Periodontitis Among Adults Aged ≥30 Years — United States, 2009–2010
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| Supplement Volume 62, Supplement, No. 3 November 22, 2013 PDF of this issue | | |
Periodontitis Among Adults Aged ≥30 Years — United States, 2009–2010
Supplements
November 22, 2013 / 62(03);129-135
Corresponding author: Paul Eke, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. Telephone: 770-488-6092; E-mail: peke@cdc.gov.
Introduction
Periodontal disease, or gum disease, is a chronic infection of the hard and soft tissue supporting the teeth (1) and is a leading cause of tooth loss in older adults (2). Tooth loss impairs dental function and quality of life in older adults (2). 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 (3,4). 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 (5).At the national level, monitoring the reduction of moderate and severe periodontitis in the adult U.S. population is part of the health-promotion and disease-prevention activities of Healthy People 2020 (6). Approximately 47% of adults aged ≥30 years in the United States (approximately 65 million adults) have periodontitis: 8.7% with mild periodontitis, 30.0% with moderate, and 8.5% with severe periodontitis (7). Periodontitis increases with age; adults aged ≥65 years have periodontitis at rates of 5.9%, 53.0%, and 11.2% for mild, moderate, and severe forms, respectively (7). As the U.S. adult population ages and is more likely to retain more teeth than previous generations, the prevalence of periodontitis is expected to increase and consequently could increase the need for expenditures for preventive care and periodontal treatment (8).
Periodontitis is directly associated with lower levels of education and higher levels of poverty, both of which influence the use of dental services by adults (9–12). Educational attainment and poverty might mediate significant differences in the prevalence of periodontal disease between different racial/ethnic populations. Smoking and some chronic diseases such as diabetes are important modifiable risk factors for periodontitis (13). Since the early 1960s, U.S. national surveys have assessed the periodontal status of adults (14). However, the validity of estimates from these surveys has been limited by the use of partial-mouth periodontal examination protocols, which significantly underestimate the prevalence of periodontitis (15–17). The 2009–2010 National Health and Nutrition Examination Survey (NHANES) cycle is the first to include a full-mouth periodontal examination for U.S. adults (aged ≥30 years) and provides the most direct evidence for the true prevalence of periodontitis in this population.
This report is part of the second CDC Health Disparities and Inequalities Report (CHDIR). The 2011 CHDIR (18) was the first CDC report to assess disparities across a wide range of diseases, behavioral risk factors, environmental exposures, social determinants, and health-care access. The topic presented in this report is based on criteria that are described in the 2013 CHDIR Introduction (19). This report provides information concerning disparities in periodontitis, a topic that was not discussed in the 2011 CHDIR (18). The purposes of this periodontitis in adults report are to discuss and raise awareness of differences in the characteristics of people with periodontal disease and to prompt actions to reduce these disparities.
Methods
To examine racial/ethnic disparities in the estimated percentage of adults aged ≥30 years with periodontitis by age, sex, education, poverty levels, and smoking status, CDC analyzed data from the 2009-2010 NHANES cycle. NHANES is a cross-sectional survey designed to monitor the overall health and nutritional status of civilian, noninstitutionalized U.S. population. NHANES uses a stratified multistage probability sampling design. For 2-year data cycles, NHANES surveys a national representative sample. The technical details of the survey, including sampling design, periodontal data collection protocols, and data, are available online (http://www.cdc.gov/nchs/nhanes.htm). A total of 5,037 adults aged ≥30 years participated in the survey, and 951 were excluded for medical reasons or incomplete oral examinations. In this analysis, 343 edentulous participants were excluded, leaving a total of 3,743 participants, representing a weighted population of approximately 137.1 million civilian noninstitutionalized U.S. adults. The findings in this report cannot be compared with those of previous studies using NHANES data (9,10) because the case definitions and age range used in this analysis differed.All periodontal examinations were conducted in a mobile examination center by dental hygienists registered in at least one U.S. state. Gingival recession was defined as the distance between the free gingival margin and the cementoenamel junction; pocket depth was defined as the distance from free gingival margin to the bottom of the sulcus or periodontal pocket. These measurements were made at six sites per tooth (mesiobuccal, midbuccal, distobuccal, mesiolingual, midlingual, and distolingual) for all teeth except third molars. For measurements at each tooth site, a periodontal probe (Hu-Friedy PCP 2) with graduations of 2 mm, 4 mm, 6 mm, 8 mm, 10 mm, and 12 mm was positioned parallel to the long axis of the tooth at each site. Each measurement was rounded to the lowest whole millimeter. Data were recorded directly into an NHANES oral health data management program that instantly calculated attachment loss as the difference between probing depth and gingival recession. Bleeding from probing and the presence of dental furcations were not assessed.
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