Recent epidemiologic trends in periodontitis in the USA

The most important development in the epidemiology of periodontitis in the USA during the last decade is the result of improvements in survey methodologies and statistical modeling of periodontitis in adults. Most of these advancements have occurred as the direct outcome of work by the joint initiative known as the Periodontal Disease Surveillance Project by the Centers for Disease Control and Prevention and the American Academy of Periodontology that was established in 2006. This report summarizes some of the key findings of this important initiative and its impact on our knowledge of the epidemiology of periodontitis in US adults. This initiative first suggested new periodontitis case definitions for surveillance in 2007 and revised them slightly in 2012. This classification is now regarded as the global standard for periodontitis surveillance and is used worldwide. First, application of such a standard in reporting finally enables results from different researchers in different countries to be meaningfully compared. Second, this initiative tackled the concern that prior national surveys, which used partial‐mouth periodontal examination protocols, grossly underestimated the prevalence of periodontitis of potentially more than 50%. Consequently, because previous national surveys significantly underestimated the true prevalence of periodontitis, it is not possible to extrapolate any trend in periodontitis prevalence in the USA over time. Any difference calculated may not represent any actual change in periodontitis prevalence, but rather is a consequence of using different periodontal examination protocols. Finally, the initiative addressed the gap in the need for state and local data on periodontitis prevalence. Through the direct efforts of the Centers for Disease Control and Prevention and the American Academy of Periodontology initiative, full‐mouth periodontal probing at six sites around all nonthird molar teeth was included in the 6 years of National Health and Nutrition Examination Surveys from 2009‐2014, yielding complete data for 10 683 dentate community‐dwelling US adults aged 30 to 79 years. Applying the 2012 periodontitis case definitions to the 2009‐2014 National Health and Nutrition Examination Surveys data, the periodontitis prevalence turned out to be much greater than previously estimated, namely affecting 42.2% of the population with 7.8% of people experiencing severe periodontitis. It was also discovered that only the moderate type of periodontitis is driving the increase in periodontitis prevalence with age, not the mild or the severe types whose prevalence do not increase consistently with age, but remain ~ 10%‐15% in all age groups of 40 years and older. The greatest risk for having periodontitis of any type was seen in older people, in males, in minority race/ethnic groups, in poorer and less educated groups, and especially in cigarette smokers. The Centers for Disease Control and Prevention and the American Academy of Periodontology initiative reported, for the first time, the periodontitis prevalence estimated at both local and state levels, in addition to the national level. Also, this initiative developed and validated in field studies a set of eight items for self‐reported periodontitis for use in direct survey estimates of periodontitis prevalence in existing state‐based surveys. These items were also included in the 2009‐2014 National Health and Nutrition Examination Surveys for validation against clinically determined cases of periodontitis. Another novel result of this initiative is that, for the first time, the geographic distribution of practicing periodontists in relation to the geographic distribution of people with severe periodontitis is illustrated. In summary, the precise periodontitis prevalence and distribution among subgroups in the dentate US noninstitutionalized population aged 30‐79 years is better understood because of application of valid periodontitis case definitions to full‐mouth periodontal examination, in combination with reliable information on demographic and health‐related measures. We now can monitor the trend of periodontitis prevalence over time as well as guide public health preventive and intervention initiatives for the betterment of the health of the adult US population.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153044/1/prd12323.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153044/2/prd12323_am.pd

Dental visits among adult Hispanics – BRFSS 1999 and 2006

Objectives: This study examined and compared utilization of dental services by adult US Hispanics 18 years and older in the years 1999 and 2006. Methods: Dental utilization data collected by telephone interviews by the state‐based Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. Results: In 2006, the state mean and median prevalence of adult Hispanics with dental visits during the past year were 56.2 percent and 62.1 percent, respectively, and had not changed significantly since 1999. In 40 states, utilization was well below the national prevalence of 70.3 percent. Frequency of dental visits was significantly higher among females and those with higher income (>$50,000), higher education, nonsmokers, and persons having medical health insurance. Conclusions: Findings from this study suggest that barriers to utilization of dental services among Hispanic adults exist in most states and may contribute to existing oral health disparities. The magnitude of this problem may increase in the future with the expansion of the US Hispanic population.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87091/1/j.1752-7325.2011.00259.x.pd

Risk Indicators for Periodontitis in US Adults: NHANES 2009 to 2012

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142205/1/jper1174.pd

Update on Prevalence of Periodontitis in Adults in the United States: NHANES 2009 to 2012

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141963/1/jper0611.pd

Update on Prevalence of Periodontitis in Adults in the United States: NHANES 2009 to 2012

This report describes prevalence, severity, and extent of periodontitis in the US adult population using combined data from the 2009–2010 and 2011–2012 cycles of the National Health and Nutrition Examination Survey (NHANES)

Increasing access to integrated ESKD care as part of Universal Health Coverage

The global nephrology community recognizes the need for a cohesive strategy to address the growing problem of end-stage kidney disease (ESKD). In March 2018, the International Society of Nephrology hosted a summit on integrated ESKD care, including 92 individuals from around the globe with diverse expertise and professional backgrounds. The attendees were from 41 countries, including 16 participants from 11 low- and lower-middle–income countries. The purpose was to develop a strategic plan to improve worldwide access to integrated ESKD care, by identifying and prioritizing key activities across 8 themes: (i) estimates of ESKD burden and treatment coverage, (ii) advocacy, (iii) education and training/workforce, (iv) financing/funding models, (v) ethics, (vi) dialysis, (vii) transplantation, and (viii) conservative care. Action plans with prioritized lists of goals, activities, and key deliverables, and an overarching performance framework were developed for each theme. Examples of these key deliverables include improved data availability, integration of core registry measures and analysis to inform development of health care policy; a framework for advocacy; improved and continued stakeholder engagement; improved workforce training; equitable, efficient, and cost-effective funding models; greater understanding and greater application of ethical principles in practice and policy; definition and application of standards for safe and sustainable dialysis treatment and a set of measurable quality parameters; and integration of dialysis, transplantation, and comprehensive conservative care as ESKD treatment options within the context of overall health priorities. Intended users of the action plans include clinicians, patients and their families, scientists, industry partners, government decision makers, and advocacy organizations. Implementation of this integrated and comprehensive plan is intended to improve quality and access to care and thereby reduce serious health-related suffering of adults and children affected by ESKD worldwide