Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
Records 1-22 (of 22 Records) |
Query Trace: Thornton-Evans G [original query] |
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Prevalence and mean number of teeth with amalgam and nonamalgam restorations, United States, 2015 through 2018
Beltrán-Aguilar ED , Thornton-Evans G , Wei L , Bernal J . J Am Dent Assoc 2023 154 (5) 417-426 BACKGROUND: Amalgam has been used for more than 150 years as a safe and reliable restorative material. The authors described the occurrence of amalgam and nonamalgam restorations in the United States in primary and permanent teeth across age groups and according to sociodemographic characteristics. METHODS: The authors used clinical examination data from the National Health and Nutrition Examination Survey 2015-2018 for participants 2 years and older (n = 17,040). The authors estimated the prevalence and mean number of amalgam and nonamalgam restorations in primary and permanent teeth according to age groups (2-5 years, 6-11 years, 12-15 years, 16-19 years, 20-39 years, 40-59 years, 60-79 years, and ≥ 80 years), race and ethnicity, federal poverty guideline, education, and pregnancy status. RESULTS: The prevalence of amalgam restorations ranged from 4% through 69%. Overall, amalgam restorations were more prevalent in children and adolescents from racial and ethnic minority groups and families at lower poverty levels and with lower education. The mean number of teeth with nonamalgam restorations was higher than those with amalgam restorations in primary teeth of children aged 6 through 11 years, permanent teeth of those 12 through 15 years and 20 through 39 years, and women aged 20 through 49 years, regardless of pregnancy status. The mean number of amalgam restorations was higher than that for nonamalgam restorations in older age groups. CONCLUSIONS: Nonamalgam restorations were the most common in the primary teeth of children older than 5 years and in the permanent teeth of adults younger than 40 years. Amalgam restorations were more common in older adults. Amalgam and nonamalgam restorations were equally common in children younger than 5 years. PRACTICAL IMPLICATIONS: The study findings suggest a shift from amalgam to alternative restorative materials in the United States. |
Untreated caries among US working-aged adults and association with reporting need for oral health care
Williams S , Wei L , Griffin SO , Thornton-Evans G . J Am Dent Assoc 2021 152 (1) 55-64 BACKGROUND: National data indicate that working-aged adults (20-64 years) are more likely to report financial barriers to receiving needed oral health care relative to other age groups. The aim of this study was to examine the burden of untreated caries (UC) and its association with reporting an unmet oral health care need among working-aged adults. METHODS: The authors used National Health and Nutrition Examination Survey data from 2011 through 2016 for 10,286 dentate adults to examine the prevalence of mild to moderate (1-3 affected teeth) and severe (≥ 4 affected teeth) UC. The authors used multivariable logistic regression to identify factors that were associated with reporting an unmet oral health care need. RESULTS: Low-income adults had mild to moderate UC (26.2%) 2 times more frequently and severe UC (13.2%) 3 times more frequently than higher-income adults. After controlling for covariates, the variables most strongly associated with reporting an unmet oral health care need were UC, low income, fair or poor general health, smoking, and no private health insurance. The model-adjusted prevalence of reporting an unmet oral health care need among low-income adults with mild to moderate and severe UC were 35.7% and 45.1%, respectively. CONCLUSIONS: The burden of UC among low-income adults is high; prevalence was approximately 40% with approximately 3 affected teeth per person on average. Reporting an unmet oral health care need appears to be capturing primarily differences in UC, health, and financial access to oral health care. PRACTICAL IMPLICATIONS: Data on self-reported unmet oral health care need can have utility as a surveillance tool for monitoring UC and targeting resources to decrease UC among low-income adults. |
Geospatial distribution of periodontists and US adults with severe periodontitis
Eke PI , Lu H , Zhang X , Thornton-Evans G , Borgnakke WS , Holt JB , Croft JB . J Am Dent Assoc 2019 150 (2) 103-110 BACKGROUND: In this study, the authors report on the geospatial distributions of periodontists and adults with severe periodontitis in the United States. METHODS: The authors used geospatial analysis to describe the distribution of periodontists and adults, periodontists vis-à-vis estimated density of adults with severe periodontitis, and their ratios to adults with severe periodontitis. The authors identified locations of 5,415 practicing periodontists through the 2014 National Provider Identifier Registry, linked them with the weighted census number of adults, and estimated the number of adults within a series of circular distance zones. RESULTS: Approximately 60% of adults 30 through 79 years lived within 5 miles of a periodontist, 73% within 10 miles, 85% within 20 miles, and 97% within 50 miles. Proximity to a periodontist varied widely. In urban areas, 95% of adults resided within 10 miles of a periodontist and 100% within 20 miles. Only 24% of adults in rural areas lived within 10 miles of a periodontist. Most periodontists (96.1%) practiced in urban areas, clustering along the eastern and western coasts and in the Midwest, 3.1% in urban clusters elsewhere, and 0.8% in rural areas. Ratios of fewer than 8,000 adults with periodontitis to 1 or more periodontists within 10 miles were clustered mostly in the Northeast, central East Coast, Florida, West Coast, Arizona, and Midwest. CONCLUSIONS: In this study, the authors identified wide variations in geographic proximity to a practicing periodontist for adults with severe periodontitis. PRACTICAL IMPLICATIONS: Dental practitioners may provide preventive care and counseling for periodontitis and referrals for specialty care. Geographic proximity to specialized periodontal care may vary widely by locality. |
Visualizing county-level data to target dental safety-net programs for children
Hamilton EK , Bernal J , Lin M , Thornton-Evans G , Griffin SO . Prev Chronic Dis 2021 18 E21 More than 19% of third-graders in Georgia had untreated dental caries (tooth decay) in 2016–2017 (1). The national average among children of similar age (6–9 y) was 15.5% in 2013–2016 (2). Untreated tooth decay can cause pain and infection and impair eating, speaking, and learning. Among children it can lead to missed school days and lower academic performance (3). The most recent US data indicated that 34 million school hours were missed in 2007 as a result of acute unplanned dental care needs (4). | | Dental sealants (5), topical fluoride (6), and restorative care are effective in preventing tooth decay. Most caries-prevention programs are implemented at the local level. The prevalence of untreated tooth decay, however, varies by geographic area — ranging from 8.2% to 32% among third-graders across 29 states during 2013–2016 (1). By county, modeled estimates among children aged 6 to 9 years nationwide ranged from 4.9% to 65.2% (7). Thus, having local data on the risk of untreated tooth decay and dental workforce capacity is critical to effectively target dental safety-net programs for children at highest risk of untreated tooth decay. | | We developed a data visualization tool that maps county-level need for caries prevention and treatment programs and the distribution of dental safety-net programs in Georgia. This tool can be used by public health decision makers to 1) assess how well dental safety-net programs are currently allocated and 2) plan and target future programs. |
Public health aspects of periodontitis: Recent advances and contributions by Dr. Robert J. Genco
Eke PI , Borgnakke WS , Thornton-Evans G . Curr Oral Health Rep 2021 8 (1) 1-8 Purpose of Review: This review provides an overview of the objectives, activities, and accomplishments of the CDC-AAP collaboration on public health aspects of periodontitis focusing mostly on surveillance. Dr. Robert Genco was co-chair of this effort. Recent Findings: This initiative developed new standard periodontitis case definitions for surveillance and implemented for the first time a full-mouth periodontal examination protocol for NHANES 2009–2014. Measurements from this survey resulted in a significantly greater estimate of the national prevalence of periodontitis in US adults and improved our understanding of population risk factors associations with periodontitis. Notably, this initiative also developed, and validated by field-testing, a battery of eight questions for multivariable modeling of self-report measures for predicting periodontitis in populations. Summary: This initiative resulted in significant improvements of surveillance of periodontitis and produced unique findings with important implications for advancing our understanding of population aspects of periodontitis in US adults at the national, state, and local levels. At long last, the world finally had a set of periodontitis case definitions that applied globally would enable valid comparisons between populations in different geographic settings and at different times. |
The impact of dental insurance and medical insurance on dental care utilization during pregnancy
Robison V , Bauman B , D'Angelo DV , Espinoza L , Thornton-Evans G , Lin M . Matern Child Health J 2021 25 (5) 832-840 OBJECTIVE: To measure the association between dental and medical insurance with the receipt of dental cleaning during pregnancy. METHODS: We analyzed Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2012 to 2015 on 145,051 women with a recent live birth from 36 states. We used adjusted prevalence ratios [aPR] from multivariable regression to examine the association of dental and medical insurance with receipt of dental cleaning during pregnancy, controlling for selected covariates that influence dental care utilization. RESULTS: Seventy-seven percent (77%) of all women reported having dental insurance during pregnancy. Receipt of dental cleaning before pregnancy was strongly associated with dental cleaning during pregnancy. Among women without pre-pregnancy dental cleaning who had dental insurance, those with Medicaid medical insurance had a significantly higher prevalence of dental cleaning during pregnancy [aPR = 1.42, 95% CI (1.32 - 1.52)], compared to those private medical insurance. Among women without pre-pregnancy dental cleaning, those without dental insurance but with Medicaid medical insurance were about 70% less likely to have dental cleaning during pregnancy compared to those with dental and private medical insurance. CONCLUSIONS FOR PRACTICE: With or without dental insurance, pre-pregnancy dental cleaning was strongly associated with dental cleaning during pregnancy. Dental insurance was an important determinant of dental utilization. Medical insurance had an independent and positive effect. This effect varied by private versus Medicaid medical insurance. Programs which provide women with dental insurance both before and during pregnancy could improve the oral health of maternal and infant populations. |
Disparities in dental use and untreated caries prevalence by income
Griffin SO , Thornton-Evans G , Wei L , Griffin PM . JDR Clin Trans Res 2020 6 (2) 234-241 INTRODUCTION: Untreated dental caries (UC), although preventable, is the most prevalent disease in the United States. UC diminishes quality of life and lowers productivity for millions of Americans and is notably higher among lower-income compared to higher-income persons. OBJECTIVE: This study examines changes in disparities by income in past-year dental use (DU) and UC in 4 life stages (2-5, 6-19, 20-64, and >/=65 y) between 1999-2004 and 2011-2016. We also examined changes in dental safety net policies during this time. METHODS: We obtained data on dependent variables, UC and DU, from cross-sectional, nationally representative surveys for 1999-2004 and 2011-2016. We used multivariable regression models with 3 main-effect explanatory variables: income (<200% or >/=200% federal poverty level), life stage, and survey period (1999-2004 or 2011-2016) and sociodemographic variables. We included 2-way interaction terms among main-effect variables to test whether disparities had changed over time in each life stage and a 3-way term to test changes in disparities differed across life stages. RESULTS: Model-adjusted disparities in DU decreased for both preschool-age and school-age children, and disparities in UC decreased for school-age children. Changes in DU and UC disparities were not detectable for working-age adults and increased for retirement-age adults. Changes in DU and UC among preschool and school-age children were not significantly different from one another and were significantly different from changes among retirement-age adults. Compared to working-age adults, changes in disparities for DU and UC were significantly different for school-age children, and changes in DU were significantly different for preschool-age children. Between surveys, the dental safety net was expanded for youth but remained largely unchanged for adults. CONCLUSIONS: Expanding the dental safety net for youth could have contributed to increased access to dental care among children relative to adults and contributed to the decrease in disparities in DU and UC among youth. Knowledge Transfer Statement: Between 1999-2004 and 2011-2016, the dental safety net was expanded for youth but remained largely unchanged for adults. Using national survey data to compare changes in disparities in past-year dental use and untreated dental caries by income between adults and youth sheds light on the potential impact of expanding the dental safety net. |
Prevalence of and changes in tooth loss among adults aged 50 years with selected chronic conditions - United States, 1999-2004 and 2011-2016
Parker ML , Thornton-Evans G , Wei L , Griffin SO . MMWR Morb Mortal Wkly Rep 2020 69 (21) 641-646 Extensive tooth loss can lead to poor diet resulting in weight loss or obesity (1). It can also detract from physical appearance and impede speech, factors that can restrict social contact, inhibit intimacy, and lower self-esteem (1). Chronic medical conditions and oral conditions share common risk factors (2). Persons with chronic conditions are more likely to have untreated dental disease, which can result in tooth loss. Three measures of tooth loss during 1999-2004 and 2011-2016 were estimated by comparing data from the National Health and Nutrition Examination Survey (NHANES) for each period among adults aged >/=50 years with selected chronic conditions.* The three measures were 1) edentulism (having no teeth); 2) severe tooth loss (having eight or fewer teeth) (3); and 3) lacking functional dentition (having <20 teeth out of 28, which is considered a full set for the purpose of NHANES assessments) (4). During 2011-2016, prevalences of edentulism and severe tooth loss were >/=50% higher among adults with fair or poor general health, rheumatoid arthritis, asthma, diabetes, emphysema, heart disease, liver condition, or stroke than among those with those adults without the chronic condition. Lack of functional dentition was also more prevalent among adults with chronic conditions than among persons without these conditions. Tooth loss is preventable with self-care and routine dental visits (1). To encourage these behaviors, public health professionals can educate the public about the association between having a chronic condition and tooth loss, and primary care providers can educate their patients about the importance of healthy behaviors and screen and refer them for needed dental care. |
Overview and quality assurance for the oral health component of the National Health and Nutrition Examination Survey (NHANES), 2011-2014
Dye BA , Afful J , Thornton-Evans G , Iafolla T . BMC Oral Health 2019 19 (1) 95 BACKGROUND: Following implementation in 2009-2010 to the oral health component for the National Health and Nutrition Examination Survey (NHANES), a full-mouth periodontal examination was continued during 2011-2014. Additionally, a comprehensive dental caries assessment was re-introduced in 2011 after a 6-year absence from NHANES. This report provides oral health content information and results of dental examiner reliability statistics for key intraoral assessments conducted by dentists during 2011-2014. METHODS: During the 2011-2014 NHANES 17,463 persons age 1 and older representing the US civilian, non-institutionalized population received an oral health examination. From this group, 387 individuals underwent a repeat examination conducted by the survey reference examiner. A combination of examiner training and calibration, electronic data capture, and ongoing performance evaluation with statistical monitoring was used to ensure conformance with NHANES protocols and data comparability to prior data collection periods. RESULTS: During 2011-2014, the Kappa statistics for the tooth count assessment ranged from 0.96 to 1.00, for untreated dental caries Kappa scores were 0.93 to 1.00. The overall Kappa statistics for identifying combined moderate-severe periodontitis using the CDC/AAP case definition was 0.66 and 0.69 with percent agreement of 83 to 85% during 2011-2014. When evaluating inter-examiner agreement using information collected from 3 periodontal sites for comparability to the NHANES 2003-04 periodontal examination protocols, Kappa scores for combined moderate-severe periodontitis was 0.65 and 0.80 during 2011-2014. For total mean attachment loss and pocket depth across all 6 periodontal sites, the inter-class coefficients (ICCs) ranged from 0.80-0.90 and 0.79-0.86 respectively. Site-specific mean attachment loss ICCs were generally higher for the 4 interproximal measurements compared to the 2 mid-site probing measurements and this observation was similar in 2009-2010. CONCLUSION: During 2011-2014, results overall indicate a high level of data quality and substantial examiner reliability for tooth count and dentition; reliability for periodontal disease, across various assessments, was at least moderate. When comparing the 2011-2014 examiner performance to findings from 2003 to 2004, comparable concordance between the examiners and the reference examiner exists. |
Use of toothpaste and toothbrushing patterns among children and adolescents - United States, 2013-2016
Thornton-Evans G , Junger ML , Lin M , Wei L , Espinoza L , Beltran-Aguilar E . MMWR Morb Mortal Wkly Rep 2019 68 (4) 87-90 Fluoride use is one of the main factors responsible for the decline in prevalence and severity of dental caries and cavities (tooth decay) in the United States (1). Brushing children's teeth is recommended when the first tooth erupts, as early as 6 months, and the first dental visit should occur no later than age 1 year (2-4). However, ingestion of too much fluoride while teeth are developing can result in visibly detectable changes in enamel structure such as discoloration and pitting (dental fluorosis) (1). Therefore, CDC recommends that children begin using fluoride toothpaste at age 2 years. Children aged <3 years should use a smear the size of a rice grain, and children aged >3 years should use no more than a pea-sized amount (0.25 g) until age 6 years, by which time the swallowing reflex has developed sufficiently to prevent inadvertent ingestion. Questions on toothbrushing practices and toothpaste use among children and adolescents were included in the questionnaire component of the National Health and Nutrition Examination Survey (NHANES) for the first time beginning in the 2013-2014 cycle. This study estimates patterns of toothbrushing and toothpaste use among children and adolescents by analyzing parents' or caregivers' responses to questions about when the child started to brush teeth, age the child started to use toothpaste, frequency of toothbrushing each day, and amount of toothpaste currently used or used at time of survey. Analysis of 2013-2016 data found that >38% of children aged 3-6 years used more toothpaste than that recommended by CDC and other professional organizations. In addition, nearly 80% of children aged 3-15 years started brushing later than recommended. Parents and caregivers can play a role in ensuring that children are brushing often enough and using the recommended amount of toothpaste. |
Increased dental use may affect changes in treated and untreated dental caries in young children
Lin M , Thornton-Evans G , Griffin SO , Wei L , Junger M , Espinoza L . JDR Clin Trans Res 2018 4 (1) 49-57 Introduction: From 1999–2004 to 2011–2014, untreated dental caries prevalence decreased among US children aged 2 to 5 y, regardless of family income. Policies were concurrently initiated for children to increase access to preventive dental services in dental, primary, and community settings and to restorative care in dental settings. Objectives: We aimed to examine 1) whether changes in prevalence and severity of untreated and treated caries between the periods varied by family income and 2) to what degree increased past-year dental visit (PYDV) contributed to the changes. Methods: We used data for 3,822 children in the National Health and Nutrition Examination Survey 1999 to 2004 and 2011 to 2014. Caries prevalence included prevalence of untreated caries with ≥1 decayed teeth (dt) and prevalence of treated caries with ≥1 filled teeth (ft). Caries severity included number of dt and ft among those with ≥1 dt or ft. We estimated changes in caries outcomes among low- and higher-income children with models—one controlling for sociodemographics and another controlling for sociodemographics and PYDV. Significant changes (P < 0.05) becoming insignificant after controlling for PYDV provide insight on the contribution of PYDV to changes in outcomes. Results: Prevalence of untreated caries decreased for low- and higher-income children, with a slightly larger decrease for low-income children; dt decreased only for low-income children; and estimated decreases did not vary by model. An increase in prevalence of treated caries was observed only among low-income children but became minimized and insignificant after controlling for PYDV. Similarly, after controlling for PYDV, the increase in ft among low-income children lost significance, whereas the increase among higher-income children remained. Conclusion: Untreated caries among children aged 2 to 5 y declined from 1999–2004 to 2011–2014, with larger declines among low-income children. While changes in PYDV contributed to increases in treated caries, particularly for low-income children, additional factors appear to have contributed to decreased untreated caries. Knowledge Transfer Statement: For young children, the degree and direction of changes in caries over the last decade varied by outcome measure (e.g., untreated or treated) and family poverty status. Examining the effect of increased dental utilization on changes in untreated and treated caries outcomes can help identify those policies that contribute to changes in these outcomes and highlight the potential role of the different caries assessment criteria used in dental offices versus those in a population-based survey. |
Periodontitis in US Adults: National Health and Nutrition Examination Survey 2009-2014
Eke PI , Thornton-Evans GO , Wei L , Borgnakke WS , Dye BA , Genco RJ . J Am Dent Assoc 2018 149 (7) 576-588.e6 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. |
Periodontitis prevalence in adults ≥ 65 years of age, in the USA
Eke PI , Wei L , Borgnakke WS , Thornton-Evans G , Zhang X , Lu H , McGuire LC , Genco RJ . Periodontol 2000 2016 72 (1) 76-95 The older adult population is growing rapidly in the USA and it is expected that by 2040 the number of adults ≥ 65 years of age will have increased by about 50%. With the growth of this subpopulation, oral health status, and periodontal status in particular, becomes important in the quest to maintain an adequate quality of life. Poor oral health can have a major impact, leading to tooth loss, pain and discomfort, and may prevent older adults from chewing food properly, often leading to poor nutrition. Periodontitis is monitored in the USA at the national level as part of the Healthy People 2020 initiative. In this report, we provide estimates of the overall burden of periodontitis among adults ≥ 65 years of age and after stratification according to sociodemographic factors, modifiable risk factors (such as smoking status), the presence of other systemic conditions (such as diabetes) and access to dental care. We also estimated the burden of periodontitis within this age group at the state and local levels. Data from the National Health and Nutrition Examination Survey 2009/2010 and 2011/2012 cycles were analyzed. Periodontal measures from both survey cycles were based on a full-mouth periodontal examination. Nineteen per cent of adults in this subpopulation were edentulous. The mean age was 73 years, 7% were current smokers, 8% lived below the 100% Federal Poverty Level and < 40% had seen a dentist in the past year. Almost two-thirds (62.3%) had one or more sites with ≥ 5 mm of clinical attachment loss and almost half had at least one site with probing pocket depth of ≥ 4 mm. We estimated the lowest prevalence of periodontitis in Utah (62.3%) and New Hampshire (62.6%) and the highest in New Mexico, Hawaii, and the District of Columbia each with a prevalence of higher than 70%. Overall, periodontitis is highly prevalent in this subpopulation, with two-thirds of dentate older adults affected at any geographic level. These findings provide an opportunity to determine how the overall health-care management of older adults should consider the improvement of their oral health conditions. Many older adults do not have dental insurance and are also likely to have some chronic conditions, which can adversely affect their oral health. |
Risk indicators for periodontitis in US adults: National Health and Nutrition Examination Survey (NHANES) 2009 - 2012
Eke PI , Wei L , Thornton-Evans GO , Borrell LN , Borgnakke WS , Dye B , Genco RJ . J Periodontol 2016 87 (10) 1-18 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. |
Predicting periodontitis at state and local levels in the United States
Eke PI , Zhang X , Lu H , Wei L , Thornton-Evans G , Greenlund KJ , Holt JB , Croft JB . J Dent Res 2016 95 (5) 515-22 The objective of the study was to estimate the prevalence of periodontitis at state and local levels across the United States by using a novel, small area estimation (SAE) method. Extended multilevel regression and poststratification analyses were used to estimate the prevalence of periodontitis among adults aged 30 to 79 y at state, county, congressional district, and census tract levels by using periodontal data from the National Health and Nutrition Examination Survey (NHANES) 2009-2012, population counts from the 2010 US census, and smoking status estimates from the Behavioral Risk Factor Surveillance System in 2012. The SAE method used age, race, gender, smoking, and poverty variables to estimate the prevalence of periodontitis as defined by the Centers for Disease Control and Prevention/American Academy of Periodontology case definitions at the census block levels and aggregated to larger administrative and geographic areas of interest. Model-based SAEs were validated against national estimates directly from NHANES 2009-2012. Estimated prevalence of periodontitis ranged from 37.7% in Utah to 52.8% in New Mexico among the states (mean, 45.1%; median, 44.9%) and from 33.7% to 68% among counties (mean, 46.6%; median, 45.9%). Severe periodontitis ranged from 7.27% in New Hampshire to 10.26% in Louisiana among the states (mean, 8.9%; median, 8.8%) and from 5.2% to 17.9% among counties (mean, 9.2%; median, 8.8%). Overall, the predicted prevalence of periodontitis was highest for southeastern and southwestern states and for geographic areas in the Southeast along the Mississippi Delta, as well as along the US and Mexico border. Aggregated model-based SAEs were consistent with national prevalence estimates from NHANES 2009-2012. This study is the first-ever estimation of periodontitis prevalence at state and local levels in the United States, and this modeling approach complements public health surveillance efforts to identify areas with a high burden of periodontitis. |
Update on prevalence of periodontitis in adults in the United States: NHANES 2009-2012
Eke PI , Dye BA , Wei L , Slade GD , Thornton-Evans GO , Borgnakke WS , Taylor GW , Page RC , Beck JD , Genco RJ . J Periodontol 2015 86 (5) 1-18 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. |
Periodontitis among adults aged ≥30 years - United States, 2009-2010
Thornton-Evans G , Eke P , Wei L , Palmer A , Moeti R , Hutchins S , Borrell LN . MMWR Suppl 2013 62 (3) 129-35 Periodontal disease, or gum disease, is a chronic infection of the hard and soft tissue supporting the teeth and is a leading cause of tooth loss in older adults. Tooth loss impairs dental function and quality of life in older adults. The chronic infections associated with periodontitis can increase the risk for aspiration pneumonia in older adults and has been implicated in the pathogenesis of chronic inflammation that impairs general health. The severity of periodontal disease can be categorized as mild, moderate, or severe on the basis of multiple measurements of periodontal pocket depth, attachment loss, and gingival inflammation around teeth. |
Prevalence of periodontitis in adults in the United States: 2009 and 2010
Eke PI , Dye BA , Wei L , Thornton-Evans GO , Genco RJ . J Dent Res 2012 91 (10) 914-20 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. |
Advances in surveillance of periodontitis: the Centers for Disease Control and Prevention Periodontal Disease Surveillance Project
Eke PI , Thornton-Evans G , Dye B , Genco R . J Periodontol 2012 83 (11) 1337-42 The Centers for Disease Control and Prevention (CDC) has as one of its strategic goals to support and improve surveillance of periodontal disease. In 2003, CDC initiated the CDC Periodontal Disease Surveillance Project in collaboration with the American Academy of Periodontology to address population-based surveillance of periodontal disease at the local, state, and national levels. This initiative has made significant advancements towards the goal of improved surveillance including developing valid self-reported measures that can be obtained from interview-based surveys to predict prevalence of periodontitis in populations. This will allow surveillance of periodontitis at the state and local levels and in countries where clinical resources for surveillance are scarce. This work has produced standard cases definitions for surveillance of periodontitis that are now widely recognized and applied in population studies and research. At the national level, this initiative has evaluated the validity of previous clinical examination protocols and tested new protocols on the National Health and Nutrition Examination Survey (NHANES), recommending and supporting funding for the gold standard full-mouth periodontal examination in NHANES 2009-2012. These examinations will generate accurate estimates of the prevalence of periodontitis in the U.S. adult population and provide a superior dataset for surveillance and research. Also this data will be used to generate the necessary coefficients for our self-report questions for use in subsets of the total U.S. population. The impact of these findings on population-based surveillance of periodontitis and future directions of the project are discussed along with plans for dissemination and translation efforts for broader public health use. |
Dental visits among adult Hispanics - BRFSS 1999 and 2006
Eke PI , Jaramillo F , Thornton-Evans GO , Borgnakke WS . J Public Health Dent 2011 71 (3) 252-256 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. |
Trends in oral health by poverty status as measured by Healthy People 2010 objectives
Dye BA , Thornton-Evans G . Public Health Rep 2010 125 (6) 817-30 OBJECTIVES: Poverty is a significant social determinant for oral health, yet Healthy People 2010 (HP 2010) does not monitor changes in oral health status by poverty. We assessed recent trends for six HP 2010 oral health objectives by poverty status. METHODS: We used data from the 1988-1994 and 1999-2004 National Health and Nutrition Examination Surveys to analyze trends for HP 2010 age-specific objectives relating to caries experience, untreated tooth decay, dental sealants, periodontal disease, tooth retention, and complete tooth loss by poverty status. RESULTS: Dental caries significantly increased from 19% to 24% for children aged 2-4 years, but when stratified by poverty, caries only increased significantly for non-poor 2- to 4-year-old children (10% to 15%) (Objective 21-1a). The largest percentage point increase in dental caries was for non-poor boys (9% to 18%). The use of dental sealants continues to grow in the U.S. The largest percentage point increase in sealant use (Objective 21-8) between the two survey periods was for all poor children aged 8 years (3% to 21%). Among adults aged 35-44 years, periodontal disease significantly declined in the U.S. from 22% to 16% (Objective 21-5b) and more adults retained all of their natural teeth (30% to 38%) (Objective 21-3). However, the increase in tooth retention was significant only for non-poor adults, particularly non-poor men (34% to 48%). CONCLUSIONS: Overall, the oral health status of Americans as measured by HP 2010 objectives mostly showed improvement or remained unchanged between 1998-1994 and 1999-2004. However, some changes in oral health status for some traditionally low-risk groups, such as non-poor children, may be reversing improvements in oral health that have consistently been observed in previous decades. These results suggest that poverty status is an important factor for planning and monitoring future national oral health goals. |
Accuracy of NHANES periodontal examination protocols
Eke PI , Thornton-Evans GO , Wei L , Borgnakke WS , Dye BA . J Dent Res 2010 89 (11) 1208-13 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. |
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