental Research . GA 30341. Gordon Douglass (Past President. 1991). 2008. For adults aged 65 years and older. Ann Arbor.A.7%.. 2012 Abstract Introduction This study estimated the prevalence. from the collec- Periodontitis was highest in men. and probing depth (PD) were measured at 6 sites per Historically. the prevalence of periodontitis in the United States. No other uses without permission. ings from this surveillance initiative have provided the evidence and opportu- Accepted July 17. in particular. Eighty-six and 40. 2007). 30. USA). Ann Arbor. Last revision July 16.1177/0022034512457373 Initiative has been to further improve surveillance of periodontitis in the adult U. 2013 For personal use only. beginning in the 914 Downloaded from jdr. and representatives of the American Academy of Periodontology.sagepub. 64% had either mod. Over 47% of odontal status of the U. adults.gov J Dent Res 91(10):914-920. Buffalo. 4State University of New York. Dye and Thornton-Evans.I. of the civilian non-institutionalized population. population. with ≥ 3 mm AL and ≥ 4 mm PD. epidemiology. periodontal disease. tion of measurements from 2 randomly selected quadrants of the mouth for adults with less than a high school education. L. Eke et al. 56% and 18% of These assessments have been made by various partial mouth periodontal the adult population had 5% or more periodontal sites examinations (PMPE) protocols (Brown et al.S. and the 1971-1974 National Health and Nutrition odontitis. measurements to assess pocket depth (PD) and gingival recession around teeth.S. 2012a). this underestimation can be significant in NHANES (Eke et al. B.9% had 1 1986. peri. respec.

7%). Extent of disease was reported by severity of disease at civilian non-institutionalized population in the 50 states of the 5. cent of adults had ≥ 1 site with AL ≥ 7 mm. adults.sagepub. and severe periodontitis was tom of the sulcus or periodontal pocket) were measured at 6 8. 8-. including sampling design. a periodontal probe (Hu-Friedy PCP 2™. Second.5% of adults had at least were identified as edentulous. of the 4. mid-.5%. cdc.7%) (Table 2). 56. For PD. Bleeding from probing and the presence of dental furca. U. from 24. 2005).0% of adults had ≥ 1 site with ≥ 4 with 1 or more natural teeth and not having a health condition mm PD.. respectively. 2007. collect. IL. and the District of Columbia. 343 by PD ≥ 4 mm. Periodontal measurements were 5% of their teeth with an AL ≥ 3 mm. odontitis. highest among Mexican Americans compared with all other tions was positioned parallel to the long axis of the tooth at each racial and ethnic groups studied. and all survey participants Results completed written informed consent. The technical details of For all data analyses. the prevalence of peri- surements at each site. AAP case definitions for surveillance of periodontitis (Page and The prevalence of AL severity from ≥ 3 mm to ≥ 7 mm gen- Eke. Oral health data collection protocols USA) to adjust for the effects of the sampling design. For mea. with Mexican American adults having the highest that required antibiotic prophylaxis before periodontal probing prevalence (67. 73. At the tooth level.1% had at least 30% affected while. Total Estimates were determined according to suggested standard periodontitis was the sum of severe.0. whereas 4.037 least 5% of their probed sites recording an AL ≥ 3 mm. USA) with 2-.2% had at collected for the remaining 3.0%. 2010  915 NHANES 2009-2010 survey cycle.086 adults who were examined completely. 32.4% had at least 30% of their probed sites affected by AL ≥ 3 these.S. increased with increasing poverty meter. the (CEJ)] and pocket depth (PD) (= distance from FGM to the bot. the total prevalence of periodontitis in examination center (MEC) by dental hygienists registered in at adults aged 30 yrs and older was 47. 2012b) to estimate the bur. were analyzed with SAS-callable SUDAAN software (release tion protocols. proximal sites with ≥ 3 mm AL and ≥ 2 interproximal sites with population from data collected during NHANES 2009-2010. 10. definitions are presented in Appendix Table 2. All periodontal examinations were conducted in a mobile In 2009 through 2010.6% had at least 30% of their teeth affected by PD ≥ 4 mm Prevalence of periodontitis was reported by 2 approaches. (2001) (1 or more sites with den of periodontitis in the adult U. Severity was also reported as the mean and Data from NHANES 2009-2010 were used for this study. 18.. 5. state. 2013 For personal use only. and 12-mm gradua.4% in adults 30 to 34 yrs old to 70. tooth) or 2 or more interproximal sites with PD ≥ 5 mm. ≥ 4 mm PD (not on the same tooth) or 1 site with ≥ 5 mm. and data availability. 4-. and highest among current smokers. Among all adults. we reported percentage severity of PD and AL using measurements Materials & Methods from all 6 sites. whereas non-institutionalized American adults 30 yrs of age and older. mid-.2% (representing about 64. prevalence was reported according to the suggested CDC. Total periodontitis ranged sites per tooth (mesio-. Standardized for age. only adults aged 30 yrs or older (28. ≥ 5 mm PD. we also tis (Page and Eke. When free gingival margin (FGM) and the cemento-enamel junction the CDC-AAP case definitions were applied individually. while PD severity as the presence of 2 or more interproximal sites with ≥ 6 mm AL from ≥ 3 mm to ≥ 7 mm remained relatively steady across all Downloaded from jdr. and older having the highest prevalence (96.0% weighted population of approximately 137. (CDC) National Center for Health Statistics (NCHS) Ethics Review Board (the IRB equivalent).com by guest on February 19. can be accessed at www. Gingival recession [= distance between the million adults aged 30 yrs and older) in the U. 6-.4% had at were eligible for the periodontal examination.S. 13. less than a high school education having the highest prevalence In NHANES 2009-2010. © 2012 International & American Associations for Dental Research . 65 yrs and older. and 30% of sites and teeth.3%) (Table 3). data (with MEC examination weights) the survey. population. (Appendix Table 1)..gov/nchs/nhanes.7 least one U. No other uses without permission. a).7%. Moderate periodontitis was defined as 2 or more ing probe measurements from 6 sites per tooth for all teeth interproximal sites with ≥ 4 mm clinical AL (not on the same (except third molars) in U. and disto-buccal.743 participants. Fifteen per- sion. For PD.S. included definitions by Arbes et al. Severe periodontitis was defined erally increased with increasing age (Fig. ≥ 3 mm AL and ≥ 4 mm PD) and the European Federation of Periodontology (EFP) (Tonetti and Claffey. 10. due to medical exclusions or incomplete examinations. Prevalence estimates based on the EFP First. 2012b). prevalence of AL and PD cut-points. including were approved by the Centers for Disease Control and Prevention the unequal probability of selection. whereas adults aged 30 yrs and older participated in NHANES. affected by PD ≥ 4 mm. Data were recorded directly into an NHANES oral health levels. representing a least 30% of their teeth affected by AL ≥ 3 mm. Chicago. and extent of periodontitis in the adult U. This survey cycle is the first (not on the same tooth) and 1 or more interproximal site(s) with national probability sample to use the FMPE protocol. with adults who had tions were not assessed. Eighty-six percent data management program that instantly calculated attachment of adults had ≥ 1 site with AL ≥ 3 mm. ranging from 3 mm to NHANES is a stratified multistage probability sample of the 7 mm. whereas 47. also not The aim of this study was to provide estimates on the preva. and mild peri- case definitions for population-based surveillance of periodonti. 2007.1 million civilian had at least 5% of their teeth affected by PD ≥ 4 mm. 951 were excluded from the oral health assessment in the mm.S. Eke et al. excluding third molars. odontitis was significantly higher in males than in females. Research Triangle Park. prevalence of mild.J Dent Res 91(10) 2012 Prevalence of Adult Periodontitis in the US: 2009. severity. and 8.S. NC. periodontal data collec. Nearly 41.1% in adults aged and disto-lingual) for all teeth. In total. with adults aged 65 yrs loss (AL) as the difference between probing depth and reces. moderate.htm. Among 19. 10-. Eke et al. lowest educational status.7% had at least 5% of their probed sites MEC. Each measurement was rounded to the lower whole milli. highest among persons with site. on the same tooth. mesio-. 30.S. moderate. For comparison with other published studies. (Table 1). Mild periodontitis was defined as ≥ 2 inter- lence. Research Triangle Institute.

3 55.3 1.2 2. The poverty level is based on definitions originally developed by the Social Security Administration and includes a set of income thresholds that vary by family size and composition.7 10.8 17.4 35.2 2.872 67.7 2.0 0.8 49.6 53.2 2.4 1.0 1.2 2.8 31.0 1.2 3.9 57.058 78.9 4. Smoking status was constructed from responses to 2 questions: (1) Have you smoked at least 100 cigarettes in life? (SMQ020).2 3.3 43.5 44.4 2.6 8.0 5.shtml.6 37.733 136.1 33.3 0.7 9.0 40.5 67.7   Non-Hispanic White 1.4 1.1 40.5 3. Poverty status or percentage of poverty levels based on family income.6 9.7 3.9 11.0 7.3 2.5 44.6 68.0 14.1 57. *Standardized to age distribution of the 2000 U.1 1.9 70. N Millions PD SE Standardized SE PD SE PD SE PD SE 2001 SE Total 3.3 39.1 42.7   Separated 145 3.6 2.8 1.2 2.9 23.1 10.gov/poverty/11poverty.7   Non-smoker 2.8 1.3 70.3 2.8 8.9 3.6 2. Education was classified as less than high school.1 11.2   65+ 828 22. 2 Prevalence estimates based on the PMPE protocol used in NHANES 2001–04 using only measurements of PD and AL from 3 fixed sites per tooth (mid-buccal.0 27.0 6. Downloaded from jdr.5 1.8 1.2 50.6 3.5 2.4 60.0 59.8 19.1 67.8 3. AL = Attachment loss.7 2.0 13.3 35.8 1.1 2.4   Divorced 472 16.7 52. 1 -28).2 10.3 2.2 2. family size.2 0.6 7.2 2.1 46. mesio-buccal.0 36.4 2.3 7.3 1.9 2.1 28.3 3.4 1.4 2.5 1.6 3.8 37. and greater than high school.6 1.1 45.8 66.6 13.5 for age group 35-49.1   Former smoker 957 35.9 35.4 8.4 20.7 Race/Ethnic†   Mexican American 673 10.743 137.3 1. Six individuals with only 1 tooth were categorized as not having periodontitis according to the CDC-AAP case definitions because of the requirement for measures from more than 1 tooth.2 9.7 2.7 2.8 19.2 2.4 1.1 2.7 1.1 56.9   Non-Hispanic Black 673 15.6 2.2   >= 400% FPL 960 52.4 5.1 0.6 62.2 2.1 59.8 1.1 2.1 8.196 88.4 3.7 8.7 2.6 for age group 65+.0 9.8 27.792 95.4 38.0 29.5 28.8 33.1 4. J Dent Res 91(10) 2012 Table 1.2 55.2 53.8 Gender   Male 1.9 1.1 6.1 14.5 1.6 3.352 54.5 2.9 12.6 6.4 4.1 28.1   High school 815 29.0 St* 11. Race and ethnicity were self-reported and.2 49.3 4.sagepub.5 2.1 47.9 66. and the number of children in the family and for families with two or fewer adults.8 0.6 2.6 Poverty Level   < 100% FPL 625 13.2   Widowed 292 7.3 59. 2009-10.0 2.5 3. and 20.3 7. Additional information can be located at: http://aspe.4 2.6 2.6 17.3 Marital status   Married 2.6 St* 6. No other uses without permission.9 0.5 2.7 4.com by guest on February 19.5 2.4 30.5 4.1 47.7 24.8 15.0 5.916  Eke et al.3 Smoking status   Current smoker 728 23.9 1.1 Source: CDC/NCHS.0 34.5 49.3 2.0 45.1 2. † Other race and ethnic groups are included in the total but not shown separately.2   > High school 1.6 St* 11.2 5.5 for age group 30-34.7 1.1 3.5 16..0 58.2 2.0 35.2 37.4 1.3 35.7 1.7 57.2 0. and (2) Do you now smoke cigarettes? (SMQ040).9 3.4 2.0 1.9 12.8 0.4 60.5 7.2 4.4 0. for which statistical reliability was adequate: Mexican-Americans.6 1.2 44.9 65. on the age of the adults in the family. and persons who reported never having smoked were categorized as non-smokers. These thresholds are updated annually by the US Census Bureau.7 26.5 65.hhs.128 43.030 23. United States.2 60.4 2.7   50-64 1.7   Female 1.2 64.6 2.1 53.733 136.1 2.9 56.4 2. Persons who reported smoking every day or some days and who had smoked at least 100 cigarettes were categorized as current smokers.7 2.2 45.6 1. 2009-2010 % PD based on Weighted % Total % Arbes N in % Total PD Age* % Severe Moderate % Mild et al.4 3.7 0.9 9.5 56.5 14.5 9.9 19.2 4.0 1.4 12.8 32.6 2.4 0.6 9. PD = pocket depth. high school graduate or General Education Development high school equivalency test (GED).8 1.7 St* 1.8   Never married 390 13.8 2.8 1.9 30.889 83.7 1.1 43.5 1.6 34.6 17.5 2.4 1. Mean number of total teeth was 24 (range.2 for age group 50-64.6 1.9 2.9   200-499% FPL 905 37.9 11.6 2.0 34.4 Education   < High school 1.871 69. Families or individuals with income below their appropriate thresholds are classified as below the poverty level.2 1.3 33.6 1.9 8.4 66.8 2.0 25. for our analysis.S.3 2.3 34.1 2.1   100-199% FPL 901 22.1 2.4 57.3 40.3 2.6 3.4 6.6 3.4 2.9 1.8 40.5 0.3 2.5 2. and distal sites) from all teeth in 2 randomly selected quadrants of the mouth.4 62.3 1. distributed as 26.3 2. 1 Prevalence estimates based on the PMPE protocols used in NHANES III and 1999-2000 of using only measurements of PD and AL from 2 fixed sites per tooth (mid-buccal and mesio-buccal sites) from all teeth in 2 randomly selected quadrants of the mouth.0 2.5 0.6 38.1 47.4 NHANES 2000-2004 3.9 1.3 5. 2013 For personal use only.6 4.  Prevalence of Periodontitis by Selected Characteristics for Persons Aged 30 yrs and Older.4 2. were reported in 3 groups.9 28.8 6. 23.7 1.9 1.0 41. population.4 35.5   Living with partner 245 8. © 2012 International & American Associations for Dental Research .8 3.8 40.4 1.9 16.1 2.0 49.1 10. 25.5 1. non-Hispanic black.1 5.3 17.9 10.5 3.9 25.2 53.4 36.4 10.0 1.5 Protocol2 Age groups (yrs)   30-34 435 16.7 0.7 50.1   35-49 1.7 2.9 5.7 NHANES III Protocol1 3.5 1.3 1.7 2.7 4.6 1.0 1. and non-Hispanic white. National Health and Nutrition Examination Survey.9 1.1 7.5 0.5 6.4 34.3 2.0 1. persons who reported having smoked more than 100 cigarettes but were currently not smoking were catego- rized as former smokers.1 41.4 2.4 2.3 2.2 7.1 47.1 39.

8 75.07   >= 400% FPL 83.11 Gender   Male 90.09   Former smoker 87.2 54.34 0.03   35-49 83.3 6.31 0.07   Female 81. 2009-2010 Percentage (%) AL > = AL > = AL > = AL > = AL > = Mean of   3 mm SE 4 mm SE 5 mm SE 6 mm SE 7 mm SE AL (mm) SE Total 85.0 2.1 3.0 37.04 Mean of AL is the average attachment loss in millimeters of all measured sites in all study participants.3 30.7 43.1 65.6 39.S.3 63.08 Education   < High school 90.6 52.76 0.1 66.2 2.07   100-199% FPL 89.5 1.2 1.2 2. Holtfreter et al.8 1.8 60.8 1.0 1.8 2.7 2.7 18.8 3.5 1.02 0.08   High school 87.4 1.3 1.18 0.9 4.50 0.2 1.8 49.9 1. while the demographic groups of the adult U.5 3.0 26.78 0.5 1.5 1. respectively.2 19.2 32. Compared with earlier findings.04   50-64 92.1 1.5 1.9 2.1 11.8 2.09   Mexican American 92.6 2.5 2.7 19.10   Never married 81. prevalence of mild and severe periodontitis remained relatively Using the CDC-AAP suggested case definitions for surveil- steady at less than 15% across all age groups (Fig. with 38% of the Discussion adult population 30 yrs and older and 64% of adults 65 yrs and The FMPE protocol used in NHANES 2009-2010 collected older having either severe or moderate periodontitis.S.7 1.7 1.4 58.5 35.9 66. 2007.3 20.0 49.3 16.5 77.91 0..15   Divorced 90.37 0.3 2.89 0.2 2.0 1.9 1.3 2.79 0.9 1.09   200-499% FPL 85.6 45.14 0.9 30.5 1.4 2.84 0.8 73.4 19.4 1.1 3.7 1.2 1. of a FMPE protocol in NHANES.9 4. population has now become clearer.1 27.5 53. c). population when U.2 2.4 2.3 2.6 1.8 3.9 2.8 1.com by guest on February 19.2 2.5 2.6 3.5 4..S.4 3. lance of periodontitis.0 1.0 1.07   65+ 96.5 41.5 22.5 4.6 73.4 1.37 0.3 34.9 37.8 0.3 2.9 32.6 2.7 1.08   > High school 83.8 19.9 1.05 Race/Ethnic†   Non-Hispanic White 84.1 16.3 1.37 0.4 10.8 70.0 1.0 2.07   Non-Hispanic Black 86.6 2.5 2. © 2012 International & American Associations for Dental Research .4 2.1 1.8 37.10 Smoking status   Current smoker 90.2 59.3 1.4 67.6 1.5 1.5 3.9 16.6 2.1 62.9 2.1 2. the findings presented in this 2010).5 0.1 1.3 72.0 2.4 45.3 1.9 2.6 15.sagepub. 2013 For personal use only.7 2.9 3.70 0.6 1.3 13. the underestimation of report have provided the most direct evidence for estimating the periodontitis in the U.2 1.9 1.4 69.04   Widowed 93.8 2.9 2.J Dent Res 91(10) 2012 Prevalence of Adult Periodontitis in the US: 2009. No other uses without permission.10   Non-smoker 83.61 0.9 1.9 55.4 21.3 1.05 Marital status   Married 85. population.53 0.1 2.10   Living with partner 81.7 3.6 47.5 20.9 1.3 2.4 19.0 9.7 5.1 2.0 23.7 2.8 2.9 1.7 25.7 1.1 39.0 40.9 1.9 1.7 1.2 3.1 1.8 11.6 2.7 35. we determined that about 47% of U. Because this is the first use European populations (Bourgeois et al. 2010  917 Table 2. population.7 4.2 11.0 1.7 23.1 2.6 68.0 28.4 9.5 2.51 0.8 2.05 Poverty Level   < 100% FPL 90.9 2.2 2.3 54.8 2.3 1.3 0.3 1.09   Separated 91.8 1. optimal surveillance measurements for assessing the burden of these estimates were much lower than those reported from periodontitis in the U.0 23. the earlier estimates for mod- compared with results from previous national surveys.7 1.0 1.3 1.2 1.6 2.7 25.7 1. Prevalence of total and moderate periodon.1 2.  Prevalence of Different Cut-off Values of Attachment Loss (AL) and Mean by Selected Characteristics for Persons Aged 30 yrs and Older.6 1. adults aged 65 yrs and older.59 0. Analysis erate or severe periodontitis were 26% and 17% in NHANES III of the overall data collected from this survey demonstrates a and NHANES 1999-2004.9 2.1 2.5 35.0 25.1 1.3 60.6 9.4 15.10 0.3 15.5 3.8 1..5 2.7 1.0 54.7 3.8 1.85 0.1 56.7 1.1 1.3 2.3 29.3 56. b).4 57.8 1.4 8.7 31.5 49.6 33.5 2.5 0.0 1.1 1.S.1 1.3 1.85 0.7 0.6 2.3 34.2 26.6 1. dentate adults aged 30 yrs and older (representing approxi- mately 65 million adults) have periodontitis.4 39.9 80.5 1.S.9 85.5 1.5 1.2 3.5 41.05 0.7 67.0 2. age groups (Fig.05 Age groups (yrs)   30-34 64.1 73.0 71.6 51.7 32.1 32. based on the PMPE Downloaded from jdr.S.6 56. United States.17 0.6 51. high burden of periodontitis and disease disparity within socio- titis increased with increasing age among all adults.8 20.83 0.0 20.7 1. For true burden of periodontitis in the adult U.1 2..4 58. Overall.

6 17..5 6.7 47.7 18.8 2.8 1.67 0.5% and 27.1 1.7 1.5 1.5 1. respectively.6 1.2 55.0 7.7 47.7 1.1 35.05   Living with partner 82.3 2.7 0.1 13.9 3.sagepub.2 2.0 1.6 8.04   50-64 81.04 Mean of PD is the average pocket depth in millimeters of all measured sites in all study participants.3 40.6 3.2 2.6 1.0 1.7 33.76 0.0 2.4 1. United States.1 34.4 62. respectively.7 11.3 1.7 1.4 20.0 1.7 16.8 4.88 0.5 1. we report factors for future surveys based on PMPE protocols.1 1.9 6.3 4.50 0.3 2.8 7.7 0.9 3.1 2.8 2.2 2.8 40.3 22.0 5. a much higher prevalence of AL ≥ 3 mm and PD ≥ 4 mm of Our findings reaffirm disparities in the burden of periodontitis 85.9 1.7 2. Beck et al.8 4. although concern that a full-mouth periodontal examination should be more detailed multivariable analyses controlling for factors Downloaded from jdr.8 4.2 1.3 1.07 Smoking status   Current smoker 86.04   Widowed 77.05 Gender   Male 83. 2007).8 23.1 1.9 4.05   65+ 84.9 2.2 2.57 0.3 1.09 0.6 3.5 1.6 2.06   > High school 72.1 11. 2010) and other education.0 13. the highest prevalence of peri- tion of prevalence from previous PMPE protocols are consistent odontitis was seen among Mexican Americans.0 2.6 2.0 8.2 57.6 1.4 4.0 7.1% from both protocols.5 2.1 1. 1999).74).5 3.5 2.6 1. FPL having periodontitis.5 1. and serve as the basis for ings from previous NHANES (Albandar et al.6 0.03 0.1% and by socio-demographic segments of the adult U.4 0.1 18.9 26.9 1.10   Never married 77.6 1.2 0.04   Non-smoker 71.05   100-199% FPL 81.1% reported from NHANES III (Albandar et al.3 34.7 26.3 2.3 2.8 1.5 3.57 0. odontitis.1 4.8 30.8 33. reports (Kingman and Albandar.7 22.7 1.2 15.87 0.1 5. respectively.8 45.5 1.7 40. adults with lowest with findings from our pilot study (Eke et al.4 6.3 1.6 55.6 13.7 0.9% and 40.5 7.8 3.9 16.5 1.1 3.5 1.7 2.6 9.8 22.3 2.4 3.1 3.9 3.3 35.03 Poverty Level   < 100% FPL 87.5 1.8 1.1 3.98 0. we determined a total groups.4 1. Among racial and ethnic PMPE protocols to this survey dataset. Susin.4 21.7 3.5 1.06 Education   < High school 84.65 0.3 60.7 4.59 0.4 1. 2005. The high levels of bias and underestima.7 11. The preva- compared with 47% from the FMPE protocol.1 33.51 0.4 1. and These socio-demographic patterns remain consistent with find- Albandar.4 1.5 0.6 2.4 1.5 1.8 1.7 3.4 3..8 2.0 5.62 0.91 0.8 3.0 1.9 2. No other uses without permission.8 1.7 6.4 6.  Prevalence of Different Cut-off Values of Pocket Depth (PD) and Mean by Selected Characteristics for Persons Aged 30 yrs and Older.3 2. © 2012 International & American Associations for Dental Research . compared with our current finding of 64% utilized intermittently in NHANES to generate valid correction using the FMPE.8 8.7 1.1 1.4 3.6 2.7 17.4 2.5 17. with about 67% of persons less than 100% of and 1.6 13.84 0.76 0.5 2.6 43. 2013 For personal use only.7 7.9 1.7 26.5 1. Mexican Americans had the highest prevalence of peri- prevalence of 19.0 2.9 59.6 2.9 14.3 10.3 1. and current smokers. total periodontitis was sig- When we applied the NHANES III and NHANES 1999-2004 nificantly higher in men than in women.4 1.0 0.9 0. 23.7 8.04   Non-Hispanic Black 84.2 0.1 49.75 0.2 22.0 2. 2002. Among adults aged 30 yrs and older.45 lower education.6 2.04   Separated 85. 2009-2010 Percentage (%) PD > = PD > = PD > = PD > = PD > = Mean of   3 mm SE 4 mm SE 5 mm SE 6 mm SE 7 mm SE PD (mm) SE Total 76.7 1.71 0.4 29.. adults less than 100% of FPL.67 0.03 Race/Ethnic†   Non-Hispanic White 72.08   Mexican American 90.1 40.9 1.3 37. Overall.8 1.9 7.6 1.8 1.2 15.62 0.5 3.0 2.com by guest on February 19.8 1. closely followed by Non-Hispanic blacks.3 67.8 2.1 2.0 1.71 0. (USDHHS.1 14.2 3.0 4.04 Marital status   Married 74.0 2.2 10.3 12.9%.0 0.04   35-49 72.05   Female 68.2 19.918  Eke et al.4 53.3 2.1 2.S. After adjustment for the effect of age.9 31.1 4. J Dent Res 91(10) 2012 Table 3.0 1.4 2.5 11.3 15.6 2.4 2.3 50.5 1.07   Divorced 78.4 2. Kingman.07   Former smoker 79.04 Age groups (yrs)   30-34 64.6 1.8 2.04   >= 400% FPL 69. population.7 2.4 2.6 1.93 0.5 3.1 2.1 1.0 2.5 1.3 2.9 37.7 9.2 2.4 3.4 2.0 43..9 6.06   High school 79.9 1.1 13.6 29. 2006).8 3.4 3.2 3. 1999).3 19. compared with 53.8 0.6 2.2 15. representing a lence of periodontitis increased with increasing poverty levels and negative relative bias of 59% and 43% (inflation factors of 2.00 0.8 2.05   200-499% FPL 77.7 22.5 2.1 2.72 0.5 1.51 0.1 33.2 4.

  Prevalence by age. which are more likely to capture true disease. the prevalence of cases that includes all forms of segments detected from this survey. (b) The percentage prevalence of different cut-off values (3 mm. suggest periodontitis exclusion and the non-sampling of institutionalized persons in as an important dental public health problem. which results in better representation of persons.g. while severity of AL increased with age. sion. especially among nursing homes may have introduced some selection bias. The increase in the prevalence of periodontitis with increasing age appears to be influenced mostly by the increas- ing prevalence of moderate periodonti- tis. Collectively. even though this NHANES 2-year conclusions in this report are those of the authors and do not dataset is considered a nationally representative sample. several factors may still underestimate the preva- lence of disease. necessarily represent the official position of the Centers for mum of 4. No other uses without permission. these factors ensure mini- mal misclassification of disease status in the source population than in previous NHANES and present a superior dataset for etiologic research. In conclu- prevalence estimates included only gingivitis that may accom. Severity of PD did not increase with age. and the use of conservative case definitions for periodontitis. and did not include individuals with only tion and the prevailing disparities among socio-demographic gingivitis. which may further underestimate periodontitis. the CDC-AAP suggested case definitions use only measures from inter. The strength of this report comes from the unprecedented use of data from a FMPE protocol. (c) The percentage of total 47. 4 proximal sites and detect a prevalence of mm. 5 mm. (a) The percentage prevalence of different cut-off values (3 mm. Ongoing NHANES for the contributions from the CDC Periodontal Disease Surveillance Downloaded from jdr. moderate periodontitis. Figure. 2013 For personal use only. because of possible under-sampling of certain The authors provided the following disclaimer: The findings and subsets of our population. and mild periodontitis by age. medical economic cost for prevention and treatment.com by guest on February 19. 5 mm. yrs of data may be required to affirm Disease Control and Prevention. 7 mm) for AL by age. Also. probably due to cases deteriorating from mild periodontitis with increasing age. the higher burden of periodontitis in the adult U.2% compared with a prevalence of periodontitis. 2011-2014 data cycle will over-sample the Asian-American popu- inflammation and furcation status were not assessed. teeth. Notably. our aging population. Finally. © 2012 International & American Associations for Dental Research . 7 mm) for PD by age. However. Acknowledgments We consider the estimates derived in this report to be interim national estimates.S. The authors acknowledge the national estimates on all sub-groups. thus. 6 mm. possibly 6. popula- pany the cases detected. 2010  919 associated with prevalence of periodonti- tis will be required to confirm these find- ings. 56% when measures from all 6 sites (including the mid-buccal and mid-lingual sites) are used. 6 mm. This may be due to loss of teeth associated with severe disease. which can lation to provide more stable estimates for this sub-group and to provide additional information regarding disease status. the survey did not collect data from third molars. coupled with the potential periodontal disease would likely be even higher.sagepub. or there may be other unique features of those who have severe periodontitis.. conservative case definitions not using measurements from all 6 sites may underestimate dis- ease. suggesting that AL may be a more relevant measure of periodontitis in population studies. e. and sites assessed. Also.J Dent Res 91(10) 2012 Prevalence of Adult Periodontitis in the US: 2009. severe periodontitis. Our provide a sufficient pool for the assessment of trends. A mini. 4 mm. Prevalence of severe periodontitis appears to have remained consistent at less than 15% across all age groups.

A brief history of national surveillance cols on estimates of prevalence of periodontal disease. Suppl):1373S-1379S. Albandar JM (2008). Albandar JM. Thornton-Evans GO. ported by any external funding or institution. the case definitions for population-based surveillance of periodontitis. Kingman A (1996). J Periodontol efforts for periodontal disease in the U. Wei L. Case definitions for use in population-based sur- States. J Periodontol 78:1387-1339. 1988-91: prevalence. Accessed on declare no potential conflicts of interest with respect to the August 6. 667. J Periodontol [Epub ahead of print March 16. J Dent Res 66:1044-1048. Kingman A. Tonetti MS. 1988 . mating prevalence and severity of periodontal disease. MD: US Department of lance of periodontitis: the CDC periodontal disease surveillance proj. Kocher T. Rockville. periodontal recording of older adults. Caplan DJ. extent and demographic variation. Mattout C (2007). J Periodontol 70:13-29. Slade G (2001). 2012] (in press). Environmental tobacco smoke and cal studies of periodontal diseases. Dye B. J Periodontol 78(7 76:262-267. 2002-2003. Systematic errors in esti- Beck JD. Res 75(Spec Iss):672-683. Advances in the progression of periodontitis Eke PI. CDC periodontal disease surveillance project: and proposal of definitions of a periodontitis case and disease progres- background. Effect of partial recording proto- Dye BA. Destructive periodontal Hunt RJ. Wei L. J Periodontol 78(7 sion for use in risk factor research.S. Brown LJ. Health and Human Services. Agustsdottir H. 2007). Group C consensus report of the 5th Suppl):1366S-1371S. J Dent Res 91(10) 2012 Workgroup (Eke and Genco. Community Dent Oral Epidemiol 34:1-10. Eke PI. No. Reducing the bias of prob. Update of ported by CDC as part of an internal project and was not sup. J Periodontal Res 42:219-227. Series 11. 1994 and 1999-2004. Downloaded from jdr. Effect of examining half the teeth in a partial disease in adults 30 years of age and older in the United States. Micheelis W (2010). Periodontal status in the United Page RC. J Periodontol [Epub ahead of print Feb 11. Thornton-Evans G.920  Eke et al. Albandar JM (2005).Improving the Health of Americans. Bouchard P. Brunelle JA. Susin C. Smith J (1988).gov authorship and/or publication of this article. Advances in surveil. Borgnakke WS. The authors Healthy People 2020 . European Workshop in Periodontology. Kingman A. 2013 For personal use only. Methodological aspects of epidemiologi- Arbes S. No other uses without permission. Thornton-Evans G (2007). Holtfreter B. J Clin Periodontol 35:659- in dentate adults in France. 1994. J Clin Periodontol 32 (Suppl Eke PI. Vital and Health 89:1208-1213.sagepub.healthypeople. Fann SJ (1991). Hoffmann T. National Institute of Dental and ect. Statistics. J Periodontol ing depth and attachment levels estimates using random partial-mouth 59:707-713. 2012 at http://www. Epidemiology of periodontal status severity estimates of periodontal disease. Prevalence of periodontal disease and treatment demands based on a German dental survey (DMS IV). Preisser JS. 6):210-213. Albandar JM (2002). Trends in Oral Health Status: United States. Claffey N (2005). Desvarieux M. J Dent Res 70:1380-1385. Kingman A. Thornton-Evans G. National Institutes of Health. © 2012 International & American Associations for Dental Research View publication stats . Effects of partial recordings on Bourgeois D.com by guest on February 19. J Dent veillance of periodontitis. Morrison E. 1988- Eke PI. Page RC. Accuracy of NHANES periodontal examination protocols. References Hunt RJ (1987).S. Genco RJ (2012b). 248. Kingman A (1999). Kingman A. Craniofacial Research. 2012] (in press). J Clin Periodontol 37:211-219. recordings. Genco R (2012a). Brunelle JA. periodontal disease in the U. Eke PI (2007). Periodontol 2000 29:11-30. Am J Public Health 91:253-257. Susin C. This workgroup was sup. objectives. The efficiency of half-mouth examinations in estimating the prevalence of periodontal disease. J Dent Res US Department of Health and Human Services (2007). Dye BA (2010). Genco RJ (2007). and progress report. Moss K (2006). Löe H.