EPIDEMIOLOGY OF PERIODONTAL DISEASE

Gingivitis is highly prevalent at all age levels, reaching a peak at puberty and declining slightly during adolescence. Periodontitis occasionally affects a few teeth in the deciduous dentition and is quite common in older adolescents, but is rarely clinically significant in these age groups. With increasing age, attachment loss may become more generalized within the dentition and more severe, and a small but, with age, increasing minority of the population suffer generalized advanced destruction. While most periodontitis is characterized as ‘chronic’, rapidly progressive forms are now classified as ‘aggressive periodontitis’ and limited epidemiological data are available which demonstrate that, in adolescents, aggressive periodontitis (formerly ‘juvenile periodontitis’) affected approximately 0.1 0.2% of white and 2 to3% of black populations. Localized aggressive periodontitis was 3 times more prevalent in white females than white males and 3 times more prevalent in black males than black females. In some countries, where standards of oral hygiene have improved, gingivitis, and perhaps also early periodontitis, may be less prevalent now than in previous decades, although population reductions in gingivitis have proved difficult to sustain. However, there is no convincing evidence of a decline in the proportion of individuals with advanced periodontitis, suggesting that once periodontitis is initiated by plaque accumulation in a susceptible patient, its subsequent progression is largely dependent on host response factors and modifying factors.