Destructive periodontal disease in adults 30 years of age and older in the United States, 1988-1994

J Periodontol. 1999 Jan;70(1):13-29. doi: 10.1902/jop.1999.70.1.13.


Background: Accurate information on the prevalence and extent of periodontal diseases in the United States adult population is lacking. This study estimated the prevalence and extent of periodontal disease in the United States using data from the third National Health and Nutrition Examination Survey (NHANES III).

Methods: A nationally representative sample was obtained during 1988 to 1994 by a stratified, multi-stage probability sampling design. A subsample of 9,689 dentate persons 30 to 90 years old who received a periodontal examination was used in this study, representing approximately 105.8 million civilian, non-institutionalized Americans in 1988 to 1994. Periodontal attachment loss, probing depth, and furcation involvement were assessed in 2 randomly selected quadrants per person. Attachment loss and probing depth were assessed at 2 sites per tooth, the mesiobuccal and mid-buccal surfaces. The periodontal status of each subject was assessed by criteria based on the extent and severity of probing depth and furcation involvement. These assessments were used to classify each subject as having a mild, moderate, or advanced form of the disease. In the analyses, weighted data were used to reflect the complex sampling method.

Results: Prevalence of attachment loss > or = 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 probing depth > or = 3 mm was 63.9% and, on average, 19.6% of teeth were affected. Fourteen percent of these persons had furcation involvement 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 and 12.6% having a moderate or severe form. The prevalence and extent of attachment loss and the prevalence of periodontitis increase considerably with age. However, the prevalence of moderate and advanced periodontitis decreases 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 the oldest age cohorts. Attachment loss and destructive periodontitis were consistently more prevalent in males than females, and more prevalent in blacks 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 average, have about a third of their remaining teeth affected by > or = 3 mm attachment loss and probing depth, respectively. We also estimate that about 21 million persons have at least one site with > or = 5 mm attachment loss, and 35.7 million persons have periodontitis. These are conservative estimates based on partial-mouth examinations, and the true prevalence and extent of periodontal disease may be significantly higher than what is reported here.

Conclusions: Periodontitis is prevalent in the U.S. adult population. The results show that black and Mexican American males have poorer periodontal health than the rest of the U.S. adult population. Primary and secondary preventive measures should therefore be specifically targeted towards these groups.

MeSH terms

  • Adult
  • Age Distribution
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Black or African American / statistics & numerical data
  • Dental Health Surveys
  • Female
  • Furcation Defects / epidemiology
  • Furcation Defects / ethnology
  • Humans
  • Male
  • Mexican Americans / statistics & numerical data
  • Middle Aged
  • Nutrition Surveys
  • Periodontal Attachment Loss / epidemiology
  • Periodontal Attachment Loss / ethnology
  • Periodontal Diseases / epidemiology*
  • Periodontal Diseases / ethnology
  • Periodontal Index
  • Periodontitis / epidemiology
  • Periodontitis / ethnology
  • Prevalence
  • Reproducibility of Results
  • Risk Factors
  • Sampling Studies
  • Sex Ratio
  • United States / epidemiology
  • White People / statistics & numerical data