Periodontitis Affects Nearly Half of Americans Over 30

October 5, 2012 — Nearly half of American adults older than age 30 years have periodontal disease, according to recent findings from the Centers for Disease Control and Prevention (CDC) and the American Academy of Periodontology. The study, published in the October issue of the Journal of Dental Research, also found that the prevalence of periodontitis rises to 70.1% in adults older than age 65.

Researchers, led by Paul Eke, MPH, PhD, epidemiologist at the CDC, Atlanta, Georgia, evaluated data collected from 3743 adults age 30 years or older as part of the CDC's 2009-2010 National Health and Nutrition Examination Survey (NHANES), which assesses the health and nutritional status of adults and children in the United States. In previous years, NHANES included only partial-mouth examinations for periodontitis; the 2009-2010 survey was the first to include a full-mouth periodontal examination.

More Accurate Assessment of Prevalence

Dr. Eke and colleagues found that 47.2% of the population (which would account for approximately 64.7 million adults) has periodontal disease, a figure far higher than previous national estimates.

"As periodontal disease is not evenly distributed in the mouth, these prior studies, [on the basis of] how they were designed, may have underestimated prevalence rates in the US population by as much as 50%" said Dr. Robert M. Pick, DDS, a practicing periodontist in Chicago, Illinois, and spokesperson for the American Dental Association, in an interview with Medscape Medical News "[These findings] add an entirely new set of statistics and a whole new set of percentages not known before."

The researchers further classified participants as having mild, moderate, or severe periodontitis, with rates of 8.7%, 30.0%, and 8.5%, respectively. Although the prevalence of mild and severe periodontitis remained stable at less than 15%, moderate periodontitis increased with age among all adults.

In an interview with Medscape Medical News, Pamela McClain, DDS, immediate past president of the American Academy of Periodontology and a practicing periodontist in Aurora, Colorado, said: "With what is known about the health complications related to periodontal disease, namely tooth loss and the increased risk of other systemic diseases, periodontitis is a significant public health issue."

Disparities in the Burden of Periodontitis

The study authors noted that periodontal disease was higher in men than in women (56.4% vs 38.4%) and was highest among Mexican-Americans (66.7%) than other racial or ethnic groups. Current smokers and those living below the federal poverty level also had high prevalence rates, at 64.2% and 65.4%, respectively.

Another important finding, the researchers note, was that 64% of adults 65 years of age or older had evidence of moderate or severe periodontitis. The authors hypothesize that this may be due to deterioration of mild periodontitis cases with increasing age.

"[M]aintaining great periodontal health is a very important factor in the well-being and subsequent overall health of our aging population. As these adults retain their teeth, periodontal disease should take on more prominence in the oral health of adults," Dr. Pick said.

The authors note that use of the full-mouth periodontal examination in the 2009-2010 NHANES may have contributed to these figures being higher than previous national estimates. They caution, however, that other factors, such as conservative case definitions, exclusion of inflammation and furcation status, and nonsampling of institutionalized persons in the current study, may still have resulted in underestimation of true prevalence.

"[T]he higher burden of periodontitis in the adult U.S. population and the prevailing disparities among socio-demographic segments detected from this survey, coupled with the potential economic cost for prevention and treatment, suggest periodontitis as an important dental public health problem, especially among our aging population," conclude the study authors.

"There are likely many individuals that have periodontal disease and are not aware of the risk and complications associated with this condition. Patients should expect to receive a comprehensive periodontal evaluation on an annual basis as part of their routine oral care," said Dr. McClain. "I am hopeful that the prevalence findings encourage researchers to continue to investigate this complicated disease."

The study authors and independent commentators have disclosed no relevant financial relationships.

J Dent Res. Published online August 30, 2012. Abstract