U.S. periodontitis rates underestimated by 50%

Sep 20, 2010

The number of adults in the U.S. suffering from periodontal disease may be significantly higher than previous research has indicated, according to a study published online in the Journal of Dental Research (September 21, 2010).

The study, conducted by the Centers for Disease Control and Prevention (CDC) and the American Academy of Periodontology (AAP), researchers appear to have underestimated by as much as 50% how many cases of moderate to severe periodontitis actually exist in the U.S. population.

Historically, National Health and Nutrition Examination Surveys (NHANES) have served as the main source for determining prevalence of periodontal disease in U.S. adults. In the NHANES pilot study published today, a full-mouth, comprehensive periodontal examination was conducted on more than 450 adults over the age of 35. Periodontal disease was classified according to definitions determined by the CDC in collaboration with the AAP. The prevalence rates were then compared with results from previous NHANES studies (NHANES III and NHANES 2001-2004) that used partial-mouth periodontal exams.

"Both NHANES protocols substantially underestimated the prevalence of periodontitis by 50% or more, depending on the periodontitis case definition used, and thus performed below threshold levels for moderate-to-high levels of validity for surveillance," the researchers found.

In addition, adding measurements from lingual or interproximal sites to the NHANES 2001-2004 protocol did not improve the accuracy sufficiently to reach acceptable sensitivity thresholds, they reported. These findings suggest that NHANES protocols produce high levels of misclassification of periodontitis cases and thus have low validity for surveillance and research.

"This study shows that periodontal disease is a bigger problem than we all thought. It is a call to action for anyone who cares about his or her oral health," said Samuel Low, D.D.S., M.S., associate dean and professor of periodontology at the University of Florida College of Dentistry and president of the AAP, in a press release. "Given what we know about the relationship between gum disease and other diseases, taking care of your oral health isn't just about a pretty smile. It has bigger implications for overall health, and is therefore a more significant public health problem."

According to Paul Eke, Ph.D., M.P.H., an epidemiologist at the CDC and lead author of the study, the findings have significant public health implications. Several research studies have associated gum disease with other chronic inflammatory diseases such as diabetes, cardiovascular disease, and rheumatoid arthritis.

"The study suggests we have likely underestimated the prevalence of periodontal disease in the adult U.S. population," he said. "We are currently utilizing a full-mouth periodontal examination in the 2009/10 NHANES to better understand the full extent and characteristics of periodontal disease in our adult population."

Because recent research suggests a connection between periodontal health and systemic health, "understanding the relationships between periodontal disease and other systemic diseases in the adult U.S population is more crucial than ever," he added.