BACKGROUND: This report presents weighted average estimates of the prevalence of periodontitis in the adult US population during the 6 years 2009-2014 and highlights key findings of a national periodontitis surveillance project. METHODS: Estimates were derived for dentate adults 30 years or older from the civilian noninstitutionalized population whose periodontitis status was assessed by means of a full-mouth periodontal examination at 6 sites per tooth on all non-third molar teeth. Results are reported according to a standard format by applying the Centers for Disease Control and Prevention/American Academy of Periodontology periodontitis case definitions for surveillance, as well as various thresholds of clinical attachment loss and periodontal probing depth. RESULTS: An estimated 42% of dentate US adults 30 years or older had periodontitis, with 7.8% having severe periodontitis. Overall, 3.3% of all periodontally probed sites (9.1% of all teeth) had periodontal probing depth of 4 millimeters or greater, and 19.0% of sites (37.1% of teeth) had clinical attachment loss of 3 mm or greater. Severe periodontitis was most prevalent among adults 65 years or older, Mexican Americans, non-Hispanic blacks, and smokers. CONCLUSIONS: This nationally representative study shows that periodontitis is a highly prevalent oral disease among US adults. PRACTICAL IMPLICATIONS: Dental practitioners should be aware of the high prevalence of periodontitis in US adults and may provide preventive care and counselling for periodontitis. General dentists who encounter patients with periodontitis may refer these patients to see a periodontist for specialty care.

OBJECTIVE: To determine population-average risk profiles for severe and non-severe periodontitis in US adults (30 years and older) using optimal surveillance measures and standard case definitions. METHODS: We used data from the 2009-2012 National Health and Nutrition Examination Survey (NHANES), which for the first time used the "gold standard" full-mouth periodontitis surveillance protocol to classify severity of periodontitis following the suggested CDC/AAP case definitions. The probabilities of periodontitis by socio-demographics, behavioral factors, and co-morbid conditions, were assessed using prevalence ratios (PR) estimated by the predicted marginal probability from multivariable generalized logistic regression models. The analyses were further stratified by gender for each classification of periodontitis. RESULTS: The likelihood of periodontitis increased with age for overall and non-severe relative to non-periodontitis. Compared to non-Hispanic whites, periodontitis was more likely among Hispanics (aPR=1.38; 1.26-1.52) and non-Hispanic blacks (aPR=1.35; 1.22-1.50), whereas severe periodontitis was most likely among non-Hispanic blacks (aPR=1.82; 1.44-2.31). There was at least a 50% greater likelihood of periodontitis among current smokers compared to non-smokers. Among males, the likelihood of periodontitis among adults 65 years and older was greater (aPR=2.07; 1.76 - 2.43) than adults 30-44 years old. This probability was even greater among women (aPR=3.15; 95% CI 2.63 - 3.77). The likelihood of periodontitis was higher among current smokers relative to non-smokers regardless of gender and periodontitis classification. Periodontitis was more likely among men with un-controlled diabetes compared to persons with no diabetes only. CONCLUSIONS: An assessment of risk profiles for periodontitis in US adults based on gold standard periodontal measures show important differences by severity of disease and gender. Cigarette smoking, specifically among current smokers remains an important modifiable risk for all levels of periodontitis severity. The higher likelihood of periodontitis in older adults and in males with uncontrolled diabetes is noteworthy. These findings could improve the identification of target populations for effective public health interventions to improve periodontal health of US adults.

This report describes prevalence, severity, and extent of periodontitis in the US adult population using combined data from the 2009-2010 and 2011-2012 cycles of the National Health and Nutrition Examination Survey (NHANES). METHODS: Estimates were derived for dentate adults 30 years and older from the civilian non-institutionalized population. Periodontitis was defined by combinations of clinical attachment loss (CAL) and periodontal probing depth (PPD) from six sites per tooth on all teeth, except third molars, using standard surveillance case definitions. For the first time in NHANES history, sufficient numbers of Non-Hispanic Asians were sampled in 2011-2012 to provide reliable estimates of their periodontitis prevalence. RESULTS: In 2009-2012, 46% of US adults representing 64.7 million people had periodontitis, with 8.9% having severe periodontitis. Overall, 3.8% of all periodontal sites (10.6% of all teeth) had PPD≥4 mm and 19.3% of sites (37.4% teeth) had CAL≥3 mm. Periodontitis prevalence was positively associated with increasing age and was higher among males. Periodontitis prevalence was highest in Hispanics (63.5%) and Non-Hispanic blacks (59.1%), followed by Non-Hispanic Asian Americans (50.0%), and lowest in Non-Hispanic whites (40.8%). Prevalence varied two-fold between the lowest and highest levels of socioeconomic status, whether defined by poverty or education. CONCLUSION(S): This study confirms a high prevalence of periodontitis in US adults aged 30 years and older, with almost half affected. The prevalence was greater in Non-Hispanic Asians than Non-Hispanic whites, although lower than other minorities. The distribution provides valuable information for population-based action to prevent or manage periodontitis in US adults.

This study estimated the prevalence, severity, and extent of periodontitis in the adult U.S. population, with data from the 2009 and 2010 National Health and Nutrition Examination Survey (NHANES) cycle. Estimates were derived from a sample of 3,742 adults aged 30 years and older, of the civilian non-institutionalized population, having 1 or more natural teeth. Attachment loss (AL) and probing depth (PD) were measured at 6 sites per tooth on all teeth (except the third molars). Over 47% of the sample, representing 64.7 million adults, had periodontitis, distributed as 8.7%, 30.0%, and 8.5% with mild, moderate, and severe periodontitis, respectively. For adults aged 65 years and older, 64% had either moderate or severe periodontitis. Eighty-six and 40.9% had 1 or more teeth with AL ≥ 3 mm and PD ≥ 4 mm, respectively. With respect to extent of disease, 56% and 18% of the adult population had 5% or more periodontal sites with ≥ 3 mm AL and ≥ 4 mm PD, respectively. Periodontitis was highest in men, Mexican Americans, adults with less than a high school education, adults below 100% Federal Poverty Levels (FPL), and current smokers. This survey has provided direct evidence for a high burden of periodontitis in the adult U.S. population.

OBJECTIVES: This study examined and compared utilization of dental services by adult US Hispanics 18 years and older in the years 1999 and 2006. METHODS: Dental utilization data collected by telephone interviews by the state-based Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. RESULTS: In 2006, the state mean and median prevalence of adult Hispanics with dental visits during the past year were 56.2 percent and 62.1 percent, respectively, and had not changed significantly since 1999. In 40 states, utilization was well below the national prevalence of 70.3 percent. Frequency of dental visits was significantly higher among females and those with higher income (>$50,000), higher education, nonsmokers, and persons having medical health insurance. CONCLUSIONS: Findings from this study suggest that barriers to utilization of dental services among Hispanic adults exist in most states and may contribute to existing oral health disparities. The magnitude of this problem may increase in the future with the expansion of the US Hispanic population.

This study evaluates the accuracy of periodontitis prevalence determined by the National Health and Nutrition Examination Survey (NHANES) partial-mouth periodontal examination protocols. True periodontitis prevalence was determined in a new convenience sample of 454 adults ≥ 35 years old, by a full-mouth "gold standard" periodontal examination. This actual prevalence was compared with prevalence resulting from analysis of the data according to the protocols of NHANES III and NHANES 2001-2004, respectively. 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. Adding measurements from lingual or interproximal sites to the NHANES 2001-2004 protocol did not improve the accuracy sufficiently to reach acceptable sensitivity thresholds. These findings suggest that NHANES protocols produce high levels of misclassification of periodontitis cases and thus have low validity for surveillance and research.