Application of the 2018 Periodontal Status Classification to Epidemiological Survey Data (ACES) Framework to Estimate the Periodontitis Prevalence in the United States.

Abstract

Aims: To compare periodontitis prevalence estimates based on the Application of the 2018 periodontal status Classification to Epidemiological Survey data (ACES) and the Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP) classification.

Materials and methods: National Health and Nutrition Examination Survey data for the years 2009/2010, 2011/2012 and 2013/2014 were survey-weighted and post-stratified to estimate the prevalence of periodontitis. Estimates based on ACES and CDC/AAP were cross-classified and stratified by age group. Prevalence estimates using different partial recording protocols were examined.

Results: Using the ACES framework, the prevalence of adults with periodontitis was 93.1% (95% CI: 91.9-94.2) (Stage I: 17.9%; Stage II: 46.2%; Stage III: 16.7%; Stage IV: 12.4%). Complexity factors did not alter Stage II prevalence. The CDC/AAP classification yielded a periodontitis prevalence of 38.9% (95% CI: 36.4-41.4) (Mild: 3.5%; Moderate: 28.1%; Severe: 7.3%). Partial recording protocols resulted in increased prevalence in the lower stages of periodontitis.

Conclusions: The European Federation of Periodontology/American Academy of Periodontology Classification (using the ACES framework) overestimates periodontitis cases compared with the CDC/AAP classification. Including complexity factors in the ACES framework provides limited benefits in staging periodontitis. Partial-mouth recording protocols overestimate health and early disease stages while underestimating more severe disease.