Prevalence of Periodontal Diseases in Adults

Many studies look at the prevalence of “advanced periodontitis”, but have differing definitions of this term. Generally though, severe forms of periodontitis do not seem to affect more than 15% of the population of industrialized countries. The proportion of such subjects increases with age and seems to peak between 50 and 60 years. A later decline in prevalence may be due to tooth loss

Tooth loss

Tooth loss is when one or more teeth come loose and fall out. Tooth loss is normal for deciduous teeth , when they are replaced by a person's adult teeth. Otherwise, losing teeth is undesirable and is the result of injury or disease, such as mouth trauma, tooth injury, tooth decay, and gum disease...

.

There are a number of methodological concerns with prevalence studies, particularly 1) the ability of partial recording to reflect full-mouth conditions and 2) the use of the CPITN recording system.

The performance of a partial recording system is affected by the actual prevalence

Prevalence

In epidemiology, the prevalence of a health-related state in a statistical population is defined as the total number of cases of the risk factor in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population...

 of periodontal disease in the population in question. The less frequent the disease, the more difficult it becomes for a partial recording system to detect it and thus may lead to greater underestimation of the disease prevalence. A full-mouth examination remains the best method of accurately assessing the prevalence and severity of periodontal disease

Periodontal disease

Periodontitis is a set of inflammatory diseases affecting the periodontium, i.e., the tissues that surround and support the teeth. Periodontitis involves progressive loss of the alveolar bone around the teeth, and if left untreated, can lead to the loosening and subsequent loss of teeth...

 in a population.

The use of the CPITN system for epidemiological

Epidemiology

Epidemiology is the study of health-event, health-characteristic, or health-determinant patterns in a population. It is the cornerstone method of public health research, and helps inform policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive...

 purposes has flaws, which are grounded in a number of historical truths. At the time the system was designed, the initiation of periodontal disease was thought to develop from a continuum from an inflammation-free state to gingivitis

Gingivitis

Gingivitis is a term used to describe non-destructive periodontal disease. The most common form of gingivitis is in response to bacterial biofilms adherent to tooth surfaces, termed plaque-induced gingivitis, and is the most common form of periodontal disease...

, to calculus deposition

Calculus (dental)

In dentistry, calculus or tartar is a form of hardened dental plaque. It is caused by the continual accumulation of minerals from saliva on plaque on the teeth...

 and pocket formation and then to progressive disease. Treatment concepts were based on the concept of pocket depths being the most critical criterion for surgical versus non-surgical treatments. This index was also designed to screen large populations to determine treatment needs and formulate preventive strategies, not to describe the prevalence and severity of periodontal diseases.

Albandar (1999) reported on data from the Third National Health and Nutrition Examination Survey

National Health and Nutrition Examination Survey

The National Health and Nutrition Examination Survey is a survey research program conducted by the National Center for Health Statistics to asses the health and nutritional status of adults and children in the United States, and to track changes over time. The survey combines interviews and...

 (NHANES III). This was derived from a large nationally representative, stratified, multistage probability sample in the USA comprising 9689 subjects. Pockets > 5mm were found in 7.6% of non-Hispanic white subjects, 18.4% of non-Hispanic black subjects and 14.4% in Mexican American

Mexican American

Mexican Americans are Americans of Mexican descent. As of July 2009, Mexican Americans make up 10.3% of the United States' population with over 31,689,000 Americans listed as of Mexican ancestry. Mexican Americans comprise 66% of all Hispanics and Latinos in the United States...

s; a total of 8.9% of all subjects had pockets > 5mm. Attachment loss > 5mm was found in 19.9% of non-Hispanic white subjects, 27.9% of non-Hispanic black subjects and 28.3% of Mexican Americans; a total of 19.9% of all subjects had attachment loss > 5mm. This suggests that severe periodontitis in not uniformly distributed among various races, ethnicities and socioeconomic groups.

Hugoson (1998) examined three random samples of 600, 597 and 584 subjects in 1973, 1983 and 1993 respectively. These subjects were aged 20–70 years. The severity of disease was divided into five groups, with group 5 having the most severe disease. There was an apparent increase from 1% to 2% to 3% over the three study periods, which may have been due to an increase of dentate subjects in the older age groups.

Susin 2004 examined a representative sample of 853 dentate individuals in Brazil

Brazil

Brazil , officially the Federative Republic of Brazil , is the largest country in South America. It is the world's fifth largest country, both by geographical area and by population with over 192 million people...

 who were selected by a multistage probability sampling method. They had a full-mouth clinical examination of six sites per tooth and answered a structured written questionnaire. Seventy-nine percent (79%) and 52% of the subjects and 36% and 16% of the teeth per subject had CAL >5 and >7mm, respectively.

Oliver 1998

Bourgeois 2007 found that the prevalence of deep pockets (> 5mm) is low (10.21%) in a cross-sectional study.

Baelum 1996 recalculated their previous data from Kenya

Kenya

Kenya , officially known as the Republic of Kenya, is a country in East Africa that lies on the equator, with the Indian Ocean to its south-east...

n and Chinese

China

Chinese civilization may refer to:* China for more general discussion of the country.* Chinese culture* Greater China, the transnational community of ethnic Chinese.* History of China* Sinosphere, the area historically affected by Chinese culture...

 populations to conform to the methods of examination and data presentation utilized in six other surveys. They did not find that the data supported the traditional generalization

Generalization

A generalization of a concept is an extension of the concept to less-specific criteria. It is a foundational element of logic and human reasoning. Generalizations posit the existence of a domain or set of elements, as well as one or more common characteristics shared by those elements. As such, it...

 that prevalence and severity of periodontitis is markedly increased in African and Asian populations.

Incidence of Periodontitis

Like measurements of prevalence of periodontitis, the measurement of incidence will vary depending upon the case definition of the disease. Often “incidence” refers to new sites that meet the definition of periodontitis, even if they occur within a person that already has other diseased sites.

Beck 1997 found that past disease predicted subsequent CAL, although not usually at the same site. Also, persons with greater attachment loss at baseline were more likely to lose teeth over the next 5 years.

Beck 1997 – looked at incidence density such that the numerator was attachment loss greater or equal to 3mm while the denominator was the time at risk for each site. The incident density for all subjects was 0.0017 per site per month. In other words, if 1000 sites were followed for one month, 1.7 sites would lose 3mm or greater attachment. In one year, 20.6 sites would be expected to show this degree of loss.
- blacks has twice the incidence density of whites; males > females.

Gilbert 2005 describes a prospective study of persons in Florida

Florida

Florida is a state in the southeastern United States, located on the nation's Atlantic and Gulf coasts. It is bordered to the west by the Gulf of Mexico, to the north by Alabama and Georgia and to the east by the Atlantic Ocean. With a population of 18,801,310 as measured by the 2010 census, it...

 > 45 years old. In-person interviews and examinations were conducted at baseline and 48 months. The study size was 560 persons and at the 48-month examination, 22% of persons and 1.8% of teeth had attachment loss incidence.

Early Onset Periodontitis

Albandar 2002 examined 690 school attendees aged 12–25 years. They found that 2.3% had generalized EOP and 4.2% had localized EOP. This total of 6.5% contrasted with 1.8% for Nigeria

Nigeria

Nigeria , officially the Federal Republic of Nigeria, is a federal constitutional republic comprising 36 states and its Federal Capital Territory, Abuja. The country is located in West Africa and shares land borders with the Republic of Benin in the west, Chad and Cameroon in the east, and Niger in...

, 3.1–3.7% for Brazil, 6.8% in India

India

India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...

 and 8% in Sudan

Sudan

Sudan , officially the Republic of the Sudan , is a country in North Africa, sometimes considered part of the Middle East politically. It is bordered by Egypt to the north, the Red Sea to the northeast, Eritrea and Ethiopia to the east, South Sudan to the south, the Central African Republic to the...

. The prevalence in Caucasian

Caucasian race

The term Caucasian race has been used to denote the general physical type of some or all of the populations of Europe, North Africa, the Horn of Africa, Western Asia , Central Asia and South Asia...

 populations is in the 0.1% to 0.2% range and may indicate that subjects originating from the sub-Saharan countries of Africa may be at higher risk of developing EOP.

Tinoco 1997 examined 7843 children between the ages of 12 to 19 in Brazil with strict clinical and radiographic criteria. A 0.3% prevalence of localized juvenile periodontitis was found, with different subpopulations exhibiting a range between 0.1% to 1.1%. This study found that LJP was highly associated with Actinobacillus actinomycetemcomitans.

Lopez 2001 examined 9,162 high school children for clinical attachment loss in 6 sites of first and second molars

Molar (tooth)

Molars are the rearmost and most complicated kind of tooth in most mammals. In many mammals they grind food; hence the Latin name mola, "millstone"....

 and incisor

Incisor

Incisors are the first kind of tooth in heterodont mammals. They are located in the premaxilla above and mandible below.-Function:...

s. Overall, CAL >1mm was seen in 69.2% of the students; >2mm in 16% of the students and >3mm in 4.5%. They noted that while the distribution of CAL was markedly skewed, it followed a continuum of disease severity. No sharp distinction exists between periodontal health and disease among Chile

Chile

Chile ,officially the Republic of Chile , is a country in South America occupying a long, narrow coastal strip between the Andes mountains to the east and the Pacific Ocean to the west. It borders Peru to the north, Bolivia to the northeast, Argentina to the east, and the Drake Passage in the far...

an adolescents.

Levin 2006 studied 642 young Israel

Israel

The State of Israel is a parliamentary republic located in the Middle East, along the eastern shore of the Mediterranean Sea...

i army recruits (562 men and 80 women) – clinical periodontal examination of four first molars and eight incisors and radiographs were completed. Aggressive periodontitis was found in 5.9% of the subjects (4.3% localized and 1.6% generalized). This was significantly associated with current smoking

Smoking

Smoking is a practice in which a substance, most commonly tobacco or cannabis, is burned and the smoke is tasted or inhaled. This is primarily practised as a route of administration for recreational drug use, as combustion releases the active substances in drugs such as nicotine and makes them...

 and ethnic origin (North African).

Eres 2009 examined 3,056 students between the ages of 13 to 19 years at public schools in Turkey

Turkey

Turkey , known officially as the Republic of Turkey , is a Eurasian country located in Western Asia and in East Thrace in Southeastern Europe...

. Their mouths were coded according to the recommendations of the CPITN (Community Periodontal Index of Treatment Needs). Among the 3,056 students screened, 170 were scheduled for further examination and 18 were diagnosed with localized aggressive periodontitis. Thus, the prevalence of LAgP was 0.6% with a female to male ratio of 1.25:1.

Tooth Loss

Baelum 1997 reported on the incidence of tooth loss over 10 years among adult and elderly Chinese and looked at some predictive factors. There were 440 subjects, 8 of which were edentulous at baseline and 31 who lost all remaining teeth during the study period. Of the 401 who remained dentate, the incidence of tooth loss ranged from 45% in the 20-29 year old group to 96% in the 60 years plus group. He found that the best baseline predictors of tooth loss of all remaining teeth was that at least one tooth had attachment loss greater or equal to 7mm. As in other studies, a major portion of the total number of teeth lost was accounted for by a small group of persons. In this study, dental caries

Dental caries

Dental caries, also known as tooth decay or a cavity, is an irreversible infection usually bacterial in origin that causes demineralization of the hard tissues and destruction of the organic matter of the tooth, usually by production of acid by hydrolysis of the food debris accumulated on the...

was the dominant reason for tooth loss.

Further reading

• Hugoson A et al. (2008). Trends over 30 years, 1973–2003, in the prevalence and severity of periodontal disease. J Clin Perio 35, 405-414.
• Levin L et al. (2006). Aggressive periodontitis among young Israeli army personnel. J Periodontol 77, 1392-1396.
• Levy SM et al. (2003). The prevalence of periodontal disease measures in elderly adults, aged 79 and older. Special Care in Dentistry 23, 50-57.
• Lopez R et al. (2001). Epidemiology of clinical attachment loss in adolescents. J Periodontol 72, 1666-1674.
• Oliver RC et al. (1998). Periodontal diseases in the United States population. J Periodontology. 69, 269-278.
• Susin C et al. (2004). Periodontal attachment loss in an urban population of Brazilian adults: effect of demographic, behavioral and environmental risk indicators. J Periodontol 75, 1033-1041.