Age‐dependent distribution of periodontitis in two countries: Findings from NHANES 2009 to 2014 and SHIP‐TREND 2008 to 2012

Abstract

Objective: We used epidemiologic data of clinical periodontal status from two population-based samples in two countries, United States and Germany, to examine 1) the impact of age on the relative contribution of recession and pocketing on the distribution of clinical attachment loss, and 2) whether it is feasible to define age-dependent thresholds for severe periodontitis. 2012. NHANES used a full-mouth examination protocol to collect data on recession (R), pocket depth (PD) and clinical attachment loss (CAL) for six sites/tooth on a maximum of 28 teeth; SHIP-Trend used a half-mouth examination at four sites/tooth. In both samples, percentile distributions of mean CAL/person were generated for each 5-year age interval. Age-dependent thresholds defining the upper quintile of mean CAL were calculated for both samples. The topographic intraoral distribution of CAL and the relative contribution of R and PD on CAL was assessed.Results: Mean CAL increased linearly with age in both samples and was higher in SHIP-Trend than NHANES across the age spectrum. In contrast, mean PD was constant across age groups in both populations. R contributed increasingly to CAL with age, especially after 45 to 49 years. Upper quintile mean CAL thresholds in NHANES were < 3 mm for ages up to 39 years, and under 3.58 mm in all other age groups. Corresponding values in SHIP-Trend were also < 3 mm in ages up to 39 years but increased linearly with age up to 7.21 mm for ages ≥75 years.Conclusions: Despite substantial differences in the overall severity of attachment loss between the two samples, common patterns of CAL and of the relative contribution of R and PD to CAL with increasing age were identified. Although periodontitis severity may vary in different populations, empirical evidence-driven definitions

Staging and grading of periodontitis: Framework and proposal of a new classification and case definition

“…To update evidence that has accumulated since the latest classification workshop, the organizing committee commissioned a review on acute periodontal lesions including necrotizing periodontitis, 12 a review of manifestations of systemic diseases that affect the periodontal attachment apparatus, 13 and three position papers that are relevant to the discussion of aggressive and chronic periodontitis. [14][15][16] The position papers that addressed aggressive and chronic periodontitis reached the following overarching conclusions relative to periodontitis:…”

“…28 One major limitation in the implementation of this knowledge has been the assumption that such forms of periodontitis represent different entities and thus focus has been placed on identification of the form rather than the factors contributing to progression. The reviews commissioned for this workshop [13][14][15][16] have indicated that there is no evidence to suggest that such forms of periodontitis have a unique pathophysiology, rather the complex interplay of risk factors in a multifactorial disease model may explain the phenotypes of periodontitis in exposed patients. In this context, it seems useful to provide a framework for implementation of biological grade (risk or actual evidence of progression) of periodontitis.…”

“…31,70 More recently, an individual's severity of CAL has been compared to his/her age cohort. 16 This information from large and diverse populations could be considered an age standard for CAL, with the assumption that individuals who exceed the mean CAL threshold for a high percentile in the age cohort would be one additional piece of objective information that may represent increased risk for future progression. The CAL must be adjusted in some way based on number of missing teeth to avoid biasing the CAL based on measuring only remaining teeth after extraction of the teeth with the most severe periodontitis.…”

Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions

“…Despite substantial differences in the overall severity of attachment loss between the two population samples analyzed by Billings et al 3 , suggesting presence of cohort effects, common patterns of CAL were identified across different ages, along with consistencies in the relative contribution of recession and pocket depth to CAL.…”

A new classification scheme for periodontal and peri‐implant diseases and conditions – Introduction and key changes from the 1999 classification

“…necrotizing periodontitis, 15 periodontitis as a manifestation of systemic disease, 16 and the forms of the disease previously recognized as "chronic" or "aggressive", now grouped under a single category, "periodontitis". 14,[17][18][19][20] In revising the classification, the workshop agreed on a classification framework for periodontitis further characterized based on a multidimensional staging and grading system that could be (Table 3). For a complete description of the new classification scheme for periodontitis, the reader is directed to the consensus report on periodontitis 14 and the case definition paper on periodontitis.…”