Periodontal Disease in Adults (Age 30 or Older)
The prevalence of periodontal (gum) disease continues to be an important public health problem in the United States as 2 in 5 adults are affected by some form of this disease. Significant disparities continue to affect some population groups and smoking remains a major risk factor for periodontitis.
The table below presents information about the prevalence of severe and nonsevere (mild or moderate) periodontitis among dentate adults 30 years or older.
The table uses the Centers for Disease Control and Prevention (CDC)/American Academy of Periodontology (AAP) periodontitis case definitions for surveillance.
Per CDC/AAP, severe periodontitis is defined as having 2 or more interproximal sites with clinical attachment loss (CAL) 6 mm or greater (not on the same tooth) and 1 or more interproximal sites with periodontal probing depth (PPD) 5 mm or greater.
Nonsevere periodontitis is comprised of the two less severe categories of disease (moderate and mild periodontitis). Moderate periodontitis is defined as 2 or more interproximal sites with CAL 4 mm or greater (not on the same tooth) or 2 or more interproximal sites with PPD 5 mm or greater (also not on the same tooth); mild periodontitis is defined as 2 or more interproximal sites with CAL 3 mm or greater and 2 or more interproximal sites with PPD 4 mm or greater (not on the same tooth) or 1 or more sites with 5 mm or more.
Finally, total periodontitis is defined as the combination of mild, moderate, and severe periodontitis.
Prevalence of periodontitis classified by the CDC/AAP case definitions
- Overall, 42.2% (standard error, ± 1.4) of adults 30 years or older in the United States had total periodontitis, consisting of 7.8% with severe periodontitis and 34.4% with nonsevere periodontitis.
- The prevalence of nonsevere (mild or moderate) and of total—but not of severe—periodontitis increased with age.
- The prevalence of total periodontitis was greatest among men (50.2%), Mexican Americans (59.7%), adults below 100% of the FPL (60.4%), current smokers (62.4%), and those who self-reported diabetes (59.9%).
- The prevalence increased with increasing number of teeth missing but not with increasing body mass index (BMI).
- Among dental health-related behavior subgroups, the prevalence of total periodontitis was highest among adults who did not use dental floss regularly (53.1%) and increased with increasing duration since last dental visit to 54.8% of those without a dental visit the past year.
Table: Prevalence of severe and nonsevere (mild or moderate) periodontitis among dentate adults 30 years or older
| Characteristic | Severe Periodontitis, % (Standard Error) | Nonsevere (Mild or Moderate) Periodontitis, % (Standard Error) | Total Periodontitis, % (Standard Error) |
|---|---|---|---|
| Total | 7.8 (0.5) | 34.4 (1.2) | 42.2 (1.4) |
| Age, y: 30-44 | 4.1 (0.3) | 25.3 (1.4) | 29.5 (1.5) |
| Age, y: 45-64 | 10.4 (0.8)† | 35.6 (.14)† | 46.0 (1.6)† |
| Age, y: 65 or older | 9.0 (1.0)† | 50.7 (1.9)† | 59.8 (2.1)† |
| Sex: Male | 11.5 (0.8)† | 38.8 (1.2)† | 50.2 (1.4)† |
| Sex: Female | 4.3 (0.4) | 30.2 (1.4) | 34.6 (1.5) |
| Race/Ethnicity: Mexican American | 13.4 (1.4)† | 46.4 (1.5)† | 59.7 (1.7)† |
| Race/Ethnicity: Other Hispanic | 7.8 (0.9) | 40.7 (1.5)† | 48.5 (1.6)† |
| Race/Ethnicity: Non-Hispanic white | 5.9 (0.6) | 31.1 (1.5) | 37.0 (1.7) |
| Race/Ethnicity: Non-Hispanic black | 14.7 (1.1)† | 42.0 (1.3)† | 56.6 (2.0)† |
| Race/Ethnicity: Other race, including multiracial | 9.3 (1.4)‡ | 36.9 (2.3)‡ | 46.2 (2.6)§ |
| Smoking Status: Nonsmoker | 4.9 (0.5) | 29.5 (1.2) | 34.4 (1.4) |
| Smoking Status: Former smoker | 8.0 (0.7)‡ | 37.7 (1.8)† | 45.8 (1.8)† |
| Smoking Status: Current smoker | 16.9 (1.3)† | 45.4 (1.7)† | 62.4 (1.7)† |
| Socioeconomic Level - Income category A¶: < 100% FPL# | 13.9 (1.0)† | 46.5 (1.5)† | 60.4 (1.7)† |
| Socioeconomic Level - Income category A¶: 100%-199% FPL | 12.1 (1.1)† | 41.5 (1.9)† | 53.6 (2.0)† |
| Socioeconomic Level - Income category A¶: 200%-399% FPL | 7.2 (0.8)† | 37.4 (1.8)† | 44.6 (2.0)† |
| Socioeconomic Level - Income category A¶: > 400% FPL | 4.0 (0.6) | 24.6 (1.2) | 28.6 (1.4) |
| Socioeconomic Level - Income category B¶: Low ≤ 130% | 13.8 (1.0)† | 45.2 (1.4)† | 59.0 (1.7)† |
| Socioeconomic Level - Income category B¶: Middle 131%-350% | 8.6 (0.7)† | 40.0 (1.7)† | 48.5 (1.8)† |
| Socioeconomic Level - Income category B¶: High ≥ 351% | 4.5 (0.6) | 25.3 (1.2) | 29.7 (1.4) |
| Body Mass Index**: < 25 | 7.6 (0.6) | 31.6 (1.6) | 39.2 (1.8) |
| Body Mass Index**: 25-30 | 8.1 (0.7) | 34.0 (1.3) | 42.1 (1.4) |
| Body Mass Index**: > 30 | 7.7 (0.7) | 36.7 (1.5)§ | 44.4 (1.5)‡ |
| Diabetes Mellitus: Yes | 10.8 (1.3)‡ | 49.0 (2.5)† | 59.9 (2.2)† |
| Diabetes Mellitus: No | 7.5 (0.5) | 32.8 (1.2) | 40.4 (1.4) |
| Use of Dental Floss in Past 7 Days: Yes | 5.8 (0.5) | 32.1 (1.2) | 37.9 (1.3) |
| Use of Dental Floss in Past 7 Days: No | 12.8 (1.0)† | 40.3 (1.6)† | 53.1 (1.8)† |
| Last Dental Visit, mo††: ≤ 6 | 3.9 (0.6) | 26.4 (1.6) | 30.3 (1.7) |
| Last Dental Visit, mo††: > 6-12 | 6.3 (1.0)‡ | 31.6 (2.2)‡ | 37.9 (2.4)§ |
| Last Dental Visit, mo††: > 12 or never | 13.3 (1.1)† | 41.5 (1.7)† | 54.8 (1.8)† |
| No. of Teeth Missing: 0 | 2.6 (0.5) | 20.9 (1.2) | 23.5 (1.4) |
| No. of Teeth Missing: 1-5 | 7.0 (0.7)† | 36.0 (1.2)† | 43.0 (1.3)† |
| No. of Teeth Missing: 6-27 | 17.1 (1.2)† | 51.5 (1.7)† | 68.6 (1.5)† |
* Third molars were excluded. A Wald x2 test was used for testing significance of proportion difference in each group. †P < .001. ‡P < .05. §P < .01. ¶ Income values were missing in 895 respondents. # FPL: Federal poverty level. ** Body mass index values in kilograms per square meter were missing in 64 respondents. †† Based on data from National Health and Nutrition Examination Survey 2011-2014 only.
Data Source: The National Health and Nutrition Examination Survey (NHANES) has been an important source of information on oral health and dental care in the United States since the early 1970s. The table presents the latest NHANES data (collected between 2009 and 2014) regarding prevalence of severe and nonsevere (mild or moderate) periodontitis among dentate adults 30 years or older.
Reference: Eke PI, Thornton-Evans GO, Wei L, Borgnakke WS, Dye BA, Genco RJ. Periodontitis in US Adults: National Health and Nutrition Examination Survey 2009-2014. J Am Dent Assoc. 2018 Jul;149(7):576-588.e6. doi: 10.1016/j.adaj.2018.04.023. PMID: 29957185; PMCID: PMC8094373.
August 2021