Periodontitis is very common and ranked as one of the world’s sixth commonest disease in the global burden of disease with an estimated 11% of the world’s population suffering with severe periodontitis (Dental Elf – 1st Oct 2014) between 1990 and 2010.
The aim of this review was to estimate the prevalence of periodontitis between 2011 and 2020 from epidemiological data.
Methods
A protocol was registered with PROSPERO and searches conducted in the PubMed, Web of Science, and LILACS (Latin-American Scientific Literature in Health Sciences) databases with no language restriction. Studies reporting on the prevalence of periodontitis conducted between January 2011 and December 2020 were considered. Two reviewers independently screened and selected studies data was extracted, and study quality assessed using the Hoy Tool (Hoy et al.,2012). Periodontitis case definitions were assessed as confident and non-confident and random effects meta-analyses with double arcsine transformation were conducted. The effect of confounders on findings was explored using sensitivity subgroup and meta-regression analyses.
Results
- 55 studies from 25 different countries were included.
- A majority of studies (30) used a non-confident periodontitis case definition.
- 11 studies were considered to be at low risk of bias and 44 at medium risk.
- A total of 88,917 adults were included from the studies with 44,614 adults reported to have periodontitis.
- Overall studies with confident case definition reported a periodontitis prevalence = 6% (95%CI; 55.1% to 67.9%) compared with 38.5% (95%CI; 30.4% to 46.9%) for studies using a non-confident definition.
- The 32 studies using full-mouth protocols reported a prevalence of 45.7% (95%CI; 38.0% to 53.6%) compared to 1% (95%CI; 44.3% to 65.6%) for the 19 studies using partial-mouth protocols.
- 7 low risk of bias studies using a confidence case definition produce a periodontitis prevalence =54.1% (95%CI; 47.4% to 60.6%) compared with 64.7% (95%CI; 56.3% to 72.6%) derived from 17 studies at a low risk of bias.
- Periodontitis estimates by age and Continent for studies using a confidence case definition as shown in the table below.
| No. of studies | Prevalence (95%CI) | |
| Age ≥30 years old | 7 | 61.4% (55.4% to 67.2%) |
| Age <65 years old | 2 | 59.4% (34.5% to 81.9%) |
| Age ≥65 years old | 3 | 79.3% (64.2% to 91.2%) |
| Asia | 10 | 62.4% (55.0% to 69.5%) |
| Europe | 5 | 65.5% (48.7% to 80.5%) |
| North America | 4 | 62.6% (48.3% to 75.9%) |
| South America | 4 | 54.9% (33.4% to 75.5%) |
- The estimated moderate to severe periodontitis prevalence = 53.2% (95%CI; 44.3% to 61.9%) [20 studies].
- The estimated prevalence of severe periodontitis = 23.6% (95%CI;17.6% to 30.1%) [20 studies] which was significantly influenced by the male/female ratio.
Conclusions
The authors concluded: –
……over the last decade (from 2011 to 2020), the estimated pooled prevalence of periodontitis is nearly 60%, with its severe stage affecting approximately 24% of the studied population. These results show an alarmingly high prevalence compared to estimates from 1990 to 2010.
Comments
The authors have preregistered their protocol and searched 3 major databases restricting inclusion to studies reporting between 2010 and 2020. One of the challenges with assessing periodontitis are measurements issues and variations in case definitions. In this review the authors have specified 4 definitions they consider confident (see table)-
| Definition | Reference |
| Interdental clinical attachment loss (CAL) in ≥2 non-adjacent teeth, or buccal or oral CAL ≥3 mm with periodontal pocket depth (PPD >3 mm detectable at ≥2 teeth | American Academy of Periodontology [AAP]/European Federation of Periodontology [EFP]. Tonetti et al., 2018 |
| Two or more inter-proximal sites with CAL ≥3 mm and two or more inter-proximal sites with PPD ≥4 mm (not on the same tooth) or one site with PPD ≥5 mm | Centers for Diseases Control [CDC]/ AAP, 2012. Eke et al., 2012 |
| At least two sites on different teeth with clinical attachment level (CAL) 6 mm and at least one site with PPD 4 mm | CDC/AAP 2007; R. C. Page & Eke, 2007 |
| Generalized chronic periodontitis (at least 30% sites with CAL ≥4 mm) | CDC 1999; Armitage, 1999. |
The WHO CPT score 3/4 in at least one quadrant; at least one site with PPD >4 mm; CAL ≥1 mm definition was considered to be a non-confident case definition and 30 of the included studies used this definition. Of those studies using a confident case definition the CDC/AAP 2012 was the most commonly used (15 studies). Only 11 studies were considered to be at low risk of bias and the authors comment that the individual studies did not represent the national population of the countries where they were conducted. This review suggests a high prevalence of periodontitis and severe periodontitis that previous reviews highlighting that periodontal disease is a persistent and ongoing public health problem that requires effecting prevention and management strategies to combat this common global health issue.
Links
Primary Paper
Trindade D, Carvalho R, Machado V, Chambrone L, Mendes JJ, Botelho J. Prevalence of periodontitis in dentate people between 2011 and 2020: A systematic review and meta-analysis of epidemiological studies. J Clin Periodontol. 2023 Jan 11. doi: 10.1111/jcpe.13769. Epub ahead of print. PMID: 36631982.
Review protocol in PROSPERO
Other references
Hoy D, Brooks P, Woolf A, Blyth F, March L, Bain C, Baker P, Smith E, Buchbinder R. Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol. 2012 Sep;65(9):934-9. doi: 10.1016/j.jclinepi.2011.11.014. Epub 2012 Jun 27. PMID: 22742910.
Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. J Periodontol. 2018 Jun;89 Suppl 1:S159-S172. doi: 10.1002/JPER.18-0006. Erratum in: J Periodontol. 2018 Dec;89(12):1475. PMID: 29926952.
Eke PI, Page RC, Wei L, Thornton-Evans G, Genco RJ. Update of the case definitions for population-based surveillance of periodontitis. J Periodontol. 2012 Dec;83(12):1449-54. doi: 10.1902/jop.2012.110664. Epub 2012 Mar 16. PMID: 22420873; PMCID: PMC6005373.
Page RC, Eke PI. Case definitions for use in population-based surveillance of periodontitis. J Periodontol. 2007 Jul;78(7 Suppl):1387-99. doi: 10.1902/jop.2007.060264. PMID: 17608611.
Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol. 1999 Dec;4(1):1-6. doi: 10.1902/annals.1999.4.1.1. PMID: 10863370.
Dental Elf – 1st Oct 2014
Severe periodontitis: affected 11% of the world population in 2010
