Destructive periodontal disease in adults 30 years of age and older in theUnited states, 1988-1994

Background: Accurate information on the prevalence and extent of periodonta l diseases in the United States adult population is lacking. This study est imated the prevalence and extent of periodontal disease in the United State s using data from the third National Health and Nutrition Examination Surve y (NHANES III). Methods: A nationally representative sample was obtained during 1988 to 199 4 by a stratified, multi-stage probability sampling design. A subsample of 9,689 dentate persons 30 to 90 years old who received a periodontal examina tion was used in this study, representing approximately 105.8 million civil ian, non-institutionalized Americans in 1988 to 1994. Periodontal attachmen t loss, probing depth, and furcation involvement were assessed in 2 randoml y selected quadrants per person. Attachment loss and probing depth were ass essed at 2 sites per tooth, the mesiobuccal and mid-buccal surfaces. The pe riodontal status of each subject was assessed by criteria based on the exte nt and severity of probing depth and furcation involvement. These assessmen ts were used to classify each subject as having a mild, moderate, or advanc ed form of the disease. In the analyses, weighted data were used to reflect the complex sampling method. Results: Prevalence of attachment loss greater than or equal to 3 mm was 53 .1% for the population of dentate U.S. adults 30 to 90 years of age and, on average, 19.6% of teeth per person were affected. The prevalence of probin g depth greater than or equal to 3 mm was 63.9% and, on average, 19.6% of t eeth were affected. Fourteen percent of these persons had furcation involve ment in one or more teeth. We estimate that at least 35% of the dentate U.S . adults aged 30 to 90 have periodontitis, with 21.8% having a mild form an d 12.6% having a moderate or severe form. The prevalence and extent of atta chment loss and the prevalence of periodontitis increase considerably with age. However, the prevalence of moderate and advanced periodontitis decreas es in adults 80 years of age and older. This is most likely attributed to a combination of a high prevalence of tooth loss and gingival recession in t he oldest age cohorts. Attachment loss and destructive periodontitis were c onsistently more prevalent in males than females, and more prevalent in bla cks and Mexican Americans than whites. We estimate that in persons 30 years and older, there are approximately 56.2 and 67.6 million persons who, on a verage, have about a third of their remaining teeth affected by 2 3 mm atta chment loss and probing depth, respectively. We also estimate that about 21 million persons have at least one site with greater than or equal to 5 mm attachment loss, and 35.7 million persons have periodontitis. These are con servative estimates based on partial-mouth examinations, and the true preva lence and extent of periodontal disease may be significantly higher than wh at is reported here. Conclusions: Periodontitis is prevalent in the U.S. adult population. The r esults show that black and Mexican American males have poorer periodontal h ealth than the rest of the U.S. adult population. Primary and secondary pre ventive measures should therefore be specifically targeted towards these gr oups.