Accuracy of NHANES periodontal examination protocols

J Dent Res. 2010 Nov;89(11):1208-13. doi: 10.1177/0022034510377793. Epub 2010 Sep 21.


This study evaluates the accuracy of periodontitis prevalence determined by the National Health and Nutrition Examination Survey (NHANES) partial-mouth periodontal examination protocols. True periodontitis prevalence was determined in a new convenience sample of 454 adults ≥ 35 years old, by a full-mouth "gold standard" periodontal examination. This actual prevalence was compared with prevalence resulting from analysis of the data according to the protocols of NHANES III and NHANES 2001-2004, respectively. Both NHANES protocols substantially underestimated the prevalence of periodontitis by 50% or more, depending on the periodontitis case definition used, and thus performed below threshold levels for moderate-to-high levels of validity for surveillance. Adding measurements from lingual or interproximal sites to the NHANES 2001-2004 protocol did not improve the accuracy sufficiently to reach acceptable sensitivity thresholds. These findings suggest that NHANES protocols produce high levels of misclassification of periodontitis cases and thus have low validity for surveillance and research.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Black or African American / statistics & numerical data
  • Diabetes Mellitus / epidemiology
  • District of Columbia / epidemiology
  • Female
  • Gingival Recession / epidemiology
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Male
  • Maryland / epidemiology
  • Middle Aged
  • Nutrition Surveys*
  • Periodontal Attachment Loss / epidemiology
  • Periodontal Index
  • Periodontal Pocket / epidemiology
  • Periodontitis / classification
  • Periodontitis / epidemiology*
  • Population Surveillance
  • Prevalence
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Smoking / epidemiology
  • Tooth Loss / epidemiology
  • United States / epidemiology
  • Urban Health / statistics & numerical data
  • White People / statistics & numerical data