The current AAO Consumer Awareness Program is targeting adults over the age of 30 years. It is hoped that this new initiative will make adult consumers more aware of the potential benefits of orthodontic treatment so that they will flock to our offices in increasing numbers. This will be wonderful. Or will it? Some of these adults might have underlying periodontal disease that could complicate the orthodontic treatment plan. Should orthodontists be concerned about the prevalence of adult periodontal disease in the United States? Unfortunately, researchers recently discovered that the prevalence of US adults affected by periodontal disease is much higher than previously reported. Let me explain.
Prevalence data regarding periodontal disease require intensive investigations of broad segments of the population. The samples for these types of studies are carefully selected to prevent bias or misinformation. Over the past 50 years, the periodontal status of the US population has been assessed through a series of surveys. The first of these, conducted in 1960 through 1962, was entitled the Health Examination Survey. Later investigations became known as the National Health and Nutrition Examination Surveys (NHANES) and have been repeated about once each decade.
Initially, the periodontal status of the subjects who participated in these surveys was evaluated visually. In succeeding surveys, partial periodontal probings were included to create a more accurate estimate of the periodontal health. However, some researchers have suggested that partial periodontal screening protocols underestimate the true prevalence of the disease. As a result, the most recent NHANES survey, completed during 2009 and 2010, involved full-mouth periodontal examinations. In other words, the survey collected and recorded periodontal probing measurements from 6 sites per tooth for all teeth (except third molars). The objective was to provide a more accurate estimate of the prevalence of periodontal disease in the adult population in the United States.
During this 2-year survey, periodontal measurements were collected from over 3700 adults. This information represents a weighted population of about 137 million civilian noninstitutionalized American adults 30 years of age and older. The data are divided into 3 broad categories. Severe periodontitis is defined as 2 or more interproximal sites with 6 mm or greater attachment loss not on the same tooth. Moderate periodontitis is defined as 2 or more interproximal sites with 4 mm or greater attachment loss not on the same tooth. Mild periodontitis is defined as 2 or more interproximal sites with 3 mm or greater attachment loss not on the same tooth.
Here is the bad news. The survey in 2009 and 2010 found that the total prevalence of periodontitis in adults aged 30 years and older was 47%. When the case definitions were applied, the prevalence values of mild, moderate, and severe periodontitis were 8.7%, 30.0%, and 8.5%, respectively. Furthermore, total periodontitis ranged from 24% in adults 30 to 34 years of age up to 70% in those aged 65 years and older. What impact does this information have on orthodontists?
These adults will be coming to your offices. You will be placing orthodontic appliances on many of them. If a patient has undiagnosed periodontal disease before treatment, it could get worse during orthodontics. Are you prepared to deal with these types of problems? Currently, exacerbation of periodontal problems during orthodontic treatment is a major cause of malpractice litigation. Do you have the diagnostic skills to manage these patients?
The AAO is trying to help. This past year, an AAO-AAP Task Force created a series of recommendations for the appropriate diagnostic records that should be taken and the specific methods that should be used to detect the current level of disease and the risk of future periodontal breakdown in adult patients. This month, the AAO and the AAP will hold a conference on the topic of managing treatment for adults with underlying periodontal problems.
As this influx of new adults invades orthodontic offices throughout the United States, make certain that you evaluate the periodontal health of each new patient. Remember, the prevalence of periodontal disease in adults is worse than we thought.
