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Novel Analysis Methods Used to Estimate Geographic Distribution of Periodontitis in the United States

February 12, 2016

Knowing which areas in the United States bear the highest burden of periodontal disease is essential to developing and delivering oral health policy and interventions.  However, there is very little surveillance of periodontitis at the state and local levels.  To predict those  geographical regions with the highest rates of periodontitis, a secondary analysis of national datasets was recently conducted.1  This is the first-ever estimation of the geographical distribution of periodontitis prevalence in the United States.

As part of the National Health and Nutrition Examination Survey (NHANES) 2009-2019 survey cycle, adult survey respondents underwent a full-mouth periodontal examination in which probe measurements from 6 sites per tooth for all teeth (except third molars) were collected.2  Using this survey data, the authors calculated the probabilities of periodontitis (as defined by the Centers for Disease Control and Prevention and the American Academy of Periodontology case definitions) for adults by their age, gender, race/ethnicity, smoking status, and poverty status.  The Behavioral Risk Factor Surveillance System (BRFSS), American Community Survey (ACS), and US 2010 census were used to estimate the number of people with each set of these characteristics (age, gender, race/ethnicity, smoking, and poverty) living in each census block.  The periodontitis probabilities estimated from NHANES were applied to the estimated number of people with each periodontal risk marker in each US census block, thus generating periodontitis prevalence estimates for each region.  The authors validated their model-based demographic estimates against the distributions in the NHANES, BRFSS, and US census, and the periodontitis estimates for each demographic group against the national data from NHANES.  In each case, the model-based estimates were comparable with the survey data.

Consistent with the NHANES data upon which the periodontitis probabilities are based, total periodontitis rates were higher among men (55.6%), than women (37.0%), and higher among those living below 150% of the federal poverty level (59.2%), than above it (42.0%).  The prevalence of periodontitis increased with advancing age.  Current smokers had the highest periodontitis prevalence (66.4%), former smokers the next highest (50.0%), and those who never smoked had the lowest prevalence (37.4%). Non-Hispanic blacks had the highest prevalence of periodontitis (58.5%) followed by Hispanics (56.4%), non-Hispanics of other races (50.7%), and non-Hispanic whites (41.5%).  The study’s multilevel regression model estimated that periodontitis prevalence was highest in the southeastern and southwestern states, as well as Native American reservations, Hawaii, and remote areas of western Alaska.  The estimated periodontitis prevalence for each state can be found in the appendix of the paper. Severe periodontitis showed similar demographic and geographic distribution patterns.

This modeling approach offers new insights into the geographic distribution of periodontitis in the United States.  Better insight about areas and subpopulations with higher burdens of periodontitis can be used to better meet patient needs.   Studies of clinical periodontal surveillance are needed to validate these estimates.


  1. Eke PI, Zhang X, Lu H, et al. Predicting Periodontitis at State and Local Levels in the United States. J Dent Res 2016.
  2. Eke PI, Dye BA, Wei L, Thornton-Evans GO, Genco RJ. Prevalence of periodontitis in adults in the United States: 2009 and 2010. J Dent Res 2012;91(10):914-20.
Prepared by: Center for Scientific Information, ADA Science Institute

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